Therapeutic communication, theorists and theories, nursing considerations
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| Rapport Trust Respect Genuineness Empathy | What are the conditions essential to the development of a therapeutic relationship?
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| Transference | Occurs when the client unconsciously displaces (transfers) to the nurse feelings formed towards a person from the past.
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| Countertransference | Refers the nurse's behavioral and emotional response to the client
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| Restatement | Therapeutic communication technique which involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client’s statement has been heard and understood.
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| Denial | Refusal to admit to a painful reality. Example: the patient is not acknowledging the trauma of an assault either verbally or nonverbally
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| Projection | Transferring one’s internal feelings, thoughts, and unacceptable ideas and traits to someone else.
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| Rationalization | Justifying the unacceptable attributes about oneself.
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| Intellectualization | Excessive use of abstract thinking or generalizations to decrease painful thinking.
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| Offering Self | Technique that makes the nurse available on an unconditional basis, increasing client’s feelings of self-worth. Professional boundaries must be maintained when using the technique
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| Presenting reality | Used when the client has a misperception of the environment. The nurse defines the environment or indicates his or her perception of the situation for the client.
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| Requesting an Explanation | Nontherapeutic. When the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking “why” can be very intimidating and implies that the client must defend his or her behavior or feelings.
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| Termination phase | In which nurse-client relationship phase are these tasks presented: evaluating patient performance, evaluating achievement of expected outcomes, evaluating future needs, making appropriate referrals
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| Working phase | In which phase are these tasks presented: planning short term goals, developing realistic solutions, and identifying expected outcomes?
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| Sitting squarely | S (SOLER)
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| Open posture | O (SOLER)
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| Leaning forward | L (SOLER)
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| Establishing Eye contact | E (SOLER)
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| Relaxing | R (SOLER
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| False Imprisonment | An act with the intent to confine a person to a specific area. Ex: A nurse prohibits a patient from leaving the hospital if the pt has been admitted voluntarily.
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| Reflection | Identifies a client’s emotional response and reflects these feelings back to the client so that they may be recognized and accepted.
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| False Reassurance | Nontherapeutic technique that indicates to the client that there is no cause for anxiety, thereby devaluing the client’s feelings.
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| Focusing | Therapeutic technique that takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.
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| General lead | Therapeutic technique that encourages the client to continue sharing information. Ex: "Yes, I see. Go on."
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| Giving approval | Nontherapeutic technique that implies that the nurse has the right to pass judgment on whether the client’s ideas or behaviors are “good” or “bad.” This creates a conditional acceptance of the client.
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| Broad opening | Therapeutic technique that allows the client to take the initiative in introducing the topic and emphasizes the importance of the client’s role in the interaction. Ex: "What would you like to talk about?"
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| Exploring | Therapeutic technique that allows the nurse to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.
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| Making observations | Therapeutic technique that involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse’s perceptions.
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| Giving recognition | Therapeutic technique that acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse’s judgment.
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| Assessment | Step in which information is gathered from which to establish a client database
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| Diagnosis | Step in which data from the assessment is analyzed. Potential problem statements are formulated and prioritized
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| Outcome Identification | Expected results of care are identified. Must me measurable and estimate a time for attainment
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| Planning | Evidence-based interventions for achieving the outcome criteria are selected
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| Implementation | Interventions selected during the planning stage are executed. Specifics include: Coordination of care, health teaching and health promotion, Milieu therapy, pharmalogical, biological, and integrative therapies
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| Evaluation | Measures progress towards attainment of expected outcomes
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| Care Management | A health delivery process whose goals are to provide quality health care, decrease fragmentation, enhance the client's quality of life, and contain costs.
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| Managed Care | A concept designed to control the balance between cost and quality of care. Individuals receive are based on need, which is determined by coordinators of the providership.
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| Case Manager | The individual responsible for negotiating with multiple health-care providers to obtain a variety of services for the client.
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| Using Silence | Allows the client to take control of hte discussion, if he or she so desires
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| Accepting | Conveys positive regard
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| Giving recognition | Acknowledging, indicating awareness
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| Offering self | making oneself available
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| Giving broad openings | allows client to select the topic
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| Offering general leads | Encourages client to continue
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| Placing the event in time or sequence | Clarifies the relationship of events in time
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| Making observations | Verbalizing what is observed or perceived
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| Encouraging description of perception | Asking client to verbalize what is being perceived
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| Encouraging comparison | Asking client to compare similarities and differences in ideas, experiences, or interpersonal relationships
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| Restating | Letsclient know whether an expressed statement has or has not been understood
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| Reflecting | Directs questions or feelings back to client so that they may be recognized and accepted
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| Seeking clarification and validation | Striving to explain what is vague and searching for mutual understanding
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| Voicing Doubt | Expressing uncertainty as to the reality of the client's perception
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| Verbalizing the implied | Putting into words what the client has only implied
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| Attempting to translate words into feelings | Putting into words the feelings of the client has expressed only indirectly
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| Formulating a plan of action | Striving to prevent anger of anxiety from escalating to unmanageable levels when the stressor reoccurs
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| Process recordings | Written reports of verbal interactions with clients. Written by the nurse or student as a tool for improving communication techniques (like the dialogue history in KOTOR)
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| Critical Pathways of Care (CPCs) | The tools for provision of care in a case management system. CPCs are abbreviated plans of care on which outcome-based guidelines for goal achievement within a designated length of time have been established.
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| Milieu Therapy | Therapeutic community: A scientific structuring of the environment to affect behavioral changes and to improve the psychological health and functioning of the individual. The client is expected to learn adaptive coping, interaction and relationship skills
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| Milieu Therapy | Every interaction is an opportunity for therapeutic intervention. Client owns their environment and behavior.
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| Maslow | Identified a hierarchy of needs with self-actualization as a fulfillment of one's highest potential
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| Erikson | Theorist who developed the eight stages of childhood
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| Trust v Mistrust | Birth-18 months, infancy. Feeding is the important event. Children develop a sense of trust when caregivers provide reliability, care, and affection. A lack of this will lead to mistrust.
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| Autonomy v Shame and Doubt | 2-3 yrs, early childhood. Toilet Training Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt.
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| Initiative v Guilt | Preschool, 3-5 yrs. Exploration Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt
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| Industry v Inferiority | School-age, 6-11 yrs. School Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority.
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| Identity v Role Confusion | Adolescence, 12-18 yrs. Social Relationships Teens needs to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self.
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| Intimacy v Isolation | Young adulthood, 19-40 yrs. Relationships Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation.
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| Generativity v stagnation | Middle adulthood, 40-65 yrs. Work and Parenthood Need to create or nurture things that will outlast them. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world.
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| Integrity v Despair | Maturity 65-death. Reflection on Life. Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.
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| Paranoia | Maladaption associated with failure to attain independence during the Autonomy v Shame and Doubt phase.
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| Oral | 0 – 18 months Mouth Orally Aggressive:
Involves chewing gum or ends of pen.Orally Passive:
Involves smoking/eating/kissing/fellatio/cunnilingus
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| Anal | 18 – 36 months Bowel and Bladder Elimination Anal-retentive:
Obsession with organization or excessive neatnessAnal-expulsive:
Reckless, careless, defiant, disorganized, Coprophiliac
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| Phallic | 3 – 6 years Genitals Oedipus Complex (in boys according to Freud)Electra Complex (in girls according to Jung not Freud)
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| Latency | 6 years – Puberty Dormant Sexual Feeling (People do not tend to fixate at this stage, but if they do, they tend to be extremely sexually unfulfilled.)
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| Genital | Puberty and beyond Sexual interest mature Frigidity, impotence, unsatisfactory relationships
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| Participant Observer | Role of the therapist, as defined by Sullivan, as both participating and observing the progress of the relationship.
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| Psychosocial | This theory developed by Erikson is the most widely used. At each stage, children confront a crisis that requires the integration of personal needs and skills with social and cultural expectations with two possible outcomes: favorable and unfavorable.
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| Psychosexual | Frued's theory considered sexual instincts to be significant in the development of personality. At each stage, regions of the body assume prominent psychologic significance as a source of pleasure.
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| Mental Health | A state of emotional and psychosocial well being, self awareness and self directive, problem solving, independently able to cope with stress, and fulfill the capacity to love and work and sets goals and realistic limits.
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| Subconscious | Refers to the materials that are partly remembered partly forgotten but these can be recalled spontaneously and voluntarily.
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| Anxiety | As defined by Freud, a state due to opposing action drives between the ID and superego
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| Superego | As defined by Freud, the critical censoring portion of one's personality; the conscience.
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| Ego | As defined by Freud, the portion of one's personality that uses defensive function for protection from anything that threatens it.
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| ID | As defined by Freud, the portion of the personality that is composed of the untamed, primitive drives and impulses. Lacks morality.
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| Counter transference | An emotional reaction of the nurse and the client based on her unconscious needs and conflicts. Ex: revealing personal information to the client.
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