Therapeutic interpersonal process; by using good communication

Therapeutic
communication is a practice in which the nurse assists a client to an improved
understanding through verbal or nonverbal interaction (Mosby’s Medical
Dictionary, 2009). According to Russell Delucas 2010, therapeutic communication
is a type of psychotherapy that uses vocal and nonverbal skills. It is an
interpersonal relation between the nurse and the client throughout which nurse centres
on the client’s specific needs to uphold an effectual swap of information
(Videbeck 2010, p.99). This
assignment will explore how the skill therapeutic communication is important to
the nursing practise in the healthcare environment. The benefits of doing therapeutic
communication will be covered, along with the effects of not using therapeutic
communication.  Key issues such as verbal
and non-verbal therapeutic communication will be covered. Also, how questions
can be used in therapeutic communication. Furthermore, this assignment will
talk about patient diversity. The main areas of patient diversity will be environment,
mental capability, learning disability/difference and age. The Code (2015)
composed by The Nursing and Midwifery Council (NMC) will be explored to
identify its impact on therapeutic communication. Finally, a conclusion on this
discussion summarising how the skill is relevant to present-day nursing practice
will be drawn.

Rationale as to why this is an
important skill – include some facts and figures on:

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Links to the benefits of TC

According to C and P (2007,) Peplau had described nursing as an
important therapeutic interpersonal process; by using good communication skills
the nurse can establish and maintain a helping nurse client relationship
Hildegard Peplau’s theory is based on the principles of person’s relationships.
It suggests the development of interaction between the patient and the nurse to
enhance the patient’s contribution in his/her treatment. This can be useful to
nursing practice by reviewing the patient’s needs through therapeutic
communication and working with his/her to find solutions that deal with the
crisis.

The benefits of effective communication in nursing have been researched
for many years by Dougherty and Lister (2007, P52), Kihlgren et al (2003,
P1-13), Boore (1978, P29) and Hayward (1975, P73) and all suggest that the way
in which a nurse interacts and communicates with their patients can have an
impact on recovery time and can also greatly affect the patient’s experience
and the standard of care given

Therapeutic communication is an crucial tool above all other
interventions in mental health setting, for optimistic results, for building of
nurse client relationship, for ventilation of sentiments, for exploring
fundamental approach of patients about themselves and their illnesses
(Morrissey & Callaghan, 2011)

Effects of not using TC

In contrast when carried out ineffectively communication has been shown
to be the leading cause of inadvertent patient harm and clinical errors
(Leonard et al, 2004, P85-90, Pincock, 2004, P1136, Gardezi et al, 2009,
P1390-1391, Sutclifee et al, 2004, P186-194, Ghandi, 2005, P353-358). In the
Every Complaint Matters (2008-2009) report produced by The Parliamentary and
Health Service ombudsman it is stated that a large percentage of complaints
against the NHS are a result of communication breakdown between healthcare
professional and patients. Chant et al (2002, P12-21) suggests that one of the
most fundamental barriers to effective communication in practice is the
clinical environments policies and practices. This is supported by a
qualitative study of patient experiences by McCabe (2004, P41-49) which stated
that patients felt that ‘nurses were often to task orientated’ and only
approached patients to carry out administrative or functional tasks. Chant et
al (2002, P12-21) also writes that students often steered away from chatting
with patients through fear of appearing lazy and not looking busy.

Non-therapeutic communication converses that patient’s dignity and care
is not our priority that make him feel disregarded and not the valuable
creature (Morrissey & Callaghan, 2011)

The reason therapeutic communication is sometimes forgotten could
be because of the fact that most nurses (86%) came forward and stated
that multiple care activities had been left not finished because of lack of
time on their last shift. Comforting or talking with service users (66%) came
out as the most unfinished task in a nurses day (Jane E Ball, Trevor Murrells,
Anne Marie Rafferty, Elizabeth Morrow, Peter Griffiths 2013).

Whilst
patient care is primarily associated with medical treatments and procedures, it
is important to recognise that the relationships formed between patients and
nurses significantly influence patient wellbeing. In a study conducted (Street,
Makoul, Arora and Epsteine 2009), it was shown that the communication between
patients and nurses has a direct impact on patient health and moreover, has the
potential to benefit or worsen their condition.

Key issues – discuss fewer in greater
depth than briefly mentioning everything

Verbal

Verbal communication relates to the spoken word and can be conducted
face-to-face or over the telephone (Docherty &McCallum 2009). Nurses
continually communicate with patients; verbal communication allows the nurse
opportunity to give information to the patient about their care or treatment,
to reassure the patient and to listen and respond to any concerns the patient
may have (NMC 2008). Effective communication is beneficial to the patient in
terms of their satisfaction and understanding of care and treatment they have
been given (Arnold & Boggs 2007), while at the same time optimising the
outcomes or care and/or treatment for the patient (Kennedy- Sheldon 2009).

Non-Verbal

Another part of therapeutic communication that gets discussed time and
time again is non-verbal communication. Words are powerful things and can
stimulate or shut down a conversation, however body language and tone of voice
will override any spoken words (Calcagno, 2008, P333-336). This means even if a
service user says one thing if a nurse understands there body language the
nurse can direct the service user in the right direction. Bush (2001, P39) writes
that body language communicates for up to 80% of the message shown by the
service user. Berman (2008, P461) agrees with this and writes non-verbal
communication can convey how a person is feeling more noticeably than what is
being said and suggests this is because non-verbal communication is controlled
less consciously than verbal communication, in which people have to think about
and choose what words they use. Dougherty and Lister (2004, P17) also agree and
suggest that nurses should always be self-aware, as their body language, tone
of voice, posture,
eye contact and facial expressions can have a great influence on the message
that is being communicated. To communicate effectively with patients nurses
should be positioned at the patient’s eye level, using gestures to show that
they are interested in, listening to and understand what the patient is saying.
Patients often read cues from the nurse’s non-verbal behaviour, which can
indicate interest or disinterest. Attentiveness and attention to the patient
can be achieved through SOLER: S – sit squarely, O – Open posture, L – learn
towards the patient, E – eye contact, R – relax (Egan 2002).

There must be congruency between verbal and non-verbal messages for
effective communication to be achieved. Non-verbal communication can contradict
the spoken word and the ability to recognise these non-verbal cues is vitally
important in nursing practice (McCabe 2006).

Questions and
listening

To help clear things up a nurse must be outstanding at questioning, this
allows the nurse to gather further information and open or closed questions can
be used. Closed questions usually require a yes or no response and are used to
gather the necessary information, whereas open questions allow the patient
opportunity to play an active role and to discuss and agree options relating to
their care as set out in the Healthcare Standards for Wales document (2005).
Probing questions can be used to explore the patient’s problems further thus
allowing the nurse to treat the patient as an individual and develop a care
plan specific to their individual needs (NMC 2008).

Shipley (2010) talks about listening should be deliberate and demands a
conscious effort on behalf of nurses as messages sent through both the
patient’s verbal and non-verbal cues are decoded. In order to do this, nurses
must have the ability to remain silent as in this silence, a patient will have
the freedom to fully express themselves. Through the lone act of sharing their
thoughts and being listened to, it has been found that therapeutic benefits are
achieved as patients are provided with a sense of wellbeing and acceptance
(Shipley, 2010). Furthermore, by actively listening and giving patients the
opportunity to share, nurses are able to receive invaluable information
regarding the patient’s condition and needs.

Active listening is essential for the decoding of patient messages and
will influence the accuracy of documented patient information. In turn, this
will enable the correct medical treatment to be provided. On the contrary,
failing to actively listen may lead to the provision of misdirected healthcare
amounting to poor patient care and potentially entailing adverse patient health
outcomes. Additionally, nurses responsible for such breakdowns in communication
may be held liable for negligence (Forrester & Griffiths, 2011). This
further reinforces the importance of active listening skills being used when
receiving patient messages.

Empathy

Explored by Davis (2010), the ability to show empathy is a much needed
communication skill for nurses as it allows them to be sensitive to the
emotional needs of patients and assess their perspective. Davis (2010) further
elaborated that patients often experience a range of emotions and by being
empathetic, nurses are able to personally identify with patients and share
their feelings. However, empathy should not be confused with sympathy; the
feelings of pity or sorrow for patients (Grover, 2005). It has also been
acknowledged that humans have an innate desire to be understood and this
understanding underpins interpersonal connection and the initiation of healing
(Davis, 2009). Hence through the expression of empathy, better patient care can
be provided

Patient Diversity

There are
different reactions to therapeutic communication as all patients differ in
their characters, background, social status, culture_________

Cultural and age variations, comprehension and proficient differences,
tongue barrier and way of thinking are other obstacles (Klimova ,
2012)

Other factors may affect communication in a negative way, endangering
the process, and nurses must be aware of internal and external barriers. Lack
of interest, poor listening skills, culture and the personal attitude are
internal factors, which may affect the process. External barriers such as the
physical environment, temperature, the use of jargon and/or technical words can
also negatively influence the process (Schubert 2003).

As Stevenson (2008,
p.109) points out, “one size does not fit all”

Mental capability/ LD

Not all
service users are able to understand what the nurse is saying due to a learning
disability, so the nurse must adapt the way in which they communicate with the
service user to help them better understand and therefore make them better.
Ways in which therapeutic communication could be adapted in this situation are;
the nurse could use pictures, photographs, drawings and videos to explain the
situation to the service user. For the nurse to then know if the service user
has understood they can have the service user pick up the picture that relates
to their situation described by the nurse.

Sullivan (1954, as cited in Lorebell n.d.) considers anxiety as a chief
barrier to effective communication.

Environment

One of the main barriers is environment (Fielding, 2006). It is also
observed in clinical setting that wards are usually overloaded that doesn’t
make the patient feel comfortable during conversation.

(Arthur, 2010) suggests that therapeutic gatherings must be conducted in
a peaceful, quiet, regular tenor of voice to deliver that the environment is
safe and harmless. Besides, encouraging the client to use any of the modes of
communication like jotting down, symbolic sketches may also promote therapeutic
communication (Jootun & McGhee 2011)

The Code (NMC 2015) – 2 issues related
to the code:

The value of
Therapeutic communication is that it gives the service user the opportunity and
ability to direct the role they have in their own care. Additionally, Therapeutic
communication makes it so that the nurse can better care for the service user
(Morrissey & Callaghan, 2011). This statement backs up what part 2 of The
Code (NMC, 2015) is telling a nurse, individuals are born with not only the
ability but also the compulsion to express themselves (Daniels 2004) and nurses
have to listen and respond appropriately to the service users’ needs The Code
(NMC, 2015).

The Code
(NMC, 2015) parts 2 states listening to service users and respond to their
preferences and concerns, by doing this nurses must take their time to talk to
service users and give the users the time to understand and reply with their
views and concerns, this means that patient-centred communication uses open
ended questions, reflective listening, and empathy, but patient encounters take
more time, especially if the conversation drifts off focus (Charlton, Dearing,
Berry, & Johnson, 2008).

Conclusion – summary of essay and the
key points you have raised, no new information

Therapeutic
communication which is intended to help the patient involves the interpersonal
communication between the patient and the nurse. Therapeutic communication
techniques infer independence on the patient. The role of the healthcare
professional is then to use this information to help the client to further
investigate his own feelings and options.

Barriers to
communication may have a negative effect on the patient, lowering the patient’s
self-esteem and may block communication. Collaboration with all the members of
the health care team might be considered the key to a successful therapeutic
communication.

The impact of therapeutic communication is that it facilitates client’s
autonomy, emphasizes a holistic view of a person, communicate that nurse is
here to listen, help and plan for their betterment (Banar, 2012)