communication, therapeutic communication in nursing

1. Presented by
RESMI G S
M Sc Nursing 1st year
12/8/2013

2. INTRODUCTION
Communication is a dynamic, reciprocal
process of sending and receiving messages.
Communication is more than the act of
talking and listening. From the first cry of a
newborn to the whisper of a person who is
dying, the primary purpose of a
communication is to share information and
obtain a response.
People use
communication to meet their physical,
psychosocial, emotional and spiritual needs

3. DEFINITION
• Communication is ‘any act by which one
person gives to or receives from person
information about that person’s needs desires,
perception, knowledge or affective states’.
Communication may be intentional or
unintentional, may involve conventional or
unconventional signals, may take linguistic or
non-linguistic forms and may occur through
spoken or other modes.

4. LEVELS OF COMMUNICATION
• INTRAPERSONAL COMMUNICATION
• INTERPERSONAL COMMUNICATION
• GROUP COMMUNICATION
–
PUBLIC SPEAKING

5. INTRAPERSONAL COMMUNICATION
• It is conscious internal dialogue, sometimes
known as self-talk. It is language use or thought
internal to the communicator. The individual
becomes his or her own sender and receiver,
providing feedback to him or herself in an
ongoing internal process. It can be useful to
envision intrapersonal communication occurring
in the mind of the individual in a model which
contains a sender, receiver and feedback loop.

6. INTERPERSONAL COMMUNICATION
• It is communication between two or more
people.
• Face to Face conversation between two
people is the most frequent form of
interpersonal communication.
• Nurses use interpersonal communication
to gather information during assessment,
to teach about health issues to explain
care and to provide comfort and support.

7. GROUP COMMUNICATION
• It is interaction that occurs among several
people.
• Small group communication occurs when
you engage in an exchange of ideas with
two or more individuals at the same time.

8. PUBLIC SPEAKING
• It is a unique form of group communication.
Generally the speaker addresses a dozen to
hundreds of people, and varying degrees of
interaction occur.
• Speaker may deliver a speech talk directly with a
group of audience members or have open
discussion with the group. It is at the heart of our
economy, society and politics.
• Nurses often engage in public speaking to
educate groups of people about health issues

9. THE COMMUNICATION PROCESS
• Communication requires a sender, a message, a
receiver and a response or feedback.
• Communication is a two-way process involving
the sending and the receiving of a message.
Because the intent of communication is to elicit
a response the process of ongoing; the receiver
of the message then becomes the sender of a
response, and the original sender then becomes
the receiver.

10. Communication Process
•Message
•Source (sender)
•Channel
•Receiver
•Feedback (response)

11. The Communication Process
Message
Barrier
SENDER
(encodes)
Barrier
Feedback/Response
RECEIVER
(decodes)

12. MODES OF COMMUNICATION
• VERBAL COMMUNICATION
• NONVERBAL COMMUNICATION

13. Factors in verbal and nonverbal modes
of communication
• VERBAL
a) Pace and intonation
b) Simplicity
c) Clarity and brevity
d) Timing and relevance
e) Adaptability
f) Credibility
g) Humor
•
•
•
•
•
•
NONVERBAL
Facial expression
Posture and Gait
Personal Appearance
Gestures
Touch

14. CHARACTERISTICS OF EFFECTIVE
COMMUNICATOR
An effective verbal
communicator:
• Clarifies
• Listens
• Encourages
empathically
• Acknowledges
• Restates/repeats
An effective nonverbal
communicator:
• Relaxes
• Opens up
• Leans toward the other
person
• Establishes eye contact
• Shows appropriate
facial expressions

15. What are the most common ways
we communicate?
Written Word

16. FACTORS INFLUENCING THE
COMMUNICATION PROCESS
•
•
•
•
•
•
•
•
•
Development,
Gender
Values And Perceptions,
Personal Space,
Territoriality Roles And Relationships,
Time
Environment,
Congruence
Interpersonal attitudes.

17. THERAPEUTIC COMMUNICATION
• Therapeutic communication means that
nurses use their communication in such a
way that it will be benefit to their patient.
• Therapeutic communication differs from
normal communication in that it introduces
an element of “empathy’’ into what can be
traumatic experience for the patient and also
the patient are made to feel validated.

18. IMPORTANCE OF THERAPEUTIC
COMMUNICATION
• It impels a feeling of comfort in the face of
patient.
• To increase self-worth or decrease
psychological
distress
by
collecting
information to determine the illness, assessing
and modifying the behaviour and providing
health information.

19. •
•
•
•
•
•
•
•
•
•
•
•
•
•
•
THERAPEUTIC COMMUNICATION
TECHNIQUES
USING SILENCE
BEING SPECIFIC AND TENTATIVE
USING OPEN-ENDED QUESTIONS
USING TOUCH
RESTATING OR PARAPHRASING
SEEKING CLARIFICATION
PERCEPTION CHECKING OR SEEKING CONSENSUAL VALIDATION
OFFERING SELF
ACKNOWLEDGING
GIVING INFORMATION
CLARIFYING TIME OR SEQUENCE
PRESENTING REALITY
FOCUSING
REFLECTING
SUMMARISING AND PLANNING

20. BARRIERS TO COMMUNICATION
•
•
•
•
•
•
•
•
•
•
•
STEREOTYPING
AGREEING AND DISAGREEING
BEING DEFENSIVE
CHALLENGING
PROBING
TESTING
REJECTING
CHANGING TOPICS AND SUBJECTS
UNWANTED REASSUARENCE
PASSING JUDGEMENT
GIVING COMMON ADVICE

21. FIVE WAYS TO FACILITATE
THERAPEUTIC COMMUNICATION
•
•
•
•
•
MAINTAIN PAIENT – CENTERED TEACHING
SUPPRESS PREJUDICES
CREATE A THERAPEUTIC ENVIRONMENT
BE ALERT TO NON VERBAL CLUES
ESTABLISH A TRUSTING RELATIONSHIP

22. INTERPERSONAL RELATIONSHIP
• An interpersonal relationship is a strong deep
or close association / acquaintance between
two or more people that may range in
duration from brief to enduring. The nurse is
an important of the health care team that
must work in co-operation and harmony for
the care of the patient. This co-operation and
harmony depends upon the IPR that is
maintained among the members of the health
care team.

23. THEORETICAL ASSERTION
• The purpose of nursing achieved though the
establishment of a human to human relationship.
• The human condition is shared by all human being.
• Most people at one time or another and in varying
degrees will experience joy, contentment, happiness
and love.
• All persons, at sometime in their lives will be
confronted by illness and pain.
• The quality and quantity of nursing care delivered to
an ill human being is greatly influenced by nurse’s
perception of the client.
• The term patient and nurses are stereotyped and
only useful for communicate economy.

24. THEORETICAL ASSERTION (CONT.)
• The roles of the nurse and patients must be
transcended to establish a human to human
relatedness.
• Illness and suffering are spiritual encounters as well
as emotional physical experience.
• Communication process enables the nurses to
establish a human to human relationship and
thereby fulfil the purpose of the nursing profession.
• Individual can be assisted top find meaning in the
experience of illness and suffering then individual
can cope with the problem exchanged by these
experience.

25. THEORETICAL ASSERTION (CONT.)
• The spiritual and ethical values of the nurse,
about illness suffering will determine the
excellent top which she will be able to assist
individuals and families to find meaning these
difficult experiences.
• It is the responsibility of the professional
nurse practitioner to assist individuals and
families to find meaning in illness and
suffering.

26. PRINCIPLES OF IPR
• Learn everyone’s, name and never address
anyone by nick name.
• Respect every one’s individually. Each member of
a team is as important as other.( Keep up the
status of every member)
• Do not impose anything on anybody.
• Keep emotions under control.
• Do not give and take personal favour.
• Don’t be afraid to admit ignorance

27. PRINCIPLES OF IPR (CONT.)
• The team leader should not make any excuse
regarding his or her responsibility.
• Develop the habits of listening and focus
attention on the problem.
• Do not do or say anything that will disturb
others faith.
• Give importance to others and practice justice

28. PRINCIPLES OF IPR (CONT.)
• The members of team should be loyal, honest
dependable and willing to carry out the
directions of the team leader.
• There should be team spirit or team feeling
among the members. Each member should
work for the interest of the group.
• There should be mutual understanding
between the members. They should be willing
to give and take corrections.

29. PRINCIPLES OF IPR (CONT.)
• There should be delegation of responsibility in
a group and every member should carry out
his or her responsibility to the satisfaction of
the groups.
• The relationship between the members of a
group should be decent and considerate.
• Teach the newcomer about the job. Make sure
that all the assignments are understood.

30. PRINCIPLES OF IPR (CONT.)
• The new comer of the group should feel; at
home when he joins the group.
• Establish a good rapport among the member
in order to achieve the aim.
• Every member should be familiar with
organizations plan and the policies of the
group.
• Be up to date with the information that is
going around

31. PRINCIPLES OF IPR (CONT.)
• Avoid arguments in the group.
• Talk in terms of other man’s interest.
• Praise the slightest improvement made by
others. Use words of encouragement.
• Have a smiling face always.
• Prepare yourself mentally to accept the worst
if necessary.

32. CHARACTERSTICS OF IPR
• Helping relationship is a therapeutic relationship
in nursing which promoting a psychological
climate that brings a positive change in the client
and promote his group.
• Facilitative characteristics
• Action oriented

33. FACILITATIVE CHARACTERISTICS
• They are the essential message for the nurse to
establish positive and supportive relationship
with the client.
• These are condition that creates an emotional
environment in which a patient feels
comfortable and safe.

34. FACILITATIVE CHARACTERISTICS
(CONT.)
• TRUST
It may be defined as the belief that other will
provide in terms of need and distress trust fosters
open therapeutic communication to foster the
nurse’s act consistently, reliably and competently.
• EMPATHY
It’s the ability to understand and enter the client’s
frame of reference. Empathy is sensing,
comprehensive and sharing the client’s frame of
reference beginning with the problem that the client
recognises in other words. It is a phase of sensitive
and objective look at what another person
experiences.

35. FACILITATIVE CHARACTERISTICS
(CONT.)
• CARING
It is having a positive regard for another person.
It is basic in helping relationship. Nurses can
show caring by expediting clients as who they are
and respecting them as individuals. It promotes
trust and decrease anxiety and distress.
• AUTONOMY AND MUTUALITY
It is the ability to the self director. Mutuality
involves sharing with another. These are
important in any helping relationship.

36. FACILITATIVE CHARACTERISTICS
(CONT.)
• GENUINESS
It is considered to be most basic of helping
conditions. The helper needs you be aware of his
own feelings. He should be comfortable with who
he is so that he does not lookout his own feelings
from himself.
• NON POSSESSIVE WARMTH
It simply means unconditional positive regard,
respect for others and praising the other

37. ACTION ORIENTATION
These are conditions that assist a person to move towards
his goals.
Action oriented characteristic are used on the nurse patient
relationship to progress beyond the initiation process.
• CONCRETENESS IN COMMUNICATION
A person is helped when he is encouraged to express his
concern in specific and personal terms.
• IMMEDIACY
The nurse attends to any interpersonal process within the
therapeutic relation.
• SENSITIVE CONFRONTATION
It is non-judgemental point out of discrepancy in a helping
behaviour. It should be used carefully and should never
used in earlier phase of therapeutic relationship.

38. INTERPERSONAL COMMUNICATION
• It occurs between two or more person with a goal
to exchange messages.
• Most of the nurse’s day is spent communicating
with the patient, family members and member of
health care team.
• The nurses’ ability to communicate effectively at
this level influences the nurses interpersonal
sharing, problem solving, goal attainment, team
building and effectiveness in critical nursing roles.
(E.g.:- care giver, teacher, counsellor, leader,
manager, and patient advocate)

39. MODEL PRESENTING HUMAN TO
HUMAN RELATIONSHIP
• The model represents the interaction between the
nurse and patient or recipient of her care.
• The major characteristics of this experience are that
the nursing need of the individuals is met.
• The half circle at the point of original encounter
indicates the possibility of and need for developing
encounter into therapeutic relationships.
• As the interaction process progresses towards rapport
the circle joins in to one full circle, representing that
the potential for a therapeutic relationship has been
attained.

40. MID-RANGE THEORY OF IPR
• Hildegard Peplau’s (1952:1997) mid-range theory of
interpersonal relationships is considered an essential theory
frame work for the study of interpersonal relationships.
• The model describes how the nurse-client relationship can
facilitate the identification and accomplishments of
therapeutic goals top enhance client and family well-being.
• In today’s health care environment nurse-client relationships
are of short duration concise and effective. Despite the
brevity of the relationship, Peplau’s basic principles
partnership and terminating a relationship remain relevant.
• Peplau’s frame work for interpersonal relationships is
applicable to all areas of nursing.

41. MAJOR CONCEPTS
• The theory explains the purpose of nursing to help others
identify their felt difficulties.
• Nurses should apply principles of human relations to the
problems that arise at all levels of experience.
• Peplau’s theory explains the phases of interpersonal
process, roles in nursing situations and methods of
studying nursing as an interpersonal process.
• Nursing is an interpersonal process because it involves
interaction between two or more individuals with a
common goal.
• The attainment of goal is achieved through the use of a
series of steps following a series of pattern.
• The nurse and patient work together so both become
mature and knowledgeable in the process.

42. DEFINITIONS
• Person- A developing organism that tries to reduce anxiety
caused by needs.
• Environment- Existing forces outside the organism and in
the context of culture.
• Health- A word symbol that implies forward movement of
personality and other ongoing human process in the
direction of creative, constructive, productive, personal
and community living.
• Nursing- A significant therapeutic interpersonal process. It
functions cooperatively with other human process that
makes health possible for individuals in communities

43. PEPLAU’S SIX NURSING ROLES
• Stranger: Receives the client the same way one meets a
stranger in other life situations, provides an accepting
climate that builds trust.
• Resource role: Answers questions, interprets clinical
treatment data, and gives information.
• Teaching role: Gives instructions and provides training,
involves analysis and synthesis of the learner experience.
• Counselling role: Helps client understand and integrate the
meaning of current life circumstances provide guidance
and encouragement to make changes.
• Surrogate role: Helps client clarify domains of
dependence, interdependence and independence and acts
on client’s behalf as an advocate.
• Leadership role: Helps client assume maximum
responsibility for meeting treatment goals in a mutually
satisfying way.

44. ADDITIONAL ROLES INCLUDE
•
•
•
•
•
•
•
•
•
•
•
Technical expert
Consultant
Health teacher
Tutor
Socializing agent
Safety agent
Manager of environment
Mediator
Administrator
Recorder observer
Researcher

45. PHASES OF INTERPERSONAL
RELATIONSHIP
• The nurse-client relation is therapeutic not social in
nature.
• It is always client centred and goal directed.
• It is objective rather than subjective. The intent of a
professional relationship is for client behaviour to
change.
• It is a limited relationship, with the goal of helping
the client find more satisfying behaviour patterns
and coping strategies and increase self worth.
• It is not for mutual satisfaction.

46. PHASES OF INTERPERSONAL
RELATIONSHIP (CONT.)
• Peplau’s developmental stages parallel to the
nursing process.
• The orientation phase correlates with the
assessment phase of the nursing process.
• The identification component of the working
phase corresponds to the planning phase, where
as the exploitation phase parallels the
implementation phase.
• The final resolution phase of the relationship
corresponds to the evaluation phase of the
nursing process.

47. PRE INTERACTION PHASE
• The pre interaction phase is the only one in
which the client does not directly participate.
Awareness of professional goal is important.
• The preinteraction phase occurs before you
meet the client. In this phase you will gather
information about the client. In this phase,
the nurse and client do not have direct
communication.
• First phase in Peplau’s theory is orientation
phase.

48. ORIENTATION PHASE
• The nurse enters the relationship in the
“Stranger” role and begins the process
of developing trust by providing the
client with basic information about the
nurse and essential information about
the purpose, nature, and time available
for the relationship.
• It is also referred to as the introductory
or the prehelping phase is important
because it sets the tone for the rest of
the relationship.

49. ORIENTATION PHASE (CONT.)
• It begins when you meet the client.
• The goal in this phase is to establish rapport
and trust.
• This phase begins with introductions,
followed by an initial exchange of information.
• During this phase verbal and nonverbal
communication occurs.

51. WORKING PHASE / IDENTIFICATION
PHASE
• It is the planning phase. The conversation
in the working phase turns active
problem solving related to assess health
care needs.
• Clients are able to discuss deeper, more
difficult issues and experiment with new
role and actions.

52. WORKING PHASE/ IDENTIFICATION
PHASE (CONT.)
• Working phase focuses on self direction and self
management to whatever extent is possible in
promoting the clients health and well-being.
• It is the active part of the relationship.
• During this phase, caring is communicated,
thoughts and feelings are expressed, mutual
respect is maintained, and honest verbal and
nonverbal expression occurs.
• Key communication goals are to assist the client
to clarify feelings and concerns

53. EXPLOITATION PHASE
• Use of professional assistance for problem
solving alternatives.
• Individual feels as an integral part of the helping
environment.
• The principles of interview techniques must be
used in order to explore, understand and
adequately, deal with the underlying problem.
• Patient may fluctuate on independence.
• Nurse aids the patient in exploiting all avenues of
help and progress made towards the final step.

54. TERMINATION PHASE
• In the termination phase, the nurse and client
evaluate the client’s responses to treatment, and
explore the meaning of the relationship and what
goals have been achieved. Nurses need to be
sufficiently aware of their own feelings so that
they may use them constructively without
imposing them on the client.
• Patient drifts away and breaks bond with nurse
and healthier emotional balance is demonstrated
and both become mature individuals.

55. TERMINATION PHASE (CONT.)
• The termination phase is the conclusion
of the relationship, whether at the end of
the nurse’s shift or on the client’s
discharge from the unit, facility or
service. If communication has been
effective, the termination phase prepares
the nurse and client for future
interactions

56. INTERPERSONAL THEORY AND
NURSING PROCESS
• Both are sequential and focus on
therapeutic relationship.
• Both use problem solving techniques
for the nurse and patient to
collaborate on, with the end purpose
of meeting the patient needs.

57. ASSESSMENT
 Data
collection
and
(Continuous).
 May not be a felt need.
ORIENTATION
analysis  Non
continuous
collection
 Felt need.
 Define needs
NURSING DIAGNONSIS PLANNING
 Mutually set goals
IDENTIFICATION
 Interdependent goal setting
IMPLEMENTATION
EXPLOITATION
 Plans initiated towards achievement of  Patient actively
mutually set goals
and drawing help
 May be accomplished by patient nurse or
 Patient initiated
family.
EVALUATION
 Based on mutually expected behaviour
 May led to termination and initiation
data
seeking
RESOLUTION
 Occurs after other phases
are completed successfully.
 Leads to termination.

58. CONCLUSION
• Communication is essential wherever there are
people living and working together. Interpersonal
relationship is also an important factor in our day
to day communication, especially in the field of
nursing. Considerable thought and attention have
been given to the subject of IPR. Nursing is a
caring profession and basically the primary role of
a nurse is to render on effective harmonious
relationship to the patient so both communication
and interpersonal relationship are both sides of a
coin.

59. Success for YOU…
…in the new global and diverse
workplace requires
excellent communication skills!