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RelationshipDevelopmentand
TherapeuticCommunication
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Introduction
The nurse-client relationship is the
foundation on which psychiatric
nursing is established. The therapeutic interpersonal
relationship is the process by which
nurses provide care for clients inneed of psychosocial intervention.
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Introduction (cont.)
Therapeutic use of self is the
instrument for delivery of care to
clients in need of psychosocialintervention.
Interpersonal communication
techniques are the tools ofpsychosocial intervention.
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TheTherapeutic Nurse-Client
Relationship
Therapeutic relationships are goal- oriented
and directed at learning and growth
promotion.
How do Social Relationships differ from
Therapeutic Relationships?
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Therapeutic Use of Self
The ability to use ones personality
consciously and in full awareness in an
attempt to establish relatedness and to
structure nursing interventions
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Nurses must possess self-awareness, self-understanding, and a philosophical belief about
life, death, and the overall human condition
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Conditions Essential to Developmentof a Therapeutic Relationship
Rapport Trust
Respect
Genuineness
Empathy
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Phases of a
Therap
eutic Nurs
e-ClientRelationship
Pre-interaction phase
Orientation/Introductory Period
Working
Termination
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Proxemics: Use of Space
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Intimate distance - the closest distance thatindividuals allow between themselves and others
Personal distance - the distance for interactions
that are personal in nature, such as closeconversation with friends
Social distance - the distance for conversation withstrangers or acquaintances
Public distance - the distance for speaking in publicor yelling to someone some distance away
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Nonverbal Communication:
Body Language
Components of nonverbal communication:
Physical appearance and dress
Body movement and posture Touch
Facialexpressions
Eye behavior
Vocal cues or paralanguage
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Therapeutic Communication Techniques
Using silence - allows client to take controlof the discussion, ifhe or she so desires
Accepting - conveys positive regard
Giving recognition - acknowledging,indicating awareness
Offering self - making oneself available
Giving broad openings - allows client toselect the topic
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Therapeutic Communication Techniques (cont.)
Offering general leads - encourages clientto continue
Placing the event in time or sequence -clarifies the relationship ofevents in time
Making observations - verbalizing what isobserved or perceived
Encouraging description ofperceptions - asking client to verbalizewhat is being perceived
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Therapeutic Communication Techniques (cont.)
Encouraging comparison - asking client tocompare similarities and differences in ideas,
experiences, or interpersonal relationships
Restating - lets client know whether anexpressed statement has or has not been
understood
Reflecting - directs questions or feelingsback to client so that they may be recognized
and accepted
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Therapeutic Communication Techniques (cont.)
Focusing - taking notice of a single idea oreven a single word
Exploring - delving further into a subject,
idea,experience, or relationship Seeking clarification and validation -
striving to explain what is vague and searching
for mutual understanding Presenting reality - clarifying
misconceptions that client may beexpressing
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How To Set Limits on Inappropriate
Behavior?
Accept the person; Reject the behavior
Best approach: Be firm, but accepting
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Mr D, I really enjoy playing monopolywith you, but I dont like it when youswear. I am wondering if you can
express your angry feeling in anothermanner?
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Active Listening
To listen actively is to be attentive to
what client is saying, both verbally and
nonverbally. Several nonverbal behaviors have been
designed to facilitate attentivelistening.
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Active Listening (cont.)
S Sit squarely facing the client
O Observe an open posture
L Lean forward toward the client
E Establisheye contact
R Rel
ax
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Process Recordings
Written reports of verbal interactions
with clients
A means for the nurse to analyze thecontent and pattern of interaction
A learning tool for professional
development
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Nontherapeutic Communication Techniques
Giving reassurance - may discourage clientfrom further expression of feelings if clientbelieves the feelings will only be downplayedor ridiculed
Rejecting - refusing to consider clients ideasor behavior
Approving or disapproving - implies that
the nursehas the right to pass judgment onthe goodness or badness of clientsbehavior
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Nontherapeutic Communication Techniques (cont.)
Agreeing or disagreeing - implies that thenursehas the right to pass judgment onwhether clients ideas or opinions are rightor wrong
Giving advice - implies that the nurse knowswhat is best for client and that client isincapable of any self-direction
Probing - pushing for answers to issues theclient does not wish to discuss causes client tofeel used and valued only for what is sharedwith the nurse
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Nontherapeutic Communication Techniques (cont.)
Defending - to defend what client has criticized
implies that client has no right to express ideas,
opinions, or feelings
Requesting an explanation - asking why impliesthat client must defend his or her behavior or
feelings
Belittling feelings expressed - causes client to
feel insignificant or unimportant Introducing an unrelated topic - causes the
nurse to take over the direction of the discussion
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