Psych -Lec2-Ch 5.8.9-Canvas-1 (1).pptx (1)

Prof. Jerry Cervantes, MSN, RN

• Focus on Culture, Therapeutic Professional Communication & Relationships

• Chapters 5, 8, and 9 overview.

The Importance of Attitude

• Quote by Charles Swindoll:

  • Emphasizes the significance of attitude over facts and circumstances.

  • Highlights the power of personal choice in determining attitude daily.

  • Life is portrayed as 10% events and 90% reaction to those events.

  • Encourages self-reflection on personal attitude decisions.

Learning Objectives

• Describe the communication process.

• Analyze boundaries and the effects of transference and counter-transference on therapy.

• Discuss divergent values and cultural beliefs impacting therapeutic relationships.

• Explain phases of the nurse-patient relationship.

• Identify patient behaviors in clinical settings.

• Compare verbal and nonverbal communication.

• Examine communication differences across cultures, emphasizing style, eye contact, and touch.

• Address issues arising from cultural insensitivity in communication.

• Explore benefits and concerns related to Information Communication Technologies (ICT).

Concepts of the Nurse-Patient Relationship

• Communication is the basis of psychiatric nursing treatment approaches.

• Establishing characteristics of a therapeutic nurse-patient relationship:

  • Safe

  • Confidential

  • Reliable

  • Consistent

  • Clear boundaries

Therapeutic Use of Self

• Utilize personality consciously and purposefully.

• Focus on establishing relatedness with patients.

• Structure nursing interventions based on the patient’s needs.

Goals and Functions of Therapeutic Relationships

• Facilitate communication of distressing thoughts and feelings.

• Assist patients in problem-solving.

• Help patients examine self-defeating behaviors and consider alternatives.

• Promote self-care and independence.

Social vs. Therapeutic Relationships

• Social Relationships:

  • Initiated for friendship and socialization.

  • Focus on mutual needs with superficial communication content.

• Therapeutic Relationships:

  • Identifies patient needs.

  • Establishes clear boundaries.

  • Utilizes problem-solving approaches.

  • Develops new coping skills and encourages behavioral change.

Necessary Behaviors for Nurses

• Accountability: Focus on patient needs.

• Clinical competence and delaying judgment.

• Establishing physical boundaries and personal space contracts.

Boundary Issues

• Blurring of Boundaries: Occurs when:

  • Relationships slip into social context.

  • Nurse’s needs supersede patient’s needs.

Roles and Transference

• Transference:

  • Patient displaces feelings related to significant figures in their past onto the nurse, often heightened in authoritative relationships.

• Countertransference:

  • Nurse displaces feelings from their past onto the patient, leading to over-identification and potential boundary issues.

Values, Beliefs, and Self-Awareness

• Nurses' values and beliefs derive from an array of cultural influences and role models.

Peplau’s Model of Nurse-Patient Relationship Phases

1. Pre-Orientation Phase

2. Orientation Phase

3. Working Phase

4. Termination Phase

Detailed Phases

Orientation Phase

• Build rapport and define relationship parameters.

• Establish confidentiality and terms of termination.

Working Phase

• Maintain relationships, continue collecting data, and promote patient’s problem-solving skills and self-esteem.

Termination Phase

• Starts from the initial visit and discusses incorporating new coping strategies, summarizes goals achieved, and exchanges memories.

Factors Enhancing Nurse-Patient Relationships

• Consistency: Necessary for building trust.

• Pacing: Understanding patient comfort.

• Listening skills: It's critical for establishing rapport.

Factors Promoting Patient Growth

• Genuineness and Empathy: Essential for positive regard without judgment.

• Aiding patients in developing resources to foster independence.

Therapeutic and Nontherapeutic Communication

Verbal Communication

• Comprises all spoken words conveying beliefs, values, and perceptions.

• Can express interest, understanding, or conflicting messages.

Nonverbal Communication

• Includes tone, emphasis, physical appearance, facial expressions, body language, and gestures.

Interaction Between Verbal and Nonverbal Communication

• Nonverbal messages often convey deeper meanings than spoken words, leading to potential double-bind messages where content and process conflict.

Therapeutic Communication Techniques

• Tools include:

  • Using silence and active listening.

  • Clarifying techniques: paraphrasing, restating, reflecting, exploring.

  • Projective questions like the “Miracle” question.

Asking Questions and Eliciting Patient Responses

• Differentiate between open-ended and closed-ended questions; leveraging the power of effective inquiry.

Cultural Considerations in Communication

• Key factors include communication style, eye contact, touch, and cultural biases.

Cultural Implications for Psychiatric Mental Health Nursing

• Importance of culturally relevant care and understanding cultural barriers impacting mental health service efficacy.

Definitions and Concepts Related to Culture

• Ethnocentrism: Belief in the superiority of one's own culture.

• Enculturation: Process of integrating cultural traits.

• Minority Status: Individuals identifying as part of differentiated groups based on shared characteristics.

America's Indigenous Culture and Mental Health

• Emphasis on harmony with the environment and community in understanding disease.

Impact of Culture on Mental Health

• Cultural barriers including stigma, misdiagnosis, and differing interpretations of distress.

Cultural Competence Framework

1. Cultural Awareness: Self-exploration of beliefs.

2. Cultural Knowledge: Learning about diverse cultures enhances nursing practice.

3. Cultural Encounters: Promotes individualized care and diminishes stereotypes.

4. Cultural Skill: Conducting sensitive cultural assessments.

5. Cultural Desire: Commitment to understanding and valuing patient perspectives.

Case Studies and Application Questions

• Examines how cultural attitudes affect patient behavior and therapeutic relationships, including ethical dilemmas in care delivery.