9. Communication and Therapeutic Relationship Flashcards
understanding personal beliefs, thoughts, motivations, biases, and limitations
self-awareness
characteristics of self-awareness
- introspective
- recognize the impact our biases have on others
parts of the biological self
- physical characteristics
- genetic makeup
- chronic illness or unobservable physical disability
parts of the psychological self
- psychological makeup
- emotions
- motivations
- beliefs
- traumatic experiences
parts of the social self
- sociocultural values
- cultural beliefs
- patterns of communication
types of verbal communication
- spoken word
- underlying emotion
- context
- connotation
types of nonverbal communication
- gestures
- expressions
- body language
ongoing process of interaction in which meaning emerges
therapeutic communication
proper nonverbal communication with a patient
SOLER
- Sit squarely
- Open posture
- Leaning towards the pt
- Eye contact
- Relaxed
What is the nurse-patient relationship built on?
therapeutic communication (positive verbal and nonverbal)
therapeutic communication: focus
focus on the patient
therapeutic communication: attitude
professional and nonjudgemental
therapeutic communication: self-disclosure
rarely and with therapeutic purpose
therapeutic communication: advice
waste of time; help them explore options instead
therapeutic communication: social relationships
inappropriate
therapeutic communication: patient confidentiality
must be maintained
therapeutic communication: approach
at the level of the patient’s intellectual ability
therapeutic communication: goal
rationale reinterpretation of experiences
therapeutic communication: changing the subject
avoid; unless in the patient’s best interest
Reason for showing acceptance of patients
indicates to patient that they are being heard
gently (take baby steps) presenting a different reality of a situation
confrontation
verbal technique not used very much but can be used when the nurse wants to guide the patient towards other explanations
doubt
putting the patients words into your own words; helps the patient identify ideas or feelings
interpretation
monitoring a patients behavior or response to a certain situation
observation
Purpose of using open-ended statements
invites the pt to give more information
redirecting an idea or topic of conversation back to the patient for classification of important feelings, emotions, and experiences
reflection
repeating the main idea expressed by the patient back to them; lets them know that they communicated their thought or idea effectively
restatement
gives the patient time to think and express themselves and lets them know you are listening
silence
clarifying your understanding of a situation and the patient’s feelings about that situation
validation
6 blocks to communication and why
- advice: don’t want to give advice in case it goes wrong
- agreement: doesn’t allow the pt to think about what they have said or give them a chance to change their mind
- challenges: belittles them and injures self-esteem
- reassurance: don’t want to tell them everything will be okay when you don’t know for sure
- disapproval: belittles them and does not create a therapeutic relationship
- asking “Why” questions: demands an explanation and implies criticism
reason for developing rapport with patients
show that you care about them and are genuine
reason for empathy
can help you understand what the patient is feeling (place yourself in their shoes)
What are empathetic linkages
when you are talking to a patient about their feelings and you start to feel the same way (be aware of your own feelings)
T/F: it is okay to hug a patient to show them you care
False; goes against professional boundaries (need to develop your own personal boundaries)
4 body space zones
- intimate
- personal
- social
- public
Purpose of defense mechanisms
prevents us from experiencing unpleasant feelings or being uncomfortable
2 types of defense mechanisms
- maladaptive
- adaptive
refusing to acknowledge some painful aspect of reality or subjective experience that would be apparent to others
denial
taking out frustrations, feelings, and impulses on people or objects that are less threatening
displacement
experiencing a breakdown in the usually integrated functions of consciousness, memory, perception of self or the environment, or sensory and motor behavior
dissociation
tending to perceive another individual as having more desirable qualities than he or she may actually have
idealization
falsely attributing to another one’s own unacceptable feelings, impulses, or thoughts
projection
explaining an unacceptable behavior or feeling in a rational or logical manner, avoiding the true reasons for the behavior
rationalization
taking up the opposite behavior, thought, or feeling to one’s own unacceptable thoughts or feelings (usually occurs w/ repression)
reaction formation
when a feeling is hidden and forced from the consciousness to the unconscious because it is seen as socially unacceptable
repression
both harmful and helpful impulses are split off and integrated into the self or others; no room for ambiguity
splitting
allows people to act out unacceptable impulses by converting them to a more acceptable form
sublimation
intentionally avoiding thinking about disturbing problems, wishes, feelings, or experiences
suppression
trying to make up for what one feels are inappropriate thoughts, feelings, or behaviors
undoing
writing a verbatim transcript of an interaction
process recording
purpose of process recording
help us distinguish pt’s thoughts and feelings through a conversation
3 things to look for in a process recording
- symbolism
- content themes
- communication blocks
use of a word or phrase to represent an object, event, or feeling
symbolism
concerns or feelings verbally expressed repeatedly in several different ways
content themes
identified by topic changes that either the nurse or the patient makes; changed for various reasons
communication blocks
phase with the first patient meeting; the relationship is tested and information is gathered about the patient with confidentiality maintained
orientation phase
phase where problems are identified and problem solving occurs
working phase
phase where problems are resolved and the relationship ends
resolution phase
phase where you obtain assessment and initial data about the pt and explore your feelings about interacting with them
pre-interaction phase
redirection of feelings and attitudes onto the nurse
transference
when the nurse redirects their feelings and attitudes onto the patient
countertransference
identifying patient’s stage of change and using patient decision-making abilities to help them make a change
motivational interviewing
8 features of motivational interviewing
- openness and collaboration w/ patient’s expertise
- proficiency in patient centered counseling (including empathy)
- recognition of key aspects of patient speech
- eliciting and strengthening patient change talk
- rolling w/ resistance
- negotiating change plans
- consolidating patient communication
- switching flexibility between MI and other interventions
transitioning from one relationship to another
transitional relationship model
describe a non therapeutic relationship
feelings of frustration -> grappling and struggling to reach common ground -> mutual withdrawal
phases of a deteriorating relationship
- withholding phase: nurse is perceived as withholding nursing support
- avoiding and ignoring phase: pt begins avoiding nurse and perceives nurse is avoiding them; nurse ignores pt’s request for help
- struggling to make sense phase: pt struggles and tries to make sense of relationship; end as enemies
