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Mental Health > Therapeutic Communication > Flashcards

Therapeutic Communication Flashcards

1
Q

What is Hildegard Peplau known for?

A

emphasized the NURSE-CLIENT RELATIONSHIP as the foundation of nursing practice!!

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2
Q

What are the phases of the Therapeutic relationship (Hildegard Peplau Interpersonal Relationship)????

A

Phase 1: Orientation– (This sets the tone for the nurse-client relationship!!!)
1. Meeting the nurse and the nurse meeting the client
2. Establish the relationship
3. Discuss the purpose and parameters of future meetings
4. Clarifications on expectations
5. Identifying the patient’s problems. Patient seeks assistance, tells his needs, ask questions, etc
6. Nurse-client contracts/confidentiality. Duty to warn/self-disclosure.

Phase 2: Identification/Working Phase – Help the patient identify wellness barriers
1. Pt. begins to have sense of belonging and a capacity to deal with the problem, which decreases the feelings of helplessness

Phase 3: EXPLORATION – the patient uses the service offered.
1. Use of professional assistance for problem-solving alternatives
2. Based on the needs & interest of the client

Phase 4: RESOLUTION – Patient no longer needs professional services and gives up dependent behavior. The relationship ends.

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3
Q

What is a therapeutic communication?

A

Privacy and Respect for Boundaries!!!
1. Distance zones:
A) Intimate Zone (0-18in): comfortable for parents w/ young children, ppl who mutually desire personal contact, or ppl whispering.
B) Personal Zone (18-36 in): Comfortable between family and friends who are talking.
C) Social Zone (4-12 ft): for communication in social, work, and business settings.
D) Public Zone (12-25 ft): Between speaker and audience, small groups, and other informal functions!

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4
Q

What is the most comfortable zone that the nurse and patient is recommended to be for therapeutic communication???***

A

Most comfortable when nurse & pt. are 3 to 6 feet apart!!!!!

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5
Q

What non-verbal therapeutic communication is recommended for nurses to follow when they’re listening/talking to their pt’s???????

A

“SURETY”
1. Sit at an ANGLE!!! (NEVER sit squarely in front of em”
2. Uncross arms & legs
3. RELAX
4. Eye contact
5. Touch!!
6. Your intuition

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6
Q

How do we build client Trust and Rapport and Therapeutic Alliance???

A

1) Qualities that engender trust:
1. Honest
2. Transparency
3. Respect
4. FIDELITY (KEEPING UR PROMISES)
5. Understanding

2) Barriers to Trust included perceived Differences in:
1. Gender
2. Education
3. Language/lliteracy
4. Racial/cultural ways
5. Socioeconomic (financial)

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7
Q

What is Active Listening??

A

Concentrating exclusively on what the patient says!!!!!

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8
Q

Is silent ever good when you are with a patient???

A

YES!! It is sometimes good AND therapeutic!!!!! If you’re asking them questions and the conversation come to a stall, IT IS OKAY FOR IT TO BE SILENCED in the room!!!!! Let ur patient INITIATE the next statement!!

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9
Q

What is Active Observation??

A

Watching non-verbal actions as the speaker communicates!!!!

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10
Q

What are the 13 verbal communication skills??

A
  1. Exploring: Encourages the client to provide more info about details. EX: “Can you tell me more about what happened about that situation?”
  2. Focusing: Helps facilitate the pt ability to focus and pay attention to the matters at hand.
  3. Making AN Observation.
  4. Placing Events in Time or Sequence.
  5. Presenting Reality: Present reality but also VALIDATE their feelings! EX: “There is a Spider over there!!!!” “Well, I really don’t see any spider there” & then maybe turn the lights on, etc..
  6. Affirmations: Empower client behavior & decision-making.
    EX: “You took your medications last night. You are making positive steps in treatment!”
  7. Reflecting:
    A) Restating what they say to confirm understanding
    B) Reflection should go UP, NOT DOWN. It’s a statement, not a question!!!
    - Simple Reflection: like taking an educated guess on how the client is feeling.
    - Complex reflection: A therapeutic communication technique where the nurse infers client emotion or thoughts in an effort to portray engagement/clarity.
  8. Restating for Clarification: Restate what they say AND Ask what the patient think THEY should do. Help them come up with the solutions!!!!!
    EX: when they say “what do you think I should do with my son? He’s a drugie”. Instead, Ask them what THEY think THEY should do. “What do you think you should do to hold your son accountable?”

9 Summarizing: Restating major key concepts in a conversation

  1. Voicing Doubt: u want to voice their doubt!
    EX: I’m just gonna die when my husband finds out that I’m dying”. Then u respond, “I can see why you might be worried about that, BUT are you really gonna die?”.
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11
Q

What are the non-therapeutic techniques that should be avoided???

A
  1. Advising
  2. Probing –> pt talking to u and then you ask them questions that feels like ur interrogating them.
  3. Reassuring!! FALSE REASSURING IS BAD!! like saying, “Oh, it’ll work out. Don’t worry about it”.
  4. Requesting an explanation from them.
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12
Q

What are the Overt cues and Covert cues??

A
  1. Overt- OBVIOUS, Direct and not obvious statements!!! EX: “I want to Die”.
  2. Covert - Hidden and not obvious. Must be able to pick up some outward cues to find out.
    EX: worrying; thinking, they’re being quiet & not rlly talking to you and only giving short answers.
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13
Q

What are nonverbal cues from patient that require verbal clarification from the nurse?? Affect, Appearance, Autonomic, Body, Eyes.

A

Basically see what’s going and ask them if they’re okay (we don’t wanna assume)
1. Affect (mood/facial expressions): frowning, grimacing, smacking & pursed lips, biting, licking.
2. Appearance: sudden disrobing, clothing that’s inappropriate to the temperature, and dissolved grooming
3. Autonomic: visible brow or palm perspiration, pupil dilation, facial flushing or paleness, increased respiration
4. Body: Gait, posture, hand clenching, rocking, agitation
5. Eyes: sus, squinting, minimal blinking

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14
Q

What is Subjective and Objective????

A

Objective: Data based upon facts; Something we measure and observe. Like: VS, lab & test results,
Subjective (subject = person): Info obtained from the patient and CANNOT BE VERIFIED by others. LIKE: pain, how they feel, SYMPTOMS

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15
Q

What are the Self-awareness Issues??

A
  1. Non-verbal communication is as essential as verbal communication
  2. Therapeutic communication is important for the effectiveness of interventions
  3. Awareness of own communication is the FIRST step in improving communication
    1) Ask for feedback from colleagues
    2) Examine own communication skills
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16
Q

What is Empathy?

A

The ability of the nurse to perceive the meanings & feelings of the patient and to communicate that understanding back to the patient

17
Q

What is Sympathy??

A

feeling of concern or compassion. Focus shifting to nurse’s feelings!!

18
Q

What is self-awareness??

A

Know self— such as values, beliefs, attitudes!

19
Q

What is the JOHARI window??

A
  1. Open self: info about you that both you and others know
  2. Hidden Self: Info abt you that you know but others don’t know
  3. Blind self: info about you that you don’t know but others know
  4. Unknown self: info about you that neither you nor others know who
20
Q

How do we convey empathy???

A

Taking “I” and “Why” out!!!

21
Q

What does the blurring of boundaries interfere with?? What are the 2 main type of boundary blurrings????

A
  • Boundary blurry interferes w/ treatment goals!!!!
  • Transference and Countertransference!!!
22
Q

What’s the meaning of Transference?? What’s an Example??

A

When the CLIENT displaces feelings for the nurse!!! EXAMPLE: “Aw, You remind me of my mom!” “I dont want that nurse taking care of me. She reminds me of my bossy sister”. So, even if it’s positive or negative!

23
Q

What is Countertransference? What’s an example???

A

When the NURSE displaced l feeling onto the patient!! “Awh, that patient reminds me of my grandfather”. Then you started to tear him more like a grandfather than a patient.

24
Q

What is the termination phase??

A
  1. Patient is discharged
  2. Patient may feel anger or abandon!
  3. It summarizes the goals achieved!
25
Q

What are the behaviors diminishing therapeutic relationship??

A
  1. Inappropriate boundaries when the relationship becomes TOO SOCIAL or TOO INTIMATE.
  2. Feelings of SYMPATHY, encouraging client dependency.
  3. Non-acceptance of the client or avoidance!
26
Q
  1. What should you consider before using frequent eye contact with a patient????????**
  2. What are the cultural considerations??????
    (Remember of the cultural considerations)
A
  1. CULTURE!!
  2. Cultural Considerations:
    1) Speech patterns & Habits
    2) Styles of speech, expression
    3) Eye contact
    4) Touch
27
Q

Before leaving, the nurse explained to the client how to contact her with the additional questions. What nonverbal communication is most valuable when the nurse is explaining it?????***

A

Gestures. The nurse uses gestures when explaining the pt how to use the call light

28
Q

What is assertive communication??

A

The ability to express positive and negative ideas and feelings in an open, honest, and direct way

29
Q

What is Incongruent message??

A

When content and process disagree; when the speaker says and what he/she does do not agree

30
Q

What is Congruent message?

A

Is conveyed when content and process agree

31
Q

What is the difference between content and context???

A

Content is the literal words that a person speak.
Context is the environment in which communocation occurs and can include time and the physical, social, emotional, and cultural environments.

32
Q

What is Direct role and non-directive role??

A

Direct: asking yes-or-no questions and using problem-solving to help the patient develop new coping mechanisms to deal with present issues.
Non-Directive Role: using open-ended questions

33
Q

Is reflecting communication skills using a down or up inflection? What is an example of reflection?????

A

Inflection should go DOWN, not up!!!! (even if it’s a question)
”Nurse, I can’t continue like this. I am running out of options,” a simple reflection would be, “You can’t continue like this,” or alternatively, “You feel like you are running out of options.”

34
Q

How do you use the ‘restating for clarification’ communication technique??

A

You RESTATE what they say AND ASK what the pt. think they should do!!!!

35
Q

What’s diff about reflection, summary, and restating for clarification?

A
36
Q
A

Mental Health (12 decks)

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