Therapeutic interactions

1. Therapeutic interactions COMMUNICATION SKILLS

2. THERAPEUTIC COMMUNICATION * THERAPEUTIC COMMUNICATION IS A DYNAMIC METHOD OF INTERACTING WITH PATIENTS FOR PROBLEM SOLVING AND GROWTH.

3. THE COMMUNICATION CYCLE • COMMUMNICATION IS THE SENDING AND RECEIVING OF MESSAGES. • SENDER—MESSAGE—RECEIVER-FEEDBACK • SENDER-Begins the cycle , must formulate a clear thought to send. • MESSAGE- the content to be communicated . • RECEIVER- recipient of the message must decode the message. Primary sensory skill is listening. • FEEDBACK- the receiver and sender both verify perception of message. May be verbal or nonverbal and relevant to the situation.

4. MODES OF COMMUNICATION • 1. SPEAKING • 2. LISTENING • 3. GESTURES OR BODY LANGUAGE • 4. WRITING

5. One to one nurse /patient relation INITIATING PHASE- • GETTING ACQUAINTED • ASSESS PATIENT • MAKES PATIENT FEEL ACCEPTED • LET PT. SET PACE OF RELATIONSHIP

6. GOALS • BUILD TRUST/RAPPORT, HELPING PURPOSEFUL RELATIONSHIP. • THERAPEUTIC ENVIRONMENT • ESTABLISH MODE OF COMMUNICATION • EST. TIME, PLACE, DURATION FOR EACH MEETING AND LENGTH OF TIME OF RELATIONSHIP • ASSES PT’S STENGTHS AND WEAKNESSES

7. INITIATING PHASE • NURSE USES THERAPEUTIC COMMUNICATION TECHNIQUES TO FACILITATE THIS PHASE

8. WORKING PHASE • ABLE TO DISCUSS GOALS WITH PATIENT DISCUSS ALTERNATIVE BEHAVIORS • PATIENTS ABLE TO FOCUS ON PROBLEM

9. WORKING PHASE GOALS • DEVELOP POSITIVE COPING BEHAVIORS • IDENTIFY AVAILABLE SUPPORT SYSTEMS • DEVELOP POSITIVE SELF IMAGE • ENCOURAGE VERBALIZATION OF FEELINGS • DEV, IMPLEMENT AND EVALUATE PLAN OF CARE • PROMOTE INDEPENDENCE

10. TERMINATING PHASE • NURSE TERMINATES RELATIONSHIP WHEN GOALS ARE MET • PATIENT TRANSFERRED • COMPLETED CLINICAL ROTATION

11. GOALS • PT PROVIDES SELF CARE • INDEPEND AND WORKS WITH OTHERS • RECOGNIZES S & S OF HIGHER STRESS AND ANXIETY • COPE POSITIVELY WITH FEELINGS • DEMONSTRATES EMOTIONAL STABILITY

12. TECHNIQUES FOR THERAPEUTIC COMMUNICATION • OPEN-ENDED QUESTIONS • EX. 1. HOW ARE YOU TODAY? • 2. WHAT CAN I DO FOR YOU TO HELP? • AVOID YES/NO ANSWERS • CLARIFYING TERMS • 1. ENCOURAGE PT TO RESTATE THE • COMMENT. • 2. IMPROVES CHANCES THAT MESSAGE SENT IS MESSAGE RECEIVED.

13. TECHNIQUES • REFLECTION/REPEATING/PARROTING • 1. ENCOURAGES EXPLORING THE MEANING OF THE STATEMENT.OR EVENT. • 2.USE WITH CAUTION, CAN BECOME IRRITATING IF OVERUSED. • ASKING FOR WHAT YOU WANT • EX. I NEED TO ASK YOU A FEW QUESTIONS. • 1. STATES PURPOSE OF INTERACTION • 2. KEEPS SPEAKER ASSERTIVE AND SELF RESPONSIBLE.

14. TECHNIQUES • IDENTIFYING THOUGHTSD AND FEELINGS. • EX.” I FEEL LIKE YOU HAVE MORE TO SAY.” • 1. HELPS PT. TO IDENTIFY AND LABEL • THOUGHTS AND EMOTIONS. • 2 . MAY GIVE INSIGHT TO UNDERLYING • CONCERNS OR COMPLICATIONS • OF HEALING.

15. TECHNIQUES • USING EMPATHY-ACKNOWLEDGE THE PATIENT’S FEELINGS • EMPATHY- THE ABILITY TO KNOW AND APPRECIATE ANOTHER, SEEING THINGS THE WAY OTHERS DO. IT MEANS LITERALLY WALKING IN ANOTHER’S FOOTSTEPS. • EMPATHY WILL ASSIST YOU TO GAIN THE TRUST OF THE PATIENT.

16. TECHNIQUES • SILENCE- SHOWS THAT NURSE IS COMFORTABLE WITH WHAT PT. SAYS AND IS WILLING TO HEAR MORE. • ALLOWS NURSE AND PATIENT TO COLLECT THEIR THOUGHTS.

17. TECHNIQUES • GIVING INFORMATION-INFORMING THE PT. WHAT IS GOING ON WITH HIM,INDIVIDUAL TREATMENT PLAN , D/C PLAN ETC. • INCREASES RAPPORT • EASES ANXIETY • CONFIRMS DR. INFORMATION • SUGGESTS COLLABORATION OF CARE.

18. GENERAL LEADS • “YES” • “GO ON” • “ AND THEN?” • TELLS THE PATIENT THE NURSE IS LISTENING. • ENCOURAGES THE PATIENT TO ELABORATE.

19. STATING IMPLIED THOUGHT AND FEELING • 1. LETS PATIENT KNOW YOU ARE PAYING ATTENTION. HEAR THEM AND CARE TO HELP. • 2. IDENTIFIES A SPECIFIC BEHAVIOR OR CHANGE IN BEHAVIOR. WHICH LOWERS CHANCE OF DENIAL. • EX.” Mrs. Jones you are not smiling today, I sense you are upset . How can I help?”

20. BLOCKS • BLOCKING COMMUNICATION BY THE NURSE OR THE PATIENT. • CLOSED-ENDED QUESTIONS. • EX. “CAN YOU TELL ME HOW YOU FEEL?” • “ DO YOU SMOKE?” • “ CAN I ASK YOU A FEW • QUESTIONS?” • 1. ALLOWS FOR YES OR NO ANSWER. • 2. DISCOURAGES FURTHER EXPLORATION OF THE TOPIC. • 3. DISCOURAGES PATIENT FROM GIVING INFORMATION.

21. BLOCKS • FALSE REASSURANCE OR SOCIAL CLICHES • EX. “DON’T WORRY IT WILL BE FINE” • MINIMIZING/BELITTLING • EX. “ WE ALL FEEL LIKE THAT AT TIMES” • THIS MAY JEOPARDIZE PATIENT’S TRUST IN NURSE • IMPLIES THAT PATIENT’S FEELINGS ARE NOT SPECIAL TO HIM OR HER.

22. BLOCKS • “WHY” • AVOID THE WORD WHY PT. FEELS OBLIGATED TO ANSWER WHEN HE OR SHE WISHES NOT TO OR IS UNABLE TO. • IT MAY COME ACROSS AS PROBING IN AN ABRASIVE WAY.

23. BLOCKS • ADVISING- “ YOU SHOULD” • “ IF I WERE YOU” • PLACES VALUE ON THE ACTION • GIVES IMPRESSION THAT NURSE’S VALUES ARE THE RIGHT ONES • JEOPARDIZES NURSE’S CREDIBILITY IF THIS ADVICE DOES NOT WORK FOR THE PATIENT.

24. OFFER INFORMATION • CAN OFFER PATIENT INFORMATION REGARDING SUPPORT GROUPS • INFORMATION ABOUT MEDICATIONS • ASSISTANCE WITH ADLS • OFFERING INFORMATION AND SUPPORT WITHOUT GIVING ADVICE

25. BLOCKS • AGREEING AND DISAGREEING • 1. PLACES A VALUE OF RIGHT OR WRONG ON AN ACTION • 2 CAN BE ARGUMENTATIVE • 3. PATIENT MAY BE RELUCTANT TO CHANGE BECAUSE NURSE HAS EXPRESSED A VALUE.

26. BLOCKS • CLOSED- ENDED QUESTIONS • “ CAN YOU TELL ME HOW YOU FEEL?’ • “ DO YOU SMOKE?” • “ CAN I SIT WITH YOU?” • ALLOWS FOR A SIMPLE YES OR NO • DISCOURAGES FURTHER EXPLORATION OF A TOPIC • DISCOURAGES PT. FROM GIVING INFORMATION.

27. BLOCKS • PROVIDING AN ANSWER WITH A QUESTION. • “ ARE YOU FEELING AFRAID?” • COMBINES A CLOSED ENDED QUESTION WITH A SOLUTION • DISCOURAGES PATIENT FROM PROVIDING OWN RESPONSE.

28. BLOCKS • CHANGING THE SUBJECT • 1. DISCOUNTS THE IMPORTANCE OF THE PATIENT’S NEED TO EXPLORE HIS/HER THOUGHTS AND FEELINGS • 2. MAY BE A REFLECTION OF THE NURSE’S OWN “UNCOMFORT” LEVEL WITH THE TOPIC.

29. BLOCKS • APPROVING OR DISAPPROVING • EX. “THAT’S THE WAY TO THINK IT” GOOD FOR YOU”. • “ THAT’S NOT A GOOD IDEA” • 1. CAN SOUND JUDGEMENTAL • 2. CAN SET THE PATIENT UP FOR FAILURE IF APPROVAL OR DISAPPROVAL DOES NOT HELP. • 3. CAN LOWER NURSES CREDIBILITY.

30. ATTENTIVENESS SHOWING ATTENTION IS NECESSARY FOR EFFECTIVE COMMUNICATION. POSTURE AND POSITION INDICATE ATTENTIVENESS. 1. Leaning forward toward the client is better then leaning back or sitting straight. 2. Open body posture suggests the nurse is ready to give and receive. Folded arms are a closed body posture. 3. Listening is a very important aspect of communication. It shows that the nurse is giving attention. Eye contact essential.

31. MILEU • STRUCTURED OR THERAPEUTIC ENVIRONMENT THAT ENCOURAGES PERSON TO FUNCTION WITHIN SOCIAL NORMS THRU MODIFICATION OF PERSON’S LIFE CIRCUMSTANCES AND IMMEDIATE ENVIRONMENT. • Treatment setting that can reduce behavioral disturbances.

32. MILIEU • ENVIRONMENT CLEAN AND SAFE HARMONIOUS COLORS AND COMFORTABLE SETTINGS CONTRIBUTE TO AN OVERALL SENSE OF WELL-BEING. • INCLUDES MANY THERAPY MODALITIES; GROUP THERAPY, ART AND MUSIC THERAPY, PET THERAPY,NUTRITIONAL COUNSELING, OCCUPATIONAL THERAPY AND VOCATIONAL WORK.

33. GOAL OF MILEU THERAPY • ENABLE PT. TO LIVE OUTSIDE INSTITUTION • ENCOURAGE DECISION MAKING AND COMMUNICATION • PROVIDE SAFETY AND COMFORT TO PT. • HELP FEEL ACCEPTED, CALM AND QUIET • PT EXPOSED TO RULES, EXPECTATIONS, PEER PRESSURE AND SOCIAL INTERACTIONS • PROVIDE OPPURTUNITY TO ENHANCE SELF ESTEEM AND LEARN NEW SKILLS AND BEHAVIORS

34. PSYCHO PHARMACOLOGY • VERY IMPORTANT TO THE EFFECTIVE TREATMENT OF THE PT. • WILL COVER IN PHARM

35. PSYCHO THERAPY • PROCESS IN WHICH FEELINGS AND THOUGHTS ARE EXPLORED, NEW WAYS OF PERCIEVING ENVIRONMENT ARE TAUGHT AND INTERVENTIONS ARE REINFORCED

36. TYPES OF PSYCHOTHERAPY PSYCHOANALYSIS- PT TALKS IN SPONTANEOUS MANNER FOR APPROX 45 MIN BRINGING REPRESSED EXPERIENCES TO THE CONSCIOUS MIND WHERE THEY CAN BE RESOLVED. HYPNOSIS – PT IN HYPNOTIC TRANCE AND ENCOURAGED TO DISCUSS CONFLICTS

37. TYPES OF PSYCHOTHERAPY • BEHAVIOR MODIFICATION • REPLACEMENT OF NEGATIVE BEHAVIOR WITH POSITIVE BEHAVIOR COPING SKILLS • CAN BE DONE THROUGH POSITIVE REINFORCEMENT OR NEG. REINFORCEMENT • CLEARLY STATES BEHAVIOR AND CONSEQUENCES • MUST ENFORCE RULES CONSISTENTLY

38. GROUP THERAPY • APPROX 6-10 PERSONS • GIVE OPPURTUNITY FOE EACH MEMBER TO EXAMINE INTERACTIONS, LEARN AND PRACTICE SUCCESSFUL INTERPERSONAL COMMUNICATION SKILLS AND EXPLORE EMOTIONAL CONFLICT

39. FAMILY THERAPY • GOAL ALL FAMILY MEMEMBERS TO ATTEND – TRY TO ESTABLISH OPEN COMMUNICATION AND HEALTHY INTERACTIONS WITHIN FAMILY.

40. ECT • PASSES ELECTRICAL CURRENT THROUGH ELECTRODES TO BRAIN • SIDE EFFECTS- • SKELETAL FRACTURES • MEMORY LOSS • ONSET OF DIMENTIA

41. ECT • SEVERALLY DEPRESSED • SUICIDAL • PSYCHOSIS • USUALLY USED IF NO RESPONSE TO MEDS

42. PSYCHOSURGERY • REMOVE OR DESTROY BRAIN TISSUE TO MODIFY DISTURBED BEHAVIOR

43. CRISIS INTERVENTION ATTEMPT TO RESOLVE AN IMMEDIATE CRISIS WHERE A PERSON’S LIFE GOALS ARE OBSTRUCTED AND USUAL PROBLEM SOLVING METHODS FAIL.

44. GOALS • ENSURE SAFETY – YOUR SAFETY FIRST • DIFFUSE THE SITUATION- VERBALLY • DETERMINE THE PROBLEM- FROM PTS. VIEWPOINT- DON’T PUSH PATIENT TO TELL • DECREASE ANXIETY LEVEL- DON’T TOUCH, STAY CALM, REASSURE PT OF SAFETY • RETURN TO PRECRISE LEVEL OF FUNCTION

45. MENTAL HEALTH DEVIATIONS/ MULTI AXIAL SYSTEM/ DSM-IV A MULTIAXIAL SYSTEM FOR ASSESSMENT AND CLASSIFICATION OF MENTAL ILLNESS • THE DIAGNOSTIC TOOL USED BY PSYCHIATRISTS AND PSYCHOLOGISTS WHICH CLASSIFIES MENTAL HEALTH PROBLEMS DESIGNED TO PROVIDE A COMPREHENSIVE DIAGNOSIS, ENCOMPASSING FACTORS THAT ACCOUNT FOR PATIENTS MENTAL ILLNESS • DSM-IV (DIAGNOSTIC AND STATISTICAL MANUAL IV)

46. AXIS’S • AXIS I – CLINICAL DISORDERS • DELERIUM • DEMENTIA • MOOD DISORDERS • PSYCHIATRIC DISORDERS

47. AXIS’S II • PERSONALITY AND DEVELOPMENT DISORDERS • MENTAL RETARDATION

48. AXIS’S III • GENERAL MEDICAL CONDITIONS • DIABETES • HYPERTENSION

49. AXIS’S IV • PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS – EDUCATION, SOCIAL, AND ECONOMIC • EVENTS IN ONES LIFE ,MARITAL STATUS • HOUSING SITUATION • LOSS- DIVORCE, DEATH OF LOVED ONE,PET

50. AXIS’S AXIS V GAF- GLOBAL ASSESSMENT OF FUNCTIONING HIGHEST LEVEL FUNCTIONING - # OF FUNCTIONING SYSTEMS FOR RANKING SEVERITY OF SX’S • SCALE 0-100 • DETERMINED AFTER OBSERVATION BY DOCTOR , NURSES AND THERAPISTS