communication and the therapeutic relationship chapter 10 nursing 411 mental health nursing
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Communication and the Therapeutic Relationship
Chapter 10
Nursing 411Mental Health Nursing
Self-awareness
Process of understanding one’s own beliefs, thoughts, motivations, biases, and physical and emotional limitations, and recognizing how they affect others with whom we interact.
Self-awarenessText Box 10.1
BiologicGender, age, body weight, height, and other observed physical characteristicsGenetic makeup, chronic illness, or physical disability
PsychologicalPsychological makeupTraumatic experiences
SocialSociocultural valuesAcknowledge cultural heritage
Understanding Personal Feelings
Avoid projecting personal bias on patient.
Ask for feedback from people you know and trust.
Behavior change can follow serious introspection if there is a willingness to change.
CommunicationTherapeutic communication.
Ongoing process of interaction in which meaning emerges.
Verbal communication.Spoken word, underlying emotion, context, connotation.
Nonverbal communication.Gestures, expressions, body language.
Empatheic linkages.Direct communication of feelings.
Communication and the Therapeutic Process
Therapeutic Communication: Ongoing process of interaction.
Focuses on the patient and patient-related issues
Signs of slipping into a social relationshipTelling patient about personal social lifeTelling patient about frustrating experiences that relieve stressLetting patient believe that relationship is a friendship
Principles of Therapeutic Communication
Patient focus of interaction.Attitude sets the tone.Use self-disclosure cautiously and for a purpose.Avoid social relationships.Maintain patient confidentiality.Assess level of understanding.Implement intervention from a theoretical basis.
Principles of Therapeutic Communication
Maintain a nonjudgmental interactionGuide patient to reinterpret experiences rationallyTrack verbal interaction with clarifying statements. Avoid changing the subject (unless in the best interest of client).
Techniques of Verbal Communication
(Table 10.2)AcceptanceConfrontationDoubtInterpretationObservation
Open-ended statementsReflectionRestatementSilenceValidation
Listening
On what patient statements, questions saysUses open-ended activeFocusing Avoid changing subjectPositive body language
PassiveSitting quietlyLetting patient talkBoring body language
Closed body and closed attitude.
Open body and open attitude.
Selecting a Technique
Listen to verbal and non-verbal
Decide goal of communicationClarifyProblem-solveSupport
Therapeutic Communication Concepts
Rapport: interpersonal harmony characterized by understanding and respect.Validation: checking out one’s own thoughts or feelings with another.
Empathy: ability to experience, in the present, the situation as another did at some time in the past.
Boundaries: defining limits of persons, objects, or relationships.
BoundariesPhysical: body space zones
Social:Parent-child relationshipsRomantic relationship
Psychological:Nurse-patient relationshipProblems when:
Professional relationship turns into social oneNeeds of nurse are met at expense of patient.
Defense Mechanisms(table 10-4)
Automatic psychological process protecting the individual against anxiety and from awareness of internal or external dangers/stressors.
Defense MechanismsProjectionProjective identificationRationalizationReaction formationRepressionSelf-assertion
Self-observationSplitting Acting outAffiliationAltruismAnticipation
Defense Mechanism (cont.)
Autistic fantasyDevaluationDisplacementDissociationHelp-rejectingHumor
IdealizationAutistic fantasyDenial SublimationSuppressionUndoing
Analyzing Interactions
Process Recordings
Analysissymbolismthemescommunication blocks
Nurse-Patient Relationship(Table 9.4)
Orientation Phasefirst meetingconfidentialitytesting the relationship
Working Phaseidentification of problemsproblem solving
Resolution Phaseproblems resolverelationship ends
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