Transcript of Therapeutic Relationships. Concepts of the Nurse-Patient Relationship Basis of all psychiatric...
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- Therapeutic Relationships
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- Concepts of the Nurse-Patient Relationship Basis of all
psychiatric nursing treatment approaches To establish that the
nurse is Safe Confidential Reliable Consistent Relationship with
clear boundaries
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- Goals and Functions Facilitate communication of distressing
thoughts and feelings Assist patient with problem solving Help
patient examine self-defeating behaviors and test alternatives
Promote self-care and independence
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- Social Relationships Initiated for the purpose of friendship or
meeting a goal Mutual needs are met Communication to give advice,
give or ask for help Content of communication superficial
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- Therapeutic Relationships Needs of patient identified and
explored Clear boundaries established Problem-solving approaches
taken New coping skills developed Behavioral change encouraged
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- Necessary Behaviors for Nurses Accountability Focus on patients
needs Clinical competence Delaying judgment Supervision
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- Establishing Boundaries Physical boundaries The contract
Personal space
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- Blurring of Boundaries When relationship slips into social
context When nurses needs are met at expense of patients needs
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- Blurring of Roles Transference patient unconsciously displaces
onto individual in current life emotions and behaviors from
childhood that originated in relationships with significant others
Transference intensified with person in authority in current
life
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- Blurring of Roles Continued Countertransference nurse displaces
feelings related to people in nurses past onto patient Patients
transference to nurse often results in countertransference in nurse
Common sign of countertransference in nurse is overidentification
with the patient
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- Values, Beliefs, and Self-Awareness Nurses values and beliefs
Not right for everyone Reflect own culture/subculture Derived from
range of choices Chosen from a variety of influences and role
models
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- Peplaus Model of Nurse-Patient Relationship Orientation phase
Working phase Termination phase
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- Orientation Phase Establishing rapport Parameters of the
relationship Formal or informal contract Confidentiality Assessing
patient strengths and coping Identification of Nursing Diagnosis
and NOC Terms of termination
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- Working Phase Maintain relationship Gather further data Clarify
expectations Develop plan of care Promote patients problem-solving
skills self-esteem
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- Working Phase Continued Facilitate behavioral change Overcome
resistant behaviors Evaluate problems and goals Redefine them as
necessary Promote practice and expression of alternative adaptive
behaviors
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- Termination Phase Summarize goals and objectives achieved
Discuss ways for patient to incorporate new coping strategies
learned Review situations of relationship Exploring the need for
referrals post-discharge Establish plans for long-term post
discharge functioning
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- Factors That Help Nurse-Patient Relationship Consistency Pacing
Listening Encouraging active patient collaboration Initial
impressions
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- Factors That Help Nurse-Patient Relationship Continued
Promoting patient comfort and balancing control Patient factors
include trust and active participation
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- Factors That Encourage and Promote Patient Growth Genuineness
Empathy (not sympathy) Positive Regard attitudes and actions
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- Factors That Encourage and Promote Patient Growth Continued
Attending Suspending value judgments Helping patients develop
resources
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- A nurse seeks to establish a relationship with a patient
readmitted to the hospital. The patient has bipolar disorder,
depressed type, and was hospitalized the preceding month. Which
statement by the nurse would contribute to establishing trust?
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- Answers a. Werent you complying with your medication regimen?
b. It must be discouraging to be readmitted to the hospital so
soon. c. Everyone with bipolar disorder ends up in the hospital
occasionally. d. You must take your drugs as prescribed or you will
be rehospitalized.
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- Communication and the Clinical Interview
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- The Communication Process Stimulus for information, comfort, or
advice Sender initiates contact Message sent or expressed Variety
of media hearing, visual, touch, smell Feedback received
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- Factors That Affect Communication Personal factors
Environmental factors Relationship factors
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- Nonverbal Communication Tone of voice Emphasis on certain words
Physical appearance Facial expressions Body posture Amount of eye
contact Hand gestures
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- Verbal Communication All words a person speaks Communicates
Beliefs and values Perceptions and meaning Can convey Interest and
understanding Insult and judgment Double or mixed messages
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- Therapeutic Communication Techniques Tools for enhancing
communication Using silence Active listening Listening with
empathy
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- Clarifying Techniques Paraphrasing Restating Reflecting
Exploring
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- Asking Questions and Eliciting Patient Responses Open-ended
questions Closed-ended questions
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- Nontherapeutic Communication Techniques Excessive questioning
Giving approval or disapproval Giving advice Asking why
questions
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- Cultural Considerations Communication style Eye contact Touch
Cultural filters form of bias or prejudice
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- Preparing for the Interview Pace Setting Seating Introductions
Initiating the interview
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- Attending Behaviors Foundation of the interview Eye contact
Body language Vocal quality Verbal tracking
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- Process Recording Written record of a segment of the
nurse-patient session that reflects as closely as possible the
verbal and nonverbal behaviors of both patient and nurse Useful
tool for identifying communication patterns