Communication is a method, which we use every day to convey messages and interpret meaning. Communication is the exchanges of information between two or more people. This sort of communication uses methods such as talking and listening or writing and reading. However, signs, painting, dancing and storytelling are also methods of communication. In addition, opinions are conveyed to others not only by spoken or written words but also by signs or body language. In contrast to social conversations, therapeutic communication is a purposeful form of communication used in the helping relationship. It is an interpersonal interaction between the nurse and patient during which the nurse centres on the patient’s specific needs to encourage an efficient exchange of information. Nurses use curative communication skills to provide new information, accurate misinformation, encourage understanding of patient’s responses to health troubles, explore choices for care, help in choice making, and facilitate patient wellbeing. The point of healing communication is to provide a secure place for the patient to look at the meaning of the illness understanding, and to provide the information and emotional support that each client needs to attain utmost health and well-being. Therapeutic communication is therefore different from social communication. This essay discusses about the concept of therapeutic communication and its importance in caring for clients using examples from my most recent practice as a registered nurse. The benefits of the use of therapeutic communication in my practice and to the client will be outlined. It also includes the nursing theory as a model and its phases in the use of therapeutic communication and the use of communication techniques to communicate effectively.
Nursing theories are mental creations created to help recognize and find meaning from our experience, organize and articulate our knowledge and ask questions leading to new insights. They are descriptions of our reflections, of what we observe and read. Theory of interpersonal relations is of particular significance to nursing practice. Nursing is a therapeutic interpersonal process because it involves the communication between two or more people who have a common goal. For people who are sick and in need of health care, it is a healing art. According to C and P (2007,) Peplau had described nursing as an important therapeutic interpersonal process; by using good communication skills the nurse can establish and maintain a helping nurse client relationship Hildegard Peplau’s theory is based on the principles of person’s relationships. It suggests the development of interaction between the patient and the nurse to enhance the patient’s contribution in his/her treatment. This can be useful to nursing practice by reviewing the patient’s needs through therapeutic communication and working with his/her to find solutions that deal with the crisis. The nurse should develop and maintain a healing relationship in which the patient will experience secure and optimistic that positive change is possible. As Halter and Carson (2010), discussed that Peplau proposed an approach in which nurses are equally contributor and observer in therapeutic conversations. She thought that during the discussion, it is vital for nurses to monitor the behaviour not only of the patient but also of themselves. This self alertness on the part of the nurse is necessary in keeping the focus on the patient, as well as keeping the social and individual requirements of the nurse out of the nurse patient discussion. The interpersonal process is operationally defined in terms of four different phases: orientation is the first phase; the nurse and patient meet as unfamiliar person and recognise, clarify and define the existing trouble by communicating efficiently. Identification is the second phase in which nurse ease the patient’s expression of whatever feelings are experienced and remains able to provide the nursing care needed. This appearance without rejection permits the experiencing of illness as an opportunity to reorient feelings and strengthen the positive force of personality. In third the nurse helps the patient maintain a balance between dependence and independence and use of the services to help to resolve the current crisis and work toward optimal health. In forth phase the patient become independent of the nurse and the relationship is terminated. Thus these four phases characterized a logical developmental process in which the nurse guides the patient from dependent toward increasingly independent interactions with the social environment.
Therapeutic communication works as a treatment for persons in need effective communication with patients can help to develop therapeutic interpersonal relationship, decrease anxiety, enhance patient compliance and result in a optimistic experience for all involved. Likewise, in my past working experience, a male patient was admitted with the complaint of urine retention and lower abdominal pain and the doctor advised him to have catheterization to remove urine, but the patient asked for a stronger dose of medicine rather than catheterization. Even though, the patient’s condition was getting worse, he kept on refusing to have catheterization. As I read about Hildegard Peplau’s theory when I was studying nursing, and on reflection of that I used Peplau’s theory as a model in my practice to develop the therapeutic nurse patient relationship by communicating effectively with the client. I talked in a calm voice, asked why he refused to have catheterization. I sat next to the patient and held his hand; touch is often synonymous with reassurance, understanding and caring. And I asked him that if he would like to talk to me about his condition, I explained to the client that I would like to get an idea of what some of his issues and concerns were so that I could help him better. This kind of message encouraged him and allowed the client to tell his concerns without imposing my idea, then patient expressed his feeling that he did not want to be exposed in front of female nurses. Through therapeutic communication, I gathered information needed for my plan of care. I had important responsibility of making an accurate and appropriate clinical decision. I was accountable to help my patient maintain and improve his health. As a nurse I had to think critically to solve the problem and find the best way to meet the client’s needs. I arranged for a male nurse for the patient who could catheterize him. Conveying genuine respect for my client and communicating effectively could assist me in building a professional relationship with him. Having therapeutic communication skills and provision of a caring relationship that facilitates health and healing are believed to be an essential feature of contemporary nursing practice. As my goal was to maximize the client’s health status and relieve pain, I conveyed respect for his values and opinions. Effective communication techniques and therapeutic interpersonal development helped me to encourage patient to express his feelings and worries and also benefitted the patient by relieving his pain and making him comfortable in clinical environment. I find myself possibly listening more keenly to my patients now I find myself much more easily and speedily gaining their faith and their relationship through them understanding me So the result for me definitely was very positive and very worthwhile.
Communication barriers can effect in a host of troubles for patients. Barriers in communication can result in uneasiness incorrect medications. Similarly, in my past working experience a young patient was admitted whose haemoglobin level was low, and the doctor advised her to have blood transfusion but she refused to have blood transfusion then my colleague a male nurse who was looking after that patient tried to communicate to convince her that why the blood transfusion is important for her recovery. Patient was anxious and upset and did not like that information; she interpreted it as the nurse was forcing her to have blood transfusion. As the male nurse used therapeutic communication skills to persuade the patient about the benefits of blood transfusion for her but the patient felt humiliated by opposite gender nurse. Gender relations are complex and do not lend themselves to quick fix that are easily implemented. The challenges in nursing are to acknowledge the power and commonness of gender relation and the role they play in all nurses lives. At that time it was challenging for my colleague male nurse to use therapeutic communication in practice because the patient was not comfortable with his style of communication. The nursing supervisor asked me to take charge of that patient and after taking charge, I used Hildegard Peplau’s theory in same way as a model in my practice, which I have used in my first example. I held the patient’s hand and asked her if she would like to discuss with me her concerns about blood transfusion, then she expressed that she was afraid to catch communicable diseases through blood transfusion. As a registered nurse I had responsibility to give proper answer to the patient’s questions and I explained the blood transfusion procedure to the patient, answered all her questions and also explained the disadvantages of not having blood transfusion, that could convinced her that she must have blood transfusion. This all was possible only by using therapeutic communication skills, because if I don’t know how to communicate effectively then it is very difficult for me to develop therapeutic relationship and patient might hide important information from me. As I find myself listening more actively to my patients, and also find myself much more easily gaining their trust and their rapport now it would be easy and helpful for me to use therapeutic communication in practice.
Therapeutic communication techniques are useful tools for nurses when communicating with their patients, and those techniques include the use of active listening, paraphrasing, reflection and touch. These techniques are discussed below: Active listening is vital to communicating effectively; it is not simply the act of hearing. The nurse listens actively while attending to the patient, hearing what is being said and communicating back to the patient that the nurse has heard the patient’s message. Active listening involves all of the nurse’s sense. It takes an incredible amount of energy focus and self discipline as well as seeing and filtering out internal and external factors and barriers that may impede communication. Paraphrasing is a response strategy to active listening designed to help the patient elaborate more on the content of a verbal message. Through paraphrasing the nurse sends feedback that lets other know whether his/her messages were understood. If the meaning has changed through paraphrasing communication may become ineffective. Reflection is a technique used during active listening to turn around a question to obtain a response from the client. Coaching client to answer the question best answered by the client help them to accept their own ideas and feelings regarding an important event. Touch is another powerful tool for communication. Touch can be used to sooth comfort and establish rapport and a therapeutic bond between nurse and client. When a patients is admitted in emergency department nurse may not have sufficient time to talk on the bed, but the holding of a hand could communicate a lot more than words to the patient in such a minute.
Therapeutic communication can assist nurse to achieve many goals like assess the patient’s awareness of the problem as it give details of the patient’s thoughts and feelings about the situation and identify the most important client concerns at that moment. To have effective therapeutic communication the nurse have to consider rapport, trust, respect and also empathy. Rapport implies special feelings during discussion on the part of both the patient and the nurse based on acceptance warmth friendliness a sense of trust and a nonjudgmental attitude. Trust is very important to carry on the communications if patient does have faith on the nurse than he/she might not share all information that can be very important and supportive to treat that patient and plan nursing care for him/her. It is vital for nurse to convey an atmosphere of honesty which requires that he/she possess a sense of self confidence. Empathy is process in which an individual is able to see beyond outward behaviour and sense accurately another’s inner experience at a given point in time. With empathy the nurse can accurately distinguish and understand the meaning and importance of the patient’s thoughts and feelings.
To conclude, communication is an active two way circular method in which all type of informations are shared between two or more people. Therapeutic communication is one of the most valuable tool that nurses have to use to build rapport and trust. This means that the nurses let the patients to feel safe enough to share information with them. In this essay, concept of therapeutic communication has been clearly discussed, that it is important in caring for patients in contemporary nursing practice. By using therapeutic communication techniques to assist with relationship development this helps the nurse to focus on the patient’s concerns. Examples from most recent practice as a registered nurse in my home country, and the benefit and challenges of the use of therapeutic communication to my practice and the patient are illustrated. Barriers in communication can result in discomfort and misunderstandings; It has been identified that how the use of Hildegard Peplau’s nursing theory of interpersonal relations can help in practice development and decision making with the use of effective communication skills. It has been highlighted that nursing is an significant healing interpersonal process by using good communication skills the nurse can develop and maintain a helping nurse patient relationship.
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