Relationship development and therapeutic communication

Nurse is open, honest, and realgenuinenessAble to see beyond their behavior, understand their point of viewempathyConditions Essential to Development of a Therapeutic Relationshiprapport, trust, respect, genuineness, empathyBefore you meet the patient •Obtain information about the patient from chart, significant others, or other health team members. •Examine one's own feelings, fears, and anxieties about working with a particular patient.Pre-interaction phase•Create an environment for trust and rapport. •Establish contract for intervention - details about expectations and responsibilities. •Gather assessment data. •Identify patient's strengths and limitations.Orientation (introductory) phase•Formulate nursing diagnoses. •Set mutually agreeable goals. •Develop a realistic plan of action. •Explore feelings of both patient and nurse.Orientation phase last steps•Maintain trust and rapport that you have begun •Promote patient's insight and perception of reality. •Use problem-solving model to work toward achievement of established goals. •Overcome resistance behaviors. •Continuously evaluate progress toward goal attainment.Working phaseOccurs when the patient unconsciously displaces (or "transfers") to the nurse feelings formed toward a person from the pastTransference (working phase)Refers to the nurse's behavioral and emotional response to the patientCountertransference (working phase)Therapeutic conclusion of relationship occurs when:•Progress has been made toward attainment of the goals. •A plan of action for more adaptive coping with future stressful situations has been established. •Feelings about termination of the relationship are recognized and explored.Types of boundaries to determine acceptable limits:material, social, personal, professionalProfessional boundary concerns commonly include issues such as...self-disclosure, gift-giving, touch, friendship or romantic associationA transaction between the sender and the receiverinterpersonal communicationIn the ________ model, both participants perceive each other, listen to each other, and simultaneously engage in the process of creating meaning in a relationship.transactional modelThe ___________ in which the transaction takes place influences the outcome of the interactionenvironmentThe innate tendency to own spaceterritorialityThe number of people within a given environmental space, at times prolonged high density situations can be correlated with stress, aggression, and a deterioration of mental and physical health.densityThe means by which various cultures use space to communicatedistanceAspects of environment that communicate messages:territoriality, density, distanceFour kinds of distance in interpersonal interactions (by Hall):intimate distance, personal distance, social distance, public distanceNonverbal communicationphysical appearance, body movement, touch, facial expressions, eye behavior, vocal cuesTherapeutic or non-therapeutic? SilencetherapeuticTherapeutic or non-therapeutic? AcceptingtherapeuticTherapeutic or non-therapeutic? Giving recognitiontherapeuticTherapeutic or non-therapeutic? Offering selftherapeuticTherapeutic or non-therapeutic? Giving broad openingstherapeuticTherapeutic or non-therapeutic? Offering general leadstherapeuticTherapeutic or non-therapeutic? Placing the event in time or sequencetherapeuticTherapeutic or non-therapeutic? Making observationstherapeuticTherapeutic or non-therapeutic? Encouraging description of perceptionstherapeuticTherapeutic or non-therapeutic? Encouraging comparisontherapeuticTherapeutic or non-therapeutic? RestatingtherapeuticTherapeutic or non-therapeutic? ReflectingtherapeuticTherapeutic or non-therapeutic? FocusingtherapeuticTherapeutic or non-therapeutic? ExploringtherapeuticTherapeutic or non-therapeutic? Seeking clarification and validationtherapeuticTherapeutic or non-therapeutic? Presenting realitytherapeuticTherapeutic or non-therapeutic? Voicing doubttherapeuticTherapeutic or non-therapeutic? Verbalizing the impliedtherapeuticTherapeutic or non-therapeutic? Attempting to translate words into feelingstherapeuticTherapeutic or non-therapeutic? Formulating plan of actiontherapeuticTherapeutic or non-therapeutic? Giving reassurancenon-therapeuticTherapeutic or non-therapeutic? Rejectingnon-therapeuticTherapeutic or non-therapeutic? Approving/disapprovingnon-therapeuticTherapeutic or non-therapeutic? Agreeing/disagreeingnon-therapeuticTherapeutic or non-therapeutic? Giving advicenon-therapeuticTherapeutic or non-therapeutic? Probingnon-therapeuticTherapeutic or non-therapeutic? Defendingnon-therapeuticTherapeutic or non-therapeutic? Requesting an explanationnon-therapeuticTherapeutic or non-therapeutic? Indicating the existence of an external source of powernonTherapeutic or non-therapeutic? Belittling feelings expressednonTherapeutic or non-therapeutic? Making stereotyped comments, cliches, and trite expressionsnonTherapeutic or non-therapeutic? Using denialnonTherapeutic or non-therapeutic? InterpretingnonTherapeutic or non-therapeutic? Introducing an unrelated topicnonActive listening SOLERS - Sit squarely facing the client O - Observe an open posture L - Lean forward toward the client E - Establish eye contact R - RelaxEvidence-based, patient-centered style of communication that promotes behavior change by guiding patients to explore their own motivation for change and the advantages and disadvantages of their decisionsmotivational interviewingWritten reports of verbal interactions with patientsprocess recordingsWritten by the nurse or student as a tool for improving communication techniques.process recordingsIncorporates active listening and therapeutic communication techniques but focuses on what the patient wants to domotivational interviewing

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