Therapeutic nurse pt relationship.docx

therapeutic nurse patient relationship .ppt

1. Mental health nursing PRESENTED BY :- PATEL PRITESH D M.Sc.in Mental Health Nursing ( THERAPEUTIC NURSE- PATIENT RELATIONSHIP )

2. THERAPEUTIC NURSE- PATIENT RELATIONSHIP INTRODUCING THE CHAPTER :- Therapeutic nurse patient relationship : definition ,components and phases, importance , impasses . Communication skills :- definition, elements , type , factor influencing communication , barriers

3. Definition :- Therapeutic nurse patient relationship :- it is an interaction process in which the nurse fulfils her role by using her professional knowledge and skill in such way that she is able to help the patient physically , socially and emotionally .

4. Types of relationship

5. 1. Social relationship 1. it is defined as a relationship that is primarily initiated with the purpose of friendship , socialization , enjoyment or accomplishing task . Exp :- participants share ideas , feelings and experiences . 2.mutual needs are met during social interaction .

6. 2. Intimate relationship It occurs between two individuals who have an emotional commitment to each other . Often the relationship is a partnership where in each member cares about the others need for growth and satisfaction. Those is an intimate relationship usually react naturally with each other.

7. 3.Therapeutic relationship 02. The focus of the relationship is on the patients ideas experiences and feelings . 01.The relationship differs from both a social and intimate relationship in that the nurse maximizes inner communication skills, understanding of human behavior and personal strengths in order to enhance the patients growth

8. Goals of therapeutic nurse-patient relationship Facilitating communication of distressing thought and feeling Helping client examine self – defeating Behavior and test -alternatives Assisting client with problem solving . Promoting self –care and independence .

9. Components of therapeutic nurse – patient relationship EMPATHY RAPPORT WARMTH GENUINENESS ACCEPTANCE UNDERSTANDING

10. 1. Rapport is a relationship or communication , especially when useful and harmonious Rapport is one of the most important features or characteristics of unconscious human interaction . Rapport is relationship of mutual understanding or trust and agreement between people . A mental health nurse develops rapport throught demonstration of understanding , warmth and non – judgmental attitude . RAPPORT

11. 2. It is the ability to feel with the patient while retaining the ability to critically analyse the situation . In empathy ,nurse receives information from the patient an opan , non- judgemental acceptance and communicates this understanding of the experience and feelings patient feels understood. EMPATHY

12. 3. Warmth is the ability to help the patient feel cared for and comfortable . It shows acceptance of the patient as a unique individual. It involves a non – possessive caring for the patient as a person and willingness to share the patients joy WARMTH

13. 4. Genuineness involoves being ones own self This implies that the nurse is aware of her thoughts , values and theory relevance in the immediate interaction with a patient . It is also important that the nurses verbal and non – verbal communication corresponds with each other GENUINENESS

14. 5. The nurse who does not become upset or respond negatively to a clients anger , or acting out conveys acceptance to the client . Avoiding judgments of the person no matter what the behavior ,is acceptance . ACCEPTANCE

15. 6. The relationship was significant to the extent that he feel a continuing desire to understand a sensitive empathy with each of the client feelings and communication ,as they seen to him at that movement . UNDERSTANDING

16. Phases of therapeutic nurse patient relationship

17. 1. Pre – interaction phase :- The pre – interaction phase begins before the nurses first contact with the patient . tasks :- Nurse explores own fears and anxieties Analyze own professinal strenghths and limitations Plan for first meeting with patient

18. 2. Orientation phase :- It is during the introductory phase that the nurse & patient meet for the first time Tasks :- Establish rapport , trust and acceptance Establish communication , assist in the verbal expression of thoughts and feelings Gather data , including the patients feelings , strengths and weaknesses Define patient problem set priorities for nursing intervention Mutually set goals

19. 3. Working phase :- MOST OF THE THERAPEUTIC WORK IS CARRIED OUT DURING THE WORKING PHASE . THE NURSE & THE PATIENT EXPLORE RELEVANT STRESSORS &PROMOTE THE DEVELOPMENT OF INSIGHT IN THE PATIENT TASKS :- collection of data from patient , source files helps patient identify his problems helps patient to communicate helps patient to socialize to understand his active participation in the experience to find out alternative solution to try out new behaviors

20. 4. TERMINATION PHASE :- IT IS MOST DIFFICULT BUT MOST IMPORTANT PHASE OF THERAPEUTIC RELATIONSHIP . IT IS A TIME TO EXCHANGE FEELING AND MEMORIES AND TO EVALUATE MUTUALLY REFLECTING THE QUALITY OF THE RELATIONSHIP BY BOTH THE NURSE AND THE PATIENT. TASKS:- Establish reality of separation Mutually explore feelings of rejection , loss , sedness,anger and related behavior Review progress of therapy and attainment goals Formulate plans for meeting future therapy needs

21. Therapeutic impasses Resistance = resistance is the patients attempt to remain unaware of anxiety producing aspect with in the self. Transference = Is an unconscious response of the client in which he / she experiences feelings and attitudes towards the nurse that were originally associated with significant figures, in his / her early life. Eg : A client perceives the nurse as acting the way that his/her Mother did, regardless of how the nurse is truly acting.

22. Con.. Countertransference = Refers to a specific emotional response by the nurse towards the patient that is in appropriate to the content and context of the therapeutic relationship or inappropriate in its emotional intensity. Boundary violation . = It occurs when a nurse goes outside the boundaries of the therapeutic relationship and establishesa social , economic relationship with a client.

23. Importance of therapeutic relationship It is helpful in communicating of disease stressing thoughts &feelings of a client It facilitates communication process. It is also important is assisting the client in solving the problems in their day to day life It is useful in helping the clients to examine self – defeating behaviors & test alterrnatives for the behaviour It promotes self –care and independence in the client

24. IT IS A PROCESS OF EXCHANGING OR SHARING IDEAS, FEELING , AND INFORMATION communication

25. COMMUNICATION PROCESS &ELEMENTS OF COMMUNICATION

26. sender It is a originator of the message . To be an effective communicator , he must know – his objectives clearly defined , The sender purpose must be translated into a code, this is done with language or nonverbal signals , such as gestures , facial expressions ,

27. MESSAGE A message is the information which the communicator transmits to the receiver , to receive ,understand , accept and act upon . It may be in the form of words , pictures A good message must be meaningful , need , clear and understandable , specific and accurate ,audience interesting ,culturally and socially appropriate .

28. Receiver The receiver is the target of the communication and must be able to understand the message This can be singal person or group .

29. Channel By channel is implied the ‘ physical bridges ‘ or the media of communication between the sender and receiver . interpersonal communication mass media Folk dance

30. Feedback Feedback means that the sender and receiver use one anothers reaction to produce further messages .it is the flow of information from the audience to the sender If the message is not clear or otherwise not acceptable the audience may reject .

31. Type of communication 1. Verbal communication :- verbal communication refers to the form of communication in which message is transmitted verbally ,communication is done by word ,mouth and a piece of writing. Non – verbal non – verbal communication includes action , such as gesture , vocalization , facial expression and other behavior .

32. Con .. Formal communication :- formal communication includes all the instances where communication has to occur in a set formal format . the style of communication in this form is very formal and official . Official conferences , meetings and written memos and corporate letters and used for communication

33. Con .. Informal communication :- informal communication includes instances of free unrestrained communication between people who share a casual rapport with each other . informal communication dose not have any rigid rules and guidelines .

34. Con… Written communication :- written communication is writing the words which you want to communicate . good written communication is essential for business purposes. written communication is practiced in many different languages ,E-mails, reports , articles are some of the ways of using written communication in business.

35. Con .. Visual communication :- the last type of communication out of the four types of communication is the visual communication . visual communication is visual display of information like photography ,signs ,symbols and designs . Television and vedio clips are the visual communication

36. Therapeutic communication Therapeutic communication is defined as the face to face process of interesting that focuses on advancing the physical and emotional well-being of a patient . Definition

37. Therapeutic communication techniques :- 1. listening :- listening is an active process of receiving information and examining reaction to the messages received . 2. Broad openings :- here the nurse is encouraging the patient to select topics for discussion. Patient should be welcomed to the communication with warmth and respect .patient should feel that nurse is ready to listen . 3. Questioning :- the nurse skilfully asks open –ended question during the initial admission .interviewing skills are necessary to avoid asking too many personal questions in one session .

38. Con… 4.Restating :- repeating the main thought expressed by the patient . for exp :-you say that your mother left you when you were 5 year old ?. 5.Clarification :-here , the nurse makes specific questions to help clear up a specific point patient makes by attempting to put in to words vague ideas of the patient . e.g :- I am not sure what you mean . Could do tell me about it again ?

39. Con .. 6. Reflection :- Directing Break the patients ideas ,feelings , questions and content . for exp :- “ you are feeling tense and anxious and it is related to a conversation you had with your husband last night .” 7. Focusing :- focusing helps the patient expand a topic of importance and also helps in analyzing in detail .it helps the patient talk about life experiences or problem area and accepts the responsibility for improving them . 8. Sharing perception :- it involves asking the patient to verify the nurses understanding of what the patient is thinking or feeling .

40. Con .. 9. informing :- informing or giving information is nurse shares simple fact whith the patient .this skill is use in patient education like when to take medication 10. Suggestion :-suggestion is the presentation of altemate idea. As a therpeutic technique .it is useful intervention in the working phase of the relationship .

41. Barrier of communication 1.Language:- the most prominent communication barrier is languange many clients speak engalish as a second language ,and a smaller proportion are hearing impaired or deal . 2.age and developmental level :- age differences may pose communication problems . With aging can come loss of hearing ,eyesight ,or cognition . In addition the elderly hold values that may be different than those of yonger people . 3. level of health :- an indiv idu with depression may speak little because of the level of illness. And imitiating and maintaining communication may be difficult . Those with mania may have unusual speech patterns.

42. Con…. 4. Knowledge level:- communication is affected by the amount and kinds of facts the client has at hand . The nurse assesses the client fund of knowledge and educational background at the time of admission. 5. Time :- counseling takes time , and the need to hurry blocks communication . Therefore , plan to interview .hectic time time to avoid include changes of shift , visitations , doctors rounds or when other appointment are pending .

43. Con …. 6. The nurses or clients feelings :- whenever the nurses or client becomes anxious communication changes . Talking about or listening to disturbing experiences or information is uncomfortable . 7. Unhelpful communication techniques :- nurses overcome responses that communication by being aware of statements that change the focus ,finalize the interview .