Communication communication process is focused on patients needs and problems.

CATEGORIES OF COMMUNICATION

Communication is an interaction between two or more people that involves the exchange of
information between a sender and a receiver.

o Written Communication
Written material is a primary means of acquiring and sharing information. Must master
vocabulary, grammar, and organization of ideas.
o Telephone Communication
Facilitates discharge planning and increase in adherence to follow-up appointments
and treatments.
o Electronic Communication
o Health Information Privacy
o Speech and Behavior

DYNAMICS OF THERAPEUTIC COMMUNICATION

Interpretation of Communication
o Interpretation is filtered through an individuals knowledge, experience, and biases.
o Having a broad knowledge of the effects of cultures is important if the nurse is to interpret
accurately and respond appropriately to patient communications.
Themes in Patient Communications
o Pt communications often convey indirect messages or underlying themes about content
mood, or interaction issues.
o Themes are reflected in pts thoughts, which engender feelings and then produce
behaviors.
o Content themes underlying messages, beyond a pts words. Relate to beliefs and
values, self-concept and self-esteem, a sense of helplessness and hopelessness,
suspiciousness, risk for suicide, and disturbance in thinking or processing of information
and beliefs.
o Mood themes relate to affect and the feelings conveyed while pt discuss their issues
and concern. Feelings often reflect shame, guilt, anger, sadness, and fear. Affect can be
flat, blunted, full range, euphoric, labile, congruent, or incongruent.
o Interaction themes examining the ways in which pts relate to family, friends, or other
pts.
Environmental Considerations
o Factors that can affect quality of communication noise level, privacy, type of furniture,
space, and temperature.
Physical Considerations
Kinesics Considerations

THERAPEUTIC COMMUNICATION

Therapeutic Versus Social Communication

o Therapeutic communication focuses on helping patients
o Social communication involves equal disclosure of personal information and intimacy.
Therapeutic Use of Self
o The nurses communication is a major vehicle that helps patients achieve productive
thinking and good emotional and behavioral outcomes.
 Technique
o Therapeutic techniques are a means of helping patients toward productive goals but
are not goals in themselves.

INTERFERENCE WITH THERAPEUTIC COMMUNICATION

Nurses Fears and Feelings

Ineffective Responses

STAGES OF DEVELOPMENT OF A THERAPEUTIC RELATIONSHIP

STAGE I: Orientation Stage

Building Trust
Beginning Assessment
Managing Emotions
Providing Support
Providing Structure

STAGE II: Working Stage

In-Depth Data Collection

Reality Testing and Cognitive Restructuring
Writing and Journaling
Promoting Change

STAGE III: Termination Change

Evaluation and Summary of Progress

Synthesizing the Outcomes
Referrals

STUDY NOTES

1. Therapeutic techniques are skills to help people, but are not goals in themselves.
2. Therapeutic communication occurs with a plan and a purpose, whereas social communication
involves equal levels of intimacy, sharing, and the opportunity for spontaneity.
3. Therapeutic communication differs from social communication because the focus is on the
patient rather than on a give-and-take experience.
4. Goals of psychiatric nursing are to understand patients, ensure that patients understand the
nurse, and teach more effective communication skills.
5. Listening is a therapeutic communication technique that requires careful concentration to
guide the conversation toward a goal.
6. Nurses are responsible for therapeutic communication and must recognize communication
interferences that they might be causing.
7. Some common causes of interference with therapeutic communication are fear, lack of
knowledge, insecurity, and inappropriate responses.
8. To be therapeutic, the nurse uses verbal and nonverbal communication to convey a willingness
to listen, genuine respect, desire to help, and understanding of the person with unique problems
and needs
9. The nurse-patient relationship is a series of goal-directed interactions that focus on the patients
thoughts, feelings, behaviors, and potential solutions to problems.
10. The nurse-patient relationship is a tool that the nurse can use to assess each patients problems,
select and carry out specific interventions, and evaluate the effectiveness of care.
 11. Each stage of the nurse-patient relationship (orientation, working, termination) involves specific
tasks that are used according to the needs and problems of each patient at a given time.
12. Issues and patient behaviors that interfere with the progress of nurse-patient relationship must
be addressed by the nurse.

DEFENSE MECHANISMS

DENIAL refusal to admit an unacceptable idea or behavior

REPRESSION involuntary forgetting of painful ideas, events, and conflicts

SUPPRESSION exclusion from awareness anxiety-producing feelings, ideas, and situations

RATIONALIZATION attempts to make or prove that ones feelings or behaviors are justifiable

INTELLECTUALIZATION using only logical explanations without feelings or an effective

component

DISSOCIATION separation of painful feelings and emotions from an unacceptable idea,

situation, or object

IDENTIFICATION attempt to model oneself after a respected person

INTROJECTION incorporating values and attitudes of others as if they were your own

COMPENSATION covering up for a weakness by overemphasizing or making up a desirable

trait

SUBLIMATION channeling instinctual drives into acceptable activities

REACTION FORMATION a behavior is the exact opposite of an unconscious feeling

UNDOING doing something to counteract or make-up for a transgression or wrongdoing

DISPLACEMENT discharging pent-up feelings to a less threatening object

PROJECTION blaming someone else for ones difficulties or placing ones unethical desires on
someone else

CONVERSION expression of intrapsychic conflict symbolically through physical emotions

REGRESSION return to an earlier and more comfortable developmental level

FIXATION immobilization of a portion of the personality resulting from unsuccessful completion

of task in a developmental stage

RESISTANCE overt/covert antagonism toward remembering or processing anxiety-producing

information

SUBSTITUTION replacing the desired gratification with one that is more readily available