Ch 10 Developing Therapeutic Relationship

Front 1

Social Vs Therapeutic Communication

Back 1

Social Communication is base on giving advice, meeting dependency, content is superficial; focus on significant personal issues
Therapeutic Communication:
focus on the client in identifying and exploring clients needs

Front 2

What occurs in Therapeutic relationship?

Back 2

needs of client are ID and explored,
alternative problem-solving approaches are taken,
new coping skills are developed,
change in behavior is ENC

Front 3

Social Relationship

Back 3

friendship initiated, socialization & enjoyment,accomplishment of task, mutual needs met through social interaction, communication skills include giving advice, lending money, communication content is superficial, in social interaction roles shift, little emphasis on interaction

Front 4

Intimate Relationship

Back 4

emotional commitment; react natural to each other, partnership, each member cares about hte other's need and growth and satisfaction, mutual needs met and intimate desires, fantasies are shared, may or may not evaluate interaction

Front 5

Therapeutic Relationship

Back 5

focus is on the client, rn able to maximize communication skill, understand human behavior and personal strenght to enhance client growth, its about identifying clients nees and exploring it; focus on personal significant issues, rn may have variety of roles (teacher, counselor, socializing agent, laison)

Front 6

3 Types of Relationship

Back 6

Social, Intimate, Therapeutic

Front 7

3 Personal Characteristic that help promote change and growth in the clients

Back 7

genuiness, empathy and positive regard

Front 8

Genuineness

Back 8

self-awareness of feelings that may arise in a relationship and being able to communicate it when its appropriate; key to building trust; convey by actions such as not hiding behind the role of a rn, listening and communicate w/o distorting the message and being clear and concrete in communicating skils; ability to use therapeutic communication in a spontaneous manner-not parroting

Front 9

Empathy

Back 9

is not empathy; its multidimensional concept; it means you understand the ideas expressed and feelings that are present;
being empathic is accurately perceiving the client's situation, perspective and feelings, you are able to communicate your understanding and check in with client for accuracy; can act on this understanding in a helpful way toward the client

Front 10

Sympathy

Back 10

conveys compassion, pity, comisseration; express agreement w/c discourage exploration

Front 11

5 Concepts of Empathy

Back 11

human, professional state, communication process; a caring proces and special relationship

Front 12

Positive Regard

Back 12

Respect; viewing the a person and worthy of caring about and as someone who has strengths and achievement potential

Front 13

Respect (positive regard) can be conveyed by:

Back 13

Attitudes:
willingness to work with the client
Actions:
attending, suspending value judgments, helping client develop own resources

Front 14

Attending

Back 14

basis of interviewing; being with the client or the intesity of presence; reflected by body posture, eye contact, body language

Front 15

Suspending Valued Judgment

Back 15

not imposing your judgment on client; focusing instead on the client's behavior;
work towards identifying the thoughts and feelings that influence this behavior

Front 16

Helping Develop Resources

Back 16

being aware of client's strengths and enc client to work at optimal level; decrease feelings of helplessness and dependency

Front 17

Establishing Boundaries

Back 17

roles and needs of nurse and client are different; so the boundaries are well stated; practice supervision and counterferance to prevent role blurring

Front 18

Role Boundaries Blurring are due to

Back 18

relationship slips into social context and the nurse's needs are met at the expense of the client

Front 19

Nursing action that manifest when role boundaries are blurred:

Back 19

overhelping, controlling and narcissism

Front 20

How does Role boundaries blurring occur:

Back 20

result in unrecognized transference or countertransference

Front 21

Transference

Back 21

clients displaces feelings of their current life, patterns of beh &emotional rxn originated in relation to significant figures in childhood..usually towards authority figure
projecting strong feelings in the client to the nurse

Front 22

Countertransference

Back 22

RN clinician displace feelings to clients r/t people in therapeutic past ct; When nurse feels strongly positive/negative rxn to a clt like when RN overidentification w/ the clt, or gets involve w/ power struggle, competition or argument w/ the ct

Front 23

In therapeutic relationship must understand yourself and others by:

Back 23

self-awareness, value clarification;
Subprocesses of value clarification:
prizing one's belief and behavior; the you choose; then you act on it

Front 24

Therapeutic Encounter

Back 24

short, brief encounter with the client but the relationship is helpful and important to the client

Front 25

Therapeutic relationship ecounter:

Back 25

encounter is longer and more formal; allows the development of nurse-client relationship

Front 26

3 Phases of the nurse-client relationship

Back 26

orientation, working and termination phase

Front 27

Preorientation

Back 27

planning for the firs meeting; work out common concerns such as fear of physicla harm or violence, saying ht wrong thing , using the client as guinea pig, feeling inadequate about new developing communication skills

Front 28

Orientation phase

Back 28

establish rapport; set boundaries/set parameters, informal/formal contract, discuss confidentiality and termination

Front 29

Testing behavior that may occur during orientation phase or later phases:

Back 29

test to see if nurse can set boundaries, show concern if client acts up, if nurse still comes even when client comes late, leaves early, refuses to speack
Other:
shifting focus to the nurse, asking the nurse to do something for them, sexual advances, arriving late

Front 30

Working Phase:

Back 30

maintain the relationship, gather further data, promote teh client's problem-solving skills, self-esteem and use of language, facilitate behavioral change, overcome resistant behaviors, evalate problems and goals and redefine them, promote practice and expression of adaptive behaviors

Front 31

strong transferences and countertransference feelings may appear at what phase

Back 31

working phase

Front 32

Reason for termination phase

Back 32

symptom relieve, improve social functioning, greater sense of identity, development of more adaptive behaviors, accomplishment of the client's goals, impass in the therapy that the nurse is unable to resolve

Front 33

Arises unresolve feeling of abandonment or loneliness, or feelings of not being wanted

Back 33

Termination phase

Front 34

What should the nurse do to appease the client of separation anxiety?

Back 34

work with the client to bring into awareness of feelings and rxn that client may experience related to separation

Front 35

summarizing goals and objectives achieve is what part of the nurse-client relationship

Back 35

termination phase

Front 36

what are teh common response of beginign practitioners in terminating relationship

Back 36

feelings of guilt

Front 37

What hinders nurse-client relationship

Back 37

inconsistency and unavailability, nurse's feeling and awareness (negative ideas/feelings towards the client)

Front 38

What helps the nurse-client relationship

Back 38

consistency, pacing, listening, initial impression, comfort & control and clients factor

Front 39

Behaviors that have relevence to health care workers

Back 39

accountability, focusing on the client, clinical competence, supervision

Front 40

process the helps people understand and build their value systems, addressing some question in the process

Back 40

Value clarification

Front 41

most potent means of value education b/c it present a vivid example of values in action

Back 41

Modeling

Front 42

validation of performance quality through regularly scheduled supervisory session

Back 42

Supervision

Front 43

building client's trust include

Back 43

genuineness, empathy, positive regard, consistency