Prepared By :- GHADA ALMUKHAINI Supervised by :- PROF.DR. ELHAM FAYADH King Saud University College of Nursing Graduate program
Prepared By :- GHADA ALMUKHAINISupervised by :- PROF.DR. ELHAM FAYADH
King Saud UniversityCollege of NursingGraduate program
• State the Goals of the Therapeutic Nursing-patient relationship.
• Discuss the elements affecting the nurse’s ability to be therapeutic.
• Discuss the nurse's tasks and possible problems in the four phases of the relationship.
• Examine the level of communication, two modes of the communication process.
• Discuss the therapeutic communication Technique.
• Analyze how the nurse uses the responsive dimensions in a therapeutic communication.
• Analyze how the nurse uses each of the action dimensions in a therapeutic relationship.
• Evaluate therapeutic Impasses.
• Nurse-patient Relationship:--Definition-Goal of Nurse-patient relationship-Characteristics of the relationship.-phases of the relationship.• Elements of the affecting the nurses abilities to be
therapuetic.• Personal Qualities of the nurse.• Facilitative communication.-verbal communication VS non verbal
communication
• Communication process.• Model of the communication process• Therapeutic communication technique.• Responsive Dimensions • Action Dimensions• Therapeutic Impasses.
• Is a mutual learning experience and a corrective emotional experience for the patient.
• It is based on the underlying humanity of nurse and patient.
• It is a mutual respect and acceptance of sociocultural difference.
• Self-realization , self acceptance , and an increased genuine self-respect.
• A Clear sense of personal identity and an improved level of personal integration.
• Ability to form intimate ,interdependent, interpersonal relationships with a capacity to give and receive love.
• Improve functioning and increased ability to satisfy needs and achieve realistic personal goals.
• It is a Vital characteristics of the nurse-patient is sharing of behavior, thoughts, feelings.
• Social relationship :2 people are part of a natural social network.
• Professional relationship: is based on clear role expectations.
• Apply to all clinical setting
• Preinteraction phase• Introductory phase• Orientation phase• Working phases• Termination phase
• Explore own feeling, fantasies, and fears .commonly for students ( self-exploration).
• Analyze own professional strengths and limitations.
• Gather data about patient when possible.
• Plan for first meeting with patient.
• Nurse-Patient are stranger to each other.
• Determine why patient sought help.
• Formulating a contract: Establish trust, acceptance, open communication.
• It involve a mutual agreement on specific goal.
• Explore feelings: discomfort & nervousness.
• Patient & nurse explore stressors.
• Promote development of insight in the patient.
• These insight should translated into action and a change in behavior.
• Patient often display resistance, it involves the greater part of the problem-solving process.
• Important phase.
• Establish reality of separation.
• Review progress of therapy and attainment of goals.
• Mutuality explores feelings of rejection, loss, sadness, anger.
Elements affecting the nurse’s ability to be Therapeutic
1. Self- awareness
2. Clarification of value.
3. Exploration of feelings
4. Role modeling
5. Altruism
6. Ethics& responsibilities
• Self awareness is the key part of the
psychiatric nursing experience, and the nurse’s
goal is to achieve authentic, open and personal
communication.
• The nurse must be able to examine personal
feelings, actions and reactions.
• Values:- formed as a result of life experiences with family, friends, culture, education.
• Nurse’s today challenges is he need to provide care for patients from diverse backgrounds.
• Value clarification process allows individuals to
discover their values by assessing, exploring, and detmeining what those vales are and they influence their own thoughts.
• Nurses should be open, a ware, and in control of their feelings so that they can be used to help patients.
• The feeling that nurses have serve an important purpose as barothers for feedback about themselves and their relationship with others.
• The nurses feelings are valuable clues to the patients.
• Formal helpers have a strong influence on those they help.
• The nurse may object, saying that it is possible to separate one’s personal life from one’s professional life.
• The nurse’s approach to life must convey growing, hopefulness, and adapting.
• Is the concern for the welfare of others.
• Every one seeks a certain amount of personal satisfaction and fullfiment from work.
• It can apply to changing social conditions to meet human welfare needs.
• One goal of the all helping facilitating society.
• Personal believes about people and society can serve as conscious guidelines for action.
• code for Nurses reflects common values
regarding nurse –patient
• Sense of ethics is the need to assume
responsibility for behaviors.
• Is the art of Transferring or Exchanging ideas and information or thoughts.
• It is done Verbally or non Verbally.
• Occur through words, spoken or written.
• Verbal communication can convey factual information accurately and efficiently .
• It is less effective .• 7% of meaning is transmitted by
words.
• It represent a small part of total human communication
• Includes all relayed information that does not involve the spoken or written words.
• 38%by paralinguistic cures .
• 55%transmitted by body Cues.
Types of non verbal Behavior
• Verbal acues: speech pitch.
• Action Cues : body movement.
• Object cures.
• cultural art facts.
• Touch:- personal space and action.
Interpretation of non-verbal communication
Sociocultural background
is a major influence on the meaning of nonverbal behavior.
Therapeutic Dialogue
Patient
• (Shifting nervously in his chair, eye scanning the room and avoiding the nurse)What…. What do you want to talk about?
I Sense that you are uncomfortable talking to me . Could u describe , how u are feeling.
You are not sure what we should be talking about, and you want me to start us off?
You look very nervous, and I can feel those same feeling in me as I sit here with you
Communication process
• Defined as a sending-receiving process.
Component of the structural model of communication.
• Sender:-the originator of the message.
• The message is the information that is transmitted from the sender to the receiver .
• The Receiver is the perceiver of the message .
• The feedback is the verbal and behavioral response of the receiver to the sender.
• The context is the setting in which the communication takes places.
Example of therapeutic Dialogue in structural model
.total agreement between the verbal and nonverbal communication.
-Verbal level :- I am pleased to see you.
-nonverbal level:- warm tone of voice , continue eye contact , smile.
Transactional Analysis model
• Is the study of the communication or transactions that takes place between people.
• It uncovers the unconscious and destructive way in which people relate to each other.
• It provides the nurse the framework for the nurse to use in exploring the patient recurrent behavior.
Transactional Analysis model
Complementary Transaction Dialogue
-I know that when I get mad at my boss, I take it out on my wife and kids.
• Nurse:-
-Are you ready to think about some other way you can handle your anger?
• Patient:-
Crossed Transaction Dialogue
-I know that when I get mad at my boss, I take it out on my wife and kids.
• Nurse:-
-Men always think that ‘is ok, but the women have to suffer for it.
• patient
Ulterior Transaction• Patient:- I know that when I get mad at my boss, I
take it out on my wife and kids, but know what else to do.
• Nurse:- do you think you could let your boss know how you are feeling?
• patient:-He will fire me sure.• Nurse: perhaps you could talk it over with a co-
worker .• Patient:- I don’t’ have time to chat on the job like
that.• Nurse:-sometimes physical exercise helps people
get rid of their anger. Have you ever tried it?
Therapeutic Communication Techniques
• Two requirement for therapeutic communication:
-All communication must preserve the self-respect of both individual.
-One should communicate understanding before giving any suggestions or advise.
Therapeutic communication Technique
• Listening:
• the first rule of a therapeutic relationship is to listen to the patient.
• It is an active , not passive , process.
• The nurse should stop thinking of own personal experience
Therapeutic Communication Technique
• Broad openings:-• It lets the patient to
select topics to discuss.
- E.g., what are thinking
about?- Can you tell me more
about that ?
Therapeutic Communication Technique
• Restating :--the nurse repeats of the
main thought the patient expressed.
-it indicates that the nurse is listening.
-it brings attention to something important that might was passed over.
Therapeutic Communication Technique
• Clarification :-
-occurs when the nurse attempts to put into words vague ideas or thoughts
Therapeutic communication technique
• Focusing:-- Helps the patient
expand on a topic of importance.
- Help the patient to be specific.
- effectively used.
Therpuetic communication Technique
• Sharing perceptions:- -involves asking the to
verify the nurse’s understanding of what the patient is thinking or feeling.
-paraphrasing-implied feelings of
nonverbal.
Therapeutic Communication technique
• Silences:-
-lack of verbal communication for a therapeutic reason .
-e. g; sitting with the patient and nonverbally communicating interest.
Therapeutic communication technique
• Humor:- • The discharge of energy
through the comic enjoyment of the imperfect.
• It is constructive coping behavior .
Therapeutic Communication technique
• Suggestion:-
-Presentation of alternative ideas for the patient consideration relative to problem solving.
3. Responsive Dimension
• The nurse must possess certain skills or qualities to establish and maintain a therapeutic relationship.
• It helps the patient to achieve insights.
• Includes: Genuineness , Respect, empathetic understanding , concreteness.
Genuineness
• Means the nurse is an open, honest, sincere person who is actively involves in the relationship .
• The nurse shows must be real and not merely professional" Response that has been learned and repeated.
Respect• Unconditional positive regard.• It does not depend on the patient
behavior.
• The patient is regarded as a person of worth and is respected.
• Nonjudgmental.• • Without criticism ,ridicule.
Empathetic understading
• Is the ability to enter into the life of another person .
• Empathy is an essential part of the Therapeutic process.
Concreteness • Involves using specific terminology
rather than abstraction.
• It keeps the nurses response close to the patient feeling’s and experience.
• It fosters accuracy understanding by the nurse.
• It encourage the patient to attend to the specific problem
4. Action Dimension
• The action-oriented conditions for interpersonal relationships .
• upwards and outwards by identifying obstacles to the patient progress and behavior change.
1. Confrontation2. Immediacy3. Nurse self-disclosure4. Emotional Catharsis5. Role playing
confrontation
• Is the expression; by the nurse of perceived discrepancies in the patient behavior.
• Confrontation requires high levels of empathy.
• Important in pointing out when the patient has developed insight but has not changed behavior.
Immediacy
• Involves focusing on the current interaction of the nurse and the patient in the relationship.
• Involves sensitivity of the patient feelings.
Nurse- self Disclosure
• Personal statement about the self , intentionally revealed to another person.
• It is an index of the closeness's of the relationship and involves a particular kind of respect for the patient.
Emotional Catharsis
• Occur when the patient is encouraged to talk about things that are most bothersome.
• It brings fears, feelings• The expression of feeling can
be very therapeutic in itself.
• Involves acting out a particular situation.
• It increases the patient’s insights into human relations.
• Can deepen the ability to see the situation from another person’s point of view.
• Are blocks in the progress of the nurse-patient relationship.
• Impasses provokes intense feeling in both the nurse and the patient.
– 4 specific therapeutic impasses :-
-Resistance, Transference, Counter transference,
Boundary violation.
• Is the patient’s reluctance or avoidance of verbalizing or experiencing troubling aspects of oneself.
• It comes in form of suppression or repression of the pertinent information.
• It might be a superficial talk .
• Is an unconscious response in which patient experience feelings and attitudes towards the nurse that were triggered by facial features, or manner of speech.
• Is a therapeutic impasse created by the nurse’s specific emotional response to the qualities of the patient.
• E.g., Reactions of intense love or caring. or Reaction of intense anxiety.
• It occurs when a nurse goes outside the boundaries of the therapeutic relationships.
• E.g:-1. the patient takes the nurse out to lunch our
dinner.2.the patient gives the nurse an expensive gifts.