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Establishing a Therapeutic Rapport with Psychiatric Patients

Jacksonville University, MSN
by

Ashley Carter

on 7 August 2015

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Transcript of Establishing a Therapeutic Rapport with Psychiatric Patients

Therapeutic Communication in
Psychiatric Nursing

By: Ashley Carter
Jacksonville University, MSN

Objectives
References
After the lesson, the learner will know the:
Factors that influence effective therapeutic communication
Phases of the nurse-patient therapeutic relationship
Types of therapeutic and non-therapeutic communication
What is Therapeutic Communication?
Factors that Influence Therapeutic Communication
Developmental stage

Perceptions of self and others

Culture, language, ethnic values

Social class

Education
Setting and presentation

Past relationships

Timing

Choice of words and body language

Other
Therapeutic communication is the primary strategy that psychiatric nurses use to implement all phases of the nurse-patient relationship.

It is a goal-directed conversation with patients aimed at helping them sort through difficult issues.

It can help empower patients to take action in improving their mental health and well-being.
Types of Communication
Verbal communication is the sharing of information between individuals using:

Speech

Writing
Verbal
Nonverbal communication is communication without the use of spoken language. This includes:

Body movement and posture

Facial expression

Touch

Vocal cues- pitch, speed, tone, and volume of voice

Dress and appearance

Eye behavior
Non-Verbal
Pre-interaction
Self exploration

Consider timing of nurse-patient interactions

This is where the nurse gathers data about the patient
Orientation
Introductions

Explain the nurse's role

Explain the purpose, possible goals, and time frame of relationship

Establish goal consensus, trust, and collaboration

Include patient as partner in relationship

Working
Most of the therapeutic work happen during this phase

Implement the plan of care

Evaluate outcomes

Patient may display resistance

Refer patient if needed
Termination
The most important part of the therapeutic relationship

Occurs when goals have been reached or if further referral is needed

Nurse and patient examine meaning of relationship

Feelings are discussed
Phases of the Therapeutic Relationship
Therapeutic Communication Techniques
Attending Behaviors
Essential for effective communication.

Types of attending behaviors include:
Open, relaxed, attentive posture

Facing and leaning slightly toward the patient

Maintaining appropriate eye contact

Respecting interpersonal space of patient~distance at least 18 inches

Removing all unnecessary distractions

Active Listening
An interactive and reflective process in which the nurse actively focuses on what the patient is saying with an open attitude.

The nurses then uses structured responses to fully understand the meaning of the communication.
Active Listening Response Strategies
Open-ended questions
- Questions that can't be answered with a simple yes or no
Ex: "What does a typical day look like for you?"

Minimum encouragers
- Encourages the patient to go into more detail
Ex:"I see" or "Go on"

Restatement
- Repeating the main thought or core of the communication by using the patients own words
Ex: "If I understand you correctly" or "So what you're saying is"

Silence
- Appropriately timed and brief. Usually done after and important idea or feeling is expressed.
Paraphrasing
- Recapping the core content of the patient's message in your own words
Ex: Patient-"I am angry with my doctor, he shouldn't have taken away my privileges." Nurse-"You believe your doctor shouldn't have done this?"

Reflection
- A response that focuses on the feeling, rather than the content, of the communication.
Ex: Patient-"I can't stand how dependent I am on my friends all the time." Nurse-"It sounds like you feel frustrated by your level of dependence right now. Is that what you are feeling?"
Clarification
-Signals the listener's need to understand the speaker's situation more fully; A way to check perceptions
Ex: Patient-"Shaun isn't honest with me. He always promises he'll change, but he never does for more than a couple of weeks." Nurse-"It sounds as if Shaun's failure to follow through is very discouraging to you."

Empathizing
- Verbally acknowledges the patient's emotional state; Nurse is able to relate to the patient's situation
Ex: I can see how difficult this conversation is for you."
References
Nontherapeutic Communication Strategies
Giving false reassurance
- Minimizes the patient's concerns.
Ex: "Everything is going to be alright."

Giving advice
- Direct advise imposes the nurse's own opinions and solutions on the patient and is inappropriate.
Ex: "If I were you" or "You would be better of doing it this way."
Making stereotypical comments
-
Drawing a conclusion about a person based on general knowledge of ethnicity, gender, or social status detracts from considering each person's attributes.

Changing the subject
- This can make the patient feel unimportant and abandoned.
Being judgmental
-Imposing the nurse's values onto the patient implies that the nurse is entitled to make value judgment regarding the patient's feeling or behavior.
Ex: "You shouldn't do that, it's wrong."

Minimizing the patient's feelings
- Denies the importance of the patient's feelings and perceptions.
Ex: "I know just how you feel" or "Everyone gets depressed sometimes."
Disagreeing with the patient
- It can indicate that what the patient said has not been accepted. Only therapeutic if doing a reality check.
Ex: "That's not true" or "You're wrong
"

Tangential or irrelevant comments
-
Can keep the conversation at a superficial level.
Ex: "You have a lot to be grateful for" or "Isn't it a beautiful day?"
Conclusion
Effective therapeutic communication is the core skill when creating the nurse-patient relationship with psychiatric patients

The nurse-client relationship is the foundation on which psychiatric nursing is established.

Therapeutic communication techniques are the “tools” of psychosocial intervention
Hutchinson, K., Kverno, K., Arnold, E., & Arnold, E. (2012).
Psychiatric-mental health nursing: Review and resource manual
(4th ed.). Silver Spring, MD: American Nurses Credentialing Center.

Nursing Planet. (2013). Therapeutic Communication in Psychiatric Nursing. Retrieved from http://nursingplanet.com/pn/therapeutic_communication.html
Therapeutic vs Non-therapeutic Communication
Time to Role Play!
I will act out scenarios and I would like for you to come up with a therapeutic and non-therapeutic way to handle the situation.

Tell me the name of the therapeutic and non-therapeutic communication you used after each statement.
Full transcript