A personal, interactive system; a series of ever-changing, ongoing transactions in the environment.
What is therapeutic communication?
A meaningful relationship between the patient and professional helper. The patient-centered approach is influenced and directed by the professional.
What are the theories that influence nursings approach to therapeutic communication?
Therapeutic communication involves the patient and professional.
Feedback Loop involves a response-stimulus interchange.
Internalization involves patterned learning and behavior from influences of gender, culture and developmental needs.
Transactional Analysis I involves using the functions of the ego as a way of relating and communicating.
Describe communication patterns.
Patterns of communication include parent, child or adult patterns (the different ego states).
Adult patterns are most effective because they do not communicate rebellion (child pattern) or judgement (parent pattern).
Describe dysfunctional communication.
There are several patterns.
Crossed dysfunctional communication is a message addressed to a specific ego state but not received in that state.
Double messages in a double message the exchange seems to be adult to adult but the subtle relevant message may be coming from another ego state.
Facts on Communication.
Even if a person tried they could never not communicate lack of eye contact or not speaking communicates something.
Communication is a personal, interactive system a series of ever-changing, ongoing transactions in the environment it is how we develop a sense of identity and being.
Communication involves what three essential steps?
The transmission of information (sending and receiving messages).
The meaning of the transmission.
And the behavioral effects of the transmission.
What communication model does nursing use?
A model of communication compatible with the nursing process is an adaptation of the Wenburg and Wilmot process model of communication.
This is useful for nursing because it emphasizes behavioral aspects and internal and external influences on communication.
What are the components of the communication process (or model)?
A sender or encoder person sending the message - can be verbal or nonverbal.
A
receiver - or decoder gets the message.
A message
unit of information received.
Message variables
verbal and nonverbal communication.
Verbal - is written and spoken structural defects, malfunctioning due to disease, auditory and verbal impairments, sensory deprivation, overload or learning disabilities may affect or decrease accurate communication. Examples: A schizophrenic person, a stutterer, a mentally retarded or autistic person.
Voice pitch, voice quality (harsh, weak or strained), voice amplification (soft or loud), words, grammar and understanding are included in assessment.
Nonverbal - is gestures, facial expressions and dress and represents 65% of the communication. Examples of nonverbal behavior include: crying, screaming, laughing, moaning, giggling and sighing, facial expression, body posture, gait, tone of voice and gestures.
Space and territory are forms of nonverbal communication as well. Personal space is the space preferred for interactions. Territory refers to implied space such as a patients room or a specific seating arrangement.
Intrusion or violation of these areas can distract or distort communication.
Noise
sound interference can impair accurate transmission.
Communication skills
include being able to observe, listen, clarify and validate by both sender and receiver.
Setting
where communication takes place.
Media
refers to sensory channels that carry the message hearing, sight, touch, taste and smell. Example: You get the message a patient needs pain medication you hear (hearing)complaints of pain, you see (sight) tears in their eyes, they grasp (touch) your arm in pain.
Feedback
involves the continuous interpretation of response of the sender and receiver as messages are simultaneously encoded and decoded.
Environment
are the internal and external influences affecting the communication process. External examples: room temperature, smells and lighting. Internal examples: feeling cold, tired or experiencing pain.
Interpersonal Communication
Is the most direct and pertinent form of communication because through this transaction needs are met.
The main focus of interaction occurs at the interpersonal and group levels.
There are three basic interpersonal styles of communicating:
Nonassertive or passive letting others control behavior
Aggressive threatening, blaming and hostile
Assertive openly expressive, spontaneous, yet considerate of others.
Important elements in therapeutic communication
Empathy which is a communication skill and behavior.
Attending being with the patient both in physical and psychological presence.
Observing
Listening
Congruence between verbal and nonverbal communication
There are two levels to every message content and feeling when content and feeling do not match this is termed incongruent. Example: A patient with a sad facial expression and tear filled eyes, tells you he is fine. Or a husband says he is supportive of his wifes therapy but will be too busy to attend family sessions with her.
Barriers to therapeutic communication
Lack of planning by the nurse.
Poor data collection.
Inappropriate Nursing Diagnosis and Outcome criteria.
Lack of regard or respect for the patient.
These are just examples review page 67 Table 6-2 and 6-3 for more examples.
