Mental Health and Crisis Management - Therapeutic Communication

Mental Health and Crisis Management Theory Therapeutic Communication Therapeutic Relationship Group Therapy Therapeutic Relationship Part 1  Concepts of the Nurse–Patient Relationship Basis of all psychiatric nursing treatment approaches To establish tha...

Mental Health and Crisis Management Theory Therapeutic Communication Therapeutic Relationship Group Therapy Therapeutic Relationship Part 1  Concepts of the Nurse–Patient Relationship Basis of all psychiatric nursing treatment approaches To establish that the nurse is Safe Confidential Reliable Consistent Relationship with clear boundaries Therapeutic Use of Self 1 2 3 Use Attempt to Structure personality establish nursing consciously relatedness interventions and in full awareness  Goals and Functions Facilitate communication of distressing thoughts and feelings Assist patient with problem solving Help patient examine self-defeating behaviours and test alternatives Promote self-care and independence  Initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task Social Mutual needs are met Relationshi Communication to give ps advice or to give or ask for help Content of communication superficial  Needs of patient identified and explored Clear boundaries established Therapeuti c Problem-solving approaches taken Relationshi ps New coping skills developed Behavioural change encouraged  Accountability Focus on patient’s Necessary needs Behaviours Clinical competence for Nurses Delaying judgement Supervision  Boundaries are commonly established using strategies from the following four areas: Establishin Treatment planning and delivery g Space Comportment Boundaries Location of service delivery **Refer to CNO Practice Standard: Therapeutic Nurse-Client Relationships Blurring of Transference Patient unconsciously Boundaries and inappropriately displaces onto nurse feelings and behaviours related to significant figures in patient’s past Transference intensified in relationships of authority  Counter-transference Blurring of Nurse displaces feelings Boundaries related to people in nurse’s past onto patient Patient’s transference to nurse often results in counter-transference in nurse Common sign of counter- transference in nurse is over-identification with the patient  Values, Beliefs, and Self- Awareness Nurse’s values and beliefs Reflect own culture/subculture Derived from range of choices Chosen from a variety of influences and role models  Peplau’s Model of Nurse– Patient Relationship Following are necessary behaviours of all health care workers, including nurses: Accountability Focus on patients needs Clinical competence Delaying judgement Reflection Peplau’s Model of Nurse–Patient Relationship 1. Orientation phase 2. Working phase 3. Termination phase *An additional preorientation phase, during which the nurse prepares for the orientation phase has also been identified Orientation Establishing rapport Parameters of the Phase relationship Formal or informal contract Confidentiality Terms of termination  Maintain therapeutic relationship Working Phase Gather further data Promote patient’s Problem-solving skills Self-esteem Use of language  Facilitate behavioural change Working Phase Overcome resistance behaviours Evaluate problems and goals Redefine as necessary Promote practice and expression of alternative adaptive behaviours  Summarize goals and objectives Termination achieved Phase Discuss ways for patient to incorporate new coping strategies learned Review situations of relationship Exchange memories  Factors that enhance the nurse– patient relationship: What Consistency Hinders & Pacing Listening What Helps Initial impressions Promoting patient comfort and Nurse– balancing control Patient Trust Relationshi Two factors that did not progress p therapeutic relationship 1. Inconsistency 2. Unavailability  A nurse seeks to establish a relationship with a patient readmitted to the hospital. Reflectiv The patient is diagnosed e Case with bipolar disorder, depressed type, and was hospitalized the preceding Study month. 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 medications as prescribed, or you will be re- hospitalized.”  Therapeutic Communication Part 2  Therapeutic relationship Fundamental and essential to effective psychiatric care Patients experience positive outcomes when engaged in therapeutic relationships Introduction Therapeutic communication Central to the formation of therapeutic relationship Skills take time Development of own style and rhythm Empathy  Communication is an interactive Communicat process between two or more ion Process people who send and receive messages to one another Stimulus Sender Message Message sent through a variety of media Receiver  Effective Communication in Therapeutic Relationships Depends on Nurses knowing what they are trying to convey Communicating to the patient what is really meant Comprehending the meaning of what the patient intentionally or unintentionally conveys Peplau identifies two main principles to guide communication: Clarity Continuity  A new nurse on a psychiatric unit wants to effectively communicate in a therapeutic Class relationship with a patient. Reflection What are some things that will help this communication?  Personal factors Factors Affecting Environmental factors Communicati on Relationship factors  Verbal Communication All words a person speaks Communication is 10% verbal Communicates Beliefs and values Perceptions and meaning Can convey Interest and understanding Insult and judgement Clear or conflicting messages Honest or distorted feelings  Nonverbal Communication Communication is 90% nonverbal Tone of voice Emphasis on certain words Physical appearance Facial expressions Body posture Amount of eye contact Hand gestures  Interpretation of feelings and attitudes Interaction of Meaning based on body language and vocal Verbal and tones Nonverbal behaviours and cues do influence Nonverbal communication Communicati Messages are not always simple on Verbal message – content of message Nonverbal behaviour – process of the message  Communication Skills for Nurses Therapeutic Communication Strategies (Table 10.2 for full list) Silence Active listening Listening with empathy Clarifying techniques Paraphrasing Restating Reflecting Exploring  Communication Skills for Nurses Asking questions and eliciting patient responses Open-ended questions Close-ended questions Nontherapeutic Communication Techniques (Table 10.3 for full list) Excessive questioning Giving approval or disproval Giving advice Asking “why questions”  Cultural Considerations Consequential for interpretation of verbal and nonverbal cues: Communication style Use of eye contact Perception of touch Cultural filters – Form of bias or prejudice  Assertive Communication Clearly expressing needs with respectful language and behaviours in order to Challenge and promote alternatives De-escalate behaviours Provide and provoke new lines of thinking Advocate for oneself or others  Factors That Promote Patient Growth Genuineness Empathy Empathy versus sympathy Positive regard Attitudes Actions Attending Suspending value judgements Helping patients develop resources Empathy Versus https://youtu.be/KZBTYViDPlQ Sympathy