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Slide 1 - 1 Therapeutic N-Pt RelationshipCommunication
Slide 2 - 2 Therapeutic N-P Relationship Def: a series of goal-directed interactions Peplau: nursing as a significant, therapeutic, interpersonal process Characteristics - goals, stages, specific time and place. It is different from a social relationship
Slide 3 - 3 N-Pt Relationship Communication skills Respect and a desire to help Trust is based on confidentiality Understanding mental mechanisms adaptation styles coping strategies therapeutic intervention skills
Slide 4 - 4 Communication In-born nature Happened at anytime, anyplace, Multi-level Verbal & Nonverbal Proxemics - environmental, social, and personal space Kinesics - body movement Can be learned
Slide 5 - 5
Slide 6 - 6 Therapeutic Communication Def: It is an interpersonal interaction in which the nurse used the self to focus on the client’s emotional issues, establish a therapeutic relationships, identify client’ issues, discern the most important topic at that time, and guide the client toward identifying his/her own solutions to problems
Slide 7 - 7 Therapeutic Communication Techniques (I) Broad opening - start the conversation Offering self - available, concern, interest Active listening - content, emotion Using silence - respect, anxiety Asking questions - what, when, who… General leads - go on, Mm... Restating - repeating
Slide 8 - 8 Thera. Commu. Tech (II) Making observation - comment on what have been seen Verbalizing the implies - rephrasing, reflecting Clarification - restate, elaborate Focusing - single, important topic Exploring - getting more information Interpreting - Consensual validation - mutual agreement
Slide 9 - 9 Thera. Commu. Tech (III) Giving information - decision making Presenting reality - but no argument Voicing doubt - uncertainty about pt’s interpretation/conclusion Placing an event in time or sequence - R among events Encouraging comparison - similarity & difference Summarizing - review the main points
Slide 10 - 10 Nontherapeutic communication techniques Advising vs. information giving Agreeing/approval vs. giving recognition Disagreeing vs. information seeking Challenging/arguing vs. information seeking Defending vs empathy Introducing unrelated topic vs. focusing Judging vs. voicing doubt
Slide 11 - 11 Nontherapeutic communication techniques (cont’d) Literal response Probing - Reassuring - false promising Rejecting - no more sharing Testing - level of insight/knowledge Close-ended question - yes/no
Slide 12 - 12 Phases of N-Pt Relationship Preinteraction phase self-awareness, self-exploration Introductory or orientation phase making a contract, building trust, setting goals Working phase explore stressors, promoting insight, reality testing, problem-solving, coping, identifying past ineffective behavior Termination phase goals, evaluation, referrals, separation, loss, emotional responses
Slide 13 - 13 Orientation Stage Building trust - honest, consistent, warmth Basic assessment - coping styles, needs, tentative goals, awareness of the problems Management of emotions- fear of losing control, anxiety, guilt, confusion, Providing support - non-judgmental, recognize the healthy actions & feelings Providing structure - limit setting
Slide 14 - 14 Assessment Mental status examination - orientation, memory, calculation, attention, judgment… Fifth vital signs - Pain Violence - domestic, history of physical/sexual abuse Substance abuse Withdrawal symptoms, differential Dx, dual Dx. Holistic/ interdisciplinary team- realistic goals
Slide 15 - 15 Working Stage The process of learning - observation, analysis, interpretation, In-depth data collection, Reality testing & cognitive restructuring Supportive confrontation Promoting change, Teaching new skills – social skills, problem solving skills…
Slide 16 - 16 Termination Stage Evaluation; summarize the objectives achieved Referrals Discussion of termination - emotional responses; acceptance, denial, anger, regression, acting-out...
Slide 17 - 17 Use of Self - Self is the “Tool” Want to help Open to learn about self and others - Process recording Respect & privacy Communication - verbal/nonverbal Insight - defense mechanisms, adaptation, and coping
Slide 18 - 18 Process Recording The tool with which the nurse assesses pt’s problems, elicits pt’s input, selects interventions evaluates the effectiveness of care learns about self
Slide 19 - 19 Process Recording (cont’d) Verbal interaction & nonverbal behaviors Analysis of content, mood, and interaction Share with colleagues Learning tool / professional growth
Slide 20 - 20 Nursing Challenges Silence - being quiet, listening, respect, “Doing nothing” - lack of structure Fear of aggression What to say - saying wrong thing Being there vs. being therapeutic - no one is 100% therapeutic Touch
Slide 21 - 21 More Nursing Challenges Self-disclosure - guidelines & cautions Keep self disclosure effective Not to meet your own needs Monitor your comfort level Respect pt privacy/ comfort level Never agree to secrecy Cultural variations
Slide 22 - 22 Clinical Wisdom Remain true to nursing role and avoid the seductions of institutionalization Nurses must constantly monitor and understand boundary management, transference and countertransference issues
Slide 23 - 23 Empathy Putting yourself in the other’s shoes Being there Listening Assumption - as if Interpretation and validation
Slide 24 - 24 Barriers in Expressing Empathy Stress Lack of time High acuity, high workload New employee Caring for difficult patients Limited opportunities to spend time with patients
Slide 25 - 25 English as a Second Language Diversity trend of the society. Process information in another language & articulate a culturally sensitive patient response. Mentor & support the ESL psychiatric worker in linguistic competence & therapeutic communication techniques.
Slide 26 - 26 Demographics in the U.S. 1998 - U.S. Bureau of Census White, 72%; Black, 13% Hispanic, 11%; Asian and Pacific Islanders 4%. 2050: Euro-Americans will be the slight majority and the combination of other cultural groups will make up the remaining 48% of the people in the United States
Slide 27 - 27 Shrink the Earth’s Population to 100 57 Asians 21 Europeans 14 North, Central and South Americans 8 Africans 70 would be non-white, 30 white 70 would be non-Christian, 30 Christian
Slide 28 - 28 Cultural Issues Ethnocentrism – only acknowledging and valuing one’s own culture Cultural competent nursing Sensitivity Awareness Knowledge Encounter Desire
Slide 29 - 29 Nursing Dx. - be specific and point to a desired outcome Goals - 1. adaptive behavior vs. dysfunctional one 2. measurable and achievable in time frame 3. Short- term vs. long-term goals Nursing Diagnosis & Nursing Goals
Slide 30 - 30 Behavioral Assessment Context, thought, and feeling associated with the behavior, Congruence of the behavior to the context Adapativeness of the behavior
Slide 31 - 31 Planning Behavior-oriented problems - suicide, aggression, escape, withdrawal, delusion, compulsive acts, Update with treatment team Patient’s strength and weakness Continuum of care - education, referral, ...
Slide 32 - 32 Anxiety, Coping & Crisis Stressor Anxiety Neurochemical/ physiological reactions Adaptive Coping behaviors Maladaptive Dysfunctional
Slide 33 - 33 Defense Mechanisms Compensation Conversion Denial Displacement Dissociation Identification Intellectualization Projection Rationalization Reaction formation Regression Repression Sublimation Suppression Undoing
Slide 34 - 34 Defense Mechanisms (II) Primary gain – relief or expression of anxiety through symptoms of disorder. Secondary gain – attention and support received from others while ill.
Slide 35 - 35