Understanding Therapeutic Communication In Healthcare

What is Therapeutic Communication?

Question:

Discuss about the Complementary and Alternative Therapies.

Therapeutic Communication (TC) is defined as the face-face interaction process which focuses on advancement of the physical and emotional wellbeing of a patient. The concept of TC refers to the process whereby nurses consciously influence patients or assists the patients to an improved understanding verbally or non-verbally. TC entails the utilization of particular strategies which encourage the patients to express ideas as well as feelings and which convey respect and acceptance.

Nevertheless, the concept of TC has been described further by various researchers examining phrases/terms individually on the basis of the word structures as well as connotation (meaning). Communication and Therapeutic are the 2 multifaceted terms which separately entail varying connotations. Nonetheless, this phrase assumes rather a different meaning in medical vocabulary context and if regarded as the compound-noun.

Therapeutic describes a science as well as an art of healing of or relating to the treatment/beneficial action. This can be extended further to entail what is called the assisting/helping relationships that is one that encourages and promotes the development and growth as well as enhanced coping with life for the other individual. On the other hand, communication has an array of definitions with tendencies to stress either the meaning or the message (Mills 2017). It can be defined as the ordered transfer of meaning: social interaction via message: reciprocal meaning conception: information/ideas/attitudes sharing between or amongst individuals.

Communication has been as well suggested to be the act by which 1 or additional individuals sends as well as receives messages which can be disrupted by the ‘noise’, takes place under a setting, have certain impact as well as offers certain opportunity (Stuart 2014). TC encompasses the info exchange on two degrees –non-verbal or verbal. Messages are being sent as well as received concurrently. Verbal-communication entails words’ arrangement into sentences, the content and context-a region in which conversation occurs that could include time alongside the social cultural, physical and emotional surroundings.

Non-verbal-communication entails a behavior that accompanies verbal-content like eye consent, body-language, and facial-expression, voice tone among others (Fan and Taylor 2016). Non-verbal communication primarily signals the thoughts feelings and needs of the patient, primarily subconsciously (Lindquist, Snyder and Tracy 2013).

TC techniques are used by the nurses to offer support as well as information to the patients. A variety of TC techniques are essential to achieve the nursing goals in the communication with patients. Through the verbal and non-verbal communication the nurses use TC to influence as well as help the patient. TC includes the utilization of different tactics which inspire patients to express ideas alongside feelings. Because each patient vary in culture, social-status, characters, and background, there are a range of reactions to TC (Fan and Taylor 2016).  

Components of Therapeutic Communication

Nurses must efficient master effective TC techniques to create empathy towards the experiences revealed by the patients. It is imperative among the nurses to have effective communicative therapeutic competence to efficaciously employ the communicative processes and fulfil the required standards of patients’ healthcare. Via the TC, nurses must create an association, recognize the needs and worries of patients, and estimate the patients’ perception encompassing comprehensive actions (messages and behavior).

Different theories as well as perspectives of TC have been presented by different scholars. They have studied TC techniques and elaborated them by varying viewpoints. The primary contributor to the mental health law reform was Hildegard E. Peplau. He led the way toward human treatment of the clients with behavior as well as personalities disorder. She ushered in theories of developmental phases of the nurse-patient associations. Such phases entailed, the orientation stage; identification stage; exploitation stage alongside resolution stage. This theory steered the way to subsequent nurse theorists as well as clinicians in the development of increasingly sophisticated techniques of TC (Wessel 2015).

A. De Vito’s engaged 3 setting dimensions to regard in the course of communication process. Such included social psychological; physical alongside temporal. These dimensions interact, and are applied together. Variables in every dimension impact the commutation’s formality, seriousness as well as intimacy. De Vito implied that communication assumes a liner process in which it begins with a single individual and advances through sequence of steps to another individual.

Northhouse and Northhouse (1992) demonstrated that utilizing a kind of touch allow patients to perceive it in an encouraging manner. The form must be relevant to a given context, never to utilize a touch gesticulation which inflicts increased intimacy on the patient than the patient desires, and to be keen to observe the reaction of the patient to such touch. Potter and Perry (1999) probed as well as examined various elements of verbal communication leading to 6 elements as the utmost significant one in TC. These elements included vocabulary; intonation, pacing; clarity and brevity, timing and relevance alongside denotative and connotative meaning.

Knapp and Hall (2002) did arrange the manner that non-verbal messages could interact easily with those of verbal ones. They categorized them as follows; conflicting, repeating, substituting, regulating, complementing as well as accenting/moderating. It remains a duty of the mental-health practitioner to pay extra alertness to the techniques of non-verbal communication utilized by patients to obtain extra info in case of mixed messages. Body-movements alongside positioning must be observed where the individual perceive mixed-messages in the interaction process.

The Importance of Effective Therapeutic Communication in Healthcare

Arnold and Boggs (2003) focused on non-verbal-communication that encompassed messages that are established via body-motions, facial-expressions, and utilization of space as well as sounds alongside the utilization of touch.  The authors highlighted 4 areas whereby non-verbal behaviors are utilized including cultural variations; proxemics; kinesis which entails body-languages and facial-expression; and appearance.   

The main goals of the TC are to assist the patient feel well cared for as well as understand and establish the relationship between the patient and nurse whereby the patient feels extremely free to express his attitudes, opinions and even feelings. TC is intended to help make the patient cope as with the illness and eventually feel excited and increasingly relaxed. The nurses benefit from TC because the job of making their patients feel both comforted as well as care for squarely fall under the nurse prevue and have to bare this on her shoulders. The nurses have to learn the key principles of TC to best meet the patients’ needs in their practice.

TC that is envisioned to assist the patients encompasses the interpersonal-communication amongst the nurses and the patients. Techniques of TC usually infer the independence on patients. The nurse’s duty or role is then to utilize the info gathered to assist the patient to further probe his individual opinions and feelings. TC needs awareness of the nurse toward what is being asserted and any nonverbal cues (Yas and Mohammed 2016). The mental health nurse has to pay extra courtesy to patient alongside techniques followed as the nurse could insentiently impact patient via the utilization of the therapeutic communication techniques.

The nurse’s role in the determination of the illness via steps as well as techniques followed remains of utmost importance to a successful TC. TC remains a purposeful kind of communication, permitting the patient and nurse to arrive at health-associated goals via partaking in the focused relationship. Obstacles to communication could have adverse effects on patient thereby lowering the self-esteem of the patient and could as well as bar communication. Nurse and patients must collaborate will all other members of the health care team to promote a successful TC.

The TC will encourage positive interaction between the nurse and the patient. It helps the nurse to encourage the patient to express himself which then permits the nurse a more succinct notion or idea of the emotional tendencies of the patient. This will then help the nurse to determine the most beneficial approaches to treatment. The TC will allow the nurse to exemplify empathy, respect as well as nonjudgmental attitude which promote the preferred side of the patient’s self-expression as well as inspire the mutually patient-nurse trusting relationship. This allows the compassion toward the patient thereby encouraging the genuine concern as well as interest in the patient’s wellbeing as well as teaches the patient how to interact with the nurse in the constructive way to help in the caring and treatment of the patient (Yas and Mohammed 2017).

Theories and Perspectives of Therapeutic Communication

The TC will also support personal accountability. TC helps the nurse to teach as well as provide the patient with essential tools the patient requires to recognize his challenges and enhance life contexts. The patient will then be empowered to become increasingly cognizant of his individual behavior and hence self-correct. TC also encourages the growth in areas the patient would wish to enhance instead of compelling the patient in any given direction. It will thus help the nurse avoid any resistance as it makes nurse collaborate with the patient without insisting in his own agenda thereby improving the therapeutic process. When the nurses uses the personal TC approach, the nurse will boost the probability that the patient will react or respond competently in his learning to cope with the illness, regulate patient moods, develop patient’s self-confidence as well as enhance relationship (Riley 2015).

The TC also promotes openness. Where the lines of TC communication remain open, the patient will more likely to ask the nurse for assistance and more prone to be always open regarding persisting symptoms as well as challenges he is experiencing. The patient’s honest summation of how the therapy is assisting or impairing him will permit the nurse an opportunity to speak to such problematic matters instantly and reevaluate the options of treatment (Webster 2014). TC promotes empathy and hence encourages the patient to develop as well as reinforce beneficial therapeutic tools including open, communication, honesty and self-confidence. The use of TC permits the patient to learn how to reach his individual decisions as well as conclusions whereas reaffirming his confidence in own ability to make meaningful determinations.     

The therapeutic nurse-patient relationship will help understand the importance of TC to both nurse and patient. The TC encompasses the interpersonal communication between the nurses and the patient (Sherko, Sotiri and Lika 2013). The TC is purposed to assist patients. The competencies needed in TC are highly delicate as well as too many than the ones needed in the over-all interpersonal communication (interaction), and mastery of such techniques assists nurses in understanding their patients much effectively. Sound-interpersonal interactions competencies for the nurses remain of utmost significance as well as essential for the efficient TC. Nevertheless, TC is intended at the establishment of various purposes for nurses as a mental-health practitioner. Communication describes the channel that initiates, expounds as well as brings to an end the patient-nurse association.

To accomplish effective TC, nurses must adhere to rules of confidentiality and privacy. This will protect the rights as well as privacy of patients, permit the patient to freely express himself, and respect patient by considering background, socioeconomic status, race, religion, age in respecting patients’ personal-space (Knapp 2014). A nurse has to be willing to separate between the intentions and needs of the patient; she could require to set boundaries where she feels that they will be dishonored. Utmost professionalism in TC is extremely imperative for the association between patient and nurse. Both must adhere to the rules, and utilize courteousness forms.  

Effective Strategies and Techniques of Therapeutic Communication in Nursing

The TC communication entails 5 levels. The first level is the interpersonal communication-face-to-face interactions between the nurse and another individual. The second level is the transpersonal communication- Involves the interaction which takes place within the individual’s spiritual domain (Fortinash and Worret 2014). The third level is the small-group communication-Involves the interaction occurring where the small number of individuals meet and subsequently share a similar goal. The fourth level is intrapersonal communication- Powerful type of communication which takes place within the person. The fifth level is the Public communication-interaction with the audience including nurses being required to maintain eye contacts as well as use gesture. 

The patient and the nurse must collaborate actively following various kinds of communication.

• Active listening: Attentive/Alertness to what the patient is communicating nonverbally and verbally
• Share Observations: Making comments of how the patients looks acts and sounds
• Share empathy: Being sensitive to the patients
• Share Hope: The nurse must convey the sense of feasibility or possibility
• Share Humor: The nurse has to use this because it has a positive impact on the patient. The nurse must ensure that the patient is fully understanding what is being communicated
• Sharing feelings: This is importance as it assist the patient to share his feelings by via observation and encouragement of communication
• Utilize Touch: This will bring the sense of caring for the patient where the nurse holds the hands of the patient
• Utilize silence: This is also useful in permitting patients to think and also certain insight into the context. Listening remains imperative.   

What are the effective Techniques of therapeutic communication?

To understand the effectiveness of the techniques of TC, it is appropriate to compare the therapeutic against non TC techniques. A nurse could use a range of techniques when establishing an association with patients. The choice of such techniques anchors entirely on the intention or the collaboration purposes alongside the patient abilities to verbally communicate with a nurse. The nurse must have a mastery of every technique to choose the right one to facilitate her interaction with the patient as well as reinforce the nurse-patient connection (Birks, Chapman and Davis 2015). TC assists the patients to trust as well as relax, whereas non-non-therapeutic communication triggers patients to feel increasingly uncomfortable as well as untrusting thus building walls which bar the communication between the nurse and the patient.

• Asking appropriate and suitable questions: the nurse should ask a single question at a time to enable her explore the topic before asking another one.
• Clarifying: the nurses must assess whether patient understood the provided info
• Confronting: This helps the patient to recognize his inconsistencies in feeling, beliefs and attitudes.
• Focusing: the nurse must focus on salient issues in conversation
• Paraphrasing: the nurse needs to restate the message of the patient to allow the patient to acknowledge that the nurse is listening
• Providing info: the nurse has to provide info which patient wants and needs to know
• Self-disclosing: it allows the nurse to show patient that the info is understood and signals respect for patient
• Summarizing: the nurses must summarize to bring a sense of closure between her and the patient to the conversation

Whilst therapeutic techniques enhances efficiency, the non-therapeutic techniques could have opposing impacts. They will bar communication with the patients. The nurse must be well trained and competent to avoid utilizing non-therapeutic techniques with the patients. The non-therapeutic communication which must be avoided at all cost include the following: 

• Altering the subjects that blocks further communication
• Approval/disapproval could send message that a nurse has right to make decisions or judgment
• Arguing might means that the patient is telling lies or misinformed.
• Asking for explication/explanation which can potentially trigger resentment
• Asking patients personal questions
• Automatic reactions/responses indicate that the nurse is never taking the context seriously
• Defensive reaction/response may make the patient feel that she lacks right to an opinion
• False reassurance that is never backed by facts could lead to more harm than good
• Passive/aggressive reaction/responses-passive reactions evades the issues while aggressive ones could be confrontational
• Providing personal opinions
• Sympathy remain subjective and hence bars a precise image of the situation of the patient

Nurse-patient communication based on therapeutic techniques creates an association between the patient and the nurse. Such techniques are placed into the practice in the course of the communication with a patient. Thera are various types or forms utilized in the collection of the info from patient (Arnold and Boggs 2015). The useful ones on a wider perspective include interview. The interview is a prearranged conversation with patient to acquire history of the patient as well as the info regarding the present illness. The interview encompass various forms of questions as well as stages. Three main questions each of which serve specific purpose are as follows:

• Open-ended questions: This makes the patient to tell his entire story relating to health problem. The nurses then establishes the concern regarding the patient and could encourage the patient to give additional info by asserting: “Is there anything else”
• Closed-ended questions: These are indeed confined to a single or two word responses like “yes” or “no”. Nevertheless, such questions are utilized where the nurses wishes to know a particular response to a query.
• Focused questions: These are utilized where there is an already established, firm nurse-patient relationship. Such questions lead in extended reactions, but are merely utilized with the resistant patient.

• Orientation Stage: This is the phase at which the nurse introduces herself to patient as well as explains the interview purpose. The nurse explicates the reason the data is collected. The nurse has to understand the needs of the patient. Trust as well as confidentiality have to be conveyed by the nurse. Professionalisms is of utmost imperative.
• Working Stage: This is the point at which a nurse asks the patients questions to acquire data for purpose of nursing care plan development. In this stage, the nurse utilizes strategies like silence, clarifying, paraphrasing, and listening to facilitate the TC.
• Termination Stage: This is the phase at which the nurse makes the patient know the interview is coming to the end. The nurse could say that there remains a few more queries to ask. The nurse then needs to give a summary of the info and ask the patient to confirm the accuracy of the information.

References

Arnold, E.C. and Boggs, K.U., 2015. Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.

Birks, M., Chapman, Y.B. and Davis, J., 2015. Professional and Therapeutic Communication. Oxford University Press.

Fan, C.W. and Taylor, R., 2016. Quality of a Theory-Based Assessment to Measure Therapeutic Communication Styles During Rehabilitation. American Journal of Occupational Therapy, 70(4_Supplement_1), pp.7011500070p1-7011500070p1.

Fan, C.W. and Taylor, R.R., 2016. Assessing Therapeutic Communication During Rehabilitation: The Clinical Assessment of Modes. American Journal of Occupational Therapy, 70(4), pp.7004280010p1-7004280010p10.

Fortinash, K.M. and Worret, P.A.H., 2014. Psychiatric Mental Health Nursing-E-Book. Elsevier Health Sciences.

Knapp, H., 2014. Therapeutic communication: Developing professional skills. Sage Publications.

Lindquist, R., Snyder, M. and Tracy, M.F. eds., 2013. Complementary & alternative therapies in nursing. Springer Publishing Company.

Mills, J., 2017. Therapeutic Communication In Mental Health Nursing: Aesthetic And Metaphoric Processes In The Engagement With Challenging Patients. Issues in mental health nursing, 38(8), p.684.

Riley, J.B., 2015. Communication in nursing. Elsevier Health Sciences.

Sherko, E., Sotiri, E. and Lika, E., 2013. Therapeutic communication. JAHR, 4(7), pp.457-466.

Stuart, G.W., 2014. Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health Sciences.

Webster, D., 2014. Using standardized patients to teach therapeutic communication in psychiatric nursing. Clinical Simulation in Nursing, 10(2), pp.e81-e86.

Wessel, P., The Genesis Institute Initiative, 2015. Two-way television enabled therapeutic communication systems and methods. U.S. Patent Application 14/837,526.

Yas, I.W. and Mohammed, S.H., 2017. Improving Nurses Knowledge regarding to therapeutic Communication by implementing an Educational Program in Al Rashad Psychiatric Teaching Hospital at Baghdad City. Research Journal of Pharmacy and Technology, 10(7), pp.2088-2090.

Yas, M.I.W. and Mohammed, S.H., 2016. Assessment of Nurses Knowledge about Therapeutic Communication in Psychiatric Teaching Hospitals at Baghdad City. Kufa Journal for Nursing Sciences.