Transcript Communication PPT

Nursing 411
Mental Health Nursing
Communication and the
Therapeutic Relationship
Chapter 10
Self-awareness
Process of understanding one’s own
beliefs, thoughts, motivations, biases,
and physical and emotional limitations,
and recognizing how they affect others
with whom we interact.
Self-awareness
Text Box 10.1
Biologic
Gender, age, body weight, height, and other
observed physical characteristics
Genetic makeup, chronic illness, or physical
disability
Psychological
Psychological makeup
Traumatic experiences
Social
Sociocultural values
Acknowledge cultural heritage
Understanding Personal Feelings
Avoid projecting personal bias on patient.
Ask for feedback from people you know and
trust.
Behavior change can follow serious
introspection if there is a willingness to
change.
Communication
Therapeutic communication.
Ongoing process of interaction in which meaning
emerges.
Verbal communication.
Spoken word, underlying emotion, context,
connotation.
Nonverbal communication.
Gestures, expressions, body language.
Empatheic linkages.
Direct communication of feelings.
Communication and the Therapeutic
Process
Therapeutic Communication: Ongoing process of
interaction.
Focuses on the patient and patient-related issues
Signs of slipping into a social relationship
Telling patient about personal social life
Telling patient about frustrating experiences that relieve
stress
Letting patient believe that relationship is a friendship
Principles of Therapeutic
Communication
Patient focus of interaction.
Attitude sets the tone.
Use self-disclosure cautiously and for a
purpose.
Avoid social relationships.
Maintain patient confidentiality.
Assess level of understanding.
Implement intervention from a theoretical
basis.
Principles of Therapeutic
Communication
Maintain a nonjudgmental interaction
Guide patient to reinterpret experiences
rationally
Track verbal interaction with clarifying
statements. Avoid changing the subject
(unless in the best interest of client).
Techniques of Verbal Communication
(Table 10.2)
Acceptance
Confrontation
Doubt
Interpretation
Observation
Open-ended
statements
Reflection
Restatement
Silence
Validation
Listening
On what patient
statements, questions
says
Uses open-ended
active
Focusing
Avoid changing subject
Positive body language
Passive
Sitting quietly
Letting patient talk
Boring body
language
Closed body and
closed attitude.
Open body and
open attitude.
Selecting a Technique
Listen to verbal and non-verbal
Decide goal of communication
Clarify
Problem-solve
Support
Therapeutic Communication
Concepts
Rapport: interpersonal harmony
characterized by understanding and respect.
Validation: checking out one’s own thoughts
or feelings with another.
Empathy: ability to experience, in the
present, the situation as another did at some
time in the past.
Boundaries: defining limits of persons,
objects, or relationships.
Boundaries
Physical:
body space zones
Social:
Parent-child relationships
Romantic relationship
Psychological:
Nurse-patient relationship
Problems when:
Professional relationship turns into social one
Needs of nurse are met at expense of patient.
Defense Mechanisms
(table 10-4)
Automatic psychological process
protecting the individual against anxiety
and from awareness of internal or
external dangers/stressors.
Defense Mechanisms
Projection
Projective
identification
Rationalization
Reaction formation
Repression
Self-assertion
Self-observation
Splitting
Acting out
Affiliation
Altruism
Anticipation
Defense Mechanism (cont.)
Autistic fantasy
Devaluation
Displacement
Dissociation
Help-rejecting
Humor
Idealization
Autistic fantasy
Denial
Sublimation
Suppression
Undoing
Analyzing Interactions
Process Recordings
Analysis
symbolism
themes
communication blocks
Nurse-Patient Relationship
(Table 9.4)
Orientation Phase
first meeting
confidentiality
testing the relationship
Working Phase
identification of problems
problem solving
Resolution Phase
problems resolve
relationship ends