Ch. 9 Communication and the Therapeutic Relationship

Question 1

Professional Core Belief

Answer 1

Nurses need to communicate assertively and responsibly w/ clients and colleagues to demonstrate caring

Patients request

• -Understanding
• -Action
• -Information
• -Comfort

You may need to validate w/ them what they are requesting if it is not clear

Question 2

Responsible Communication

Answer 2

willing to answer for ones own conduct instead of blaming situations or other people

Question 3

Caring Communication

Answer 3

focusing on the relationship w/ the client instead of the procedure you are doing. Having meaningful connections w/ clients. Creating hope and trust

Question 4

Assertive Communication

Answer 4

being clear about your needs and respectful in language and behavior, striving for win-win situations. This is in contrast to passive or aggressive.

Question 5

Assertive Communication: Passive

Answer 5

does not state needs, lets others make decisions and choices, frustrating to others

Question 6

Assertive Communication: Aggressive

Answer 6

wants to win at all costs, defeat others, makes choices for others

Question 7

Assertion

Answer 7

3 criteria for success in assertiveness:
–doing it when there is adequate time, respectfully phrasing your needs, and doing it when the person is receptive to discussion

To improve your assertiveness:

1. Determine what rights you are giving up
2. Identify what irrational belief you have
3. Use DESC
   - -Describe situation
   - -Express what you think and feel
   - -Specify your request
   - -State consequences

Question 8

Therapeutic Use of Self

Answer 8

Application of nurse’s own personality and characteristics w/in the interaction to facilitate hearing

Open-ended process, continues to develop throughout life as we learn new ways to relate to others

Basic concept involves understanding of self and others

Question 9

Nurse-Patient Relationship

Answer 9

Pre-orientation phase
-get report

Orientation phase

• First meeting
• Confidentiality
• Testing the relationship
• Ends when patient begins identifying problems

Working phase

• Identification of problems
• Problem solving

Resolution phase

• Problems resolve
• Relationship ends

Question 10

Therapeutic impasses are usually in what phase?

Answer 10

Working phase

Question 11

Therapeutic Impasses: Transference

Answer 11

Unconscious response of client

Client: inappropriate intensity of feelings: hostility, anger, love, dependence

Nurse: confront distortions of reality gently, facilitate client awareness

Question 12

Therapeutic Impasses: Countertransference

Answer 12

Inappropriate intensity of nurse’s feelings

Nurse must increase self-awareness and access supervision to assist in dealing w/ client more effectively

Question 13

Resistance - Testing Behaviors

Answer 13

Normal response to anxiety-provoking thoughts and feelings - afraid of self-exploration

Client: avoidance, acting out, forgetting, silence, lateness

Nurse: make observations, support client to deal w/ anxiety

Question 14

Self-Awareness

Answer 14

The process of understanding one’s own beliefs, thoughts, motivations, biases, and limitations, and recognizing how they affect others

The development of self-awareness requires a willingness to be introspective

Includes:
Biologic, Psychological, and Social

Question 15

Self-Awareness: Biologic

Answer 15

1. Gender, age, body weight, height, and other physical characteristics
2. Genetic makeup, chronic illness, or physical disability

Question 16

Self-Awareness: Psychological

Answer 16

1. Psychological makeup

2. Traumatic experiences

Question 17

Self-Awareness: Social

Answer 17

1. Sociocultural values

2. Acknowledge cultural heritage

Question 18

Johari’s Window: Quadrant 1

Answer 18

Open quadrant known to self and known to others

Question 19

Johari’s Window: Quadrant 2

Answer 19

Blind quadrant known to others but not known by self

Question 20

Johari’s Window: Quadrant 3

Answer 20

Hidden quadrant private life space personal secrets

Question 21

Johari’s Window: Quadrant 4

Answer 21

Unknown quadrant unconscious self and unknown to others

Question 22

Goals of Self-Awareness

Answer 22

Increase size of quadrant 1

• -Learn more about yourself, reveal more about yourself to others
• -Represents free and spontaneous interaction, easier to relate to others
• -Increased self-concept increases confidence, insight produces growth

As quadrant 1 grows, quadrants 2, 3, and 4 shrink accordingly

Reduce size of quadrant 3
–Freer to be yourself

Tiny quadrant 4

Question 23

Johari Window

Answer 23

The 4 quadrants represent total self

A change in any quadrant affects all other quadrants

The smaller quadrant 1, the poorer the communication

Interpersonal learning means that a change has taken place so quadrant 1 is larger and one or more of the other quadrants is smaller

Question 24

Increasing Self-Awareness and Changing Behavior

Answer 24

Begin by listening to yourself - experience emotions, explore thoughts, feelings, and impulses

Listen and learn from others, be open to feedback

Reveal to others important aspects about self (self-disclosure)

Through self-awareness and conscious effort, the nurse can change learned behaviors to engage effectively in therapeutic relationships

Question 25

Communication

Answer 25

``` Verbal communication (7% of communication) --Spoken word, underlying emotion, context, connotation ``` ``` Nonverbal communication (93% of communication) --Gestures, expressions, body language ``` Therapeutic communication --Ongoing process of interaction in which meaning emerges

Question 26

Transactional Analysis Model - Eric Berne

Answer 26

Parent: attitudes and behaviors taught Adult: logic, rational, realistic Child: feelings from childhood Three types of transactions: 1. Complementary (ex: adult to adult) 2. Crossed (ex: one party speaking as an adult and the other as a parent) 3. Ulterior (ex: appears to be adult to adult but in reality the client is asking for parenting from the nurse, but does not really want it so rejects all ideas suggested)

Question 27

Principles of Therapeutic Communication

Answer 27

1. The patient should be the primary focus 2. A professional attitude sets the tone 3. Use self-disclosure only when disclosure has a therapeutic purpose 4. Avoid social relationships with patients 5. Maintain patient confidentiality 6. Assess the patient’s intellectual competence 7. Implement interventions from a theoretic base 8. Maintain a nonjudgemental attitude 9. Avoid giving advice 10. Guide the patient to reinterpret his or her experiences rationally 11. Track the patient’s verbal interaction through the use of clarifying statements

Question 28

Using Verbal Communication

Answer 28

Self-disclosure Verbal communication techniques - -Science and listening 1. Passive listening 2. Active listening

Question 29

Communication Process

Answer 29

Sender of message --Incongruent verbal and non-verbal Message not transmitted --Not relevant, nor enough info Receiver is perceiver of message --Misinterpretation Feedback is response of receiver --Failure to give feedback Context is the setting --Noise, temperature, or distractions

Question 30

Selecting Communication Techniques

Answer 30

Choosing the best response begins with assessing and interpreting the meaning of patient’s communication - both verbal and nonverbal The next step is identifying the desired patient outcome Focus on the patient’s feelings

Question 31

Applying Communication Concepts: Rapport

Answer 31

interpersonal harmony characterized by understanding and respect

Question 32

Applying Communication Concepts: Validation

Answer 32

explicitly checking out one’s own thoughts or feelings w/ another person

Question 33

Applying Communication Concepts: Empathy

Answer 33

ability to experience, in the present, the situation as another did at some time in the past

Question 34

Applying Communication Concepts: Boundaries

Answer 34

the defining limits of persons, objects, or relationships

Question 35

Biopsychosocial Boundaries and Body Space Zones

Answer 35

Personal boundaries: - Four body zones [from closest to farthest away from person] 1. Intimate zone 2. Personal zone 3. Social Zone 4. Public Zone The patient will allow the nurse to enter the personal zone, but will express discomfort is the nurse breaches the intimate zone For the nurse, the difficulty lies in differentiating the personal zone from the intimate zone for each patient

Question 36

Nonverbal Behaviors

Answer 36

Space Vocal cues -Tone, loudness, rate, laughing Action cues -Body movement, gestures, facial movements, posture Object cues -Dress, furnishings, possessions

Question 37

Professional Boundaries and Ethics

Answer 37

Be aware of professional boundaries to avoid exploitation of the patient When concerns arise related to therapeutic boundaries, the nurse must seek clinical supervision or transfer the care of the patient immediately

Question 38

Potential Boundary Violations

Answer 38

Role: firm limits Time: odd, unusual treatment time Place and space: lunch Money: compensation, free therapy Gift and service: consider the reason; obligation, manipulation, gift to the organization for excellence of care Clothing: revealing vs. professional Language: first/last name, off color jokes Self disclosure: use only for patient benefit Post discharge social: confuse social w/ professional support Physical boundaries: touch, space, sexual

Question 39

Defense Mechanisms

Answer 39

Automatic psychological processes protecting the individual against anxiety (denial, splitting, altruism) Individuals often are unaware Some defense mechanisms are maladaptive Others may be either maladaptive or adaptive The nurse evaluates the purpose of a defense mechanism and then determines whether or not it should be discussed w/ the patient

Question 40

Analyzing Interactions

Answer 40

Process recordings - will do in mental health class Role play Exam questions Analysis: - Symbolism - Content themes - Communication blocks