Chapter 9 - Therapeutic Communication Flashcards
Self exam
a willingness to be introspective
Verbal communincation
Spoken word
Underlying emotion
Context
Connotation
Nonverbal communincation
Gestures
Expressions
Body Language
Therapeutic communincation
Ongoing process of interaction through which meaning emerges
What is the #1 principle of therapeutic communication?
The patient is the primary focus
Interventions should come from ___ based
Theory based
How can the nurse track the pt’s verbal communication using therapeutic communication?
Clarification
Avoid ___, ___, and ___
Avoid giving advice, social relationships, and changing the subject
What is a very important therapeutic communication principal to follow when conversing w/ pt?
Limit self disclosure
Acceptance
Encouraging and receiving info in a nonjudgemental and interested manner
The use of acceptance is usefully when:
Establishing a rapport and trust
Confrontation
Presenting the pt. with a different reality of the situation
Doubt
Expressing/voicing doubt when a pt. relates a situation
Why would the nurse use doubt?
To guide the pt. toward other explanations
Interpretation
Putting into words what the pt. is implying/feeling
Why would the nurse use Interpretation?
Help the pt. identify underlying thoughts or feelings?
Observation
Stating to the pt. what the nurse is observing
Open-ended questions
Introducing an idea and letting the pt. respond
Reflection
Redirecting the idea back to the pt. for classification about what is important
It gives pt. permission to have feelings they may not realize they have
The pt. is explaining ideas about getting a job and ask the nurse what the nurse thinks the pt. should do. What therapeutic techniques is useful here?
Reflection - when the pt. is asking for the nurse’s approval or judgement
Restatement
Repeating the main idea expressed
Silence
remaining quiet but nonverbally expressing interest during an interaction
Validation
Clarifying the nurse’s understanding of the situation
Why would the nurse use validation?
When the nurse is trying to understand the situation the pt. is trying to describe
Communication blocks
Advice (#1) Agreement Challenges (disputing pt. beliefs) Reassurance Disapproval
The pt. is very anxious while the nurse is interviewing her. The nurse notices that her own speech is becoming faster and shaky. What is this called?
Empathetic linkage- direct communication of feelings
Intimate zone
whispering
embracing
Personal zone
Close friends
Social zone
For acquaintances
Public zone
Interacting with strangers
Defense Mechanisms
Psychological mechanisms that help an individual respond to and cope with emotional conflicts and external stressors
Acting out
Using actions rather than reflections/feelings during periods of emotional conflict
Affiliation
Turing to other for help or support
Altruism
dedicating life to meeting the needs of others - receives gratification from others
Anticipation
Experiencing emotional reactions in advance or anticipating consequences of possible future events and considering realistic alternative solutions
Autistic Fantasy
Excessive daydreaming as a substitute for human relationships, more effective action or problem-solving
Devaluation
Attributing exaggerated negative qualities to self or others
Ex. A boy has been rejected by his long-time girlfriend. He tells his friends that he realizes that she is stupid and ugly.
Displacement
Transferring a feeling about or a response to one object onto another
Ex. A child is mad at her mother for leaving for the day but says she is really mad at the sitter for serving her food she does not like.
Denial
Refusing to acknowledge some painful aspect of external reality or subjective experience
Dissociation
An adult relates severe sexual abuse experienced as a child but does it without feeling. She says that the experience was as if she were outside her body watching the abuse.
Help-rejecting/Complaining
Complaining or making repeated requests for help. Rejecting suggestions or advice
Humor
Emphasizing the amusing or ironic aspects of the conflict or stressor
Idealization
Attributing exaggerated positive qualities to others
An adult falls in love and fails to see the negative qualities of their significant other, is an example of:
Idealization
Intellectualization
Excessive use of abstract thinking or the making of generalizations to control or minimize disturbing feelings
Isolation of affect
Separation of ideas from the feelings originally associated with them
An individual looses touch with the feelings associated with rape while remaining aware of the details is an example of:
Isolation of affect
Omnipotence
Feeling or acting as if one possesses special powers or abilities and is superior to others
Passive aggression
Indirectly and unassertively expressing aggression toward others
Projection
Falsely attributing to another one’s own unacceptable feelings, impulses, or thoughts
Projective identification
Falsely attributing to another’s own unacceptable feelings, impulses, or thoughts.
A child is angry at a parent but the child accuses the parent of being angry is an example of:
Projection
A child is angry at a parent who in turn becomes angry at the child but not sure why. The child then feels justified at being angry at the parent is an example of:
Projective identification
Rationalization
Concealing the true motivations for one’s own thoughts, actions, or feelings through elaboration of reassuring or incorrect explanations
Reaction formations
Substituting behavior, thoughts, or feelings that are opposite from one own’s unacceptable thoughts or feelings
Reaction formation usually occur with ___
Repression
A wife find out her husband is having an affair. She tells her friend she thinks the affairs are perfectly appropriate. She truly does not have any anger or hurt. Is an example of:
Reaction formation
Repression
Expelling disturbing wishes, thoughts, or experiences from conscious awareness
A woman does not remember the experience of being raped is an example of:
Repression
Self-assertion
Expressing feelings and thoughts directly in a way that is not coercive or manipulative
A woman reaffirms that going to a ball game is not what she wants to do is an example of:
Self-assertion
Self-observation
Reflecting feelings, thoughts, motivation, and behavior and responding to them appropriately
Ex. An individual notices an irritation at his friend’s late arrival and decides to tell the friend of the irritation.
Splitting
Compartmentalizing opposite affect states and failing to integrate the positive and negative qualities to the self or others in cohesive images
Sublimination
Channeling potentially maladaptive feelings or impulses into socially acceptable behavior
An adolescent boy is very angry with his parents he channeling this by hitting someone very hard in football practice is an example of:
Sublimination
Suppression
Internally avoiding thinking about disturbing problems, wishes, feelings, or experiences
A student is anxiously awaiting a test result but goes to a movie to stop thinking about it is an example of:
Suppression
Undoing
Words or behaviors designed to negate or to make amends symbolically for unacceptable thoughts, feelings, or actions
Symbolism
The use of a word or phrase to represent an object, event, or feeling
Which theorist suggests building a nurse-patient relationship?
Hildegarde Peplau
Orientation phase
First meeting
Confidentiality is addressed
The pt. may test the relationship
Working Phase
Identification of problems
Problem solving
Resolution phase
Problem resolve
Relationship ends
Transference
Unconscious assignment to others of the feelings and attitudes that the pt. originally associated with important figures
Countertransference
The provider’s emotional reaction to the pt. based on unconscious needs and conflicts
The nurse and pt. are in the termination phase of their relationship. The nurse noticed the pt. keeps bringing up problems that have previously been solved. What does the nurse interpret the pt. is doing?
The pt. is attempting to prolong the relationship and avoid it ending
Nurse should reassure that they have already solved these problems
