I am Cathy with Level Up RN, and
in this video, I'm going to talk about the nurse-client relationship,
as well therapeutic communication. And at the end of the video, I'll give
you guys a little quiz to check your knowledge about some of the key concepts
that I'm going to cover in this video. So let's first talk about a
nurse-client relationship. Within that relationship, there are four phases.
The first phase is Pre-orientation. This is where you prepare for your meeting with
the patient. You will do a chart review, and then you also want to examine your thoughts
and feelings about working with the patient. Then, during the Orientation Phase, you would
perform introductions, establish rapport with the patient, also establish boundaries,
and talk about patient confidentiality. You will set mutually agreeable goals with
the patient and also establish the date, time, place, and duration of meetings.
Then, when we get to the Working Phase, which is next, this is where we
gather data and identify and practice problem-solving skills and coping skills.
We would provide education to the patient, and then we would evaluate progress being made
towards those goals during that Working Phase. And then, finally, we have the Termination
Phase of the nurse-client relationship and during this time we would summarize the
goals that were achieved during the relationship. We can discuss incorporation of those new coping
mechanisms and problem-solving skills into their life and discuss their discharge plans.
And then we also want to allow time for the patient to share their feelings
regarding termination of their relationship because termination of the relationship may
elicit a sense of grief from the patient. Now let's talk about the concepts of
transference and countertransference. Transference is where the
patient redirects or transfers their feelings about a person from their past onto
the nurse. So let's say a nurse reminds a patient of their abusive mom and it causes that patient
to treat the nurse in a very negative way. That's an example of transference.
And then countertransference is where the nurse's feelings and response towards the patient
are influenced by their past relationships. So if a patient reminded the nurse
of somebody from their past it may cause the nurse to treat that patient
differently. That is countertransference. So within my wound care team, we have several
team members and sometimes one of my partners on the team. They have a really hard time with
a certain personality or a certain person, but it's not a really big deal for me.
So I'm like, "Let me take them. That's not a big deal," and vice versa. If
there's somebody that kind of gets under my skin or I have a harder time with, then
sometimes my partner will take that patient. That doesn't happen a lot, but every once in
a while it does. And it's kind of nice that we can share that burden and help each other out
when counter-transference becomes an issue. Alright. Next, let's talk about therapeutic
communication. So I'm going to go through some therapeutic communication techniques,
and then we'll go through non-therapeutic communication techniques.
So therapeutic communication is so important in the mental health setting, but
it's also important in any setting, and so you'll need to know these techniques for all your classes
in nursing school, not just psychiatric nursing. And then it's also going to be important to
know these techniques for your nursing practice. So let's go through some of them.
First, we have broad opening remarks. So this could be saying something like, "What would
you like to talk about today?" And that helps to engage the patient and get them talking, which is
really the goal with a lot of these techniques. Then we have open-ended questions. So, "Tell me
more about the voices that you're hearing," and that's important to get the patient talking and
telling you what those voices are saying to he or she so that you can determine if they're at risk
for harm, or if others are at risk for harm so that you can get the patient the help they need.
Then we have sharing observations, and an example of this would be, "You seem a little
sad to me today." And then that kind of opens the door for the patient to share more about how
they're feeling and why they're feeling that way. Then we have a technique called clarification,
which is also referred to as validation, and this is where you seek understanding
for something that is vague or confusing. So you can say something like, "Do I understand
you correctly when you say this?" Right? So if the patient is giving you a lot of
information and you really just want to clarify that you're understanding them correctly, then
clarification or validation are good techniques. Reflection is a technique you would use
to refer a question back to the patient. So if the patient's like, "Do you think I should
try that new medication?" then I might say, "Well, what are your thoughts on that?"
And that's kind of like reflection. So they ask me a question, and I kind of reflect
it back to them so that they can really think about it and make that decision.
Another technique is offering self, and and this is where you make yourself available
to the patient. And an example of this would be-- I had a patient at the hospital. I had just
finished some wound care, and he was in ICU, and he was getting ready to get an IJ vascular
access put in, and he was really scared. And I told him-- I was like, "I will wait
here with you while you get that done," even though I was done with wound care. He was
really scared, and I was just there, and I held his hand. So that was like offering of myself.
Then we have restating. This is where you repeat what the patient said to confirm
your understanding. So if the patient says, "I'm so anxious that I can't get to sleep," you
could say something like, "So your anxiety is keeping you up at night?" So kind of restating
what they said to confirm my understanding. And then lastly, we have presenting reality, which
is really important in the mental health setting. So this is where you are correcting a patient's
misconception. So if they are saying that they're hearing voices, you want to acknowledge that
they are hearing voices, but you don't want to validate the fact that there are voices.
So you can say, "I understand that you're hearing voices, but I do not hear any voices."
So again, you want to acknowledge that their perception of reality is real to them, but
you also want to let them know that you don't hear those voices, right?
You want to present that reality. And then other therapeutic communication
techniques can include silence as well as eye contact and therapeutic touch if appropriate.
And this will vary across individuals, different cultures, religions, so you really want
to not make any assumptions that these techniques would be okay for every single patient.
But they can be helpful for many patients. Alright. Let's now talk about
non-therapeutic communication techniques. So you do not want to use these
techniques. These are not therapeutic. So false reassurance. If you were to say
to your patient, "Everything is going to be just fine in the end," that would be false
reassurance, and that is not therapeutic. Also, passing judgement, so approving or
disapproving is not therapeutic. So if you were to say to your patient, "Yes, you did the right
thing," that is not what we want to be doing. Giving advice is also something we shouldn't
do. So "you should or shouldn't" should not be something that you say to your patient.Of
course, I'm giving you advice right now, but this is not therapeutic. But you
shouldn't use "you should or shouldn't" when talking to your patient in a therapeutic way.
Then we have close-ended questions. So these are like yes/no questions. "Are you
feeling sad and they're like, "Yes," and that's the end of the conversation.
That's not what we want. We really want them to talk. So asking those
close-ended questions really shuts off the conversation when we want to open it up.
Then we have why questions. "Why are you so angry?" It really puts the patient on the
defensive when you use these why questions. So that is definitely not a therapeutic way
to phrase a question. No why questions. And then we have leading or biased questions
like, "You don't smoke, do you?" And we're kind of biased and leading the patient towards a
certain answer. And that is also non-therapeutic. And then finally, changing the
subject is also not therapeutic. So, "Let's talk about something else," is
not something you're going to want to do. Alright. Quiz time. First question. During
which phase of the nurse-client relationship do you discuss confidentiality with the patient? If you answered... the
orientation phase, you are right. Okay. Now we're going to do a little speed round.
I want you to give me a thumbs up if the statement or question I give you is therapeutic and a thumbs
down if it is not therapeutic. So we're going to do four different question statements.
First one. "You seem sad to me today." Therapeutic, because you're sharing observations.
"Why are you so angry?" Not therapeutic. The question starts with why,
which is always a warning sign, and it really just puts the patient on the defensive.
Third statement. "Everything will be okay in the end." Not therapeutic, right.
It's false reassurance, and you don't actually know that things will be okay in the end.
And then, "Tell me more about how you're feeling." Therapeutic, because it
encourages open communication, encourages the patient to share more.
Alright. That's it for this video. Thank you so much for watching, and I'll see you soon.
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