Patient-Centered Care and Therapeutic Relationships

Patient-Centered Care

• Patient-Centered Care: Nurses consider and involve patients in their care.
• Dignity and Respect: Treat patients with care and value, respecting their rights and individuality.
• Information Sharing: Provide patients with all necessary details about their care and treatment options.
• Patient and Family Participation: Actively involve patients and their families in decisions about their care.
• Collaboration: Working with others to create policies that enhance patient care and improve outcomes.

Therapeutic Relationships: Boundaries and Interventions

• Boundaries: Clear boundaries ensure a professional relationship while respecting privacy and dignity.
• Therapeutic Use of Self: Nurses consciously use their personality and maintain a safe, confidential, and consistent approach.
• Nursing Intervention Goals: Facilitate communication, assist with problem-solving, examine self-defeating behaviors, promote self-care and independence, and educate about disorders and treatments.
• Building Healthy Relationships: Assess patient needs, identify unmet needs, and find de-escalation strategies.
• Maslow's Hierarchy: Meet physical needs before psychological assessments to ensure patient comfort and readiness.

Personal vs. Therapeutic Relationships

• Personal Relationships: Initiated for friendship, socialization, or task accomplishment, with mutual needs being met.
• Differences: Personal relationships involve mutual needs, advice, and superficial topics, while therapeutic relationships focus on professional care and patient goals.
• Therapeutic Relationship: A healthy, professional relationship focused on the patient's care and well-being.
• Key Elements: Identify and explore patient needs, establish clear boundaries, use problem-solving approaches, develop coping skills, and encourage behavioral change.
• Necessary Nurse Behaviors: Accountability, focus on patient needs, clinical competence, delayed judgment, and supervision.
• Goals and Functions: Facilitate communication, assist with problem-solving, help patients identify thoughts and feelings, and promote self-care and independence.

Risks and Important Considerations

• Defined: Boundaries are legal, ethical, and professional standards that separate nurses from patients, creating a safe space for exploring feelings and concerns.
• Risks: Over-involvement can lead to boundary crossings, violations, professional sexual misconduct, and blurring of roles.
• Blurring of Roles: Occurs when patients displace feelings onto the nurse.
• Transference: Patients project feelings related to past figures onto the nurse.
• Countertransference: Nurses project feelings related to past figures onto the patient.
• Self-Awareness: Enables nurses to recognize their own values and beliefs, ensuring patient-centered care despite differences.

Peplau's Model of Nurse-Patient Relationship

• Phases: Pre-orientation, Orientation, Working, and Termination.
• Pre-orientation Phase: Preparing for assignment, researching patient history, recognizing one's own thoughts and feelings, and setting ground rules.
• Orientation Phase: Establishing rapport, defining relationship parameters, creating a contract, ensuring confidentiality, and discussing termination.
• Working Phase: Maintaining the relationship, gathering data, and promoting problem-solving skills such as self-esteem and use of language.
• Additional Working Phase Goals: Facilitate behavioral change, overcome resistance, evaluate problems and goals, redefine goals as necessary, and promote adaptive behaviors.
• Termination Phase: Summarizing goals, discussing coping strategies, reviewing the relationship, exchanging memories, and transitioning to the next level of care.

Promoting Patient Growth

• Factors: Genuineness, empathy, positive regard, appropriate attitudes and actions, active engagement, suspending value judgments, and helping patients develop resources.
• Making mistakes can help refine more useful interventions to help patients reach their goals

Therapeutic Communication

• Importance: Crucial for patient-centered relationships, learned and practiced, respects patient values and needs, and is goal-directed and scientifically based.
• Benefits: Patients feel safer, are more satisfied, have increased recovery rates, and show improved treatment adherence.
• Consequences of Poor Communication: Death, malpractice claims, increased costs, decreased safety, lower satisfaction, reduced recovery, and poor adherence.

Transactional Model of Communication

• Elements: Communicator, message, channel, feedback, encoding/decoding, context, and environmental noise.
• Communicators: Sender and receiver.
• Message: The information sent.
• Channels: Auditory, visual, tactile, olfactory, or a combination.
• Feedback: The receiver's response to the sender.
• Encoding/Decoding: The sender develops and sends the message, and the receiver interprets it.
• Context: Social, relational, or cultural influences.
• Environmental Noise: Disrupts message flow.

Principles of Communication

• Peplau's Interpersonal Theory: Encourages non-directive listening for reflective and non-judgmental feedback.
• Guiding Principles: Clarity ensures accurate understanding, and continuity promotes connections among ideas and feelings.

Factors Impacting/Types of Communication

• Personal Factors: Depression, cognition, language/cultural barriers, environmental factors, and relationship factors.
• Verbal Communication: Words conveying emotions, beliefs, and values.
• Nonverbal Communication: Tone of voice, appearance, facial expressions, posture, eye contact, and gestures.
• Interaction: Verbal is the content, and nonverbal is the process. Double-bind messages are contradictory.
• Communication Skills: Silence, active listening, clarifying techniques, open-ended questions, closed-ended questions, projective questions, and the miracle question.
• Barriers: Excessive questioning, giving approval/disapproval, giving advice, and asking "why" questions.
• Cultural Considerations: Communication style, eye contact, touch, and cultural filters.

Clinical Interview

• Considerations: Pace, setting, seating, introductions, and initiating the interview.
• Tactics to Avoid: Arguing, minimizing, giving false reassurance, interpreting, probing, selling treatment, joining in attacks, and criticizing staff.

Supportive Behaviors

• Includes: Attending behaviors, kinetic communication, vocal quality (paralanguage), and proxemics (personal space).
• Types of Personal Space: Intimate (0-18 inches), personal (18 inches-4 feet), social (4-12 feet), and public (12+ feet).

This lesson covers patient-centered care, emphasizing dignity, respect, information sharing, and collaboration. Also covers the importance of therapeutic relationships, boundaries, and nursing intervention goals in facilitating communication and promoting self-care.