1. Communication and the Therapeutic Relationship Chapter 10 Nursing 411 Mental Health Nursing

2. 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.

3. 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

4. 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.

5. 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.

7. 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

8. 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.

9. 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).

10. Techniques of Verbal Communication (Table 10.2) Acceptance Confrontation Doubt Interpretation Observation Open-ended statements Reflection Restatement Silence Validation

11. 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

13. Closed body and closed attitude. Open body and open attitude.

14. Selecting a Technique Listen to verbal and non-verbal Decide goal of communication Clarify Problem-solve Support

15. Therapeutic Communication Concepts Rapport: i nterpersonal harmony characterized by understanding and respect. Validation: checking out one’s own thoughts or feelings with another. Empathy: a bility to experience, in the present, the situation as another did at some time in the past. Boundaries: d efining limits of persons, objects, or relationships.

16. 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.

18. Defense Mechanisms (table 10-4) Automatic psychological process protecting the individual against anxiety and from awareness of internal or external dangers/stressors.

19. Defense Mechanisms Projection Projective identification Rationalization Reaction formation Repression Self-assertion Self-observation Splitting Acting out Affiliation Altruism Anticipation

20. Defense Mechanism (cont.) Autistic fantasy Devaluation Displacement Dissociation Help-rejecting Humor Idealization Autistic fantasy Denial Sublimation Suppression Undoing

21. Analyzing Interactions Process Recordings Analysis symbolism themes communication blocks

22. 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