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chapter 5 therapeutic communication Flashcards

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1
Q

Hays and Larson stated that therapeutic nurse patient relationship is?

A

to relate therapeutically with a patient, it is necessary for the nurse to understand his or her role and its relationship to the patient’s illness

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2
Q

Hays and Larson stated that the role of the nurse is to provide the patient with the opportunity to:

A
  1. identify and explore problems in relating to others
  2. discover healthy ways of meeting emotional needs
  3. experience a satisfying interpersonal relationship
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3
Q

what the the therapeutic interpersonal relationship?

A

is the process by which nurses provide care for patients in need of psychosocial interventions

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4
Q

therapeutic use of self is?

A

is the instrument for delivery of that care

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5
Q

interpersonal communication techniques are?

A

(both verbal and nonverbal) are the “tools” of psychosocial intervention

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6
Q

therapeutic relationship

A

An interaction between two people (usually a caregiver and a care receiver) in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention.

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7
Q

when is a interpersonal relationship possible?

A

only when each individual in the interaction perceives the other as a human being.
- not a nurse patient relationship but a human to human relationship

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8
Q

what is the mutually significant experience?

A

both the nurse and the recipient of care have needs met when each views the other as a unique human being, not an illness, a room number or all nurses.

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9
Q

The goal of a therapeutic relationship is based on what model? What is the goal directed at?

A
  • based on the problem-solving model

- learning and growth promotion in an effort to bring about some type of change in the patient’s lif

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10
Q

what’re some interventions for the goal - the patient will demonstrate more adaptive coping strategies for dealing with (specific life situation)

A
  1. identify what is troubling the patient at this time
  2. encourage the patient to discuss changes he or she would like to make
  3. discuss with the patient what changes are possible and what aren’t
  4. have the patient explore feelings about aspects that cannot be changed and alternative ways of coping more adaptively
  5. discuss alternative strategies for creating changes that patient desires to make
  6. weigh the benefits and consequences of each alternative
  7. assist the patient to select an alternative
  8. encourage the patient to implement the change
  9. provide positive feedback for the pt’s attempts to create change
  10. assist the pt to evaluate outcomes of the change and make modifications as required
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11
Q

what does Travelbee describe the therapeutic use of self as?

A

the ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention

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12
Q

what must the nurse understand about using therapeutic use of self?

A

the nurse has to understand that the ability to, and the extent to which on can, effectively help others in time of need is strongly influenced by the internal value system (combo of intellect and emotions)
-they have to have a great deal of self-awareness and self-understanding, arrived to a philosophical belief about life, death, and the overall human condition

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13
Q

Rapport

A

special feelings on the part of both the pt and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust and a nonjudgmental attitude.

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14
Q

Travelbee explains Rapport to be?

A

a sense of harmony based on knowledge and appreciation of each individual’s uniqueness. the ability to be still and experience the other as a human being and to appreciate the unfolding or each personality.

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15
Q

what is the core of rapport?

A

the ability to truly care for and about others

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16
Q

Trust

A
  • earned not presumed
  • one must feel confidence in that person’s presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested
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17
Q

psychiatric patients with schizophrenia or any thought disorders may have trouble with what? what should the nurse do?

A 
thinking abstractly (concrete thinking)
the nurse should communicate and behave in a simple, concrete manner to promote the development of trust
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18
Q

nursing intervention that can promote trust to a person who thinks concretely

A
  1. give a blanket when cold
  2. give food when hungry
  3. keep promises
  4. be honest
  5. simply and clearly provide reasons for certain policies, procedures, and rules
  6. attending activities with the pt if they dont want to go alone
  7. be consistent in adhering to unit guidelines
  8. listening to the pt’s preferences, request, and opinions, and making collaborative decisions concerning their care
  9. ensuring confidentiality
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19
Q

Respect

A
  1. to believe in the dignity and worth of an individual regardless of their unacceptable behavior
  2. unconditional positive regard
  3. nonjudgmental attitude
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20
Q

why does psychiatric patient lack self-respect?

A

related to low self-esteem that accompanies illnesses such as clinical depression or it may be related to rejection and stigmatization by other

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21
Q

how can the nurse convey respect to patients?

A
  1. calling pt by name (and title, if they prefers)
  2. spending time with the patient
  3. allowing sufficient time to answer the patients questions and concerns
  4. promoting an atmosphere of privacy during therapeutic interactions with the patient or when the patient may be undergoing physical examination or therapy
  5. always being open and honest with the patient, even when the truth may be difficult to discuss
  6. listening to the pt’s ideas, preferences, and requests, and making collaborative decisions concerning his/her care whenever possible
  7. striving to understand the motivation behind the patient’s behavior, regardless of how unacceptable it may seem
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22
Q

genuineness

A
  • the nurse’s ability to be open, honest, and real in interactions with the client
  • the nurse responds to the patient with truth and honesty rather than with responses that he or she may consider more “professional” or that merely reflect the “nursing role.”
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23
Q

genuineness calls for a degree of what? what happens when the nurse uses this “degree”?

A

self-disclosure.

a quality of “humanness” is revealed to the patient, creating a role for the patient to model in similar situations.

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24
Q

empathy

A

the ability to see beyond outward behavior and to understand the situation from the patient’s point of view.

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25
Q

sympathy

A

taking on the other’s needs and problems as if they were your own and becoming emotionally involved to the point of losing you objectivity.

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26
Q

accurate empathetic perceptions on the part of the nurse assist the patient to do what?

A

identify feelings that may have been suppressed or denied.

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27
Q

what is the primary difference between social and therapeutic relationship?

A

therapeutic relationships always remain focused on the healthcare needs of the patient, they are never for the purpose of addressing the nurse’s personal needs, and they progress through identified phases of development for the purpose of helping the patient to solve health-related problems.

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28
Q

what’re the four phases of the therapeutic nurse-patient relationship?

A
  1. pre-interaction phase (explore self-perceptions)
  2. orientation [introductory] phase (establish trust and formulate contract for intervention)
  3. working (promote patient change)
  4. termination phase (evaluate goral attainment and ensure therapeutic closure)
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29
Q

the preinteraction phase

A
  • preparation for the first encounter with the patient
  • get info about the pt from their chart, SO, or other health team members
  • nurse becomes aware of personal responses to knowledge about the patient
  • examining feelings, fears, and anxieties about working with that patient.
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30
Q

the orientation (introductory) phase

A
  • nurse and client become acquainted
  • create an env for the establishment of trust and rapport
  • establishing a contract for intervention that details the expectations and responsibilities of both the nurse and patient
  • gathering assessment information to build a strong database
  • identifying the patients strengths and limitations
  • formulating nursing diagnosis
  • setting goals that are mutually agreeable to the nurse and patient
  • developing a plan of action that is realistic for meeting the established goals
  • developing a plan of action that is realistic for meeting the established goals
  • exploring feelings of both the patient and nurse in terms of the introductory phase
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31
Q

the working phase

A
  • when the nurse and the patient work together to solve problems and accomplish goals
  • maintaining the trust and rapport that was established during the orientation phase
  • promoting insight and perception of reality
  • problem-solving
  • overcoming resistance behaviors as the level of anxiety rises in response to discussion of painful issues
  • continuously evaluating progress toward goal attainment
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32
Q

what is transference?

A
  • pt unconsciously displaces (or “transfers”) to the nurse feelings formed toward a person from their past.
  • interferes with the therapeutic interaction when the feelings being expressed include anger and hostility
  • anger towards nurse may manifest uncooperativeness and resistance to the therapy
  • overwhelming affection or excessive dependency
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33
Q

interventions of tansference include?

A
  • relationship doesn’t need to be terminated unless it poses as a serious barrier to therapy or safety
  • nurse should work with pt to sort out the past from the present, assist the pt into identifying the transference, and reassign a new and more appropriate meaning to the current nurse-pt relationship
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34
Q

What is countertransference?

A

-Refers to the nurse’s behavioral and emotional response to the client

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35
Q

what feelings can interfere with the therapeutic relationship when the nurse experiences countertransference?

A
  1. the nurse over identifies with the patient’s feelings because they remind him/her of their problems
  2. the nurse and pt develop a personal relationship
  3. the nurse tries to rescue the pt
  4. the nurses encourages the patient’s dependence
  5. the nurse’s anger engenders feelings of disgust toward the pt
  6. nurse is bored and apathetic in sessions with the pt
  7. the nurse feels anxious and uneasy around the pt
  8. the nurse has difficulty setting limits on the pt’s behavior
  9. the nurse defends the patient’s behavior to other staff members
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36
Q

interventions of countertransference?

A
  1. relationship shouldn’t be terminated
  2. support and assist the nurse in identifying their feelings
  3. may be important to have evaluative sessions with the nurse and their next encounter with the patient
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37
Q

The Termination Phase
what is the main task?
when does this phase occur?

A
  • occurs at the end of a relationship
  • bringing a therapeutic conclusion
  • progress has been made toward attainment of mutually set goals
  • a plan for continuing care or for assistance during stressful life experiences is mutually established
  • feelings about the termination of the relationship are recognized and explored
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38
Q

what is a boundary?

A

a border or a limit. determines the extent of acceptable limits

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39
Q

what is a material boundary?

A

physical property that can be seen (fences)

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40
Q

what is a personal boundary?

A

boundaries that people define for themselves.

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41
Q

what is included in regards to personal boundaries and their meanings.

A
  1. physical distance boundaries - how close people will allow others to invade their physical space
  2. emotional boundaries - how much a person chooses to disclose
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42
Q

what is a professional boundary?

A
  • outline appropriate professional relationships with patients
  • the space between the nurses power and the patient’s vulnerability
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43
Q

what’re some concerns regarding professional boundaries?

A
  1. self-disclosure
  2. gift giving
  3. touch
  4. friendship or romantic association
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44
Q

self-disclosure?

A
  1. may be appropriate when it is judged that the information may therapeutically benefit the pt
  2. should never be undertaken for the purpose of meeting the nurses needs
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45
Q

gift giving?

A
  1. some cultures find it insulting if you don’t accept their gift/ share with staff
  2. accepting financial gifts is never appropriate but you can tell them to donate to a charity of their choice
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46
Q

touch?

A
  1. caring touch is the touching of patients when there is no physical need
  2. touching/hugging can be beneficial but make sure they consent to it
  3. vulnerable patients may misinterpret the meaning of touch
  4. in some cultures, touch is inappropriate unless they know each other well
  5. touch should be avoided when the patient is experiencing levels of anxiety, suspiciousness, or psychosis
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47
Q

friendship or romantic association?

A
  1. if the nurse is unable to accomplish the separation from a personal nature to a professional one the nurse should withdraw from the nurse-patient relationship
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48
Q

what are some warnings that indicate that the professional boundary of the nurse-patient relationship is in jeopardy?

A
  1. favoring one patient’s care over that of another
  2. keeping secrets with a patient
  3. changing dress style for working with a particular patient
  4. giving special attention or treatment to one patient over others
  5. spending free time with a patient
  6. frequently thinking about the pt away from work
  7. sharing personal information or work concerns with the patient
  8. receiving from or continuing communication with the pt after discharge
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49
Q

how are boundary violations determined?

A

any actions that overstep the established boundaries to meet the needs of the nurse are boundary violations

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50
Q

what is Communication?

A

an interactive process of transmitting information between two or more entities

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51
Q

What is interpersonal communication?

A

transaction between the sender and the receiver

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52
Q

Values, attitudes, and beliefs

A
  1. attitudes of prejudice are expressed through negative stereotyping
  2. one’s value system may be communicated with behaviors that are more symbolic in nature
53
Q

culture and religion

A
  1. culture mores, normas, ideas, and customs provide the basis for our way of thinking
  2. priest and ministers wear collars to communicate their mission in life. people wear cross or hang crucifix on the wall to communicate religious beliefs
54
Q

social status

A
  1. high status persons are associated with gestures that communicate their higher-power position (use less eye contact, have relaxed posture, use louder voice pitch, place hands on hips more frequently, are “power dressers”, have greater height, and maintain more distance when talking to people of lower social status)
55
Q

gender

A
  1. most cultures have gender signals

2. gender roles are changing and words like unisex are becoming more acceptable

56
Q

age or developmental level

A
  1. adolescents struggle to separate parental confines and establish their own identity
  2. adolescents generate their own unique pattern of communication
  3. people who are deaf or hearing impaired use American Sign Language to communicate
  4. people who are blind never learn subtle nonverbal gestures and change the meaning of spoken word
57
Q

environment in which the transaction takes place

A

territoriality
density
distance - intimate, personal, social, and public

58
Q

Territoriality

A
  1. the innate tendency to own space

2. interpersonal communication can be more successful if the interaction takes place in a “neutral” area.

59
Q

Density

A
  1. the number of people within a given environment space

2. influences interpersonal interaction

60
Q

distance

A
  1. the means by which various cultures use space to communicate
61
Q

intimate distance

A
  1. the closest distance that individuals allow between themselves and others
  2. 0-18 inches
62
Q

personal distance

A
  1. 18-40 inches
  2. reserved for the interactions that is personal on nature
  3. close convos with friends or colleagues
63
Q

social distance

A
  1. 4-6 ft

2. interactions include conversations with strangers or acquaintances

64
Q

public distance

A
  1. exceeds 12 feet

2. speaking in public or yelling to someone some distance away

65
Q

What is nonverbal communication?

A

communication based on a person’s use of voice and body, rather than on the use of words

66
Q

physical appearance and dress (nonverbal)

A
  1. dress
  2. hair
  3. body jewelry or art etc
67
Q

body movement and posture (nonverbal)

A
  1. slumped posture, head and eyes pointed downward = low self-esteem
  2. warm individual =shift posture toward the person, a smile, direct eye contact, and hands that remained still
  3. cold individual = slumped posture, looking around the room, drumming fingers on desk, not smiling
68
Q

Touch (nonverbal)

A
  1. functional-professional: impersonal and businesslike touch. used to accomplish a task. ex: a tailor measuring you
  2. social-polite: still impersonal, conveys an affirmation or acceptance of the other person ex: handshake
  3. friendship-warmth: strong liking for the other person ex; laying hand on the shoulder of another person
  4. love-intimacy: an emotional attachment or attraction to another person ex: strong, mutual embrace
  5. sexual arousal: expression of physical contact only. ex: caressing or touching another
69
Q

facial expression (nonverbal)

A

-primary source of communication

70
Q

eye behavior (nonverbal)

A
  1. windows of the soul
  2. indicates communication is open
  3. gazing at another’s eyes arouses strong emotions
71
Q

vocal cues or paralanguage (nonverbal)

A
  1. Paralanguage is the vocal component of the spoken work
  2. consists of pitch, tone, and loudness of spoken messages, the rate of speaking, expressively placed pauses, and emphasis assigned to certain words
  3. include facial expressions and gestures that accompany vocal components and contribute to the interpretation of the message
72
Q

Nose - nostril flare wrinkling up

A

anger; arousal dislike; disgust

73
Q

Lips - grin; smile

A

happiness; contentment

74
Q

Lips - grimace

A

fear; pain

75
Q

Lips - compressed

A

anger; frustration

76
Q

Lips - Canine-type snarl

A

disgust

77
Q

Lips - pouted; frown

A

unhappiness; discontent; disapproval

78
Q

Lips - pursing

A

disagreement

79
Q

Lips - sneer

A

contempt; disdain

80
Q

Brows - frown

A

anger; unhappiness; concentration

81
Q

Brows - raised

A

surprise; enthusiasm

82
Q

Tongue - stuck out

A

dislike; disagree

83
Q

Eyes - widened

A

surprise; disagree

84
Q

Eyes - narrowed; lids squeezed shut

A

threat; fear

85
Q

Eyes - stare

A

threat

86
Q

Eyes - Stare, blink, look away

A

dislike; disinterest

87
Q

Eyes - Eyes downcast; lack of eye contact

A

submission; low

88
Q

Eyes - eye contact (generally intermittent as opposed to a stare)

A

self-esteem, self-confidence; interest

89
Q

what is therapeutic communication?

A

verbal and nonverbal techniques that focus on the care receiver’s needs and advance the promotions of healing and change.

90
Q

what does therapeutic communication encourages?

A

exploration of feelings and fosters understanding of behavioral motivation. it is nonjudgmental, discourages defensiveness, and promotes trust

91
Q

Using Silence (therapeutic)

A

encourages client to organize thoughts and put them into words

92
Q

Accepting (therapeutic)

A

conveys an attitude of understanding and willingness to interact

93
Q

Giving recognition (therapeutic)

A

acknowledging, indicating awareness

94
Q

Offering Self (therapeutic)

A

willingness to spend time with the patient

95
Q

Giving Broad Openings (therapeutic)

A

allows the patient to direct the focus of the interaction and emphasize the importance of the pt’s role

96
Q

Offering general leads (therapeutic)

A

offers the patient encouragement to continue with minimal input from the nurse

97
Q

Placing the event in time sequence (therapeutic)

A

facilitates organizing one’s thoughts about their experience

98
Q

Making observations (therapeutic)

A

encourages the pt to develop awareness of how they are perceived and promotes exploration of issues that may be problematic

99
Q

Encouraging description of perceptions (therapeutic)

A

facilitates the patient’s ability to develop awareness and understanding.
-hallucinating patients = give clarification about what the patient’s perceptual experiences are communicating

100
Q

Encouraging comparison (therapeutic)

A

helps the patient recognize life experiences that tend to recur and those aspects of life that are changeable

101
Q

Restating (therapeutic)

A

repeating the main idea lets the patient know whether an expressed statement has been understood

102
Q

Reflecting (therapeutic)

A

questions and feelings are referred back to the patient so that the patient engages in problem solving instead of looking for advice from the nurse

103
Q

Focusing (therapeutic)

A

taking notice of a single idea or even a single word

-difficult for a patient with extreme anxiety

104
Q

Exploring (therapeutic)

A

facilitates the patients development of awareness and understanding about events, thoughts and feelings

105
Q

Seeking clarification and validation (therapeutic)

A

explaining what is vague or incomprehensible

106
Q

Presenting reality (therapeutic)

A

when pt has a misperception of the environment, the nurse defines reality without challenging the patient’s perception

107
Q

Voicing Doubt (Therapeutic)

A

used with patients with delusional thinking. expressing uncertainty about the validity of the patient’s perception

108
Q

Verbalizing the Implied (therapeutic)

A

putting into words what the patient has voiced or implied

109
Q

Attempting to translate words into feelings (therapeutic)

A

the nurse tries to desymbolize what has been and to find clues of the underlying true feelings

110
Q

Formulating a plan of action (therapeutic)

A

encourage patient to formulate a plan

111
Q

Active listening - SOLER

A

S - sit squarely facing the patient
O - open posture.
L - lean forward toward the patient
E - establish eye contact
R - relax. restlessness and fidgetiness communicates a lack of interest and may convey a feeling of discomfort that is likely to be transferred to the patient
-creates a climate in which the patient can communicate; the nurse communicates acceptance and respect for the patient, and trust is enhanced

112
Q

Giving false reassurance (non-therapeutic)

A

conveys that the nurse already knows the outcome and minimizes the pt’s expressed concerns
-ask the pt to tell you more about their concerns

113
Q

Rejecting (non-therapeutic)

A

refusing to consider or showing contempt for the pt’s ideas or behaviors
-ask the pt to explain their concerns further

114
Q

Approving or disapproving (non-therapeutic)

A

this implies that the nurses role is to pass judgement on whether the patient’s ideas or behaviors are good or bad
-ask the pt to explain further what happened

115
Q

Agreeing or disagreeing (non-therapeutic)

A

agreement prevents the pt from later modifying their pov. disagreement may provoke defensiveness

116
Q

Giving advice (non-therapeutic)

A

implies that the nurse knows what’s best for the patient and discourages independent thinking

117
Q

Probing (non-therapeutic)

A

patient may feel used only for information the nurse is seeking and may place the patient on the defensive.

118
Q

Defending (non-therapeutic)

A

Defending (non-therapeutic)

119
Q

Requesting an Explanation (non-therapeutic)

A

asking “why” questions may cause the patient to be intimated and may want to defend their behavior

120
Q

Indicating the existence of an external source of power (non-therapeutic)

A

encourages the patient to project blame for their own thoughts and behaviors on others rather than accepting responsibility

121
Q

Belittling Feelings Expressed (non-therapeutic)

A

a lack of empathy and understanding may be conveyed. patient may feel like their concerns are insignificant or unimportant

122
Q

Making stereotyped comments (non-therapeutic)

A

choose words, sentences and nonverbal languages that convey a sincere interest in encouraging the patient to share more about the pt’s thoughts, feelings, and behaviors

123
Q

Using Denial (non-therapeutic)

A

blocks discussion with client and avoids helping client identify and explore areas of difficulty

124
Q

Interpreting (non-therapeutic)

A

attempts to tell the patient the meaning of the pt’s experience. pt may feel like the nurse doesn’t understand them.
-leave interpreting to the therapist

125
Q

Introducing an Unrelated Topic (non-therapeutic)

A

it conveys to the patient that the nurse doesn’t want to talk about the original topic

126
Q

What is motivational interviewing?

A

an evidence-based, patient-centered style of communication that promotes behavior change by guiding patients to explore their own motivation for change and the advantages and disadvantages of their decision
-focused on what the patient wants to do and not what the nurse thinks should be the next steps in behavior change

127
Q

Process recording

A
  1. written reports of verbal interactions with patients
  2. includes verbal and nonverbal communication of both the nurse/student nurse and the patient.
  3. not documented
  4. learning tool for professional development
128
Q

What is feedback?

A

method of communication that helps the client considers a modification of behavior.

129
Q

characteristics of feedback

A
  1. descriptive rather than evaluative
  2. focused on the behavior rather than the person
  3. avoid evaluative language to avoid defensive communication
  4. specific rather than general
  5. directed toward behavior that the patient has the capacity to modify
  6. impart information rather than offer advice
  7. should be well timed

psych (2 decks)

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