Therapeutic

Nurse – Patient
Relationship
Lecture 4
 Learning Objectives


At the end of the class, students will be able to
 Define the term “Communication”
 Explain the modes, types, model and process of
communication.
 Discuss therapeutic Nurse -patient relationship
 Define ”therapeutic communication.”
 Enumerate the goals of therapeutic communication.
 Determine common Nursing Interventions to minimize
the barriers in communication.
Therapeutic Communication and Nurse-
Patient Relationship

 I ntroduction


 Communication refers to the reciprocal exchange
of information, ideas, beliefs, feelings and attitudes
between persons or among a group of persons

 It is a goal – directed process in which people use a

system of symbols and signs to convey a message.
 Definition


Nurse patient relationship is an interaction process
in which the nurse fulfill her role by using her
professional knowledge and skill in such a way that
she is able to help the patient physically, socially and
emotionally.
 Functions of Therapeutic Communication


 Allows the patient to express his thoughts and
feelings.
 Clarifies the areas of conflict and anxiety.
 Identifies the patient’s strengths and encourages
socialization.
 Corrects communication problems.
 Modifies mal adaptive behavior patterns.
 Encourages patient to test new patterns of behavior
and new coping mechanisms.
 Characteristics of Nurse Patient Relationship


 A client centered approach focused on identified
actual or potential health care needs.

 Health related goals of empowering client to

achieve maximum health and well being.

 A defined beginning and end dictated by a health

related purpose and realistic interventions to serve
that purpose.
Model and Process of Communication

Sender

Feed
back Communication Message

Receiver
Five Sensation Channels


 Seeing

 Hearing

 Touching

 Smelling

 Tasting
 Types of Communication


✓ Intra Personal Communication

✓ Inter Personal Communication

1. Social Communication

2. Collegial Communication

3. Therapeutic Communication
 Intra-Personal Communication

 Self-talk occurs in this type.

 Individuals give themselves all types of positive

and negative messages.

 Self-talk can be helpful if the messages one gives

oneself are helpful or positive.

 It can be functional or dysfunctional.

 Inter-personal Communication

It occurs between two or more individuals and
contain both verbal and non-verbal messages.

Emphasis placed on therapeutic and collegial

communication when the nurse is at work.
 Social Communication

 It occurs in everyday situations, usually away from
the work setting. This interactions may include
discussions regarding:
Family business, social activities, family issues,
vacations, school or church.

 This interaction is superficial, light and may not

have a goal.
Purpose of social Communication:

 To maintain a relationship and for enjoyment.

 Typically given in the form of suggestions and

advice by friends and family.
 Collegial Communication


 It occurs among colleagues in their professional
work settings.
Purpose:-
➢ Professional collaboration.
➢ Discuss client treatment.
➢ Share knowledge, collaborate on a project
➢ Improves upon the profession itself.
Modes of Communication


written

verbal

Non-verbal
 Verbal Communication


 Refers to spoken words that encompass the
symbols of language.

 Words are phrases have different meanings.

 Figures of speech, jokes and other terms.

 Non Verbal Communication


 It refers to all the messages communicated by
behaviors, cues and presence
 Components of Non Verbal
Communication

 Physical space.
 physical appearance.
 Gestures/ kinetics/ actions.
 Body cues.
 Vocal cues/ paralinguistic cues.
 position / posture.
 Touch.
Zones of Interaction


PUBLIC PERSONAL
SPACE SPACE

SOCIAL INTIMATE
SPACE SPACE
 Principles of Nurse Patient Relationship


 The patient should be the primary focus of
interaction.

 A professional attitude sets the tone of the

therapeutic relationship

 Use self disclosure cautiously and only when the

disclosure has the therapeutic purpose.
 Maintain patient confidentiality.

 Assess the patience intellectual competence to
determine the level of understanding.

 Implement interventions from a therapeutic base.

 Maintain a non judgmental attitude.

 Therapeutic Communication Techniques


1. Silence 2.Acceptance. 3. Observing.

4. Restating. 5. Providing information

6. Clarifying 7. Focusing. 8. Sharing.

9. Summarizing. 10. Questioning.

 Factors Determining the Effective Nurse
Patient Relationship

Self Empathy
awareness

Self
Genuineness disclosure
Respect

Attitude
towards
Sensitivity warmth the
patient
 Goals of Nurse Patient Relationship


The nurse help the patient to:
❖Cope with the present problems.
❖Understand the problems.
❖Understand the active participation in an experience.
❖Communicate.
❖Find out a new alternative for his or her problem.
❖Socialize.
 Barriers to Communication

• Parroting.

• Changing the topic.
• Disagreeing.
• Challenging.
• Requesting explanation.
• Imposing values.
• Double/ multiple questions.
 How to Improve Existing Level of
Communication?

 Improve language.

 Improve pronunciation.
 Work on voice modulation.
 Work on body language.
 Read and Listen more
Avoid reading or watching or listening unwanted
literature, gossip, media presentation … etc.
 Interact with qualitative people.
 Improve on your topic of discussion.

 Practice meditation & good thoughts.
 Think and speak.
 Do not speak too fast.
 Use simple vocabulary.
 Do not speak only to impress someone.
 Look presentable and confident.
 So What Does a Psychiatric Nurse Do?

 Assess …

 Diagnose …

 Plan …

 Implement …

 Evaluate …

 Document …
 Common Nursing Intervention to Minimize the
Barriers
Do …

 Set time for the relationship session.
 Begin and end session in time.
 Call the person by his/ her name.
 Give the full information to the patient about the
disorder and medication.
 Safe guard the patient from becoming too vulnerable in
the relationship.
 Protect the patient right to privacy and confidentiality.
 Don’t …

➢ Don’t give the personal phone number to the patient
➢ Don’t give the gift
➢ Don’t discuss the value of the therapeutic intervention of
other health team member with the patient.
➢ Don’t accept gift from the patient.
➢ Don’t make promises that you cant keep to the patient.
Unit 1: lecture 4
Legal and Ethical Issues in
Psychiatry

Prepared by
Mental Health Nursing Team
2019-2020 II Semester
 Learning Outcomes
At the end of this lecture, students will be able to:
◼ Define and legal and ethical rights of mentally ill

patients
◼ Understand Medical laws for psychiatric patients

◼ Explain Ethical and legal responsibilities and role of

a psychiatric nurse

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 Values
◼ Values are Concepts or beliefs that guide how we
make decisions about and evaluations of behaviors
and events.
◼ Values are freely chosen enduring beliefs or
attitudes about the worth of a person, object, idea,
or action. For nurses, values are important as they
influence decisions and actions.
◼ Value system: it is when people organize their set of
values internally along a continuum from most
important to least important.
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 Beliefs
◼ Beliefs are interpretations or conclusions that
people accept as true. They are based more on
faith than fact and may or may not be true.
◼ Beliefs do not necessarily involve values; “If I
study hard, I will get a good grade”. By
contrast, the statement “good grades are
important: I must study hard to obtain them”,
involves both beliefs and values.
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 Attitudes
◼ An attitude lasts overtime, while a
belief may last only briefly. Attitudes
are often judged as bad or good,
positive or negative, whereas beliefs
are judged as correct or incorrect.
◼ Attitudes vary greatly among
individuals .
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 Rokeach Value Survey
◼ Types of values
◼ Terminal: Goals that individuals would like to
achieve during their lifetime.
◼ Instrumental: Preferable ways of behaving.
◼ Importance of values
◼ Values generally influence attitudes and
behaviour.

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 Terminal values:
◼ A comfortable life
◼ An exciting life (a stimulating, active life)
◼ A world at peace
◼ A world of beauty
◼ Equality
◼ Family security
◼ Freedom
◼ Happiness
◼ Self respect

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 Instrumental:
◼ Ambitious (hard working)
◼ Broad-minded
◼ Cheerful
◼ Clean (neat and tidy)
◼ Courageous
◼ Forgiving

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 Values Transmission

◼ Values are learned through observations and

experience. (child valuing honesty & religious
practices). Values are either personal or professional.
◼ Personal values are derived from the society and
individual subgroups.
◼ Professional values are acquired through
socialisation into nursing codes of ethics, nursing
experiences, teachers, and peers.

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Values that important to nursing are:

Altruism: which is a concern for the

welfare and well-being of others
(patients, other nurses and colleagues).
Autonomy: this is the right for self-
determination.
◼ In nursing, autonomy is reflected when the

client’s rights to make decisions about

health care is respected.
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 Values that important to nursing are:

Human dignity: this is the respect for the worth and

uniqueness of individuals.
◼ Within this context, nurses value and respect all

patients and colleagues.

Integrity: is acting in accordance with appropriate
code of ethics and accepted standards of practice.
◼ In nursing, integrity is embodied when the nurse is

honest and provides care that is sound and ethical.

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 Values that important to nursing are:

Social justice: is upholding moral, legal, and humanistic

principles. This means that the nurse ensure equal
treatment and equal access to quality health care.
◼ We should explore our own values and beliefs regarding
such situations as the following:
◼ An individual’s right to make decisions for self when

conflicting with medical advice

◼ Abortion

◼ End-of –life issues

◼ Cloning

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 Morals and Ethics

◼ Morals: is similar to ethics and many people use

the two wards interchangeably (closely
associated with the concept of ethics).Derived
from the Latin “mores”, means custom or habit.
◼ Morality: usually refers to an individual’s
personal standards of what is right and wrong
in conduct, character, and attitude.
◼ Morals: are based on religious beliefs and social
influence and group norms 13
 Morals and Ethics (continue)

◼ Ethics is a branch of philosophy (the study of

beliefs and assumptions) referred to as
moral philosophy.
◼ Derived from the Greek word “ethos” which
means customs, habitual usage, conduct and
character.

14
 Basic ethical concepts
◼ Beneficence
◼ Nonmaleficence
◼ Autonomy
◼ Justice
◼ Fidelity
◼ Veracity

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 Concepts Underlying Ethical & Moral Judgments

◼ Beneficence: (doing good) promotion of the

welfare of others, nurses are obligated to do
good.
◼ Nonmaleficence: duty to do no harm; becomes
more complex than is obvious when trying to
judge between intentional versus unintentional
harm. (In nursing intentional harm is never
acceptable)
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 Cont.
◼ Autonomy: the right to make one’s own decisions,
individual’s right to be in control and make decisions.
◼ Nurses recognize that each client is unique, has the right
to be what that person is, and has the right to choose
personal goals.
◼ Justice: fair and equal treatment for all, (Fairness) the
nurse needs to weigh the facts carefully in order to
divide her/his time justly among her clients.

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 Cont.
◼ Fidelity: to be faithful to agreements and
promises. Examples: “You will be all right.”
“I’ll be right back.” “I will find out for you.”
Clients take such promises seriously, and so
should nurses.
▪ Veracity: telling the truth

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 Cont. Examples: Veracity

• What about when the family doesn’t want

the patient to know?
• What about telling patients info that will
create anxiety?
◼ What about when an error is made; esp. an
error where there is no harm?
(The loss of trust in the nurse and the anxiety
caused by not knowing the truth does not worth
lying).
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 Nursing Obligations in Ethical
Decisions
◼ Maximize the patient’s well-being
◼ Balance patient’s autonomy with family
◼ Support the family system
◼ Carry out hospital policies
◼ Maintain standards of care

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 References
◼ Kozier, B., Erb, G., Berman, A., &
Burke, K. (2008). Fundamentals of
Nursing: Concepts, Process and
Practice (6th ed.). Upper Saddle Rive,
NJ: Prentice Hall Health.
◼ Janice Ellis, Celia Hartley, 2008.
Nursing in Today’s World, Trends,
issues, and management.
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 THANK YOU

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