Communication, Perception, and Assessment/Therapeutic Relationships

what is active listening

The nurse seeks to capture the meaning, intention, and content of the message.

• Keep appropriate physical, emotional, social, and cultural boundaries to build and maintain a therapeutic and caring relationship.

what are the elemnets of active listening

• Facing the client

• Maintaining appropriate eye contact

• Focusing on the client’s words, nonverbal cues, and body language

• Being nonjudgmental and minimizing interrupting the client

what is the Johari model of self awarness

a framework that helps people understand self-awareness and how they interact with others. It was developed by Joseph Luft and Harrington Ingham (hence the name "Johari").

• It divides self-awareness into four quadrants (or “windows”):

• Open Area (Arena):

  • What you know about yourself and others also know.

  • Example: your skills, communication style, or habits that are visible.

• Blind Area (Blind Spot):

  • What others know about you, but you don’t realize.

  • Example: a habit of interrupting people that you aren’t aware of.

• Hidden Area (Facade):

  • What you know about yourself, but choose not to share with others.

  • Example: personal fears, insecurities, or private experiences.

• Unknown Area:

  • What neither you nor others know about you.

  • Example: untapped potential, unconscious motives, or hidden talents.

what is self disclosure

an interactive communication process wherein one person shares information about themselves in an appropriate context, modeling the behavior for others in the therapeutic relationship.

Here are the key aspects of self-disclosure in nursing practice:

• Self-Awareness as a Prerequisite: Self-awareness is crucial before a Registered Nurse (RN) begins the assessment, and is an antecedent of therapeutic communication.

• Judicious Use: Self-disclosure should be used judiciously.

• Purpose (for client benefit): It can be a therapeutic technique utilized within professional boundaries. It may be used to model behavior for others in the therapeutic relationship

What are Antecedents of therapeutic communication

the conditions that must be present before therapeutic communication can effectively take place between a nurse (or healthcare provider) and a patient. They create the foundation for a trusting and meaningful interaction.

what are some important points of confidentiality

• The RN must let the patient know that information gleaned from the assessment will be shared with the treatment team.

• There are no secrets especially if the client is suicidal or homicidal.

what is nonverbal communication and what is included

Communication that occurs without words

• Body movements

• Facial expression (affect)

• Gestures

• Non-verbal sounds

  • Sighing

  • Laughing

  • Humming

  • Chuckling

• Body movements & facial expressions

  • Eye rolling

  • Grimacing

  • Tapping the foot

  • Crossing the legs and arms

  • Posture

  • Eye contact or lack of eye conta

What are the barriers to therapeutic communication

• Inattentive Listening

• Use of Medical Terminology

• Asking personal questions unrelated to the visit

• Expressing Approval or Disapproval

• Changing the Subject

• Making Remarks that are Minimizing

• Providing False Reassurance

• Expecting Justifications

• Disagreeing with the client/patient

What characterizes a healthy nurse-client relationship

healthy relationship that develops over time, and is based on mutual trust and respect.” (OpenStax)

There is nurturing of

• Health

• Hope

• Wellness

• Empathy

• Therapeutic interventions to help the client/patient their current encounter.

What are the phases of the therapeutic relationship

1. Pre-orientation phase

2. Orientation Phase

3. Working Phase

4. Termination Phase

What is done in the pre-orientation phase

• The nurse:

  • self-reflects on the feelings, fears, and thoughts on the client and client situation.

  • Analyzes their own personal and professional strengths and weaknesses in the context of the client/patient.

  • Collect information about the client and prepare a plan of care.

May occur after bedside report or grand rounds on the client/patient.

There is a strong element of collaboration with nurse, social worker, mentor, supervisor, psychiatrist etc.

What is done in the orientation phase 

• Establishing rapport with the client, gaining trust, and creating an environment where the client feels safe and accepted.

• Initiation of the communication and collection of data about the client’s feelings and the reason why they are seeking treatment.

• Identification of problem areas and planning potential interventions.

• Collaboration between the nurse and client establishing goals to solve problem areas.

• Explanation of the plan of care. What to expect from the nurse and possible discharge or termination.

What is done in teh working phase

• This is where the work occurs (therapeutic interventions).

• It is a collaborative relationship between the nurse and the client to identify stressors, promote insight into the patient’s problems.

• Identify and explore potential solutions and ways of implementing the solutions.

• The nurse continues to collect data on the patient and promotes healthy coping mechanisms.

• Encouraging the patient to self-reflect on how their behavior and the changes needed to get healthy.

• Encouraging the patient to function independently and re-define the problem as needed.

What is done in termination phase

• Is discussed during the Orientation phase

• This is the critical phase in the nurse-patient relationship

• The focus of the plan of care is to have the patient move toward resolution of their issues with independence and confidence.

• The nurse-patient relationship comes to an end.

• The nurse discusses the reality of termination. The nurse-patient relationship is coming to an end and the patient will move forward.

• Evaluation of whether treatment was effective and was there progress towards the goals set in the Orientation Phase.

• Exploration of feelings that both nurse and patient may experience with termination of the nurse-patient relationship.

what is proxemics

how much physical space persons like to have between them when conversing with other people

Emotional boundries 

• It will be important for the nurse to assess the patient’s emotional state and what is best for that client in terms of emotional limits.

• It is imperative that the nurse be able to separate their own feelings from those of the patient.

  • One can be compassionate and caring without getting caught in judging the patient and becoming enmeshed with patient emotional state. Maintaining respect for the patient is crucial.

  • It will be important for the nurse to maintain awareness of why the patient is seeking treatment.

what are social boundaries

•Socializing with the patient is for the most part inappropriate.

•One could start the conversation with the patient by making general comments to ease the patient into the interview.

•However, sharing intimate details about one’s personal life is inappropriate.

•Not asking irrelevant questions that have nothing to do with the present moment.

•Taking lunch or work breaks with the patient is a big NO!!!!!

what is transference

When the patient reacts emotionally toward the nurse when triggered by memories of a past relationship

What is countertransference

When the nurse is triggered emotionally by the patient and then engages in acting out.

• Ignoring the present patient because of an unresolved issues from the nurse’s past.

Where does a pt learn beliefs regarding illness

• Societal stigma

• Cultural beliefs

• Treatment issues

what factors influence perceptions

• culture

• spirituality

• langauge

what are non-modifiable risk factors

• Cognitive factors

• Poor insight

• Cost factors

• Limited access to health care

• Lack of social support

What are modifiable risk factors

• Client’s attitudes toward their own mental health

• Being informed about their medications and side effects

• Discussing treatment issues with physician and nurse

what is included in nuero assessment

• Explaining to the patient what the nurse will do and asking for permission to begin

• Orienting the patient to person, place and time

• Conducting a mental status examination

• Check PERRLA

• Observing the patient’s behavior. Are they cooperative, resistant, anger, able to follow the directions

• Test strength of patient’s grip and ability to push against the nurse’s hands

• Assess gait, ability to stand up straight, etc

What is included in a psychosocial assessment 

thier mental health in relation to their social well-being

• Home environment

• Education/employment

• Activities outside of work/hobbies

• Drug/tobacco/alcohol use

• Sexuality/gender

• Suicide risk

• Violence risk

What is AIDET

a framework for initiating therapeutic relationship

• Acknowledge: Greet the client by their preferred name, verifying their identity and preferred pronouns.

• Introduce: Introduce yourself by name and role. For example, stating, "I'm John Doe, and I'm a nursing student working with your nurse to take care of you today".

• Duration: Estimate the amount of time the interaction will take, such as to complete an assessment.

• Explanation: Explain step-by-step what the client can expect next and answer questions. For example, detailing the next steps and explaining how a blood pressure reading will be taken.

• Thank You: At the end of the encounter, thank the client and ask if they have any further questions before leaving

what does AIDET stand for

Acknowledge

• Greet patient by their preferred name, verifying their identity.

• Ask the patient/client their preferred way of being addressed and their preferred pronouns.

Introduce yourself by name and role

• I am John Doe and I am a nursing student working with your nurse to take of you today.

Duration

• Estimate the amount of time it will take to complete the assessment.

Explanation

• step by step what to expect next and answers questions.

Thank you

• At the end of the encounter, thank the patient and ask if they have any further questions before you walk away

what are the 5 types of boundaries

• Physical

• Sexual

• Intellectual

• Emotional

• Financial

what are some signs of inappropriate boundaries

• Self-disclosing intimate or personal issues with the client

• Engaging in behaviors what could be interpreted as flirting

• Keeping secrets with the patient

• Believing the nurse is the only one who truly understands or can help the patient

• Spending more time than is necessary with a particular patient

• Speaking poorly about colleagues or the employment setting with the client and/or their family

• Showing favoritism to a particular client

• Meeting a client in setting outside of work

• Contacting or permitting contact by a client and/or their family members using social media

what are functional families

are able to work together toward common goals. Family members support one another, and have good communication.

what are family dynamics

is the way that a family members interact, communicate, and problem solve

What are dysfunctional family dynamics

Cause distress in the family system, increases family stress with potential poor outcomes.

what is a nuclear family

what is a single parent family

what is extended family

what is a childless family

what is a grandparent family

what is a stepfamily/blended family

what kind of burden can a person with mental illlness have on a fmaily member

Objective Burden

• A family member’s inability to manage day to day living obligations (e.g. finances, ADL) increased friction with the family system as a direct result of dealing with a family member with mental illness

Subjective Burden

• feelings family members exhibit when dealing with mental illness

  • Worries and anxiety

  • Resentments

  • Feeling trapped

  • Fear of being stigmatized because of the family member mental illness

  • Interactions and disturbing behaviors on the part of the family member

What is the family systems model

What is a collaborative relationship

Interprofessional, collaborative relationships are those that evolve between the interprofessional team and the family

what are the 5 principles of engagement

• Understand the person and their illness

• Facilitate growth

• Therapeutic use of self

• Choose the right approach

• Emotional versus restrictive containment

what is protected enegament time

setting aside a specific amount of time to work with the patient

what are barriers to pateint engagement

• Outdated policies and procedures

• Lack of care coordination

• Negative treatment of persons with mental health issues

• Lack of respect from healthcare providers

• High caseloads

• Rigid rules

• Provider turnover

• Lack of transportation

• Cost of care and treatment

• Scheduling difficulties

• School, work, and implicit bias

What is Trauma informed care

acknowledging all past and present parts of a person’s life situation, including any trauma they have endured.

• Treatment includes supporting the patient’s autonomy, their strength, and control over making healthcare decisions.

What are the 6 core pinicples of trauma informed care

• Safety

• Trustworthiness and transparency

• Peer support

• Collaboration and mutuality

• Empowerment voice and choice

• Cultural, historical, and gender issues

what are some examples Adverse childhood experiences(ACES)

• Sexual or Physical Abuse

• Hunger

• Poverty

• Bullying

• Immigration Status

• Premature birth

• Chronic medical conditions

what is complex trauma

experiencing multiple recurring traumatic events.

• These traumatic events can include, but are not limited to:

  • Physical abuse

  • Sexual abuse

  • Psychological abuse