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    NPI

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    Marti Gregorio
    The document discusses the nurse-patient therapeutic relationship and communication. It covers key aspects like establishing trust, assessing patients, and using various communication techniques. The relationship progresses through phases from orientation to working and termination. Challenges include issues like self-disclosure, cultural competence, and addressing patient needs while maintaining professional boundaries. The overall goal is to help patients through effective communication and by understanding their perspectives.

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    NPI

    Uploaded by

    Marti Gregorio
    612 views39 pages
    The document discusses the nurse-patient therapeutic relationship and communication. It covers key aspects like establishing trust, assessing patients, and using various communication techniques. The relationship progresses through phases from orientation to working and termination. Challenges include issues like self-disclosure, cultural competence, and addressing patient needs while maintaining professional boundaries. The overall goal is to help patients through effective communication and by understanding their perspectives.

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    Nurse Patient Interaction

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    The document discusses the nurse-patient therapeutic relationship and communication. It covers key aspects like establishing trust, assessing patients, and using various communication techniques. The relationship progresses through phases from orientation to working and termination. Challenges include issues like self-disclosure, cultural competence, and addressing patient needs while maintaining professional boundaries. The overall goal is to help patients through effective communication and by understanding their perspectives.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    612 views39 pages

    NPI

    Uploaded by

    Marti Gregorio
    The document discusses the nurse-patient therapeutic relationship and communication. It covers key aspects like establishing trust, assessing patients, and using various communication techniques. The relationship progresses through phases from orientation to working and termination. Challenges include issues like self-disclosure, cultural competence, and addressing patient needs while maintaining professional boundaries. The overall goal is to help patients through effective communication and by understanding their perspectives.

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    You are on page 1of 39

    Therapeutic N-Pt Relationship

    Communication

    Therapeutic N-P Relationship


    Def: a series of goal-directed interactions
    Peplau: nursing as a significant, therapeutic, interpersonal process Characteristics - goals, stages, specific time and place. It is different from a social relationship
    2

    N-Pt Relationship
    Communication skills Respect and a desire to help Trust is based on confidentiality Understanding
    mental mechanisms adaptation styles coping strategies therapeutic intervention skills

    Communication
    In-born nature Happened at anytime, anyplace, Multi-level Verbal & Nonverbal
    Proxemics - environmental, social, and personal space Kinesics - body movement

    Can be learned
    4

    Therapeutic Communication
    Def: It is an interpersonal interaction in which the nurse used the self to focus on the clients emotional issues, establish a therapeutic relationships, identify client issues, discern the most important topic at that time, and guide the client toward identifying his/her own solutions to problems
    6

    Therapeutic Communication Techniques (I)


    Broad opening - start the conversation Offering self - available, concern, interest Active listening - content, emotion Using silence - respect, anxiety Asking questions - what, when, who General leads - go on, Mm... Restating - repeating
    7

    Thera. Commu. Tech (II)


    Making observation - comment on what have been seen Verbalizing the implies - rephrasing, reflecting Clarification - restate, elaborate Focusing - single, important topic Exploring - getting more information Interpreting Consensual validation - mutual agreement
    8

    Thera. Commu. Tech (III)


    Giving information - decision making Presenting reality - but no argument Voicing doubt - uncertainty about pts interpretation/conclusion Placing an event in time or sequence - R among events Encouraging comparison - similarity & difference Summarizing - review the main points
    9

    Nontherapeutic communication techniques


    Advising vs. information giving Agreeing/approval vs. giving recognition Disagreeing vs. information seeking Challenging/arguing vs. information seeking Defending vs empathy Introducing unrelated topic vs. focusing Judging vs. voicing doubt

    10

    Nontherapeutic communication techniques (contd)


    Literal response Probing Reassuring - false promising Rejecting - no more sharing Testing - level of insight/knowledge Close-ended question - yes/no
    11

    Phases of N-Pt Relationship


    Preinteraction phase
    self-awareness, self-exploration

    Introductory or orientation phase


    making a contract, building trust, setting goals

    Working phase
    explore stressors, promoting insight, reality testing, problem-solving, coping, identifying past ineffective behavior

    Termination phase
    goals, evaluation, referrals, separation, loss, emotional responses
    12

    Orientation Stage
    Building trust - honest, consistent, warmth Basic assessment - coping styles, needs, tentative goals, awareness of the problems Management of emotions- fear of losing control, anxiety, guilt, confusion, Providing support - non-judgmental, recognize the healthy actions & feelings Providing structure - limit setting
    13

    Assessment
    Mental status examination - orientation, memory, calculation, attention, judgment Fifth vital signs - Pain Violence - domestic, history of physical/sexual abuse Substance abuse Withdrawal symptoms, differential Dx, dual Dx. Holistic/ interdisciplinary team- realistic goals
    14

    Working Stage
    The process of learning - observation, analysis, interpretation, In-depth data collection, Reality testing & cognitive restructuring Supportive confrontation Promoting change, Teaching new skills social skills, problem solving skills
    15

    Termination Stage
    Evaluation; summarize the objectives achieved Referrals Discussion of termination - emotional responses; acceptance, denial, anger, regression, acting-out...
    16

    Use of Self - Self is the Tool


    Want to help Open to learn about self and others Process recording Respect & privacy Communication - verbal/nonverbal Insight - defense mechanisms, adaptation, and coping
    17

    Process Recording

    The tool with which the nurse assesses pts problems, elicits pts input, selects interventions evaluates the effectiveness of care learns about self
    18

    Process Recording (contd)


    Verbal interaction & nonverbal behaviors Analysis of content, mood, and interaction Share with colleagues Learning tool / professional growth

    19

    Nursing Challenges
    Silence - being quiet, listening, respect, Doing nothing - lack of structure Fear of aggression What to say - saying wrong thing Being there vs. being therapeutic - no one is 100% therapeutic Touch
    20

    More Nursing Challenges


    Self-disclosure - guidelines & cautions Keep self disclosure effective Not to meet your own needs Monitor your comfort level Respect pt privacy/ comfort level Never agree to secrecy Cultural variations
    21

    Clinical Wisdom
    Remain true to nursing role and avoid the seductions of institutionalization
    Nurses must constantly monitor and understand boundary management, transference and countertransference issues

    22

    Empathy
    Putting yourself in the others shoes
    Being there Listening Assumption - as if Interpretation and validation

    23

    Barriers in Expressing Empathy


    Stress Lack of time High acuity, high workload New employee Caring for difficult patients Limited opportunities to spend time with patients
    24

    English as a Second Language


    Diversity trend of the society. Process information in another language & articulate a culturally sensitive patient response. Mentor & support the ESL psychiatric worker in linguistic competence & therapeutic communication techniques.
    25

    Demographics in the U.S.


    1998 - U.S. Bureau of Census White, 72%; Black, 13% Hispanic, 11%; Asian and Pacific Islanders 4%.
    2050: Euro-Americans will be the slight majority and the combination of other cultural groups will make up the remaining 48% of the people in the United States
    26

    Shrink the Earths Population to 100


    57 Asians 21 Europeans 14 North, Central and South Americans 8 Africans 70 would be non-white, 30 white 70 would be non-Christian, 30 Christian
    27

    Cultural Issues
    Ethnocentrism only acknowledging and valuing ones own culture Cultural competent nursing
    Sensitivity Awareness Knowledge Encounter Desire
    28

    Nursing Diagnosis & Nursing Goals


    Nursing Dx. - be specific and point to a desired outcome Goals 1. adaptive behavior vs. dysfunctional one 2. measurable and achievable in time frame 3. Short- term vs. long-term goals
    29

    Behavioral Assessment
    Context, thought, and feeling associated with the behavior, Congruence of the behavior to the context Adapativeness of the behavior

    30

    Planning
    Behavior-oriented problems - suicide, aggression, escape, withdrawal, delusion, compulsive acts, Update with treatment team Patients strength and weakness Continuum of care - education, referral, ...

    31

    Anxiety, Coping & Crisis


    Stressor Anxiety Neurochemical/ physiological reactions
    Adaptive Maladaptive Dysfunctional
    32

    Coping behaviors

    Defense Mechanisms
    Compensation Conversion Denial Displacement Dissociation Identification Intellectualization Projection Rationalization Reaction formation Regression Repression Sublimation Suppression Undoing
    33

    Defense Mechanisms (II)


    Primary gain relief or expression of anxiety through symptoms of disorder.
    Secondary gain attention and support received from others while ill.

    34

    35

    Theory and model


    Theory beliefs about how things happen and work Theory lead to the expansion of knowledge Theories & models:
    Psychoanalytic theory Behavior theory Cognitive-behavior theory Ecologic-developmental model
    36

    Family Adaptation Model


    Dealing with the catastrophic event
    Crisis, chaos, shock Denial Hoping against hope

    Learning to cope
    Anger, gild, resentment recognition grief

    Moving into the advocacy


    Understanding, acceptance, advocacy and action
    37

    Evidence based practice


    Nursing practice based on the scientific method and empirical evidence Def: Care that integrates the best available evidence from research with clinical expertise Barrier
    some clients are disenchanted with the outcomes of professionally approved treatments 38 Pseudoscientific information from internet

    39

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