Need help with Therapeutic Communication

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    hello all!!

    i have been a cardiac nurse for 2 years. i went into this immediately after graduating nursing school. i also began to work on my bsn immediately after i earned my associate degree. tonight is my very last bsn class and i am graduating with a 4.0 (just had to throw that in)

    last week, i accepted a full time position as an rn in a long term care psych facility. i believe most of the consumers are coming from state hospitals which have closed down in the last year. i believe our goal is to use a holistic approach in helping them to meet goals.

    the reason why i am writing this thread is because i am concerned about therapeutic communication techniques. i feel that i would be perfectly capable, but i must learn them first. i realize that someone without training or knowledge in this area could actually harm patients and that is the last thing i want to do. i think that i desperately need help in this area in order to keep patients safe and be an effective nurse. i do not believe there will be any experienced pysch nurses to mentor me, because this is a new 14 bed facility, and i believe staff consists of 1 rn each shift with additional techs. the other rn that works there is only a few months into psych herself. the main thing i am concerned with is therapeutic communication, assertiveness... etc. although there is probably a whole lot more i could be concerned about....

    i guess i was wondering if any of you knew of a book on therapeutic communication. i wouldn't have the patience to read a long drawn out book. i would be excited to read it if there were short stories/case studies which described a situation, the interventions, and the therapeutic communication techniques in detail. does anyone know of such a book?
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  4. 0
    I'm not familiar with a specific book, but I really think it is necessary that you get some mentoring/training!! I would dearly hope that no one would expect me to jump to a cardiac unit and be ok.
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    shrimpchips likes this.
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    I don't think there is a book/recipe for therapeutic communication. The withdrawn or depressed patients will be harder to engage than others who spontaneously initiate conversation. The key is to LISTEN, LISTEN. Be resourceful, if you don't know something that you are asked, find out. Be honest and keep promises. It is probably best to avoid promises in psych.(just do whatever you would promise as a surprise).Make sure you introduce yourself before you start asking a slew of questions. Avoid the urge to divulge all personal info...Remember patients aren't therapists. Set limits on inappropriate conversations(difficult for some to do).
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    Sounds like you're going in at the deep end, and to be honest communication isn't about reading but doing. Can you do some voluntary work/placement in a psychiatric unit that would expose you to experienced psychiatric nurses in practice.

    It takes years to perfect the various elements of verbal and non verbal communication, even after a three years hospital based training, let alone all the other stuff you'll need to know about.

    I would strongly recommend that you

    locate a mentor, someone that you would have relatively easy access to, who is not only an expert in psychiatric nursing but dynamic, inspirational and innovative etc. They preferably should be external to the service you will be working for.

    locate a clinical supervisor, someone with whom you can discuss your practice in depth, with a view to enabling your professional development in the area.

    commence reflective practice, you could start this in your current position, with a view to addressing inter and intra personal communication as this will assist in developing the skills you are likely to require in your new position.

    What you have to remember is that good psychiatric nurses learn from experience, hopefully as a student so that they have guidance and support from various clinicians. It is therefore essential to ensure safe practice that you secure structured support. However in the context of what you describe (lack of trained/experienced staff) it sounds as though an effective therapeutic milieu that ensures high quality healthcare and professional development is not what the service providers are aiming for.

    Good Luck
    Thunderwolf likes this.
  8. 0
    there are books on therapeutic communication skills, but i can't think of any names offhand. you can google the topic and find some, i'm sure. but all the posters have given good advice. i worked on an inpatient mental health unit for about 16 years, and i was nervous too,when i started. but unless you have advanced training, most nurses learn it on-the-job, as did i and most everyone i worked with.

    i'm also concerned about the environment you describe, though. it's important to have people to learn from by observing and having them mentor you and be role models. be careful about jumping into something just to get away from something else...

    but the main points i'd make are: 1.) don't give patients advice on important decisions. never ever tell anyone "you should divorce him, you don't have to take that", or "yes, i'd quit that job if it's so stressful", or "you should move out of your parents' house", etc. you have to leave those things for patients to work on with their therapists. but you can listen, let them talk, give support. use your basic skills you learned in school. ("that must be very difficult for you.."; "you look sad- would you like to talk about it?" etc.) 2.) don't give out a lot of personal information about yourself. it's just a bad move. it's about the patient, not about the nurse. 3.) understand boundaries. don't get caught up in doing special favors for patients like bringing them little gifts, or stopping by the store for them, etc. that's a hard one to master- a good psych nurse definately feels empathy for her patients and cares about them- but you have to keep the relationships within the boundaries of the therapeutic relationship. it's not uncaring to set boundaries- it helps to keep patients from becoming overly dependent and personally involved with staff.

    i loved the field. the only reason i left it is because the unit i worked on closed down due to a corporate decision involving, what else, $$$$$ and there are no other venues in my town that i feel drawn to work at. so i'm an office nurse now. i like that too. especially the hours!
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    Everyone who has already posted has offered good advice, but I'll just offer a couple of bullet points because it's late and I'm too tired to do anything else!

    - This applies to any interpersonal communication, but just remember that communication isn't just about words. Ever seen Conan O'Brien sing the lullaby song? Here's another example. I work with a nurse who is incredibly high-strung and has a way of making everyone around her, staff and patients, feel tense because of the frantic pace of her speech, her sharp tone, and the way she flails around when she's frustrated. I've seen her try to deal with a psychotic patient in the midst of a panic attack by yelling "CALM DOWN!!!!" Needless to say, she's not very effective in a psych setting. If a patient approaches you yelling, use a quieter tone so that they have to quiet down to listen to you, and always be aware of what your face looks like. As you already know, patients will tell you some WEIRD stuff and it's your job to keep on your sympathetic face, or at the very least, your poker face.

    -Try to anticipate some of the issues you'll run into as a new person on the floor and think of how you'll respond. The first time a patient said to me "I hate this &%*# place and I want to get the &%)! out of here because all the nurses are @#& horrible," I had absolutely NO IDEA what to say. I was similarly dumbfounded the first time a pt asked if I would hypothetically go out with him if he wasn't my patient. Talk to your coworkers about how they handle weird/tough conversations. Good luck!
    medsurgrnco and Whispera like this.
  10. 0
    Try The Gift of Therapy by Irvin Yalom


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