Therapeutic Therapeutic CommunicationCommunication

the helping interviewthe helping interview

Helping Relationship Helping Relationship CharacteristicsCharacteristics CaringCaring HopefulHopeful SensitiveSensitive GenuinenessGenuineness EmpathyEmpathy Positive regardPositive regard

Empowering Empowering AssertiveAssertive

Helping vs Social Helping vs Social RelationshipsRelationships HELPINGHELPING CareCare TrustTrust GrowthGrowth Purposeful/Purposeful/

intentionalintentional Unequal sharingUnequal sharing Focus on Client’s Focus on Client’s

needsneeds Time limitedTime limited

SOCIALSOCIAL CareCare TrustTrust GrowthGrowth SpontaneousSpontaneous Usually equal or Usually equal or

near equal sharingnear equal sharing Focus on needs ofFocus on needs of both individualsboth individuals OngoingOngoing

LOCUS OF CONTROLLOCUS OF CONTROL

THOSE GIVING HELPTHOSE GIVING HELP Feeling importantFeeling important Feeling usefulFeeling useful Feeling powerfulFeeling powerful Feeling gratifiedFeeling gratified Feeling happyFeeling happy

THOSE NEEDING HELPTHOSE NEEDING HELP Feeling unimportant Feeling unimportant

or inadequateor inadequate Feeling useless or Feeling useless or

depresseddepressed Feeling powerlessFeeling powerless Feeling frightened Feeling frightened

or embarrassedor embarrassed Feeling sad or Feeling sad or

angryangry

Phases of Helping Phases of Helping RelationshipRelationship Orientation (professional and Orientation (professional and

client to each other)client to each other)

Working (identification of the Working (identification of the client’s problem)client’s problem)

Termination (resolution of the Termination (resolution of the client’s problem)client’s problem)

Orientation PhaseOrientation Phase

““Getting to know you” phaseGetting to know you” phase Sets the toneSets the tone IntroductionsIntroductions RolesRoles Initiated by the nurseInitiated by the nurse Agreement/contract/goalsAgreement/contract/goals OrientationOrientation Trust developsTrust develops

Working PhaseWorking Phase

““Problem solving” phaseProblem solving” phase Attend to client’s needsAttend to client’s needs Nurse in role of teacher/counselorNurse in role of teacher/counselor Client actively participatesClient actively participates Gather further dataGather further data Facilitate changeFacilitate change Evaluate problems & goalsEvaluate problems & goals

Termination/Termination/Resolution PhaseResolution Phase Review and summarize progress & Review and summarize progress &

goals met/not metgoals met/not met Acknowledge feelingsAcknowledge feelings Clients mostly seeking explanationClients mostly seeking explanation How will problem affect their lives?How will problem affect their lives? What will need to be changed?What will need to be changed? How will they cope?How will they cope?

AvoidAvoid

ArguingArguing MinimizingMinimizing ChallengingChallenging Giving false Giving false

reassurancereassurance Interpreting or Interpreting or

speculating on speculating on the dynamics of the dynamics of the client’s the client’s problemsproblems

““Selling” client on Selling” client on accepting accepting treatmenttreatment

Probing sensitive Probing sensitive areasareas

Participating in Participating in criticism of any criticism of any staff memberstaff member

Joining any attacks Joining any attacks led by the clientled by the client

Attentive Listening Attentive Listening ScaleScale-THINGS TO AVOID-THINGS TO AVOID Lack of eye contact Lack of eye contact Responding before the other finishes speakingResponding before the other finishes speaking Finishing other people’s sentencesFinishing other people’s sentences Talking so much that others cannot respondTalking so much that others cannot respond Continuing to work while someone is talking to Continuing to work while someone is talking to

youyou Repeat a point just madeRepeat a point just made Allow your mindAllow your mind to wander during a to wander during a

conversationconversation

Active ListeningActive Listening

STOP TALKINGSTOP TALKING Put the speaker at easePut the speaker at ease Show that you want to listenShow that you want to listen Remove distractionsRemove distractions Be empatheticBe empathetic Be patientBe patient Hold your temperHold your temper Avoid criticism & argument Avoid criticism & argument STOP TALKINGSTOP TALKING

Interviewing Interviewing TechniquesTechniques the purpose of the interview isthe purpose of the interview is to obtain accurate & thorough informationto obtain accurate & thorough information begin with an explanationbegin with an explanation use open-ended questions use open-ended questions (exception: use closed-ended to obtain (exception: use closed-ended to obtain specific information)specific information) Validating/ClarifyingValidating/Clarifying ReflectingReflecting SequencingSequencing Acknowledging feelingsAcknowledging feelings

Interviewing Interviewing TechniquesTechniques Validating & ClarifyingValidating & Clarifying Reflecting & ParaphrasingReflecting & Paraphrasing SequencingSequencing Acknowledging feelingsAcknowledging feelings Sharing ObservationsSharing Observations

Effective TechniquesEffective Techniques

as a professional nurse, you will as a professional nurse, you will spend about half of your time spend about half of your time asking questions of clients and asking questions of clients and colleaguescolleagues

excellent questioning/interviewing excellent questioning/interviewing skills are fundamental to nursesskills are fundamental to nurses

Why, What, How?Why, What, How? why do you need the information?why do you need the information? how will the information I am seeking how will the information I am seeking

direct me in helping my client?direct me in helping my client? explain reasons in advance, explain reasons in advance,

as this prepares clients for your lineas this prepares clients for your line

of questioningof questioning what will you ask? what will you ask? how will you phrase your questions?how will you phrase your questions?

Who to Ask?Who to Ask?

if client is able to speak for themselves,if client is able to speak for themselves,

ask them ask them family perspectives may also be family perspectives may also be

importantimportant written consent may be required to written consent may be required to

question concurrent/previous healthcare question concurrent/previous healthcare providers providers

be courteous and respectfulbe courteous and respectful never never forget client confidentialityforget client confidentiality

Communication Communication BarriersBarriers ““A barrier to communication is A barrier to communication is

something that keeps meanings something that keeps meanings from meeting. Meaning barriers from meeting. Meaning barriers exist between all people, making exist between all people, making communication more difficult communication more difficult than most people seem to than most people seem to realize.”realize.”

(Ruel Howe)(Ruel Howe)

Communication Communication BarriersBarriers without realizing it, people typically without realizing it, people typically

interject communication barriers into interject communication barriers into conversation 90% of the timeconversation 90% of the time

communication barriers triggercommunication barriers trigger

defensiveness, resistance and defensiveness, resistance and resentment, withdrawal, and feelings of resentment, withdrawal, and feelings of inadequacyinadequacy

they also decrease the likelihood of they also decrease the likelihood of

finding a solutionfinding a solution

JudgingJudging

criticizing: making a negative criticizing: making a negative evaluation of persons, their actions or evaluation of persons, their actions or attitudesattitudes

putting down: stereotyping putting down: stereotyping diagnosing: analyzing why a person is diagnosing: analyzing why a person is

behaving the way he/she isbehaving the way he/she is praising evaluatively: making a praising evaluatively: making a

positive judgment of person, actions or positive judgment of person, actions or attitudesattitudes

Avoiding theAvoiding theOther’s Concerns Other’s Concerns

diverting: pushing the other person’s diverting: pushing the other person’s problems aside through distractionsproblems aside through distractions

logical argument: attempting to convince logical argument: attempting to convince the other person with an appeal to facts the other person with an appeal to facts or logic without consideration of the or logic without consideration of the emotional factors involvedemotional factors involved

False reassurance: trying to stop the False reassurance: trying to stop the other person from feeling the negative other person from feeling the negative emotionsemotions

they are experiencingthey are experiencing

Other BarriersOther Barriers

ordering: commanding the other ordering: commanding the other person to do what you wantperson to do what you want

threatening: trying to control the other threatening: trying to control the other person’s actions by warning of person’s actions by warning of negative consequences you will negative consequences you will imposeimpose

moralizing: preaching, telling someone moralizing: preaching, telling someone what they should dowhat they should do

excessive/inappropriate questioningexcessive/inappropriate questioning

Other BarriersOther Barriers

closed ended questions, like “are you closed ended questions, like “are you sorry you did it?”sorry you did it?”

advising: giving the solutionadvising: giving the solution

Common ErrorsCommon Errors

long winded buildup long winded buildup

(use KISS principle & be concise & focused)(use KISS principle & be concise & focused) the thunder stealer: jumping in with your the thunder stealer: jumping in with your

views & opinions before giving them views & opinions before giving them

a chancea chance bombarding patients with questionsbombarding patients with questions complicated medical terms-complicated medical terms-

don’t use terms patients can’t understanddon’t use terms patients can’t understand

Common ErrorsCommon Errors

offensive misuse of ‘why’ appears offensive misuse of ‘why’ appears threatening and aggressivethreatening and aggressive

closed questionsclosed questions being too abruptbeing too abrupt use of clichésuse of clichés

Blocks to Blocks to CommunicationCommunication

Failure to respect Failure to respect clientclient

Failure to listenFailure to listen Minimizing feelingsMinimizing feelings Inappropriate Inappropriate

comments & comments & questionsquestions

Excessive questionsExcessive questions ClichésClichés Yes/no questionsYes/no questions

ProbingProbing Changing the Changing the

subjectsubject Leading questionsLeading questions AdviceAdvice JudgmentsJudgments False reassuranceFalse reassurance Giving Giving

approval/disapprovaapproval/disapprovall

Blocks to Blocks to CommunicationCommunication

Therapeutic VersusTherapeutic VersusNontherapeutic Nontherapeutic CommunicationCommunication Facilitates transformation of Facilitates transformation of

working nurse-patient relationshipworking nurse-patient relationship Relationship allows for adequate Relationship allows for adequate

& accurate data collection & & accurate data collection & assessmentassessment

Performed with & not for patientPerformed with & not for patient

Therapeutic VersusTherapeutic VersusNontherapeutic Nontherapeutic CommunicationCommunication NON-THERAPEUTICNON-THERAPEUTIC Hinders relationship formationHinders relationship formation Prevents patient from becoming Prevents patient from becoming

mutual partner & relegates mutual partner & relegates him/her to passive recipient of him/her to passive recipient of carecare

Self-DisclosureSelf-Disclosure

Use self disclosure to Use self disclosure to help clients open uphelp clients open up

to you – not to meet to you – not to meet your own needsyour own needs

Keep disclosures briefKeep disclosures brief Don’t imply that your Don’t imply that your

experience is exactly experience is exactly the same as the the same as the client’sclient’s

Only self-disclose Only self-disclose about situations you about situations you have masteredhave mastered

Monitor your own Monitor your own comfort withcomfort with

self-disclosureself-disclosure Respect your client’s Respect your client’s

needs for privacyneeds for privacy Remember that there Remember that there

are cultural variations are cultural variations in the amount of self-in the amount of self-disclosure considered disclosure considered appropriateappropriate

Identify risks and Identify risks and benefits of self benefits of self disclosuredisclosure