Therapeutic Communications and Nurse Relationships

1. Silence

2. Accepting

3. Recognition

4. Offering self

5. General leads

6. Broad openings

7. Events in time/sequence

8. Observations

9. Description of perception

10. Comparison

11. Restating

12. Reflecting

13. Focusing

14. Exploring

15. Giving info

16. Seeking clarification

17. Presenting reality

18. Voicing doubt

19. Consensual validation

20. Verbalizing the implied

21. Evaluation

22. Translate into feelings

23. Collaboration

24. Summarizing

25. Plan of action

What are the techniques that enhance communication?

Silence

Gives person time to gather thoughts or to think through a point

Accepting

• Indicates that the person has been understanding

• The statement doesn’t indicate acceptance but is nonjudgemental

Recognition

• Indicates awareness of change and personal efforts

• Doesn’t imply good or bad or right or wrong

Offering self

• Offers presence, interest, and a desire to understand

• Is not offered to get the person to talk or behave in a certain way

General leads

• Allows other person to take direction

• Indicates RN is interested in what’s next

Broad openings

Clarifies that the lead is to be taken by the patient however RN discourages pleasantries

Events in time/sequence

• Put events and actions in better perspective

• Notes cause and effect and identify interpersonal difficulties

Observations

• Calls attention to person’s behavior

• Encourages person to notice behavior to describe thoughts and feelings for personal understanding

Mute and withdrawn

What group of people is observation helpful with?

Description of perception

Encourages RN understanding of patient perception

The need to act out inappropriately

What can description of perception lessen?

Comparison

• Reveals recurring themes in experiences or interpersonal relationships

• Helps clarify similarities and differences

Restating

• Repeats main idea expressed

• Gives patient an idea of what has been communicated

Reflecting

Direct questions, feelings, and ideas back to the patient. Encourages patient to accept his or her own feelings

Focusing

Concentrates attention on single point

Exploring

Examines certain ideas, experiences, or relationships fully

Giving info

• Makes available facts the person needs

• Supplies knowledge from which decisions can be made or conclusions drawn

Seeking clarification

Helps patients clarify their own thoughts and maximize mutual understanding between nurse and patients

Presenting reality

Indicates what is real. The nurse does not argue or try to convince the patient, just describes personal perceptions or just facts in the situation

Voicing doubt

Undermines the patients beliefs by not reinforcing the exaggerated or false perceptions

Consensual validation

Clarifies that both the nurse and the patient share mutual understanding or communication. Helps the patient become clearer about what or she is thinking

Verbalizing the implied

Puts into concrete terms what the patient implies, making the patient’s communication more explicit

Evaluation

Aids the patient in considering people and event from the perspective of the patients own set of values

Translate into feelings

Responds to the feelings expressed, not just the content. AKA decoding

Collaboration

Emphasizes working with the patient, not doing things for the patient. Encourages the view that change is possible through collaboration

Summarizing

Combines the important points of the discussion to enhance understanding. Also allows the opportunity to clarify the communications so that both nurse and patient leave the interview with the same ideas in mind

Plan of action

Allows the patient to identify alternative actions for interpersonal situations the patients find disturbing

1. Premature advice

2. Minimizing feelings

3. False reassurance

4. Value judgements

5. “Why” questions

6. Excessive questions

7. Approval; agreeing

8. Disapproval; disagreeing

9. Changing subject

What are techniques that are non-therapeutic?

Premature advice

Assumes the nurse knows best and the patient cannot think for self. Inhibits problems solving and fosters dependency

Minimizing feelings

• Indicate that the nurse is unable to understand or empathize with the patient

• Patients feelings or experiences are being belittled, which can cause the patient to feel small or insignificant

False reassurance

Underrates the patient’s feelings and belittles the patients concerns. May cause the patient to stop sharing feelings of the patient think he or she will be ridiculed or not taking seriously

Value judgements

Prevents problem solving can make the patient feel guilty, angry, misunderstood, not supported, or anxious to leave

“Why” questions

Implies criticism often has the effect of making the patient feel defensive

Excessive questions

Results in the patient not knowing which question to answer and possibly being confused about what is being asked

Approval; agreeing

Implies that the patient is doing the right things, and that not doing it is wrong. May lead the patient to focus on pleasing the nurse or clinician, Denis the patient the opportunity to change his or her mind of decision

Disapproval; disagreeing

Can make a person defensive

Changing subject

May invalidate the patient’s feelings and needs can leave the patient feeling alienated and isolated and increase feelings of hopelessness

Culture indicates a person’s comfort of lack of comfort with eye contact. Some cultures consider it disrespectful and improper

With regards to culture, what should the nurse know about making eye contact?

Yes: German, Russian, Haiti, French, British, AA, Greece

No: Hispanic, Asian cultures, Native Americans

What cultures are ok and not ok with eye contact?

A great number of cultures express through touch, therapeutic use is a base part of the nurse patient relationship perceived as a gesture of warmth and friendship. In some cultures, it can be an invasion of privacy

With regards to culture, what should the nurse know about touch?

Yes: Hispanic, Italian, French

No: German, Swedish, British, Japan, China

Which cultures are ok and not ok with touch?

Initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task (ex. giving advice, meeting dependency needs like lending money or helping with jobs)

What are the elements of social relationships?

Social

Which relationship meets mutual needs (ex. sharing ideas, feelings, and experiences)?

Patient centered partnership, nurse maximizes his/her communication skills, understanding of human behavior and personal strengths to enhance patient’s growth

What are the elements of therapeutic relationships?

Providing a safe space through which the patient can explore feelings and treatment issues

What is meant by establishing boundaries?

Transference

The process where by a person unconsciously and inappropriately transfers patterns of behaviors and emotional reaction towards another person that originated in relation to significant figures in childhood

Countertransference

Refers to the tendency of the nurse to transfer onto to patient feelings related to people in his/her past

1. Preorientation

2. Orientation

3. Working

4. Termination

What are Peplau’s phases of nurse-patient relationship?

Preorientation

When the nurse gets ready to meet the patient

• Reviews medical records/background info

• Thinks about what the patient might need

• May feel some anxiety, uncertainty, or curiosity

• Mental prepares for interaction

What does the nurse do in preorientation?

Orientation

Can last for a few meetings or can extend over a longer period

• First time nurse and patient meet and are strangers

Working

The nurse and patient together identify and explore areas in the patient’s life hat are causing problems

Termination

Summarize goals and objective achieved in the relationship

• Ways for patient to incorporate into daily life any new coping strategies learned during the time spent with nurse

• Review situations that occurred during time together

• Exchange memories → help validate experience for both nurse and patient and facilitate closure of that relationship

What is included in the termination phase of the nurse patient relationship?

1. Consistency

2. Pacing

3. Listening

4. Initial impressions

5. Comfort and control

6. Pt. factors

What are factors that HELP the nurse-patient relationship?

1. Genuineness

2. Empathy

3. Attitudes

4. Actions

5. Attending

What are factors that ENHANCE GROWTH the nurse-patient relationship?

1. Inconsistency

2. Unavailability

3. Nurse’s feelings and lack of awareness

What are factors that HINDER the nurse-patient relationship?

Pacing

Letting patient set the pace and letting it be adjusted to patient’s mood

Initial impressions

Positive initial attitudes

Comfort and control

Promoting patient comfort and balancing control

Patient factors

Trust on the part of the patient and patient’s active participation in the nurse-pt. relationship

Attitudes

Willingness to work with the patient

Actions

Suspending values, judgements and helping patients develop their own resources

Attending

Listening and being there for patient