Week 2 Therapeutic Communication/ Responding to Emotions

Question 1

Name the 3 categories of communication

Answer 1

1. verbal
2. non verbal
3. paraverbal

Question 2

Name and explain the components of nonverbal communication with examples of each

Answer 2

1. Proxemics - personal space (generally 1.5 - 3 ft between you and the patient)
2. Kinesics - body language (includes postures, gestures, or non-verbals)
3. Haptics - communication through touch (includes fist bumps, handshakes, high fives, etc)
4. Position - where are you in relation to other, your orientation (approaching from the side = less threatening to patient)
5. Posture - how you hold and move your body
6. Proximity = distance between people (remain patient’s arm length away from person and always warn someone if you need to get into someone’s personal space)

Question 3

What are the 3 zones within personal space

Answer 3

Intimate zone, personal zone and social zone

Question 4

Name and explain the components of paraverbal communication and examples of each

Answer 4

1. Tone - quality and pitch (are you sarcastic, are you kind?)
2. Volume - loudness and intensity (shouting or whispering)
3. Cadence - rhythm and rate of speech (how fast or slow someone is talking)

Question 5

What are some environmental considerations to keep in mind when treating a mental health patient

Answer 5

1. privacy - ensuring that when you meet with a patient, there is always privacy
2. Furniture - how is the furniture arranged? does it allow for comfort?
3. temperature - is it a comfortable temp in the room?
4. proxemics - how close you are to the patient

Question 6

What is the difference between social and therapeutic communication?

Answer 6

Social:

• equal disclosure (me and you are sharing information)
• spontaneous
• meets personal needs of both
• confidentiality may or may not be observed
• listener may not be objective

Therapeutic:

• patient centered
• planned (specific content agenda to discuss at a specific time)
• directed by professional
• meets the patient’s needs
• listener objective
• information is shared with health care team on a need to know basis

Question 7

What do you do when a patient presents with depressed affect, apathy, or psychomotor retardation

Answer 7

• provide patience and empathy
• discourage rumination
• encourage performing ADLs
• encourage participation in activities (includes individual, group or art therapy that the patient can be involved in)

Question 8

When your patient appears with severe anxiety and incoherent speech patterns, what do you do?

Answer 8

• demonstrated as disturbed thought processes
• clarify meaning
• focus on themes, feelings
• keep interaction brief and structured (anxious patients can’t focus on many things at once)
• offer PRN meds as appropriate

Question 9

Explain 2/4 barriers to therapeutic communication (denial and projection) and examples of each

Answer 9

• Denial = refusing to acknowledge some painful aspect of external reality or subjective experience that would be apparent to others

Ex; a teenagers best friend moves away but the adolescent says he does not feel sad

• Projection = falsely attributing to another one’s own unacceptable feelings, impulses, or thoughts.

Ex: a child is very angry at a parent but accuses the parent of being angry

Question 10

Explain Transference and countertransference and how they are barriers to therapeutic communication. Give and example

Answer 10

• Transference = unconscious assignment to others of the feelings and attitudes that the patient originally associated with important figures
• Countertransference = the provider’s emotional reaction to the patient based on personal unconscious needs and conflicts
• Example for the two above: patient could be hostile to a nurse because of underlying resentment of authority figures; the nurse in turn could respond defensively because of earlier experiences of anger

Question 11

What are the three stages of the nurse-patient relationship?

Answer 11

• orientation
• working
• termination

Question 12

What is the patient’s responsibilities during the orientation phase

Answer 12

• attending agreed upon sessions

- interacting during the sessions and participating in the nurse patient relationship

Question 13

What is the RN’s role during the orientation stage?

Answer 13

• focus on patient’s needs and concerns (what brought them in for treatment)
• delineate nurse’s and patient’s role
• specify purpose and goals
• discuss the different phases, especially the termination phase
• protecting confidential information and maintaining professional boundaries

Question 14

What are the emphases of the orientation phase?

Answer 14

1. Building trust (communication, confidentiality, show interest and concern)
2. Beginning assessment
   
   • understand their needs, coping, defenses, adaptation
   • understand their thoughts, feelings, and behaviors associated with being in treatment
   • tentative goals, awareness and motivation
3. Managing emotions (talking to them about their feelings, validating them, and teaching palliative coping strategies)
4. Providing support
   
   • confirming patient’s worth and rights
   • avoiding value judgement
   • convey that we learn from mistakes and provide realistic hope
5. Providing structure
   
   • take temporary control
   • decrease withdrawal and isolation
   • set limits to control dysfunctional behavior
   • identify behaviors needing immediate intervention

Question 15

What is the RN’s responsibilities during the working phase

Answer 15

• in depth data collection
• change vs stabilization
• the nurse can use various verbal and nonverbal techniques to help the patient examine problems and to support the patient through the healing process

Question 16

What are the patient’s responsibilities in the working stage

Answer 16

• identify problems to work on
• when the patient reaches this stage its because they trust the nurse and the relationship
• they should include writing/journaling to release emotions
• promote change by showing rational decisions and a readiness for healthy change (patient initiated is more successful)

Question 17

What are the RN’s responsibilities during the termination phase

Answer 17

• Evaluation/summary of progress:
  
  • help patient evaluate positive change
  • set priorities for dealing with future issues
• Referrals to address continuing problems, provide support, foster treatment compliance, and provide discharge instructions
• Synthesize results by review indirect outcomes of the relationship & encourage future therapeutic relationships and friendships
• Discussion of termination/ discuss nurse and patient feelings/reactions

Question 18

What are the patient’s responsibilities during the termination phase

Answer 18

• connects with community resources, solidifies a newly found understanding and practices new behaviors

Question 19

Explain the levels of the crisis development model and the best responses/approaches to each

Answer 19

1. Anxiety: approach by providing support
   
   • anxiety includes pacing, finger drumming, wringing of the hands and starring
2. Defensive: approach by providing direction
   
   • this includes being belligerent; may challenge authority; refusing to cooperate and shouting
3. Risk behavior: approach by physical intervention
   
   • person lost total control; may be physical such as hitting, biting, or self infliction
4. Tension reduction: approach by therapeutic rapport
   
   • decrease in physical and emotional energy; regain rationality, remorseful, embarrassment, fear, sadness, and confusion

Question 20

What are the different stages of the defensive level

Answer 20

1. Questioning: rational question seeking rational response; challenging authority
2. Refusal: noncompliance, slight loss of rationality
3. Release: verbal and emotional outburst, letting steam, screaming or swearing
4. Intimidation: verbal or nonverbal threat; avoid physical intervention unless last resort
5. tension reduction

Question 21

What are the key and examples to setting limits

Answer 21

Keys:

• simple/clear
• reasonable: don’t place multiple demands at once
• enforceable: be sure you can make it happen if you set limits

Examples:

• interrupt and redirect: “you’re shouting at me, please speak quietly”
• when and then pattern: “when you’ve cleaned your room, then we can go to the dayroom”
• if and then pattern: “if yo make your bed then we can go to the dayroom, if you do not then we will not be able to go”

Question 22

What are internal factors that can cause a patient to go into crisis

Answer 22

• impaired cognitive ability
• impaired communication skills
• fear, anxiety, phobias, stress
• lack or loss of esteem, loss of control or personal power
• failure
• low expectations or expectations that are too high
• unmet need for love, affection, recognition, etc.
• coping mechanisms: displaced anger, projection, learned helplessness
• trauma or previous life experiences

Question 23

What are external factors that can cause patients to go into crisis

Answer 23

• attitudes and behaviors of others
• physical environment: people, space, cleanliness, noise, temperature, etc.
• stimulus response: behavior occurs as an interaction between the person and their environment
• level of value, dignity, and respect afforded to people

Question 24

Explain the integrated experience

Answer 24

Behavior influences behavior

• consider how your behavior impacts those in your care (your emotions can escalate rather than de-escalate)
• treat those in your care respectfully
• make objective decisions

Question 25

Give examples of unproductive and productive responses related to fear and anxiety

Answer 25

Unproductive:

• freeze (stage fright)
• overreact
• Respond inappropriately (things not pertinent to situation; use of offensive or inappropriate language)

Productive: (these prepare the body for action)

• increased speed and strength (increased motor reaction)
• increased sensory activity (sharpening senses)
• decreased reaction time