Chapter 5: Relationship Development and Therapeutic Communication
weigh _____ and ________ of each alternative
benefits and consequences
•A diagrammatic teaching and learning strategy
concept map
•Shows interrelationships among medical and nursing diagnoses, assessment data, and treatments
concept map
•asking client to compare similarities and differences in ideas, experiences, or interpersonal relationships
encouraging comparison
taking notice of a single idea or even a single word
focusing
striving to prevent anger or anxiety from escalating to an unmanageable level the next time the stressor occurs
formulating plan of action
client reacts to nurse based on feelings toward another person in their life
transference (working phase)
blocks discussion with client and avoids helping client identify and explore areas of difficulty
using denial
•allows client to take control of the discussion, if they so desire
using silence
includes prejudices
values, attitudes, and beliefs
Verbalizing what is observed or perceived. This encourages the client to recognize specific behaivors & compare perceptions with the nurse. EXAMPLE: "You seem tense." "I notice you are pacing a lot." "You seem uncomfortable when you..."
making obervations
•expressing uncertainty as to the reality of client's perception
voicing doubt
countertransference
nurse reaction to client (working phase)
•Obtain information about the client from chart, significant others, or other health-team members
pre-interaction phase
•Both sender and receiver bring ____ ____ to the exchange that influence the intended message and the way in which the message is interpreted
preexisitng conditions
clarifying misconceptions that client may be expressing
presenting reality
pushing for answers to issues the client does not wish to discuss causes client to feel used and valued only for what is shared with the nurse
probing
Goals are often achieved through the use of a problem solving model Identify the client's _____ promote discussion of ____ ___ discuss aspects that cannot realistically be changed and ways to _______ with them more adaptively discuss alternative strategies for creating changes the client ______ to make
problem desired changes cope desires
•Written reports of verbal interactions with clients •A means for the nurse to analyze the content and pattern of interaction
process recording
name the conditions essential to development of a therapeutic relationship
rapport trust respect genuineness empathy
• •In the transactional model, both participants perceive each other, listen to each other, and _______________engage in the process of creating meaning in a relationship
simultaneously
process by which nurses provide psychosocial care
therapeutic interpersonal relationship
A mother rescues two of her four children from a house fire. In an emergency department, she cries, "I should have gone A mother rescues two of her four children from a house fire. In an emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? 1."The smoke was too thick. You couldn't have gone back in." 2. "Are you experiencing feelings of guilt, because you weren't able to save your children?." 3. "Focus on the fact that you could have lost all four of your children." 4. "It's best if you try not to think about what happened. Try to move on."
2
After an episode with difficulty breathing that was treated effectively, the patients says, "What if this happens again? I stay awake at night afraid I won't be able to breath Which is the best initial response by the nurse? A.Why do you think this will happen again? B. This problem is called stridor. C. I will see if you have an order for sleep medication. D. It sounds like it was a very frightening experience for you.
D
Laura was diagnosed yesterday with Type 1 Diabetes. She says, "I wish I hadn't gotten the flu. Then, this diabetes wouldn't have been discovered, and I could keep having a normal life." Which is the best initial response by the nurse? A. What do you mean when you say normal life? B. It's better to find out now before complications develop. C. Perhaps you would like to speak to someone with diabetes. D. It must be quite a shock to learn that you have diabetes.
D
allows client to select the topic
Giving broad openings
meaninglessness
Making stereotyped comments, clichés, and trite expressions
•Several -------- behaviors have been designed to facilitate attentive listening
NONVERBAL
Active listening SOLER
S - Sit squarely facing the client O - Observe an open posture L - Lean forward toward the client E - Establish eye contact R - Relax
•putting into words what client has only implied
Verbalizing the implied
conveys positive regard
accepting
•To be attentive to what the client is saying, both verbally and nonverbally
active listening
-Example: slang words used by different generations: "dude," "wicked," "groovy".
age or developmental level
•: implies that the nurse has the right to pass judgment on whether client's ideas or opinions are "right" or "wrong"
agreeing or disagreeing
help the client select and _______ encourage the client to _____ the change
alternative implement
implies that the nurse has the right to pass judgement on the "goodness" or "badness" of client's behavior
approving or disapproving
Putting into words the feelings the client has expressed only indirectly
attempting to translate words into feelings
Therapeutic use of self is most successful when nurses possess self-awareness, self-understanding their own ________ about life, death, and the overall human condition
beliefs
•causes client to feel insignificant or unimportant
belittling feelings expressed
norms and customs
culture or faith/spirituality traditions
•defend what client has criticized implies the client has no right to express ideas, opinions, or feelings
defending
the number of people within a given environmental space
density
Feedback is useful when it -Is_______rather than evaluative and focused on the behavior rather than on the client -Is _______ rather than general -Is directed toward ______that the client has the capacity to modify -Imparts ______ rather than offers advice -Is well ______
descriptive specific rather than general behavior info timed
the means by which various cultures use space to communicate
distance
Components of nonverbal communication •Physical appearance and ______ •Body movement and ____ •________ •Facial _______ •_____ behavior •Vocal _____ or paralanguage
dress posture touch facial expressions cues
Asking the client to verbalize what is being perceived
encourage description of perceptions
help the client ______ outcomes of the change and make modifications as required
evaluate
-Masculine and feminine gestures influence messages conveyed in communication with others
gender-- impact of preexisting conditions
may discourage the client from further expression of feeling
given false reassurance
implies the nurse knows what is best for client and that client is incapable of any self-direction
giving adnice
•transaction between the sender and the receiver—both persons participate
interpersonal communication
•results in the therapist's telling client the meaning of his or her experience
interpreting
interventions: help client sort out past from present only terminate the relationship if serious barrier
interventions (working phase)
-There are four kinds of distance in interpersonal interactions •_________ distance: the closest distance • •_____ distance: for interactions such as close conversation with friends • •______ distance: for conversation with strangers or acquaintances • •_____ distance: for speaking in public or yelling to someone some distance away
intimate personal social public
causes the nurse to take over the direction of discussion
introducing an unrelated topic
encourages client to continue
offering general leads
making oneself available
offering self
create an environment for trust and rapport and gather assessment data
orientation phase
develop realistic plan of action
orientation phase
identify client's strength and weaknesses and set mutually agreeable goals
orientation phase
•: clarifies the relationship of events in time
placing the event in time or sequence
Termination phase •Ideally therapeutic conclusion of relationship occurs when ______ has been made toward attainment of the goals -A plan of action for more adaptive ______ with future stressful situations has been established -***______ about termination of the relationship are recognized and explored
plan cope feelings
•Examine nurse's own feelings, prejudices, fears, and anxieties about working with a particular client
pre-interaction phase
•directs questions or feelings back to client so that they may be recognized and accepted
reflecting
refusing to consider client's ideas or behavior
rejecting
Asking "why" implies that the client must defend his or her behavior or feelings.
requesting an explanation
•lets client know whether an expressed statement has or has not been understood
restating
•Warning signs that indicate professional boundaries may be in jeopardy -Keeping ____ with a client -_______ client assignments to care for a particular client -Spending ____ ___ with a client -Giving _____ ______ to one client over others -Sharing ________ information with a client -Receiving _________ or continuing contact with client after discharge
secrets swapping free time special attention personal gifts
striving to explain what is vague
seeking clarification and validation
professional boundary concerns include issues of
self-disclosure gift-giving touch friendship or romantic interaction
body language and traditional status of nurses
social status
the innate tendency to own space
territoriality
continuously evaluate progress
working phase
maintain trust and rapport; promote client's insight and perception of reality
working phase
use problem-solving model to work toward achievement of established goals + overcome resistance behaviors
working phase