Test 1 - Therapeutic Communication Flashcards
____ is the unconscious process of the patient displacing feelings for significant people in the past to the RN or clnician
transference
_________ is the clinician/RN’s emotional reaction to clients based on feelings for significant people in their past
countertransference
Give an example of a broad opening…
What would you like to work on today?
What is one of the bes tthings that happened this week?
Give an example of “giving recognition” to the client…
I NOTICE YOU are wearing a new dress.
I NOTICE YOU made your bed today.
What is offering self? Give an example…
“I will sit with you until it’s time for your family session.”
Give examples of ineffective communication
parroting, changing the topic, challenging, disagreeing, probing, advising, cliches,
reminder: let the client get to the conclusion
A client is looking at a black belt lying on the ground but sees a snake. This is called
illusion
A client is certain that he is the president of the united states, but he is not Obama. This is called
delusion
Another example: firmly believes that cops are listening in on him or watching him 24/7 (but this is not actually happening).
What are the five types of hallucinations?
auditory visual olfactory gustatory (taste) tactile (touch)
If a patient says they taste blood, what do you do?
First look for blood - RULE OUT MEDICAL!!!!
Then, if there is no blood, treat psych
If a patient says, “I see the devil, do you see the devil.” How do you respond?
I know you see the devil, but I do not.
A 16 year old asian requests to have coining treatment. What is the best RN response?
Respect culural beliefs but do not allow it. This treatment leaves marks on the patient’s body.
Review whatever it is the patient is seeking and make sure it is not harmful. Ex, hail mary okay but exorcism is not. We wouldn’t want a person belittling the patient and accusing them of being evil.
In the DEVELOPMENT OF A THERAPEUTIC RELATIONSHIP with a new admission with the dx of post self-inflicted gsw to the head, which of the following is the priority for the nurse?
assess YOUR own feelings toward this client. Address your personal issues with their situation, check for countertransference, etc.
Therapeutic relationship are ____ oriented
goal
The ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention is called…
therapeutic use of self
What are characteristic of a therapeutic relationship?
Respect develops inphases Focus is on the client May be unpleasant Team decides on discharge Nurses look at MEANING of behaviors, not behaviors themselves
Remind client they have choices
Reassurance is discouraged (no telling them everything is gonna be alright)
COnfidential at all times (within team share okay)
A _______ is an idea that one holds to be true, and can take several forms such as rational or irritational
belief
_______ is an ideal that an individual holds true for which no object of evidence exists.
Faith
_________ is a fram of reference around which an individual organizes knowledge about his or her world. It can be a prejudgment and may be selective and biased.
attitude
check yours before treating patient
What are examples of nursing interventions that would promote trust in an individual who thinks concretely?
Provide blanket when client is cold
Keep promises
Be honest
Go to activities with client if they do not want to go alone
Take client’s preferences and requests into consideration when planning care
What is unconditional positive regard?
The attitude is nonjudgemental, and respect is unconditional in that it does not depend on the behavior of the client
Conditions essential to development of a therapeutic relationship are…
Rapport
Trust
Respect (unconditional positive regard)
What are the phases of the therapeutic nurse-client relationship?
The preinteraction phase - prep for the first encournter with the client including obtaining available information about the client from chart, significant others, etc. AND examining one’s own feelings.
The orientation phase (introductory phase) - Establish expectations with client, ID weakness/strength, develop action plan (Assess, Plan, Develop goals), explore feelings. “GET TO KNOW YOU” Phase
The Working Phase - promote client insight and perception of reality, problem solve, continuously evaluate. DOING THE WORK with client (no longer just talking about it)
The Termination Phase - occurs when goals are reached, client is discharged, clinical rotation ends
If the patient experiences transference or the nurse experiences countertransference, what are we to do?
The relationship should not be terminated. It is an opportunity to help the patient work through it. In the case of CT, the nurse should seek support from others.
What are signs of countertransference?
Nurse overidentifies with pt develop personal /social relationship RN tries to rescue pt nurse feels disgust/uneasiness RN has diffciulty setting limits
What is the diference between parroting and restating?
Parroting “I am sad” “You are sad.”
Restating “This treatment makes me want to scream.” “So you are saying the treatments really upset you.”
Parroting is non therapeutic
Restating is therapeutic
Therapeutic techniques include reflecting, focusing, exploring, general to specific, making observations encouraging descriptions of perceptions, and seeking clarification as well as voicing doubt and verbalizing the implied. Examples are
reflecting - Client asks what he/she should do. Nurse retorts with “What do YOU think you should do?”
focusing - client gives list of things bothering them. Nurse asks which bother the most and focuses in on that.
exploring - tell me more about that…
general to specific - You said they keep saying blah blah…who are they?
making observations - I NOTICE you made the bed, You apper tense…
Encouraging descriptions of perceptions - Tell me when you feel anxious, tell me what the voices are saying…
seeking clarification - I’m not sure I understand…what would you say is the main point?
voicing doubt - That’s unusual….I believe that you think it is true. I do not see it that way.
verbalizing the implied - Client “I can’t talk to anyone! It is a waste f time.” “So what you are saying is you feel no one understands you.”
If a client were to insist that you were their sister, how would you respond?
My name is _____ and I am your nurse. I’m not your sister but perhaps I remind you of her.
T or F: THe statement “I am sure everything will be alright” is appropriate when comforting a patient.
false.
never reassure patients in this manner
T or F: It is okay to ask patients why they acted in a particular way.
False.
Do not ask WHY. If you see WHY, scratch out the answer.
Never say I THINK YOU SHOULD….either.
Better to say something like, “When the incident occured, what were you feeling?”
What is indicating an external source? give an example
Example: Who made you do that?
It puts the blame OUTSIDE of the patient. Instead, what were you feeling when the incident occurred? etc
What should you do before using touch with a client?
Get their history. While some may benefit, patients with high levels of anxiety or exhibiting suspicious psychotic behaviors may interpret it as being aggressive.
T or F: The power of staff is derived from patient trust
True
What are the five most common boundary violations?
- excessive disclosure - revelaing too much personal info
- Dual relationship - mom is checked in and daughter is the nurse; best to transfer care.
- Inappropriate contact - touching, holding, etc.
- becoming friends - unequal attention to one client, dating, seeing outside of working hours
- sexual contact - mandatory termination and possibie license suspension
How long post treatment must RN wait to date a client?
two years….
T or F: All conversations must be documented.
True
Some differences in social behavior vs therapeutic…
In social, there is no obligation to examine one’s own behavior, or to help another gain insight. Each person assume respect (in therapeutic it must be earned in phases).
A terminal cancer client states to the nurse, “I wish my family would stop hoping for a cure. I know I am going to die and I wish they would stop.” The nurses best response is:
A. We can’ control our families
B. It sounds as though you are feeling angry your family is still hoping for a cure.
C. I can tell you are in acceptance.
D. I will tell the team to arrange a family meeting.
B.
If a patient is admitted and you know them personally, what do you do?
Transfer care due to dual relationship violating therapeutic boundary.
A client on the psych unit states, “I feel like a bird.” The best response is:
A. You are a patient not a bird.
B. Birds can fly, can you?
C. That must be distressing for you, you don’t look any different to me
D. What you say indicates to me the reason you are in this hospital.
C.
Know the Do’s of therapeutic boundaries…
- Be aware of transference and countertransference
- Transfer care of client if dual relationship
- Maintain confidentiality at all times.
- Respect privacy (don’t tell your husband you saw you neighbor admitted to the psych unit)
- Use chaperone of same sex as client when conducting physical exam. Know background before hand!
- Notify supervisor if you are uncomfortable with behaviors or if you need help setting limits.
What do you do if you suspect a coworker is crossing boundaries with a patient?
Report to your supervisor (even suspicion)
In transactional analysis, the transaction should be ________
complimentary
Parent to Parent
Adult to adult
Child to child
(in slides from Tuesday night, but on thursday llist)
If a client says “GIVE ME A CIGARETTE NOW!” The response is “When it is smoking time, I will give you a cigarette.
Interpersonal communication is a transaction between two people. It can be verbal or non verbal. Interpersonal transactions are affected by _________ _______ such as value systems, internalized attitudes, culture, social status, gender, etc
preexisting conditions
This is why we view our feelings about a client prior to treatment
Does environment have an effect on interaction with a cleint?
YES!
Usually neutral area is better
Distance, territoriality and density all play a part
_________ is the innate tendency to own space.
territoriality
____ refers to the number of people within a given enironment.
density
some studies show that prolonged time in dense populations can cause certain behaviors such as agression
What is paralanguage?
tone of voice, rate of speech (the how you said it type shits)
Feedback should be specific rather than general, directed toward behavior to be modified (not the client), impart information rather than offer advice or evaluate the client, and should be well timed (deal with it when it happens).
Examples of feedback
YES: Janes was upset when you called her fat and ugly and laughed at her in front of others (uses description of behavior, sort of like I NOTICE)
NO: You were very rude and inconsiderate to Jane today (evaluate statement)
NO: You are a very insensitive person (focus on client)
p.146
Questions like:
“Why do you think that way?”
“Why do you feel this way?”
“Why did you do that?”
Are examples of which non therapeutic communication technique?
Requesting an explanation
Statements like “That’s good” or “That’s bad” are examples of
Approving/disproving
THats right or Thats wrong are examples of
agreeing/disagreeing
