1. Therapeutic Relationships

2. Concepts of the Nurse-Patient Relationship Basis of all psychiatric nursing treatment approaches To establish that the nurse is Safe Confidential Reliable Consistent Relationship with clear boundaries

3. Goals and Functions Facilitate communication of distressing thoughts and feelings Assist patient with problem solving Help patient examine self-defeating behaviors and test alternatives Promote self-care and independence

4. Social Relationships Initiated for the purpose of friendship or meeting a goal Mutual needs are met Communication to give advice, give or ask for help Content of communication superficial

5. Therapeutic Relationships Needs of patient identified and explored Clear boundaries established Problem-solving approaches taken New coping skills developed Behavioral change encouraged

6. Necessary Behaviors for Nurses Accountability Focus on patient’s needs Clinical competence Delaying judgment Supervision

7. Establishing Boundaries Physical boundaries The contract Personal space

8. Blurring of Boundaries When relationship slips into social context When nurse’s needs are met at expense of patient’s needs

9. Blurring of Roles Transference – patient unconsciously displaces onto individual in current life emotions and behaviors from childhood that originated in relationships with significant others Transference intensified with person in authority in current life

10. Blurring of Roles Continued Countertransference – nurse displaces feelings related to people in nurse’s past onto patient Patient’s transference to nurse often results in countertransference in nurse Common sign of countertransference in nurse is overidentification with the patient

11. Values, Beliefs, and Self-Awareness Nurse’s values and beliefs Not right for everyone Reflect own culture/subculture Derived from range of choices Chosen from a variety of influences and role models

12. Peplau’s Model of Nurse-Patient Relationship Orientation phase Working phase Termination phase

13. Orientation Phase Establishing rapport Parameters of the relationship Formal or informal contract Confidentiality Assessing patient strengths and coping Identification of Nursing Diagnosis and NOC Terms of termination

14. Working Phase Maintain relationship Gather further data Clarify expectations Develop plan of care Promote patient’s problem-solving skills self-esteem

15. Working Phase Continued Facilitate behavioral change Overcome resistant behaviors Evaluate problems and goals Redefine them as necessary Promote practice and expression of alternative adaptive behaviors

16. Termination Phase Summarize goals and objectives achieved Discuss ways for patient to incorporate new coping strategies learned Review situations of relationship Exploring the need for referrals post-discharge Establish plans for long-term post discharge functioning

17. Factors That Help Nurse-Patient Relationship Consistency Pacing Listening Encouraging active patient collaboration Initial impressions

18. Factors That Help Nurse-Patient Relationship Continued Promoting patient comfort and balancing control Patient factors include trust and active participation

19. Factors That Encourage and Promote Patient Growth Genuineness Empathy (not sympathy) Positive Regard attitudes and actions

20. Factors That Encourage and Promote Patient Growth Continued Attending Suspending value judgments Helping patients develop resources

21. A nurse seeks to establish a relationship with a patient readmitted to the hospital. The patient has bipolar disorder, depressed type, and was hospitalized the preceding month. Which statement by the nurse would contribute to establishing trust?

22. Answers a. “Weren’t you complying with your medication regimen?” b. “It must be discouraging to be readmitted to the hospital so soon.” c. “Everyone with bipolar disorder ends up in the hospital occasionally.” d. “You must take your drugs as prescribed or you will be rehospitalized.”

23. Communication and the Clinical Interview

24. The Communication Process Stimulus for information, comfort, or advice Sender – initiates contact Message – sent or expressed Variety of media – hearing, visual, touch, smell Feedback received

25. Factors That Affect Communication Personal factors Environmental factors Relationship factors

26. Nonverbal Communication Tone of voice Emphasis on certain words Physical appearance Facial expressions Body posture Amount of eye contact Hand gestures

27. Verbal Communication All words a person speaks Communicates Beliefs and values Perceptions and meaning Can convey Interest and understanding Insult and judgment Double or mixed messages

28. Therapeutic Communication Techniques Tools for enhancing communication Using silence Active listening Listening with empathy

29. Clarifying Techniques Paraphrasing Restating Reflecting Exploring

30. Asking Questions and Eliciting Patient Responses Open-ended questions Closed-ended questions

31. Nontherapeutic Communication Techniques Excessive questioning Giving approval or disapproval Giving advice Asking “why” questions

32. Cultural Considerations Communication style Eye contact Touch Cultural filters – form of bias or prejudice

33. Preparing for the Interview Pace Setting Seating Introductions Initiating the interview

34. Attending Behaviors Foundation of the interview Eye contact Body language Vocal quality Verbal tracking

35. Process Recording Written record of a segment of the nurse-patient session that reflects as closely as possible the verbal and nonverbal behaviors of both patient and nurse Useful tool for identifying communication patterns