Relationship Development & Therapeutic Communication Flashcards
Milieu and community meeting
Milieu:
Place for healing
Community meeting:
Tells pt the plan, expectation, goal for the day, tell them who is helping today
Roles of nurse
Focus on clients ideas, feelings
Identify their needs (not what you think they are)
Discuss problem solving
Help develop client strengths and new coping skills
Encourage positive behavior changes
Develop sense of autonomy and self reliance
Portray geuineness, empathy
Empathy vs sympathy
Empathy is good
-remaining nonjudgemental and attempt to understand clients actions and feelings
Sympathy is bad
-nontherapeutic, feeling the way the client does
Therapeutic relationship
Pt centered
Goal oriented
Takes time to establish
Have positive impact on success of tx
Supervision
Enhances ability to examine own thoughts/feelings
Talking to others to see what they thinl about how youre communicating with pts
Therpeutic use of self
Using personality consciously to be relatable and structure nursing interventions
Good things for therapeutic relationshsips
Consistent approach
Attentive listening
Comfort level
Consistently avaiable
Adjustment of pace to client needs
Self awareness of own thoughts/feelings
Rapport
Pt factors that are good for therapeutic relationship
Trusting attitude
Willingness to talk
Active participation
Consistently available
Signs of blurred boundaires
Relationship begins to meet needs of nurse rather than clients
Transference
Pt views a member of healthcare team as having characteristics of another person who has been significant to the clients personal life
Ex: i love/hate my aunt kathy and you remind me of her
Countertransference
Nurse displaces characteristics of people in their past onto a client.
Ex: pt that remind you of your mom
-affects your care
-need to be self aware
Fix for tranference
Getting them someone they have a good relationship with
Explain that a transference is happening
Restart and reintroduce yourself
Phases of a therapeutic relationship
Preorientation
Orientation
Working
Termination
Preorientation
Before meeting the pt
Going through the chart
May develop bias/assumptions
-check with yourself to prevent countertranference
Oritentation:
First meeting them
Intro
Establish boundaries
Parameters around meeting
Confidentiality
Build trust
Discuss ecpectations
Set goals
Explore ideas/issues/needs
Explore the meaning of behaviors
Set limits of testing/inappropriate behaviors
Working:
Most work is done
Maintain relationship
Ongoing assessment
Facilitate clients expression of needs/issues
Encourage problem solving
Promote clients self-esteem
Foster positive behavioral change
Explore/deal with resistance/defense mechanisms
Recognize trans/countertrans.
Reassess/revise plans as needed
Support adaptive alternatives and new coping skills
Remind of termination
Termination
-Provide an opportunity to-talk about it
-Discuss previous experiences with loss
-Elicit feelings about the therapeutic work of the relationship
-Summarize goals/ achievements
-Review memories
-Express own feelings about sessions to validate the experience
-Discuss ways to incorporate healthy behaviors into life
-Maintain limits of termination
Interference with therapeutic relationship
Over identifying with clients feelings as they remind them of problems for their past/present
Developing social relationship
Giving advice/attempting to rescue
Promoting clients dependence (want independence)
Nurse:
anger engenders, disgust toward client
Anxious and uneasy in presence of pt
Bored and apathetic in sessions
Difficult setting limits on clients behaviors
Defending clients behaviors
Intrapersonal vs interpersonal
Intra: between self (self reflection)
Inter: between 2 people
Therapeutic communications
13
Client centered
Silence
Active listening
Open ended/closed/projective presupposition
Restating/reflecting/paraphrasing
Offering general leads/broad opening statements
Showing acceptance/recognition
Focusing(focusing on something they said)
Summarizing
Giving info
Offering self
Presenting reality (for hallucinations)
Touch
Barriers to communication (nontherapeutic)
Irrelevant personal questions
Offering personal opinions
Giving advice
False reassurance
Minimizing feelings
Changing the topic
WHY questions
Offering judgement
Approval/disapproval
Excessive questioning
