Intro to Therapeutic Relationships Flashcards
Which 5 components is the TNCR based on?
- Trust
- Respect
- Empathy
- Power
- Professional Intimacy
Why is TRUST important to the TNCR?
- trust is fragile; once broken, it is difficult to reestablish
- keep promises to client
- avoid saying “Ill be back in 1 minute” unless you are 100% sure that you will be back - if you promise that you will be back in 5 with medication and you are not back in 5 - the client is less likely to trust in your word
Why is RESPECT important to the TNCR?
- recognize the dignity, worth, ad uniqueness or every individual
- you must treat a patient convicted of murder the same way you would an ill patient
Why is PROFESSIONAL INTIMACY important to the TNCR?
- physical: baths, wound care
- psychological: mental illness, poor, intimate life details
- social: family/friend dynamics
- understanding personal health info
Why is EMPATHY important to the TNCR?
- important to understand, validate, and resonate with the meaning that the health care experience holds for the client
Why is POWER important to the TNCR?
- misuse of power = abuse
- appropriate use of power (specialized knowledge and access to info) can help meet the clients needs
What is the therapeutic relationship?
1) PURPOSEFUL and 2) GOAL-DIRECTED relationships
- aimed at advancing the best interest and outcome of the client
- interpersonal process between the nurse and the client
What is the reason we have shifted the term from “patient” to “client”?
- Patient emphasizes the power imbalance between the nurse and the client
- Client encompasses a person, group, community
- patient is used in acute care settings (ie.hospitals)
What is the goal of the TNCR?
- allow the client to have SELF-EXPRESSION to promote health growth
A therapeutic relationship is NOT _____________.
Psychotherapy
- a TNCR can be applied to other disciplines (pyschotherapy)
What is the objective of the nursing process?
- to assess, diagnose, plan, and provide and evaluate client-centred care
- to understand the significance of the clients problem
- to help identify and resolve problems
How is the TNCR established/maintained?
- by the nurse using their knowledge and skills, caring attitudes/behaviours
- by providing services that contribute to the clients health
How is the TNCR demonstrated?
- having respect and empathy and interest for clients
- maintaining boundaries between professional therapeutic relationships and (non-professional) personal relationships
- collaborating with clients and their families in a way that recognizes their needs, values, and beliefs
- recognizing the potential and preventing client abuse (being aware of the power imbalance)
- stop or report abuse
Nurse Considerations in the TNCR
- Personal values, beliefs, and experiences
- Self-assessment and awareness
- must be aware of words/body language (ie. clients with a past of abuse can be triggered by “Can I grab your arm to take your BP”) - Mental health status
- Personal qualities
- Components of the TNCR
Client Considerations in the TNCR
- Personal values, beliefs, and experiences
- Mental and physical health
- Developmental stage
- Psychosocial factors
- Spiritual Factors
Considerations in developing the TNCR.
- professional, ethical, and legal responsibilities (ie. duty to report that client is expressing harm to self or others)
- social vs. professional therapeutic relationships (they are not our friends)
- Boundaries, safety, and trust development
- effective verbal; and non-verbal communication skills
- barriers (ie. client is stressed or in pain)
Who is Hildegard Peplau?
- 1st theorist to identify the patient relationship as central to nursing care
- In the 1950’s, pysch/mental health nurse were ‘companions’ to clients and were not to talk about their thoughts, feelings experiences
- Peplau advocated that clients are NOT objects: it not what you are doing TO the client (body), rather what you are doing WITH the client
3 Phases of TNCR
- Orientation
- Working
a. Identification
b. Exploitation - Resolution
What is involved in the Orientation Phase?
- Getting to know each other
(can vary from minutes to months) - The parameters of the relationship are established
- Rapport begins todevelop between the client and the nurse
- Nurses begin to obtain essential information about clients as individuals with unique needs, values, beliefs, and priorities
- Trust, respect, honesty, and effective communication are key to developing the relationship
What is the difference between identification and exploitation in the WORKING Phase?
1) Identification: The client begins to identify problems and define goals
- the client is more dependent
- Ex. A senior client post knee surgery Goals: wants to walk in home on stairs
- Nurse can support/assist with ADL’s
2) Exploitation: Theclient makes use of the services of the nurse to work through identified goals
- The client develops increasing independence and responsibility
- The nurse does not take sole responsibility in solving the client’s problems, RATHER gives the client info and promotes/validates their strengths
- Ex. A senior client post knee surgery
- client is more independent with ADL’s (modify them to be able to do it on their own)
What is involved in the RESOLUTION Phase?
- The termination of the relationship
- Termination is based on mutual understanding
- Client develops increasing independence
- Client develops new goals as old goals have been met/problems are solved
(E.g. Connect with community resources for additional support) - Client and nurse should share feelings related to the ending of the TR
- Evaluate the relationship
- Allow for processing the termination of the relationship
What is the difference between responsive and action dimensions?
Responsive - helps establish trust and open communication
Action - examine differences between clients feelings and behaviours
- identify obstacles to clients progress and need for behaviour change
- (ie. client wants to be discharged,
but they are threatening to self-
harm)
Responsive dimension includes:
- Respect
- providing care free of judgement
- Genuineness
- Transparency; not just saying nice things to the patient to spare them, but to provide the truth regardless
- Concreteness
- Being firm in what you say, avoiding being vague or ambiguity, aligning what you say with what you do
- Empathy
- being open-minded
- understanding and validating
someone’s experience/feelings
Action dimension includes:
- Confrontation
- Being direct in communication
- Ie. I can sesne that you hace
concerns, would you like to
discuss them?
- Being direct in communication
- Self-Disclosure
- Not exposing info about yourself that can harm the reputation TNCR
- Immediacy
- Dealing with a confrontation IMMEDIATELY, and nor procrastination on dealing with it
- Client says they never get angry, but you see them clenching their fists with an angry facial expression. - Nurse: I am aware that you have said you never get angry, but I notice that you are clenching your fists and I am sensing your anger. Can you tell me more..?
-
- Catharsis
- Providing a safe environment that encourages the client to speak about their feelings and experiences
3 Types of Communication
- Written
- Verbal
- Non-Verbal
Verbal VS. Non-Verbal Communication
Verbal: oral communication that happens through spoken words, sounds, vocal intonation, and pace
- Vocal intonation - the rise and fall of your voice at the end of sentences to indict your meaning and attitude
- Ex. The raise of your voice at the end of a sentence indicates a question
Non-verbal communication:occurs through facial expressions, eye contact, gestures, and body positions and movements
- Ie. Body language
Principles of Communication
- Communication is learned – not innate
- Culture and context influence how you perceive and define communication
- Communication is symbolic, negotiated and dynamic
- Communication varies among people, contexts and cultures
- Nurses have their own terminology and expressions that might not make sense to others
○ “WNL” - within normal limits
○ “PRN” - as needed
What is Therapeutic Communication?
- Foundation of the nurse-client relationship
- Intended to develop an effective interpersonal nurse-client relationship that supports the client’s wellbeing, ensures holistic, client-centered, quality care
- TC conveys respect, compassion, and trust
- TC encourages clients to open up about their physical, mental, social, and spiritual well-being
What is involved in professional communication?
- Overcome implicit bias, hierarchical social dynamics and misunderstanding related to cultural and language barriers
- Essential for collaborating with healthcare team members
- Prevents errors, ensure positive patient outcomes and adherence to treatment
- Influences public perception of the healthcare system and healthcare professionals
- Develops collaborative partnerships with clients and families that respect their needs, wishes, knowledge, experience, values and beliefs
- Promotes patient autonom
Consequences of Poor Communication
- Increased sentinel events
- Sentinel event - a patient safety event that results in death, permanent harm, or severe temporary harm
Ie. When a surgical instrument (scalpel) is left in the patients body after completion of surgery
- Sentinel event - a patient safety event that results in death, permanent harm, or severe temporary harm
-1 of the leading causes of adverse events and patient harm
- Client misunderstanding directions = failure to follow treatment protocols
↑ risk of readmission
↑ length of stay
↑ healthcare costs & resource use
↑ patient and caregiver dissatisfaction - causes work dissatisfaction, lack of autonomy and poor retention among nurses
What are the Barriers to communication?
- Personal (ie. age, education, past experiences, perosnality traits)
- Environment - distractions that create competition for attention and time b/w senders and receivers
- TV noise, pictures on wall
- Physical (ie. Closed doors, distance)
- Organizational (ie. status if power, levels of hierarchy)
- Cultural - different values, work ethics, norms, and preferences
- Semantic - use of terminology unfamiliar to the receive
- Gender
- Perceptual - how we perceive others or assume what they think
(ie. During shift change, the nurse tells you not to spend too much time with patient A bc they talk too much and call for help a lot. You automictically make assumptions causing you to rush their assessments and not take time to listen to them bc you do not want to end up stuck in their room.) - Language - slang, colloquialisms, different generations or from different regions
- Emotional - emotions and communication are closely related (Ie. If you feel anxious, you might hesitate to speak up)
4 Components to Facilitating Communication
- Maintain a positive attitude towards communication to facilitate openness, understanding, and collaboration
- It takes knowledge and work to improve your communication skills
- Prioritize goal-oriented communication
- Approach communication as a creative process
- Accept theinevitability of miscommunication
