Relationship Development and Therapeutic Communication Flashcards
therapeutic nurse-patient relationship
when each views the other as a unique human being; both participants have needs met by the relationship
what are therapeutic relationships
goal-oriented and directed at learning and growth promotion
what is the problem-solving method of achieving goals
identify the patient’s problem; promote discussion of desired changes; discuss aspects that cannot realistically eb changed and ways to cope with them more adaptively; discuss alternative strategies for creating changes that the patient desires to make
goals and the problem-solving model
weigh benefits and consequences of each alternative; help each patient to implement the change; provide positive feedback for patient’s attempts to create change; help patient evaluate outcomes of the change and make modifications as required
therapeutic use of self
ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions
what do nurses need to understand to be therapeutic
self-awareness, self-understanding; and a philosophical belief about life, death, and the overall human condition
what are some conditions essential to development of a therapeutic relationship
rapport; trust; respect; genuineness; empathy
rapport characteristics
acceptance, warmth, friendliness, common interest, non-judgmental attitude
trust characteristics
sincere desire to help, patient feels confidence with you, keeping promises, consistency
respect characteristics
unconditional; call them by name, spend time with them
genuineness characteristics
be real, honest, transparent
empathy characteristics
being aware of patient’s feelings and help them explore and work through it
what are the phases for the therapeutic nurse-patient relationship
pre-interaction phase; orientation phase; working phase; termination phase
pre-interaction phase
obtain information about the patient from chart, significant others, or other health team members; examine your own thoughts
orientation phase
create an environment for trust and rapport; establish contract for intervention; gather assessment data; identify patient’s strengths and limitations; formulate nursing diagnoses; set mutually agreeable goals; develop a realistic plan of action; explore feelings of both patient and nurse
working phase
maintain trust and rapport; promote patient’s insight and perception of reality; use problem-solving model to work toward achievement of established goals; overcome resistance behaviors; continuously evaluate progress toward goal attainment
transference
occurs when the patient unconsciously displaces (or “transfers”) to the nurse feelings formed toward a person from the past
countertransference
refers to the nurse’s behavioral and emotional response to the patient
termination phase
therapeutic conclusion of relationship occurs when: progress has been made toward attainment of the goals; a plan of action for more adaptive coping with future stressful situations has been established; feelings about termination of the relationship are recognized and explored
types of boundaries in the nurse-patient relationship
material, social, personal, and professinal
what are some professional boundaries to be put
self disclosure; gift-giving; touch; friendship/romantic association
warning signs that indicate that professional boundaries of the nurse-patient relationship may be in jeopardy
favoring; keeping secrets; change in dress style; swapping assignments; giving special attention/treatment; spending free time with the patient; frequently thinking about the patient when away from work; sharing personal information; receiving gifts/continued communication with the patient after discharge
interpersonal communcation
a transaction between the sender and receiver; both persons participate simultaneously
transactional model of communication
both participants perceive each other, listen to each other, and simultaneously engage in the process of creating meaning in a relationship
what are some impacting preexisting conditions
values, attitudes, and beliefs; culture and religion; social status; gender; age/developmental level
different types of environments where a therapeutic relationship might take place
territoriality, density, distance
four kinds of distance in interpersonal interactions
intimate, personal, social, public
components of non-verbal communication
physical appearance and dress; body movement and posture; touch; facial expressions; eye behavior; vocal cues/paralanguage
therapeutic communications techniques
using silence; accepting; giving recognition; offering self; giving broad openings; offering general leads; placing the vent in time or sequence; making observations; encouraging comparison; restating; reflecting; focusing; exploring; seeking clarification and validation; presenting reality; voicing doubt; verbalizing the implied; attempting to translate words into feelings; formulating plan of action
nontherapeutic communication techniques
giving reassurance; rejecting; approving/disapproving; agreeing/disagreeing; giving advice; probing; defending; requesting an explanation; indicating the existence of an external source of power; belittling feelings expressed; making stereotyped comments, cliches, and trite expressions; using denial; interpreting; introducing an unrelated topic
active listening
Sit, Observe, Lean forward, Eye contact, Relax
motivational interviewing
evidence-based, patient centered style of communication that promotes behavior change by guiding patients to explore their own motivation for change and the advantages/disadvantages of their decisions
what does it incorporate?
active listening and therapeutic communication techniques but focuses on what the patient wants to do; looks at how to motivate a patient to change their behavior
process recordings
written reports of verbal interactions with patients; written by the nurse or students as a tool for improving communication techniques
when is feedback useful
is descriptive rather than evaluative; specific rather than general; is directed toward behavior that the patient has the capacity to modify; imparts information rather than offers advice; well-timed
