Download In nursing

Therapeutic Listening
Ms. Rica A. Santos, RN
Objectives
• Describe how the nurse as communicator assesses
to understand the client’s met and unmet needs.
• Intervene to assist the client toward mutual goal
setting.
• Practice active listening using therapeutic skills
deliberately monitoring for non therapeutic
interventions.
Objectives
• Relate how the self-aware nurse as communicator
can holistically facilitate the client’s health.
• Relate how the nurse in communicator and
caregiver roles manifests caring and valuing.
Activity
Note taking
by Tony Buzan
Mind Map
• Try the following words
– Compass
– Port
MMUNICATION
What is
communication
?
Definition
• Process of sending a message to one or more
persons (Varcarolis)
• Process by which information is exchanged
between individuals through a common system of
symbols, signs, or behavior (Merriam-Webster)
• Process of exchanging information and the process
of generating and transmitting meanings between
two or more individuals (Taylor)
Definition
• Process by which humans meet their survival needs,
build relationships, and experience emotions
(Kozier)
• In nursing, communication is a dynamic process
used to gather assessment data, to teach and
persuade and to express caring and comfort.
(Kozier)
MMUNICATION
Why do we need to communicate?
Purpose (Stimulus)
• To influence others
• To obtain information
• To give comfort or advice
*Nurses who are able to communicate
effectively are better able to collect
assessment data, initiate interventions,
evaluate outcomes of interventions,
initiate change that promotes health,
and prevent legal problems
associated with nursing practice.
MMUNICATION
Levels of communication
• Intrapersonal
“self-talk”
• Interpersonal
• Group
Communication
– Small group
communication
– Organizational
Communication
MMUNICATION
How do we
communicate?
Process of Communication
• Stimulus
• Sender
• Message
• Channel – auditory, visual, kinesthetic
• Receiver
• Response
Communication Process Model
MMUNICATION
Modes of Communication
• Content of the message
• Considerations
• Pace and Intonation
• Simplicity
• Clarity and Brevity
• Timing and Relevance
• Adaptability
• Credibility
• Humor
• Process of the message
• Considerations
• Personal Appearance
• Posture and Gait
• Facial Expression
• Gestures
• Eye contact
• Tone of voice
• Mode of dress and
grooming
Non verbal
• Electronic
MMUNICATION
Factors Influencing the
Communication Process
• Personal Factors
• Emotional factors
• Physical state
• Roles and responsibilities
• Values and Perceptions
• Developmental Level
• Gender
• Cognitive factors
• Congruence
Factors Influencing the
Communication Process
• Environmental factors
• Territoriality
• Background noise, uncomfortable
accommodations
Factors Influencing the
Communication Process
• Relationship factors
• Interpersonal Attitudes
– Symmetrical relationship
– Complimentary relationship
• Personal Space
– Proxemics - study of distance between people and
interactions
» Intimate – Touching to 1 ½ feet
» Personal – 1 ½ to 4 feet
» Social – 4 to 12 feet
» Public – 12 to 15 feet
MMUNICATION
• Two main principles that can guide the
communication process (Peplau)
• Clarity
• Continuity
Therapeutic Communication
Purpose
• Promotes understanding and can help
establish a constructive relationship
between the nurse and the client
• Client and goal directed
• Nurses need to respond not only on the
content of the client’s verbal message but
also to the feelings expressed
Clinical Interview
Attentive Listening
Physical Attending
• Manner of being present to another or
being with another
• Listening in what a person does while
attending
• Body language
– Consider kinesics and proxemics
• Paralinguistics
– “It’s not what you say, but how you say it.”
– “I will see you tonight”
Physical Attending
• Verbal tracking
• Five actions of physical
attending
(Egan, 1998)
– Face the other person
squarely
– Adopt an open posture
– Lean toward the person
– Maintain good eye
contact
– Be relatively relaxed
Cultural Communication Barriers
• Communication style
• Use of eye contact
• Perception of touch
• Cultural filters
Degree of Openness
• Open-ended questions
• Closed-ended questions
• Indirect or implied questions
Communication
Techniques
Using silence
• There is no universal rule as to how much silence is
too much, it is said to be worthwhile as long as it is
serving its purpose and not frightening the client.
• Knowing when to speak during an interview is
largely dependent on the nurse’s perception about
what is being conveyed through the silence.
• Silence may indicate an expression of anger and
hostility, being ignored and insulted, or it may
provide meaningful moments of reflection
Accepting
“Yes”
“Uh-huh”
“I follow what you say.”
Providing general leads
“Can you tell me how it is for you?”
“Perhaps you would like to talk
about….”
“And then…”
Being specific and tentative
“Rate your pain scale from 1-10”
(specific)
“You seem unconcerned about your
diabetes.” (tentative)
Giving Broad Openings
“How have you been feeling lately?”
“What brought you to the hospital?”
Using touch
Putting an arm over the client’s shoulder
Placing your hands over the client’s
hand
Restating or paraphrasing
Client: “I couldn’t manage to eat any
dinner last night – not even dessert.”
Nurse: “You had difficulty eating
yesterday?”
Seeking Clarification
“I’m not sure I understand that.”
“Would you please say that again?”
Perception checking or
seeking consensual validation
Client: “My husband never gives me any presents.
Nurse: “You mean he has never given you any present
for your birthday or Christmas?”
Client: “Well-not never. He does get me something for
my birthday and Christmas, but he never thinks of
giving me anything at any other time.”
“Tell me whether my understanding agrees with you.”
Offering self
“I’ll stay with you until your daughter
arrives.”
“We can sit here quietly for a while; we
don’t need to talk unless you would
like to.”
Giving information
“Your surgery is scheduled for 11am
tomorrow.”
“You will feel a pulling sensation when
the tube is removed from your
abdomen.”
Acknowledging/ Giving Recognition
“You walked twice as far today with
your walker.”
“You trimmed your beard and mustache
and washed your hair.”
Clarifying time or sequence
Client: “I vomited this morning.”
Nurse: “Was that after breakfast?”
Making observations
“You seem tense.”
“I notice you biting your lips.”
Presenting reality
“Your magazine is here in the drawer. It
has not been stolen.”
“The telephone ring came from the
television program.”
Exploring
“Tell me more about that…”
“Would you describe it more fully?”
Encouraging comparisons
“Has this ever happened before?”
“Is this how you felt when?”
Restating
Client: “I can’t sleep. I stay awake all
night.”
Nurse: “You have difficulty sleeping?”
Focusing
Client: “My wife says she will look after
me but I don’t think she can, what with
the children to take care of, and
they’re always after her about
something – clothes, homework,
what’s for dinner not night.”
Nurse: “Sounds like you are worried
about how well she can manage
Reflecting
Client: “What can I do?”
Nurse: “What do you think would be
helpful?”
Summarizing and Planning
“During the past hour we have talked
about…”
“Tomorrow afternoon we may explore
this further.”
Barriers to
Communication
•
•
•
•
•
•
•
•
Stereotyping
Agreeing and Disagreeing
Minimizing feelings
Being defensive
Challenging
Probing
Testing
Rejecting
•
•
•
•
•
•
•
Changing topics and subjects
Unwarranted reassurance
Passing judgment
Asking why questions
Giving common or premature advice
Asking excessive questions
Showing nonverbal signs of boredom and
resentment
Dimensions
• Empathy
• Respect
• Therapeutic genuineness
• Concreteness
Facilitative skills checklist
(Myrick & Erney)
Indicate whether you strongly agree (SA), Agree (A),
not sure (NS), Disagree (D), strongly disagree (SD)
• I maintain good eye contact.
• Most of my verbal comments follow the lead of the
other person.
• I encourage others to talk about feelings.
• I am able to ask open-ended questions.
• I can restate and clarify a person’s ideas
• I can summarize in a few words the basic ideas of a
long statement made by a person
• I can make statements that reflect the person’s
feelings
Facilitative skills checklist
(Myrick & Erney)
• I can share my feelings relevant to the discussion
when appropriate to do so
• I am able to give feedback
• At least 75% or more of my responses help enhance
and facilitate communication
• I can assist the person to list some alternatives
available
• I can assist the person to identify some goals that
are specific and observable
• I can assist the person to specify at least one next
step that might b taken toward the goal
MMUNICATION
It is not enough that we have the knowledge of skills and
techniques to communicate effectively but we as nurse also
need to have genuine respect and the ability to listen and to
understand the client’s concern and a desire to work with the
individual to help in his or her situation.
References
communication. (2009). In Merriam-Webster Online Dictionary.
Retrieved June 6, 2009, from http://www.merriamwebster.com/dictionary/communication
Kozier B., Berman A., Synder S., &Erb, G. (2008). Fundamentals of Nursing
Concepts, Process, and Practice (8th edition). Jurong, Singapore:
Pearson Education Inc.
Taylor C., Lillis C., LeMone P. (2005). Fundamentals of Nursing The Art and
Science of Nursing Care (5th edition)
Philadelphia: Lippincott Williams and Wilkins.
Varcarolis, E., Carson V., & Shoemaker N. (2006). Foundations of
Psychiatric Mental Health Nursing A Clinical Approach(5th edition)St.
Louis Missouri: Elsevier Inc.
Lab Activity
In each of the following, identify the
types of responses which block the
client’s attempts to express himself.
Correct the nurse’s response so that it
is therapeutic.
Patient:
“Well, I haven’t been able to work for
quite a while now, and the doctor says I
might not even work as a carpenter again.”
Nurse:
“It must be difficult for you right now, but
I’m sure everything will be all right.”
Patient:
“I don’t know. I hate to have him see me
looking like this. Just thinking about him coming
makes me nervous.”
Nurse:
“You really should stop worrying. That may
be what’s keeping you from getting the rest you
need. And, after all, no one expects you to look
your best when you’re in the hospital.”
Nurse:
“How are you feeling this morning, Mr.
Patterson?”
Patient:
Oh, fine, thanks.”(unenthusiastic)
Nurse:
“That’s good.”
Patient:
“But it’s kind of hard having to watch what I eat,
and trying to be careful about what I do. I just sit
around the house most of the time, watching TV.”
Nurse:
“You should take up a good hobby - something you can do without much physical strain.
If you keep busy, it might take your mind off your
troubles.”
Patient:
“You’d think a doctor could have
prevented some of this, but he’s too busy to
care about what’s happening to me.”
Nurse:
“You have a fine doctor. We have lots of
his patients. He always takes every
precaution.”
Patient:
“What’s there to talk about? First they say
they have to operate, and then when I’m
beginning to feel better, I get this infection. I
don’t think I’m ever going to get out of here.”
Nurse:
“I know just how you feel. You know,
everyone gets frustrated when things aren’t
going right.”
Patient:
“Maybe I should find a hobby or
something. I try not to get discouraged. I
know I shouldn’t let it get me down.”
Nurse:
“That’s the right attitude. It really doesn’t
help to worry about it.”
• Look at activities in the syllabus to
review
QUIZ
1. Which of the following best describes therapeutic
communication?
A. Communication that facilitates cooperative,
effective patient interaction
B. Communication that helps to avoid or
ameliorate violent patient encounters
C. Communication that helps reduce the chance
of a lawsuit
D. All except C
E. All of the above
2. In regards to feedback, if the message was not
properly received the sender should:
A. Restate the original message
B. Modify the content of the original message to
clarify
C. Rethink the message and get back to the receiver
at a later date
D. All except C
E. All of the above
3. Reflection allows the health care provider to
facilitate an effective patient interview. Which of the
following describes reflection?
A. Allows the patient to restate something that
confuses the healthcare worker
B. Allows patient more time for their thought
process
C. Technique that involves paraphrasing what the
patient says to clarify
D. All of the above
E. All except C
4. When faced with a patient who has a hearing
disorder, which of the following techniques would
facilitate better communications?
A. Gaining the patient’s attention by shaking the
patient
B. Speaking more monotone
C. Speak normally to facilitate lip reading
D. All of the above
E. None of the above
5. A nurse is teaching a home care patient how to
administer a topical medication. The patient is
watching television while the nurse is talking. What
might be the result of this interaction?
A. The message will likely be misunderstood.
B. The stimulus for communication is unclear.
C. The receiver will accurately interpret the
message.
D. The communication will be reciprocal.
E. All of the above
6. Open-ended questions encourage the patient to:
A. Answer “yes” or “no”
B. Allows the nurse to manipulate the response
C. Restrict the response
D. Freely provide a more objective response
E. All of the above
7. Which of the following is NOT an effective
communication technique?
A. Avoiding ambiguous phrases and excessive
medical jargon
B. Using analogies to everyday situations so that the
patient can understand
C. Using more versus fewer words to avoid confusing
the patient
D. Repeating the key elements during history taking
E. None of the above