Module 5: Therapeutic Relationships and Therapeutic Communication

Question 1

Compare and contrast the three phases of the nurse-patient relationship and the dimensions of the helping relationship

Answer 1

• Intimate: can occur between people who have an emotional commitment to one another. Mutual needs are met and intimate desires and fantasies are shared
• social:
• therapeutic

Question 2

Compare and contrast a social relationship and a therapeutic relationship in terms of purpose, focus, communications style, and goals

Answer 2

Social relationships
- initiated primarily for purpose of friendship, socialization enjoyment, or accomplishment of a task

Therapeutic relationships

- needs of patient identified and explored 
- clear boundaries established 
- alternative problem solving approaches are taken 
- new coping skills developed 
- behavioural change is encouraged

Question 3

Explore qualities that foster a therapeutic nurse-patient relationship, as well as qualities that hinder a therapeutic nurse-patient relationship

Answer 3

• Qualities that foster therapeutic nurse-patient relationships include:
  
  • Consistency
  • Pacing
  • Listening
  • Initial Impressions
  • Promoting patient comfort and balancing control usually reflect caring behaviours
  • Patient factors that seem to enhance the relationship include trust on the part of the patient and the patient’s active participation in the nurse-patient relationship
• Qualities that hinder the relationships include inconsistency and unavailability

Question 4

Empathy

Answer 4

the individual helping attempts to understand the world from the patient’s perspective “ temporarily living in the other’s life moving about in it delicately without making judgements”

Question 5

Genuineness

Answer 5

is converted by listening to and communicating with patients without distorting their messages and being clear and concrete in communications

Question 6

Positive regard

Answer 6

implies respect, viewing the other person as worthy of being cared about and as someone who has strengths and achievement potential, usually communicated indirectly by attitudes and actions rather than directly by words

Question 7

Transference

Answer 7

patient unconsciously and inappropriately displaces onto nurse feelings and behaviours related to significant figures in patient’s past

Question 8

Countertransference

Answer 8

nurse displaces feelings related to people in nurse’s past onto patient

Question 9

Examine boundaries and roles within the nurse-patient relationship and identify situations of blurring of these boundaries and roles

Answer 9

Boundaries are commonly established in the following three areas:

- > treatment and planning and deliver: anticipated length of treatment or service delivery, limits of confidentiality, members of treatment team etc
- > Personal space: physical space, emotional space, agreement between nurse and patient as to roles and responsibilities of all involved in the therapeutic relationship and so forth 
- > Location of service delivery: inpatient unit, community clinic, home visits, treatment room, conference room and other such places

Question 10

Discuss the differences between verbal and nonverbal communication and review examples of nonverbal communication

Answer 10

nonverbal communication

- body language 
- facial expressions 
- lack of eye contact 
- touch 
- hand gestures
- sighs 
- fidgeting

Question 11

non-therapeutic communication techniques

Answer 11

• Giving premature advice: assumes the nurse knows best and the patient can’t think for self; inhibits problem solving and fosters dependency
• Minimizing feelings: indicates the nurse is unable to understand or empathize with the patient; the patient’s feelings or experiences are being belittled. which can cause the patient to feel small or insignificant
• Falsely reassuring: under-rates a person’s feelings and belittle’s a person’s concerns; may cause the patient to stop sharing feelings if he or she expects to be ridiculed or not taken seriously
• Making Value judgements: prevents problem solving; can make the patient feel guilty, angry, misunderstood, not supported or anxious to leave
• Asking “why” questions: Implies criticism; often has the effect of making the patient feel a need to justify behaviour and leaves the patient feeling defensive
• Asking Excessive Questions: results in the patient not knowing which question to answer and possibly being confused about what is being asked
• Giving Approval, Agreeing: Implies the patient is doing the right thing- and not doing it’s wrong; may lead the patient to focus on pleasing the nurse or clinician; denies the patient the opportunity to change his or her mind or decision
• Disapproving; disagreeing: can make a person defensive
• Changing the subject: May invalidate the patient’s feelings and needs; can leave the patient feeling alienated and isolated and increase feelings of hopelessness

Question 12

Therapeutic Communication Techniques

Answer 12

• Using silence: gives the person time to collect thoughts or think through a point
• Accepting: Indicates that the person has been understood; an accepting statement does not necessarily indicate agreement but it is nonjudgemental
• Giving Recognition: Indicates awareness of change and personal efforts; does not imply good or bad, right or wrong
• Offering self: offers presence , interest and a desire to understand; isn’t offered to get the person to talk or behave in a specific way
• Restating: Repeats main idea expressed; gives the patient an idea of what has been communicated; if the message has been misunderstood the patient can clarify it
• Seeking Clarification: helps the patients clarify their won thoughts and maximizes mutual understanding between nurse and patient
  To list a few more:
• summarizing, voicing doubt, seeking consensual validation, attempting to translate into feelings