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
