ppt. therapeutic communication and nurse patient relationship (1)

UNIT 4
THERAPEUTIC
COMMUNICATION AND NURSE-
PATIENT RELATIONSHIP
Textbook of Psychiatric & Mental
Health Nursing
Authors
Bharat Pareek
Sandeep Arya
www.visionbookspublisher.com 1

LEARNING OBJECTIVES
v
Define therapeutic communication.
v
Describe the type, techniques and characteristics of therapeutic
communication.
v
Discuss various types of relationship.
v
Describe the elements of nurse patient relationship.
v
Discuss the technique of interpersonal relationship- Johari
window.
v
Describe the goals, phase, task, therapeutics techniques of nurse
patient relation.
v
Discuss the therapeutic impasse and its intervention.

CHAPTER OUTLINE

COMMUNICATION

COMMUNICATION PROCESS

THE QUALITIES OF A GOOD
COMMUNICATOR
v
RESPECT AND EMPATHY FOR THE CLIENT
v
GOOD COMMUNICATION SKILLS
v
TOLERANCE OF VALUES AND BELIEFS DIFFERENT FROM
ONE’S OWN
v
UNBIASED ATTITUDES
v
PATIENCE
v
AWARENESS OF GENDER ISSUES

THERAPEUTIC TECHNIQUES OF
COMMUNICATION
v
ACTIVE LISTENING
v
BROAD OPENINGS
v
OFFERING SELF
v
ACCEPTING

v
SHARING OBSERVATIONS
v
SHARING HUMOR
v
GIVING RECOGNITION
v
REFLECTING
v
SHARING FEELINGS
you look tired” or “I
haven’t seen you eating
anything today”.

v
SHARING EMPATHY
v
SHARING HOPE
“It must be very
frustrating to know
what you want and
not be able to do it”.
“I believe you will
find a way to face
your situation,
because I have seen
your courage in the
past”.

v
THEME IDENTIFICATION
v
USING TOUCH
v
PROVIDING INFORMATION
"I've noticed that in all of the
relationships you've described you've
been hurt by a man. Do you think this is
an underlying issue?" Promotes client's
exploration and understanding of
client's problems.

v
CONFRONTATION
v
SUGGESTION
v
SELF-DISCLOSURE

NON-THERAPEUTIC COMMUNICATION
TECHNIQUES
v
ASKING PERSONAL QUESTIONS
v
GIVING PERSONAL OPINIONS
v
CHANGING THE SUBJECT
v
AUTOMATIC RESPONSES
v
FALSE REASSURANCE
v
SYMPATHY
v
ASKING FOR EXPLANATIONS
v
APPROVAL OR DISAPPROVAL

v
PASSIVE OR AGGRESSIVE RESPONSES
v
DEFENSIVE RESPONSES
v
ARGUING

JOHARI WINDOW
IT IS A MODEL FOR SELF-AWARENESS,
PERSONAL AND GROUP DEVELOPMENT
AND UNDERSTANDING RELATIONSHIP.
THIS IS A SIMPLE MODEL FOR
IMPROVING COMMUNICATIONS,
INTERPERSONAL RELATIONSHIPS,
GROUP DYNAMICS, TEAM
DEVELOPMENT AND INTERGROUP
RELATIONSHIPS.

NURSE-PATIENT RELATIONSHIP
TYPES
v
Social Relationships: Relationship that is primarily initiated for the purpose of
friendship, socialization, enjoyment, or accomplishment of a task.
v
Intimate Relationships: - An intimate relationship occurs between two or
more individuals who have an emotional commitment to each other. Often the
relationship is a partnership in which each member cares about the other’s
needs for growth and satisfaction.

v
Therapeutic Relationships: - The therapeutic relationship between nurse and
client differs from both a social and an intimate relationship in that the nurse
maximizes his or her communication skills, understanding of human behaviors,
and personal strengths to enhance the client’s growth.

PERSONAL QUALITIES FACILITATIVE
COMMUNICATION
RESPONSIVE
DIMENSION
ACTION DIMENSION THERAPEUTIC
IMPASSES
THERAPEUTIC
OUTCOMES
1. SELF AWARENESS
2.CLARIFICATION
OF VALUES
3.EXPLORATION OF
FEELINGS
4.ROLE MODELING
5.ALTRUISM
6.ETHICS &
RESPONSIBILITIES
1.VERBAL BEHAVIOR
2.NON VERBAL
BEHAVIOR
3.ANALYSIS OF
PROBLEMS
4.THERAPEUTIC
TECHNIQUES

1.GENUINENESS
2.RESPECT
3.EMPATHY
4.CONCRETENESS
1.CONFRONTATION
2.IMMEDIACY
3.SELF DISCLOSURE
4.CATHARSIS
5.ROLE PLAYING
1.RESISTANCE
2.TRANSFERENCE
3.COUNTER-
TRANSFERENCE
4.BOUNDARY
VIOLATIONS
1.FOR PATIENTS
2.FOR SOCIETY
3.FOR NURSE
ELEMENTS AFFECTING NURSE ABILITY TO BE THERAPEUTIC

ELEMENTS AFFECTING NURSE ABILITY TO BE
THERAPEUTIC
•
Personal Qualities of the Nurse
•
Facilitative Communication
•
Responsive Dimensions
•
Action Dimension
•
Therapeutic impasses

THERAPEUTIC IMPASSES

Resistance: A patient who becomes resistant to exploring vulnerable
feelings or experiences to such a degree that he or she is unwilling to
verbalizing troubling aspects of oneself. Resistance is often caused by
the patient's unwillingness to change when the need for change is
recognized.

Transference is a situation where patient redirects his/her feelings from
a significant other or person in their life to the therapist or nurse. Here
client projecting their feelings onto nurse as they would another person
in their life. In most cases, the client experiences unconscious
transference and is unaware that they are doing it. Transference can be
positive or negative

Counter transference: Counter-transference refers to the tendency of
the nurse to displace onto the client feelings related to people in the
therapist’s past. Frequently, the client’s transference to the nurse evokes
counter-transference feelings in the nurse

Boundary violation: It is a condition where nurse cross her/his professional
boundary and fail to behave as per the professional code of conduct. Nurses are
expected to maintain therapeutic relationship with the patients, when they goes
outside of this relation and establish intimate, social, economic relations with the
patients and their families.

PHASES OF THE NURSE-PATIENT RELATIONSHIP
PRE-ORIENTATION PHASE
•
Begins when the nurse is assigned to the patient.
•
The patient is excluded as an active participant.
•
The nurse feels a certain degree of anxiety.
•
It includes all that the nurse thinks and does before interacting with the
patient.
•
Major task of the nurse is self-awareness
•
Other task of the nurse is data gathering and planning for the first
interaction, read chart patient interview other health team involve in
treatment.

ORIENTATION PHASE
The orientation phase can last for a few meetings or can extend over a
longer period. This first phase may be prolonged in the case of severely
and persistently ill mental health clients. The first time the nurse and the
client meet, they are strangers to each other. When strangers meet,
whether or not they know anything about each other, they interact
according to their own backgrounds, standards, values, and experiences.

WORKING PHASE
Moore and Hartman (1988) identified specific tasks of the working phase
of the nurse-client relationship that are relevant in current practice:
v
Maintain the relationship.
v
Gather further data.
v
Promote the client’s problem-solving skills, self-esteem, and use of
language.
v
Facilitate behavioral change.
v
Overcome resistance behaviors.
v
Evaluate problems and goals and redefine them as necessary.
v
Promote practice and expression of alternative adaptive behaviors.

TERMINATION PHASE
It is the gradual weaning process since it is the most difficult and
important phase of the relationship. During this phase, learning is
maximized by the nurse and the patient. It is a mutual agreement and a
time to exchange feelings and memories and also to evaluate the
patient’s progress and goal attainment.

ETHICAL COMPONENTS OF THE NURSE-CLIENT
RELATIONSHIP

CHAPTER SUMMARY
Therapeutic communication is a process in which the nurse consciously influences
a client or helps the client to a better understanding through verbal or nonverbal
communication. Johari window is a model for self-awareness, personal and group
development and understanding relationship. Therapeutic impasses are blocks in
the progress of the nurse-patient relationship. Peplau (1952, 1999) described the
nurse-client relationship as evolving through interlocking, overlapping phases. The
following distinctive phases of the nurse-client relationship are generally
recognized: Orientation phase, Working phase, Termination phase

ppt. therapeutic communication and nurse patient relationship (1)

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