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Therapeutic Communication The Helping Interview Helping Relationship Characteristics Caring Hopeful Sensitive Genuine Empathy Positive Regard Values Self & Others Empowering Teaching Goal- Oriented, Purposeful Time Limited Assertive Helping vs Social Relationships HELPING Care Trust Growth Purposeful/Intentional Unequal Sharing Focus on Client’s Needs Time Limited SOCIAL Care Trust Growth Spontaneous Similar Sharing Focus on Needs of Both Individuals Ongoing Control GIVING HELP feeling important feeling useful feeling powerful feeling gratified feeling happy NEEDING HELP feeling unimportant or inadequate feeling useless or depressed feeling powerless feeling frightened or embarrassed feeling sad or angry Phases of Helping Relationship Orientation (professional and client to each other) Working (identification of the client’s problem) Termination (resolution of the client’s problem) Orientation Phase “getting to know you” phase sets the tone introductions roles initiated by the nurse agreement/contract/goals trust develops TRUST T R U S T try expression reflection use of silence setting limits time with client Working Phase “problem solving” phase attend to client’s needs role of teacher/counselor client actively participates gather further data facilitate change evaluate problems & goals Termination “ending” phase review and summarize progress & goals met/not met acknowledge feelings use clear language check the receiver understands the message sent Resolution clients mostly seeking explanation how will problem affect their lives? what will need to be changed? how will they cope? Avoid arguing minimizing challenging giving false reassurance interpreting or speculating on the dynamics of the client’s problems “selling” client on accepting treatment probing sensitive areas participating in criticism of any staff member joining any attacks led by client Nursing Interventions to Encourage The Helping Relationship active listening therapeutic communication techniques other factors attentive listening scale hard to maintain eye contact respond before other finishes speaking finish other people’s sentences talk on and on so no one can respond go on working while someone is talking to you repeat a point just made allow your mind to wander during a conversation good listening STOP TALKING put the speaker at ease show that you want to listen remove distractions empathetic be patient hold your temper go easy on argument and criticism STOP TALKING communication techniques open ended questions (closed for obtaining specific information) validating/clarifying reflective/restating & paraphrasing sequencing sharing observations acknowledging feelings interpersonal skills warmth and friendliness openness (acceptance) consideration of client variables – non-english speaking – developmental considerations – older adults – sociocultural – occupational – patients with special needs other factors promoting therapeutic communication comfortable environment Providing some personal space privacy confidentiality client focus optimal pacing nursing observations blocks to communication failure to respect client failure to listen minimizing feelings inappropriate comments & questions excessive questions yes/no questions why & how probing changing the subject leading questions advice judgmental false reassurance giving approval/disapproval therapeutic vs non-therapeutic THERAPEUTIC facilitates transformation of working nurse/patient relationship relationship allows for adequate & accurate assessment & data collection performed with patient, not for patient NON-THERAPEUTIC hinders relationship formation prevents patient from becoming mutual partner & relegates him/her to passive recipient of care disclosure, yes or no? use self disclosure to help clients open up to you – not to meet your own needs keep your disclosures very brief don’t imply that your experience is exactly the same as the client’s only self-disclose about situations that you have mastered monitor your own comfort with self-disclosure respect your client’s needs for privacy remember that there are cultural variations in the amount of selfdisclosure considered appropriate identify risks and benefits of self disclosure discuss the goals of medical care is not enough! We need more than medical care or surgery--we need competent care & a good communicator