Communication and the Therapeutic Relationship Chapter 10 Nursing 411 Mental Health Nursing.
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Transcript of Communication and the Therapeutic Relationship Chapter 10 Nursing 411 Mental Health Nursing.
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Communication and the Therapeutic Relationship
Chapter 10
Nursing 411Mental Health Nursing
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Self-awareness
Process of understanding one’s own beliefs, thoughts, motivations, biases, and physical and emotional limitations, and recognizing how they affect others with whom we interact.
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Self-awarenessText Box 10.1
BiologicGender, age, body weight, height, and other observed physical characteristicsGenetic makeup, chronic illness, or physical disability
PsychologicalPsychological makeupTraumatic experiences
SocialSociocultural valuesAcknowledge cultural heritage
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Understanding Personal Feelings
Avoid projecting personal bias on patient.
Ask for feedback from people you know and trust.
Behavior change can follow serious introspection if there is a willingness to change.
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CommunicationTherapeutic communication.
Ongoing process of interaction in which meaning emerges.
Verbal communication.Spoken word, underlying emotion, context, connotation.
Nonverbal communication.Gestures, expressions, body language.
Empatheic linkages.Direct communication of feelings.
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Communication and the Therapeutic Process
Therapeutic Communication: Ongoing process of interaction.
Focuses on the patient and patient-related issues
Signs of slipping into a social relationshipTelling patient about personal social lifeTelling patient about frustrating experiences that relieve stressLetting patient believe that relationship is a friendship
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Principles of Therapeutic Communication
Patient focus of interaction.Attitude sets the tone.Use self-disclosure cautiously and for a purpose.Avoid social relationships.Maintain patient confidentiality.Assess level of understanding.Implement intervention from a theoretical basis.
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Principles of Therapeutic Communication
Maintain a nonjudgmental interactionGuide patient to reinterpret experiences rationallyTrack verbal interaction with clarifying statements. Avoid changing the subject (unless in the best interest of client).
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Techniques of Verbal Communication
(Table 10.2)AcceptanceConfrontationDoubtInterpretationObservation
Open-ended statementsReflectionRestatementSilenceValidation
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Listening
On what patient statements, questions saysUses open-ended activeFocusing Avoid changing subjectPositive body language
PassiveSitting quietlyLetting patient talkBoring body language
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Closed body and closed attitude.
Open body and open attitude.
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Selecting a Technique
Listen to verbal and non-verbal
Decide goal of communicationClarifyProblem-solveSupport
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Therapeutic Communication Concepts
Rapport: interpersonal harmony characterized by understanding and respect.Validation: checking out one’s own thoughts or feelings with another.
Empathy: ability to experience, in the present, the situation as another did at some time in the past.
Boundaries: defining limits of persons, objects, or relationships.
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BoundariesPhysical: body space zones
Social:Parent-child relationshipsRomantic relationship
Psychological:Nurse-patient relationshipProblems when:
Professional relationship turns into social oneNeeds of nurse are met at expense of patient.
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Defense Mechanisms(table 10-4)
Automatic psychological process protecting the individual against anxiety and from awareness of internal or external dangers/stressors.
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Defense MechanismsProjectionProjective identificationRationalizationReaction formationRepressionSelf-assertion
Self-observationSplitting Acting outAffiliationAltruismAnticipation
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Defense Mechanism (cont.)
Autistic fantasyDevaluationDisplacementDissociationHelp-rejectingHumor
IdealizationAutistic fantasyDenial SublimationSuppressionUndoing
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Analyzing Interactions
Process Recordings
Analysissymbolismthemescommunication blocks
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Nurse-Patient Relationship(Table 9.4)
Orientation Phasefirst meetingconfidentialitytesting the relationship
Working Phaseidentification of problemsproblem solving
Resolution Phaseproblems resolverelationship ends