Nur 41 thearpeutic communication

• Verbal agreement to solve 1 or more problems
• Establish trust, honesty, and enthusiasm
• Confidentiality
• Therapeutic rapport

• Additional assessment and analyses
• Completion of nursing interventions and evaluation

• Should not be abrupt or unexpected
• Planned from the beginning

• The nurse
• The client
• The communication between the nurse and client

(sender) Initiates transaction to engage other person

(reciever) Person to whom the message is aimed

• stranger
• teacher
• resource manager
• counselor
• surrogate
• leader

• Developmental differences
• Cultural differences
• Gender differences

• Offer self
• Provide broad openings
• Make observations
• Suggest collaboration

• provide silence
• Accepting messages
• provide general leads
• exploring
• focusing
• active listening
• passive listening

• Encourage formulation of a plan of action
• Summarizing

A professional, interpersonal alliance in which the nurse and client join together for a defined period to achieve health- related treatment goals.


A purposeful form of conversation designed to help a pt achieve identified health related goals thru participation in a focused relationship.

I and thou relationship in which each is aware of and respects the other in building a shared reality. An equal relationship marked by respect, mutuality, and reciprocity.

Based on the belief that each person has within him or herself the capacity to heal, given support from a helping person who treats the client with the upmost respect and unconditional regard in a caring, authentic relationship. The client’s preferences, values, beliefs, and needs are fundamental in nursing interventions and must be included.

A client health outcome should always be encouraged even though the nurse may think completely different from the client. The best way to go is to have the nurse and the client collaboratively think of an ideal goal that is realistic.

During this phase, the individual has a felt need and seeks professional assistance. The nurse helps the individual to recognize and understand his/ her problem and determine the need for help.

The patient identifies with those who can help him/ her. The nurse permits exploration of feelings to aid the patient in undergoing illness as an experience that reorients feelings and strengthens positive forces in the personality and provides needed satisfaction.

During this phase, the patient attempts to derive full value from what he/ she are offered through the relationship. The nurse can project new goals to be achieved through personal effort and power shifts from the nurse to the patient as the patient delays gratification to achieve the newly formed goals.

The patient gradually puts aside old goals and adopts new goals. This is a process in which the patient frees himself from identification with the nurse.

to help pts learn about illness, how to cope with it, to comfort dying pts, and assure the pt someone is there with them and to ease their suffering

Establishing a trusting environment in which the pt will feel comfortable sharing info about him/herself (begining of shift!)

Open ended questions

Sharing observations

Clarifying

More focused than open ended, but cant be answered with a yes or noTell me more about the pain in your arm.When did you begin to feel helpless?

false reassurance

giving advice and making a decision for a pt

having an understanding of pt's feeling without taking feelings on to yourself

tells pt you are listening; nodding head...

MAKES PT FEEL INFERIOR; CLOSES DOOR FOR COMMUNICATION; "YOU'RE OVERREACTING, IT'S NOT THAT BAD"

CAN IMPLY JUDGEMENT; DO WITH CAUTION!"I THINK YOU SHOULD..."

Asking for definition of meaning.Ex. "I'm unclear about what you meant. Would you explain it to me again?"

Fear is specific and anxiety is non specific

• To provide the roles of licensed and unlicensed health care workers.
• emphasizes and clarifies the responsibility performed by unlicensed health care workers
• Responsibility of licensed nurses to delegate nursing tasks in accord with their legal scopes of practice.
• A decision-making tool which can be used in clinical and administrative settings to guide the process of delegation.
• The accountability of each person involved in the delegation process and potential liability if competent, safe care is not provided.

• Right task
• Right circumstances
• Right Person
• Right direction/Communication
• Right Supervision/Evaluation

Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.

Stress can cause chronic fatigue, digestive upsets, headaches, and back pain

Stress can affect d blood cells that help u fight off infection, so u are more likely to get colds and other diseases

Constant stress can increase blood pressure and can increase the risk for stroke

Constant stress can cause heart disease!!

Nurse resumes full responsibilities for their actions at all times.

In a therapeutic relationship, the nurse is responsible because in the final analysis, the nurse is in control.

The phases of a relationship: pre-interaction phase, orientation phase, active phase, termination phase.

standing in for someone

an example would be prioritizing the needs of a client after you have assessed the situation.

All therapeutic relationships require defined boundaries. That protects both the nurse and the client.

A mild level of anxiety is good for people, including the client. Key word being 'mild.'

Severe anxiety can turn to depression if they don't learn techniques to diffuse the feelings.

Self awareness is important for any nurse....know how to capitalize on your strengths, and address your weaknesses.

the event itself

when you perceive a threat and you are deciding how to address the threat.

Post-Traumatic Stress Disorder

You are not responsible for a client's behavior, but you are responsible for setting boundaries.

Denial is a form of ego-defense mechanism.

is repeating what the client says.

Active listening response - paraphrasing

is asking a client to repeat to aid in your understanding

Hospitals will have language banks to assist in clients who do not speak English, as well as translators

You can use non-verbal communication to address clients who can't speak

understands conversation but cannot express themselves

increased HPA 4 more energy, if failed, body accommodate stressor, failed, @ risk 4 stress-related illness. A&B p394

d alarm stage of GAS hormone levels increases, heart rate increases, pupils dilate 4 greater visual field. P&P p487

during alarm phase rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine

self-efficacy is strongly associated with self-esteem and the nursing diagnosis of powerlessness Boggs p77

body image is how we perceive ourself whereas physical appear..is the way people respond to us based on how we look

Peplau identified 6 proffesional roles that the nurse can assume during the course of the nurse-client relationship

• 1. Stranger
• 2. Resource
• 3. leader
• 4. teacher
• 5. surrogate
• 6. Counselor

and he also described the 3 sequential phases of a nurse client relationship.

• 1. Orientation phase
• 2. Working phase/implementation phase
• 3. Termination phase

The 3 phases are:

• 1. Orientation phase
• 2. Working phase/implementation phase3. Termination phase

• Therapeutic Communication
• 1. Validating
• 2. Broad opening statement
• 3. Reflecting
• 4. sharing Observations
• 5. General leads
• 6. Obtaining observations or making direct questioning
• 7. Verbalizing implied thoughts & feelings
• 8.Clarifying
• 9. Selective reflecting
• 10. Sequencing events

• Non Therapeutic Communication
• 1. Stereotyped comments
• 2. Hostility
• 3. Reassuring cliche
• 4.Probing
• 5.Changing the subject
• 6. Belittling
• 7. Closed question
• 8.Giving advice
• 9. Leading question
• 10. False reassurance
• 11. Disapproving

Table 10-2 (p188) Negative Listening Responses....

Purposeful thinking is focused thinking...addressing the client issue, about that particular issue (a part of critical thinking)

• Look for feelings of persistent and severe worry
• Pay attention to your energy levels as fatigue is a symptom of anxiety. Note your muscle tensions and twitches as anxiety can cause muscle pain and spasms. Be aware of how your stomach feels and how your bowels are functioning. Diarrhea and an upset stomach can both be attributed to anxiety

let me see if I understand what you are saying...I may ask you for more information

paraphrasing is the same as restatement except you are putting it in your own words... In restatement u repeat what the client is saying but in their own words

Silence is a therapeutic communication when the client is very distressed and maybe they just need a human presence near them.

In therapeutic communication you help a client get a health related goal by having good communication skills to help ur client feel comfotable and get a better understanding of their health. A non therapeutic communication you try to get a client a health related goals but with poor communication skills which will not help a client in participating in their own health and not feeling comforted.

A steroid hormone produced by the adrenal cortex that mediates various metabolic processes, has anti-inflammatory and immunosuppressive properties, and whose levels in the blood may become elevated in response to physical or psychological stress.

the body's chief stress fighting hormone produced by the adrenal gland (a glucocorticoid). Cortisol is high during periods of stress, and low when relaxing. A decrease in cortisol is associated with increase in serotonin and dopamine. ...

the difference between self-esteem and self-concept is that self-concept is the image you have of yourself and self esteem is how confident you are.

The key difference between self-concept and self-esteem is that the addition of feelings. Self-concept is simply the informational side of things, where you know facts about what you are like. Self-esteem is how you feel about those things you know, like whether you enjoy the fact that you are talkative at parties (high self-esteem) or you think that you are annoying and need to learn to shut up sometimes (low self-esteem). There are a variety of self-esteem effects that can come from the self-concept.

broad open, offering self, suggesting collaboration.