Saint Mary’s University

SCHOOL OF HEALTH and NATURAL SCIENCES

Nursing Department
Bayombong, Nueva Vizcaya
Course No. NCM117 Lecture
Subject: Care of Client with Maladaptive Patterns of Behavior, Acute and Chronic
Year Level: BSN 3
Contact Hours/Credit Units: 4 hours/week (4units)

CHAPTER 3

THERAPEUTIC COMMUNICATION

l. Introduction

Therapeutic communication is the foundation of the nurse-patient relationship. It has a specific purpose
within the healthcare context. It is intended to develop an effective interpersonal nurse-patient relationship
that supports the patient well-being, ensures holistic, client-centered, and quality care.

ll. Learning Objectives

1. Explain the process of communication.

2. Interpret the essential components of therapeutic communication.
3. Discuss the essential ingredients to facilitate communication.
4. Describe the goals to accomplish in using therapeutic communication.
5. Differentiate and describe therapeutic from non-therapeutic communication.
6. Identify verbal and nonverbal communication skills.
7. Discuss the characteristics of a successful communication.
8. Differentiate the four proxemics of communication.
9. Describe the different speech patterns.
10. Explain the importance of avoiding blocks to communication.

lll. Core Content of the Chapter

COMMUNICATION:
Communication involves the giving and receiving of information.
Three elements of communication:
1. the sender
2. the message
3. the receive.
The sender creates the message and sends the message to a receiver or a listener who then decodes it.
The receiver may now return a message to the initiator of the message.

THERAPEUTIC COMMUNICATION:
An interpersonal interaction between the nurse and the patient which focuses on the specific needs of the
patient.

GOALS TO ACCOMPLISH IN USING A THERAPEUTIC COMMUNICATION:

1. Establish a therapeutic N-P relationship.
2. Identify patients concern. (pt. centered)
3. Assess patients perception of the problem.
4. Recognize the patients underlying needs.
5. Guide the patient toward identifying pathways to a satisfying and socially acceptable solution.
ESSENTIAL COMPONENTS OF THERAPEUTIC COMMUNICATION:
1. Confidentiality
2. Self-disclosure
3. Privacy and respecting boundaries

How to promote privacy:

a. talk slowly
b. pulling curtains
c. staying in a quiet room with wide space or outside when the weather is nice with suitable sites
for interaction.

Proxemics – it is the study of the distance zone between two people communicating.
4 DISTANCE ZONE: (Invisible boundary)
a. intimate (0-18 in.)
b. personal (18-36 in.)
c. social (4-12 ft.)
d. public (12-25ft)

4. Touch – it is a process of holding a person, to comfort and support them when it is permitted.

TYPES OF TOUCH:
a. functional - professional
b. social - polite
c. friendship - warmth
d. love - intimacy
e. sexual - arousal

5. Active listening and active observation

Note: avoid internal mind activity.

ESSENTIAL INGREDIENTS TO FACILITATE COMMUNICATION:

1. Responding with empathy.
2. Responding with respect.
3. Responding with genuineness.
4. Responding with immediacy.
5. Responding with warmth.

2 TYPES OF COMMUNICATION:
1. Verbal
2. Nonverbal

LEVELS OF COMMUNICATION:
1. Intrapersonal
2. Interpersonal
3. Public

CHARACTERISTIC OF SUCCESSFUL COMMUNICATION:

1. Feedback
2. Appropriateness
3. Efficiency
4. Flexibility
 Over control - It is the frequent checking and counterchecking of what the patient said during the
interview.
Under control - It is when the patient does and say what he wants to. They disregard the above
characteristic of successful communication.

BLOCKS TO COMMUNICATION:
1. Changing the subject of conversation.
2. Stating one’s idea and personal opinion.
3. Giving false or inappropriate reassurances.
4. Jumping to conclusion or offering solution to patients problem.
5. Making inappropriate use of medical or nursing knowledge.

VERBAL COMMUNICATION SKILLS:

In a verbal communication, the nurse should use concrete messages and not abstract messages.
This will help us get accurate information from the patient.

CUES:
This is a non verbal and verbal message that gives us hint or suggestion from the patient.
Overt cues: It is a clear statement of what the patient intended to do.
Covert cues: Vague or hidden messages which the nurse needs to interpret.

NONVERBAL COMMUNICATION:
1. Facial expression
3 CLASSIFICATIONS:
a. expressive
b. impassive
c. confusing

2. Body language
2 CLASSIFICATIONS:
a. close body position
b. accepting body position

3. Eye contact
a. visual learners are those who learn best by seeing things.
b. auditory learners are those who learn best by hearing.
c. kinesthetic learners are those who best by doing things.

4. Vocal cues or paralanguage: refers to how something is said rather than what is said.
This includes the:
volume (loudness)
tone (quality)
pitch (high/low)
intensity (strength/importance)
emphasis (accent)
speed and pause

SPEECH PATTERNS:
1. Circumstantiality - It is a speech with a long-winded description.
2. Pressured speech - It is a long talking wherein the patient doesn’t want to be interrupted. Slowly and
ceremonious delivery.

UNDERSTANDING THE LEVELS OF MEANING:

As a nurse one of your responsibilities is to discover or understand what the patient really wanted
to impart. This is done by:
1. Surface listening – It is hearing the actual message.
 2. Depth listening – It is interpreting the unspoken action and words of the patient.

What do you need to do in response to clients behavior:

Crying:
Stay with the client: reinforce that it is alright to cry.

Asks to keep a secret:

A nurse CANNOT make such a promise.

Leaving before the session is over:

Inform the client you will wait for him until his time is over.
Never engage in conversation with any client or nurse.
When time is up, approach the client and inform him about the next meeting.

Interruption during your time with a selected client

keep your contract with the selected client. Keeping it means that the session is important.

Suicidal/Elope
Consider the seriousness of the situation,
inform the client about the harm that can happen and the need to be reported.

Client who says he does not want to talk:

spend time without talking.
spend short, frequent periods of time with the client.

Client prolong the interview

setting limits
reinforce the original contract

Interruption during your time with a selected client

keep your contract with the selected client. Keeping it means that the session is important.

Suicidal/Elope
Consider the seriousness of the situation,
inform the client about the harm that can happen and the need to be reported.

Interruption during your time with a selected client

keep your contract with the selected client. Keeping it means that the session is important.

NOTE: AVOID Double Bind Communication

Inconsistent AND incongruent
 THERAPEUTIC COMMUNICATION TECHNIQUE
TECHNIQUE EXAMPLE
1. USING SILENCE - assessment  Encouraging a client to talk by waiting for the answer.
2. ACCEPTING - assessment  Yes, I follow what you say.
3. GIVING RECOGNITION  Good morning Mr. Tee, I notice that you wear the new shirt.
4. OFFERING SELF - assessment  I will stay with you for a while.
5. OFFERING GENERAL LEADS - assessment  Tell me more about it. Go on. And then?
6. GIVING BROAD OPENING - assessment  What do you want to talk about?
7. PLACING THE EVENT IN TIME/SEQUENCING –  When did this happen?
nsg. diagnosis
8. MAKING OBSERVATION – nsg. diagnosis  You appear nervous when the doctor entered.
9. ENCOURAGING DESCRIPTION OF PERCEPTION  What are these voices telling you?
– nsg. diagnosis
10. ENCOURAGING COMPARISON – nsg. diagnosis  Has this ever happened before?
11. RESTATING - assessment  Patient: I can’t eat, it started yesterday. Nurse: You have a poor appetite?
12. REFLECTING - implementation  Patient: I think I should go now. Nurse: Do you think you should go now?
13. FOCUSING – nsg. diagnosis  Let us talk more about your family, you were saying….
14. EXPLORING  Tell me more about that. Would you describe it fully?
15. GIVING INFORMATION - planning  My purpose of being here is. Or This medication is for
16. SEEKING CLARIFICATON - assessment  I don’t think I understand what you were saying.
17. PRESENTING REALITY – nsg. diagnosis  Your mother is not here, I am your nurse Pedro.
18. VOICING DOUBT – nsg. diagnosis  That’s hard to believe.
19. SEEKING CONSENSUAL VALIDATION  Tell me if my understanding agrees with yours.
20. VERBALIZING THE IMPLIED - assessment  Patient: I cannot talk to you or anyone else. It is a waste of time.
Nurse: Do you feel no one understands?
21. ENCOURAGING EVALUATION -evaluation  Can you tell me the reasons you do not want to be discharge?
22. SUGGESTING COLLABORATION - planning  Perhaps you can discuss this with your parents so that they will know how you
feel about it.
23. ACTIVE LISTENING - assessment  Maintaining eye contact which encourage further communication.
24. ASKING QUESTION - assessment  How did you feel when you were visited by your family?
25. ENCOURAGING DECISIONS -planning  If that is your choices, what would you prefer to do?
26. LIMIT SETTING - implementation  Please stop now. If you don’t I will ask you to leave and go to your room.
27. FEEDBACK - implementation  I see you consumed your meal.
28. ROLE PLAYING - implementation  I will play as your sister and tell me what you would say to her when you will
meet her tomorrow.
29. REHEARSING - implementation  Supposing you will go in the same place and see those people, how would
you respond?
30. SUMMARIZING – nsg. diagnosis  During the past hour you and I have discuss….

NONTHERAPEUTIC TECHNIQUE

TECHNIQUE EXAMPLE
1. REASSURING  Don’t worry everything will be alright.
2. GIVING APPROVAL  That’s good…
3. REJECTION  Let us not discuss that.
4. ADVISING  I think you should or If I were you…
5. PROBING  Come on, tell me more about your husband.
6. CHALLENGING  If you are not crazy, how come you are in the hospital.
7. TESTING  What day is today, do you know?
8. DEFENDING  For sure, no one here would lie to you.
9. REQUESTING AN EXPLANATION  Why did you do that?
10. BELITTLING FEELINGS EXPRESSED  Patient: I wish I was dead. Nurse: I know what you mean, I feel that
way sometimes.
11. MAKING STEREOTYPICAL COMMENT  It is for your own good or I’m fine, how are you.
12. OVERLOADING  What’s your name? I see you are busy. How are you?
13. VALUE JUDGMENTS  You should not do that. It’s wrong.
14. INCONGRUENCE  I like to spend time with you, but the nurse walks away.
15. UNDERLOADING  The patient asks but the nurse would just keep quiet.
16. FALSE ASSURANCE  Just be calm and everything will be alright.
17. FOCUSING ON SELF  I like the color of this shirt, it is fits to my complexion.
18. CHANGING THE SUBJECT  Patient: I am worried with the result of my blood exam. Nurse: How are
you related to that lady.
19. LOOKING TOO BUSY/IGNORING THE PATIENT  I have a lot of things to do at present.
20. ARGUING  I know I am right and you are wrong.
21. SHOWING A CLOSE POSTURE  Crossing of legs and arms on chest.
22. MAKING FALSE PROMISES  I will visit you tomorrow, but nurse failed to.
23. DISAPPROVING  That’s not the way how it is done.
24. LAUGHING NERVOUSLY or inappropriately

IV. Activity:
Long Quiz

V. Bibliography:
Videbeck, S. (2020). Psychiatric-Mental Health Nursing. Wolters
Keltner, N., Bostrom C., & McGuiness T. (2012). Psychiatric Nursing. Elsevier Inc.

Prepared by:

Mrs. Rosalie C. Carreon, RN, MSN

Nursing Department