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