Intro to Therapeutic Relationships Flashcards
(32 cards)
1
Q
Which 5 components is the TNCR based on?
A
- Trust
- Respect
- Empathy
- Power
- Professional Intimacy
2
Q
Why is TRUST important to the TNCR?
A
- trust is fragile; once broken, it is difficult to reestablish
- keep promises to client
- avoid saying “Ill be back in 1 minute” unless you are 100% sure that you will be back - if you promise that you will be back in 5 with medication and you are not back in 5 - the client is less likely to trust in your word
3
Q
Why is RESPECT important to the TNCR?
A
- recognize the dignity, worth, ad uniqueness or every individual
- you must treat a patient convicted of murder the same way you would an ill patient
4
Q
Why is PROFESSIONAL INTIMACY important to the TNCR?
A
- physical: baths, wound care
- psychological: mental illness, poor, intimate life details
- social: family/friend dynamics
- understanding personal health info
5
Q
Why is EMPATHY important to the TNCR?
A
- important to understand, validate, and resonate with the meaning that the health care experience holds for the client
6
Q
Why is POWER important to the TNCR?
A
- misuse of power = abuse
- appropriate use of power (specialized knowledge and access to info) can help meet the clients needs
7
Q
What is the therapeutic relationship?
A
1) PURPOSEFUL and 2) GOAL-DIRECTED relationships
- aimed at advancing the best interest and outcome of the client
- interpersonal process between the nurse and the client
8
Q
What is the reason we have shifted the term from “patient” to “client”?
A
- Patient emphasizes the power imbalance between the nurse and the client
- Client encompasses a person, group, community
- patient is used in acute care settings (ie.hospitals)
9
Q
What is the goal of the TNCR?
A
- allow the client to have SELF-EXPRESSION to promote health growth
10
Q
A therapeutic relationship is NOT _____________.
A
Psychotherapy
- a TNCR can be applied to other disciplines (pyschotherapy)
11
Q
What is the objective of the nursing process?
A
- to assess, diagnose, plan, and provide and evaluate client-centred care
- to understand the significance of the clients problem
- to help identify and resolve problems
12
Q
How is the TNCR established/maintained?
A
- by the nurse using their knowledge and skills, caring attitudes/behaviours
- by providing services that contribute to the clients health
13
Q
How is the TNCR demonstrated?
A
- having respect and empathy and interest for clients
- maintaining boundaries between professional therapeutic relationships and (non-professional) personal relationships
- collaborating with clients and their families in a way that recognizes their needs, values, and beliefs
- recognizing the potential and preventing client abuse (being aware of the power imbalance)
- stop or report abuse
14
Q
Nurse Considerations in the TNCR
A
- Personal values, beliefs, and experiences
- Self-assessment and awareness
- must be aware of words/body language (ie. clients with a past of abuse can be triggered by “Can I grab your arm to take your BP”) - Mental health status
- Personal qualities
- Components of the TNCR
15
Q
Client Considerations in the TNCR
A
- Personal values, beliefs, and experiences
- Mental and physical health
- Developmental stage
- Psychosocial factors
- Spiritual Factors
16
Q
Considerations in developing the TNCR.
A
- professional, ethical, and legal responsibilities (ie. duty to report that client is expressing harm to self or others)
- social vs. professional therapeutic relationships (they are not our friends)
- Boundaries, safety, and trust development
- effective verbal; and non-verbal communication skills
- barriers (ie. client is stressed or in pain)
17
Q
Who is Hildegard Peplau?
A
- 1st theorist to identify the patient relationship as central to nursing care
- In the 1950’s, pysch/mental health nurse were ‘companions’ to clients and were not to talk about their thoughts, feelings experiences
- Peplau advocated that clients are NOT objects: it not what you are doing TO the client (body), rather what you are doing WITH the client
18
Q
3 Phases of TNCR
A
- Orientation
- Working
a. Identification
b. Exploitation - Resolution
19
Q
What is involved in the Orientation Phase?
A
- Getting to know each other
(can vary from minutes to months) - The parameters of the relationship are established
- Rapport begins todevelop between the client and the nurse
- Nurses begin to obtain essential information about clients as individuals with unique needs, values, beliefs, and priorities
- Trust, respect, honesty, and effective communication are key to developing the relationship
20
Q
What is the difference between identification and exploitation in the WORKING Phase?
A
1) Identification: The client begins to identify problems and define goals
- the client is more dependent
- Ex. A senior client post knee surgery Goals: wants to walk in home on stairs
- Nurse can support/assist with ADL’s
2) Exploitation: Theclient makes use of the services of the nurse to work through identified goals
- The client develops increasing independence and responsibility
- The nurse does not take sole responsibility in solving the client’s problems, RATHER gives the client info and promotes/validates their strengths
- Ex. A senior client post knee surgery
- client is more independent with ADL’s (modify them to be able to do it on their own)
21
Q
What is involved in the RESOLUTION Phase?
A
- The termination of the relationship
- Termination is based on mutual understanding
- Client develops increasing independence
- Client develops new goals as old goals have been met/problems are solved
(E.g. Connect with community resources for additional support) - Client and nurse should share feelings related to the ending of the TR
- Evaluate the relationship
- Allow for processing the termination of the relationship
22
Q
What is the difference between responsive and action dimensions?
A
Responsive - helps establish trust and open communication
Action - examine differences between clients feelings and behaviours
- identify obstacles to clients progress and need for behaviour change
- (ie. client wants to be discharged,
but they are threatening to self-
harm)
23
Q
Responsive dimension includes:
A
- Respect
- providing care free of judgement
- Genuineness
- Transparency; not just saying nice things to the patient to spare them, but to provide the truth regardless
- Concreteness
- Being firm in what you say, avoiding being vague or ambiguity, aligning what you say with what you do
- Empathy
- being open-minded
- understanding and validating
someone’s experience/feelings
24
Q
Action dimension includes:
A
- Confrontation
- Being direct in communication
- Ie. I can sesne that you hace
concerns, would you like to
discuss them?
- Being direct in communication
- Self-Disclosure
- Not exposing info about yourself that can harm the reputation TNCR
- Immediacy
- Dealing with a confrontation IMMEDIATELY, and nor procrastination on dealing with it
- Client says they never get angry, but you see them clenching their fists with an angry facial expression. - Nurse: I am aware that you have said you never get angry, but I notice that you are clenching your fists and I am sensing your anger. Can you tell me more..?
-
- Catharsis
- Providing a safe environment that encourages the client to speak about their feelings and experiences
25
3 Types of Communication
1. Written
2. Verbal
3. Non-Verbal
26
Verbal VS. Non-Verbal Communication
Verbal: oral communication that happens through spoken words, sounds, vocal intonation, and pace
- Vocal intonation - the rise and fall of your voice at the end of sentences to indict your meaning and attitude
- Ex. The raise of your voice at the end of a sentence indicates a question
Non-verbal communication: occurs through facial expressions, eye contact, gestures, and body positions and movements
- Ie. Body language
27
Principles of Communication
- Communication is learned – not innate
- Culture and context influence how you perceive and define communication
- Communication is symbolic, negotiated and dynamic
- Communication varies among people, contexts and cultures
- Nurses have their own terminology and expressions that might not make sense to others
○ "WNL" - within normal limits
○ "PRN" - as needed
28
What is Therapeutic Communication?
- Foundation of the nurse-client relationship
- Intended to develop an effective interpersonal nurse-client relationship that supports the client’s wellbeing, ensures holistic, client-centered, quality care
- TC conveys respect, compassion, and trust
- TC encourages clients to open up about their physical, mental, social, and spiritual well-being
29
What is involved in professional communication?
- Overcome implicit bias, hierarchical social dynamics and misunderstanding related to cultural and language barriers
- Essential for collaborating with healthcare team members
- Prevents errors, ensure positive patient outcomes and adherence to treatment
- Influences public perception of the healthcare system and healthcare professionals
- Develops collaborative partnerships with clients and families that respect their needs, wishes, knowledge, experience, values and beliefs
- Promotes patient autonom
30
Consequences of Poor Communication
- Increased sentinel events
- Sentinel event - a patient safety event that results in death, permanent harm, or severe temporary harm
Ie. When a surgical instrument (scalpel) is left in the patients body after completion of surgery
-1 of the leading causes of adverse events and patient harm
- Client misunderstanding directions = failure to follow treatment protocols
↑ risk of readmission
↑ length of stay
↑ healthcare costs & resource use
↑ patient and caregiver dissatisfaction
- causes work dissatisfaction, lack of autonomy and poor retention among nurses
31
What are the Barriers to communication?
1. Personal (ie. age, education, past experiences, perosnality traits)
2. Environment - distractions that create competition for attention and time b/w senders and receivers
* TV noise, pictures on wall
3. Physical (ie. Closed doors, distance)
4. Organizational (ie. status if power, levels of hierarchy)
5. Cultural - different values, work ethics, norms, and preferences
6. Semantic - use of terminology unfamiliar to the receive
7. Gender
8. Perceptual - how we perceive others or assume what they think
(ie. During shift change, the nurse tells you not to spend too much time with patient A bc they talk too much and call for help a lot. You automictically make assumptions causing you to rush their assessments and not take time to listen to them bc you do not want to end up stuck in their room.)
9. Language - slang, colloquialisms, different generations or from different regions
10. Emotional - emotions and communication are closely related (Ie. If you feel anxious, you might hesitate to speak up)
32
4 Components to Facilitating Communication
1. Maintain a positive attitude towards communication to facilitate openness, understanding, and collaboration
2. It takes knowledge and work to improve your communication skills
3. Prioritize goal-oriented communication
4. Approach communication as a creative process
5. Accept the inevitability of miscommunication
