NUR1 222 Week #3 Part 1 Therapeutic Relationship and Clinical Conversations PDF

NUR1 222 Strengths-Based Nursing & Professional Practice September 14, 2023 Therapeutic Relationships and Clinical Conversations Part 1 Prof. Maria Di Feo Outline Nurse- Patient Relationships § Collaborative Partnership § Professional Communication § Therapeutic Relationship § Clinical Conversat...

NUR1 222 Strengths-Based Nursing & Professional Practice September 14, 2023 Therapeutic Relationships and Clinical Conversations Part 1 Prof. Maria Di Feo Outline Nurse- Patient Relationships § Collaborative Partnership § Professional Communication § Therapeutic Relationship § Clinical Conversations § Developing Patient Centered Communication Skills Readings Gottlieb, L.N. (2013). Strengths-based nursing care: Health and healing for person and family. New York: Springer Publishing Company. Chapters 8 Mallette, C., Yonge, O., Arnold, E. C., & Boggs, K. U. (2021). Arnold and Boggs's Interpersonal Relationships: Professional Communication Skills for Canadian Nurses. Toronto: Elsevier Health Sciences Chapter 5 Go Objectives • Describe the elements of person-centered communication and the elements of a collaborative partnership. • Describe how attunement, authentic presence and attentive listening assists in developing a therapeutic relationship. • Explain how each SBNH values guides a nurse in clinical conversations. Nursing is as much about “being”, as it is about “doing”. Itʼs harder to teach, explain and measure the “being” dimension of (Koerner, 2011) nursing. Work Of Nursing DOING - Tasks, procedures… - Visible and measurable BEING - Relational profession in which the nurse and person /family enter into partnership to promote the personʼs /familyʼs health, alleviate their suffering and facilitate their self – healing. - Skills of “being” - The Heart of Nursing - The Art of Nursing (Koerner, 2011) Engagement & Relational Care Why are relationships so critical to nursing? Nursing is a relational phenomenon because everything a nurse sees, does, and experiences arises from the relationship. (Koerner, 2011) 9/14/23 7 “Being” in SBN Approach - The way a nurse is with the person /family - The way a nurse engages, interacts, connects and is involved with the person - Giving the other voice - Being committed to and and dignity caring for another with compassion, respect Caring • (Mayeroff, 1990) Caring is a process that helps someone grow and actualize himself, and that through caring for others “a man lives the meaning of his own life”. v Maslow ʼs (1943) def inition of self-actualization is for a person “to become ever ything that one is capable of becoming” (p. 382). Person meeting their goals. • Caring involves creating conditions that foster a personʼs growth and development. Promotes Health and Healing Communication connects people and ideas through words, nonverbal behaviors and actions. Interpersonal Communication in Healthcare Settings: • Patient • Families • Staff in healthcare settings (unit coordinator, housekeeping staff, security…) • Healthcare professionals • …. Effective Interpersonal Communication Skills Support Safety and Quality in Healthcare Delivery How? Effective Interpersonal Communication Impacts Quality of Care: • Helps development a collaborative care partnership • Better understanding of the person & his situation • Identification of health issues & earlier recognition of health challenges /changes in health • Helps create individualized care plans • When nurses invest in patients and show that they Communication a Therapeutic Tool care, patients connect with nurses and become engaged in their care and healing • Patients need to feel safe and secure with the nurse, understood and accepted. (Gottlieb, 2013) Therapeutic Communication Term introduced by Jurgen Ruesch (1961) A dynamic process entered into by health care providers, with the person and significant others for the purpose of achieving health – related goals. Therapeutic Communication (Gottlieb, 2013) - Encompasses many skills; both verbal and nonverbal - Helps people meet their goals and places patients in better conditions to heal Engaging in Therapeutic Communication Assists in Developing a Therapeutic Relationship Nurse – patient Relationship is the Foundation of Nursing Practice. Establishing a Trusting Collaborative Relationship Therapeutic Relationship (Gottlieb, 2013) Ø Nurse comes to know the person as a unique individual.Through “knowing” the person the nurse connects with the person. Ø “The therapeutic relationship is a type of social involvement that the nurse creates with patients /clients /families to help promote health, help them deal with suffering, recover from insults, and facilitate self-healing.” Ø When nurses become invested with patients and show them that they care, patients are more likely to connect with nurses and become engaged in their own care, health and healing. Ø It is in this therapeutic relationship “way of a being” with patients that nurses provide knowledgeable and compassionate care. 9/14/23 19 Foundations for Therapeutic Relationships All therapeutic relationships begin with establishing a rapport /connection There are 3 elements to building a connection with a patient: • Mutual attentiveness – attend to the otherʼs concerns & communicate understanding • Positivity – focus on strengths • Coordination –tailoring your response to the other in a way that respects and matches their individual Gottlieb, L.N. (2013) SBNC, p. 270-284 Therapeutic Relationships are Built on the Essential “Aʼs” (Gottlieb, 2013) • Attunement and Awareness • Authentic Presence • Attentive Listening Reforming Skills of Clinical Involvement - The Three “A”s: Attunement & Awareness • The nurse and patient/family are attuned to one anotherʼs thoughts and feelings and are responding in ways that are in sync. Adopting an, “I donʼt know but I want to learn more” stance. • Becoming an astute (sharp) observer and attentive listener. • Being aware of our thoughts and feelings and the effect that we may have on others. Authentic Presence • Being fully present (mentally and physically). • Communicating our interest in the patient/family via our verbal and non-verbal communication. • Adopting the stance of a learner (i.e. respect & humility) Attentive Listening • Being present both physically and mentally • Adapting an unhurried stance • Listening for the underlying message, stated or not stated • Being comfortable with silence • Not interrupting • Use open ended questions that will encourage patient to share thoughts.. A person who is well attuned will Attunement describes how reactive a person is to another's emotional needs and moods. respond with appropriate language and behaviors based on another person's emotional state. They are good at recognizing moods and emotions in another person and adapting their own response in accordance. – i.e. Being able to detect what people are feeling or thinking and respond appropriately. Establishing Therapeutic Relationships - Nursing Best Practice Guidelines Registered Nurses Association of Ontario (RNAO) – 2002 (revised 2006) Establishing Therapeutic Relationships - Nursing Best Practice Guidelines Registered Nurses Association of Ontario (RNAO) – 2002 (revised 2006) https://rnao.ca /sites /rnao-ca /f iles /Establishing_Therapeutic_Relationships.pdf “The therapeutic relationship is grounded in an interpersonal process that occurs between the nurse and the client(s). Therapeutic relationship is a purposeful, goal directed relationship that is directed at advancing the best interest and outcome of the client.” 9/14/23 25 Establishment of a therapeutic relationship requires reflective practice. Establishing Therapeutic Relationships Nursing Best Practice Guidelines RNAO (cont..) • Self-awareness (self reflection) • Self-knowledge (knowing oneʼs values * beliefs) • Empathy • Awareness of boundaries and limits of the professional role. 9/14/23 Interpersonal Boundaries (Professional Boundaries) - Focus on person /family - Health related - Involves thought (choice of words), reflection, self awareness - Health care provider generally should avoid disclosing personal information about themselves Establishing Therapeutic Relationships - Nursing Best Practice Guidelines Registered Nurses Association of Ontario (RNAO) – 2002 (revised 2006) https://rnao.ca /sites /rnao-ca /f iles /Establishing_Therapeutic_Relationships.pdf Boundaries define the limits of the professional role. A nurse is obligated to place the clientʼs needs before his /her own needs. Through self-awareness, the nurse reflects on whether or not his /her actions are in the clientʼs best interest. 9/14/23 28 Clinical Conversation vs Social Conversation What are some differences? Clinical Conversations Can occur during brief Can take many forms; a encounters or a lengthy discussion, interviewing, conversation or combinations.. Clinical Conversations Getting to know your patient so that you can deliver appropriate care (unique to person's situation) • Clinical Inquiry - gathering salient and relevant information which will inform you interventions. Monitoring a patientʼs situation • Opportunity for nurses promote health, alleviate suffering, and promote healing – therapeutic interventions Using Open Ended Questions to Facilitate Dialogue Want to get to know patient /family to understand their health concern and how they are dealing with it.. E.g. • What have you been experiencing? • What is your biggest concern at this moment? • How do you understand what is happening? Clinical Conversations Guided by SBN Values 9/14/23 34 Clinical Conversations Guided by SBN Values Week of September 7 Video Intro to SBN Video How do the Values of SBN Guide a Nurseʼs Practice? The Values of SBN Guide a Nurseʼs Practice • How they engages /acts with patients /families • What they choose to explore with patients /families • Type of questions they ask patients /families 9/14/23 37 Reflect On.. How does each SBN value guide a nurseʼs practice? v The nurseʼs behaviors /action? v What the nurse chooses to explore with patients? v Questions the nurse asks patients /families? 9/14/23 38 Primarily guided by? A nurseʼs exploration of a topic / question /action may be guided by more than one SBN value. Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/14/23 40 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/14/23 41 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/14/23 42 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/14/23 43 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/14/23 44 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/14/23 45 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/14/23 46 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/14/23 47 Case Scenario – Questions Discussion Post #1 Guided by SBNH Values Opens this evening Instruction on my Courses – Assignment Folder