Nurse/Client Relationship, Therapeutic Communication -Psychiatric Mental Health Nursing

There are four phases in the nurse-client relationship. The Pre-orientation phase (00:00:21) involves preparing for the patient meeting, chart review, and examining personal feelings. The Orientation Phase (00:00:39) includes introductions, building rapport, establishing boundaries, discussing confidentiality, setting mutual goals, and agreeing on meeting logistics. The Working Phase (00:01:06) focuses on data gathering, problem-solving, coping skill development, education, and evaluating progress. Finally, the Termination Phase (00:01:25) summarizes achievements, discusses incorporating new skills, plans for discharge, and allows the patient to express feelings about the relationship ending.

Transference (00:02:06) occurs when a patient redirects feelings about a past person onto the nurse. Countertransference (00:02:34) is when the nurse's feelings and responses to a patient are influenced by their past relationships, sometimes necessitating team collaboration to manage.

Therapeutic communication is crucial in all nursing settings. Techniques include broad opening remarks (00:04:06) (e.g., 'What would you like to talk about today?'), open-ended questions (00:04:22) (e.g., 'Tell me more about the voices you're hearing?'), sharing observations (00:04:49) (e.g., 'You seem a little sad to me today.'), clarification/validation (00:05:01) (e.g., 'Do I understand you correctly?'), reflection (00:05:31) (referring a question back to the patient), offering self (00:05:59) (making oneself available), restating (00:06:35) (repeating patient's words to confirm understanding), and presenting reality (00:06:53) (correcting misconceptions while acknowledging their perception). Other techniques include silence, eye contact, and appropriate therapeutic touch, considering cultural differences.

Nurses should avoid non-therapeutic communication techniques such as false reassurance (00:08:10) (e.g., 'Everything is going to be just fine.'), passing judgment (00:08:21) (approving or disapproving), giving advice (00:08:34) ('you should or shouldn't'), close-ended questions (00:08:56) (yes/no questions that limit dialogue), 'why' questions (00:09:11) (which can make patients defensive), leading or biased questions (00:09:29), and changing the subject (00:09:43).

A quiz reinforces key concepts: confidentiality is discussed during the orientation phase (00:09:59). Identifying statements as therapeutic or non-therapeutic: 'You seem sad to me today' is therapeutic (sharing observations) (00:10:20). 'Why are you so angry?' is non-therapeutic (why question) (00:10:34). 'Everything will be okay in the end' is non-therapeutic (false reassurance) (00:10:45). 'Tell me more about how you're feeling' is therapeutic (encourages open communication) (00:10:58).