the nurse to meet with the patient once discharged. The nurse can plan for discharge by recalling successes achieved with the patient and taking pride in helping the patient gain positive outcomes to date. The patient may experience feelings of abandonment which may be revealed in behavior or emotions. For example, the patient may avoid signing necessary papers or have sudden outbursts. The nurse may need to discuss the importance of the termination phase with the patient, help redirect the patient to reflect on successes achieved while working together, and refer the patient to the next level of care, if appropriate (https://psychscenehub.com/psychinsights/ten- point-guide-to-mental-state-examination-mse-in-psychiatry/).
countertransference can occur when the nurse’s emotions may also be displaced onto the patient (Boyd, 2018). The nurse’s self- awareness and ability to maintain healthy boundaries and remain patient focused are important elements of the nurse-patient relationship. The termination phase is the final phase of the relationship. In this phase, the nurse and the patient discuss the goals and outcomes achieved, review coping skills, and determine how to incorporate new behaviors into life outside of the facility. Closure of the relationship occurs so that the patient and the nurse can move forward. However, this phase can elicit strong emotions of loss or abandonment. For the nurse, feelings of guilt can arise if the patient has not met all goals. It is not appropriate for
THERAPEUTIC COMMUNICATION
techniques will elicit responses that give the nurse insight into the patient’s thoughts and emotions (Boyd, 2018). Use open-ended questions so that the patient can respond with more than a yes or no answer. Give the patient enough time to answer the question as well. Avoid using jargon or medical terminology (https:// publichealth.tulane.edu/blog/communication-in-healthcare/). Table 1. Therapeutic And Nontherapeutic Communication
Therapeutic communication and the therapeutic relationship are a significant part of mental health nursing. Hildegard Peplau reiterated this sentiment in her work many times, stating that understanding was central to the nurse-patient relationship (Ramesh, 2013). Therapeutic communication differs from social communication in that patient goals are the central focus of the interaction. The goal may be to solve a problem, examine self-defeating behaviors, or promote self-care. Additionally, therapeutic communication involves active listening and responding in a way that creates rapport and moves the patient toward the end goal. Therapeutic communication involves trust, boundaries, empathy, genuineness, and respect for the patient, regardless of the patient’s condition (Halter, 2018; Morgan & Townsend, 2019). Sometimes, recognizing an individual’s behaviors and making statements can add to the assessment data and provide insight into the patient’s current state. An example is “I notice you are pacing more today.” Allow the patient to respond. Remember that no response from an individual provides further insight into the individual’s state of mind. One important aspect of therapeutic communication is the therapeutic use of self. This is when the nurse uses self- disclosure in a goal-oriented manner to promote trust and teach the patient how to view the feelings or actions of others (Riley, 2015). Use of self, however, should not reveal personal details. Effective use of self involves self-reflection, self-awareness, and self-knowledge. As in any nurse-patient interaction, it is important to remain objective and nonjudgmental while considering the patient’s needs. Nonverbal communication can tell the nurse a lot about the patient. Awareness of how the patient gestures or moves while conversing is vital in determining verbal/nonverbal congruence. Sitting across from the patient with an open stance demonstrates openness and a willingness to listen. An angled position or sitting side by side can promote comfort. Additionally, the doorway should never be blocked; this promotes safety as well as prevents the patient from feeling trapped or confined (Boyd, 2018). A general opening, such as asking how the patient slept, can help facilitate the conversation. Gradually start asking open-ended questions to encourage the patient to engage, such as “Tell me a little about what has been going on.” If anxiety or nervousness is observed, the nurse may need to step back and alter the questions or provide encouraging statements such as go on or tell me more about that . Those types of statements confirm that the nurse is listening and is open to knowing more about the topic. Why questions can be perceived as challenging and judgmental (e.g., “Why would you do that?”). Reword the question so that the patient can answer without feeling belittled or betrayed. It is important to get as much of the patient’s history as possible. However, this may be difficult if the patient has severe symptoms that may limit their ability to carry on a conversation. In that case, observation will take precedence in the interview. Samples of therapeutic and nontherapeutic communication techniques are provided in Table 1. Therapeutic and nontherapeutic communication techniques . Each of these
Techniques Therapeutic
Example Open-ended question “How are you feeling?” Offering self
“I’ll sit here with you for a while.” “Go on … you were saying.”
Giving general leads
Silence
Sitting quietly.
Active listening
Leaning forward, making eye contact, and being attentive.
Restating
“So, what you’re saying is …”
Clarification
“I don’t quite understand. Could you explain …” “I notice that you shake when you say that.”
Making observations
Reflecting feelings
“You seem sad.”
Encouraging comparisons Interpreting
“How did you handle this situation before?” “It sounds like what you mean is …”
Nontherapeutic Example Closed-ended question “Did you do this?” Challenging
“Just what do you mean by that, huh?”
Arguing
“No. That’s not true.”
Not listening
Body turned away, poor eye contact. (Patient states he is sad.) “Where do you work?” “I’m sure things will turn out just fine!” “Well, that’s not important or anything. Not!” “All’s well that ends well.” “I wouldn’t worry about it.” “That was a bad thing to do.” “Did anyone see the news today?” “I’ll make the doctor listen to you!”
Changing the subject
Being superficial Being sarcastic
Using clichés Being flippant
Showing disapproval Ignoring the patient Making false promises
(Boyd, 2018)
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Book Code: ANCCUS3023
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