Therapeutic Communication & Therapeutic Relationships: Exam 1 Flashcards
Trust associated behaviors include:
-caring
-honesty
-keeping promises
-listening
Trust builds when…
-client is confident in the nurse
-nurses presence conveys integrity and reliability
when words and actions match. the nurse needs to exhibit congruent behaviors to build trust with the client. (ex: im really glad you’re taking part today!) seeing is believing!
Congruence
mentally ill clients can detect when someone is exhibiting dishonesty or artificial behavior. (ex. talking over him/her, assuring them that everything will be alright.)
Genuine interest
perceive the meaning or feelings of the pt and to communicate that understanding to the client. considered an essential skill a nurse must develop to provide high-quality, compassionate care. (ex: empathy- I see you are sad, how can I help. sympathy- I feel so sorry for you)
Empathy
Not becoming upset or responding negatively to a clients behavior. NOT acceptance of the negative behavior, but acceptance of the person as worthy.
Acceptance
unconditional, non-judgement attitude. Appreciate the patient as a unique worthwhile human being. Can respect them no matter their behavior, background, or life-style. (Ex: you are awesome.)
Positive regard
Developing an understanding of ones own values, belief, thoughts, feelings, attitude, motivations, prejudices, strengths, and limitations and how these qualities affect others is __________________________.
self-awareness
As you learn self-awareness, you as the nurse can begin to use aspect of their personality, experiences, values, feelings, intelligence, needs, coping skills, and perceptions to establish relationships with the client. This is called ______________________.
therapeutic use of self
The Johari Window: 1-4
1 = OPEN
2 = BLIND
3 = HIDDEN
4=UNKNOWN
known to self and to others
The Johari Window: OPEN
not known to self but known to others
The Johari Window: BLIND
known to self but not others
The Johari Window: HIDDEN
not known to self or others
The Johari Window: UNKNOWN
The Johari Window: GOAL?
to moves from quadrants 2, 3, & 4 to quadrant 1
ways one person expects another to behave as a roadblock to the formation of an authentic relationship.
Perceptions
Patterns of Knowing:
empirical, personal, ethical, aesthetic
derived from the science of nursing
Empirical Knowing
derived from life experiences
Personal Knowing
derived from the moral nursing knowledge
Ethical Knowing
derived from the art of nursing
Aesthetic Knowing
Munhall’s pattern of unknowing
The nurse admits to not knowing the patients or patients subjective world.
-opens the way for authentic encounters
-psych nurses, negative preconceptions can adversely affect the therapeutic relationship.
Fundamental Patterns of Knowing
-Empiric
-Personal
-aesthetic
-Ethical
-Emancipatory (center)
initiate for the purpose of friendship, socializations, and enjoyment
Social Relationship
2 people who are emotionally committed to each other
Intimate Relationship
communication skills, understand human behavior and personal strength to enhance pt growth.
Therapeutic Relationships
Nursing Theory:
Nursing Theory:
1. assessment
2. diagnose
3. implement
4. evaluate
Peplau Theory:
- orientation
- identification
- exploration
- resolution
Orientation Phase:
-meet
-establish roles
-discuss purpose and parameters of future meetings
-Nurse-Client contracts, confidentiality, and self-disclosure
-clarify expectations
-Identify clients problems
Working Phase:
-problems identification: pt identifies issue or concerns
-Exploration: examination of feelings/responses and develops better coping skills. (more positive self image, behavior changes, and independence)
Blurring of Boundaries:
-When relationship slips into social context
-When nurse’s needs are met at expense of patient’s needs
Termination/resolution Phase:
begins when problems are resolved, and ends when relationship has ended.
Nurse-Client relationships must remain …
THERAPERUTIC
the process that people use to exchange information
communication
consists of words a person uses to speak to one or more listeners
Verbal Communication
the behavior that accompanies verbal content
Non-verbal Communication
In verbal communication you have…
content
context
includes: time and physical, social, emotional, and cultural environments
the literal words that a person speaks
Verbal Communication: Content
the environment in which communication occurs
Verbal Communication: Context
in non-verbal communication you have…
process
all nonverbal messages that the speaker uses to give meaning and context to the message
Non-Verbal Communication: Process
Types of Non-Verbal Communication:
posture
body language
eye contact
blinking
tone of voice
facial expressions
smell
time
personal presentation
gestures
pitch of voice
verbal and nonverbal signals endorses each other
(ex: somebody who says that he is unhappy and weeps)
Congruent Message
verbal and non-verbal expressed are contradictory
(ex: somebody who says that he is happy and weeps)
Incongruent Message
_______________ signals have a stronger impact than _________ signals
non-verbal
verbal
An interpersonal interaction between the nurse and the client
Focuses on client specific needs
Helps the nurse understand and empathize with the client’s experiences
Encompasses goals that facilitate the nursing process
Is needed to effectively meet the standards of client care
Therapeutic Communication
Goals of Therapeutic Communication:
-Establish therapeutic relationship
-Identify patient’s most important concerns
-Assess patient’s perceptions
-Facilitate patient’s expression of emotions
-Teach patient, family necessary self-care skills
-Recognize patient’s needs;
-Implement interventions to address patient’s needs
-Guide patient toward acceptable solutions
concentrating exclusively on what the patient says
Active Listening
watching non-verbal actions as the patient communicates
Active Observation
Active Listening and Active Observations: This helps the nurse…
-recognize the most important issue
-know what questions to ask
-use therapeutic communication techniques
-prevent jumping to conclusions
-objectively respond
the words are explicit and need no interpretation
Concrete Message
unclear patterns of words that often contain figures of speech that are difficult to interpret
Abstract Message
Concrete Language has meaning that comes _______________________________________________. It portrays things we can picture, feel, smell, and hear. The words “perfume”, “spiciness” and “noisy” are all examples of concrete words.
directly from our senses
Abstract language on the other has is language that can’t be deciphered directly through a sensory pathway. It includes words like “elite” “irony” “symbolism” and “sportsmanship.” - term _______________________________.
resistant to instant visualization
Effective Communication Techniques:
L-istening
B-road openings
R-estating
C-larification
R-eflection
F-ocusing
S-haring perceptions
S-ilence
H-umor
I-nforming
S-uggesting
may discourage client from further expression of feelings if client believes the feelings will only be downplayed or ridiculed
Giving Reassurance
refusing to consider client’s ideas or behavior
Rejecting
implies that the nurse has the right to pass judgment on the “goodness” or “badness” of client’s behavior
Approving or Disapproving
implies that the nurse has the right to pass judgment on whether client’s ideas or opinions are “right” or “wrong”
Agreeing or Disagreeing
implies that the nurse knows what is best for client and that client is incapable of any self-direction
Giving Advice
verbal or nonverbal messages that signal key words or issues for the client
Cues
Types of Cues:
Overt
Covert
clear, direct statements of intent, such as “I want to die”
Overt
Vague or indirect messages that need interpretation, such as, “Nothing can help me”
Convert
Types of Cues: NOTE… if the nurse suspects ______________ _________ or _________________, use a yes, no question to elicit a clear response.
Self-harm
Suicide
Facial Expressions:
Expressive
Impassive
Confusing
portrays the person’s moment-by-moment thoughts, feelings, and needs
Expressive
face is emotionless deadpan expression like a mask
Impassive
expression is opposite of what the person wants to convey (feeling angry but smiling)
Confusing
Body Language:
Open and Closed Posture
sit facing the client with both feet on the floor, knees parallel, hands at the sides and legs uncrossed, demonstrates unconditional positive regard, trust, care, and acceptance
Open-Posture
crossed legs or arms folded across the chest, indicates that the interaction might threaten the listener who is defensive or not accepting
Closed-Posture
Factors that can Impede Communication:
Internal Factors
Sensory/Emotional Factors
Verbal Expressions
Non-verbal Expressions
Factors that can Impede Communication: Sensory/Emotional Factors
-fear
-stress, anxiety
-pain
-mental acuity, brain damage, hypoxia
-sight, hearing, speech impairment
Factors that can Impede Communication: Environmental Factors
lighting
noise
privacy
distance
temperature
Factors that can Impede Communication: Verbal Expression
-language barrier
-jargon
-choice of words/questions
-feedback, voice tone
Factors that can Impede Communication: Non-verbal Expression
body movement
facial expression
dress
professionalism
warmth
interest
Factors that can Impede Communication: Internal Factors
previous experiences
attitudes
values
cultural heritage
religious beliefs
self-concept
listening habits
preoccupations
feelings
illness
_____________________ is desirable but not always possible in therapeutic communication
Privacy
The nurse needs to evaluate locations that are most therapeutic for nurse-client interactions
the study of distance zones between people during communication
Proxemics
Distance Zones:
Intimate (0-18 inch)
Personal (18-36 inch)
Social (4-12 feet)
Public (12-25 feet)
5 Types of Touch:
functional/professional
social/polite
friendship/warmth
love/intimacy
sexual arousal
Comforting and supportive when welcome and permitted
Can be possible invasion of intimate and personal space
The nurse must evaluate use of touch based on the client’s preferences, history, and needs
messages often contain more meaning than just spoken words
Meaning
Validate with findings from the client’s verbal and non-verbal information
Assessment focuses on who, what, when, how, and why
Contest
Nurse must be aware of their own spiritual beliefs
Need to objectivity and non-judgmental attitudes about clients beliefs
Spirituality
