1. Define the concept of therapeutic communication and using at least two examples explain how and when a nurse might use this type of communication in the context of clinical nursing practice (250 words). Marks 20
2. Analyse each of the situations provided below and discuss how you would use therapeutic communication to support each of the following patients in a culturally safe and appropriate manner to provide specific patient-centred care: marks 30
a) An Indigenous 17-year-old female patient presenting to the emergency department with nausea, vomiting, low blood glucose level, having been newly diagnosed with type 1 diabetes mellitus and has had multiple hospital admissions for hypoglycaemia within 8 months since diagnosis (250 words);
b) A 36-year old man of Irish decent diagnosed with pancreatitis on the surgical ward seeking guidance with dietary changes and cessation of alcohol intake (250 words);
c) A 6-year-old boy of African descent presenting with his family to the paediatric ward with a productive cough, fever, loss of appetite, lack of energy, having been diagnosed with pneumonia, having no cough etiquette and is non-engaging with the health care staff. The family have recently migrated to Australia and have limited English. (250 words).
3. Outline at least three evidence-based strategies that can be applied by the Registered Nurse in order to improve therapeutic communication in the nursing practice.
What is therapeutic communication and how is it used in nursing practice?
1. Therapeutic communication may be defined as the face-to-face procedure of interaction of the healthcare professionals with the patients and their family members that mainly focuses caring for the physical, mental as well as emotional well-being of the patients (Marie & Jaroslav, 2016). Nurses are seen to utilize different techniques for therapeutic communication for providing information as well s support to the patients.
Often it is seen that with the increase in age, individuals get affected with different form of co morbid disorders like diabetes, arthritis, cardiovascular disorders, strokes, Alzheimer’s diseases, Parkinson and many others. In such scenarios, they tend to lead very poor quality life as they become unable to conduct daily activities of life. They tend to become dependent on their caregivers and these result in loss of confidence from themselves. They tend to lose their self-esteem as they feel that they are longer independent to care for themselves (Kourkouta & Papathanasiou, 2014). These make them depressed and they tend to withdraw themselves, as they feel embarrassed. In such situations, it becomes very important for the nursing professionals to engage in a therapeutic communication to help the patient overcome such negative feelings and developmental well-being. It also ensures compliance of the patient with the nursing intervention
Often breast cancer patients have to undergo mastectomy that often affects them mentally and emotionally. This is mainly because they tend to think about their body image as they feel that they would not be beautiful or representable that affects their confidence and emotional wellbeing. Moreover, before such surgeries, the patients are often seen to be anxious about abut the operation that might affect their blood pressure due to stress. In such scenarios, the nurses play important role in engaging into an effective therapeutic communication to pass onto valuable information about the surgery and provide empathy and compassion to the patient helping them to come out of anxiety and depression and try to accommodate accordingly with the present situation.
Mental health patients socially exclude themselves due to stigmatization and therapeutic communication helps them to open up and overcome negative feelings and depressions about society (Thornicroft et al., 2016).
Aboriginal people tend to avoid service from western healthcare systems as they feel that the professionals might not be culturally competent and might not communicate with them respectfully due to biasness. Therapeutic communication helps to overcome such beliefs (Cameron et al., 2014).
How can therapeutic communication be applied in culturally safe and patient-centered care?
Parents of children suffering from disorders like cancer or kidney failure might be broken down, anxious and filled with grief. Here also, therapeutic communication would help (Thabrew et al., 2017).
2. a. A number of important aspects need to be followed while engaging in therapeutic communication with the patient. One of them is that such patients do not like eye contact. Although western culture advises nursing professionals to maintain eye contact, the aboriginal patients consider this action disrespectful, rude and aggressive. Therefore, the professionals should not maintain eye contact. The patient from such background often uses silence during interaction as they consider it. The nurse should not take this silence as lack of understanding, urgent concerns or agreement (Keech et al., 2016). Therefore, while educating the patient during maintenance of proper blood glucose level; such aspects of communication need to be followed. Moreover, during questioning to the patient, the professionals should make sure not to use any form of direct questions, as the native people only prefer indirect questioning. Direct questioning may lead to misunderstandings and discourage any form of participation. This would make it difficult for obtaining information from such patients especially when they are from non-English background. The aboriginal patients do not also like touches of strangers and hence care should be respect while the professionals want to engage in any form of therapeutic communication techniques (Chan & Sy, 2016). Therefore, professionals should always seek for permission and immediately explain to the patient the reason why they need to touch her. Therefore, it is important for the professional to establish a rapport with the patient first and then touch her accordingly for applying interventions. In many cases, it is seen that the native patients often have their own meanings of certain English languages that are different from Standard English. Therefore, it becomes important for the nursing professionals to know the specific English words that have different meanings for them so that misunderstandings do not occur.b. One of the most important aspects that the professionals should keep in mind while communicating with Irish patients is that they prefer soft voices. They consider being loud or disruptive to be to be a poor etiquette and off-putting. Hence, the nursing professionals should always maintain soft voice. Moreover, the Irish patients tend to have warm and friendly disposition but they generally restrain themselves from showing great physical affection in public. Therefore, the nursing professionals should always maintain them during communicating with such patients. It should be remembered that such patients want consistent eye contact but not constant eye contact while talking. This reflects trust as well as engagement. Therefore while talking to the particular patient; the nurse should maintain consistent eye contact. Humor is considered to be one of the aspect which is very important for the Irish people. They have a reputation for their wit and humor (Coyne et al., 2016). They prefer humor that they use to create laughs and warm spirits among the people. Many of the members are seen to use humor as a defense mechanism in self-deprecating as well as an ironic way. This can be also shown as a way for showing a sense of acceptance as well as of attachment between the individuals who are engaged in communication (Schwind et al., 2016). Moreover, humor is also used in situations when a person transgresses social norms for easing the situation. Many of the people are also seen to enjoy witty humor as well as sarcasm. This is well intended and is never meant for perceiving negatively. In order to develop therapeutic relationship with the patent during his health education, the professionals should use humor so that they can connect with the patient emotionally and this would help in developing mutual trust, respect and comfort in the relation.c. The parents of the patient are of African origin and their traditions and communication styles are very different from the Australians. Each and every of the tribes are seen to have their own customs and therefore the nurses have to be very careful while establishing therapeutic communication with the patient. The professionals should keep in mind that Africans arrive straight to point and they tend to say what they mean. People with such origin will make no hesitation in telling what exactly is wrong or objectifying on the spot. To an Australian nurse, this can come out as overly assertive or blunt but they need to know about such communication style of Africans in order to communicate effectively with them. The professionals should not feel offended in the absence of such etiquettes; as such, etiquettes might not be present in the tribes (Defenbaugh & Chikotas, 2016). Moreover, such professionals also need to know that Africans tend to adopt a louder speaking style naturally, than what the Australians are mainly seen to do. Therefore, the professionals should keep all these aspects in mind and they should not show any negative behaviors when the African people would display such traits of communication. The professionals should also know that they are very comfortable with physical affections and they like to express their warmth through different actions like that of hugging and patting each other on the back (Liu et al., 2015). Therefore, the professionals can indulge in treating the pediatric patients by effectively making him comfortable and providing him, enough warmth so that he feels secured. Hands should never be put in the pockets as that is misinterpreted by south Africans to be disrespectful and the nurses should never do that while handling the patient or talking to his parents. Steady eye contact should be maintained while communicating.
3. Active listening is one of the best strategies by which therapeutic communication can be ensured by the professionals. By the effective utilization of the verbal and nonverbal cues such as nodding and saying phrases like “I see” would help in encouraging the patient to continue talking. It involves showing interest in what the patients are showing, acknowledging that they are listening and understanding the concerns of patients (Arnold & Boggs, 2015). Such engagement throughout the conversation would make the patient feel that they are genuinely interested in understanding their problems and these have positive effects on the relationship between them. The second most effective ways is to ensure informed consent from the patients. The communication with the patient should be such that it would maintain the autonomy and dignity of the patient. They need to feel that they are respected and they are in the centre of decision-making. They should not feel less powerful than the professionals should and communication with them maintaining their dignity and autonomy would ensure effective participation. The third would be the maintenance of proper body language while communication is carried on. The positive body language should involve the professionals facing the client, moving closer to the client as they would be speaking , avoiding being in crossed arms, making direct eye contact, maintain body postures and friendly gestures (Weber & Farrell, 2016). This will make the patient feel that the professionals are interested and would help in creating sense of mutual trust and respect.
Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences pp: 256-260
Cameron, B. L., Plazas, M. D. P. C., Salas, A. S., Bearskin, R. L. B., & Hungler, K. (2014). Understanding inequalities in access to health care services for Aboriginal people: a call for nursing action. Advances in Nursing Science, 37(3), E1-E16.
Chan, J. C. Y., & Sy, P. Y. (2016). The relationships among personality, intercultural communication, and cultural self-efficacy in nursing students. Journal of Nursing Research, 24(4), 286-290.
Coyne, I., Comiskey, C. M., Lalor, J. G., Higgins, A., Elliott, N., & Begley, C. (2016). An exploration of clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners, in Ireland. BMC health services research, 16(1), 151.
Defenbaugh, N., & Chikotas, N. E. (2016). The outcome of interprofessional education: Integrating communication studies into a standardized patient experience for advanced practice nursing students. Nurse education in practice, 16(1), 176-181.
Keech, W., Kelly, J., Dowling, A., McBride, K., & Brown, A. (2016). The Importance of Effective Communication in Hospital Between Aboriginal Cardiac Patients and Health Professionals. Heart, Lung and Circulation, 25, S316-S317.
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65.
Liu, H., Tan, Z., Yao, J., Yuan, H., Gao, J., & Wan, F. (2015). Application of therapeutic communication in nursing of stroke patients. Modern Clinical Nursing, (7), 22-26.
Marie, T., & Jaroslav, P. (2016). Provision of Nursing Care with or without Therapeutic Communication Intervention. US-China L. Rev., 13, 75.
Schwind, J. K., McCay, E., Metersky, K., & Martin, J. (2016). Development and Implementation of an Advanced Therapeutic Communication Course: An Interprofessional Collaboration. Journal of Nursing Education, 55(10), 592-597.
Thabrew, H., Stasiak, K., Hetrick, S.E., Wong, S., Huss, J.H. & Merry, S.N., (2017). eHealth interventions for anxiety and depression in children and adolescents with long?term physical conditions. The Cochrane Library.
Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., ... & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123-1132.
Weber, K., & Farrell, T. (2016). Developing therapeutic communication skills: Integration of standardized client simulation in an associate degree nursing program pp: 445-490