NURSING FINAL 2014 SPRING
Therapeutic Communication in Nursing:
• orientation - verbal agreement between patient and nurse to work together to solve
problems; Goal of orientation phase is to ground the relationship in trust, follow through,
enthusiastic care, respect of confidentiality
o data-gathering process; tone and guidelines for the relationship are established.
o Identify each other (exchange names/roles).
o Verbal/written agreement about the relationship.
o Openness + interest in concerns → trust + communication (care + respect)
• working - (longest) performs additional client assessment, analyzes the resulting data,
and modifies the plan of care as needed. Nursing interventions are implemented and
expected nursing outcomes are defined. Nurse presents information and validates and
clarifies the patient’s understanding.
o work together to meet patient’s physical/psychosocial needs.
o Purposeful interaction to ensure achievement goals/objectives.
o Importance of satisfactory sentiments and feelings in order to work together
o Providing assistance needed to perform activities of daily living.
o Use interpersonal skills - teacher/counselor roles used primarily in this stage
▪ motivate patient to learn/implement health promotion activities
▪ facilitate ability to execute plan of care and express feelings
• termination - near end of the relationship. Can be difficult as it precedes permanent
separation; experience feelings of anxiety, sadness and sense of loss. Varies depending
upon the length of the relationship, the meaning assigned to the relationship, and the
extent to which outcomes were achieved.
o acknowledge the conclusion of the initial agreement
o patient discharged/nurse leaves
o examine for fulfillment/progress of goals with the patient
▪ if fulfilled, acknowledgement is important → feeling of satisfaction
▪ if not, acknowledgement of progress to make suggestions for future
o emotions - regret of departing; anxiety about the future
▪ patient should be encouraged to express emotions about termination
o preparation - help establish relationship with another nurse; assist patient transfer
(explanation); introduce personnel
o Help/support patient about their views/emotions; easier if they have positive
anticipation for termination (ie set goals)
Active listening behaviors
• ie) Sit down at eye level; drawn curtain for privacy, quiet/relaxed atmosphere
• Ability to focus on the client and what the client’s messages are about and conveying
back to the client an accurate picture of what he/she is expressing (through restatement
• The nurse must not only listen to the patient’s words, but also his/her emotions (usually
manifested through nonverbal communication such as facial expression, body posture,
laughter, or crying).
• Ask open ended questions (How are you feeling today? Tell me about your pain. You
seem worried) Behaviors to promote therapeutic relationship
• Good clinical judgment - knowing the patient, understanding his or her concerns,
preferences, the history, the illness, as well as the best scientific knowledge - Benner and
• Empathy - The ability to enter into another person’s experience to perceive it accurately
and to understand how the situation is viewed from the person’s perspective.
• Eastern Theological Perspectives
barriers to therapeutic relationships
• Language barriers
o cognitive impairment
o aphasia- disturbance of the comprehension and formulation of language caused
by dysfunction in specific brain regions
o dysarthria - when you have difficulty saying words because of problems with the
muscles that help you talk
SBAR - presentation of all patient-related information to another caregiver
• Situation -
Video: A Touch of Mercy (review your notes on worksheet)
Sister Callista Roy:
Roy Adaptation Model - major components of model; four modes of adaptation (physiologic,
self-concept, role function and interdependence)
• Adaptive systems
o Four adaptives modes with processes for adaptation
• internal coping processes: patient is responsible for coping with external/internal changes
• Patient behavior
o physiologic mode
▪ needs: oxygen, nutrition, elimination, activity/rest, protection
▪ processes: senses, fluid/electrolytes. neurological/endocrine function
o self concept
▪ need: psychic/spiritual integrity
▪ composite of beliefs and feelings that one holds about oneself at a given
time formed from internal perceptions and perceptions of others’ reaction
o role function
▪ underlying need: social integrity
▪ need to know who one is in relation to others so that one can act
▪ underlying need: relational integrity
▪ focuses on interactions related to giving/receivin