Nur 41 thearpeutic communication

  1. Orientation Phase
    • Verbal agreement to solve 1 or more problems
    • Establish trust, honesty, and enthusiasm
    • Confidentiality
    • Therapeutic rapport
  2. Working phase
    • Additional assessment and analyses
    • Completion of nursing interventions and evaluation
  3. Termination phase
    • Should not be abrupt or unexpected
    • Planned from the beginning
  4. What are the 3 elements of a therapeutic relationship?
    • The nurse
    • The client
    • The communication between the nurse and client
  5. Encoder
    (sender) Initiates transaction to engage other person
  6. Decoder
    (reciever) Person to whom the message is aimed
  7. According to peplau's theory what are the 6 roles assumed by the nurse?
    • stranger
    • teacher
    • resource manager
    • counselor
    • surrogate
    • leader
  8. What might make therapeutic communication more difficult?
    • Developmental differences
    • Cultural differences
    • Gender differences
  9. What should you do in the beginning of the interaction?
    • Offer self
    • Provide broad openings
    • Make observations
    • Suggest collaboration
  10. What should you do to continue the interaction?
    • provide silence
    • Accepting messages
    • provide general leads
    • exploring
    • focusing
    • active listening
    • passive listening
  11. What should you do for concluding the interaction?
    • Encourage formulation of a plan of action
    • Summarizing
  12. Definition of therapeutic relationship
    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.
  13. Interdependent characteristics of a therapeutic 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.
  14. Client centered characteristics of a therapeutic relationship
    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.
  15. Health-related goals of a therapeutic relationship
    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.
  16. Definition for the orientation phase
    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.
  17. Definition for the identification phase
    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.
  18. Definition for the exploitation phase
    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.
  19. Definition for the resolution phase
    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.
  20. Why are therapeutic conversations designed?
    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
  21. What does building rapport mean?
    Establishing a trusting environment in which the pt will feel comfortable sharing info about him/herself (begining of shift!)
  22. What technique is being used:

    Will you tell me about yourself and why you came to the hospital today? What are your plans after discharge?What can I do to help you?And other questions that begin with how, what, where, when, in what way..are?
    Open ended questions
  23. What technique is being used:

    (nurse)You seem restless since your doctor was here
    Sharing observations
  24. What technique is being used:

    Client: Why is this happening?
    Nurse: I am not sure i understand. Are you reffering to your wound?
  25. What is a focused question?
    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?
  26. What technique is being used:

    "It will be ok, everything will work out" is what disconfirming response that block communication?
    false reassurance
  27. What technique is being used:

    If i were you i would, i feel that you shoud, are what disconfirming responses?
    giving advice and making a decision for a pt
  28. using empathy
    having an understanding of pt's feeling without taking feelings on to yourself
  29. using general leads
    tells pt you are listening; nodding head...
  32. Clarification
    Asking for definition of meaning.Ex. "I'm unclear about what you meant. Would you explain it to me again?"
  33. What is the difference between fear and anxiety?
    Fear is specific and anxiety is non specific
  34. What is the purpose of the 5 rights of delegation?
    • 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.
  35. What are the 5 rights of Delegation?
    • Right task
    • Right circumstances
    • Right Person
    • Right direction/Communication
    • Right Supervision/Evaluation
  36. Delegation
    Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.
  37. What effect can prolonged stress have on the body?
    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!!
  38. Accountability
    Nurse resumes full responsibilities for their actions at all times.
  39. Who is responsible in the therapeutic relationship?
    In a therapeutic relationship, the nurse is responsible because in the final analysis, the nurse is in control.
  40. What are the phases of a relationship?
    The phases of a relationship: pre-interaction phase, orientation phase, active phase, termination phase.
  41. surrogate
    standing in for someone
  42. Purposeful thinking
    an example would be prioritizing the needs of a client after you have assessed the situation.
  43. Impt hint
    All therapeutic relationships require defined boundaries. That protects both the nurse and the client.
  44. Could a mild level of anxiety be bad?
    A mild level of anxiety is good for people, including the client. Key word being 'mild.'
  45. Why must clients learn techniques to diffuse feelings?
    Severe anxiety can turn to depression if they don't learn techniques to diffuse the feelings.
  46. Why is selfawarenees impt?
    Self awareness is important for any nurse....know how to capitalize on your strengths, and address your weaknesses.
  47. Primary appraisal
    the event itself
  48. Secondary appraisal
    when you perceive a threat and you are deciding how to address the threat.
  49. What does PTSD stand for?
    Post-Traumatic Stress Disorder
  50. impt hint
    You are not responsible for a client's behavior, but you are responsible for setting boundaries.
  51. Denial is a form of what?
    Denial is a form of ego-defense mechanism.
  52. Active listening responses - restatement
    is repeating what the client says.
  53. Active listening response - paraphrasing
    Active listening response - paraphrasing
  54. Active listening response - clarification
    is asking a client to repeat to aid in your understanding
  55. Impt hint
    Hospitals will have language banks to assist in clients who do not speak English, as well as translators
  56. When can u use nonverbal communication?
    You can use non-verbal communication to address clients who can't speak
  57. Expressive aphasia
    understands conversation but cannot express themselves
  58. Which 2 terms describing self are often used interchangeably?
  59. List 3 objective. physiological changes that occur during the alarm phase of GAS
    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
  60. impt hint
    self-efficacy is strongly associated with self-esteem and the nursing diagnosis of powerlessness Boggs p77
  61. What is the difference between body image and physical apperance?
    body image is how we perceive ourself whereas physical the way people respond to us based on how we look
  62. What does evidence-based practice support is necessary to do for the stethoscope used for client care?
  63. What did Peplau do?
    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
  64. What are Peplau's three phases of the nurse/client relationship? (Boggs p.89)
    The 3 phases are:

    • 1. Orientation phase
    • 2. Working phase/implementation phase3. Termination phase
  65. What techniques block communication, which encourage communication?
    • 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
  66. Must read
    Table 10-2 (p188) Negative Listening Responses....
  67. What is purposeful thinking?
    Purposeful thinking is focused thinking...addressing the client issue, about that particular issue (a part of critical thinking)
  68. Know the symptoms of anxiety. How would a nurse identify those different levels?
    • 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
  69. an example of clarification:
    let me see if I understand what you are saying...I may ask you for more information
  70. What is the difference between paraphasing and restatement?
    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
  71. What is silence apart of?
    Silence is a therapeutic communication when the client is very distressed and maybe they just need a human presence near them.
  72. What is the difference between therapeutic and nontherapeutic communication?
    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.
  73. What is cortisol?
    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. ...
  74. What is the difference between self esteem and self concept?
    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.
  75. Name 2 techniques that facilitate communication
    broad open, offering self, suggesting collaboration.
Card Set
Nur 41 thearpeutic communication
Quiz #3 therapeutic communication