Therapeutic N-Pt Relationship Communication

1
Therapeutic N-Pt RelationshipCommunication
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

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

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

5
(No Transcript)
6
Therapeutic Communication

• Def It is an interpersonal interaction in which
  the nurse used the self to focus on the clients
  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

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

8
Thera. Commu. Tech (II)

• Making observation - comment on what have been
  seen
• reflecting
• Clarification - restate
• Focusing - single, important topic
• Exploring - getting more information
• Interpreting -

9
Thera. Commu. Tech (III)

• Giving information - decision making
• Presenting reality - but no argument
• Voicing doubt - uncertainty about pts
  interpretation/conclusion
• Placing an event in time or sequence - R among
  events
• Encouraging comparison - similarity difference
• Summarizing - review the main points

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

11
Nontherapeutic communication techniques (contd)

• Literal response
• Probing -
• Reassuring - false promising
• Rejecting - no more sharing
• Testing - level of insight/knowledge
• Close-ended question - yes/no

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

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

14
Assessment

• Mental status examination - orientation, memory,
  calculation, attention, judgment
• Fifth vital signs - Pain
• Violence , history of physical/sexual abuse
• Substance abuse
• Withdrawal symptoms, differential Dx, dual Dx.
• Holistic/ interdisciplinary team- realistic goals

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

16
Termination Stage

• Evaluation
• summarize the objectives achieved
• Referrals
• Discussion of termination - emotional responses
  acceptance, denial, anger, regression.

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

18
Process Recording

• The tool with which the nurse
• assesses pts problems,
• elicits pts input,
• selects interventions
• evaluates the effectiveness of care
• learns about self

19
Process Recording (contd)

• Verbal interaction nonverbal behaviors
• Analysis of content, mood, and interaction
• Share with colleagues
• Learning tool / professional growth

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

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

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

23
Empathy

• Putting yourself in the others shoes
• Being there
• Listening
• Assumption - as if
• Interpretation and validation

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

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.

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

27
Shrink the Earths 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

28
Cultural Issues

• Ethnocentrism only acknowledging and valuing
  ones own culture
• Cultural competent nursing
• Sensitivity
• Awareness
• Knowledge
• Encounter
• Desire

29
Nursing Diagnosis Nursing Goals

• 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

30
Behavioral Assessment

• Context, thought, and feeling associated with the
  behavior,
• Congruence of the behavior to the context
• Adapativeness of the behavior

31
Planning

• Behavior-oriented problems - suicide, aggression,
  escape, withdrawal, delusion, compulsive acts,
• Update with treatment team
• Patients strength and weakness
• Continuum of care - education, referral, ...

32
Anxiety, Coping Crisis

• Stressor Anxiety
  Neurochemical/
• 
  physiological
• 
  reactions
• Adaptive
• Coping behaviors Maladaptive
• 
  Dysfunctional

33
Defense Mechanisms

• Compensation
• Conversion
• Denial
• Displacement
• Dissociation
• Identification
• Intellectualization
• Projection

• Rationalization
• Reaction formation
• Regression
• Repression
• Sublimation
• Suppression
• Undoing

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.

35
(No Transcript)
36
(No Transcript)
37
Theory and model

• Theory beliefs about how things happen and work
• Theory lead to the expansion of knowledge
• Theories models
• Psychoanalytic theory
• Behavior theory
• Cognitive-behavior theory
• Ecologic-developmental model

38
Family Adaptation Model

• Dealing with the catastrophic event
• Crisis, chaos, shock
• Denial
• Hoping against hope
• Learning to cope
• Anger, gild, resentment
• recognition
• grief
• Moving into the advocacy
• Understanding, acceptance, advocacy and action

39
Evidence based practice

• Nursing practice based on the scientific method
  and empirical evidence
• Def Care that integrates the best available
  evidence from research with clinical expertise
• Barrier
• some clients are disenchanted with the outcomes
  of professionally approved treatments
• Pseudoscientific information from internet

40
(No Transcript)