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8/13/2019 Relationship Development and Therapeutic Communication
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Relationship Development and TherapeuticCommunication
Mr. Ibrahim Rawhi AyasrehRN MSN CNS
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Relationship Development and Therapeutic Communication
The nurseclient relationship is the foundation on which
psychiatric nursing is established.
It is a relationship in which both participants must
recognize each other as unique and important human
beings.
It is also a relationship in which mutual learning occurs.
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Relationship Development and Therapeutic Communication
Therapeutic Relationship: is an interaction between two
people (usually a caregiver and a care receiver) in which
input from both participants contributes to a climate of
healing, growth promotion, and/or illness prevention.
Interpersonal communication techniques (both verbal and
nonverbal) are the tools of psychosocial intervention.
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Conditions essentials to Development of a
Therapeutic Relationship
Rapport
Rapportimplies special feelings on the part of both the
client and the nurse based on acceptance, warmth,
friendliness, common interest, a sense of trust, and a
nonjudgmental attitude.
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Conditions essentials to Development of a
Therapeutic Relationship
Trust
To trust another, one must feel confidence in that personspresence, reliability, integrity, veracity, and sincere desire to
provide assistance when requested.
Trust is the initial developmental task described by Erikson.
If the task has not been achieved, this component of
relationship development becomes more difficult. That is not
to say that trust cannot be established, but only that
additional time and patience may be required on the part of
the nurse.
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Examples of nursing interventions that would promote
trust in an individual who is thinking concretely
Providing a blanket when the client is cold
Providing food when the client is hungry
Keeping promises Being honest (e.g., saying I dont know the answer to your question, but Ill try to
find out) and then following through.
Simply and clearly providing reasons for certain policies, procedures, and rules.
Providing a written, structured schedule of activities
Attending activities with the client if he or she is reluctant to go alone
Being consistent in adhering to unit guidelines
Taking the clients preferences, requests, and opinions into consideration when
possible in decisions concerning his or her care
Ensuring confidentiality; providing reassurance that what is discussed will not
be repeated outside the boundaries of the health care team
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Conditions essentials to Development of a
Therapeutic Relationship
Respect
To show respect is to believe in the dignity and worthof an individual regardless of his or her unacceptable
behavior.
Unconditional positive regard : The attitude is
nonjudgmental, and the respect is unconditional inthat it does not depend on the behavior of the client to
meet certain standards.
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Conditions essentials to Development of a
Therapeutic Relationship
Empathy
Empathy is a process wherein an individual is able to see
beyond outward behavior and sense accurately anothers
inner experience at a given point in time .
With empathy, the nurse can accurately perceive and
understand the meaning and relevance of the clients
thoughts and feelings.
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Conditions essentials to Development of a
Therapeutic Relationship
It is not uncommon for the concept of empathy to be
confused with that of sympathy.
The major difference is that with empathy the nurse
accurately perceives or understands what the client is
feeling and encourages the client to explore these feelings.
With sympathy the nurse actually shares what the clientis feeling, and experiences a need to alleviate distress.
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Interpersonal Communication
Interpersonal communication is a transactionbetween the sender and the receiver.
In the transactional model of communication,
both participants are simultaneously perceiving
each other, listening to each other, and mutuallyinvolved in creating meaning in a relationship.
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Pre-existing Conditions Affecting Interpersonal
Communication
Values, Attitudes, and Beliefs
Values, attitudes, and beliefs are learned ways of thinking. Children generally adopt the value systems and internalize
the attitudes and beliefs of their parents.
Children may retain this way of thinking into adulthood or
develop a different set of attitudes and values as theymature.
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Pre-existing Conditions Affecting Interpersonal
Communication
Culture or Religion
Communication has its roots in culture.
Cultural mores, norms, ideas, and customs provide the
basis for our way of thinking.
Cultural values are learned and differ from society to
society. For example, in some European countries (e.g.,
Italy, Spain, and France), men may greet each other with
hugs and kisses. These behaviors are appropriate in those
cultures, but they would communicate a different message
in the United States or England.
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Pre-existing Conditions Affecting Interpersonal
Communication
Social Status
Studies of nonverbal indicators of social status or powerhave suggested that high-status persons are associated
with gestures that communicate their higher-power
position.
For example, they use less eye contact, have a more
relaxed posture, use a louder voice pitch, place hands on
hips more frequently, are power dressers, stand taller,
and maintain more distance when communicating with
individuals considered to be of lower social status.
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Pre-existing Conditions Affecting Interpersonal
Communication
Gender
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Pre-existing Conditions Affecting Interpersonal
Communication
Environment in Which the Transaction Takes Place
Some individuals who feel uncomfortable and refuse to speak during
a group therapy session may be open and willing to discuss problems
on a one-to-one basis with the nurse.
Territoriality, density, and distance are aspects of environment that
communicate messages.
Territorialityis the innate tendency to own space.
Densityrefers to the number of people within a given environmental
space.
Distanceis the means by which various cultures use space to
communicate
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Distances
Intimate distance is the closest distance that individuals will allow
between themselves and others. In the United States, this distance,
which is restricted to interactions of an intimate nature, is 0 to 18inches.
Personal distance is approximately 18 to 40 inches and is reserved for
interactions that are personal in nature, such as close conversations
with friends or colleagues.
Social distance is about 4 to 12 feet away from the body. Interactionsat this distance include conversations with strangers or acquaintances,
such as at a cocktail party or in a public building.
A public distance is one that exceeds 12 feet. Examples include
speaking in public or yelling to someone some distance away.
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Non- Verbal Communication
Physical appearance and dress. Body movement and posture,
Touch.
Facial expressions. eye behavior.
Vocal cues or paralanguage.
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Physical appearance and dress
Dress can be formal or casual, stylish or sloppy. Hair can
be long or short, and even the presence or absence of hair
conveys a message about the person.
Other body adornments that are also considered potential
communicative stimuli include tattoos, masks, cosmetics,
badges, jewelry, and eyeglasses.
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Body Movement and Posture
The way in which an individual positions his or her body
communicates messages regarding self-esteem, gender
identity, status, and interpersonal warmth or coldness.
The individual whose posture is slumped, with head and
eyes pointed downward, conveys a message of low self-
esteem.
To stand straight and tall with head high and hands onhips indicates a superior status over the person being
addressed.
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Touch
Touch is a powerful communication tool. It can elicit both
negative and positive reactions, depending on the people
involved and the circumstances of the interaction.
It is a very basic and primitive form of communication,
and the appropriateness of its use is culturally determined.
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Types of Touch
FunctionalProfessional : This type of touch is impersonal and
businesslike. It is used to accomplish a task.
-Example : A tailor measuring a customer for a suit or a physicianexamining a client.
SocialPolite. This type of touch is still rather impersonal, but it conveys
an affirmation or acceptance of the other person.
- Example: A handshake.
FriendshipWarmth. Touch at this level indicates a strong liking for the
other persona feeling that he or she is a friend.
- Example : Laying ones hand on the shoulder of another.
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Facial Expressions
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Facial Expressions
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Eye Behavior
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Paralanguage, or vocal cues
Paralanguage, or vocal cues, is the gestural component of
the spoken word. It consists of pitch, tone, and loudness of
spoken messages, the rate of speaking, expressively
placed pauses, and emphasis assigned to certain words.
These vocal cues greatly influence the way individuals
interpret verbal messages. A normally soft spokenindividual whose pitch and rate of speaking increases may
be perceived as being anxious or tense.
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Therapeutic Communication Techniques
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Therapeutic Communication Techniques
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Non- Therapeutic Communication Techniques