When many of us think of communication, we immediately think of two or more people who get together to simply talk. Yes, talking is a vital step to the ladder of communication, yet there are a few other characteristics to keep in mind. According to the National Commission on Correctional Health Care (2011), specifically, “Therapeutic communication is defined as the faceto-face process of interacting that focuses on advancing the physical and emotional well-being of a patient.
In addition, “Therapeutic communication is designed to help your client reach a better understanding of her condition and treatment, encouraging her to express her feelings and discuss her ideas, while showing respect and an acceptance of her point of view” (Evesham, 2013). Throughout this course, I have learned a great deal of information on effective therapeutic communication, along with the types of communication, such as verbal and nonverbal. I have also learned that not all communication is simple and easy.
As I reflect back, I recall a specific challenging communication interaction that took place about a year ago while employed as a Rehabilitation Technician at a rehabilitation hospital. I had only been working at this facility for about a year when I was assigned to my first nonEnglish speaking, Hispanic patient. To begin, the patient was an older woman who was in her late 60s with a recently amputated leg. According to her daughter who acted as her translator, she was accustomed to being the head of her household, the caregiver, the matriarch, and relied on the strength of her own independence.
It was obvious that she was affected by her loss of independence and mobility because during her stay, she seemed to be in a sad and depressed state the majority of the time. As I arrived into her room and attempted to formally introduce myself, I immediately began to observe the nonverbal expressions and communications displayed across her face. I could tell that the patient was concerned with whether or not I would be able to assist her in the manner that she required. As previously stated, she had recently undergone a leg amputation and she was more of a heavyset woman.
Noticing my smaller/athletic bodyframe, it seemed as if she pondered to herself about whether or not I was capable of lifting, transferring, and transporting her safely without any issues. Quite nervous, I asked her daughter to reassure her that I was experienced with working with amputee patients and that I would do my best to ensure safety for the both of us. However, being that this patient was much older than I am, I made sure to assist her to the best of my ability with much respect and dignity. As mentioned by her daughter, the patient was the oldest of four siblings and took control in everything as the independent caregiver.
I surely did not want to take this away from her. She was the type of patient who may have needed help, but shied away with discouragement to ask others for assistance not only because she preferred to do things on her own, but also because she knew there would be great difficulty communicating with staff who only spoke English. For instance, I recall assisting her with dressing before her therapy appointment. Successfully, we were able to put her shirt on without any issues, but donning her pants was more of a challenge.
I turned around for a few seconds to fold her pajamas that she had just taken off and place them neatly into her closet. I overheard repeated sighs of distress and frustration because she was having a tough time getting the pants-leg over the amputated limb. I could tell that she wanted to do this on her own and she was hesitant about signaling me for the slightest help. Observant yet cautious, I slowly approached with an extended hand to let her know I was there for any assistance if needed and to let her know that it was r her to ask for help. Naturally, I would associate the level of need for this patient with a crisis.
A crisis is a very large predicament; short term (Tamparo and Lindh, 2008). This particular level of need has a sense of urgency; where the patient may want help but is afraid to ask (Tamparo and Lindh, 2008). On the other hand, since the patient was Hispanic, she was unfamiliar with the English language. Fortunately, as I mentioned before, her daughter served as her translator for proper communication between the patient and her health care providers. However, my particular challenging communication interaction occurred one day when her daughter was away from the facility at work.
It came time for me to transfer this patient out of bed, into her wheelchair and down the hall to the therapy gym. Frantically, I looked left and right down the halls, searching for a nearby staff member to assist in not only transferring the patient safely, but also to communicate with her effectively. To my dismay, I was unable to find anyone at the time. I went back into the room to do my best at interpreting certain words that she was saying to me. Reluctantly, I remembered a few basic words from the Spanish courses that I had taken in high school.
Again, I made sure to abide by her cultural attributes, such as making eye contact and listening carefully, to the best of my ability. According to Tamparo and Lindh (2008), in the Hispanic culture “showing respect by using direct eye contact is recommended to obtain cooperation in treatment” (pg. 42). Although I had the proper eye contact, I was struggling to comprehend the needs that my patient was attempting to express to me. In this case, our communication was not complete, clear, concise, nor cohesive. As a result, I slowly began to offer random Spanish phrases that I had remembered in order to get my point across.
In addition, I extended hand gestures along with pointing directly to the wheelchair, indicating to her that we were going to safely transfer over into it. Finally, after about 15 minutes, she was able to understand me enough to the point where we were able to move forward with a safe and successful transfer, in spite of my nervousness. Furthermore, with her new condition of an amputated leg, my patient was still adjusting to her new demands. Although I had worked with many patients with this similar impairment, the interaction was a bit different with this particular patient.
Even though I was unable to understand her language, her personality spoke volumes to continuously remind me that she was strong, determined, and independent regardless of her condition. Being that she was such a strong-minded person and did not request much help from others, I was sometimes hesitant to assist her without continuously asking her did she need/want my help with a specific activity. I wanted my patient to continue to feel that sense of independence as long as she could. I wanted her to be comfortable.
Finally, utilizing various therapeutic techniques/responses, I was able to diffuse any further negative concerns or feelings in efforts to continue to build upon a trustworthy rapport with my patient. In addition to the previously stated techniques such as making direct eye contact, active listening, and offering myself in a therapeutic manner, another technique was quite prominent in this crisis. I remembered to always speak to the patient in a calm, slow, and neutral volume. In the text, Tamparo and Lindh (2008) stated, “Just because a client does not understand English, there is no reason to speak louder.
Use a normal tone of voice and speak a little slower, while enunciating each word clearly and using simple vocabulary” (pg. 34). Personally, this key component is vital to any type of communication. Speaking in a neutral tone would assure that my patient remained comfortable and as free of frustration as much as possible. Tamparo and Lindh (2008) also mentioned, “When working with non-English speaking clients, it is vital that these limitations not be perceived as limited intelligence. In their own language, clients may be able to fluently discuss their health care needs” (pg. 34).
With a situation such as this one, it is simple for the professional to automatically assume that the client has little to no comprehension about what is going on regarding their health because they are unable to verbally communicate it. Realistically, that may not be the case. In my future career as an Occupational Therapist, I will be working with various cultures accompanied by their generalized manifestations and attributes. Comprehending and practicing effective therapeutic communication skills will ensure my capability of providing the best healthcare and improving the quality of numerous lives.