Rnur134 Therapeutic Communication

Front 1

using silence

Back 1

gives the client the opportunity to collect and organize thoughts, to think through a point, or to consider introducing a topic of greater concern than the once being discussed

Front 2

accepting

Back 2

conveys an attitude of reception and regard
"yes i understand what you said" eye contact with head nodding

Front 3

giving recognition

Back 3

acknowledging; indicating awareness; better than complimenting, which reflects nurses judgement.
"Hello James, i see you made an ashtray in OT today"

Front 4

offering self

Back 4

making oneself availabe on an unconditional basis, increasing pt feelings of self worth.
"I'll stay with you awhile"

Front 5

giving broad openings

Back 5

allows the client to take initiative in introducing the topics; emphasizes the importance of the clients rolein the interaction.
"What would you like to talk about today?"

Front 6

placing the event in time or sequence

Back 6

clarifies the relationship of events in time so that the nurse and client can view them in perspective.
" was this before or after....?"

Front 7

making observations

Back 7

verbalizing what is observed or perceived. this encourages the client to recognize specific behaviors and compare perceptions with the nurse.
"you seem tense."

Front 8

encouraging description of perception

Back 8

asking the client to verbalize what is being percieved; used when client is having hallucinations.
"Are you hearing voices again"

Front 9

encouraging comparison

Back 9

asking the client to compare similarities and difference in ideas, experinces or interpersonal relationships. this helps the client recognize life experiences that tend to recur as well as those aspects of life that are changeable.
"How does this compare to the time when?"

Front 10

restating

Back 10

repeating the main idea of what the client said. lets client know if what was said is fully understood and gives them a chance to clarify if needed.

Front 11

reflecting

Back 11

questions and feelings are referred back to the client so that they may recognized and accecpt. client recognizes that they have a valued point of view, good to use when client ask for advice.
cl: "what do you think i should do about my wifes drinking problem?"
nurse: "what do you think you should do about your wifes drinking problem?"

Front 12

focusing

Back 12

taking notice of a single detail or even a single word; works when client is moving rapidly from one idea to the next, not considered theraputic unless the patient is anxious.
"this point seems worth looking at more closely , perhaps you and i can discuss it together.

Front 13

exploring

Back 13

delving further into a subject, idea, experience,or relationship; especially helpful with clients who tend to remain on superficial level of communication, refrain from pushing the client.
"please explain that situation in more detail."

Front 14

seeking clarification and validation

Back 14

striving to explain that which is vague or incomprehensible and searching for mutual understanding; clarifying the meaning of what has been said facilitates and increases understanding for client and nurse.
"im not sure i understood you, can you please explain?"

Front 15

presenting reality

Back 15

when the client has a misperception of the enviornment, the nurse defines reality or indicates perception of the situation for the client.
"there is no one else in the room but you and me."

Front 16

voicing doubt

Back 16

expressing uncertainty as to the reality of the clients perception; used when the client is experiencing delusional thinking.
"I find that hard to believe"

Front 17

verbalizing the implied

Back 17

putting into words what the client has only implied or said indirectly, can be used with the client who is mute or having impaired verbal communication, this clarifies that which is implicit rather than explicit.
cl;"it is a waste of time being here.
Nurse: "are you feeling that no one understands?"
cl: (/mute)
Nurse: "it must be difficult for you since your husband died."

Front 18

attempting to translate words into feelings

Back 18

when feelings are expressed indirectly, they nurse tries to desymbolize what is being said and find clues to the underlying feelings.
cl: "im out in the ocean."
nurse: "you must feel alone right now."

Front 19

formulating a plan of action

Back 19

when a client has a plan in mind for dealing with what is considered to be stressful situation, used to prevent anger or anxiety.
"next time this comes up, what can you do to deal with it better?"

Front 20

conditions essential to develop a therapeutic relationship

Back 20

rapport
trust
respect
genuineness
empathy

Front 21

transference

Back 21

client unconsciously attributes to the nurse feelings and behavioral predispositions formed toward a person from his or her past, can be triggered by nurses apparance or personality.

Front 22

Nontherapeutic communication

Back 22

can be a barrier to open communication, nurse should recognized and eliminate the use of them during duration with client, this will enhance the nurse-clinet relationship

Front 23

giving reassurance

Back 23

indicating to the client that there is no cause for anxiety, there by devaluing the clients feelings, may discourage them from further expressing feelings.
"everything will be alright"
better to say:
"we will work on that together"

Front 24

rejecting

Back 24

refusing to consider or showing comtempt for the clients ideas or behavior.
"l dont wanna hear about that"
better to say:
"lets look at that a little closer"

Front 25

approving or disapproving

Back 25

sanctioning or denouncing the clients ideas or behaviors; implies that the nurse has the right to pass judgement on whether the clients behaviors are good or bad and the client is expected to please the nurse.
"thats good, im glad that you...."
better to say:
" lets talk about how your behavior envoked anger in other clients at dinner today."

Front 26

agreeing or disagreeing

Back 26

indicating accord or oppsition to the clients ideas or opinions; implies that the nurse has right to pass judgement on if the clients ideas or opinions are right or wrong. agreement prevents the client from later modifying his or her point of view without admitting error. disagreement implies inaccuracy, provoking then client for defensiveness on the part of the client.
"thats right i agree"
better to say:
"lets discuss what you feel is unfair about the community rules?"

Front 27

giving advice

Back 27

telling the client what to do or how to behave implies that the nurse know what is best and that the client is incapable of any self direction. it nurtures the clients in the dependent role by discouraging independent thinking.
"I think you should...."
better to say:
"what do you think you should do?"

Front 28

probing

Back 28

presisten questioning of the client; pushing for answers to issues that the client does not wish to discuss.
"tell me how your mother abused you as a child"
better technique:
the nurse should be aware of the clients response and discontinue the interaction the first sign of discomfort

Front 29

defending

Back 29

attempting to defend or protect someone from a verbal attack. to defend what the client has criticized is to imply that he or she has no right to express ideas, opinions, or feelings. defending does not change the clients feelings and may cause the client to think the nurse is taking sides with those being criticized and against the client.
"You have a very capable dr, im sure he only has your best intrest."
better to say:
"i will try to answer you questions and clarify some issues"

Front 30

requesting information

Back 30

asking the client to provide the reasons for thoughts, feelings, behavior, and events. asking why a client did something or feel a certian way can be very intimidating and implies the client must defend his or behavior or feelings.
"why do you think that?"
better to say
"describe what you were feelling just before that happened"

Front 31

indicating the existence of an external source of power

Back 31

attributing the source of thoughts, feelings, and behavior to others or to outside influences. this encourages the client to project blame for thoughts or behaviors on others rather than accepting the responsibility personally.
"what makes you say that"
better to say:
"you became angry when your brother insulted your wife"

Front 32

belittling feelings expressed

Back 32

when the nurse misjudges the degree of the clients discomfort, a lack of empathy and understanding may conveyed.
Cl; "i have nothing to live for"
Nurse: everybody gets down in the dumps sometimes"
better to say:
"you must be very upset, tell me what you are feeling now"

Front 33

making stereoyped comments

Back 33

cliches and trite expressions are meaningless in a nurse-client-relationship. the nurse makes empty conversations, it encourages a like response from the client.
"hang in there its for your own good"
better to say
The therapy must be difficult for you at times, how do you feel about your progress at this point?"

Front 34

using denial

Back 34

denying that a problem exists blocks discussion with the client and avoids helping the client identify and explore areas of difficulty
Cl: "i feel like im nothing"
Nurse: "of course you are something, everybody is somebody"
better to say:
"you are feeling like no one cares about you right now?"

Front 35

interpreting

Back 35

with this technique the therapist seeks to make conscious that which is unconscious, to tell the client the meaning of his or her experience.
"what you really mean is"
better technique:
the nurse must leave interpretation of the clients behavior to the psychiatrist. the nurse has not been prepared to preform this technique

Front 36

introducing an unrelated topic

Back 36

changing the subject casues the nurse to take over the direction of the discussion. this may occur to get to a discussion that the nurse wants to discuss with the client or get away from a topic that they dont wanna discuss.
Cl "i dont have anything to live for"
Nurse: "did you have visitors this weekend"
better technique:
the nurse must remain open and free to hear the client and to take in all that is being conveyed, both verbal and nonverbal.