Psychiatric Nursing

NCM 117/ LECTURE/ COMMUNICATION AND THERAPEUTIC RELATIONSHIP / PPT BASED FROM PROF. ROLANDO YABUT

Common Techniques in Communication

CORE CONCEPTS ON • Giving broad opening: giving
THERAPEUTIC COMMUNICATION the client to take the initiative in
Communication introducing the topic.
refers to the reciprocal exchange of ideas between o Example: “Is there anything
or among persons. that you want to talk
Elements of Communication about?”
Sender Originator of information o “Where would you like to
Message Information being transmitted To initiate begin?”
Receiver Recipient of information conversation • Giving recognition:
Channel Mode of communication acknowledging, indicating
Feedback Return response awareness.
Context The setting of communication o Example: “I noticed that
Criteria of Successful Communication you combed your hair
• Feedback today.”
• Appropriateness o Good morning, Mr. S…”
• Flexibility
• Efficiency • Giving information: making
Common Problems in Communication available the facts that the
• Dysfunctional communication client needs.
• Double bind communication o Example: “Visiting hours
o conveys a “dammed if I do and dammed if I are…”
don’t.” To Establish • Use of silence: refraining from
o e.g. A family member may respond to a Rapport and speech to give the patient a
direct request by another family member, Build Trust time to sort out thoughts and
only to be rebuked when the request is feelings.
fulfilled. o Example: Nurse says
• Difference between the denotative and nothing but continues to
connotative meaning maintain eye contact and
o Connotation conveys interest.
▪ an idea or quality that a word makes • Focusing: concentrating on a
you think about in addition to its single topic.
meaning. o Example:
o Denotation To Gather Client: “This point seems worth
▪ meaning of a word Information looking at more closely.”
• Incongruent meaning Nurse: “Of all the concerns you
mentioned, which is most
troublesome.”

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Psychiatric Nursing
NCM 117/ LECTURE/ COMMUNICATION AND THERAPEUTIC RELATIONSHIP / PPT BASED FROM PROF. ROLANDO YABUT
• Validating: confirming one’s
observation.
o Example: “Are you saying
that…”
• Reflecting: directing client
actions, thoughts and feelings
back to the client.
o Example:
Client: “My sister spends
all my money and then
has the nerve to ask for
more.”
Nurse: “This causes you
to feel angry?”
• Restating: repeating the main
idea expressed. Nurse repeats
what the client has said
approximately or nearly the
same words the client has used.
o Example:
Client: “I can’t sleep. I stay
awake all night.”
Nurse: “You have difficulty
sleeping.”
Client: “I’m really mad, I’m
really upset.”
Nurse: “You’re really mad
and upset.”
• Summarizing: developing a
concise resume of what has
transpired.
THERAPEUTIC NURSE – PATIENT RELATIONSHIP
• A relationship is defined as a state of being
related or a state of affinity between two
individuals
• The nurse and client interact with each other in
health care system with the goal of assisting
client to use personal resources to meet his or her
unique needs
TYPES OF RELATIONSHIPS
• A social relationship is
defined as relationship
that is primarily initiated
with the purpose of
friendship, socialization,
SOCIAL enjoyment or
RELATIONSHIPS accomplishing a task.
• Mutual needs are met
during interaction
• For example, participants
shares feelings, ideas &
experiences
• An intimate relationship
occurs between two
individuals who have an
emotional commitment
with each other.
INTIMATE • Those in an intimate
RELATIONSHIPS relationship usually react
naturally with each other.
• Often the relationship is a
partnership wherein each
member cares about the
other’s need for growth &
satisfaction.
• The therapeutic
relationship between the
nurse & the patient
THERAPEUTIC differs from both a social
RELATIONSHIP & an intimate
relationship in that the
nurse maximize inner
communication skills,
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Psychiatric Nursing
NCM 117/ LECTURE/ COMMUNICATION AND THERAPEUTIC RELATIONSHIP / PPT BASED FROM PROF. ROLANDO YABUT

understanding of human behavior responses to

knowledge
& strengths, in order to enhance about the
the patient’s growth. client.
• Examining
• The focus of the relationship
one’s feelings,
is on the patient’s ideas, fears, and
experiences & feelings anxieties
about
GOALS OF THERAPUETIC RELATIONSHIP
working with
• Facilitating communication of distressing a particular
thoughts & feelings client.
• Plan for first
• Assisting the client with problem solving meeting with
• Helping the client examine self-defeating the clients
behaviors & test alternatives • during the • Perception • Nurse
orientation of each must be
• Promoting self-care & independence other as willing to
phase, the
PHASES OF A THERAPEUTIC NURSE-CLIENT nurse and unique relate
RELATIONSHIP client become individual honestly
may not her
acquainted.
take place. feeling
PROBLEMS WAYS TO Tasks include the • Problems and
PHASES ENCOUNTE OVERCOM following: related to share it
• Creating an establishm with
RED E environment ent of an superviso
• it involves • Difficulty in • Help from for the agreement r.
preparation self- peers establishment or pact • Nurse
for the first analysis & and
The
of trust and between must feel
encounter self- superviso Orienta
rapport. the nurse free to
with the acceptance r in self- tion and reveal
• Establishing a
client. • Anxiety analysis (Introdu contract for patient. self
Task include the • Boredom and ctory) intervention without
following: • Anger facing Phase that details fear of
The Pre-
• Obtaining • Indifference reality the criticism.
interacti available • Depression • Analyze expectations
on information herself and
Phase about the and responsibilitie
client from his recognize s of both
or her chart, her asset nurse and
significant and client.
others, or limitation • Gathering
other health assessment
team information
members. to build a
This initial strong client
information data base.
may also
allow the
nurse to
become
• Identifying the • Difficulty
aware of
client’s may be
personal

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Psychiatric Nursing
NCM 117/ LECTURE/ COMMUNICATION AND THERAPEUTIC RELATIONSHIP / PPT BASED FROM PROF. ROLANDO YABUT

strengths and faced in rapport that of the when the

limitations. assisting a was patient nurse
• Formulating nurse with established • The believes
nursing countertran during the nurse’s she is
diagnoses. sference orientation fear of making
since most phase. closeness little or no
• Setting goals
of her • Promoting • Life progress.
that are
behavior is the client’s stressors • Handling
mutually
unconsciou insight and of nurse resistances
agreeable to
sly perception of • Resistanc
the nurse and determined reality. e
client. . • Problem behavior
• Developing a • A alert solving. • Transfere
plan of action supervisor • Overcoming nce
that is can resistance • Countertr
realistic for observe behaviors on ansferenc
meeting the this and the part of e
established guide the the client as
goals. nurse level of
appropriate anxiety rises
• Exploring
ly. in response to
feelings of
the discussion
both the
of painful
client and issues.
nurse in • Continuously
terms of the evaluating
introductory progress
phase. toward goal
Introductions attainment.
are often Termination may • Anger • Nurse
uncomfortabl occur for a variety • Punitive should be
e, and the of reasons: behavior aware of
participants • the mutually • Depressio patient
agreed-on n or feeling & be
may
goals may assuming able to
experience
have been non handle with
some anxiety
reached. caring them
until a degree The • the client attitude appropriate
of rapport may be • Flight to ly
Termina
has been discharged health • Assist the
tion
established. from the • Flight to patient by
Phase
hospitals illness openly
• in the case of • Nurse’s eliciting his
• the • Testing of • Conference inability thoughts &
a student
The therapeutic nurse by s with the or feelings
nurse, it may
Workin work of the the supervisors unwilling about
be the end of
relationship is patient & group ness to termination
g Phase clinical
accomplished • Unrealisti discussions make • Supervisor
in this phase c with other rotation.
specific can assist
Tasks include the assumpti members plans and the nurse in
Termination can
following: on about of the staff impleme preparing
be a difficult phase
• Maintaining progress • There will nt them patient for
for both the client
the trust and be times • discharge
and nurse. Tasks

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Psychiatric Nursing
NCM 117/ LECTURE/ COMMUNICATION AND THERAPEUTIC RELATIONSHIP / PPT BASED FROM PROF. ROLANDO YABUT

include the assist is spatial

following:
• Progress has
orientation.
been made • Temporal lobes
toward
o are centers for the sense
attainment of
mutually set of smell, hearing,
goals. memory, and
• A plan for
expression of emotions.
continuing
care or for • Occipital lobes
assistance o assist in coordinating
during language generation
stressful life
and visual
experiences is
mutually interpretation, such as
established depth perception.
by the nurse
•
and client.
feelings about
• Dopamine -controls
termination complex movements,
of the motivation, cognition,
relationship
regulates emotional
are
recognized responses
and explored. • Serotonin-regulation of
Foundation emotions, controls food
Central Nervous System intake, sleep and
• Frontal lobe wakefulness, pain control,
o control organization of Neurotransmitte sexual behaviors
thought, body rs • Acetylcholine- controls
movement, memories, sleep and wakefulness cycle
(decreased in Alzheimer’s)
emotions and moral
Cerebrum • Histamine-controls
behavior.
alertness,peripheral allergic
o Associated with
reactions, cardiac
schizophrenia,
stimulations
attention deficit / • GABA-modulates other
hyperactive disorder neurotransmitters
and dementia • Norepinephrine /
• Parietal lobe Epinephrine-causes
o interpret sensations of changes in attention,
taste and touch and

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Psychiatric Nursing
NCM 117/ LECTURE/ COMMUNICATION AND THERAPEUTIC RELATIONSHIP / PPT BASED FROM PROF. ROLANDO YABUT

learning and memory, • Flight of Ideas – shifting of one topic form one
mood subject to another in a somewhat related way.
• Looseness of Association – shifting of a topic
from one subject to another in a completely
unrelated way.
• Clang Association – the sound of the words
gives direction to the flow of thought.
• Delusion –false belief which is inconsistent with
one’s knowledge and culture and cannot be
corrected by reasons.
• Thought broadcasting – a delusional belief that
others can hear or know what the client is
thinking.
• Thought insertion ’ a delusional belief that
Genetics and Hereditary others are putting ideas to client’s head
• Alzheimer’s disease – linked with defects in • Thought Withdrawal ’ a delusional belief that
chromosomes 14 and 21 others are taking the client’s thoughts away and
• Schizophrenia the client is powerless to stop it.
• Mood disorders (depression)
• Autism and AD/HD Disturbances of Affect
Disturbances in perception • Inappropriate affect – disharmony between
• Illusion – misperception of an actual external the stimuli and the emotional reaction.
stimuli. • Flat affect – absence or near absence of
• Hallucination – false sensory perception in the emotional reaction.
absence of external stimuli. • Apathy – dulled emotional tone.
Disturbances in thinking • Blunted affect – severe reduction in
• Neologism – pathological coining of new words. emotional reaction.
• Circumstantiality – over inclusion of details. • Ambivalence – presence of two opposing
• Word salad – incoherent mixture of words and feelings.
phrases. • Depersonalization – feeling of strangeness
• Verbigeration – meaningless reception of words towards one’s self
or phrases. • Derealization – feeling of strangeness towards
• Perseveration – persistence of a response to a the environment
previous question.
• Echolalia – pathological repetition of words of
others.

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Psychiatric Nursing
NCM 117/ LECTURE/ COMMUNICATION AND THERAPEUTIC RELATIONSHIP / PPT BASED FROM PROF. ROLANDO YABUT
Disturbances in Motor Activity
• Echopraxia – the pathological imitation of
posture/action of others.
• Waxy flexibility – maintaining the desired
position for long periods of time without
discomfort.
Disturbances in Memory
• Confabulation – filling in memory gap.
• Amnesia – inability to recall past events.
• Anterograde amnesia – loss memory of the
immediate past.
• Retrograde amnesia – loss of memory of
the distant past.
• Déjà vu – feeling of having been to place which
one has not yet visited.
• Jamais vu – feeling of not having been to a
place which one has visited.
CONDITIONS ESSENTIAL TO THE DEVELOPMENT
OF A THERAPEUTIC RELATIONSHIP
Rapport
• implies special feelings on the part of both client
and the nurse based on acceptance, warmth,
friendliness, common interest, a sense of trust,
and a nonjudgmental attitude.
Trust
• to trust another, one must feel confidence in
that person’s presence, reliability, integrity,
veracity, and sincere desire to provide
assistance when requested.
Nursing Interventions that would promote TRUST.
o Providing a blanket when the client is cold.
o Providing food when the client is hungry.
o Keeping promises.
o Being honest (e.g., “I don’t know the answer
to your question, but I’ll try to find out”) and
then following through.
o Simply and providing reasons for certain
policies, procedures, and rules.
o Providing written, structured schedule of
activities.
o Attending activities with the client if he or
she is reluctant to go alone.
o Being consistent in adhering to unit
guidelines.
o Taking the client’s preferences, request, and
opinions into consideration when possible in
decisions concerning his or her care
ensuring confidentiality providing
reassurance that what is discussed will not
be outside the boundaries of the health care
team.
Respect
• to show respect is to believe in the dignity and
worth of the individual regardless of his or her
unacceptable behavior. Rogers (1951) called this
unconditional positive regard.
Interventions that would convey an Attitude of
Respect
o Calling the client by name (and title, if the
client prefers)
o Spending time with the client
o Allowing for sufficient time to answer the
client’s questions and concerns.
o Promoting an atmosphere of privacy during
therapeutic interactions with the client or
when the client may be undergoing physical
examination or therapy.
o Always being open and honest with the
client, even when the truth may be difficult
to discuss.
o Taking the client’s ideas, preferences, and
opinions into consideration when planning
care.
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Psychiatric Nursing
NCM 117/ LECTURE/ COMMUNICATION AND THERAPEUTIC RELATIONSHIP / PPT BASED FROM PROF. ROLANDO YABUT

o Striving to understand the motivation • Transference ’ occurs when the client

behind the client’s behavior, regardless of unconsciously displaces (or “transfers”) to the
how unacceptable it may seem. nurse feelings formed toward a person from his
or her past (Sadock & Sadock, 2003).
• Countertransference – refers to the nurse’s
behavioral and emotional response to the client.
Genuineness
• refers the nurse’s ability to be open, honest, and
“real” in interactions with the client. When one is
genuine, there is congruence between what is felt
and what is being expressed (Raskin & Rogers,
2005).
Empathy
• is the ability to see beyond outward behavior
and to understand the situation from the client’s
point of view.
Difference between Empathy and Sympathy
• The major difference is that with empathy the
nurse accurately “perceives and understands”
what the client is feeling and encourages the
client to explore these feelings.
• With sympathy the actually “shares” what the
client is feeling, and experiences a need to
alleviate distress. Shuster (2000) states:
• Empathy means that you remain emotionally
separate from the other person, even though
you can see the patient’s view point clearly. This
is different from sympathy, Sympathy implies
taking on the other needs and problems as if
they were your own and becoming emotionally
involved to the point of losing your objectivity. To
empathize rather then, sympathize, you must
show felling but not get caught up in feelings or
overly indentify with the patient’s and family’s
concerns.
TRANSFERENCE AND COUNTERTRANSFERENCE
• common phenomena that often arise during the
course of a therapeutic relationship.

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