ch. 5: Therapeutic Communication Flashcards
Essence of how we as nurses “treat” patients in psych nursing:
We use ourselves. Every interaction is a chance to be therapeutic.
Therapeutic communication: the goal
To help the patient “grow”
Practical ways to help a patient achieve goals
- Ask patient why they’re there, or inform them if they don’t know. Sometimes they straight up don’t know why they’re in there.
- Talk about what the pt wants to do
- Discuss treatments if the pt expresses interest
- Sometimes they want to kill themselves. Redirect their attention to something realistic like just getting out of their room.
A big obvious goal for therapeutic comm.
getting the patient to talk about feelings
Help a client see alternatives to suicide…how?
- If they think it would be better for them to die, because it would be better for their kids/spouse,,,inform them that family members who have someone close to them die are more likely to do it themselves.
- Encourage talking
Therapeutic use of self
- Encourage change in yourself. What ways can I seem more open?
- The words will come to you. Its ok to not know what to say immediately.
Rapport
Simply acknowledge patients. Start building good vibes from the start, before they even talk to you. Not everyone will like you for whatever reason. THATS OK!
Trust
I say what Im gonna do and then I follow through. Same applies to what patients say and then do. Two way street.
Respect.
Everyone deserves it. No matter how horrible they are.
Genuineness
Basically…Honesty…literally be yourself
Empathy
See things from their POV. NOT sympathy.
Phases of the therapeutic nurse-client relationship
- Pre interaction phase
- Orientation (introductory) phase
- Working phase
- Termination phase
Pre-interaction phase. What happens in this phase?
- Obtain info about the client from the chart, significant others, or other team members
- Examine ones own feelings, fears, and anxieties about working with a particular client
- Most of this happens in report. We all have biases, but try to see them as people
Orientation (introductory) phase
- Introduce yourself + ask client goals
- Create trust & rapport, establish interventions, gather assessment data,
- Identify client’s strength’s and weaknesses, get diagnoses, set goals together
- Explore feelings
Working phase
- Help pt gain insight on how to make changes
- Constant evaluation
- Maintain trust and rapport, promote client’s insight and perception of reality, use problem solving model to work toward accomplishing goals.
- Overcome resistance behaviors.
In the working phase: Transference
Occurs when the client unconsciously displaces (or “transfers”) to the nurse, feelings formed toward a person from the past
In the working phase: Countertransference
Refers to the nurse’s behavioral and emotional response to the client
Termination phase…Therapeutic conclusion happens when:
- progress has been made toward attainment of the goals
- A plan of action for more adaptive coping with future stressful situations is established
- Feelings about termination of the relationship are recognized and explored
- Patients can spiral cause of this
Pre-interaction phase: IMPORTANT first step
Look at yourself first. clarify personal attitudes, values, and beliefs. See how they might affect the nurse’s care for a particular client.
Personal boundaries with patients
- Obvious: never can have a friendship or romantic relationship
- You can give some personal info, but not too much. Can accept some drawings etc.
- Never hug psyc patients EVER…Shake hands.
Be aware of these different communication influences
- values, attitudes, beliefs…for example prejudice
- Culture or religion
- norms, ideas, and customs can affect your therapeutic communication
Be aware of these different communication influences cont.
- social status; weird power dynamic…or standing. When possible, sit with patients.
- Gender –> viewed differently by every person
Be aware of these different communication influences cont. (3rd & 4th slide)
- Age or developmental level
- The environment: be aware of surroundings. Its ok to tell people to step back.
Territoriality
the innate tendency to own space
Density
The number of people within a given space
Distance
The distance different cultures use to communicate
The four different (self explanatory) types of distances in interpersonal interactions
Intimate distance, personal distance, social distance, public distance
Therapeutic communication techniques: Using silence
Allows client to take control of the discussion, if he or she so desires
Therapeutic communication techniques: Accepting
Conveys positive regard
Therapeutic communication techniques: Giving recognition
Acknowledging, indicating awareness
Therapeutic communication techniques: offering self
making oneself available
Therapeutic communication techniques: giving broad openings
Allows client to select the topic
Therapeutic communication techniques: offering general leads
encourages client to continue
Therapeutic communication techniques: placing the event in time or sequence
Clarifies the relationship of events in time
Therapeutic communication techniques: making observations
verbalizing what is observed or percieved
Therapeutic communication techniques: Encouraging description of perception
Asking client to verbalize what is being percieved
Therapeutic communication techniques: Encouraging comparison
Asking client to compare similarities and differences in ideas, experiences, or interpersonal relationships
Therapeutic communication techniques: restating
Lets client know whether an expressed statement has been understood
Therapeutic communication techniques: Reflecting
Directs questions or feelings back to client so that they may be recognized and accepted
Therapeutic communication techniques: Focusing
Taking notice of a single idea or even a single word
Therapeutic communication techniques: Exploring
Delving further into a subject, idea, experience, or relationship
Therapeutic communication techniques: Seeking clarification and validation
Striving to explain what is vague and searching for mutual understanding
Therapeutic communication techniques: Presenting reality
Clarifying misconceptions that the client may be expressing
Therapeutic communication techniques: voicing doubt
Expressing uncertainty as to the reality of a client’s perception
Therapeutic communication techniques: Verbalizing the implied
Putting into words the feelings the client has only implied
Therapeutic communication techniques: attempting to translate words into feelings
Putting into words the feelings the client has expressed only indirectly
Therapeutic communication techniques: formulating plan of action
Striving to prevent anger or anxiety escalating to unmanageable level when stressor recurs
Highlights of NONtherapeutic communication
- Don’t do false reassurance
- Approving or disapproving
- Remember not to agree
- Prob for the information that we NEED to know. Don’t go to far in.
- NEVER ask “why?” change it to “what?” like “what made you do that?” NOT “Why would you do that?”
Use active listening
- face client
- open posture
- Lean forward
- Eye contact
- Relax
Motivational interviewing
- 1st clinical goal: have conversation with pt. (process recordings)
- promote pt to explore their motivation for change and the advantages and disadvantages of their decisions
- Incorporates active listening and therapeutic communication
