MH 9 PDF: Communication & Therapeutic Relationships

Chapter 9 Communication & Therapeutic Relationships I. Therapeutic Relationship Client-Centered Care ​ ​ Client Participation: Active involvement in treatment plan & goals. ​ ​ Nurse Role: Empathetic listening, fostering a supportive environment, holistic approach. Therapeutic Commu...

Chapter 9 Communication & Therapeutic Relationships I. Therapeutic Relationship Client-Centered Care ​ ​ Client Participation: Active involvement in treatment plan & goals. ​ ​ Nurse Role: Empathetic listening, fostering a supportive environment, holistic approach. Therapeutic Communication Techniques ​ ​ Open-ended questions (Encourage discussion) ​ ​ Clarification (Ensuring understanding) ​ ​ Closed-ended questions (For specific information) ​ ​ Summarizing (Confirming information) II. Assessment & Recognizing Cues Assessment Steps Recognizing Cues ​ ​ Identify symptoms & patterns ​ ​ Determine what is concerning ​ ​ Assess additional needed information Prioritizing Problems ​ ​ Cluster & analyze information ​ ​ Determine risk (safety, self-harm, harm to others) ​ 3.​ Client History Assessment ​ ​ Physiological: Ability to participate ​ ​ Co-occurring Conditions: Demographics, history, coping ability, cultural/spiritual beliefs Psychosocial Assessment ​ ​ Mental Status Exam (MSE) ​ ​ Risk for violence, suicide, aggression ​ ​ Work, education, family history ​ ​ Dementia care & validation therapy III. Nursing Process Planning & Implementation ​ ​ Generating Solutions: Prioritizing nursing care, adjusting to condition changes, team collaboration. ​ ​ Goals & Outcomes: Client-focused, facilitated by nurse, safety first. ​ ​ Discharge Planning: Starts at diagnosis, involves interdisciplinary communication. Implementation ​ ​ Client & Family Teaching ​ ​ Condition, medications, relapse warning signs, follow-ups. ​ ​ Evaluation of Outcomes ​ ​ Review effectiveness of care plan, revise as needed, ensure appropriateness. IV. Treatments & Therapies Cognitive Therapy Techniques ​ ​ Priority Restructuring: Focus on priorities ​ ​ Journal Keeping: Expressing stressful thoughts ​ ​ Assertiveness Training: Expressing emotions non-aggressively ​ ​ Thought Monitoring: Identifying negative thoughts Behavioral Therapy Techniques ​ ​ Modeling: Improving social skills ​ ​ Operant Conditioning: Reward-based behavior reinforcement ​ ​ Systematic Desensitization: Exposure therapy ​ ​ Aversion Therapy: Unpleasant stimuli to deter behaviors Other Psychological Techniques ​ ​ Flooding: Treating phobias & PTSD by direct exposure ​ ​ Response Prevention: Prevents compulsive behaviors (OCD) ​ ​ Thought Stopping: Stopping intrusive thoughts ​ ​ TF-CBT (Trauma-Focused Cognitive Behavioral Therapy): Used for PTSD & abuse survivors ​ ​ Validation Therapy: Respecting emotions (Dementia care, schizophrenia) ​ ​ VRET (Virtual Reality Exposure Therapy): Anxiety-provoking situations (PTSD, phobias) V. Phases of the Nurse-Client Relationship ​ 1.​ Orientation Phase: Establish trust, set boundaries. ​ 2.​ Identification Phase: Identify unmet client needs. ​ 3.​ Exploitation Phase: Collaborate on goals. ​ 4.​ Resolution Phase: Evaluate progress, set new goals. VI. Professionalism & Communication Strategies Building Trust & Rapport ​ ​ Qualities that build trust: Honesty, transparency, respect, understanding. ​ ​ Barriers to trust: Gender, education, language, culture, socioeconomic status. Maintaining Professional Boundaries ​ ​ Avoid boundary blurring. Stay professional & therapeutic. ​ ​ Transference: Client shifts feelings onto the nurse. ​ ​ Countertransference: Nurse shifts feelings onto the client. VII. Nonverbal Communication Strategies ​ ​ S.O.L.E.R. Technique ​ ​ S – Sit squarely to client ​ ​ O – Open posture ​ ​ L – Lean forward ​ ​ E – Eye contact ​ ​ R – Relax ​ ​ Adjusting for Comfort: Some clients may find direct sitting confrontational. ​ ​ Recognizing Nonverbal Cues from Clients ​ ​ Affect: Frowning, grimacing, lip-licking, biting. ​ ​ Appearance: Disheveled, inappropriate clothing. ​ ​ Autonomic Signs: Sweating, flushed face, dilated pupils. ​ ​ Body Language: Rocking, clenched hands. ​ ​ Eye Contact: Squinting, minimal blinking. VIII. Wellness & Health Promotion ​ 1.​ Primary Prevention: Preventing mental illness before symptoms arise. ​ 2.​ Secondary Prevention: Early detection, screening, education. ​ 3.​ Tertiary Prevention: Supporting well-being & quality of life.