Chapter 6: Communication in the therapeutic relationship

Question 1

Self awareness

Answer 1

The process of understanding one’s own beliefs thoughts motivations biases and limitations and recognizing how do you affect others. Nurses can implement self examination to reflect on the personal meaning of the current situation. Requires a willingness to be introspective and to examine personal beliefs attitudes and motivations

Question 2

The bio psycho social spiritual self

Answer 2

The client perceives the biological dimension of the nurse in terms of physical characteristics. The physiological state influences how the nurse analyze his client information, the emotional state can influence the therapeutic relationship. The social bias from the nurse can affect the relationship. And religious beliefs or feelings such as beliefs about divorce abortion or same-sex relationships can affect interactions.

Question 3

Understanding personal feelings and beliefs and changing behaviour

Answer 3

Nurses must understand their own personal feelings and beliefs and try to avoid projecting them onto clients.In order to change attitudes prejudice behaviours a nurse is required to introspectively analyze themselves

Question 4

Communication

Answer 4

Verbal communication achieved by spoken words including the underlying emotion and context and connotation of what is actually said. Nonverbal communication includes gestures, expressions and body language. Empathetic linkages are the direct communication of feelings. In a therapeutic relationship the nurse focusses on the client and client related issues even when engaging in social activities with the client

Question 5

Using verbal communication

Answer 5

Involves send her a message and receiver. The client is often the sender and the nurse is often nurse Seaver. The client formulate an idea, and Coates a message and then transmit the message with the motion. The nurse receives the message decodes it including feelings connotation and context and then response to the client. Validation is essential to ensure That the nurse has received the information accurately

Question 6

Self disclosure

Answer 6

Self disclosure is telling the client personal information. This is not a good idea since the conversation should focus on the client not the nurse. In revealing personal information, the nurse should be purposeful and have identified therapeutic outcomes.Nurses may feel uncomfortable avoiding questions for fear of seeming rude, however, being nice is not necessarily therapeutic. Neutral or vague answers or saying let’s talk about you maybe all that’s needed to redirect.

Question 7

Verbal communication techniques

Answer 7

Asking a question, restating, and reflecting are examples of verbal techniques. Do use of silence is affective. By maintaining an open silence the nurse allows the client to gather thoughts and proceed at their own pace. Silence consists of deliberate pauses to encourage the client to reflect and eventually respond. Listening is an ongoing activity where the nurse attends to the clients communication. Passive listening involves sitting quietly and letting the client talk, does not focus or guide the thought process, does not foster a therapeutic relationship. Active listening involves the nurse focussing on what the client is seen to interpret and respond to the message objectively, The nurse responds in directly using open ended statements or reflection and questions that elicit additional responses from the client. The nurse should avoid changing the subject and follow the clients lead in active listening.

One of the biggest blocks to communication is giving advice particularly that which others likely have already given. Advice is telling the client what to do or how to act and therapeutic communication is when the nurse and client explore alternate ways of viewing the clients world this allows the client to reach their own conclusions about the best approach is to use.

Question 8

Using nonverbal communication

Answer 8

Gestures, facial expressions and body language. If verbal and nonverbal messages are conflicting the listener likely will believe the nonverbal message since it functions on a more basic level. Some people with mental health problems have difficulty verbally expressing themselves and interpreting the emotions of others. Client iContact or lack there of, posture, movement such as shifting in chair or pacing, facial expressions and gestures communicate thoughts and feelings. In some cultures it is considered disrespectful to look directly into another person’s eyes other cultural differences Can be if someone points with the finger nose or eyes and how much and Jess Street one uses. Positive body language nurses can employee include sitting at the same level with a relaxed posture that projects interest and attention, leaning slightly forward to engage the client, not crossing arms or legs which projects openness and willingness to engage in conversation

Question 9

Recognizing empathic linkages

Answer 9

Empathic linkages are the communication of feelings. This form of communication commonly occurs with anxiety. It may be difficult for the nurse to determine whether the anxiety is communicated interpersonally or if the nurse is personally reacting to some of the context of what the client is communicating.

Question 10

Selecting communication techniques

Answer 10

Choosing the best response begins with assessing and interpreting the meaning of the clients communication both verbal and nonverbal. Nurses should not necessarily take verbal messages literally especially when a client is upset or angry.The nurse should also identified the desired client outcome.

Question 11

Rapport

Answer 11

Rapport is interpersonal harmony characterized by understanding and respect, is important in developing a trusting therapeutic relationship. Nurses established rapport through interpersonal warmth, a non-judge mental attitude and a demonstration of understanding. Nurse client rapport can alleviate anxiety and establish comfort and a sense of sharing.

Question 12

Validation

Answer 12

Validation is explicitly Confirming with another person one’s own thoughts or feelings with respect to a specific event or behavior. Generally refers to observations, thoughts, or feelings and seeks explicit feedback.

Question 13

Empathy

Answer 13

Is the ability to experience, in the present, a situation as another did at some time in the past. The ability to put oneself in another persons circumstance and feelings. The nurse receives information from the client with open nonjudgmental acceptance and communicating this understanding of the experience and feelings so that the client feels understood.

Question 14

Bio psycho social spiritual boundaries and body safe zones

Answer 14

Boundaries are the defining limits of individuals, objects or relationships. Found a smart territory and to find what is mine. Material boundaries such as fences. Personal boundaries have physical psychological social and spiritual dimensions. Physical boundaries are those established in terms of physical closeness. Psychological boundaries are established in terms of emotional distance from others and how much of her feelings and thoughts we want to share. Social boundaries Such as norms, customs and rolls, help us establish our closeness and please within the family culture and community. Spiritual boundaries relate to understanding the meaning of life and a religious values. Boundaries are dynamic.

Question 15

Personal boundaries

Answer 15

Every individual is surrounded by four different body zones. The intimate zone such as whispering and embracing, the personal zone for close friends, the social zone for acquaintances, in the public zone for interacting with strangers. The breadth Of each zone varies according to culture. The nurse needs to protect the intimate zone of that individual.

Question 16

Professional boundaries

Answer 16

In a professional relationship, the focus is on the clients knee and the nurse generally does not share personal information or attempt to meet his or her own needs. Professional boundaries are about power, influence and control but they are not clear and precise. They can be blurred and then big US given the familiarity, trust and emotional intensity often involved in the therapeutic relationship.
Crossing professional boundaries can include giftgiving by either party, a nurse spending inordinate time with a particular client, a nurse strenuously defending or explaining a clients behavior in team meetings, a nurse feeling here she is the only one who truly understands the client, a nurse and client keeping secrets, and a nurse Thinking frequently about a client outside of work.
Within psychiatric disciplines, a romantic or sexual relationship with a former client is considered inappropriate regardless of the length of time since the professional relationship was terminated.When concerns arise the nurse must seek clinical supervision or transfer care of the client immediately.

Question 17

Defence mechanisms

Answer 17

Defence or coping mechanisms are mechanisms that mediate the clients reaction to emotional conflicts and to external stressors. These include projection, splitting, acting out are invariably maladaptive. Others such as suppression and denial may be either maladaptive or adaptive depending on the severity. A defence mechanism becomes pathologic when it is used so persistently that it becomes maladaptive.
Projection is attributing one’s own feelings onto another, splitting is self or others viewed as all bad or all good, an acting out is expressing unconscious feelings in actions rather than words. Defence mechanisms are almost always used unconsciously.

Question 18

Analyzing interactions

Answer 18

Mental health professionals can monitor their interactions with clients using audio recording, video recording and process recording which is writing a verbatim transcript of the interaction. A process recording is adequate in most situations and nurses should use it when first learning therapeutic communication and during times when communication becomes problematic.
Symbolism the use of a word or phrase to represent an object event or feeling is used university. The words people with mental disorders used to symbolize events objects or feelings are often idiosyncratic. Demi see that bombs and guns are exploding to explain feeling scared and anxious. Some clients may have difficulty with abstract thinking and symbolism and all conversations may be interpreted literally. A nurse can also analyze content themes. After a few sessions a common theme normally emerges with common concerns and feelings. Communication blocks or Gentefied by topic changes that either the nurse or the client makes. Topic changes may be due to a lack of interest or because the topic makes the client uncomfortable. The nurse must also record and interpret the clients nonverbal behavior.

Question 19

The nurse client relationship overview

Answer 19

Three overlapping phases that evolve with time. It can be viewed in steps or phases with characteristic behaviour for both the nurse and the client.The orientation phase is when the nursing client get to know each other they develop a sense of trust in the nurse. The working phase is which the client uses the relationship to examine specific problems and learn new ways of approaching them. The resolution is the terminal stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.

Question 20

Orientation phase

Answer 20

Begins when the client and nurse meet and ends when the client begins to identify problems to be examined. The nurse discusses the clients expectations, explains the purpose of the relationship and its boundaries, and facilitate the development of the relationship. The goal is to develop trust and security.

First meeting
Outline both nurse and client responsibilities. Nurse provides guidance, protecting confidential information, and maintaining professional boundaries. Client is responsible for attending agreed-upon sessions, interacting during the sessions, and participating in the relationship.
In the beginning clients may deny problems were to choose to discuss them as defence mechanisms. The client is usually nervous and insecure they may exhibit behaviour reflective of this such as rambling.

Confidentiality in treatment
They should discuss the issue of confidentiality in the first session. The nurse should be clear about any information that is to be shared with anyone else. Assessment data and client progress is normally shared with supervisors and interprofessional team members including physicians.

Testing the relationship
At the end of the honeymoon phase the client begins to test the relationship to become convinced that the nurse will really except them. Testing behaviours include forgetting a scheduled session or being late, the client may express anger at something the nurse says or accuse the nurse of breaking confidentiality. The client may introduce a superficial in shoe first as if it’s the major problem.It’s important to recognize these behaviours as being designed to test the relationship. With the adoption of consistent responses these behaviours usually subside and must be understood as a normal way that humans develop trust.

Question 21

Working phase

Answer 21

When the client begins identifying problems to work on. Problem identification can field issues such as managing symptoms, coping with chronic pain, examining issues related to sexual abuse and dealing with problematic interpersonal relationships.
Transference is the unconscious assignment to others of the feelings and attitudes that the client originally associated with important figures. Counter transference is the providers emotional reaction to the client based on personal and conscious needs and conflicts. The client is psychologically vulnerable and emotionally dependent on the nurse and the nurse must recognize counter transference and prevented from eroding professional boundaries.

Question 22

Resolution phase

Answer 22

Begins when the actual problems are resolved and ends with the termination of the relationship. The client is redirected towards a life without this specific therapeutic relationship. They’re connected with community resources and they take responsibility for follow up appointments. New problems are not addressed during this phase. The nurse assists the client in strengthening relationships, making referrals and recognizing and understanding signs of future relapse. Termination begins on the first date of the relationship when the nurse explains that the relationship is time-limited.
Some clients may skip the last session to avoid feelings of sadness and separation others may feel anger towards the nurse. The nurse can handle this by helping the client acknowledge the anger and explain that it is a normal emotion when relationships are ending. Some clients may raise old problems that have already been resolved. This is because the client is unconsciously attempting to prolong the relationship and avoid it’s ending. Nurses should reassure clients that they have already covered these issues and learned methods to control them.

Question 23

Non-therapeutic relationships

Answer 23

These also start in the orientation fees, however trust is not established and the relationship moves to a phase of grappling and struggling. The nurse and client both feel frustrated and keep burying their approaches with each other in order to establish a relationship. The nurse might change from long to short meetings be more or less directive be more friendly or aloof. The client me talk about The past but then change to the present they talk about their family and then talk about work goals. They move to a phase at mutual withdrawal. The nurse may schedule the client at an end of the shift and run out of time, the client may leave or be unavailable during the scheduled meeting if the meeting does occur it will be kept short. Clinical supervision early on me assist the development of the relationship But often a therapeutic transfer to another nurse is required.
Barriers to forming therapeutic relationships include increasing administrative responsibilities, shortened length of inpatient stay, fear of causing harm, lack of experience individualizing client care, organization structure and policy, and negative perceptions of the workplace environment. Barrier seen by clients include amount of time allocated to interaction, inaccessible nursing staff, insufficient involvement in Care, being treated as an object or a problem to solve, authoritative and paternalistic staff, and a tense or unsafe atmosphere

Question 24

Motivational interviewing

Answer 24

Motivational interviewing is a clinical method designed to facilitate change in client behaviour by engaging clients own autonomous decision making ability.Encourages the client to make his or her own decisions through directed counselling that address is increasing preferred behaviors And decreasing nonpreferred behaviours. It is exploratory and adaptive.Two critical components emerge, conviction which is importance, and confidence. The principles for motivational enhancement include avoiding arguing, expressing empathy, develop discrepancy, role with resistance, and support self efficacy. The acronym frames feedback, responsibility, advice, menu, empathy, self efficacy also describes elements of brief interventions with patients.

Question 25

Transitional relationship model

Answer 25

It was originally developed to help people through the discharge process and it evolved from the transitional discharge model. It is based on the assumption that people heal in relationships and require both professional and therapeutic peer relationships. It was developed to sustain therapeutic relationships through the clients transition from hospital to community.

Question 26

Technology and the therapeutic relationship

Answer 26

Telehealth is an extension of healthcare service delivery across distance by the use of information and communication technologies such as telephone video on the Internet. This has improved access to healthcare for clients in rule areas. It is important to consider for PMH nursing how these situations influence nonverbal communication. Some clients May lack access to technology. Privacy and security and consent are other issues.