NURM-101 Therapeutic Communication, Self-Concept Exam Review

Self-esteem

Need that people have to feel good about themselves and believe that others hold them in good regard

Self-actualization

Need for people to reach full potential through development of unique capabilities

Bases of self-esteem

Significance, competence, virtue and power

Significance

Way people feel they are loved or approved of by people important to them

Competence

Way tasks that are considered important are performed

Virtue

Attainment of moral-ethical standards

Power

Extent to which people influence their own and others’ lives, lifestyle choices

Pride

Based on self-evaluation

Guilt

Based on behaviors incongruent with ideal self

Shame

Associated with global self-worth

Factors affecting self-concept

• Developmental level

  • Infants and small children → Caregiver

  • Adolescents → Peers and society

• Culture

• Internal and external resources

  • External resources are validation from others 

• History of success and failure

• Crises or life stressors

• Aging, illness, trauma

Culture

• Has beliefs, morals, ethics that we see as good/bad, right/wrong

• Ingrained in you

• Societal values/norms can conflict with home

Internal resources

Self-esteem, value, importance inside us

External resources

Validation from others

Nursing Self-Concept Assessment

• Personal identity - How would you describe yourself to others?

• Personal strengths - What are some things you do well?

• Body image - What do you like most/least about your body?

• Self-esteem - Tell me about how satisfied you are with yourself?

• Role performance - How do you feel about your ability to do all the things your roles demand of you?

Nursing Self-Concept Diagnosis

Human response to a condition/situation

• Disturbed body image

• Chronic/Situational low self esteem (risk for)

• Ineffective Role Performance

Disturbed Body Image CAUSES

• Loss of body part or function

• Disfigurement

• Developmental changes

How to ASSESS Disturbed Body Image?

• What do you like most/least about your body?

• Is there anything you would change about your body?

• How would you describe your body?

Low Self-Esteem CAUSES

• Unhealthy interpersonal relationships

  • People stay in toxic relationships when they have low self-worth

• Failure to achieve developmental milestones

  • Not progressing and growing

• Failure to achieve life goals

• Sense of powerlessness

How to ASSESS Low Self-Esteem?

• How do you feel about yourself?

• Who would you like to be?

• How are your relationships with others?

Ineffective Role Performance CAUSES

• Loss of valued roles

  • Can’t do job anymore 

• Inability to meet role expectations

• Conflicting role expectations

How to ASSESS Ineffective Role Performance?

• What roles are important to you?

• How do you feel about your ability to do all the things your roles demand of you?

Types of Communication

• Nursing Communication

• Sharing Information

• Patient Centered Care

• Giving Instructions

• Closing The Loop

Closing the loop

• Make sure they understand what you’ve said to them

• Usually having them repeat what you just said

Encoder

Sender/Source

Decoder

Receiver

Forms of Verbal Communication

• Spoken

• Written

Why is pacing important?

Going too slow can seem distrust worthy

Intonation

The way you say something

Telehealth

Delivers medical service, support and education

Telemedicine

Remote treatment and diagnosis, clinically based

INTRApersonal communication

Self talk, inner thoughts

INTERpersonal communication

2+ people (patients and families)

Group communication

• Small group (staff meetings, support groups)

• Organizational (practice councils, planning groups)

  • Practice councils are for when you’re working in the hospitals

• Group dynamics (how members relate to one another)

SBAR

Situation, Background, Assessment, Recommendation

ISBARR

Introduction, Situation, Background, Assessment, Recommendation, Readback

TST

Target Solution Tool - Developed by Joint Commission Center for Transforming Healthcare

• To see what’s going wrong with hands-off communication

CUS

I’m Concerned, I’m Uncomfortable, This is Unsafe

Nurse-Patient Relationship

• Focused on promoting and restoring health

• Need to establish rapport and trust

• Characteristics

  • Caring, Person-Centered

  • Dynamic

    • Patient should be an active participant

  • Purposeful and Timed

    • SMART Goals

  • Provider is Accountable

Therapeutic Relationship Qualities

• Care, concern, trust and growth

• Not spontaneous and has a specific purpose

• Unequal sharing of information

• Built on patient needs

Nursing Patient Relationship Phases

1. Orientation Phase

2. Working Phase

3. Termination Phase

Orientation Phase

• Call nurse by name

• Identify participants in patient’s care

• Goals set and looked at together

• Location, frequency, length of contact

Working Phase

• Patient will participate in activities to reach goals

• Patient will communicate openly

Termination Phase

• Patient will identify goals reached or progress towards goals

• Patient will communicate feelings about ending relationship

• End of shift, discharge, etc.

Conversation Skills

• Tone

• Knowledge

• Truthful

• Open Minded

Listening Skills

• Sit with patient

• Make eye contact

  • When culturally acceptable

• Alert

• Listen for themes