Communication is an interactive process of transmitting information between a speaker and a receiver as stated by Townsend 2012.According to Townsend 2012, therapeutic communication is all about "caregiver verbal and nonverbal techniques that focus on the care receiver's needs and advance in the promotion of healing and change" (p.153). Therapeutic communication plays an important role in providing holistic care to patients in general whereas to Psychiatric patients in particular.
Mr. X is admitted in private psychiatric unit I encountered a patient who was diagnosed with substance abuse with co morbid of antisocial behavior. I was taking history of patient suddenly the area Staff came and interrupted in conversation and state criticizing sentence to patient in front of me by which patient felt guilty. From my point of view it was not the proper way of communication.
There are different types of therapeutic communication. Two of them are verbal and nonverbal communications. According to Townsend 2012, verbal communication is that communication in which some body can speak some words to somebody while nonverbal communication is that in which the person himself does not speak some words but he shows his body language to convey or to send his message to his receiver. It is really difficult for us as health care providers to know about patients through any other way. One thing which helps in providing patient centered care is communication. Without communication it is not possible to know all the medical history of patient which is a building block of the care, by which health care providers find what, is the actual condition of the patient.
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According to Townsend 2012, Therapeutic communication helps in increasing, exploration of feelings and faster understanding of behavioral motivation. It is nonjudgmental discourages defenses and promote trust. Therapeutic communication, a term coined by
Ruesch 1961, is defined as a purposeful form of conversation, serving as a point of human
Contact between nurse and client and allowing them to reach common health-related goal through participation in a focused relationship. Therapeutic conversations are similar to those
Used spontaneously in social communications, with several notable distinctions. Self-disclosure
By the health care provider is limited to meeting the health-related goals of the relationship. In
Contrast to social conversations, therapeutic conversations have a serious purpose related to
Improving the health and well-being of the client. Therapeutic conversations in health care are
Designed to help clients learn about their illness and how to cope with it, to comfort dying
Persons, and to assure them that someone is there to be with them and ease their suffering
Pearson, Borbasi, & Walsh, 1997. Therapeutic conversations help make illness bearable by reinforcing self-esteem and supporting the natural healing powers of a person Peplum, 1960. The purpose of therapeutic communication is to provide a safe place for the client to explore
the meaning of the illness experience, and to provide the information and emotional support
That each client needs to achieve maximum health and well-being. In many ways, the nurse
Functions as a skilled companion, using communication as a primary tool to achieve health goals
(Pearson, Borbasi, & Walsh, 1997).
According to Townsend 2012, culture values are differ from one another for example, in Northern areas culture the females meet their elders by hand shake pay salaam than kiss their hands in the sense of respect that is a behavior which is appropriate in that area.
The nonverbal showing of social status or power has suggested that high status seems through his gestures that communicate their higher power position such that, the less eye contacts have a more relaxed posture.
The environment where we live can effected the communication in the certain culture of interact some people who feel easy and reject to speak during a group therapy, sessions are conducted to discuss openly the problems privately one to one basis with the nurse. The territory and culture are aspects of environment that communicate mass distance begins by which various cultures use space to communicate Hall 1966, According to Townsend 2012, distances matters a lot in communication the certain communicational distances are as follow,
Personal distance should be 8 to 40inches, Social distance should be 4 to 12feet, the public distances should be 12feet, and the intimate distance should be 0 to 18inch in UK.
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According to Sunder 2010, The unrecognized differences in cultural in â€¦ can result in assessment and interventions that are not optimally respectful of the patient and can be taking signally or by can be half .health care providers not having only knowledge about cultural as but also having awareness about their own cultural identities, especially important are Nurses own attitudes and beliefs towards those different cultures if nurse having knowhow then she might be able to maintain good relationship with client while taking care of the patient the nurse communication style , use of eye contact perception of patient culture are basic things for communication nurse should know this. During my clinical rotation I came across the client in a ward who was dumb , no matter attendant was with him at that moment when I assigned on that patient his attendant was went outside ward I face difficulty in providing quality care to the patient. I personally become more anxious because of lacking the primary history of patient even though, I study from patient profile and red folder but I am unable to get more past medical history of patient so that I am unable to provide quality care to patient. I fell low because I was trying to understand patient's nonverbal message but am failed. From then I get the importance of communication in health care settings, not only in medical field but every fields and in life. Through communication we come to know and share our feelings to our relatives we understand and learn through the communication. Active Listening is the one of therapeutic communication which is effective with clients begins with active listening (Bush, 2001). Active listening requires not only the act of hearing with the senses but also an active interpretation of what is heard, with feedback given to the client and often a request for validation. Gadow (1995) suggested, "In composing a narrative between nurse and patient, it does not matter who is author, because each is poet; it matters only that
there are enough words between them to make a story" (p. 11). According to Alderman (2000) refers to active listening as an art. Active listening is defined as a participatory process in which the nurse listens not only for facts but also for the underlying meaning of the communication with its attached values, attitudes, and feelings. As such, active listening is a dynamic, interactive process in which a nurse, hears a client's message, decodes its meaning, and provides feedback to the client regarding the nurse's understanding of the message. Active listening means listening without making judgments or letting your own perceptions serve as a barrier to really hearing the client. The goal of active listening is to fully understand what the other person is trying to communicate. Often the full meaning of the sender's message or intent is not readily apparent. It can be distorted when the listener's values, expectations, and experiences impose a perceptual filter on a message. Thus, two people may hear the same conversation and derive entirely different meanings from it. For this reason, frequent validating with the client and self-awareness on the part of the nurse are essential elements of the therapeutic communication process. The nurse should be sensitive to not only "what" was being said but also to "how" it was said and to what is left out of the message as well as to what is included. Included in each participant's communicated message is important nonverbal instructions met communication about the interpretation of the message. These can include body posture, gestures, tears, laughter, facial expressions, and vocal tones that reinforce or contradict the verbal message. The listener notes the tone of voice, the pauses in the conversation, and his or her own intuitive feelings in receiving the message (Metcalf, 1998). The listener consciously uses both met communication and minimal verbal cues to encourage further communication. Referred to as attending behaviors (Box 10-1), these listening connections invite the client to communicate at a deeper level with the nurse. They convey both interest and a sincere desire to understand Straka, 1997. Attending behaviors let the client know that you are focused on understanding their situation and that you are open to whatever the client has to say. Attending behaviors require frequent "check in" to make sure that what is being observed or heard is accurate. For example, the nurse might say, "I'd just like to check in with you to make sure that I understand. Are you saying that...? It also is important to put observations about nonverbal behaviors into words, with a request for validation: "I notice that you seem very quiet today. The barriers to effective communication which are giving advice, offering false reassurance, being defensive. Showing approval/disapproval, Stereotyping, Asking "why", changing the subject inappropriately. Falling to listen evaluating communication. Process recording verbatim account of a conversation includes verbal and nonverbal interactions analyze in terms of process content as it therapeutic?.What would I do deferent the next time. Client Records the purposes of communication care planning quality review research decision analysis education legal documentation, reimbursement and historic documentation. Methods of documentation source oriented, problem oriented, PIE is the Problem, Intervention, Evaluation, focus charting data, Action, Response, charting be exception, case management model and the computerized records. Guidelines for effective documentation. Agency policies, documentation forms, Accountability, Confidentiality. Confidentiality; ANA Code of Ethics The nurse safeguards the client's right to privacy by judiciously protecting information of a confidential nature. Use initials, not full name, on notes. AHA Patient's Bill of Rights. The patient has the right to expect that all communications and records pertaining to his care should be treated as confidential. Need to know the basic content, complete, accurate, relevant factual (not inference, opinion), timely, sequential, legally prudent.
REFERENCES Townsend,M.C.(2012).psychiatric mental health nursing:concepts of care in evidences_based practice.(Ed.7th).Philadelphia,PA:F.A.Davis company.
Halter, M.J.and Varcrolis,E.M.(2010).Psychatric mental health nursing:A clinical approach.(Ed.6th).Elsevier company.
Hall,E.T.(1966).The hidden dimension.Garden city NY: Double day.
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