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Therapeutic Communication and Support Systems

by Anne Vanderputten
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    00:01 Hi, I am Anne Vanderputten and welcome to the review of Therapeutic Communication and Support systems.

    00:08 I like to start off by giving an overview of communication and what is it.

    00:12 "Communication is the process of conveying and receiving ideas and information." There are three main components to communication.

    00:22 Receiving the message, understanding the message and sending the message.

    00:27 And breakdown can occur in any point within those three main components. So it seems very simple but communication can be very fragile at times.

    00:38 So let's look at the nursing and goals of therapeutic communication.

    00:43 The first goal is to establish therapeutic rapport which in return equals trust with the patient. If you can develop this rapport the patient will trust the nurse.

    00:57 You also want to assess the client's perception of the problem.

    01:01 What ever the problem might be? It may be their health.

    01:05 Why they are there? Why they have to be there? It's their perception.

    01:11 But through therapeutic communication you establish a confidence the patient has in you.

    01:17 So the patient can then feel safe.

    01:21 So when we identify the client's concerns and problems.

    01:24 Again the security in that for the patient again, safety.

    01:29 And then of-course you guide the client towards a satisfying and socially acceptable solution which is giving the patient information which satisfies their needs at the moment. Or whatever they may need during their stay with you.

    01:48 So for nurses an establishing therapeutic rapport through good communication.

    01:55 There are some key things that you want to always do.

    01:59 So you always want to lead the patient with open ended questions. That allows them to feel free to add on to that.

    02:12 You don't wanna answer the patients before themselves to speak.

    02:16 And you want be always an active listener and be attentive.

    02:20 If the patient feels that you are rushed they are going to shut down and we actually gain a lot of perspective and information from patients when they feel free to express themselves.

    02:35 You want to sharing the patient's feelings as well.

    02:38 If a patient is hopeful it would not be very therapeutic to say to them, "You know it's not much hope for you".

    02:47 So this makes sense, right? So when we are talking about sharing the patient's feelings whatever they are feeling you want to, "Can you mere them?" You can show them empathy.

    02:58 So if you are imagine that this is your family member or loved ones it's it's very much a more emphatic approach.

    03:06 Now empathy is different than sympathy and we will talk more about that. But sympathy is actually a barrier because then it becomes about the nurse and not about the patient.

    03:18 So bear that in mind. They are very similar emotions but at the same time the bases of them is very different.

    03:26 You want to remember this is about the patient. This is not about the nurse.

    03:30 Despite how the nurse may feel connected.

    03:34 One of the other useful tools is to just use silence.

    03:39 If a patient begins a very sensitive conversation with you and you say, "You want to leave them into that" Sometimes just be silent. Let them speak.

    03:51 Sometime they may need time to collect their thoughts.

    03:55 Or how they might feel about it.

    03:57 So it allows the patient time.

    04:00 Again using a caring touch. It is a appropriate but you must be like culturally aware. There are some cultures that really frown on casual contact.

    04:15 But for the most part caring touch is, it is comforting to people.

    04:24 One of the other uses of therapeutic communication is to clarify and paraphrase and summarize for the patient.

    04:32 So if you are sharing information for the patient you have to remember that they are not well. They have a lot of things that are focus about them. They sometimes don't even hear.

    04:43 Something that they are not listening but they really don't understand or hear what you are trying to say to them.

    04:50 So you may give them the information and then to have them verbalize that back you may synthesize or clarify.

    04:59 Or if they present you with a communication or message you may wanna clarify "What exactly are they asking you?".

    05:07 So these are always good things and you want to always do them when they present in your work/practice.

    05:17 Now some of the things that you don't ever wanna do is appear distracted.

    05:22 How caring would it be if your nurse is constantly going "Ahaan Yes" How caring would that be? right? So you don't wanna appear distracted.

    05:32 The other we have to be careful about is every patient would respect their humanity and we don't judge their lifestyles you know or any information they may share. And if they share something and the nurse "oh oh" and well they are not gonna tell you anything ever again probably.

    05:52 So remember it.

    05:55 you don't wanna give any personal opinions which really feels to be judgmental. But it is about the patient. So whatever the patient's life style is or things that you wouldn't agree with if you need to steer the patient back to a appropriate conversation or you know you just to wanna shut them down like they have defended you.

    06:21 You also don't wanna give false reassurance. This can be very tricky when you come across patient who may be has a poor prognosis.

    06:31 Sometimes, I mean i have had an example where a patient was terminal and there were brain dead essentially.

    06:42 And the husband kept saying "I am praying i know God is gonna cure her".

    06:48 These are really difficult situations where its okay to let the patient vocalizes so they can come to their own understanding.

    06:57 But there are times when you may have to say, you know "have you spoken to the doctor?".

    07:03 So that they know that things that are to come, you wanna prepare families or patients for may be what to expect.

    07:13 In a helpful manner, in a common manner but you don't wanna say, "O yes, yeah, i agree you are gonna get well.", if it's not the case.

    07:24 So again that's a word of caution there.

    07:27 And again here we are talking about the sympathy.

    07:31 Sometimes we have to understand our own responses because sometimes empathy and sympathy you know, they can feel very much the same you just wanna remember "It's not about you, it's about the patient".

    07:45 So I wanna to make sure that we talk about not getting tight into the sympathy.

    07:50 The other thing about the sympathy too for the nurse, "It can be exhausting".

    07:55 If you are sympathetic and you know may be one of your family members had something similar that have a patient that you are taking care of.

    08:03 It starts with a lot of a personal emotions and with sympathy it's kind of killing from yourself.

    08:10 So again as nurses we we do take on a lot of what the patient stress and things that are going on. So you want to be careful about getting too personally engrossed in an emotional interaction where it's arousing all your sympathy. You wanna be empathetic but you wanna make it about the patients. It's not about you.

    08:34 So as we talk about communication it's really important, the reason it tied together into support systems is because when we are communication with patients more and more we would becoming to patient center care and patient family center care.

    08:50 So in our environment and the nursing environment, the patient includes their family.

    08:56 And support systems are incredibly important as we spoke about when we talked about stress. The patient identifies their family or their support system by their definition.

    09:10 So we have to be careful about respecting next of kin as vs who the patient identify their family with.

    09:19 Families and their systems, patient and their systems can be very complicated.

    09:26 Despite may be what we would might be observe as a dysfunctional family system.

    09:31 We at the same time have to respect how that put into the patient and respect their need for their social support And I have a quote here.

    09:44 That "Friedman et al. assert that families are the single greatest social institution that influences a person's health".

    09:54 And just remember that because that can be positive health or negative health.

    10:00 But none of the less they grown in the environment and it plays a huge role in who the patient identifies himself as.

    10:09 So I wanna to review a little bit about Maslow pyramid of needs of-course we start with the basics and this the Physiological needs of oxygen, air, food. But as we get just a little bit higher above that it's so the pretty basic need is the need to belong. It's the need to regroup to belong to a group.

    10:31 and you can see on this pyramid here.

    10:35 How close it really is right about oxygen, food and water.

    10:39 So remember it's the patient's preference and privacy of the patient is the priority.

    10:46 So what I mean by that is that a family member could come in and they may be very dominant and speak for the patient.

    10:54 So you want to make sure that the patient is the focus and that a family sometimes is very dominant personality is going on that you include the patient "How do you feel about that?" you know.

    11:08 And make sure they are included. And the patient privacy comes first if they say that they don't want their spouse to know something. I mean you have to remember that the patient privacy is very important.

    11:20 So I wanna to stress that for you.

    11:22 The family is also defined by the patient.

    11:25 It may be their best friend from high school who they say, "They are my family" and you have to respect that.

    11:33 So we don't wanna get too in tangled with [inaudible 0:11:35.520] and next of kin type of language when we are talking about our nursing care for the patient. So family support is very individualized and it's based on the expressed needs of each family.

    11:51 There are culture, you have to be very culturally sensitive to these family groups and they can actually become very overwhelming at times.

    12:02 So but the principle underline all of this is that it's about the patient and who they identify.

    12:12 So when we continue talking about support systems we gonna move on the care and education of patients and the families.

    12:19 So "social support systems are a valuable asset to changing and improving patient health behavior".

    12:28 So what do we mean by this? Right? We talked about may be the spouse who wants to keep indulging and they can when we should be eating and his wife says "honey, remember the doctor said". So the families can really be support of health to improving the patient's health.

    12:48 I have just a little clip of systems, and patient's systems here from nurse theorists [inaudible 0:12:55,000] it really is a system within a system. So continuing a support systems and care and education You want to be assess and aware of the potential benefits that exist for patients through the family environment.

    13:11 If you have a patient who is resisting some therapy or treatments you may say you know may be ask the patient, you know, "Can you involve your family in this care?" Sometimes these therapies and care may overwhelm the patient and they don't even know really they don't wanna ask or bother people.

    13:33 So these are useful things you really wanna get that information from the patient "what is your support system?" "Who is your support system?" "And can we include the menu plan of care?" Because they can be very very helpful in the treatments.

    13:50 Again individual circumstances have to define the exact role of a family plays in the patient's education and care.

    13:57 Patient educators, meaning nurses, should evaluate the involvement of social support in the education and treatment plans of the patient.

    14:07 Remember there are some dynamics in families that are dysfunctional and there are times where you are going to realize, "O my goodness this family member is not helping this patient at all get well".

    14:24 But may be dragging them down you know in unhealthy path.

    14:28 So those are very individual cases but in general you want to keep an open mind about these patients and their families.

    14:36 No matter what the cultural difference is you have to be really aware of that.

    14:40 And their patient's needs and family's needs should be addressed promptly.

    14:46 If you have a, you know, a family member who's mom is in the hospital and they are asking you you know "What's going on with mom and what medications she gone?" You really have to be attentive to the families as well because if the family feels trust, that they can trust you and trust the environment and the care.

    15:10 This will go along away in the patient also absorbing that positive effect.

    15:20 So again for support systems and meeting the patient-family needs you want to focus on to the patient preferences and privacy of the patient is the priority.

    15:32 So as the family and as they support the patient it is very individualized based on the expressed needs of each family. You want to engage the family and the patient early in the assessment for provide education to meet cultural needs and be again an active listener.

    15:53 So care of the patient can include the family and it can include community resources as well, as part of a support system.

    16:03 So as nursing summary we talked about the communication that it should be patient focused.

    16:08 And the message can breakdown anywhere amongst that 3 points.

    16:13 So if your patient, you wanna be assessing the education level because if you are sharing information and the patient hasn't finished high school you are going to have to send the message at the level that the patient can receive the message.

    16:29 And then of-course establish trust through verbal and non-verbal communications.

    16:34 What is this mean? We all kind of being aware of this but if you are standing there like this. This is very closed communication.

    16:42 So a patient may not consciously pickup on it but it definitely emits a non-communicative stance. So these are the things we are talking about. And then of-course you wanna communicate at the patient and family level that's what I am speaking to. If, you know, you gonna have families that may be really don't even speak your language very well.

    17:08 So you have got to really assess that and recognize when you need help to convey the information.

    17:16 If you reached a point where you are saying, "I don't think they are understanding this" reach out for help. Your organization have a lot of language supports and that's when you say, "It's okay".

    17:30 A nurse does not have to be on conclusive that and never have a need for any other support services.

    17:37 So recognizing that is very important for the patient too. You wanna make all resources available.

    17:43 So again looking at support systems and summary. The patient privacy and preference is the priority. You listen attentively to build trust and safety. It is individualized to the patient and include the family (as appropriate) early in the assessment and plan of care.

    18:00 Your patient's being admitted, you can first come in that's one of how you do, you know, "How do you cope with things?". "Who do you rely on".

    18:09 That is really important to get that information right from the beginning.

    18:14 So some tips for success in summary.

    18:17 You want to use critical thinking skills to choose your best answer when you approach testing.

    18:24 Again reduce the choices by eliminating obvious incorrect choices and then priorities your choices by safety.

    18:35 You want to double check your answers by reading your question and then putting in your answer and doesn't make sense.

    18:42 Now remember a lot of these answers will be correct technically.

    18:46 But you as a nurse in this situation, they want to see that you have good critical thinking skills and good judgment. So you want to choose the best answer based on the principles presented in the question.

    19:02 Well thank you for joining me. I am Anne Vanderputten for therapeutic communication and support systems.


    About the Lecture

    The lecture Therapeutic Communication and Support Systems by Anne Vanderputten is from the course Psychosocial Integrity. It contains the following chapters:

    • Therapeutic Communication
    • DOs
    • DON'Ts
    • Support Systems - Patient and Family
    • Care and education
    • Nursing Summary

    Included Quiz Questions

    1. “It is normal to feel nervous and you will have the best care. Can you tell me your concerns?”
    2. “I can page the doctor to explain things to you.”
    3. “You have nothing to worry about, it is a minor surgery.”
    4. “The surgeon knows what you need. I think you should have the surgery.”
    1. Use open ended questions and demonstrate active listening
    2. Tell the patient they have nothing to worry about
    3. Assume the patient is angry because of the new diagnosis and demonstrate sympathy
    4. Silence – to allow the patient to verbalize feelings
    1. Printed, visual, educational material because the patient may have difficulty receiving auditory education
    2. Include a family member to give the patient the information
    3. Briefly go over the education since the patient will not likely understand
    4. Ask the patient how they feel about the planned surgery
    1. Asking the patient preference for family to be included in their plan of care
    2. Informing the family of the patient’s diagnosis and ask if they have any questions
    3. Sharing feelings of sympathy with the family
    4. Requesting the family to leave and return during regular visiting hours
    1. “The visiting hours are the same, do you have concerns I can help you with?”
    2. “Your welcome brochure has all the information you need.”
    3. “Don’t worry about that now, your family will visit you when they are able.”
    4. “Why do you ask?”
    1. Ask the clerk to wait while the nurse inquires from the patient if they would like visitors.
    2. Ask if the visitor requires education
    3. Tell the clerk to send the patient’s visitor in to the unit
    4. Tell the clerk nursing is too busy to have visitors at the bedside.
    1. “It is helpful to have a friend you can rely on for support, would you like your friend to be included in your plan of care?”
    2. “Can you tell me what caused your family dispute?”
    3. “That is very sad and I think you should let your family know about your health issues.”
    4. “I understand but we only allow next of kin to visit on this unit.”
    1. “It sounds like your sister is supportive. Would you prefer if we include this education when your sister can be here with you?”
    2. “Your sister can not be here and this education is important to you as the patient.”
    3. “This is very basic information but I will try to make it simpler for you.”
    4. “Will your sister take care of you?”
    1. Inform the patient the use of the cardiac monitoring, educate as appropriate, and offer the patient the opportunity to verbalize feelings.
    2. Tell the patient why cardiac monitors are used but stay near the door so the patient knows you cannot spend much time.
    3. Laugh with the patient about this exaggeration and tell them not to worry.
    4. To be honest and inform the patient how busy the unit is currently but will return if possible to answer any questions.
    1. Sitting near the patient, the nurse may consider using caring touch to share the patient’s feelings and allow the patient time to verbalize
    2. Offering sympathy to the patient and sharing a story about her family member with cancer.
    3. Using silence will let the patient know the nurse has time
    4. Refer this patient for a psychiatric consultation

    Author of lecture Therapeutic Communication and Support Systems

     Anne Vanderputten

    Anne Vanderputten


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