1. The Nurse Client Relationship & Therapeutic Communication
TYPES OF RELATIONSHIPS
SOCIAL / INTIMATE RELATIONSHIPS
-Client focused -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
SOCIAL / INTIMATE RELATIONSHIPS
Mutual, considers both sets of goals, needs & feelings
FACTORS THAT ENHANCE GROWTH IN OTHERS
Positive Regard Genuineness Empathetic vs. Sympathetic
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.
expressing or feeling or resulting from sympathy or compassion or friendly fellow feelings
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 -Over-helping -Controlling -Narcissism-Excessive love or admiration of oneself. -Over-identification
PHASES OF THE NURSE CLIENT RELATIONSHIP
Phase One Pre-Interaction Phase Phase Two Orientation Phase (Assessment, Diagnosing & Planning) Phase Three: Working Phase (Implementation / Intervention) Phase Four: 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 -Developing trust -Showing caring -Exploring feelings
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 silence 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
Discounted Embarrassed Frightened Frustrated Found Out Guilty Humiliated Hurt Ignored Inadequate Insecure Not Heard Out of Control of Situation Rejected Threatened Tired Vulnerable
Theories Behavioral Theory
Emotions are learned responses Anger and aggression offer Rewards
Theories Cognitive Theory
Event → Thought → Emotion → Behavior
Correlated with physiologic signs, medical conditions, genetics
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
S/S: 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).
Ineffective Coping Risk for Violence Directed at Self or Others
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. Be respectful. 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 Thought stopping Meditation Yoga Biofeedback Breathing exercises Time management Self-hypnosis Proper nutrition Regular exercise Relaxation response -Quiet environment -Passive attitude -Comfort position
Has pts agitation, aggressiveness or anger: Diminished? Resolved?
Group Interventions Functions of a Group:
-Socialization -Support -Task completion -Camaraderie -Information sharing -Normative -Empowerment -Governance 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.
Types of Groups: Task Groups
accomplishing a specific task with a specific outcome
leader has knowledge and shares with others who need it
Supportive/Therapeutic Groups -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
Leader is a member and likely has same issue as other group members
Physical Conditions that influence Group Dynamics
Open space without barriers in seating
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
Membership Open-ended groups
members leave and join at any time
all join at same time and task is met and group comes to end
Curative Factors of Groups
Other members with similar problems discuss their ways of overcoming issues