Therapeutic Relationship andCommunicationAlaa Mahsoon, PhD, MSN, BSNEmail:[email protected]om of SaudiArabiary of Educationbdulaziz Universityy of Nursing Show
Student LearningObjectivesAt the end of this lecture, the student is will be able to:–Define the nurse–patient relationship–Explain how the nurse can establish a therapeutic relationship.–Determine the importance & the goals of the nurse-patient relationship.–Discuss differences between social and professional relationship.–List the phases & the basic elements of the therapeutic relationship.–Describe what characterizes a nontherapeutic or deteriorating nurse–patient relation–Identify the importance of self-awareness in nursing practice.–Develop a collection of therapeutic verbal and nonverbal communication skills.–Develop a process for selecting effective communication techniques. Definition of the Nurse-PatientRelationshipIt is a relation that involves two peopleaprofessionalone(the nurse) who has the ability to help and relievepatient’s discomfortAndthe other person(the patient) who is seeking relief of some existingcondition. 1.The nurse-patient relationship helps the nurse to assessthe client’sneeds and meeting these needs.2.It could be used to re-educatethe client with mental disorderabout how to interact properly with people.3.It can be used to influencethe client towards participation indifferent forms of treatment.4.It influences the client’s ability to return to thecommunity.Importance of the Nurse-PatientRelationship SocialProfessional1-Always goal directed andpurposeful.1 -Definite goals not usuallyestablished, they developspontaneously.2-Concerned with helping theclients (regardless their sex,religion, race ….etc)2-Interaction is primarily forreason of pleasure orcompanionship.3- Requires the help of personwith scientific knowledgeandspecial skills.3- No person in the position ofresponsibility of helping the other.ifferences between Social and Professional Relationshi SocialProfessional4- The purpose of the relationshipis to meet the client’s needsratherthan the nurse’s needs.- Set up for mutual needsatisfaction for both participants.5- There is an intention of dealingwith patient’s problems.- There is no specific intention.6- The relationship should notentail the nurse’s personal mattersor problems.- It is up to the partners to shareeir personal affairs.7- Time limited.- Unlimited time.ifferences between Social and Professional Relationshi Aim of the Therapeutic RelationshipThe aim of the relationship is to support, to giveencouragement, and to provide understandingandacceptancewhich clients have been unable to find intheworld outside. Open Resources for Nursing (Open RN) Therapeutic communication is a type of professional communication used by nurses with patients and defined as, “The purposeful, interpersonal information-transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to patient understanding and participation.”[1] Therapeutic communication techniques used by nurses have roots going back to Florence Nightingale, who insisted on the importance of building trusting relationships with patients and believed in the therapeutic healing that resulted from nurses’ presence with patients.[2] Since then, several professional nursing associations have highlighted therapeutic communication as one of the most vital elements in nursing. Read an example of a nursing student effectively using therapeutic communication with patients in the following box. An Example of Nursing Student Using Therapeutic Communication Ms. Z. is a nursing student who enjoys interacting with patients. When she goes to patients’ rooms, she greets them and introduces herself and her role in a calm tone. She kindly asks patients about their problems and notices their reactions. She does her best to solve their problems and answer their questions. Patients perceive that she wants to help them. She treats patients professionally by respecting boundaries and listening to them in a nonjudgmental manner. She addresses communication barriers and respects patients’ cultural beliefs. She notices patients’ health literacy and ensures they understand her messages and patient education. As a result, patients trust her and feel as if she cares about them, so they feel comfortable sharing their health care needs with her.[3],[4] Active Listening and Attending BehaviorsListening is obviously an important part of communication. There are three main types of listening: competitive, passive, and active. Competitive listening happens when we are focused on sharing our own point of view instead of listening to someone else. Passive listening occurs when we are not interested in listening to the other person and we assume we understand what the person is communicating correctly without verifying. During , we are communicating verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with the speaker. For example, an active listening technique is to restate what the person said and then verify our understanding is correct. This feedback process is the main difference between passive listening and active listening.[5] TouchTouch is a powerful way to professionally communicate caring and empathy if done respectfully while being aware of the patient’s cultural beliefs. Nurses commonly use professional touch when assessing, expressing concern, or comforting patients. For example, simply holding a patient’s hand during a painful procedure can be very effective in providing comfort. See Figure 2.7[6] for an image of a nurse using touch as a therapeutic technique when caring for a patient. Therapeutic Techniquesare specific methods used to provide patients with support and information while focusing on their concerns. Nurses assist patients to set goals and select strategies for their plan of care based on their needs, values, skills, and abilities. It is important to recognize the autonomy of the patient to make their own decisions, maintain a nonjudgmental attitude, and avoid interrupting. Depending on the developmental stage and educational needs of the patient, appropriate terminology should be used to promote patient understanding and rapport. When using , nurses often ask open-ended statements and questions, repeat information, or use silence to prompt patients to work through problems on their own.[7] Table 2.3a describes a variety of therapeutic communication techniques.[8] Table 2.3a Therapeutic Communication Techniques
In addition to the therapeutic techniques listed in Table 2.3a, nurses and nursing students should genuinely communicate with empathy. Communicating honestly, genuinely, and authentically is powerful. It opens the door to creating true connections with others.[9] Communicating with empathy has also been described as providing “unconditional positive regard.” Research has demonstrated that when health care teams communicate with empathy, there is improved patient healing, reduced symptoms of depression, and decreased medical errors.[10] Nurses and nursing students must be aware of potential barriers to communication. In addition to considering common communication barriers discussed in the previous section, there are several to avoid. These responses often block the patient’s communication of their feelings or ideas. See Table 2.3b for a description of nontherapeutic responses.[11] Table 2.3b Nontherapeutic Responses
Strategies for Effective CommunicationIn addition to using therapeutic communication techniques, avoiding nontherapeutic responses, and overcoming common barriers to communication, there are additional strategies for promoting effective communication when providing patient-centered care. Specific questions to ask patients are as follows:
Listen closely for feedback from patients. Feedback provides an opportunity to improve patient understanding, improve the patient-care experience, and provide high-quality care. Other suggestions for effective communication with hospitalized patients include the following:
Adapting Your CommunicationWhen communicating with patients and family members, take note of your audience and adapt your message based on their characteristics such as age, developmental level, cognitive abilities, and any communication disorders. For patients with language differences, it is vital to provide trained medical interpreters when important information is communicated. Adapting communication according to the patient’s age and developmental level includes the following strategies:
Strategies for Communicating with Patients with Impaired Hearing and Vision Impaired Hearing
Impaired Vision
Patients with communication disorders require additional strategies to ensure effective communication. For example, aphasia is a communication disorder that results from damage to portions of the brain that are responsible for language. usually occurs suddenly, often following a stroke or head injury, and impairs the patient’s expression and understanding of language. is caused by injuries to multiple language-processing areas of the brain, including those known as Wernicke’s and Broca’s areas. These brain areas are particularly important for understanding spoken language, accessing vocabulary, using grammar, and producing words and sentences. Individuals with global aphasia may be unable to say even a few words or may repeat the same words or phrases over and over again. They may have trouble understanding even simple words and sentences.[17] The most common type of aphasia is . People with Broca’s aphasia often understand speech and know what they want to say, but frequently speak in short phrases that are produced with great effort. For example, they may intend to say, “I would like to go to the bathroom,” but instead the words, “Bathroom, Go,” are expressed. They are often aware of their difficulties and can become easily frustrated. See the hyperlink in the box below for evidence-based strategies to enhance communication with a person with impaired speech.[18] Strategies to Improve Communication with Patients with Impaired Speech
Maintaining Patient ConfidentialityWhen communicating with patients, their friends, their family members, and other members of the health care team, it is vital for the nurse to maintain patient confidentiality. The provides standards for ensuring privacy of patient information that are enforceable by law. Nurses must always be aware of where and with whom they share patient information. For example, information related to patient care should not be discussed in public areas, paper charts must be kept in secure areas, computers must be logged off when walked away from, and patient information should only be shared with those directly involved in patient care. For more information about patient confidentiality, see the “Legal Considerations & Ethics” section in the “Scope of Practice” chapter. Which intervention addresses the biologic domain?C) Pain management addresses the biological domain. the others address psychologic domain.
Which behavior of the nurse indicates that the nurse has a therapeutic relationship with the client?Explanation: Expressing empathy to a client is required for the client to make him feel more comfortable to express his feelings to the nurse. This indicates that the nurse has a therapeutic relationship with the client.
Which term is used to describe the number of cases of depression in a population that is occurring out of the entire population?Incidence is a measure of the number of new cases of a characteristic that develop in a population in a specified time period; whereas prevalence is the proportion of a population who have a specific characteristic in a given time period, regardless of when they first developed the characteristic.
Which is the best response by the nurse to the client's statement quizlet?"Do you feel that no one understands your feelings?" The nurse should put into words what the client has implied or said indirectly. This statement made by the nurse is the best response to the client. A client who separated from his or her spouse tells the nurse, "I don't know why I am living.
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