Therapeutic Communication - Literature review Example

Therapeutic Communication Introduction: The ability to communicate effectively is vital within a healthcare system, if the quality of care is to be maintained at a high standard. Communication may be verbal, which is the spoken communication, or non-verbal which contributes meaning to the verbal expressions or may occur independently of verbal communication – such as the body motions and gestures, facial expressions, smiles, nods, which also function as a medium of communication. While communication itself is the process of transmission of messages and the interpreting of their meaning, during therapeutic communication, a care giver seeks to communicate with empathy and elicit such responses from the patient which will be beneficial to his or her well being. Therapeutic communication is geared towards promoting the well being of the patient through communication and interpretation of both verbal and non verbal cues. It is especially useful in the field of nursing and in the care of patients who may face chronic health conditions. Research strategy and search results: I began my literature search by first identifying the appropriate electronic bibliographic databases using the Gale Directory of Databases. An initial search conducted on Google with the search words “therapeutic communication” yielded an excellent article titled “Using therapeutic communication to connect with others” by Melanie Sears, an article which had also appeared in the Home Health Nurse Journal. This search on Google also pulled up two books by Deborah Antai-Otong, which dealt specifically with therapeutic communication techniques, such as active listening and the need to deal effectively with confrontation. Another useful book that was searchable online and which was pulled up by searching Google using the search term “Therapeutic Communication” was a book by Rick Daniels, who also discusses the various strategies used in therapeutic communication. These books were used in this study, because they constitute useful primary sources dealing with therapeutic communication. I searched all recent editions of the British Medical Journal by going to the website at: http://www.bmj.com/ and using the search term “Therapeutic communication” and “nursing communication.” Many papers were pulled up which were not relevant, the only useful one was an editorial by Lorraine E Ferris titled “Intimate partner violence.” The BioMed site was searched using terms such as “communication$”, “nursing$”, “Therapeutic communication$”, and yielded another useful study which was conducted by Cyna et al (2006) on pregnant women, using therapeutic communication methods. When conducting my search on the PubMed site using the same search terms, especially “Therapeutic communication”, I was able to locate a relevant article by O’Gara and Fairhurst. I also searched the MedScape site, using the search term therapeutic communication but this yielded a multitude of articles using the “therapeutic” and “communication” words separately, which were not relevant in providing information on the specific topic for this study. When I narrowed the search by putting the words within quotes, I found nine articles. The results of this search strategy are provided in the Appendix. Of these, only one article by Foster and Whitworth was useful in explaining the benefits of therapeutic communication and has been included in this study. Literature Review: Based upon research carried out in communication in previous years, O’Gara and Fairhurst (2004) have identified five strategies that aid in therapeutic communication. These are questioning, listening and noticing, being empathetic, incorporating the patient’s cares and concerns in the consulting process. Therapeutic communication uses basic listening and communication through interaction in order to assess the client’s needs, formulate outcomes and evaluate how effective the intervention process has been. Therapeutic communication therefore includes all of these aspects: (a) active listening (b) questioning (c) clarifying techniques (d) therapeutic use of touch (e) Therapeutic use of silence (f)Humor (g) Focusing (h) confrontation and (i) summarizing.(Antai-Otong, 2003, p 138). Daniels defines empathy as “an emotional linkage between two or more people through which feelings are communicated; involves trying to imagine what it must be like to be in another person’s situation. (Daniels, 2004, Unit 1). Lorraine Ferris (2007) writes about intimate partner violence and identifies therapeutic communication as one of the means to work with victims, including active empathetic listening in order to establish trust. Active listening differs from ordinary listening in that it is a dynamic and interactive active process that requires concentration. According to Antai-Otong (2007, p 58), active listening “requires the use of all the senses and involves attention, comprehension and mindfulness to assess verbal and non verbal communication”, requiring an active interest in others’ points of view. It allows a nurse to establish a dialogue, so that the client is encouraged to set the tone and become more direct. In some cases, the clients may be low in self esteem and social skills, this requires that the nurse be more directive and provide a structure which enhances nurse-client interactions. According to Daniels (2004), active listening involves hearing and interpreting of language, while at the same time, noticing nonverbal movements and para-verbal enhancements and identifying the underlying feelings. Conflict management is also an important aspect of therapeutic communication, because they may be threatening and may incite negative feelings and disagreements between the patient and nurse. As pointed out by Sears (2004) the negative experiences of nurses in their own childhood may make them reluctant to face up to conflict situations with patients. The early childhood experiences of nurses may influence their perceptions of and attitudes towards conflict situations as well as their willingness to resolve it (Sears 2004). Therefore effective therapeutic communication will require nurses to deal with their own issues first before dealing with conflict situations involving patients and in influencing clinical outcomes. Confrontations may evoke intense anxiety and may be uncomfortable, as a result it may not be utilized to the optimum as a communication tool; however it may have potential to bring about healthy behavioral changes As a result it is also a part of therapeutic communication and nurses can function more effectively in assisting clients when they are able to deal with conflict. Confrontation can serve as an effective therapeutic communication technique which allows a nurse to point out to the patient, the differences between an expected behavior and the actual action. In today’s health care system which is subject to constant and rapid changes, it is vital for burses to develop assertive communication styles which are not aggressive. (Antai-Otong, 2007, p 61). The development of an assertive communication style that incorporates the ability to deal with confrontation can provide nurses a means of advancing both their personal and professional needs, ensuring safe, holistic work environments and establishing a healthy interactional pattern of communication with patients and fellow health care professionals. When communication is assertive rather than aggressive and confrontational, it promotes mutual goal setting between the nurse and patient, promotes team building and aids in conflict resolution. (Antai-Otong, 2007, p 61). For instance, assertiveness in communication is not necessarily determined by the content of the verbal message but by the manner in which the message is expressed, i.e,. the non verbal cues that accompany message delivery. Confrontation can be prevented or diminished by adopting non threatening body language, maintaining a safe distance from the patient and good eye contact, speaking in a normal tone of voice rather than a whiny or abrupt tone and using an erect posture. (Antai-Otong, 2007, p 65). Assertiveness in communication is conveyed when there is congruency between the verbal message and non verbal cues that go along with it. While there is no guarantee that assertiveness in communication will always promote respectful dialogue and communication, it does provide a good opportunity to solve problems and effectively resolve conflicts, so that the underlying root of patient problems can be determined and resolved.(Sears 2004). As pointed out by Daniels(2004), there may already be existing barriers in therapeutic communication, such as difference in language and culture between nurse and patient, which may interfere with effective communication. Gender may also influence communication, since women are more skilled at reading non verbal signals. In some instances, the poor health of the patient may be a bar in effective communication and all of the factors identified above may hinder favorable clinical outcomes (Daniels, 2004: Unit 1). Hence, developing good therapeutic communication skills through more active listening and effective interpretation of what is actually being said can aid in overcoming those barriers. Another important aspect of the therapeutic communication process is reflection, which requires not only astute listening skills but also the ability to interpret non verbal cues in order to arrive at a correct interpretation of what the client means (Antai Otong, 2003). The nurse makes certain assumptions about the real sources of conflict and anxiety in the patient’s life based upon the verbal and non verbal responses. Reflection then involves making statements based on the client’s comments in order to confirm those assumptions. Sears (2004) states that very often, the issue under which the patient has been admitted to the hospital may not be the issue with which the patient wants to deal. Using therapeutic communication which supports patients through the use of empathy, helps them to deal with repressed feelings and painful issues and thus aids in their recovery. Sears (2004) outlines four steps in the non violent therapeutic communication; (a) observing what patients are seeing, hearing or thinking which is creating their reaction (b) understanding how the person feels in response (c) recognizing the needs or unmet needs of the patient and (d) learning what the patient wants, to fulfil those unmet needs. In a study conducted by the Cardiff University, the efficacy of teaching nursing students communication skills through the use of simulated patients in training was compared to role play in terms of communication skill acquisition (Lane and Rollnick, 2007). The authors examined a wide range of studies and found that there is no significant difference in the outcomes between the two methods, and hence there is a need for more studies that can assess how best nurses can be taught the acquisition of effective therapeutic communication skills. Therapeutic communication is very important from the perspective of clinical outcomes because it involves a curative nurse-client interaction, reducing stress in both the nurse and the client and helping them to collaborate together effectively. According to O’Gara and Fairhurst (2004), therapeutic communication is essentially patient centered communication, and the application of therapeutic communication techniques such as active listening, clarifying and focusing could be of great value in emergency care and enhance the therapeutic nature of the clinician-patient interaction. In a study carried out by Foster and Whitworth (2005), the use of therapeutic communication in telemedicine and child abuse was explored. The study found that telemedicine provided an expanded role for nurses, allowing for expert consultation. Therapeutic communication techniques were important in achieving a good nurse-patient relationship. It was able to improve therapeutic benefits even for patients who were at a distance. Therapeutic communication is critical in achieving successful clinical outcomes. When a nurse or care giver is effectively prepared in therapeutic communication, having developed the skills of active listening, clarifying, focusing, conflict resolution and therapeutic touch, they are likely to collaborate more effectively with the clients (Sears 2004; Daniels 2004). They are able to tap into the underlying issues which are causing anxiety to the patient and help in providing effective solutions. Summary of findings from the literature review: Therapeutic communication is an effective and critical tool that affects clinical outcomes. It is not merely the process of relaying and interpreting messages verbally, it also takes into account non verbal cues. It is a collaborative process between the care giver and the patient in determining the source of patient anxieties and working together effectively to arrive at solutions to the problems. Therapeutic communication also requires the active participation of the care giver, who must possess the ability to deal with situations involving conflict. Therapeutic communication requires more than mere listening skills, it also requires the caregiver to interpret underlying messages being conveyed by the client in the form of non verbal cues. The care giver must then clarify and reflect on what the client is really saying and then restate it to affirm whether the assumptions made on the basis of verbal and non verbal cues are indeed correct. Therapeutic communication is critical because it can achieve successful clinical outcomes, while the lack of therapeutic communication may negatively impact upon clinical outcomes. References: * Antai-Otong, Deborah, 2003. “Psychiatric Nursing: Biological and Behavioral Concepts”, Thomson Delmar Learning * Antai-Otong, Deborah, 2007: “Nurse-client communication: A life span Approach”, Jones and Bartlett * Cooper, L.A., Roter, D.L., Johnson, R.L., Ford, D.E., Steinwachs, D.M. and Power, N.R., 2003. “Patient centered communication, ratings of care, and concordance of patient and physician race”, Annals of Internal Medicine, 139: 907-915 * Cyna, Allan M, Andrew, Marion I, Robinson, Jeffrey S, Crowther, Caroline A, aghurst, Peter, Turnbull, Deborah, Wicks, Graham and Whittle, Celia, 2006. Hypnosis Antenatal training for childbirth (HATch): a randomized, controlled trial”, BMC Pregnancy and Childbirth, 6(5), Retrieved April 25, 2008 from: ttp://www.biomedcentral.com/1471-2393/6/5 * Daniels, Rick, 2004. “Caring Fundamentals: caring and clinical decision making”, Thomson Delmar Learning * Ferris, Lorraine E, 2007. “Intimate Partner Violence” British Medical Journal, 334:706-707 * Foster, PH and Whitworth, JM, 2005. “The role of nurses in telemedicine and child abuse”, Computers, Informatics, Nursing, 23(3): 127-31 * Lane, Claire and Rollnick, Stephen, 2007. “The use of simulated patients and role play in communication skills training: A review of the literature to August 2005”, Patient Education and Counseling, 67 (1-2) :13-20 * O’Gara, Paula E and Fairhurst, Wendy E, 2004. “Therapeutic Communication: general approaches that enhance the quality of consultation”, Accident and Emergency Nursing, 12(3): 166-172 * Sears, Melanie, 2004. “Using Therapeutic Communication to Connect with Patients”, Home Healthcare Nurse, 14(8) :614-617 APPENDIX: RESULTS OF MEDSCAPE SEARCH: Motivating HIV Positive Women to Adhere to Antiretroviral Therapy and Risk Reduction Behavior: The KHARMA ProjectDespite the life saving aspects of ART, there are many difficulties for the woman who decides to begin therapy. ... Journal Article, Online J Issues Nurs, January 2006 Original Articles - What Are Adolescents Showing the World About Their Health Risk Behaviors on MySpace?the computer. In: Fish SL, ed. Talking to Strangers: Mediated Therapeutic Communication. Norwood, NJ: Ablex; 1990. Lenhart A, Madden M. Teens, privacy ... Journal Article, Medscape General Medicine, October 2007 Nursing Perspectives - Alternatives to Restraint and Seclusion in Mental Health Settings: Questions and Answers From Psychiatric Nurse Expertsthe right mix of professional staff who are properly trained in therapeutic communication and behavioral techniques. The research consistently shows that ... Article, Medscape Nurses, May 2007 The Role of Nurses in Telemedicine and Child Abusecritical. The participants all emphasized the importance of therapeutic communication that has to occur between the telemedicine nurse and the child ... Journal Article, Comput Inform Nurs, May 2005 Nursing the Child Who is Alone in the HospitalIn R. Zahourek (Ed.), Relaxation and imagery: Tools for therapeutic communication and intervention (pp. 3-27). Philadelphia: Saunders. Lefcourt, ... Journal Article, Pediatr Nurs, May 2006 Body Piercing: Issues and Challenges for Nurses. Athletic Therapy Today, 8 (5). 52-53. Sears, M., (1996). Using therapeutic communication to connect with patients. Home Healthcare Nurse 14 (8), pp. ... Journal Article, J Foren Nurs, July 2005 Transcultural Nursing Principlesvastly differs from touch in a personal relationship. When therapeutic communication is the primary goal, appropriate actions might include shaking ... Journal Article, Journal of Hospice and Palliative Nursing, May 2006 A Recruitment and Retention Program That Works!and families, family dynamics, current research topics, therapeutic communication, conflict resolution, interpersonal skill development, ... Journal Article, Nurs Econ, January 2003 Bipolar Disorders Expert Column - Adherence and Communication in the Treatment of Patients With Bipolar Disorder: An Expert Interview With Daniel Z. Lieberman, MDwhat we call psychiatric management. That implies a sort of therapeutic communication that is based on a deep understanding of the patients ... Expert Viewpoint, Medscape Psychiatry & Mental Health, December 2004 Read More