Create an account
-Exists for and because of needs & goals of the client
-Patients often get bored with talking about themselves and will try to talk about you
1. Direct identification with, understanding of, and vicarious experience of another person's situation, feelings, and motives.
2. The projection of one's own feelings or emotional state onto an object or animal.
Role of nurse and client should be well defined.
Needs of client are separated from those of the nurse.
Blurring of Boundaries:
-Social or intimate context
-Focus on needs of nurse
-Narcissism-Excessive love or admiration of oneself.
PHASES OF THE NURSE CLIENT RELATIONSHIP
Orientation Phase (Assessment, Diagnosing & Planning)
Working Phase (Implementation / Intervention)
Termination Phase (Evaluation)
Therapeutic Communication Between the Nurse & Patient
An exchange of information that facilitates a POSITIVE relationship.
Involving the patient in his or her own care.
Goal of Therapeutic Communication:
-Obtaining or providing information
Ask opened ended questions.
Avoid "why" questions
Use silence, wait for pt to respond.
Encourage pt to share & express of feelings.
Focus on pts feelings.
Support the pts expression of feelings.
Value a pts feelings.
Communication rules to follow
Rule # 1 - Always clarify message.
Rule # 2 - Be aware of non-verbal cues.
Rule # 3 - When we communicate poorly it causes frustration, loss of respect and errors.
APPLICATION of Therapeutic Communication Skills
Tactics to DO:
Validate what you are hearing
Use active listening
Use of touch
APPLICATION of Therapeutic Communication Skills
Tactics to Avoid:
DO NOT - argue, challenge, give false reassurance, coerce client into treatment, or give approval or praise
This becomes tied to pt pleasing the nurse
DO NOT - Give Advice, and no "Why" Questions!!
This implies criticism, can feel intrusive & judgmental, which serves to make the client defensive
Anger & Aggression
Harmful to the body systems if prolonged
Myth -" Getting it all out " is a useful way to diminish anger
TRUTH - Expressions of anger can lead to Increased anger & Negative physiologic changes.
Feelings that Underlie Anger
Out of Control of Situation
Nursing Assessment of Anger & Aggression
Past & Present Hx
background information, culture & childhood environment
-Assess usual coping methods
-Assess meaning of current situation to patient
Identify Anxiety/Irritation before it escalates
increased volume & rate of speech, rigid posture, increased demands, irritability, frowning, reddened face, pacing and/or twisting, jaw clenching, fists, wringing hands, staring with narrowed eyes into the eyes of another (crazy eyes).
GOALS / PLAN
Pt will demonstrate one new constructive method for coping with anger by (date, end-of-shift).
Pt will discuss issues before acting out his anger when he begins to feel angry.
Pt will refrain from injury to self & others.
Understand pts verbal & non-verbal cues.
Understand pts triggers.
Help pt identify thoughts that increase anger.
Be aware of pts past aggressive behavior.
Acknowledge pts distress to reduce their anxiety!
Validate pts anger!
Name the underlying feeling leading to anger.
Be respectful and apologize when appropriate.
Indicate a willingness to search for solutions.
Use clear & concrete communication.
Do not reinforce the behavior.
Understand your own responses to pt behavior
Set Limits on abusive behavior/language
Be prepared for escalation
Rule of thumb:
always use the least restrictive approach FIRST !
Stress Reduction Methods
Group or social supportCreative imagery
Functions of a Group:
Clients can learn from each other
Support that they find often brings about changes in them
We want to strive to empower patients to be involved in their own recovery; be their hope when they have none.
-Therapeutic groups VS Group therapy
Therapeutic groups focus on interaction between group members; leader keeps them on track and facilitates productive group interaction;
Group therapy typically led by psychologists, advanced degree nurses, social workers
Group size 2-15 depending on the topic
7-8 patients is best according to research; too much lose control; too few not enough interaction
Curative Factors of Groups
Other members with similar problems discuss their ways of overcoming issues
Please allow access to your computer’s microphone to use Voice Recording.
Having trouble? Click here for help.
We can’t access your microphone!
Click the icon above to update your browser permissions and try again
Reload the page to try again!Reload
Press Cmd-0 to reset your zoom
Press Ctrl-0 to reset your zoom
It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.
Please upgrade Flash or install Chrome
to use Voice Recording.
For more help, see our troubleshooting page.
Your microphone is muted
For help fixing this issue, see this FAQ.
Star this term
You can study starred terms together