The document discusses various types of relationships in nursing, including social, intimate, therapeutic, and transference relationships. It emphasizes that the nurse-client relationship must remain strictly professional and focused on the client's needs. The nurse must establish trust and set clear boundaries to avoid relationships becoming social or intimate. The stages of a therapeutic relationship are explored, including engagement, assessment, intervention, and termination. Factors that can threaten appropriate boundaries are also outlined.
Therapeutic and non therapeuitc communication techniquesNursing Path
One of the most important skills of a nurse is developing the ability to establish a therapeutic relationship with clients. For interventions to be successful with clients in a psychiatric facility and in all nursing specialties it is crucial to build a therapeutic relationship.
Therapeutic and non therapeuitc communication techniquesNursing Path
One of the most important skills of a nurse is developing the ability to establish a therapeutic relationship with clients. For interventions to be successful with clients in a psychiatric facility and in all nursing specialties it is crucial to build a therapeutic relationship.
THERAPEUTIC
RELATIONSHIPS &
COMMUNICATION
DIFFERENT TYPES OF
THERAPY
By: Brittani Bromley
NURSE-PATIENT
RELATIONSHIP
Therapeutic relationships are goal oriented.
Ideally, the nurse and patient decide together
what the goal of the relationship will be. Most
often, the goal is promotion of learning and
growth to bring about change in the patient’s
life. In general, the goal of a therapeutic
relationship may be based on a problem-
solving model.
2
ESTABLISHING THERAPEUTIC RELATIONSHIPS
RAPPORT
TRUST
RESPECT
EMPATHY &
GENUINENESS
Trying to connect on topics of interest;
treating patient as a person and not their
diagnosis
Nursing interventions that convey a sense of warmth and
caring to the patient i.e., providing blanket when patient is
cold; being honest; being consistent in adhering to unit
guidelines; listening to preferences, requests, opinions
Spending time with the patient, calling them by name;
giving patients sufficient time; promoting privacy;
listening; always being open and honest; striving to
understand the patient
Stepping into the patient's shoes; understanding
their perspective; remain emotionally separate
from another person in doing so; being open,
honest, and real with the patient
3
PHASES OF NURSE RELATIONSHIP
Pre-interaction Phase
Preparation for first encounter
Obtaining information on client
Reflecting on own perceptions and feelings
Orientation/Introductory Phase
Nurse and client become acquainted.
Rapport is established.
Layout expectations and responsibilities
Formulate nursing diagnoses; interventions and goals
Set action up action plan
Working Phase
Therapeutic work accomplished during this phase Provide
education about disorder
Promote patient’s insight and perception of reality
Problem-solving and promote symptom management
Continuously evaluating progress
*Transference and Countertransference may occur in this
stage*
Termination Phase
Goals have been reached;
Client discharged from hospital;
Goal is to bring therapeutic conclusion to
relationship
4
NURSE-PATIENT
RELATIONSHIP
5
• Transference occurs all the time in our everyday
interactions and is where we may be reminded of
someone in the behavior of others. So specifically
in nursing, it is when a patient will view the nurse
as someone who is similar to an important person
in their life.
• Countertransference in nursing is whenever the
nurse unknowingly transfers their unresolved
thoughts, feelings, and emotions onto a client.
This can be a problem because it can lead to a
nurse potentially pushing a patient into action
before they are ready, harshly condemning or
judging a patient, desiring a relationship outside
of the appropriate boundaries, or even
transferring bad moods onto the patient
NURSING PROCESS – ATI TEXTBOOK
Assessment
• Assess verbal and nonverbal communication
needs
• Identify cultural considerations that can impact
communicati.
THERAPEUTIC COMMUNICATION AND NURSE-PATIENT-RELATIONSHIP.pdfTejal Virola
Therapeutic communication is a technique used by healthcare professionals, particularly in the field of mental health and counseling, to establish a supportive and trusting relationship with clients or patients. Its primary goal is to promote healing, foster understanding, and facilitate positive changes in a person's thoughts, feelings, and behaviors. Effective therapeutic communication is essential for building rapport, encouraging self-expression, and facilitating the healing process.
A therapeutic nurse-patient relationship is a professional relationship established between a nurse and a patient with the aim of promoting the patient's well-being, health, and healing. This relationship is built on trust, respect, communication, empathy, and collaboration to meet the patient's healthcare needs effectively. It's a fundamental aspect of nursing practice, especially in providing holistic and patient-centered care.
this ppt contains therapeutic communication and therapeutic nurse patient relationships which is part of basic B.Sc. and M.Sc. nursing
An absolute guide on the required skills for nursingcalltutors
In this presentation, we are going to tell you about the skills for nursing. And these skills for nursing will help you to grow in your nursing career.
Identify the distinction of DSM 5 vs ICD.
Explain the significant change in the fifth edition .
Discuss and differentiate the purposes of mental illness classification.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
3. Primarily initiated for the purpose of
friendship, socialization, companionship, or
accomplishment of task.
Communication (may be superficial): usually
focuses on sharing ideas, feelings, and
experiences and meets the basic need for
people to interact.
Advise if often given.
Roles may shift.
4. Acceptable in nursing, but must be limited.
If relationship becomes more social than
therapeutic, serious work that moves the
client forward will not be done.
5. Involves two people who are emotionally
committed to each other.
Both parties are concerned about having
their individual needs met and helping each
other to meet needs as well.
May include sexual or emotional intimacy as
well as sharing of mutual goals.
NO PLACE in the nurse-client interaction.
6. Differs from the social or intimate
relationship in many ways because it focuses
on the needs, experiences, feelings, and
ideas of the clients only.
Nurse and client agree about the areas to
communicate to work on and evaluate the
outcomes.
7. Nurse uses communication skills, personal
strengths, and understanding of human
behavior to interact with the client.
Parameters are clear: the focus is the client’s
needs, not the nurse’s.
The nurse must guard against allowing the
therapeutic relationship to slip into a more
social relationship and must constantly focus
on the client’s needs, not on his or her own.
8. The nurse who has self-confidence rooted in
self-awareness is ready to establish
appropriate therapeutic relationships with
clients.
Awareness of his or her strengths at any
particular moment is a good start.
9.
10. Trust builds when the client is confident in
the nurse and when the nurse’s presence
conveys integrity and reliability.
Trust develops when the client believes that
the nurse will be consistent in his or her own
words and actions and can be relied on to do
what he or she says.
Congruence occurs when words and actions
match.
11. Trust erodes when a client sees inconsistency
between what the nurse says and does.
Trust is difficult to establish in the following:
Paranoia
Low self-esteem
Anxiety
12. Caring
Openness
Objectivity
Respect
Interest
Understanding
Consistency
Treating the client
as a human being
Suggesting without
telling
Approachability
Listening
Keeping promises
Honesty
13. When the nurse is comfortable with himself
or herself, aware of his or her strengths and
limitations, and clearly focused, the client
perceives a genuine person showing genuine
interest.
The nurse should be open and honest and
display congruent behavior.
14. Sometimes, responding with truth and
honesty alone does not provide the best
professional response.
The nurse may choose to disclose to the
client a personal experience related to the
client’s current concerns.
Be selective about personal examples.
Maybe from the nurse’s past experience, not a
current problem that is still being resolved, or a
recent, still painful experience.
Day-to-day experiences, not value-laden.
15. The ability to perceive the meanings and
feelings of the client and to communicate
that understanding to the client.
One of the essential skills a nurse must
develop.
Both the client and the nurse give a “gift of
self” when empathy occurs.
16. Understand the difference between empathy
and sympathy (feelings of concern or
compassion one shows for another).
By expressing sympathy, the nurse may
project his or her personal concerns onto the
client, thus inhibiting the client’s expression
of feelings.
17. Avoiding judgments of the person, no matter
what the behavior is.
E.g., The nurse does not become upset or
respond negatively to a client’s outbursts, anger
or acting out.
Does not mean acceptance of inappropriate
behaviors but acceptance of the person as
worthy.
18. The nurse must set boundaries for behavior
in the nurse-client relationship.
By being clear and firm without anger or
judgment, the nurse allows the client to feel
intact while still conveying that certain
behavior is unacceptable.
19. The nurse who appreciates the client as a
unique worthwhile human being can respect
the client regardless of his or her behavior,
background or style.
Measures to convey respect and positive
regard:
Calling client by name
Spending time with client
Listening and responding openly
Considering client’s ideas and preferences when
planning care.
20. The nurse relies on presence, or attending,
which is using nonverbal and verbal
communication techniques to make the
client aware that he is receiving full
attention.
Nonverbal techniques: leaning toward the
client, eye contact, being relaxed, having
the arms rested at the side, and interested
but neutral attitude.
Verbally attending: nurse avoids value
judgment about the client’s behavior.
21.
22. Begins when the nurse and client meet and
ends when the client begins to identify
problems to examine.
Activities:
Establish roles
Establish the purpose of the meeting and the
parameters of the subsequent meeting
Identify client’s problems
Clarify expectations
23. Before the meeting:
Read background materials available on the
client
Become familiar with the medications the client
is taking
Gather necessary paper work
Arrange for a quiet, private and comfortable
setting
Self-assessment
Examine preconceptions about the client and
ensure to put them aside and get to know the
real person.
24. The nurse begins to build trust with the
client.
Share appropriate information about oneself:
name, reason for being in the unit, and level
of schooling
Listen closely to the client’s history,
perceptions and misconceptions.
Be very empathetic and understanding.
It may take several sessions before a client
trust the nurse.
25. Nurse-client Contracts
Agree responsibilities in an informal or verbal
contract
A formal or written contract may be appropriate
at times.
State the following:
Time, place, and length of sessions
When session will terminate
Who will be involved in the treatment plan
Client responsibilities (arrive on time, end on time)
Nurse’s responsibilities (arrive on time, end on time,
evaluate progress with client, document sessions)
26. Confidentiality:
Respecting the client’s right to keep private
information about his or her mental and physical care
and related care.
Allowing only those dealing with client’s care to have
access to the information that the client divulges.
Only under precisely defined conditions can third
parties have access to this information.
Adult clients can decide which family members, if
any, may be involved in treatment and may have
access to clinical information.
The nurse must avoid any promises to keep secret.
27. Tarasoff vs. University of California (1976):
releases professionals from previleged
communication with their clients should the
client make a homicidal threat (duty to
warn).
Document client problems with planned
interventions.
The client needs to know the limits of
confidentiality in the nurse-client
interactions and how the nurse will use and
share this information with professionals
involved in the care.
28. Self-disclosure:
Revealing personal information such as
biographical information and personal ideas,
thoughts, and feelings about oneself to others.
Some purposeful, well-planned, self-disclosure
can improve rapport between the nurse and the
client.
May be use to convey support, educate clients,
and demonstrate that anxiety is normal and that
many people deal with stress and problems in
their lives.
29. Self- disclosure may help the client feel more
comfortable and more willing to share
thoughts and feelings, or help the client gain
insight into the situation.
Consider cultural factors.
Disclosing personal information to the
patient can be harmful and inappropriate, so
it must be planned and considered
thoughtfully in advance.
Spontaneously self-disclosing personal
information can have negative results.
30. Two sub-phases:
Problem identification: client identifies the
issues or concerns causing the problems.
Exploitation: the nurse guide the client to
examine feelings and responses and to develop
better coping skills and a more positive self-image.
Encourages behavior change and develops
independence.
31. The client must believe that the nurse will
not turn away or be upset when the client
reveals experiences, issues and behaviors,
and problems.
The client will sometimes use outrageous
stories or acting-out behaviors to test the
nurse.
The nurse must remember that it is the
client who examines and explores problem
situations and relationships.
32. Specific tasks:
Maintaining the relationship
Gathering the data
Exploring perceptions of reality
Developing positive coping mechanisms
Promoting a positive self-concept
Encourage verbalization of feelings
Facilitating behavior change
Working through resistance
Evaluating progress and redefining goals as
appropriate
Providing opportunities for the client to practice new
behaviors
Promoting independence
33. Transference: the client unconsciously
transfer to the nurse feelings he or she has
for significant others.
Countertransference: the nurse responds to
the client based on personal unconscious
needs and conflicts.
SELF-AWARENESS is important so that the
nurse can identify when transference and
countertransference might occur.
34. Final stage of the in the nurse-client
relationship.
Begins when the problems are resolved, and
it ends when the relationship is ended.
Nurse and client usually have feelings about
ending the relationship.
Clients may feel the termination as an
impending loss.
35. Clients may avoid termination by acting
angry or as if the problem is not resolved.
Acknowledge the client’s angry feelings and
assure that this response is normal to ending
a relationship.
If the client tries to reopen and discuss old
resolved issues, the nurse must avoid feeling
as if the sessions were unsuccessful; instead
he or she should identify the client’s stalling
maneuvers and refocus the client on newly
learned behaviors and skills to handle the
problem.
36. It is appropriate to tell the client that the
nurse enjoyed the time spent with the client
and will remember him or her, but it is
inappropriate for the nurse to agree to see
the client outside the therapeutic
relationship.
37. Secrets; reluctance to talk to others about
the work being done with the client.
Sudden increase in phone calls between the
nurse and client calls outside the clinical
hours.
Nurse making exceptions for client than
normal.
38. Inappropriate gift-giving between client and
the nurse.
Loaning, trading, or selling goods or
possessions.
Nurse disclosure of personal issues or
information.
Inappropriate touching, comforting or
physical contact.
Overdoing, overprotecting, or overidentifying
with the client.
39. Change in the nurse’s body language, dress
or appearance (with no other satisfactory
explanation).
Extended one-on-one sessions or home visits.
Spending off-duty time with the client.
Thinking about the client frequently when
away from work.
Becoming defensive if another person
questions the nurse’s care of the client.
Ignoring agency’s policies.
40. Realize that all staff members, whether male
or female, junior or senior, or from any
discipline are at risk for over-involvement or
loss of boundaries.
Assume that boundary violations will occur.
Supervisors should recognize potential
“problem” clients and regularly raise the
issue of sexual feelings or boundary loss with
staff members.
41. Provide opportunities for staff members to
discuss their dilemmas and effective ways of
dealing with them.
42. Privacy is desirable but not always possible in
therapeutic communication.
Possible venues:
Interview/ conference room
End of the hall
Quiet corner of the day room or lobby
Evaluate whether interacting in the client’s
room is therapeutic.
43. Proxemics: study of distance zones between
people during communication.
Intimate zone (0-18 inches between people):
parents with children, people who mutually
desire personal contact, or people whispering.
Invasion is threatening and produces anxiety.
Personal zone (18-36 inches): family and friends
who are talking.
Social zone (4-12 feet): communication in social,
work, and business settings.
Public zone (12-25 feet): between speaker and
an audience, small groups, and other informal
functions.
44. Consider the culture of the client.
Hispanic, Mediterranean, East Indian, Asian, and
Middle Eastern: comfortable with less that 4-12
feet distance.
When invading the personal zone, the nurse
should ask permission.
Therapeutic communication interaction is
most comfortable when the client and the
nurse are 3-6 feet apart.
If client invades the nurse’s personal space,
the nurse should set limits gradually.
45.
46. Five types:
Functional-professional: touch is used in examination
or procedures.
Social-polite: touch is used in greeting, such as hand-shake
and the “air kisses” some women use to greet
acquaintances, or when a gentle hand guides
someone for the correct direction.
Friendship-warmth: touch involves a hug in greeting,
an arm thrown around the shoulder of a good friend,
or the backslapping some men used to greet friends
or relatives.
Love-intimacy: touch involves tight hugs and kisses
between lovers and close relatives.
Sexual arousal: touch used by lovers.
47. Touching a client can be comforting and
supportive when it is welcomed and
permitted.
Observe for cues that show whether touch is
desired or indicated.
Although touch can be comforting and
therapeutic, it is an invasion of intimate
personal space.
When performing a procedure, prepare the client
verbally before starting the procedure.
48.
49. Active listening: refraining from other
internal mental activities and
concentrating exclusively on what the
client says.
Active observation: watching the
speaker’s nonverbal actions as he or she
communicates.
50. Active listening and observation help the
nurse to:
Recognize the issue that is most important to the
client at this time.
Know what further questions to ask the client.
Use additional therapeutic communication
techniques to guide the client to describe his or
her perceptions fully.
Understanding the client’s perceptions of the
issue instead of jumping to conclusions.
Interpret and respond to the message
objectively.