Relationship Development and Therapeutic Communication

Mr. Ibrahim Rawhi Ayasreh RN, MSN, CNS

Relationship Development and Therapeutic Communication

The nurseclient relationship is the foundation on which psychiatric nursing is established.

It is a relationship in which both participants must recognize each other as unique and important human beings.

It is also a relationship in which mutual learning occurs.

Relationship Development and Therapeutic Communication

Therapeutic Relationship: is an interaction between two people (usually a caregiver and a care receiver) in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention. Interpersonal communication techniques (both verbal and nonverbal) are the tools of psychosocial intervention.

Conditions essentials to Development of a Therapeutic Relationship Rapport

Rapport implies special feelings on the part of both the client and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude.

Conditions essentials to Development of a Therapeutic Relationship Trust

To trust another, one must feel confidence in that persons presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested. Trust is the initial developmental task described by Erikson. If the task has not been achieved, this component of relationship development becomes more difficult. That is not to say that trust cannot be established, but only that additional time and patience may be required on the part of the nurse.

Examples of nursing interventions that would promote trust in an individual who is thinking concretely

Providing a blanket when the client is cold Providing food when the client is hungry Keeping promises Being honest (e.g., saying I dont know the answer to your question, but Ill try to find out) and then following through. Simply and clearly providing reasons for certain policies, procedures, and rules. Providing a written, structured schedule of activities Attending activities with the client if he or she is reluctant to go alone Being consistent in adhering to unit guidelines Taking the clients preferences, requests, and opinions into consideration when possible in decisions concerning his or her care Ensuring confidentiality; providing reassurance that what is discussed will not be repeated outside the boundaries of the health care team

Conditions essentials to Development of a Therapeutic Relationship Respect

To show respect is to believe in the dignity and worth of an individual regardless of his or her unacceptable behavior. Unconditional positive regard : The attitude is nonjudgmental, and the respect is unconditional in that it does not depend on the behavior of the client to meet certain standards.

Conditions essentials to Development of a Therapeutic Relationship

The nurse can convey an attitude of respect by: Calling the client by name (and title, if the patient prefers) Spending time with the client Allowing for sufficient time to answer the clients questions and concerns Promoting an atmosphere of privacy during therapeutic interactions with the client, or when the client may be undergoing physical examination or therapy Always being open and honest with the client, even when the truth may be difficult to discuss Taking the clients ideas, preferences, and opinions into consideration when planning care

Conditions essentials to Development of a Therapeutic Relationship

Empathy Empathy is a process wherein an individual is able to see beyond outward behavior and sense accurately anothers inner experience at a given point in time . With empathy, the nurse can accurately perceive and understand the meaning and relevance of the clients thoughts and feelings.

Conditions essentials to Development of a Therapeutic Relationship

It is not uncommon for the concept of empathy to be confused with that of sympathy. The major difference is that with empathy the nurse accurately perceives or understands what the client is feeling and encourages the client to explore these feelings. With sympathy the nurse actually shares what the client is feeling, and experiences a need to alleviate distress.

Interpersonal Communication

Interpersonal communication is a transaction between the sender and the receiver. In the transactional model of communication, both participants are simultaneously perceiving each other, listening to each other, and mutually involved in creating meaning in a relationship.

Pre-existing Conditions Affecting Interpersonal Communication

Values, Attitudes, and Beliefs Values, attitudes, and beliefs are learned ways of thinking. Children generally adopt the value systems and internalize the attitudes and beliefs of their parents. Children may retain this way of thinking into adulthood or develop a different set of attitudes and values as they mature.

Pre-existing Conditions Affecting Interpersonal Communication

Culture or Religion Communication has its roots in culture. Cultural mores, norms, ideas, and customs provide the basis for our way of thinking. Cultural values are learned and differ from society to society. For example, in some European countries (e.g., Italy, Spain, and France), men may greet each other with hugs and kisses. These behaviors are appropriate in those cultures, but they would communicate a different message in the United States or England.

Pre-existing Conditions Affecting Interpersonal Communication Social Status

Studies of nonverbal indicators of social status or power have suggested that high-status persons are associated with gestures that communicate their higher-power position. For example, they use less eye contact, have a more relaxed posture, use a louder voice pitch, place hands on hips more frequently, are power dressers, stand taller, and maintain more distance when communicating with individuals considered to be of lower social status.

Pre-existing Conditions Affecting Interpersonal Communication

Gender

Pre-existing Conditions Affecting Interpersonal Communication Age or Developmental Level

In their struggle to separate from parental confines and establish their own identity, adolescents generate a unique pattern of communication that changes from generation to generation. Words such as groovy, cool, clueless, and awesome have had special meaning for different generations of adolescents. Communication by text messaging includes such acronyms as BRB (be right back) and MOS (mom over shoulder). Developmental influences on communication may relate to physiological alterations.

Pre-existing Conditions Affecting Interpersonal Communication

Environment in Which the Transaction Takes Place

Some individuals who feel uncomfortable and refuse to speak during a group therapy session may be open and willing to discuss problems on a one-to-one basis with the nurse. Territoriality, density, and distance are aspects of environment that communicate messages. Territoriality is the innate tendency to own space. Density refers to the number of people within a given environmental space. Distance is the means by which various cultures use space to communicate

Distances

Intimate distance is the closest distance that individuals will allow between themselves and others. In the United States, this distance, which is restricted to interactions of an intimate nature, is 0 to 18 inches. Personal distance is approximately 18 to 40 inches and is reserved for interactions that are personal in nature, such as close conversations with friends or colleagues. Social distance is about 4 to 12 feet away from the body. Interactions at this distance include conversations with strangers or acquaintances, such as at a cocktail party or in a public building. A public distance is one that exceeds 12 feet. Examples include speaking in public or yelling to someone some distance away.

Non- Verbal Communication

Physical appearance and dress. Body movement and posture, Touch. Facial expressions. eye behavior. Vocal cues or paralanguage.

Physical appearance and dress

Dress can be formal or casual, stylish or sloppy. Hair can be long or short, and even the presence or absence of hair conveys a message about the person. Other body adornments that are also considered potential communicative stimuli include tattoos, masks, cosmetics, badges, jewelry, and eyeglasses.

Body Movement and Posture

The way in which an individual positions his or her body communicates messages regarding self-esteem, gender identity, status, and interpersonal warmth or coldness. The individual whose posture is slumped, with head and eyes pointed downward, conveys a message of low selfesteem. To stand straight and tall with head high and hands on hips indicates a superior status over the person being addressed.

Touch

Touch is a powerful communication tool. It can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction. It is a very basic and primitive form of communication, and the appropriateness of its use is culturally determined.

Types of Touch

FunctionalProfessional : This type of touch is impersonal and businesslike. It is used to accomplish a task. - Example : A tailor measuring a customer for a suit or a physician examining a client. SocialPolite. This type of touch is still rather impersonal, but it conveys an affirmation or acceptance of the other person. - Example: A handshake. FriendshipWarmth. Touch at this level indicates a strong liking for the other persona feeling that he or she is a friend. - Example : Laying ones hand on the shoulder of another.

Types of Touch

LoveIntimacy. This type of touch conveys an emotional attachment or attraction for another person. - Example : Engaging in a strong, mutual embrace. Sexual Arousal. Touch at this level is an expression of physical attraction only. - Example: Touching another in the genital region.

Facial Expressions

Facial Expressions

Eye Behavior

Paralanguage, or vocal cues

Paralanguage, or vocal cues, is the gestural component of the spoken word. It consists of pitch, tone, and loudness of spoken messages, the rate of speaking, expressively placed pauses, and emphasis assigned to certain words. These vocal cues greatly influence the way individuals interpret verbal messages. A normally soft spoken individual whose pitch and rate of speaking increases may be perceived as being anxious or tense.

Therapeutic Communication Techniques

Therapeutic Communication Techniques

Non- Therapeutic Communication Techniques

Non- Therapeutic Communication Techniques