NUR322 Holistic Health Assessment Therapeutic Communication

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NUR322 Holistic Health AssessmentTherapeutic
Communication

• Carole J. Howe, RNc, PhD
• Spring 2007

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Building the Therapeutic Alliance

• Building the Relationship
• Positive regard
• Empathy
• Genuineness
• Concreteness
• DAmico Barbarito (2007)

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Communication

• Exchange of information so both the receiver and
  the sender understand

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Communication cont.

• Sender
• verbal and nonverbal
• nonverbal is more reflective of true feelings
• Receiver
• interpretation through own world view

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Types of Questions

• Open-ended
• Closed-ended
• Directive
• Permission-giving
• Barkauskas et al., 1998

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Building the RelationshipCommunication

• 1. Active Listening
• 2. Guided Questioning
• open-ended to focused
• graded responses
• one question at a time
• multiple choices
• clarifying
• continuers (general leads)
• echoing (reflection)

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• Nonverbal Communication
• -Culturally bound
• -Mirroring (position language)
• Empathic Responses
• -Identify feelings
• -Respond with acceptance
• Validation
• -acknowlege pt feelings

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• Reassurance
• -avoid false/premature reassurance
• Partnering
• -collaborative role
• Summarization
• -summarize feelings. issues, themes

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• Transitions
• -clear expectations
• 11. Empowering the Person (see Bickley, 2007 pg.
  41

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Traps in Communication

• False reassurance
• Giving unwanted advice
• Using authority
• Using avoidance language
• Engaging in distance
• Using professional jargon
• Talking too much interrupting
• Asking why questions

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cont.

• Minimizing feelings
• Changing the subject
• Social vs. therapeutic relationship
• Overloading
• Jump to conclusions
• Act defensively
• Halo effect

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Special Situations The patient who

• cries
• is sexually aggressive
• is angry
• asks personal questions

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The adolescent

• Watch attitudes
• Respect the adolescent
• Be honest
• Need direction provide rationale
• No silent periods or reflection
• Address emotional charged subjects after rapport
  established
• Jarvis (2000)

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The Older Adult

• Use last name
• Provide more time
• Adjust the pace
• Dont hurry
• Consider physical limitations
• Face directly, do not shout
• Jarvis (2000)

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Working with an Interpreter

• Interpret verbatim
• Clarify unclear messages
• No side conversations
• Selecting the interpreter
• Documentation