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Therapeutic CommunicationLacey HastingsStenberg CollegeTherapeutic CommunicationWhat is therapeutic communication? “Therapeutic communication is an application of the process of communication to promote the well-being of a patient.”(Potter & Perry, 2010, p.28) Therapeutic communication is used by Nurses in providing care for their patients. What does therapeutic communication consist of? “Therapeutic communication consists of an exchange of information that facilitates the formation of a positive nurse-patient relationship and actively involves the patient in all areas of his or her care.” (Varcarolis & Halter, 2010, p.40). It provides for effective communication between nurse and patient, with emphasis on support, and understanding, and allows for trust and collaboration. Therapeutic communication is a technique developed in nursing to optimize the care of patient’s, it takes time and practice, and can become the most powerful tool in the nursing field, according to Perry & Potter, (2010) “Therapeutic communication is essential to excellent nursing practice.”(p.28). In providing excellent psychiatric nursing care, one must have the skills of therapeutic communication, which would include the ability to develop a therapeutic one to one relationship, effective use and awareness of non-verbal communication as well as appropriate use of empathetic understanding.Developing a therapeutic one-to-one relationship is a skill, a skill that depends on therapeutic communication and a skill that registered psychiatric nurses will be expected to have. The basis of that one-to-one relationship, is support, empowerment and problem-solving. (Barker, 2009). The nurse and the patient will begin to get to know each other, and the nurse will need to establish trust as well as communicate their roles, confidentiality, reliability and consistancy of the intended relationship. The development of the relationship depends on this. With this trust the patient can then communicate any issues they might be facing, and the nurse can offer further explorations while providing support. While the nurse and the patient work through the issues at hand, the nurse is using therapeutic communication by listening, Caring and understanding. With using therapeutic communication skills the nurse is developing a relationship, in this relationship “the nurse helps the patient master anxieties, increase independence, and self-responsibility, and develop constructive coping mechanisms.” (Stuart, 2009, p.21). This nurse-patient relationship provides an opportunity to promote wellness and personal growth. While the relationship will come to an end, the nurse needs to have appropriate communication skills in regards to termination (the ending of the relationship), it should be anticipated and prepared for by both. The nurse should offer a summary of the goals identified in the relationship, discuss the coping strategies learned and how to incorporate them into daily life, review situations and exchange memories. (Halter & Varcarolis 2010). It is important to use therapeutic communication skills in this stage as feelings in patients can arouse and they need to know it is acceptable to feel sadness or loss. By sharing this separation phase in a positive manner it provides caring and can be a learning experience. (Halter and Varcarolis, 2010). From introduction to resolution of this relationship, therapeutic communication is the framework, and as Stuart states “communication is the relationship itself, because without it, a therapeutic nurse-patient relationship is impossible” (2009, p.22). Nonverbal communication makes up our nonverbal behaviors, such as tone and rate of voice, volume of speech, eye contact, physical appearance, facial expressions, body posture, and touch. (Varcarolis & Halter 2010.) The common phrase “It’s not what you say, it’s how you say it” is an example, nonverbal communication can be an identifier of the “real” message. We give off impressions or interpretations with our body language and facial expressions, one can appear closed off and disinterested, or engaged and interested, all coming from nonverbal communication. It is important in nursing when communicating with patients to be aware of and identify the nonverbal cues of the patient. These cues can offer a view at the “internal status” of the patient beyond what is being said, which can then be clarified by the nurse. (Burnard, 2005.) Nonverbal communication is mainly of the unconscious and uncontrolled, therefore can leak feelings. As Part of therapeutic communication is understanding and supporting, one must be aware of all forms of communication, to fully assist the patient in their growth and recovery. However the interpretation of nonverbal communication is not black and white, and depends on the patient, their back ground, ethnicity and personality, as everyone communicates differently. Interpreting correctly can be difficult; therefore the nurse can make notes on the nonverbal behaviors of the patient throughout the relationship paying attention to incongruent behavior and contradictory messages. (Stuart, 2009) This will allow for appropriate interpretation relating to that person specifically. It is also important to be aware of the patients nonverbal behaviors in regards to their care, so we can try to make them as comfortable as possible, for example their personal space, if they are uncomfortable with how close you are sitting, it will most likely show in there nonverbal communication, therefore we can be aware, and sit a little further away to allow the patient to be more comfortable. Therapeutic communication with a patient requires trust, and if we are unaware of those nonverbal cues when the patient is uncomfortable, that trust can be broken. Being aware of the nonverbal communication of the patient is extremely important in nursing, and according to Stuart 2009, “Nurses must be aware not only of patient’s nonverbal cues but also of their own” (p.24.) Just like a nurse can get an impression or interpretation of the patient, the patient can get an interpretation of the nurse. When communicating with patients it is important to be aware of our nonverbal cues and behaviors, as it could determine the outcome of the relationship with the client. If the client gets a sense of interest, warmth and genuiness, this is more likely to establish a therapeutic relationship then a sense of disinterest, closed off, and lack of respect. It is important in therapeutic communication to establish appropriate nonverbal behaviors with clients, according to Stuart 2009 “affilitative nonverbal behaviors include smiles, positive head nods, gestures, eye contact and a forward body lean”p.24. The patient will interpret your communication in a positive manner, therefore enhancing their comfort and trust in you. Touch is another nonverbal message, it is said to be a way of expressing concern, empathy or caring, and can express a desire to connect, and therefore be referred to as “therapeutic touch”. Therapeutic touch can be beneficial when there is a concern, trauma or death, and there isn’t the right words, sometimes silence and a light touch can convey what doesn’t need to be said. “Touch is a universal and basic aspect of all nurse-patient relationships. It is often described as the first and most fundamental means of communication” (Stuart, 2009. P.23). Although it is dependent on the response of the patient, on their personality, culture, and the type of relationship, it may cause them to feel threatened, this is another reason to look for nonverbal cues, they may be uncomfortable with that personal contact, and express that through body language and facial expressions. While being a nurse we will be communicating daily with patients, and nonverbal communication is at the forefront, which means this is another skill RPN’s will need to have under their belt, as according to Shea 1998, “communication is roughly 10% verbal and 90% nonverbal” p.178.Another therapeutic skill important in communication with patients is that of empathetic understanding. Empathy is said to be “ The ability to perceive accurately the feelings of another person and to communicate this understanding to him”(Burnard,2005, p.103). Empathetic understanding is about exploring the clients world, imagining what it is like to be them, with no hidden agendas or plans, just listening and understanding. Offering empathy is offering acceptance, and suspending judgment. (Burnard, 2005). Empathy is important in psychiatric nursing as it creates an interpersonal trusting environment, free of defensiveness (Barker, 2009), this will allow for the patient to talk about and identify their needs, therefore developing solutions and goals themselves. According to Barker, 2009, there are several concepts to empathy in the therapeutic relationship, the first being the helper must be willing to receive the another’s communication (moral), second the helper must understand what Is being communicated and put themselves in that persons place (cognitive), Third the helper communicates understanding to the patient (communicative), The final stage the patient communicates awareness of being understood and validation to the helper (relational). The Final stage being important, as it provides the patient the opportunity to clarify the helper’s perceptions, and determine the accuracy. (Barker, 2009) These components are all important in the communication process of empathy; each component affects the outcome of the next component, all with the intended outcome of the patient expressing feelings and concerns and feeling understood by the helper. The perceptions of the patient on the empathy provided to them is extremely important in this process, it provides an insight for the nurse on how to offer empathy or when to offer empathy, the patient is the one receiving the empathy therefore they can provide feedback, and insight on how it is delivered. In the process of empathetic understanding , the use of “empathy-building statements” can be beneficial to the therapeutic relationship.(Burnard, 2005) These empathy-building statements are focused on what is implied, or “reading between the lines”, when skillfully used , they can indicate to the client they are understood and provide for further disclosure. This is important as it can lead to further self-awareness of the client which can then lead to further development. It is noted however to monitor the use of empathy-building statements, as they can be off track and rejected by the patient. When discussing empathy it is important to acknowledge its difference from sympathy, empathy is understanding the feelings of the patient, and sympathy is feeling the feelings of the patient. It is important not to misuse empathy as sympathy, as sympathy resembles pity, and objectivity is lost by the helper. Expressing sympathy is like expressing agreement, which may cease further exploration in a therapeutic relationship. (Varcarolis & Holter 2010). It is also noted that “When nurses try to be sympathetic, they are apt to project their own feelings onto the patient’s, which thus limits the patient’s range of responses” (Varcarolis & Holter, 2010, p.170). Whereas Empathy conveys respect, acceptance and validation of the patients feelings without taken away from them. Therefore it is the responsibility of the nurses to have an understanding of the difference and the importance of Empathy over sympathy. So why is the communication of empathetic understanding important to psychiatric nursing? According to Barker, 2009 “Numerous studies have established a correlation between high empathy and improved health” (p.328). Also Wheeler, 2008 stated “empathy is one of the most important factors in building a trusting and therapeutic relationship.”Developing skills in therapeutic communication is a process, a process that just like anything else takes time, practice, and experience. It benefits the patient as well as the nurse, and provides for overall improved health care. It is a skill nurses should strive for as “effective therapeutic communication with patients across the life span is essential for successful nursing practice” (Perry & Potter, 2010, p.28). With skills in developing the therapeutic one-to-one relationship, trust and support can be established, allowing for growth of the patient. An awareness of non-verbal communication provides further insight into the patient’s feelings and emotions, and enables the nurse to provide therapeutic communication non-verbally. With the skill of conveying empathetic understanding, it provides the patient with the feeling of being accepted, understood and not judged. Therapeutic communication skills, promote wellness, and personal growth, empower patients to be decision makers, and is patient centered and goal directed. (Perry & Potter, 2010). With all these skills in therapeutic communication, this will only establish and improve therapeutic relationships, which is of value as “A therapeutic nurse-patient relationship is the foundation of nursing care” (Perry & Potter, 2010, p.30)ReferencesBarker, P. (Eds.). (2009).Developing therapeutic one-to-one relationships. Psychiatric and mental health nursing: The craft of caring. (2nd ed.).(pp.313-318). London, UK: Hodder ArnoldBurnard, P. (2005). Client- centered skills. Counselling skills for health professionals. (4th ed.). (pp.149-161). Cheltenham, UK: Nelson Thornes Ltd.Halter, J.M., Varcarolis, E.M. (2010). Therapeutic relationships. Foundations of psychiatric mental health nursing.(6th ed.). (pp.156-173). St. Louis, Missouri: Saunders –ElsevierPerry, A.G., Potter, P.A. (2010). Communication. Clinical nursing skills & techniques. (7th ed.). (pp.28-43). St. Louis, Missouri: Mosby-ElsevierStuart, G.W. (2009). Therapeutic nurse-patient relationship. Principles and practice of psychiatric nursing. (9th ed.). (pp.13-42). St. Louis, Missouri: Mosby-Elsevier ................
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