Question

Discussion Topics, Mohr

Chapter 11, Therapeutic Relationships and Communication

Discussion Topics	Learning Objective
1. You are learning about therapeutic communication in your mental health nursing course and begin to evaluate your own communication techniques. List two therapeutic communication techniques that you could use more often and how you would incorporate these techniques into your communication patters. List a nontherapeutic communication technique that you use, explain why it is nontherapeutic, and tell how you can change it to a therapeutic technique.	6
2. Your nursing instructor tells you that therapeutic relationships are very important in mental healthcare to help clients solve problems, cope more effectively, and achieve developmental goals. Choose one of the essential elements of a therapeutic relationship and describe how you can develop this element with a mental health client. List one of the obstacles to establishing a therapeutic relationship and describe how you can prevent this obstacle in your own professional relationships.	1, 2
3. You are working as a mental health nurse and you are caring for a patient suffering from anxiety and another suffering from psychoses. What techniques would you use to therapeutically communicate with an individual suffering from anxiety? What techniques would you use to therapeutically communicate with an individual suffering from psychoses?	7
4. You are working on the psychiatric nursing unit and the charge nurse assigns you a client with a depressive disorder. You must implement the phases of the therapeutic relationship. What are the phases of the therapeutic relationship? Describe each phase. What would you do at each phase to develop a relationship with the depressed client?	3
5. Your nursing instructor has just been lecturing in the mental health course about the importance of listening in the therapeutic nurse-client relationship. Describe what active listening means to you. What are the components of active listening? How will you incorporate active listening into your practice as a nurse?

Answer 1

1.Listening and Restating are the two therapeutic communications

Listening is an active process of recieving information.Responses on the part of the nurse such as maintaining eye contact ,nodding,gesturing and other forms of receptive non-verbal communication convey to the patient that he is being listened to and understood.The therapeutic value of it is that it helps in non-verbally communicating to the patient the nurses interest and acceptance.

Restating is repeating the main tgought expressed by the patient .For example,"You say that your mother left you when you were 5 years old".it indicates that the nurse is listening and validates,reinforces or calls attention to something important that has been said.

Non therapeutic communication

False Reassurance-I will try to reassure the patient by stating that"Things will look better tomorrow after a good nights sleep " is an example of non therapeutic technique of giving false reassurance.Giving false assurance indicatates to the client that there is no cause for anxiety ,thereby devaluing the clients feeling.

Approval-Giving approval is another non therapeutic technique which implies that the nurse has the right to pass judgement on whether the clients ideas or behaviour are good or bad.This creates a conditional acceptance of the client.

2 Pre-interaction phase is one of the elements of the therapeutic relationship .This phase begins when the nurse is assignedto initiate a therapeutic relationship and includes all that the nurse thinks,feels or does immediately prior to the first interacion with the patient.The nurses initial task is one of self-exploration.Nurse tasks in the pre-interaction phase is

• Explore own feelings,fantasies and fears.
• Analyze own professional strengths and limitations.
• Gather data about patient whenever possible.
• Plan for first meeting with patient.

Problems Ecountered are Difficulty in self-analysis and self acceptance and anxiety.

Ways to Overcome

• The nurse needs help from her supervisor and peers in self-analysis and facing reality inorder to help patients do likewise.This provides opportunity to explore feelings and fears and develops useful insight into ones professional role.
• it is also helpful to conceptualize in advance what she wish to accomplish during the relationship .The nurse may in consultation with her supervisor identify in writing goals for the initial interaction and decide the methods to be used in achieving goals.
• The nurse also needs to be consciously aware of the reasons for choosing a particular patient.

3The therapeutic technique used in relieving anxiety is Offering Self by saying that I will stay with you and giving broad openings such as Tell me what you would like to talk about.

4 Therapeutic relationship is a cornerstone of psychiatric -mental health nursing,where observation and understanding of behaviour and communicaton are of great importance.it is a mutual learning experience ,and a corrective emotional experience for the patient.

Ohases of Therapeutic Relationship are

Pre -Interaction phase which have been discussed in the above question.

Introductory Phase

• it is during the introductory phase that the nurse and patient meet for the first time.
• One of the nurses primary concern is to find out why the patient sought help.This form the basis of the nursing asessment and helps the nurse to focus on the patients problem and to determine patients level of motivation.

Working Phase

• Most of the therapeutic work is carried out during the working phase.
• The nurse and the patient explore relevant stressors and promote the development of insight in the patient.
• By linking perceptions,thoughts,feelings and actions,the nurse helps the patient to master anxieties,increase independence and coping mechanisms.
• Actual behaviour change is the focus of attention in this phase of the relationship.

Termination Phase

• This is the most difficult ,but most important phase of the therapeutic nurse patient trelationship.The goal of this phase is to bring a therapeutic end to the relationship.