Therapeutic Communication: Definition, Goals, Types - Term Paper Example

Therapeutic communication Name Xxxx Course Xxxx Lecturer Xxxx Date Xxxx Therapeutic communication The nursing art and science depends on competencies in communication. Nursing care quality is based on the ability of a nurse to create relationships with the health care consumer, family and friends and other health care team mates. Nursing communication may occur at various levels ranging from personal, interpersonal and mass or public. This paper focuses on interpersonal communication with reference to therapeutic communication. This refers to an interpersonal relationship between the client and the nurse in which the latter focuses on establishing a care relationship based on the needs of the client in which there is effective communication exchange (Videbeck 2011). Its effectiveness depends on applying effective communication skills. This paper analyses five communication skills and techniques and later gives a personal reflection on the same. These are active listening, empathy, touch, clarifying and silence. Active listening The active listening skill refers to the ability of a nurse in therapeutic care to reflect back ones understanding of what the client is saying by refraining from all other internal mental activities to exclusively concentrate (Videbeck 2011). In essence, it means more than merely showing a sense of concentration to the client but to create confidence in client and encourage sharing of information. It communicates the nurses’ acceptance and understanding of the client’s position by using verbal and non-verbal cues that indicate full attention. It has also been indicated as more listening with the heart from the heart at a deeper than superficial level (Browing & Waite 2010; Bryant 2009). This implies that it is an art that is more than just paying attention. The nurse encourages the client’s engagement by showing interest and being responsive to underlying feelings and emotions. It sets a much needed platform for the nurse to connect and partner in a intimate way with the client. Listening has been indicated in literature as a most influential healing and support mechanism (Browing & Waite 2010). As a healing mechanism, it enhances self acceptance and confidence on the part of the patient. Also referred as non-egoic listening, it has influence on the level of interaction between consequently affecting the quality of treatment plans, patient compliance, and costs of care, efficacy and relationships. With reference to the care relationship this technique transforms both the speaker and listener. Showing genuine curiosity, interest and respect for the client not only enhances client’s openness, but also provides a learning opportunity for the nurse. There are barriers to active listening. These include environmental barriers, personal barriers such as listener’s attitudes, knowledge level, assumptions and prejudices (Videbeck 2011). In response, Bryant (2009) suggests three steps a nurse may use to enhance their active listening art: create an accommodative environment, develop skills and finally, hear the story. Sharing empathy The definition of sympathy has been indicated as incorporating two dimensions: affective and cognitive components (Tavakol, et al. 2012). The affective component comprises of the nurses ability to respond to a patient’s situation in the same emotion as the patient whereas the cognitive consists of having a perspective or taking the role of the patient. As such, sharing empathy means a nurse’s ability to perceive from the perspective of the patient and communicate that understanding (Videbeck 2011). It occurs at three distinct yet highly interconnected levels: cognitive, cross-over and identification stage. It is a component of active listening that demonstrates genuine interest and respect. In nursing practice, empathy has often been construed to mean sympathy due to the affective component. This occurs when the nurse loses therapeutic objectivity thereby getting too close in the relationship. Being empathetic implies a sense of safety and understanding to the patient. Otherwise, being sympathetic implies a feeling of pity, which dissolves the healing presence. On the contrary being empathetic implies creating an internal space that accommodates the other person, understanding and sharing with them (Cunico, et al. 2012). Empathy has positive outcomes on the care relationship as well as treatment outcomes. By sending empathetic signs of care, and clarification the nurse builds the feeling of safety and confidence which are the basis of the care relationship. Accurate assessment and subsequent treatment depends on this relationship and is efficient to the extent of its being empathetic. It facilitates clinical interviews and increases the efficiency of information gathering and the effectiveness thereof of the information. The patients also feel appreciated and understood with raised self esteem (Rosenberg & Gallo-Silver 2011). However, they must perceieve the empathy given. However, giving and perceiving of empathy is hindered by barriers similar to the aforementioned in relation to active listening- personal and environmental. The difference is the dependence on the perception of another individual- the client. Touch This is a non-verbal cue of the nurse-patient interaction that characterizes active listening, empathy and expression of genuine interest. It entails a show of intimacy as it involves body contact between the nurse and the patient. It is an essential and powerful non-verbal statement that is arguably the most underutilized in contemporary clinical care owing to the barriers and misconceptions surrounding it (Morrissey & Callaghan 2010). Apart from talking, many of the nursing care activities involve body contact in form of touch. In other circumstances, it is demonstrated in the closeness during care to communicate empathy, understanding, reassurance, warmth and encouragement. Nurses may use two types of touch in therapeutic care: instrumental and expressive (Morrissey & Callaghan 2010). Instrumental refers to circumstances in which touch is necessary and unavoidable such as in dressing, bathing and injection administration. Expressive touch is spontaneous and non-procedural demonstrating care, affection, and respect. It is an intentional comfort touch reacting to patient’s need for safety, comfort and human touch based on the Nightingale theory of manipulating a patient’s environment (Howett, et al. 2010). Apart from the affective benefits, therapeutic touch in human subjects has been related to relieving fatigue, headaches, depression, anxiety, chronic fatigue syndrome and muscle pain. Importantly, nurses should make the following considerations. Firstly, one should consider age, culture and ethnicity and gender (Morrissey & Callaghan 2010). The touch technique is rather subjective and its interpretation depends on the personal and demographic characteristics of the patient. There are cultures which prohibit touch and close contact unless there is a close relationship. In addition, some ages may require permission. The touch should be offered respectfully, objectively and with reference to the needs of the patient. It should be genuinely in the interest of the patient and should not be construed as an invasion of personal space (Howett, et al. 2010). Finally, it is imperative that a nurse is conscious of own level of discomfort with touch. Clarifying This is a technique used to understand verbal and non-verbal messages especially when one is not sure of the meaning. It entails repeatedly seeking that a patient comes clear on information. It is imperative that the nurse uses this technique in order to avoid decision making that is based on assumptions about a client’s needs. It also prepares the client for the expected demands of the care relationship (Timby 2009). It may involve returning to the message, paraphrasing, rephrasing or consensual validation (Videbeck 2011). The latter refers to the nurse repeating his or her understanding of the client’s message and ask for confirmation or correction from the client. Clarifying forms a vital part of the nurse’s feedback message displaying a sense of genuine effort to undertand the client and a caring attitude. It closely relates with validation of client’s messages, which involves the nurse seeking to establish their accuracy. Essentially, the nurses ability of clarifying depends on the reflection and empathy skills, which are prominent in the internalization of the message. There is a tendency for nurses to focus more on physical components than psychological ones. However, liteture suggests the value of maintaining a psychological focus since the meaning of messages is mostly lost in expression of client’s feelings (Webb 2011). These feelings are expressed in verbal cues such as phrase and words indicating hidden concerns and non-verbal cues which express emotions such as crying, silence and anxiety. This literature further suggests that a psychological focus is more likely than a physical one to encourage clients to speak out more. Silence Silences and long pauses in therapeutic communication, like in any other, indicate many different meanings. According to Morrissey & Callaghan (2010), silence can be used as an active listening component. It is a therapeutic communication technique that is effective especially when the client is distressed and continually talking. It is a non-verbal cue meant to give time to the client to contructs their ideas and feelings into words, regain cotrol of themselves and to respond (Videbeck 2011). In the pause, the nurse may indicate having interest in the client and thereby encourage the latter to continually express the concerns. The pause also gives time for the nurse to reflect upon and understand the concerns of the client, as well as enable one to structure and control the pace. Just like touch, the silence technique may be subjectively interpreted. In some cultures, it is interpreted as a show of respect; in others, it shows hostility and distrust with the client perceiveing a “push-away” act (Antai-Otong 2007). There are others who interpret it as way of pressing for a response which may be interpreted as disrespect, nurse’s impatience, and violence. The silence should be used in a way it does not imply too long a pause of disintrest. It may evoke distress if it feels longer than it is making the client uncomfortable (Morrissey & Callaghan 2010). As such, it requires ample practice to ensure that a nurse does not fill the pause with words, and it does not feel distressfully too long. This practice will help a nurse determine when to use a pause and when and how to interrupt it (Antai-Otong 2007). Reflection The Silent Scream painting and the hospital setting photo display totally extreme ends in what the non-verbal cues communicate. To start with, the men in the hospital display a care-based interaction in which it appears there is mutualism and trust. The standing health care giver demonstrates connectedness with the client in bed. The hand on the shoulder indicates an encouraging statement and assurance to the client. I perceive there is feeling of safety compared to the man in the Silent Scream. Behind the man in the paining, there appears an extensive space evoking feelings of loneliness and fear. The man appears to be having a loud scream, silent in my ears, yet loud to my eyes. It shows a disturbing environment and distressful situations with no one to offer a hand. There is a sense of organization and a bright ambience that instils hope in the patient on the bed. On the contrary, the hospital environment depicts an accommodative ability safety and assurance. The client in the bed shows this by having a soft and calm face. It is apparent that the client and the nurse are discussing something to do with the item in the client’s hand. The Silent scream depicts to me the situation and feelings of health care clients before they seek help and what some of them experience in the hands of some nurses. It shows a client who is lost and confounded by myriad events and is screaming for help. The feelings of desperation, anxiety, loneliness and fear are vivid on the man’s face. In the man’s scream, there is a prominent recognition of terror, yet there is no shield and encouragement whatsoever. The loneliness is depicted by the vast space behind the man. Essentially, I see the mixture of the type of expected clients with myriad issues. I need to ensure that such as person first feels the human touch and safety. That way, it is possible to plan interventions. References Antai-Otong, D 2007, Nurse-Client communication: a lifespan approach, Ontario: Jones and Barlett. Browing, S, & Waite, R 2010. ‘The gift of listening: JUST listening strategies’, Nursing forum, 45(3), pp. 150-158. Bryant, L 2009. ‘The art of active listening’, Practice nurse, vol. 37 no. 6, pp. 49-52. Cunico, L, Sartori, R, Marognolli, O & Meneghini, A 2012, ‘Developing empathy in nursing students: a cohort longitudinal study’, Journal of Clinical Nursing, vol. 21, no. 13-14, pp. 2016-2025. Howett, M, Connor, A & Downes, E 2010, ‘Nightngale theory and intentioal comfort touch in management of vulnerable populations’, Journal of holistic nursing, vol. 28, no.4, pp. 244-250. 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