Ch6 Therapeutic communication Flashcards
Preinteraction Phase Nursing Goal
Explore self-perceptions: obtain info on client from chart, significant others, health team and examine one’s feelings about caring for a particular client
Empathy
When the nurse can remain emotionally separate from the other person, even though the nurse can see the patient’s viewpoint clearly. This is different from sympathy. You must show feelings but not get caught up in them.
Orientation (introductory) Phase Nursing Goal
To establish trust and formulate contract for intervention: detail the expectations of both client and nurse and set goals, gathering assessment info to build client database, formulate diagnoses, identify clients strength and limits, develop plan of action, explore feelings of both the client and the nurse in terms of the introductory phase
In which phase does the nurse and client set goals?
Orientation (introductory) phase
In which phase does the nurse identify the clients strengths and limitations?
The orientation phase
In which phase does the nurse formulate a nursing diagnosis?
The orientation phase
Working Phase Nursing Goal
Promote client change: overcoming resistant behaviors by client, positive feedback for clients that attempt to make changes. Promoting client’s perception and insight of reality. Problem-solving using model. Continuously evaluating progress toward goal.
Termination Phase Nursing Goal
Evaluate goal attainment and ensure therapeutic closure. Feelings about termination of the relationship are recognized and explored. Client may feel sad.
Transference
When the client unconsciously displaces to the nurse feelings formed toward a person from his or her past
Countertransference
Refers to the nurses behavioral and emotional response to the client. These responses may be related to unresolved feelings toward significant others from the nurses past, or they may be generated in response to transparence feelings on the part of the client.
Intimate distance
The closest distance that individuals will allow between themselves and others
Personal distance
18 to 40 inches and is reserved for interactions that are personal in nature, such as close conversations with friends or colleagues
Voicing doubt
Therapeutic.EXPRESSING DOUBT! Often used with clients expressing delusional thinking. “I find that hard to believe”
Offering general leads
Therapeutic. offers the client encouragement to continue. “Go on.” “Yes I see” “and after that?”
Reflecting
Therapeutic. Used so that the client may recognize that his or her point of view has value. Pt: “what do you think I should do about ____?” Nurse: “what do YOU think you should do?”
Restating
Therapeutic. Repeating the main idea to let the client know whether or not an express statement has been understood. Pt: “I can’t study. My mind keeps wandering.” Ns: “you have trouble concentrating.”
Focusing
Therapeutic. Taking notice of a single idea or even a single word. Not good w/ anxious pts. Pt: “my DADDY always tucked me in at night.” Ns: “id like to talk about your relationship with your FATHER.”
Presenting reality
Therapeutic. The nurse indicates his or her perception of the situation for the client. “There is no one else in the room but you and me”
Verbalizing be implied
Therapeutic. Putting into words what the client has implied or said indirectly. Used with mutes. Pt: (mute) Ns: “it must’ve been very difficult for you when your husband died in the fire.” Pt: “it’s a waste of time to be here I can’t talk to anyone.” Ns: “are you feeling that no one understands?”
Attempting to translate words into feelings
Therapeutic. “Desymbolizing” Pt: “in way out in the ocean.” Ns: “you must be feeling very lonely right now”
Belittling feelings expressed
Nontherapeutic. The nurse may unknowingly tell the client to “perk up” or “get over it.” Pt: “I have nothing to live for I wish I were dead.” Ns: “everybody gets down at times. I feel that way myself sometimes.”
Giving advice
Nontherapeutic. Telling the client what to do implies that the nurse knows what is best and that the client is incapable of any self-direction. “I think you should”
Indicating the existence of an external source of power
Nontherapeutic. Attributing the source of thoughts and behaviors to others or to outside influences. This encourages the client to project blame for his or her thoughts or behaviors on others rather than accepting the responsibility. “What makes you say such things?”
Making stereotyped comments
Nontherapeutic. Clichés are meaningless in a nurse-client relationship. When used it encourages a like response from the client. “I’m fine, how are you?” “Keep your chin up.”
Using denial
Nontherapeutic. Denying that a problem exists. Pt: “i’m nothing.” Ns: “of course you are something. Everybody is somebody.”
Interpreting
Nontherapeutic. Seeking to make conscious that which is unconscious. “What you really mean is…” “Unconsciously you’re saying…”
what is SOLER?
Nonverbal behaviors that facilitate attentive listening. S-sit and face client O-open posture L-lean toward client E-eye contact R-relax
True or false? Feedback is evaluative.
False. Feedback should be descriptive rather than evaluative.
Feedback should focus on the behavior rather than on
The client
Requesting an explanation
Nontherapeutic. Asking “WHY” a client did something. Why isn’t good!
