Week 4 - Therapeutic Communication Flashcards

1
Q

Therapeutic relationships based on _____, ______, _______, are central to nursing

A

Therapeutic relationships based on dignity, respect, caring, are central to nursing

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2
Q

What does communication & nurse-client relationship improves?

A

Improves quality of care, patient satisfaction, positive patient outcomes

Helps patients make meaning of illness experience

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3
Q

Who do nurses need to communicate with?

A

Nurses must communicate with patients, families, groups, interprofessional team members

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4
Q

Mutual exchange of ______, _______, _______ relationship b/w nurses and clients are very important

A

Mutual exchange of physical, emotional, spiritual relationship b/w nurses and clients are very important

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5
Q

What is relational practice?

A

“guided by conscious participation with clients using a number of relational skills including listening, questioning, empathy, mutuality, reciprocity, and self-observation, reflection, and a sensitivity to emotional contexts”
- CNO

  • it is not just what we say
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6
Q

What are the 5 central components inherent in all nurse-client relationships?

A
  1. trust
  2. respect
  3. professional intimacy
  4. empathy
  5. power
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7
Q

What is this component in nurse-client relationships:

Important to keep promises

A

Trust

  • professional expectation in nursing
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8
Q

What is this component in nurse-client relationships:

Recognition of inherent dignity, worth, uniqueness of each individual

A

Respect

  • professional expectation in nursing
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9
Q

What is this component in nurse-client relationships:

Due to physical, psychological, social closeness, access to personal information

A

Professional intimacy

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10
Q

What is this component in nurse-client relationships:

Understanding, validating and expressing meaning to another

A

Empathy

  • might not agree with the but you understand them and the situation
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11
Q

What is this component in nurse-client relationships:

Unequal power due to authority, knowledge, influence in the health care system

A

Power

  • have power over patients
  • be careful how you use that power
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12
Q

What are the 4 standard statements in therapeutic nurse-client relationships according to CNO practice standards?

A

Therapeutic communication
Client-centred care
Maintaining boundaries
Protecting clients from abuse

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13
Q

CNO standard:

Therapeutic communication

A

Nurses use a wide range of effective communication strategies and interpersonal skills to establish, maintain, re-establish and terminate the nurse-client relationship

  • Introduce self by name and category, use client’s preferred name
  • Provide information to promote client choice and make informed decisions
  • Use listening, allow client time to explain, respect their values and beliefs
  • Awareness of own communication style, modify accordingly, reflect on interactions with clients
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14
Q

CNO standard:

Client-centred care

A

Nurses work with clients to ensure all professional behaviours and actions meet therapeutic needs of clients

  • Include client as a partner in care
  • Understand their abilities, discuss their expectations, sensitivity and respect for client choices
  • Acknowledge own biases and feelings, how stress can impact
  • Therapeutic relationships always focus on client’s needs
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15
Q

CNO standard:

Maintaining boundaries

A

Nurses’ responsibility to establish and maintain limits or boundaries in nurse-client relationship

  • Nurse sets and maintains appropriate boundaries in therapeutic relationships
  • Increased attention in some situations
  • Develop and follow care plan
  • Refrain from personal disclosure, except when it would meet a client need
  • Relationship and strategies promote client health and well being and not the nurse’s needs
  • Refrain from giving or accepting personal gifts (some exceptions)
    - be careful with how you treat the patient after receiving a gift (don’t favor one over another bc of a gift)
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16
Q

CNO standard:

Protecting clients from abuse

A

Nurses ensure abuse is prevented, or stopped, and reported
- Verbal, physical, emotional, financial, sexual, neglect

Some abuse requires other reporting (child abuse)
- Do not engage in abusive behaviour
- Intervene and report if seen

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17
Q

What are some warning signs a nurse is crossing a professional boundary?

A
  • thinking of them outside work
  • dressing better for them
  • spent time outside work with them
  • adding social medias
  • treating them better than others
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18
Q

If delivering care in different # of hrs to different patients it should be based on ______ and not b/c you just like them better

A

If delivering care in different # of hrs to different patients it should be based on needs and not b/c you just like them better

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19
Q

Not to enter friendship or romantic relationships with clients, min. _____ after terminating nurse-client relationship

A

Not to enter friendship or romantic relationships with clients, min. 1 year after terminating nurse-client relationship

  • terminating means that there is no chance of the patient coming back to go in a nurse-client relationship with you
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20
Q

Can you deliver care to your own family, friends, etc?

A

NO

  • if you know them, try to get someone else to care for them instead
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21
Q

Communication

A

Communication is the means to establish helping, healing relationships

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22
Q

Relational practice

A

Conscious use of a skills including listening, questioning, empathy, mutuality, reflection and sensitivity

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23
Q

Nurses need to demonstrate in communication?

A

Need to demonstrate authenticity, mutuality, self-reflection, listening

24
Q

True or false

All communication influences behaviour

A

True

25
Q

True or false

Not all behaviour communicates or has meaning

A

False

  • all behaviour communicates or has meaning
26
Q

Nurses should _____ beyond the surface in communication with patients

A

Nurses should questions beyond the surface in communication with patients

27
Q

What are the 2 main types of communication?

A

Verbal and non-verbal communication

  • both are very important
28
Q

Interpersonal communication

A

B/c nurse and patient

  • Must validate meaning and understanding, as different opinions, experiences, values, beliefs exist
29
Q

Small group communication

A

Requires knowledge of group dynamics

  • Nurses work on committees, support groups, as part of health care team, research teams
30
Q

What are the elements of verbal communication?

A

Vocabulary: use of interpreters, watch medical jargon, words with multiple meanings
- eg. translators
- if no formal interpreters, then nurses that speak the language can help to translate
- can not have their family members translate
- watch the words you use (eg. acronyms) and what types of words are used for different age groups

Pace: slow and clear, avoid long pauses and rapid shifts in topic
- use transition sentences and explain to patients why you’re changing topics, etc

Tone
- read the room

Clarity & brevity: brief and direct

Timing & relevance

31
Q

Verbal cues & vs non-verbal cues in communication

A

Research estimates 7% of meaning through words, 38% by vocal cues, 55% by non-verbal body cues

32
Q

What happens if verbal and non-verbal messages are mismatched?

A

Receiver will interpret non-verbal cues as it more accurately reflects sender’s true meaning

33
Q

What are examples of non-verbal communication?

A

Appearance, posture, facial expression, eye contact, gestures, sounds, personal space all play a role

34
Q

What does professional nursing relationships require?

A

Requires application of knowledge, understanding of human behavior and communication, commitment to ethical behavior

35
Q

What do professional nursing relationships include?

A

Includes an explicit time frame, expectation of confidentiality, goal-directed approach, patient-centered approach, non-judgement on part of the nurse

  • confidentiality:
    • might be shared with other nurses that are directly involved in care with the patient
    • limits have to share if there is a potential danger/harm to the patient themselves or to others
35
Q

Professional nursing relationships

Confidentiality

A
  • might be shared with other nurses that are directly involved in care with the patient
  • limits have to share if there is a potential danger/harm to the patient themselves or to others
36
Q

What are the 4 phases of the Nurse-Patient Relationship?

A
  1. Pre-interaction
  2. Orientation
  3. Working
  4. Termination
37
Q

Nurse-patient relationship

What is the pre-interaction phase?

A

Review medical and nursing history, anticipate client needs

  • Have a plan of what to talk about but also be flexible
38
Q

Nurse-patient relationship

What is the orientation phase?

A

Set empathetic & caring tone, assess patient health status, clarify nurse and patient roles

  • explain confidentiality & also the limits to it
  • ask them what brings them here today
39
Q

Nurse-patient relationship

What is the working phase?

A

Help client express feelings, provide information, take action, use therapeutic communication skills

40
Q

Nurse-patient relationship

What is the termination phase?

A

Evaluate achievement of goals, summarize, facilitate transition to follow up care

41
Q

________ is an important initial element of communication

A

Socializing is an important initial element of communication

42
Q

What does socializing in communication help to establish?

A

Helps to establish trust before moving on to more difficult, intense topics and therapeutic communication

43
Q

Nurses need to be cautious about answering _______ questions, use skill to deflect conversation back to _______

A

Nurses need to be cautious about answering personal questions, use skill to deflect conversation back to client

44
Q

Narrative interactions

A

Encouraging patients to share personal stories

45
Q

What does professional communication include?

A
  • Appearance, demeanour, behaviour
  • Warmth, confidence, skill, competence
  • Clear, proper grammar
  • Organized, well prepared
  • Courtesy
  • Use of names-avoid nicknames, terms of endearment, by diagnosis or room number
  • Establish trust by keeping your word
46
Q

Examples of contextual factors

A
  • Age, stage of development, gender
  • Culture
  • Health status
  • Language
  • Emotional status
47
Q

What is SOLER?

A

Sit facing the client

Open posture

Lean in

Eye contact

Relax

48
Q

Therapeutic communication techniques

A

Specific responses that encourage expression of feelings and ideas and convey respect and acceptance

Active listening
- attentive to patient both verbally and non-verbally

Sharing observations:
- can assist communication without extensive questioning, careful not to make assumptions
- Example: patient does not touch the food on their meal tray

Sharing empathy:
- to understand another’s reality and convey that understanding
- Indicates understanding of both content and feelings

Sharing hope:
- providing encouragement, positive feedback
- Do not minimize or provide false hope
- celebrate the small wins

Use of humour
- laughing WITH patients, not at them

Encourage patients to share feelings

Touch

Silence:
- allows time for patient to respond, consider alternatives, sort through feelings
- Provides opportunity to interpret patient non-verbal communication

Providing information:
- increases informed decision making, decreases anxiety, increases feelings of safety & security
- Caution against providing unsolicited advice

49
Q

What are the 5 main Therapeutic Communication Techniques during communication?

A

Clarifying: assesses accuracy of understanding, clarifies statements, asks client to rephrase or provide an example

Focusing: guides conversation in specific direction of interest

Paraphrasing: restating client’s message in own words

Asking relevant questions: one at a time, one topic at a time, logical sequence, open ended for broad topics, direct or closed ended more suited during assessment
- start broad then get more narrow & specific

Summarizing: concise review of key elements, provides closure, allows client to add additional information if needed

50
Q

Examples of non-therapeutic responses (to avoid)

A
  • Asking personal questions
  • Giving personal opinions: differs from professional advice
  • Changing the subject
  • Automatic responses: dismiss patient feelings and minimize their concerns
  • False reassurance: “everything will be fine”
  • Sympathy: differs from empathy, is nurse’s own subjective perspective
  • Asking for explanations: why questions
  • Approval or disapproval: :should/shouldn’t, right/wrong
  • Defensive responses
  • Passive or aggressive responses, arguing
    - Can be assertive without being aggressive
51
Q

Performance Guideline for Therapeutic Communication:

Pre-interaction phase

A
  • review any available data and speak to the healthcare team
  • plan the appropriate location and time allotted for the interview
52
Q

Performance Guideline for Therapeutic Communication:

Orientation phase

A
  1. Introduces self: name, nursing student & level.
  2. Determines client’s name & uses name more than once during interaction.
  3. Demonstrates professional deportment and appearance.
  4. Attends to client comfort and safety. Aware of
    nonverbal cues.
  5. Informs client regarding confidentiality.
  6. Clarifies purpose of interview. Identifies time frame for
    interview and/or relationship.
  7. Demonstrates professional behaviour: eye contact, voice modulation, avoids distracting verbal and non-verbal mannerisms, respects nurse-client boundary.
  8. Sets the tone for a therapeutic relationship demonstrating a caring, empathetic manner
53
Q

Performance Guideline for Therapeutic Communication:

Working phase

A
  1. Demonstrates active listening.
  2. Encourages client to explore feelings, thoughts, and set goals.
  3. Demonstrates therapeutic techniques: paraphrasing,
    silence, empathy, presence, summarization, open-ended questions.
  4. Uses clarification, leading and/or focused questions when
    appropriate.
  5. Identifies client issue(s).
  6. Demonstrates smooth transitions between
    topics/questions.
  7. Uses appropriate non-verbal and relational skills: eye
    contact, open posture
54
Q

Performance Guideline for Therapeutic Communication:

Termination phase

A
  1. Summarizes key points from the interview.
  2. Offers actions for follow-up.
  3. Asks if the client has further questions and concerns.
  4. Facilitate smooth transition for the client to other
    caregivers as needed.