Therapeutic Communication a powerful tool.
According to Wikipedia
, Communication is the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs. Merriam Webster
says, communication is a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior.
Everyday we communicate to our spouses, children, parents, neighbors and to other people that surrounds us.
With the advancement of technological breakthrough, communication has never been the same compared to the old days. Today you can text message or e-mail a love one that is miles and miles away.
As caregivers, therapeutic communication is the lifeblood
of being a nurse. If you don’t have any clue what your patient is telling or trying to impart to you how would you offer and give appropriate treatment? Is my patient in pain? Hungry and wanting something to drink? It will be very confusing and frustrating for both the patient and the healthcare worker.
I remembered one morning shift while working in a cardiology unit, our cardiologist approached me and asked me to talk to an elderly Filipino woman whom staff think is demented. I said okay, I reviewed her chart and gathered some questions I can ask her. I noted that she’s on several anti-psychotic medications
ordered from the Emergency Room.
I entered her room, she was sitting on her chair just right after breakfast. I introduced myself and started a conversation. I asked, “Kamusta po Lola?“ (How are you grandma?). She turned towards me and I saw her face lit up. She’s so happy to see and talk to someone with the same language. During our conversation I learned that she and her husband are supposed to be together to come to Canada as their life long dream but her husband passed away before they can fly out. She just arrived in Canada about 2 months ago. She’s usually by herself at home while her daughter is at work all day.
I asked Lola (grandma) all the questions I needed to verify to make sure that she’s not demented and she passed with flying colors. I almost forgot that I have my own patients to look after because I enjoyed talking to her. I said thank you and good bye to her. Then, I approached Dr. White (cardiologist) I explained to him that she was alert, oriented and able to answer all my questions appropriately. The doctor said thank you and discontinued all her anti-psychotic drugs right away.
Another instance were I had a Chinese elderly patient before, I don’t know how to speak Cantonese or Mandarin so I use hand signals and written translations to communicate. I noticed that whenever I say “Pang-Yao” he would smile at me and nod his head. I learned that “Pengyou” (correct spelling) means “friend.” We usually call a co-worker who can translate for them or an interpreter.
Looking back at those experiences, I realized that the process of therapeutic communication is complex and needs ongoing application. Language barrier is crucial and needs to be addressed accordingly
. My fear is - It could have been worse
. Maybe somebody or a staff can be very impatient and can just inject some Haldol to that elderly woman. Failure to communicate leads to serious problem. I reminded some co-workers, students and including myself that not all elderly are demented but for sure all of them needs our understanding, care and above all - patience.
Reckless words pierce like a sword,
but the tongue of the wise brings healing.
- Proverbs 12:18 -
Nursing action is a process of social interaction whereby nurses bring about positive changes in client’s health status as a result of therapeutic communication. (Kasch, 1986). I remembered memorizing therapeutic communication techniques during our psychiatric exposure to the mentally challenged patients.
But do you know that you can use these therapeutic communication techniques to improve and maintain a harmonious relationship with your spouse, children, co-workers and friends? Let’s examine this scenario.
About a woman who nags and frustrated with her husband because he is usually out of the house. He won’t do his share of the chores and he would just give her the silent treatment. One day the woman finally snaps. “What’s your problem?! Why are you so mean? Your usually out with your friends. Does it bother your macho image if you at least help out a bit?”, she retorts, stomping off her feet away from him.
But what if, she had said something like…
1. “Honey, it’s hard for me to stay here at home by myself and when you are around I notice that you seems very quiet. I love you and I want to know if there is something bothering you“. Most people will open up because you’ve taken the blame, recognize him and empathize with him.
This communication technique is called Empathy
. Empathy is the ability to understand and accept the situation of others. It is an act of being fair, objective and sensitive to another person.
Or something like this…
2. “I’m sorry if you feel that I don’t trust you at times. We seem to be having misunderstandings lately. Whenever you are ready I am just here to listen". Instead of using fire with fire, extinguish the fiery mood with understanding and not provocative questions that can only escalate the conversation.
This communication technique is called “Asking why
”. Asking why may imply an accusation. It can cause resentment, insecurity and mistrust.
Or maybe like this…
3. “Okay honey, I miss you and I am getting worried lately. You seem very quiet and you’re not the usual you. I think there is something bothering you. I will just seat right here in the sofa, I won’t interrupt, agree or disagree with you. Whenever you're ready, I'm just here and I will listen.
This communication is called Listening Attentively
. Attentive Listening is not just hearing with your ears but also listening with your heart. It allows a person to understand an entire message conveyed verbally and nonverbally over all facilitating trust.
Other Therapeutic Communications are:
1. Maintaining silence - help both parties organize thoughts and feelings.
2. Conveying acceptance - being non judgmental and willing to hear a message.
3. Asking related questions - use of open ended questions, not answerable by yes or no.
4. Paraphrasing - restating the words received to make sure feedback is accurately received.
5. Clarifying - use of examples to properly interpret or ask the person to restate it.
6. Focusing - directs conversation to a specific topic or issue.
7. Stating observations - describe observed behavior that can provide feedback to both parties.
8. Offering information - offering suggestions to prevents one-sided conversation, vital for decision-making.
9. Summarizing - concise review of main ideas from the discussion.
10. Offering oneself - expressing willingness to be available and to listen. (promotes trust)
There you go, these are the therapeutic communication techniques that you can use. Be creative!
In the long run, our relationships to our spouse (marriage), our children (family), our church mates, our co-workers and our friends (friendship) are worth the effort, indeed worth fighting for!
Do you have any communication technique experience?
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Thank you in advance for sharing.
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