Hi, I am Anne Vanderputten and welcome to the
review of Therapeutic Communication and Support systems.
I like to start off by giving an overview
of communication and what is it.
"Communication is the process
of conveying and receiving
ideas and information."
There are three main
components to communication.
Receiving the message, understanding
the message and sending the message.
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.
So let's look at the
nursing and goals of
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.
You also want to assess the
client's perception of the problem.
What ever the problem might
be? It may be their health.
Why they are there? Why
they have to be there?
It's their perception.
But through therapeutic communication you
establish a confidence the patient has in you.
So the patient can then feel safe.
So when we identify the
client's concerns and problems.
Again the security in that for the patient
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.
So for nurses an establishing
therapeutic rapport through
There are some key things
that you want to always do.
So you always want to
lead the patient with open ended
questions. That allows them to feel free
to add on to that.
You don't wanna answer the patients
before themselves to speak.
And you want be always an
active listener and be attentive.
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.
You want to sharing the
patient's feelings as well.
If a patient is hopeful it
would not be very therapeutic
to say to them, "You know
it's not much hope for you".
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.
So if you are imagine that this is
your family member or loved ones it's
it's very much a more emphatic approach.
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.
So bear that in mind. They are very
similar emotions but at the same time
the bases of them is very different.
You want to remember this is about the
patient. This is not about the nurse.
Despite how the nurse may feel connected.
One of the other useful tools
is to just use silence.
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.
Sometime they may need time
to collect their thoughts.
Or how they might feel about it.
So it allows the patient time.
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.
But for the most part
caring touch is, it
is comforting to people.
One of the other uses of
therapeutic communication is
to clarify and paraphrase
and summarize for the patient.
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.
Something that they are not listening
but they really don't understand
or hear what you are
trying to say to them.
So you may give them the information
and then to
have them verbalize that back
you may synthesize or clarify.
Or if they present you with
a communication or message
you may wanna clarify "What
exactly are they asking you?".
So these are always good things and you
want to always do them when they present
in your work/practice.
Now some of the things that you don't
ever wanna do is appear distracted.
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.
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.
So remember it.
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 just to wanna shut them down
like they have defended you.
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.
Sometimes, I mean i have had an example
where a patient was terminal
and there were brain dead essentially.
And the husband kept saying
"I am praying i know
God is gonna cure her".
These are really difficult situations where
its okay to let the patient vocalizes so
they can come to their own understanding.
But there are times when you may have
to say, you know "have you spoken to the doctor?".
So that they know that
things that are to come, you
wanna prepare families or
patients for may be what to expect.
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.
So again that's a word of caution there.
And again here we are
talking about the sympathy.
Sometimes we have to
understand our own responses
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".
So I wanna to make sure that we talk about
not getting tight into the sympathy.
The other thing about the sympathy
too for the nurse, "It can be exhausting".
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.
It starts with a lot of a
personal emotions and with sympathy
it's kind of killing from yourself.
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.
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.
in our environment and the
nursing environment, the patient
includes their family.
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.
So we have to be careful about
respecting next of kin as vs
who the patient identify
their family with.
Families and their systems,
patient and their systems
can be very complicated.
Despite may be what we would might be
observe as a dysfunctional family system.
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.
"Friedman et al. assert that
families are the single greatest
social institution that
influences a person's health".
And just remember that because that can be
positive health or negative health.
But none of the less they
grown in the environment and
it plays a huge role in who the
patient identifies himself as.
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.
and you can see on this pyramid here.
How close it really is right
about oxygen, food and water.
So remember it's the
and privacy of the patient is the priority.
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.
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.
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.
So I wanna to stress that for you.
The family is also
defined by the patient.
It may be their best friend
from high school who they say,
"They are my family"
and you have to respect that.
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.
There are culture, you have to
be very culturally sensitive
to these family groups
and they can actually become
very overwhelming at times.
So but the principle
underline all of this
is that it's about the patient
and who they identify.
So when we continue talking
about support systems
we gonna move on the care and education
of patients and the families.
So "social support systems are a
valuable asset to changing and
improving patient health behavior".
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.
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.
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?"
therapies and care may overwhelm the
patient and they don't even know
really they don't wanna
ask or bother people.
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.
Again individual circumstances have
to define the exact role of a family
plays in the patient's
education and care.
Patient educators, meaning nurses,
should evaluate the
involvement of social support
in the education and
treatment plans of the patient.
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
But may be dragging them down
you know in unhealthy path.
So those are very individual cases
but in general you want to keep an open
mind about these patients and their families.
No matter what the cultural difference
is you have to be really aware of that.
And their patient's needs and family's
needs should be addressed promptly.
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.
This will go along away
in the patient also
absorbing that positive effect.
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.
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.
So care of the patient
can include the family
and it can include community resources
as well, as part of a support system.
So as nursing summary we talked about the
communication that it should be patient focused.
And the message can breakdown
anywhere amongst that 3 points.
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.
And then of-course establish trust through
verbal and non-verbal communications.
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.
So a patient may not
consciously pickup on it
but it definitely emits
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.
So you have got to really assess that
and recognize when you need help
to convey the information.
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".
A nurse does not have to
be on conclusive that
and never have a need for
any other support services.
So recognizing that is very important for the
patient too. You wanna make all resources available.
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.
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".
That is really important to get that
information right from the beginning.
So some tips for success in summary.
You want to use critical thinking skills
to choose your best answer when you approach
Again reduce the choices by
eliminating obvious incorrect choices
and then priorities your choices by safety.
You want to double
check your answers
by reading your question and then
putting in your answer
and doesn't make sense.
Now remember a lot of these
answers will be correct technically.
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.
Well thank you for joining
me. I am Anne Vanderputten
for therapeutic communication
and support systems.