COMMUNICATION TECHNIQUES

Communication
reciprocal

exchange of ideas between or among persons

Modes: Verbal - written/spoken Non-verbal - posture, tone of voice, facial expression

Types of Non-verbal communication:

Kinesis

body movement eye contact gestures

voice quality non-language vocalization (crying, sobbing, moaning)

Paralanguage

Proxemics law of space relationship

CONSIDERATIONS IN THERAPEUTIC COMMUNICATION

PRIVACY RESPECTING BOUNDARIES PROXEMICS science of proper spacing

Distance Zones:

1. INTIMATE ZONE- 0-18 inches between people; comfortable for parents with young children, lovers or people whispering. 2. PERSONAL ZONE - 18-36 inches; distance between family and friends when talking 3. SOCIAL ZONE - 4-12 feet; acceptable distance for communication in social, work & business settings. 4. PUBLIC ZONE- 12 to 25 feet; acceptable distance b/w speaker and audience, small groups, and informational functions.

Touch physical act Cultural artifacts

eye glasses uniform beard

Meta communication
based on role expectations hidden meaning of words

5 TYPES OF TOUCH:

1. FUNCTIONAL-PROFESSIONAL TOUCH- used in examinations or procedures 2. SOCIAL-POLITE TOUCH used in greetings, handshake & air kisses, guiding someone for direction 3. FRIENDSHIP-WARMTH TOUCH a hug in greeting, an arm around a shoulder of a good friend or back slapping some men use to greet friends & relatives. 4. LOVE-INTIMACY TOUCH involves tight hugs and kisses b/w lovers or close relatives. 5. SEXUAL AROUSAL TOUCH used by lovers.

Always develop
ACTIVE LISTENING means refraining from other internal mental activities and concentrating exclusively on what the client says. ACTIVE OBSERVATION means watching the speakers nonverbal actions as he/she communicates.

Therapeutic Communication

A way of interacting in a purposeful manner to promote the clients ability to express his thoughts and feelings openly.

ELEMENTS OF COMMUNICATION
SENDER MESSAGE RECEIVER CHANNEL FEEDBACK CONTEXT

originator of information information being transmitted - recipient of information - mode of communication - return response - the setting of communication

Elements:
F E E D B A C K

sage Me s

(Channel) (Context)

Essentials for a Therapeutic Communication

Genuineness Respect Empathy Attentive listening Trust (rapport)

REA T G

Barriers to Therapeutic Communication

Belittling Interrupting / ignoring Giving advice Social response Changing the subject Approving / disapproving Moralizing

B I G S C A M

BARRIERS TO COMMUNICATION

PHYSICAL BARRIERS

THERAPEUTIC DISTANCE: 3-6 FEET FOR DEPRESSED PTS.: LESS THAN 3 FT. AGITATED PTS.:TABLE IN BETWEEN VIOLENT PTS.: SAFE DISTANCE

LANGUAGE BARRIERS SEMANTIC BARRIERS-DOUBLE MEANING INCONGRUENCE-words and actions do not match CLICHE-false assurance STEREOTYPING- giving generalized statements.

TYPES OF RELATIONSHIP:

SOCIAL RELATIONSHIP - initiated for the purpose of friendship, socialization, companionship or accomplishment of task INTIMATE RELATIONSHIP involves two people who are emotionally committed to each other. May include sexual or emotional intimacy and sharing of mutual goals. THERAPEUTIC RELATIONSHIP focuses on the needs, experiences, feelings and ideas of the client only. The nurse uses communication skills, personal strengths and understanding of human behavior to interact with the client.

Observe these in a Nurse-Patient Relationship

CONFIDENTIALITY means respecting the clients right to keep private any information about his/her mental and physical health and related care. Note: if a patient tells a secret about harming oneself or others, avoid keeping a promise not to tell the revealed information by the client. DUTY TO WARN requires the nurse to notify physicians, authorities, intended victims of a threat SELF-DISCLOSURE nurses disclosing personal information to the patient which the nurse think can help in establishing rapport.

Therapeutic Communication

Accepting E.g. Yes, that must have been difficult for you. Acknowledging or giving recognition E.g. I noticed that you've fixed your bed. Asking direct questions E.g. How does your wife feel about your hospitalization? Clarifying E.g. I'm not sure that I understand what you are trying to say. Confronting or presenting reality E.g. I see no bats flying in this room.

Encouraging comparison E.g. Has this ever happened before? Encouraging description E.g. How do you feel when you take your medication? Encouraging evaluation E.g. Does participating in group therapy enable you to discuss your feelings? Exploring E.g. Tell me more about your job. Would you describe your responsibilities? Focusing assisting a patient to explore specific topic

Giving broad openings or asking open-ended questions E.g. Is there something you'd like to do? Informing giving needed facts E.g. I'll be your nurse for today, from 7:00 until 3:00 this afternoon. Making observations E.g. You appear to be angry. / I noticed that you're trembling. Offering general leads E.g. Go on. / You were saying

Restating E.g. Client: I can't sleep, I stay awake all night. Nurse: You can't sleep at night, (restating) Summarizing E.g. During the past hour, we talked about your plans for the future, they include... Using silence - to induce thought, pacing, acceptance Validating - confirming one's observation E.g. So you mean . . . Voicing doubt E.g. I find that hard to believe.

Non-therapeutic and Ineffective Communication

Agreeing and disagreeing E.g. I think you did the right thing. Advice E.g. You should.. Belittling E.g. "Don't be concerned, evervone feels like that". Defending E.g. "All doctors here are simply great".

 False
E.g.

reassurance

"Don't worry, everything will be all right".

Focus
E.g.

on caregivers feeling

I feel that way too. "It's your own mistake".

Judging
E.g.

DEFENSE MECHANISMS

These are automatic and usually unconscious processes or act by the individuals to:
reduce

or cope anxiety or fear resolve emotional or mental conflict protect one's self-esteem protect one's sense of security

Becomes pathologic when overused. Used by both mentally healthy and mentally ill individuals

Common Defense Mechanisms Used

Compensation
An

attempt to overcome a real or imagined short coming, inferiority, inabilities and weaknesses. A blind woman becomes proficient in playing piano.

Conversion
Emotional

problems are converted to physical

symptoms A student unprepared for a report suffered headache the day she is supposed to deliver her report.

Denial
Failure

to acknowledge an intolerable thought, feeling, experience or reality A middle-aged man after being admitted to the CCU because of an AMI, insists that he is in the hospital for just a diagnostic work-up.

Displacement
the

redirection of feelings to a less threatening object An adolescent boy, after an argument with his father, goes to the room and kicked his rooms door.

Fantasy
Conscious

distortion of unconscious feelings or wishes A boy who is being bullied by his friends wished he had the power of Superman.

Fixation
An

unhealthy mechanism which is an arrest of maturation at certain stages of development. A boy never overcame being fully reliant from his mother.

Introjection Symbolic assimilation or taking into oneself a love/hatred object. Derived from the word "introject" which literally means to take into or ingest. Common to depressed clients.
Identification An individual integrates certain aspects of someone else's personality into one's own. A young school teacher adopts his former mentor's teaching style when conducting class sessions.

Intellectualization An overuse of intellectual concepts by an individual to avoid expression of feelings A man who was asked to share a memorable experience about his grandmother who died discussed the stages of death and dying by Elizabeth Kubler Ross.

Projection Attributing to others one's unconscious wishes/fear. Literally, this means to "throw off. A student who failed a subject blames his failure on poor teaching.

Reaction Formation
Expression

of feeling that is the direct opposite of one's real feeling. Also referred to as overcompensation. A student who dislikes one of her classmates may act or show concern toward her.

Rationalization An individual finds a justifiable cause and acceptable reasons just to be saved from an embarrassing and anxiety producing thoughts or situations. A basketball player claims that he missed the shot and lost the game because of the distractions made by the audience. Regression Is the turning back to earlier patterns of behavior in solving personal conflicts. Commonly seen to schizophrenic patients A person who becomes ill in the face of disappointment has regressed to a form of childish behavior.

Repression
It

is the involuntary or unconscious forgetting of an unpleasant ideas or impulses. During the nurse-patient relationships, patients often unconsciously avoid discussing those experiences producing anxiety which are emotionally difficult to verbalize.

Suppression
Permits

the individual to store away or consciously forget the unpleasant, painful and unacceptable thoughts, desires, experiences and impulses. "I'll think it about tomorrow", "I'd rather go now", "Can we change the topic?" A boy walked out from the group and said "I have to go now", when he was asked what was happened to their relationship with his girlfriend.

Substitution
Replacing

the desired unattainable goal with one that is attainable A woman who failed the nursing board exam 3 times, worked as a nursing aide just to be in the hospital.

Sublimation
The

redirection of unacceptable instinctual drive with one that is socially acceptable Instead of harming his mother, a man expressed his anger by composing a song.

Symbolization
Less

threatening object is used to represent another A woman, missing her husband finds comfort in hugging her son who looks like his father.

Undoing
An

attempt to erase an act, thought, feeling, guilt or desire A man gives her wife a bunch of roses after their argument last night.