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LECTURE: Therapeutic Communication In Nursing By Nrs Abubakar Mustapha Koya RN
Date Posted: 04/Nov/2018
INTRODUCTION
Communication means transferring thoughts, information, emotions and  ideas through gesture, voice, symbols, signs and expressions from one person to another. Three things are most important and essential in any communication process they are Sender, Receiver and the Channel (medium).
 
This sort of communication uses methods such as talking and listening or writing and reading. However, signs, painting, dancing and storytelling are also methods of communication. 
 
Effective nurse-patient communication i.e Therapeutic Communication is the cornerstone of nursing care and treatment, irrespective of any healthcare setting. The term Therapeutic Communication is mainly  used in the field of nursing however it is not restricted to nursing only rather all healthcare professionals, family and friends of patient play a vital role in implementing the strategies of communication in a therapeutic manner. The therapeutic nurse-patient relationship gives confidence to patient that plays an active role in his/her care. It has been observed the ideal therapeutic communication between patient and nurse acts as a catalyst in gratification of patient’s physical, emotional and spiritual needs. Effective verbal and non-verbal communication forms the basis of nurse-patient interaction and fosters therapeutic communication that enables patient to achieve wellness in a better manner.
 
DEFINITIONS
Therapeutic Communication is defined in the following ways:
▫Is the interaction between a nurse and a patient that help advance the physical and emotional health of the patient.
▫Is define as the face to face process of interacting that focuses on the advancing the physical and emotional well-being of a patient.
▫Is a collection of techniques that priotize the physical, mental and emotional well-being of a patients.
▫ Therapeutic
communication is a combination of verbal and nonverbal communication techniques that helps improve a patient's physical and mental wellbeing.
 
Nurses provide patients with support and information while maintaining a level of professional distance and objectivity.
 
TYPOLOGY
There are basically two (2) types of communications:
a. Verbal Communication_
b. Non-Verbal Communication_
 
Verbal Communication
This communication happens through verbally, vocally or through written words which express or convey the message to other is called verbal communication. Example: Baby crying (vocal) is verbal communication which express the hungry or pain through vocally.
 
Verbal communication has two types;
▫Oral Communication_
▫Written Communication_
 
a. Oral Communication: Is a communication which happens through word of mouth, spoken words, conversations and also any messages or information are shared or exchanged between one another through speech or word of mouth is called oral communication. Example: Public speech, News reading, Television, Radio, telephone and mobile conversations.
 
b. Written Communication: Is a communication happens through any word written or often written sign which refers the languages uses in any medium is called written communication.
 
Non-Verbal Communication:Any communication without word of mouth, spoken words, conversation and written languages are called Non-Verbal Communication. It happens through signs, symbols, colours, gestures, body language or any facial expressions are known as non verbal communication.
 
COMPONENTS OF THERAPEUTIC COMMUNICATION IN NURSING
1. Active Listening_
2. Touch_
3. Space_
 
```Active Listening ```
Is the critical component of therapeutic communication. Active listening involves both nonverbal and verbal communication. When actively listening, a nurse needs to hear and understand what the client is saying. That is, to some extent, the easy part. What's even more important is that the nurse properly interprets the meaning behind what the patient is verbalizing. In other words, what is the patient really saying?
 
Active listening involves verbal communication, such as when a nurse paraphrases what the client has said. It also includes nonverbal types of communication, such as good eye contact that is neither absent nor prolonged, as well as silence. An example of silence in active listening would be giving a patient some time to think through their thoughts if you believe they need it.
 
```Space```
Similarly, another important nonverbal communication technique is that of personal space. Different cultures and individual people will respond in various ways to the space between themselves and a nurse. For some, it's important the nurse is physically close to them. For others, the old saying 'too close for comfort' rings true.
 
```Touch```
Another kind of nonverbal therapeutic communication technique is touch. This can give the patient the sense that you care for them. However, you must be careful with this. It's important that you are culturally aware as you engage in therapeutic communication with your patient. For instance, in some cultures, touch between strangers of opposite genders is strictly frowned upon.
 
THERAPEUTIC COMMUNICATION TECHNIQUES IN NURSING
There are a variety of therapeutic communication techniques nurses can incorporate into practice.
 
Using Silence
At times, it’s useful to not speak at all. Deliberate silence can give both nurses and patients an opportunity to think through and process what comes next in the conversation. It may give patients the time and space they need to broach a new topic. Nurses should always let patients break the silence.
 
Accepting
Sometimes it’s necessary to acknowledge what patients say and affirm that they’ve been heard. Acceptance isn’t necessarily the same thing as agreement; it can be enough to simply make eye contact and say “Yes, I understand.” Patients who feel their nurses are listening to them and taking them seriously are more likely to be receptive to care.
 
Giving Recognition
Recognition acknowledges a patient’s behavior and highlights it without giving an overt compliment. A compliment can sometimes be taken as condescending, especially when it concerns a routine task like making the bed. However, saying something like “I noticed you took all of your medications” draws attention to the action and encourages it without requiring a compliment.
 
Offering Self
Hospital stays can be lonely, stressful times; when nurses offer their time, it shows they value patients and that someone is willing to give them time and attention. Offering to stay for lunch, watch a TV show, or simply sit with patients for a while can help boost their mood.
 
Giving Broad Openings
Therapeutic communication is often most effective when patients direct the flow of conversation and decide what to talk about. To that end, giving patients a broad opening such as “What’s on your mind today?” or “What would you like to talk about?” can be a good way to allow patients an opportunity to discuss what’s on their mind.
 
Active Listening
By using nonverbal and verbal cues such as nodding and saying “I see,” nurses can encourage patients to continue talking. Active listening involves showing interest in what patients have to say, acknowledging that you’re listening and understanding, and engaging with them throughout the conversation. Nurses can offer general leads such as “What happened next?” to guide the conversation or propel it forward.
 
Seeking Clarification
Similar to active listening, asking patients for clarification when they say something confusing or ambiguous is important. Saying something like “I’m not sure I understand. Can you explain it to me?” helps nurses ensure they understand what’s actually being said and can help patients process their ideas more thoroughly.
 
Placing the Event in Time or Sequence
Asking questions about when certain events occurred in relation to other events can help patients (and nurses) get a clearer sense of the whole picture. It forces patients to think about the sequence of events and may prompt them to remember something they otherwise wouldn’t.
 
Making Observations
Observations about the appearance, demeanor, or behavior of patients can help draw attention to areas that might pose a problem for them. Observing that they look tired may prompt patients to explain why they haven’t been getting much sleep lately; making an observation that they haven’t been eating much may lead to the discovery of a new symptom.
 
Encouraging Descriptions of Perception For patients experiencing sensory issues or hallucinations, it can be helpful to ask about them in an encouraging, non-judgmental way. Phrases like “What do you hear now?” or “What does that look like to you?” give patients a prompt to explain what they’re perceiving without casting their perceptions in a negative light.
 
Encouraging Comparisons Often, patients can draw upon experience to deal with current problems. By encouraging them to make comparisons, nurses can help patients discover solutions to their problems.
 
Summarizing
It’s frequently useful for nurses to summarize what patients have said after the fact. This demonstrates to patients that the nurse was listening and allows the nurse to document conversations. Ending a summary with a phrase like “Does that sound correct?” gives patients explicit permission to make corrections if they’re necessary.
 
Reflecting
Patients often ask nurses for advice about what they should do about particular problems or in specific situations. Nurses can ask patients what they think they should do, which encourages patients to be accountable for their own actions and helps them come up with solutions themselves.
 
Focusing
Sometimes during a conversation, patients mention something particularly important. When this happens, nurses can focus on their statement, prompting patients to discuss it further. Patients don’t always have an objective perspective on what is relevant to their case; as impartial observers, nurses can more easily pick out the topics to focus.
 
Focusing
Sometimes during a conversation, patients mention something particularly important. When this happens, nurses can focus on their statement, prompting patients to discuss it further. Patients don’t always have an objective perspective on what is relevant to their case; as impartial observers, nurses can more easily pick out the topics to focus on.
 
Confronting
Nurses should only apply this technique after they have established trust. It can be vital to the care of patients to disagree with them, present them with reality, or challenge their assumptions. Confrontation, when used correctly, can help patients break destructive routines or understand the state of their situation.
 
Voicing Doubt
Voicing doubt can be a gentler way to call attention to the incorrect or delusional ideas and perceptions of patients. By expressing doubt, nurses can force patients to examine their assumptions.
 
Offering Hope and Humor Because hospitals can be stressful places for patients, sharing hope that they can persevere through their current situation and lightening the mood with humor can help nurses establish rapport quickly. This technique can keep patients in a more positive state of mind.
 
HOW THERAPEUTIC COMMUNICATION HELP PATIENTS
-Assess verbal and nonverbal client communication needs.
- Respect the client's personal values and beliefs.
- Allow time to communicate with the client.
- Use therapeutic communication techniques to provide client support.
- Encourage the client to verbalize feelings (e.g., fear, discomfort).
 
SBAR _is an acronym for_ Situation, Background, Assessment, Recommendation: a technique that can be used to facilitate prompt and appropriate communication. This communication model has gained popularity in healthcare settings, especially amongst professions such as physicians and nursing . It is a way for health care professionals to communicate effectively with one another, and also allows for important information to be transferred accurately. The format of SBAR allows for short, organized and predictable flow of information between professionals. [1]
 
Pre-SBAR
A few things are necessary for a health care professional to know before beginning an SBAR conversation. A thorough assessment of the patient should be done. The patient’s chart should be on hand with a list of current medications, allergies, IV fluids, and labs. Vital signs should be completed before making the call, and the patients code status should be known and reported.
 
Situation
This part of SBAR determines what is going on and why health care professionals are needed. Health care professionals become familiar with the environment and the patient. Identify the problem and concern and provide a brief description of it. Be able to describe what is going on with the patient and why they are experiencing what is going on. During this stage of the communication the main goal is to communicate what is happening. It is recommended that this element be brief and last no more than 10 seconds.
 
It is recommended that health care professionals identify the person with whom they are speaking, to introduce oneself (including title or role) and where one is calling from. Providing information about the patient such as name, age, sex, and reason for admission is also important. Lastly, the health care professional is to communicate the patient's status (such as chest pain or nausea).
 
Background
The goal of background is to be able to identify and provide the diagnosis or reason for the patient’s admission, their medical status, and history. The background is also the place to determine the reason or context of the patient's visit. During this stage the patient's chart is ready and as much important medical-based information is provided to set up the assessment of data.
 
Examples of medical-based information include date and reason for admission, most recent vital signs and vital signs outside of normal parameters, current medications, allergies, and labs, code status, and other clinically important information.
 
Assessment
At this stage, the situation is surveyed to determine the most appropriate course of action. Here the medical professional states what they believe the problem is based on current assessments and medical findings. Any impertinent information is avoided unless asked for.
 
Recommendation
Health care professionals give very precise and descriptive explanations on exactly what they need during that time frame. Possible solutions that could correct the situation at hand are discussed between health care professionals. Notably, suggesting ideas to physicians can be a weak point of nurses. Therefore, an explicit statement of what is required, how urgent, and what action needs to be taken is paramount.
 
Preparation is an integral part of *SBAR* and health care professionals are suggested to prepare to be able to answer any question the physician may ask. Discussion with another colleague may help. It is highly recommended that information about medical records, medication, administration records, and patient flow sheet be studied before contacting a physician.
 
Common Barriers to Effective. Communication:
The use of  jargon. Over-complicated, unfamiliar and/or technical terms.
Emotional barriers and taboos. Some people may find it difficult to express their emotions and some topics may be completely 'off-limits' or taboo. Taboo or difficult topics may include, but are not limited to, politics, religion, disabilities (mental and physical), sexuality and sex, racism and any opinion that may be seen as unpopular.
▫Lack of attention, interest, distractions, or irrelevance to the receiver.
▫Differences in perception and viewpoint.
▫Physical disabilities such as hearing problems or speech difficulties. Physical barriers  to non-verbal communication.  Not being able to see the non-verbal cues, gestures, posture and general body language can make communication less effective. Phone calls, text messages and other communication methods that rely on technology are often less effective than face-to-face communication.
▫Language differences and the difficulty in understanding unfamiliar accents.
▫Expectations. and  prejudices. which. may lead to false assumptions or stereotyping. People often hear what they expect to hear rather than what is actually said and jump to incorrect conclusions.
 
Cultural  differences The norms of social interaction vary greatly in different cultures, as do the way in which emotions are expressed. For example, the concept of personal space varies between cultures and between different social settings.
 
CONCLUSION
To conclude, communication is an active two way circular method in which all type of informations are shared between two or more people. Therapeutic communication is one of the most valuable tool that nurses have to use to build rapport and trust. This means that the nurses let the patients to feel safe enough to share information with them. 
 
In this essay, concept of therapeutic communication has been clearly discussed, that it is important in caring for patients in contemporary nursing practice. By using therapeutic communication techniques to assist with relationship development this helps the nurse to focus on the patient’s concerns. Examples from most recent practice as a registered nurse in my country, and the benefit and challenges of the use of therapeutic communication to my practice and the patient are illustrated.
 
REFERENCES
Brian Engard (2017), Rivier Online University (PDF) Therapeutic communication in nursing students: A ... https://www.researchgate.net › publication
Therapeutic Communication and Behavioral Management https://www.ncchc.org › cnp-therapeutic-...
SBAR - Wikipedia https://en.m.wikipedia.org › wiki › SBAR Essays, UK. (November 2013). Importance Of Therapeutic Communication In Caring For Clients Nursing Essay. Retrieved from https://www.ukessays.com/essays/nursing/importance-of-therapeutic-communication-in-caring-for-clients-nursing-essay.php?vref=1
 
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