L3: Therapeutic Communication

• WHAT IS COMMUNICATION?: Act or process of using any means of expressing one’s ideas, thoughts, feelings to someone else
• INTERVIEWING

  • One of the most critical tools.
  • The most important manifestation of communication in health care.
• Functions of the Interview in Healthcare

  • Determine the nature of the problem
  • Develop and maintain the provider-patient relationship
  • Communicate information and implement a treatment plan
• Interview Structure: Interview Opening, Body, Conclusion
• Opening

  • is critically important to the overall success of the interview because it sets tone for the entire interview.
  • Tone/atmosphere can be: casual, formal, friendly or hostile
• Opening

  Serves four important functions:

  1. To exchange mutual introductions
  2. To motivate the interviewee to participate
  3. To establish a good working relationship between the two parties
  4. To provide a preview of what will occur during the interview
• Opening

  Rapport: Trust, Understanding, Respect, Liking

  Building Rapport: is one of the many ways of establishing a good working relationships
• Opening

  Guidelines in Building Rapport

  1. PROPER INTRODUCTIONS:

  • know the patient’s name
  • patients should know your name
  • You should also introduce self to any other people who are present with the patient
• Opening

  Guidelines in Building Rapport

  2. ARRANGE COMFORTABLE SETTING

  2.1 Control your nonverbal behaviors

  • Make eye contact
  • Smile while exchanging pleasantries
  • Shake hands firmly (but not too firmly) Will help you to be perceived by others as self- confident, mature, and approachable
• Opening

  Guidelines in Building Rapport

  2. ARRANGE COMFORTABLE SETTING

  2.2 Monitor what you say

  • control your verbal output
  • know when to draw the line
• Opening

  Guidelines in Building Rapport

  2. ARRANGE COMFORTABLE SETTING

  2.3 Maintain your boundaries.

  • maintain the proper social distance between yourself and others
• Opening

  Guidelines in Building Rapport

  2. ARRANGE COMFORTABLE SETTING

  2.4 Turn on your feeling-detectors.

  • Learn to read the nonverbal communication of other people
  • Use these signals as “data” on which you can base what you say and do in their presence
• Opening

  Guidelines in Building Rapport

  2. ARRANGE COMFORTABLE SETTING

  2.5 Manage your emotions.

  • You also have to control your own feelings. You may get upset, feelsnubbed, or have an irrepressible desire to giggle
• Opening

  Guidelines in Building Rapport

  2. ARRANGE COMFORTABLE SETTING

  2.6 Try to build your self-esteem

  • More confidence in your ability to communicate with others will help you straighten your shoulders and muster your self-composure.
• Body

  • Is the core of the interview.
  • Both parties work to achieve their basic goal
  • The ART of Interviewing: Assessment, Ranking, Transition
• Strategies in Building Rapport

  1. Put the patient and the interviewer at ease
  2. Find the pain and express compassion
  3. Evaluate the patient’s insight and become an ally
  4. Show expertise
  5. Establish authority as a healthcare provider
  6. Balance the roles of empathic listener, expert, andauthority
• Body: ART

  1.-Assessment Phase

  • patient describes his/her concerns, situation, symptoms
  • phase which will be investigated further by the health care provide

  Strategies

  • Put the patient and the interviewer at ease compassion
  • Evaluate the patient’s insight and become an ally
  • Find the pain and express
• Body: ART

  2. Ranking of the patient's problems

  • begins almost immediately and continues until end of interview

  Strategies

  • Balance the roles of empathic listener, expert, and authority
• Body: ART

  2. Ranking of the patient's problems

  • Decisions are made regarding areas to be pursued further based on the: concerns of patient and need to establish working alliance with patient

  Strategies:

  • evaluate the patient's insight and become an ally
• Body: ART

  3. Transitions

  • Keep interview smooth flowing
  • Allow interview to move from one phase to another with sense of purpose

  Strategies

  • Put patient at ease.
  • Show expertise.
  • Establish authority as ahealthcare provider
• Attending Behavior

  This is basic to communication.

  • It encourages clients to talk, tell their stories and reduce counselor talk time.
  • It shows that you are alert & interested in what other person is saying to you
  • Is often non-verbal
• Attending Behavior

  SOLER

  S = face the other SQUARELY, sending the message "I'm with you."

  O = Adopt an OPEN posture, portrays a non-threatening and supportive body language

  L = LEAN forward, shows interest

  E = make EYE contact, do not stare or roll your eyes

  R = RELAX, clients will feel uncomfortable if they see the counsellor shows anxiousness
• CONCLUSION: Interviews should conclude with a structured end that usually consists of sharing the information you have obtained with the patient, collaborating with her or him to arrive at an acceptable plan and, where necessary, motivating the patient to act on it
• GUIDELINES in ENDING THE INTERVIEW

  The HCP should:

  1. Give the patient the chance to ask questions.
  2. Inform the patient about plans for the future.
  3. Summarize what transpired during the Interview.
  4. Thank patient for sharing the necessary information
• Active Listening Skills can help you truly understand what people are saying in conversations and meetings

  • build trust and establish rapport
  • ask specific questions
  • demonstrate concerns
  • use brief verbal affirmations
• 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.
• Therapeutic Communication Techniques

  1. Facilitation
  2. Adaptive questioning
  3. Reflection
  4. Silence
  5. Clarification
  6. Confrontation
  7. Summation
  8. Interpretation
• Facilitation

  • Verbal or nonverbal communication which encourage the patient to elaborate on something he or she said.
  • patient’s last words may be repeated
  • a questioning look given or a question asked
• Adaptive Questioning

  • helps you encourage a patient to fully communicate without interrupting the flow of his or her narrative
  • Open-ended questions: Ano ho ba ang naramdaman niyo at nagpatingin kayo ngayon?
  • Detailed close-ended questions: “Ano ho ang problema niyo sapagtulog?” “Nahihirapan ba kayong matulog?” “Pagising-gising ba kayo sa magdamag?
• Reflection

  • It reflects and mirrors what the nurse believes the client's feelings to be underneath the words
  • Example: When a client appears to be angry and upset, the nurse may state, "You seem a little angry today. Would you like to talk about it?
• Clarification

  • Response that asks the patient for further information and explanation.
  • Example: “I’m not sure I understand what you mean by ‘sicker than usual’, what is different now?"
• Silence

  • is a purposeful active process
  • Gives patient to: think about & reflect on the full meaning of received message | contemplate and reflect on how to respond to the sent message with feedback.
  • The nurse should allow the client to break the silence.
• Confrontation

  • A technique that brings the patient face-to-face with or calls his attention to some aspect of his behavior, appearance or manner that is INCONSISTENT and CONTRADICTORY.
  • Example: “You say you’ve already decided what to do, yet you’re still talking a lot about your options
• Interpretation:

  • FORMULATION by the HCP of data, events, or thoughts in terms that make the patient aware of their interrelationship
  • Should be used CAUTIOUSLY until interviewer knows the patient and has established good rapport.
  • E.g. “Sa tingin ko baka natatakot kayo magpa-opera kaya hindi na kayo bumalik para magpacheck-up ano?
• Summation

  • A technique for reviewing the information that has been given by the patient
  • Can be done at any point during the interview
  • Help the health care provider reorganize data and thoughts
  • Review what was discussed
  • Example: It is my understanding that your arm pain is a level 1 .... Taking your pain medication before physical therapy seems to help you complete the activities the doctor wants you to do for your rehabilitation. Is this correct?” Client responds “Yes. It really helps to take the medicine before I do my physical therapy because it helps reduce the pain in my arm.
• Thoughts on Patient Interviews

  • The patient interview is a professional communication
  • Should be approached with a sense of: Purpose, Compassion, Curiosity