The structure of this essay is designed to show the importance of relationship centered communication. However it will begin with a brief definition of the essential concepts intrinsic to the topic of therapeutic communication, distinct therapeutic nurse-patient relationship. Thereafter, it will focus on verbal and nonverbal communication, listening, understanding, empathy and important aspects of confidentiality and privacy.
IntroJust as chemistry sciences were adopted as the 20th century medical model, patient’s perspective into a relationship-centered communication has been suggested as appropriate for the 21st century. It is the medical dialogue that provides the fundamental vehicle through which the battle of perspectives is waged and the therapeutic relationship is defined (Roter D. 2000). In many regards, the primary challenge to the field is the development of therapeutic communication that will provide a valid representation of the therapeutic relationship (Craven & Hirnle 2000). The purpose of this essay is to explore the implications of therapeutic communications in the nature of the patient-nurse relationship and its expression in routine of medical practice.
Therapeutic communication is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient (http://tpub.com/content/medical ).
Communication is an essential process when providing culturally competent nursing care and it must be therapeutic in nature to be effective.
It involves the use of techniques such as using silence, offering self, restating, reflecting, and seeking clarification to name a few. Therapeutic communication involves displaying a genuine interest in the person communicating that is demonstrated trough the use of a relaxed and comfortable body posture. Therapeutic communication requires the components of empathy, positive regard, and a positive sense of self (Craven & Hirnle 2000).
But no single definition could possibly capture the rich and complex nature of the relationships between patients and nurses. Each relationship is distinct, because both patient and nurse are distinctive and the way they interact and relate is unique (Parbury 2006).
The therapeutic nurse/client relationship stands at the core of health nursing. Through the establishment of this relationship, nurses are ideally suited as therapists to lead clients toward accomplishing their health goals (Parbury 2006). Therapeutic relationships between patients and nurses are formed in the majority of situations. In this type of relationships nurse’s perspective is primarily that the patient is a patient, but there is also recognition and understanding of the patient as the person (Parbury 2006).
There are few similarities between the therapeutic relationship and friendship. It’s important to both to have worth, friendliness, trust, care, honesty and respect. Some differences in values and attitudes can hinder both as well as poor communication strategies. A feeling of satisfaction is important to both and also transference (involves clients feelings and acting toward the therapist as they did to other individuals in the past, mother/father for example) can occur in both ( Craven & Hirnle 2000).
Let’s look into differences between the therapeutic relationship and friendship.
Contract. A contract implicit on exploit is usually negotiated between client and workers and may include payment together they agree on. Limits are set whereas in friendship there is usually no monetary reward or contracts exchanged (Craven & Hirnle 2000).
Aims. In helping relationship there are specific goals. Friendship on the other hand, does not usually have agreed upon goals, it’s usually spontaneous.
Focus. Helpee’s needs are the focus of attention in the helping relationship- the helper temporally sets aside personal needs. In contrast, friendship usually means that mutual needs are met in sharing way (Beck & Polite 2004).
Time. Therapeutic relationship require time that is planned, limited and sometimes scheduled. In addition time is finite and perhaps negotiated by a contract. Time in friendships is mostly spontaneous and tends to have fewer limits (Parbury 2006).
Objectivity. Therapeutic relationships require that the helper strives to be objective, and to act in client’s best interests. Objectivity is mostly impossible in friendships due to the fact that self interest is largely paramount (Gladys, Husted and Husted 2001)Acceptance. The helper tries to accept the client in therapeutic relationship thereby is able to understand the behavior of imposing value and judgments. On the other hand friendships usually terminate when differences in values or interests become too great.
After actively listening to a patient it is natural for a nurse to respond verbally. The nurse’s initial verbal responses set the direction for further interaction. Because there is a variety of possible ways to respond, nurses must ensure that their verbal responses move the relationship in a desired and intended direction (Parbury 2006). Choice of the response is based on insight into how it may affect the patient, the interaction and the relationship. A nurse who has this insight and awareness is in the best position to respond in the manner that both matches the current situation and realizes the response’s desired intent (Parbury 2006).
Nonverbal responses are very important and the ability to recognize and interpret this kind of responses depends upon consistent development of observation skills. As we continue to mature in our role and responsibilities in the healthcare team, both clinical knowledge and understanding of human behavior will also grow (Beck & Polit 2000). Our growth in both knowledge and understanding will contribute to our ability to recognize and interpret many kinds of nonverbal communication. Our sensitivity in listening with our eyes will become as refined as-if not better than-listening with our ears (Roter 2000).
Most frequently, the relationship and communication between patient and nurse begins with an interview, during which the nurse collects pertinent data about the patient (Parbury 2006).
The effectiveness of an interview is influenced by both the amount of information and the degree of motivation possessed by the patient (Parbury 2006). Factors that enhance the quality of an interview consist of the participant’s knowledge of the subject under consideration; his patience, temperament, and listening skills; and our attention to both verbal and nonverbal cues. Courtesy, understanding, and nonjudgmental attitudes must be mutual goals of both the interviewee and the interviewer (Roter 2000).
Understanding a patient’s experience, that is, viewing the world from patient’s perspective is one of the most essential aspects of interacting and building relationships in nursing (Parbury 2006). In patient-nurse relationship it is the nurse’s responsibility to make mutual understanding easier, which would be the basis of meaningful interaction. Mutual understanding requires time, effort, commitment and skill. It can be challenging for one person to understand and appreciate another person’s reality. Listening and effective attending would give ability to the nurse to develop an understanding of the patient’s experience (Parbury 2006). Effective listening demonstrates open acceptance of the patient, and encourages the patient to interact.
Listening to the patient and watching how he listens. Observing how he gives and receives both verbal and nonverbal responses.
When nurses listen, just listen, they pay careful attention to what they hear and observe, they focus on what is expressed by the patient and they try to determine what the patient is meaning. Effective listening requires receptivity, sustained concentration and astute observation. The skill of listening is fundamental and crucial to patient-nurse relationship (Ooijen 2000). Listening permeates the entire relationship; if meaningful interpersonal connections are to occur, listening must be engaged in throughout every interaction in therapeutic relationship (Parbury 2006).
The skills of clarification are used whenever nurses are uncertain or unsure about what patients are saying. Clarification is often achieved trough the use of probing skills. At times a restatement of what a patient has said is an effective means of clarifying (Parbury 2006). Other times, nurses clarify what a patient has said by sharing how they might feel, think and perceive the situation if they were the patient. Reflecting feelings is useful too, because it conveys the nurse’s recognition of feelings and confirms the existence of emotions. When used to collect information, therapeutic communication requires a great deal of sensitivity as well as expertise in using interviewing skills (Roter 2000). To ensure the identification and clarification of the patient’s thoughts and feelings, we, as the interviewers, must observe his behavior.
By using the skills of understanding nurses can arrive at knowing what patient is experiencing and thus are in a better position to be empathetic. Empathy is the ability to perceive the world from another person’s view, and take on the perspective of another, while not losing one’s own perspective (Parbury 2006). The ability to enter to another person’s experience to perceive it accurately and to understand how the situation is viewed from the client’s perspective is very important in therapeutic communication.
By using therapeutic communication, we attempt to learn as much as we can about the patient in relation to his illness. To accomplish this learning, both the sender and the receiver must be consciously aware of the confidentiality of the information disclosed and received during the communication process (Roter 2000). Confidentiality is not merely keeping patient information inside the confines of a particular setting, but also considering what should be shared, trough reporting and recording, with other nurses and other health care professionals (Parbury 2006).There has to be a therapeutic reason for invading a patient’s privacy. Information that has no direct bearing on the nursing or other healthcare of the patient should be considered confidential and treated as such (Parbury 2006).
Finally, interpret and record the data we have observed. As I mentioned earlier, listening is one of the most difficult skills to master. It requires maintaining an open mind, eliminating both internal and external noise and distractions, and channeling attention to all verbal and nonverbal messages (Roter 2000). Listening involves the ability to recognize pitch and tone of voice, evaluate vocabulary and choice of words, and recognize hesitancy or intensity of speech as part of the total communication attempt. The patient crying aloud for help after a fall is communicating a need for assistance. This cry for help sounds very different from the call for assistance we might make when requesting help in transcribing a physician’s order (Roter 2000). Also advances in both video recording technology and participant observations have led us to consider ways in which these observational methods may be blended to answer research questions. Such innovations in data collection have the potential to extend our understanding of social interactions in important ways (Paterson, Bottorf & Hewat 2003).
ConclusionFinally, essential nature between patients and nurses is that of mutual understanding. It is clear that to function effectively in the therapeutic communication, we need to be informed and skilled practitioners, but not only that, active listening, empathy, understanding is necessary when we there to help our patients. They become calmer and more appreciated after having someone listen to them and express their feelings. Nurse needs to have the ability to express verbally and nonverbally, clarifying and reflecting with the patient, spending time and accepting and understanding behavior of imposing value and judgments. Also let the patient know that we care and that they are able to trust because of information that they share with us stays confidential and their privacy will not be damaged. Clearly therapeutic communication is central to health nursing and through this process nurse-client relationships can be enhanced.
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