Therapeutic Communication

Therapeutic Communication Therapeutic Relationship ● ● One of the most important skills a nurse can develop Crucial to success of interventions with clients requiring psychiatric care Components of Therapeutic Relationship ● ● ● ● ● Trust ○ Behaviors such as caring interest, understanding, consistency, honesty, promise, keeping, listening (see Box 5.1) ○ Congruence is essential Genuine interest ○ Self-comfort, self-awareness of strengths and limitations, clear focus Empathy ○ Putting oneself in client’s shoes ■ Client and nurse giving “gift of self” ■ Trying to understand what the client is going through ○ Different from sympathy (feelings of concern or compassion; focus shifting to nurse’s feelings) ■ When you feel sorry for someone Acceptance ○ No judgements ○ Set boundaries Positive regard ○ Unconditional non judgemental attitude Self-Awareness ● Know self ○ Values (sense of right and wrong, code of conduct for living) ■ Values clarification ● Choosing ● Prizing ● Acting ○ Beliefs ○ Attitudes Question Is the following statement true or false? A nurse displays empathy by showing feelings of concern and compassion? Answer: False Rationale: Empathy is putting oneself into the client’s shoes. Sympathy is showing feelings of concern and compassion. Therapeutic Use of Self ● Use of aspects of personality, experience, values, feelings, intelligence, needs, coping skills, perceptions to establish relationships beneficial to clients ○ Concept developed by H. Peplau Patterns of Knowing ● ● ● Ways of observing, understanding client interactions Four patterns (Carper, 1978) ○ Empirical (derived from nursing science) ○ Personal (from life experiences) ○ Ethical (from moral nursing knowledge) ○ Aesthetic (from art of nursing) Fifth pattern: unknowing (Munhall, 1993) ○ Nurse admits lack of knowledge of client or understanding of client’s subjective world Types of Relationships ● ● ● Social ○ Purpose of friendship, socialization, companionship, or task accomplishment ○ Superficial communication; shifting roles; outcomes rarely assessed Intimate ○ Emotional commitment of two persons ○ Individual needs met; assistance with helping each other meet needs Therapeutic ○ Focus on needs, experiences, feelings, ideas of client only ○ Use of communication skills, personal strengths, understanding of human behavior by nurse ○ Joint agreement on areas to work on; outcome evaluation Question Is the following statement true or false? A social relationship involves superficial communication for the purposes of friendship or task accomplishment. Answer: True Rationale: A social relationship occurs for friendship, socialization, companionship, or task achievement. It involves superficial communication with shifting roles. Establishing a Therapeutic Relationship ● ● Peplau’s model of three phases ○ Orientation ○ Working ○ Termination (see table 5.3) Overlapping, interlocking of phases Establishing a Therapeutic Relationship: Orientation Phase ● ● ● ● ● ● Meeting nurse, client Establishment of roles Discussion of purposes, parameters of future meetings Clarification of expectations Identification of client’s problems Nurse-client contracts/confidentiality, duty to warn/self-disclosure Establishing a Therapeutic Relationship: Working Phase ● ● ● Problem identification ○ Issues or concerns identified by client ○ Examination of clients feelings and responses Exploitation ○ Examination of feeling and responses ○ Development of better coping skills, more positive self-image, behavior change, independence Possible transference/countertransference Establishing a Therapeutic Relationship: Termination Phase ● ● ● Begins when client’s problems are resolved Ends when relationship is ended Deals with feelings of anger or abandonment that may occur ○ Client may feel termination as impending loss Behaviors Diminishing Therapeutic Relationships ● ● ● Inappropriate boundaries (relationship becomes social or intimate) Feelings of sympathy, encouraging client dependency Non-acceptance of client, avoidance Question During the working phase of a nurse-client relationship, which of the following would occur? A. Expectations are clarified B. Nurse-client contracts are established C. Feelings of loss are addressed D. Client’s feelings are examined Rationale: During the working phase, the client identifies issues or concerns and his or her feelings and responses are examined. Expectations are clarified and contracts are established during the orientation phase. Feelings of loss are addressed during the termination phase. Therapeutic Roles of the Nurse in a Relationship ● ● ● ● Teacher ○ Coping, problem solving, medication regimen, community resources Caregiver ○ Therapeutic relationship, physical care Advocate ○ Ensuring privacy and dignity, informed consent, access to services, safety from abuse and exploitation Parent surrogate Self-Awareness Issues ● ● ● Nurse’s self-awareness: crucial to developing therapeutic relationships Helpful activities: values clarification, journaling, group discussions, reading Development of self-awareness: continual, ongoing process Exam Questions: ● ● Know the phases The importance of being truthful to the patient