Theraputic Communication And Relationships

Question 1

Therapeutic communication

Answer 1

Improving patient outcomes and care by developing a partnership in care. Strong elements of trust and respect in the relationship, upholding dignity and autonomy. HCWs attend to both verbal and non-verbal cues to fully explore the thoughts and feelings of the patient

Question 2

Phases of therapeutic development (5)

Answer 2

Pre-interaction 
Introduction 
Working 
Terminating 
Reconnecting

Question 3

Pre-interaction phase

Answer 3

Gather and review information
-charts, hand over, other histories
Mentally prepare
-consider your emotions, what environment you will meet them in

Question 4

Introduction phase

Answer 4

Open the relationship 
-Introduction of both
-Role explanation 
-reasons for seeking care 
Clarifying problems
-why do they think they're there? Do they know the care planned for them?
Establish care contract 
-goals, tasks, purpose 
Begin to develop trust and respect

Question 5

Working phase

Answer 5

Take action
-short and long term goals 
Maintain balance 
-don't allow them to become dependant on you 
Explore thoughts and feelings

Question 6

Terminating phase

Answer 6

Prepare for termination
-warn them, give timeline of what is to happen next
Plan follow up meetings
Referrals
-how will they cope on their own? What help do they need
Work through feelings of loss and fear

Question 7

Reconnecting phase

Answer 7

Manage relationship after the break

Reward their independence

Question 8

Fundamental communication skills (3)

Answer 8

Ask-Tell-Ask
-ask their understanding 
-tell to build and correct 
-ask their understanding now 
Tell me more 
NURSE> acronym for responding to emotions

Question 9

NURSE> responding to emotions

“I feel really jumpy inside… that chamber is so scary…I don’t want to do chemo today”

Answer 9

NAME: what you think the emotion is
“It sounds like you’re anxious about going to chemo”
UNDERSTANDING: relate your understanding of why
“My understanding is that you’re frightened by the environment”
RESPECT: their efforts so far
“I hadn’t realised, you’ve been so brave so far”
SUPPORT: them
“If i came with you into the room, or you took bunny, would that make you feel better?”
EXPLORE: any other issues
“Do you have any other concerns? How do you feel about it now?”

Question 10

Components of authentic communication

Also used for checking understanding

Answer 10

Observations
Feelings
Needs
Request
“When you spoke to me in front of the client, I felt humiliated. I need to be told these things in private. In the future can you pull me aside and tell me one on one?”
“When you heard your operation had be cancelled again, you slumped your shoulders. I guess you’re feeling anxious because you need your pain to be relieved. Would you like me to schedule an appointment with the doctor to go over you pain medication?”

Question 11

Professional boundaries

Answer 11

Boundary crossing:
-brief, may be inadvertent. Normal relationship and boundaries can return. Must be carefully evaluated by nurse to determine potential implications.
Sexual misconduct:
-extreme form boundary violation. Never acceptable. Nurse responsibility to shut down
Boundary violation:
-severe boundary cross. May be characterised by role reversal and excessive self disclosure. Must cease and attempts to assess patient distress undertaken