UNIT 2 Lecture 4 Caring and Therapeutic Relationship September 2024 PDF

CARING & THERAPEUTIC RELATIONSHIP BODY IMAGE Edited and revised by Elizabeth Clacken 2024 Prepared by: Rachel Rowe Lecturer, Caribbean School of Nursing September 2021 Contributions From Anthonette Patterson-Bartley and OBJECTIVES  Define Caring  Discuss two theori...

CARING & THERAPEUTIC RELATIONSHIP BODY IMAGE Edited and revised by Elizabeth Clacken 2024 Prepared by: Rachel Rowe Lecturer, Caribbean School of Nursing September 2021 Contributions From Anthonette Patterson-Bartley and OBJECTIVES  Define Caring  Discuss two theories on Caring  Discuss principles of a therapeutic relationship  Describe the phases of the therapeutic nurse client relationship “Our lives begin to end the day we become silent about things that matter.” Martin Luther King, Jr. Faith Morelli Being present …fully prese DEFINITION: CARING  Caring is a process  Caring is an essential feature and expression of human being  Caring is essential to nursing because it helps nurses get close to patients and enables the best possible medical treatment  Each person throughout his or her life, grows in the capacity to express caring  Caring is sharing deep and genuine concern about the welfare of another person  DEFINITION FOR CARING  The act of assisting, supporting a client  Providing comfort using science and art  A commitment to assist or support a client  The emotional inclination to assist  Demonstration of helping with outmost intensity  Having sympathy, empathy, compassion, interest, positive attitude toward the sick  NURSE AND CARING  Nursing cannot exist without caring  In nursing, caring is not just a word, it's something that nurses live and breathe  Caring is central to all helping professions because it helps with the healing process  It takes more than compassion to be an excellent nurse; it requires knowledge and skills to provide adequate care  Two primary domains of caring:  The act of caring for another person when he/she is unable to care for self  Being a caring nurse occurs when a nurse displays actions of compassion NURSING THEORIES ON CARING LEININGER: CULTURE CARE DIVERSITY AND UNIVERSALITY  Identifies care as a distinct, dominant, unifying and central focus of nursing  Theory is based on assumption that nurses must understand different cultures to function effectively. LEININGER’ S TRANSCULTURAL NURSING  Transcultural nursing: focuses on differences and similarities among individuals in different cultures  Nurse must understand these to provide care congruent with cultural values, beliefs and practices,  Lack of knowledge of ones culture may result in conflict, non-compliance and stress may arise  LEININGER Culturally congruent care involves:  Culturally congruent practice is providing care to a patient while being aware and inclusive of their cultural values, beliefs, and practices  Applying knowledge of how culture influences one's health beliefs, health practices, and communication patterns at each stage of the nursing process  Culturally congruent care is when a nurse understands and accepts differences of each culture  JEAN WATSON  Caring is the essence and moral ideal of nursing, the end of which is protection, enhancement and preservation of human dignity.  Nursing’s contribution to society lies in its moral commitment to human care. JEAN WATSON Caring is Relational  Patients value nurse Effectiveness  Ability to perform tasks  Also value nurse Affect  Attitude or demeanor while performing the tasks  Patients are more willing to participate if they sense that they are cared about Faith Morelli  WATSON’S TRANSPERSONAL HUMAN CARING  Transpersonal means to go beyond one’s own ego and reach a deeper spiritual connection while comforting a patient.  The human connection is transpersonal human caring: the nurse enters into the experience of the client and the client can enter into the experience of the nurse.  It is an inter-subjective human-to-human relationship in which the nurse affects and is affected by the other person  WATSON’S CARING MOMENT  When human caring is created the nurse and patient come together to create a moment, this is known as the caring occasion/caring moment. Watson (1998, 1999)  The nurse and the patient must be aware of the caring moment so as to make appropriate choices and actions, thereby the nurse without knowing becomes a part of the patients “life history.” Watson (1999) Faith Morelli  SPIRITUAL CARING  Spiritual health is achieved when a person finds a balance between life values, goals, and belief systems and those of others.  Spirituality offers a sense of connectedness.  Intrapersonally = connection spiritually with ones self  Interpersonally=connected with others and the environment  Transpersonally=connected with the unseen, God Watson (1979) 16  CARING ENCOUNTERS  When clients perceive encounters to be caring their sense of dignity and self worth is increased and feelings of connectedness are expressed.  Common caring patterns: 1) knowing the client 2) nursing presence, 3) empowering the client 4) compassion and competence THERAPEUTIC NURSE- PATIENT RELATIONSHIP THERAPEUTIC RELATIONSHIP  Promotes understanding  Help establish a constructive relationship between the nurse and the client.  The therapeutic helping relationship is client and goal directed. THERAPEUTIC RELATIONSHIP  Nurses need to respond not only to the content of a client’s verbal message but also to the feelings expressed. Eg. a client says, “I am glad he has left me; he was very cruel.” However, the nurse observes that the client has tears in her eyes as she says this.? How would you respond? PURPOSE OF THERAPEUTIC RELATIONSHIP Support patient Promote healing Support or enhance functioning Differs from a social relationship in that it is health focused and patient centered with defined boundaries. It is goal oriented Faith Morelli PRINCIPLES OF THERAPEUTIC RELATIONSHIP  Respect  Genuineness  Empathy  Active listening  Trust  Confidentiality Faith Morelli  RESPECT Unconditional positive regard Faith Morelli GENUINENESS  Ability to be oneself within the context of a professional role Faith Morelli EMPATHY  Understand what a patient is experiencing from the patient’s perspective  Allows the nurse the ability to see the world from the patient’s point of view Faith Morelli TRUST Faith Morelli TERMS ACCEPTANCE  Avoiding judgments of the person, regardless of the behavior  Conveyed when the nurse does not become upset or respond negatively to a client’s outbursts, anger, or acting out. Faith Morelli TERMS  ACCEPTANCE  By being clear and firm without anger or judgment the nurse allows the client to feel intact while still conveying that certain behavior is unacceptable Faith Morelli TERMS: POSITIVE REGARD The nurse appreciates the client as a unique worthwhile human being Calling the patient by name Spending time with the client Listening Responding openly Considering the patient’s ideas and preferences when planning care Faith Morelli  Nurse–client relationship or Interpersonal relationships or Therapeutic relationships or Helping relationships  PEPLAU’S INTERPERSONAL RELATIONSHIP Phases:  Orientation  Working  Resolution or Termination  THERAPEUTIC NURSE-CLIENT RELATIONSHIP  Preinteraction Phase (similar to planning phase pre interview)  Nurse has information about client before face- to-face meeting. eg. name, age, address, medical and social history.  gathered from chart, significant others or health team.  Therapeutic Nurse-Client Relationship Orientation Phase  Sets tone for rest of relationship  Client and nurse closely observe each other and form judgments about the other’s behavior  Goal of Nurse : to develop trust and security PHASES OF THERAPEUTIC NURSE-CLIENT RELATIONSHIP Orientation phase Begins when nurse meets client Ends when problems are identified – Establishes roles – Purpose of the meeting – Parameters of subsequent meetings – Identifies the client’s problems – Clarifies expectations Faith Morelli  THERAPEUTIC NURSE-CLIENT RELATIONSHIP Orientation phase (cont’d)  Formulate nursing diagnoses  Set mutually agreeable goals  Develop a realistic plan of action  Explore feelings of both client and nurse Faith Morelli  THERAPEUTIC NURSE- CLIENT RELATIONSHIP Working Phase  Nurse and client view each other as unique,  Appreciate this uniqueness and care about each other.  Two major stages:  Exploring and understanding thoughts and feelings  Facilitating and taking action  THERAPEUTIC NURSE-CLIENT RELATIONSHIP Working phase  THERAPEUTIC NURSE-CLIENT RELATIONSHIP Termination phase  Therapeutic conclusion of relationship occurs when  Progress has been made toward attainment of the goals A plan of action for more adaptive coping with future stressful situations has been established  Feelings about termination of the relationship are recognized and explored Faith Morelli  THERAPEUTIC NURSE-CLIENT RELATIONSHIP Resolution or Termination Phase  Begins when the problems are resolved and it ends when the relationship is ended Faith Morelli  Question 1 A client threatens to kill himself, his wife, and their children if the wife follows through with divorce proceedings. During the preinteraction phase of the nurse/patient relationship, which interaction should the nurse employ? A) Acknowledging the client's actions and encouraging alternative behaviors B) Establishing rapport and developing treatment goals C) Providing community resources on aggression management D) Exploring personal thoughts and feelings that may adversely impact the provision of care Correct answer: D  In the pre-interaction phase, the nurse must clarify personal attitudes, values, and beliefs to become aware of how these might affect the nurse’s ability to care for various clients. This occurs before the nurse meets the client. FACTORS ENHANCING INTERPERSONAL RELATIONSHIPS Listen patiently  Talk meaningfully  Avoid hasty judgement  Judge unemotionally  Never gossip  Never criticize  Acquire communication skills  Respect others  Accept constructive criticism Faith Morelli BOUNDARIES IN THE NURSE-CLIENT RELATIONSHIP  Professional boundary concerns commonly include issues such as  Self-disclosure  Gift-giving  Touch  Friendship or romantic association BOUNDARIES IN THE NURSE-CLIENT RELATIONSHIP Warning signs – Indicate that professional boundaries of the nurse-client relationship may be in jeopardy Favoring a client’s care over another’s Keeping secrets with a client Changing dress style for working with a particular client Swapping client assignments to care for a particular client Giving special attention or treatment to one client over others BOUNDARIES IN THE NURSE-CLIENT RELATIONSHIP Warning Signs  Spending free time with a client  Frequently thinking about the client when away from work  Sharing personal information or work concerns with the client  Receiving of gifts or continued contact/communication with the client after discharge  Question 2 Which is the primary nursing goal when establishing a therapeutic relationship with a client? A) To promote client growth B) To develop the nurse’s personal identity C) To establish a purposeful social interaction D) To develop communication skills Correct answer: A  The goal of a therapeutic nursing interaction is to promote client insight and behavioral change directed toward client growth.  THE ART OF LISTENING  “If we were supposed to talk more than listen, we would have been given two mouths and one ear.”  Mark Twain  ACTIVE LISTENING!! S.O.L.E.R: This is a non-verbal listening process used in communication  The S.O.L.E.R. describes “active listening “, or an expression to physically transmit your message. Active listening means giving your full attention to:  The verbal message  The tone of voice  The person’s posture  The person’s gesture  Understand thoughts, feeling and behavior. ACTIVE LISTENING  S-SIT FACING THE CLIENT:  The health educator should sit squarely for the effective listening skills. Otherwise the patient will think that the educator is not interested in his conversation.  O- OPEN POSTURE  The open body posture is the key for active listening. This includes avoiding crossing arms and legs. Crossing your arms or legs may appear as if you are being defensive to the other person where as open posture says that you are open and available to the person. ACTIVE LISTENING  L-LEAN FORWARD TOWARDS THE CLIENT:  Slightly leaning forward towards the client indicates an eagerness to learn more. Leaning in towards the client every now and again tells them you are interested in what they want to say  E-ESTABLISH EYE CONTACT:  The good and proper eye contact encourage the speaker to continue. Eye contacts give the speaker a confidence to speak by giving by support that the listener is listening carefully ACTIVE LISTENING  R- RELAXED:  To avoid the false perception of hurry and artificial communication a relaxed posture is needed ACTIVE LISTENING Role of Nurse in SOLER way of communication  Record medical history and symptoms.  Collaborate with team to plan for patient care.  Advocate for health and wellbeing of patient.  Monitor patient health and record signs.  Administer medications and treatments.  Operate medical equipment.  Perform diagnostic tests. THERAPEUTIC COMMUNICATION  Ask open ended questions:  require more than a yes or no response. eg. Does your leg hurt? Open ended: Where does your leg hurt?  allow the nurse to get as much information as possible Therapeutic Relationship Therapeutic relationship It is client centered relationship using nursing knowledge, skills and positive attitudes in a caring situation The precursor to the desired change of attitude which the nurse expects in a patient (CNO, 2006  Therapeutic Communication Therapeutic use of self Perception of oneself, based on life experience and reflections by others Iterative, interactive and interdependent Qualities in therapeutic use of self Empathy Communication Reflective learning Dawn Freshwater  Therapeutic Communication Effective therapeutic communication: Simple, appropriate, adaptive, concise & credible Steps in effective therapeutic communication Open ended questions Focus on feelings (understanding) State behaviors observed Reflect, restate, & rephrase what patient says Neutral responses (non-judgemental)  IN EFFECTIVE THERAPEUTIC COMMUNICATION AVOID : Telling client he or she is wrong Giving the client advise False hope Cliché Seeking justification ( Avoid the ‘WHY’) Giving approval The use of ‘I’ and the ‘ME’ Changing subject Defending doctors or your colleagues  Therapeutic Communication Components of a Therapeutic Relationship Trust, respect, professional intimacy, empathy and power Ingredients for therapeutic relationship Therapeutic communication Client-centred care Maintaining boundaries Giving and accepting gifts Protecting the client from abuse WORD CHOICE (OPEN-ENDED QUESTIONS) Tell me about your How are you? day Do you have any What questions do you questions? have? Have I answered all What else can I help of your questions? with today? THERAPEUTIC COMMUNICATION TECHNIQUES 1. Active listening –Listening intentively with one’s whole being (mind, body and soul). 2. Sharing Observations – Stating observations helps the patient communicate without the need for extensive questioning, focusing or clarification. 3. Sharing Empathy – Builds trust. The ability to understand and accept another person’s reality, to accurately perceive feeling and to communicate this understanding to the patient 4. Sharing Hope – Is essential for healing. Communicate a sense of possibility to others. FIVE WAYS TO FACILITATE THERAPEUTIC COMMUNICATION  Maintain patient-centered listening  Suppress prejudice  Create a therapeutic environment  Be alert to nonverbal cues  Establish a trusting relationship QUESTION 3 A patient with bipolar disorder, depressed type, was readmitted after being discharged one (1) month ago. Which statement by the nurse would contribute to establishing trust? A.“Weren’t you complying with your medication regimen?” B.“It must be discouraging to be readmitted to the hospital so soon.” C.“Everyone with bipolar disorder ends up in the hospital occasionally.” D.“You must take your drugs as prescribed or you will be rehospitalized.” QUESTION 4 A client tells the nurse, “I have something secret to tell you, but you can’t tell anyone else.” The nurse agrees. What is the likely consequence of the nurse’s action? A. Healthy feelings of sympathy by the nurse toward the client. B. Blurred boundaries in the nurse-client relationship. C. Improved rapport between the nurse and client. D. Enhanced trust between the nurse and client. 64 THANK YOU BODY IMAGE Body Image  It is a psychosocial concept which refers to a person's perception of his/her own body  The sum of affective and cognitive perception of self including:  the appearance, height, shape, and weight, functioning and ageing aspects of ourself 4 ASPECTS OF BODY IMAGE  Perceptual  Affective  Cognitive  Behavioral  BODY IMAGE  The way you see your body is your perceptual body image....  The way you feel about your body is your affective body image....  The way you think about your body is your cognitive body image....  The behaviours you engage in as a result of your body image are your behavioural body image. DEVELOPMENT OF BODY IMAGE  established before the age of 6 years.  During early adolescence, body image continues to develop, especially among girls (when they gain an average of 50 lbs, 20%–30% of which is comprised of fat deposited in the hips, thighs, buttocks, and waist).  During early adolescence, body image continues to develop HOW BODY IMAGE DEVELOPS  Sociocultural factors (beauty ideals)  past and present experiences  Interpersonal experiences (eg. frequent compliments)  Physical changes (puberty, weight, etc)  Personality traits BEHAVIORAL DEFENCES TO ALTERED BODY IMAGE  Passivity (withdraw  Denial (refuse to look)  Reassurance (of acceptance)  Isolation  Hostility TO FEEL GOOD ABOUT SELF  Be active  Wear clothes that make you feel good and comfortable  Take care of your skin  Talk to friends and family  Change negative thoughts  Eat healthy foods  Deal with grief and loss ENHANCING BODY IMAGE Beauty items:  Clothing, make-up, hairstyle, jewelry, make-ups, prostheses Functioning items  Wheel chairs, eye glasses, walker, crutches Theories of body Image  Sociocultural  Developmental (Berman, A et al, 2010) REFERENCES  Berman, B., Snyder, S. & Frandsen, G. (2016) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice. (10th ed.) New Jersey, NY: Pearson Education, Inc.  Teoh, H-J (2000). Sociocultural and developmental theories as explanations of body image dissatisfaction amongst secondary school girls. Malaysian Journal of Psychiatry, 8 (1), 15 - 21.