NUR 144 - Week 2 MH - Building Therapeutic Relationships Flashcards
What are the Therapeutic Role Functions?
Social
- Advocate
Occupational
- Educator for diagnoses, defense mechanisms, meds, risk factors
- Lead group on risk factors & Coping skills
- Manager
Therapeutic
- Holistic assessment
- Coordination of care
- Encouragement
What are the phases of the Therapeutic Relationship?
1- Orientation
2 - Working
3 - termination
Describe Phase 1: Orientation of the Therapeutic Relationship
Establish the relationship, set the tone and identify boundaries
Nurse’s goal: Establish the relationship & build trust
- Explore client’s ideas, issues and needs
- Set goals with client
Describe Phase 2: Working of the Therapeutic Relationship
Nurse and client work together toward goals
- Encourage client to problem solve
- Foster positive behavioral change
- Promote client’s self-esteem
- Ongoing assessment, revise plan as necessary
Describe Phase 3: Termination of the Therapeutic Relationship
Summarize goals and achievements
- Plan for continuity of care
- Discuss how client can incorporate new, healthy behaviors into life
Building Client Trust and Report:
What are qualities that engender trust?
- Honesty
- Transparency
- Respect
- Fidelity
- Understanding
- Appropriate use of small talk and humor
Building Client Trust and Report:
What are barriers to trust?
Perceived differences in:
- Gender
- Education
- Language/Literacy
- Racial/Cultural ways of being
Best way to communicate was determined in the orientation phase of the relationship
Define Transference vs. Counter transference
Transference - client displaces feelings toward nurse
Counter transference - nurse displaces feelings toward client; can lead to nurse being removed from the care team
Communication Strategies:
Nonverbal
SOLER
S: Sit squarely to the client
O: Open posture
L: Lean forward
E: Eye contact
R: Relax
- Some clients may not like sitting squarely, may prefer sitting at angle
- Uncross arms/legs, open body
How should the relationship between verbal and nonverbal be?
They have to be congruent; in line with one another
Which nonverbal cues from a client would require verbal clarification from the nurse?
Affect: Frowning, grimacing, smacking, pursing, lip-licking
Appearance: Disheveled, clothing is inappropriate, client disrobes
Autonomic: Perspiring, flushed face, dilated pupils
Body: Rocking, posture, gait, hand clenching
Eyes: Squinting, minimal blinking
- Nurse should reassess mood and clarify when unsure how a client is feeling
Communication Strategies:
Verbal
Open ended questions = keep the conversation going
Affirmations:
- Convery support and encouragement
- Be sincere or don’t use
Reflections:
- Restate what client said to confirm understanding of what client meant to convey
- Inflection must go down, not up; it’s a statement not a question
Summaries:
- Restate concepts discussed to close interview
Interviewing techniques
Conducting the interview:
- Determine goal of interview
- Consider client mental health challenges
Active listening:
- Look interested
- Neutralize feelings
Describe Motivational Interviewing
MI- A style of communication that helps clients in developing motivation to resolve insecurities towards behavior change
Promote behavioral changes:
- Health promotion
- Therapeutic regime adherence
- Illness management
Set SMART goals
