Week 4 Therapeutic Relationship and Clinical Conversations PDF

NUR1 222 Strengths-Based Nursing & Professional Practice September 22,2022 Therapeutic Relationships and Clinical Conversations Maria Di Feo Outline Nurse- Patient Relationships - Collaborative Partnership - Professional Communication - Therapeutic Relationship - Clinical Conversations guided b...

NUR1 222 Strengths-Based Nursing & Professional Practice September 22,2022 Therapeutic Relationships and Clinical Conversations Maria Di Feo Outline Nurse- Patient Relationships - Collaborative Partnership - Professional Communication - Therapeutic Relationship - Clinical Conversations guided by SBN Values - 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 Quiz #1 During a clinic visit the patient informs the nurse that he has not been sleeping well since his last visit to the clinic two weeks ago. He explains that he has trouble falling asleep and that he doesn't sleep more than four hours a night. One of the question's the nurse asks the patient is "What do you think could be contrib uti ng to you not be able to get a good night's sleep?" The nurse is being guided primarily by which SBN value? Collaborative Partnerships Learning, Readiness, and Timing Objective/Subjective Reality and Created Meaning Self-Determination What do nurse’s do? Nurse’s Act Article 36 (OIIQ): The practice of nursing consists in assessing a person’s state of health, determining and carrying out of the nursing care and treatment plan, providing nursing and medical care and treatment in order to maintain or restore health and prevent illness, as well as provide palliative care. Anything else? 9/22/2022 5 Nursing is as much about “being”, as it is about “doing”. It’s 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 person’s /family’s 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) 9/22/2022 8 The way a nurse is with the person/family The way a nurse engages, interacts, “Being” in SBN connects and is involved with the person Approach Giving the other a voice Being committed to and caring for another with compassion, respect and dignity 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”. ❖ Maslow ’s (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 person’s 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 • … Why is it important that Healthcare providers develop Effective Interpersonal Communication Skills? Effective Interpersonal Communication Skills Support Safety and Quality in Healthcare Delivery How? Effective Interpersonal Communication Impacts Quality of Care: • Helps development a collaborative care par tnership • Better understanding of the person & his situation • Identif ication 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 puts patients in better conditions to heal Engaging in Assists in Developing Therapeutic a Therapeutic Communication Relationship Nurse – patient Relationship is the Foundation of Nursing Practice. Establishing a Trusting Collaborative Relationship Therapeutic Relationship (Gottlieb, 2013) • Nurse comes to know the person as a unique individual. • Through “knowing” the person the nurse connects with the person. • “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.” • 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. • It is in this therapeutic relationship “ way of a being” with patients that nurses provide knowledgeable and compassionate care. 9/22/2022 21 Foundations for Therapeutic Relationships All therapeutic relationships begin with establishing a rapport (i.e. demonstrating EMPATHY). There are 3 elements to building a connection with a patient: • Mutual attentiveness – attend to the other’s 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 “A’s” (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 another’s thoughts and feelings and are Authentic Presence • Being fully present (mentally and physically). • Communicating our interest in Attentive Listening • Being present both physically and mentally • Adapting an unhurried stance responding in ways that are in the patient/family via our verbal sync. Adopting an, “I don’t and non-verbal communication. message, stated or not stated • Adopting the stance of a learner • Being comfortable with silence 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. (i.e. respect & humility) • Listening for the underlying • Not interrupting • Use open ended questions that will encourage patient to share thoughts.. A person who is well attuned will respond with appropriate language Attunement describes how reactive a person is to another's emotional needs and moods. 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 /files /Establishing_Therapeutic_Relationships.pdf “The therapeutic relationship is grounded in an inter personal 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.” 9/22/2022 27 Establishing Therapeutic Relationships Nursing Best Practice Guidelines RNAO (cont..) Establishment of a therapeutic relationship requires reflective practice. • Self-awareness (self reflection) • Self-knowledge (knowing one’s values * beliefs) • Empathy • Awareness of boundaries and limits of the professional role. 9/22/2022 Focus on person/family Health related Interpersonal Health care Boundaries (Professional Boundaries) Involves thought (choice of words), reflection, selfawareness 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 /files /Establishing_Therapeutic_Relationships.pdf Boundaries define the limits of the professional role. A nurse is obligated to place the client’s needs before his /her own needs. Through self-awareness, the nurse reflects on whether or not his /her actions are in the client’s best interest. 9/22/2022 30 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 patient’s 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 9/22/2022 36 The values of SBN guide a nurse’s practice • How they engages /acts with patients /families • What they choose to explore with patients /families • Type of questions they ask patients /families 9/22/2022 37 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/22/2022 38 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/22/2022 39 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/22/2022 40 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/22/2022 41 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/22/2022 42 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/22/2022 43 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/22/2022 44 Copyrighted Material: University Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill 9/22/2022 45 References G o ttlieb, L . N . ( 2 0 1 3 ) . Str e n g ths - b as ed n u r s i n g ca r e . Sp r i n g er Pu blis he r C a na da Ko e r n e r, J. E . G . ( 2 0 1 1 ) . H e a l in g p r e s e n ce : Th e e s s e n ce o f n u r s i n g. N e w Yo r k : Sp r i n g er Pu b. C o. Ko z i e r, B., E r b, G ., B e r m a n , A., B u ck, M ., Y i u , L ., & Sta m l er, L . L . ( E d s .) ( 2 0 1 8 ) . Fu n d a m e ntals of C a na d ia n N ur s ing . C a n a d i an 4 th e d . Tor onto: Pe a r son Ed uca ti on C a na d a . M a l l ette, C ., Yo ng e, O., A r n o ld, E . C ., & B o g g s , K . U. ( 2 0 2 1 ) . A r n o ld a n d B o g g s 's In te r p er s on al Re l a tion s hips : Pr o f e s s io nal C o mmu nica tion Sk i lls f o r C a n a d i an N u r s e s . To r o n to: E l s e v ier H e a l th Sci e n ce s M a s l o w, A . H . ( 1 9 4 3 ) . A th e o r y o f h u m a n m o ti vatio n. P s yc h o lo gi c a l r evi ew , 5 0 ( 4 ) , 3 7 0 396. M aye r o f f, M . ( 1 9 9 0 ) . O n ca r i n g . N e w Yo r k , N Y: H a r p e r Per en nia l.