Therapeutic Communication
Objectives (PPT)
• List three elements of effective communication
• Name the conditions necessary for a therapeutic relationship
• Recognize the differences between therapeutic and nontherapeutic communication techniques
• Label therapeutic communication techniques
• Identify examples of therapeutic communication
• Name examples of nontherapeutic communication
• Understand the benefits of therapeutic communication and the result of nontherapeutic words
Introduction (Text)
• Patient-centered care is being promoted as central to quality and safety
• Therapeutic relationship; nurse-patient relationship is the foundation
• <Shall a nurse do thingsfor a patient or can participant relationships be emphasized so that a nurse comes
to do things with a patient as he/her share of an agenda of work to be accomplished in reaching a goal4
health.=
• <It is likely that the nursing process is educative an therapeutic when nurse and patient can come to know
and to respect each other, as persons who are alike, and yea, different, as persons who share in the solution
of problems.=
Role of Nurse and Its Relationship to Patient Illness (Text)
• Identify and explore problems in relating to others
• Discover healthy ways of meeting emotional needs
• Experience a satisfying interpersonal relationship
• Therapeutic interpersonal relationship: the process by which nurses provide care for patients in need of
psychosocial intervention
o Therapeutic use of selfis the instrument for delivery of that care
o Interpersonal communication techniquesare <tools= of psychosocial intervention
▪ Verbal and nonverbal
Role of Nurse
• Focus on pt.’s ideas, experiences, and feelings
• ID and explore pt. pt.’s needs and problems
• Discuss problem-solving alternatives
• Help client to develop new strengths and coping skills
• Encourage positive behaviors
• Assist pt. to develop autonomy and self-reliance
• Portray genuineness, empathy and positivity toward pt.
• Be nonjudgmental
• Understand the difference between sympathy and empathy
Therapeutic Relationship (Text)
• An interaction between two people (usually a caregiver and a care receiver) in which input from both
participants contributes to a climate of healing, growth promotion, and/or illness prevention
,Therapeutic Nurse-Patient Relationship (Text & PPT)
• <human-to-human relationship=
• <mutually significant experience=
• Goal oriented; usually directed at learning and growth promotion in an effort to bring about change in the
patient’s life
o Problem-solving model
• Well-defined with clear boundaries
• Structured to meet the client’s needs
• Characterized by an interpersonal process that is safe, confidential, reliable, and consistent
Goal Example
Goal: The patient will demonstrate more adaptive coping strategies fo
dealing with (specific life situation).
Interventions:
• Identify what is troubling the patient at this time
• Encourage the patient to discuss changes he or she would like to
make
• Discuss with the patient which changes are possible and which are
not possible
• Have the patient explore feelings about aspects that cannot be
changed and alternative ways of coping more adaptively
• Discuss alternative strategies for creating changes the patient desire
to make
• Weight the benefits and consequences of each alternative
• Assist the patient to select an alternative
• Encourage the patient to implement the change
• Provide positive feedback for the patient’s attempt to create change
• Assist the patient to evaluate outcomes of the change and make
modifications as required
Conditions Essential to Development of a Therapeutic Relationship (Text)
• Rapport: the development between two people in a relationship of special feelings based on mutual
acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude
o Primary task in relationship development
o Can be accomplished by discussing non-health-related topics
• Trust: one must feel confidence in that person’s presence, reliability, integrity, veracity, and sincere desire
to provide assistance when requested
o the initial developmental task
o relationship development is difficult if trust is not attained
o Simple, concrete communication and behaviors are important in developing trust
▪ concrete thinking: a difficulty thinking abstractly
• Individuals with who think concretely increases the importance of simple, concrete
communication
▪ Nursing interventions (for individuals with concrete thinking)
• Providing a blanket when the patient is cold
• Being honest and following through
, • Providing a written and structured schedule of activities
• Confidentiality: providing reassurance that what is discussed will not be repeated
outside the boundaries of the healthcare team
• Respect: to believe in the dignity and worth of an individual regardless of his or her unacceptable behavior
o Aka Unconditional positive regarregard
d
o Attitude is nonjudgmental, and the respect is unconditional
o It does not depend on the behavior of the patient to meet certain standards
o A patient is accepted and respected for no other reason than that he/she is considered to be a
worthwhile and unique human being
o Ways to convey respect:
▪ Calling patient by name (and title, if he/she prefers)
▪ Spending time with the patient
▪ Listening to patient’s ideas preferences, and requests, and making collaborative decisions
concerning his/her care
▪ Always being open and honest with the patient, even when the truth may be difficult to
discuss
• Genuineness: the ability to be open, honest, and <real= in interactions
o To be <real=: to be aware of what one is experiencing internally and to allow the quality of the inner
experience to be apparent in the therapeutic relationship
o There is a congruence between what is felt and what is being expressed
o Genuine nurse responds to pt. with truth and honesty rather than with responses that he or she may
consider more <professional=
o May call for some self-disclosure; a quality of <humanness= is revealed through self-disclosure
▪ avoid revering the roles of nurse and pt.
• Empathy: the ability to see beyond outward behavior and to understand the situation from the pt.’s point of
view
o Empathetic nurse can perceive and understand the meaning and relevance of the patient’s thoughts
and feelings
o Nurses must be able to communicate this perception to the pt. by translating words and behaviors
into feelings
Empathy vs Sympathy (Text & PPT)
• With sympathy
sympathy, the nurse <shares= what the pt. is feeling and experiences a need to alleviate distress
o The nurses feels what the patient is feeling
o Objectivity is lost
o The nurse may become focused on relief of personal distress rather than on helping the patient
resolve the problem at hand
• With empathy
empathy, the nurse <accurately perceives or understands= what the pt. is feeling and encourages pt. to
explore these feelings
o The nurse is able to maintain sufficient objectivity to allow the patient to achieve problem
resolution with minimal assistance
Phases of Therapeutic Nurse-Patient Relationship (Text)
• Preinteraction phase
• Orientation (introductory) phase
• Working phase
• Termination phase
• The tasks within these phases may overlap; particularly when the interaction is limited
Objectives (PPT)
• List three elements of effective communication
• Name the conditions necessary for a therapeutic relationship
• Recognize the differences between therapeutic and nontherapeutic communication techniques
• Label therapeutic communication techniques
• Identify examples of therapeutic communication
• Name examples of nontherapeutic communication
• Understand the benefits of therapeutic communication and the result of nontherapeutic words
Introduction (Text)
• Patient-centered care is being promoted as central to quality and safety
• Therapeutic relationship; nurse-patient relationship is the foundation
• <Shall a nurse do thingsfor a patient or can participant relationships be emphasized so that a nurse comes
to do things with a patient as he/her share of an agenda of work to be accomplished in reaching a goal4
health.=
• <It is likely that the nursing process is educative an therapeutic when nurse and patient can come to know
and to respect each other, as persons who are alike, and yea, different, as persons who share in the solution
of problems.=
Role of Nurse and Its Relationship to Patient Illness (Text)
• Identify and explore problems in relating to others
• Discover healthy ways of meeting emotional needs
• Experience a satisfying interpersonal relationship
• Therapeutic interpersonal relationship: the process by which nurses provide care for patients in need of
psychosocial intervention
o Therapeutic use of selfis the instrument for delivery of that care
o Interpersonal communication techniquesare <tools= of psychosocial intervention
▪ Verbal and nonverbal
Role of Nurse
• Focus on pt.’s ideas, experiences, and feelings
• ID and explore pt. pt.’s needs and problems
• Discuss problem-solving alternatives
• Help client to develop new strengths and coping skills
• Encourage positive behaviors
• Assist pt. to develop autonomy and self-reliance
• Portray genuineness, empathy and positivity toward pt.
• Be nonjudgmental
• Understand the difference between sympathy and empathy
Therapeutic Relationship (Text)
• An interaction between two people (usually a caregiver and a care receiver) in which input from both
participants contributes to a climate of healing, growth promotion, and/or illness prevention
,Therapeutic Nurse-Patient Relationship (Text & PPT)
• <human-to-human relationship=
• <mutually significant experience=
• Goal oriented; usually directed at learning and growth promotion in an effort to bring about change in the
patient’s life
o Problem-solving model
• Well-defined with clear boundaries
• Structured to meet the client’s needs
• Characterized by an interpersonal process that is safe, confidential, reliable, and consistent
Goal Example
Goal: The patient will demonstrate more adaptive coping strategies fo
dealing with (specific life situation).
Interventions:
• Identify what is troubling the patient at this time
• Encourage the patient to discuss changes he or she would like to
make
• Discuss with the patient which changes are possible and which are
not possible
• Have the patient explore feelings about aspects that cannot be
changed and alternative ways of coping more adaptively
• Discuss alternative strategies for creating changes the patient desire
to make
• Weight the benefits and consequences of each alternative
• Assist the patient to select an alternative
• Encourage the patient to implement the change
• Provide positive feedback for the patient’s attempt to create change
• Assist the patient to evaluate outcomes of the change and make
modifications as required
Conditions Essential to Development of a Therapeutic Relationship (Text)
• Rapport: the development between two people in a relationship of special feelings based on mutual
acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude
o Primary task in relationship development
o Can be accomplished by discussing non-health-related topics
• Trust: one must feel confidence in that person’s presence, reliability, integrity, veracity, and sincere desire
to provide assistance when requested
o the initial developmental task
o relationship development is difficult if trust is not attained
o Simple, concrete communication and behaviors are important in developing trust
▪ concrete thinking: a difficulty thinking abstractly
• Individuals with who think concretely increases the importance of simple, concrete
communication
▪ Nursing interventions (for individuals with concrete thinking)
• Providing a blanket when the patient is cold
• Being honest and following through
, • Providing a written and structured schedule of activities
• Confidentiality: providing reassurance that what is discussed will not be repeated
outside the boundaries of the healthcare team
• Respect: to believe in the dignity and worth of an individual regardless of his or her unacceptable behavior
o Aka Unconditional positive regarregard
d
o Attitude is nonjudgmental, and the respect is unconditional
o It does not depend on the behavior of the patient to meet certain standards
o A patient is accepted and respected for no other reason than that he/she is considered to be a
worthwhile and unique human being
o Ways to convey respect:
▪ Calling patient by name (and title, if he/she prefers)
▪ Spending time with the patient
▪ Listening to patient’s ideas preferences, and requests, and making collaborative decisions
concerning his/her care
▪ Always being open and honest with the patient, even when the truth may be difficult to
discuss
• Genuineness: the ability to be open, honest, and <real= in interactions
o To be <real=: to be aware of what one is experiencing internally and to allow the quality of the inner
experience to be apparent in the therapeutic relationship
o There is a congruence between what is felt and what is being expressed
o Genuine nurse responds to pt. with truth and honesty rather than with responses that he or she may
consider more <professional=
o May call for some self-disclosure; a quality of <humanness= is revealed through self-disclosure
▪ avoid revering the roles of nurse and pt.
• Empathy: the ability to see beyond outward behavior and to understand the situation from the pt.’s point of
view
o Empathetic nurse can perceive and understand the meaning and relevance of the patient’s thoughts
and feelings
o Nurses must be able to communicate this perception to the pt. by translating words and behaviors
into feelings
Empathy vs Sympathy (Text & PPT)
• With sympathy
sympathy, the nurse <shares= what the pt. is feeling and experiences a need to alleviate distress
o The nurses feels what the patient is feeling
o Objectivity is lost
o The nurse may become focused on relief of personal distress rather than on helping the patient
resolve the problem at hand
• With empathy
empathy, the nurse <accurately perceives or understands= what the pt. is feeling and encourages pt. to
explore these feelings
o The nurse is able to maintain sufficient objectivity to allow the patient to achieve problem
resolution with minimal assistance
Phases of Therapeutic Nurse-Patient Relationship (Text)
• Preinteraction phase
• Orientation (introductory) phase
• Working phase
• Termination phase
• The tasks within these phases may overlap; particularly when the interaction is limited
