Fluent Essays

Please see attached files. PROCESS RECORDING GUIDELINES INTRODUCTION Communication is an essential component of the nurse-patient relationship. It impacts the nurse’s ability to positively influence the therapeutic relationship, moving patients towards an exploration of their feelings and attainment of their treatment goals. The process recording is a written record and analysis of the therapeutic communication (both verbal and nonverbal) between the nurse and patient. This exercise affords the student nurse an opportunity to analyze communication in an objective manner and examine the content and the process of the nurse-patient interaction. Benefits include: learning to pay attention to the communication process; reflecting on the significance of nonverbal behaviors, and becoming comfortable using a variety of therapeutic communication techniques; becoming more self-aware by reconstructing and analyzing both your responses and those of your patients; and developing the ability to purposefully guide the process of the nurse-patient relationship. OBJECTIVES · Initiate the nurse-patient relationship using therapeutic communication techniques. · Identify and describe both verbal and nonverbal data. · Identify and describe therapeutic communication techniques used and rationale for use. · Examples of revisions and alternatives to therapeutic communication techniques. · Identify and analyze the nurse’s thoughts and emotions. Purpose for Interaction with Patient: With the purpose of examining and analyzing your communication skills, thoughtfully facilitating the encounter through therapeutic use of self and evaluating the patient’s and nurse’s behaviors and approaches in the therapeutic relationship. Introduction: Identify any pertinent information regarding your patient as well as your goals for the therapeutic encounter. Nurse and Patient Interactions: FOR EACH EXCHANGE, write down and analyze the words spoken by you and your patient verbatim from memory. ( Also, observe and record nonverbal cues for both the nurse and the patient such as body posture, quality of eye contact, tone of voice, rate of speech, affect, mood and changes in facial expressions). Every communication (Student nurse said-patient said) will be referred to as “an exchange. Analyze a minimum of a flow of 10 (ten) exchanges. Analysis: FOR EACH EXCHANGE, identify the therapeutic communication techniques utilized and rationale for use in each of the exchanges between you and your patient. Identify whether the exchange was therapeutic or nontherapeutic and if nontherapeutic identify what you might have said and done differently to elicit communication at a feelings level (write in direct quotes what should have been said to change this from a non-therapeutic to therapeutic communication) and further the therapeutic communication process. Reflect after each exchange and identify your thoughts and your emotions (distinguishing between the 2) that occurred during that exchange. Summary: Summarize your overall impressions of the therapeutic encounter, and assess the role that the setting played in the communication process. Critically evaluate the effectiveness and therapeutic value of your exchanges and how you managed termination of the therapeutic encounter. Discuss therapeutic communication techniques that were most useful and lessons learned from this interaction. The Process Recording is a learning tool and is supposed to be a critical analysis of your encounter. It does not have to be perfect; it is evaluated according to whether you thoughtfully and critically analyzed the interaction, correctly and comprehensively recorded all information, made corrections when there were actual or potential blocks (nontherapeutic), identified therapeutic techniques used and appropriate rationales, and identified your references. THERAPEUTIC COMMUNICATION TECHNIQUES USING SILENCE Planned absence of verbal response. Gives the patient time to collect thoughts and to reflect on what was just said. If silence goes on too long, can then ask patient what they are thinking. ACCEPTING Conveys an attitude of reception & regard. EXAMPLE: Yes, I understand what you said. Making eye contact; nodding. GIVING RECOGNITION Acknowledging; indicating awareness; better than complimenting, which reflects the nurses judgement. EXAMPLE: Hello, Mr. J. I notice that you made a ceramic ash tray in OT. I see you made your bed. OFFERING SELF Making oneself available on an unconditional basis, increasing patients feelings of self-worth EXAMPLE: Ill stay with you awhile. We can eat our lunch together. GIVING BROAD OPENINGS Allows the patient to take the initiative in introducing the topic; emphasizes the importance of the patients role in the interaction. EXAMPLE: What would you like to talk about today? “What are you thinking?” OFFERING GENERAL LEADS Offers the patient encouragement to continue. EXAMPLE: Yes, I see. Go on. “Uh Huh” Placing the Event in Time or Sequence Clarifies the relationship of events in time so that the nurse & patient can view them in perspective. EXAMPLE: What seemed to lead up to...? Was this before or after...? When did this happen? MAKING OBSERVATIONS Verbalizing what is observed or perceived. This encourages the patient to recognize specific behaviors & compare perceptions with the nurse. EXAMPLE: You seem tense.”; “I notice you are pacing a lot.; FOCUSING Taking notice of a single idea or even a single word; works especially well with a patient who is moving rapidly from one thought to another. EXAMPLE: This point seems worth looking at more closely; let’s discuss it together. Encouraging Description of Perceptions Asking the patient to verbalize what is being perceived; often used with patients experiencing hallucinations. EXAMPLE: Tell me what is happening now.; Are you hearing the voices again?; What are the voices saying? ENCOURAGING COMPARISON Asking the patient to compare similarities & differences in ideas, experiences, or events. EXAMPLE: How does this compare with the time when...? What was your response the last time this situation occurred? RESTATING/PARAPHRASING Restating another’s message using one’s own words. Lets the patient know has been understood by nurse EXAMPLE: Patient: I cant study. My mind keeps wandering. Nurse: You have trouble concentrating. REFLECTING Questions & feelings are referred back to the patient so that they may be recognized & accepted, & so that the patient may recognize that his/her point of view was valued - good technique to use when patient asks for advice. EXAMPLE: Patient: What do you think I should do about my wifes drinking problem? Nurse: What do you think you should do? Exploring Delving further into a subject, idea, experience, or relationship; especially helpful with patients who tend to remain on a superficial level of communication. EXAMPLE: Please explain that situation in more detail”; “Tell me more about that particular situation” Voicing Doubt Expressing uncertainty as to the reality of the patients perceptions; often used with patients experiencing delusional thinking. EXAMPLE: I understand that you believe that to be true, but that is difficult for me to believe” Seeking Clarification & Validation Striving to explain that which is vague or incomprehensible & searching for mutual understanding; EXAMPLE: Do I understand correctly that you said...? Tell me if my understanding agrees with yours. Presenting Reality Stating what is real without arguing with patient. When the patient has a misperception of the environment, the nurse defines reality or indicates his/her perception of the situation for the patient. EXAMPLE: I know you hear these voices, but I do not hear them” “I am Lynn, your nurse, and this is the hospital” Verbalizing the Implied Putting into words what the patient has only implied. This clarifies that which is implicit rather than explicit. EXAMPLE: Patient: Its a waste of time to be here. I won’t be bothering you anymore soon” Nurse: Are you thinking of killing yourself” Reflecting Feelings/Attempting to Translate Words into Feelings Recognizing and acknowledging the patient’s feelings. Conveys empathy. EXAMPLE: “It sounds like you are feeling hopeless about your situation”; “It’s hard to live alone after being married for 30 years” Patient with Schizophrenia: Im way out in the ocean. Nurse: it sounds like you are feeling lonely right now” Formulating a Plan of Action When a patient has a plain in mind for dealing with what is considered to be a stressful situation, it may serve to prevent anger or anxiety from escalating to an unmanageable level. EXAMPLE: What could you do to let your anger out harmlessly? What could you do to let your anger out harmlessly? Next time this comes up, what might you do to handle it differently? Encouraging Evaluation Asking for patients views of meaning or importance of something; asking patient to evaluate their actions and outcomes. EXAMPLE: “What do you think are the reasons for ….”; “What did you feel after participating in group therapy” “How did using deep breathing work for you?” Self-Disclosure Share limited personal experiences about the self, for the purpose of emphasizing both the similarities and the differences of experiences. These exchanges are offered as an expression of genuineness and honesty by the nurse and disclosures should be relevant and appropriate. They are used sparingly so the patient is the focus of the interaction: “That happened to me once, too. It was devastating, and I had to face some things about myself that I didn’t like. I went to counseling and it really helped.... what are your thoughts about seeing a counselor?” Summarizing Concise review of key aspects of conversation; brings a sense of closure. Example: “During our meeting we talked about your causes of depression and your plans for socializing more after discharge by joining a grief support group” NON-THERAPEUTIC COMMUNICATION TECHNIQUES Giving Reassurance Indicating to the patient that there is no cause for anxiety, thereby devaluing the patients feelings. EXAMPLE: Everything will be all right. I wouldnt worry about that. Rejecting Refusing to consider or showing contempt for the patients ideas or behavior EXAMPLE: Lets not discuss... I dont want to hear about... Giving Approval Sanction or denouncing the patients idea or behavior. Implies the nurse has the right to pass judgment, and patient is expected to please the nurse. The nurse’s acceptance is then seen as conditional on the patient’s behavior EXAMPLE: Thats good. Im glad that you... Agreeing Indicating accord with the patients ideas or opinions. EXAMPLE: Thats right. I agree. Closed Ended Questions: questions that elicit yes or no response Social Responding Engaging in superficial conversation. Example: “Are you watching the football game tonight” “isn’t this weather horrible?” Giving Advice Telling the patient what to do or how to behave implies that the nurse knows what is best & that the patient is incapable of self-direction. EXAMPLE: I think you should... Why dont you... Probing Persistent questioning of the patient; pushing for answers to issues the patient does not wish to discuss. EXAMPLE: Tell me more about how your mother abused you when you were a child. Defending Arguing or justifying your position, justifying behavior of another EXAMPLE: No one here would lie to you. You have a very capable physician. Im sure he only has your best interest in mind. Requesting an Explanation/Asking Why questions Asking the patient to provide the reasons for thoughts, feelings, behavior, and events. Asking why the patient did something. EXAMPLE: Why did you think that? Why do you feel this way? Why did you do that? Diminishing/Belittling Feelings Discounting patient’s feelings EXAMPLE: Patient: I have nothing to live for. I wish I were dead. Nurse: Everybody gets down in the dumps at times. I feel that way myself sometimes. Making Stereotyped Comments Offering platitudes or wise sayings that seem automatic or contrived  EXAMPLE: Keep your chin up., “Time heals all wounds”, “Everything happens for a reason” Hang in there” Interpreting Psychoanalyzing; the therapist seeks to make conscious that which is unconscious, to tell the patient the meaning of his/her experience. (generalist nurses are not trained to do this) EXAMPLE: What you really mean is... Unconsciously your saying... “I think you are in denial about…” Changing the Subject Introducing an unrelated topic EXAMPLE: Patient: “I don’t think my husband finds me attractive since my mastectomy” Nurse: “I didn’t know you had breast cancer; does it run in your family” PROCESS RECORDING ASSIGNMENT Student Name Client Diagnoses Adult or Adolescent? Exchange Nurse (Verbal & Non-Verbal) Patient (Verbal & Non-Verbal) Nurse Thoughts & Emotions Analysis of the Interaction (Communication Technique used and Rationale for Use) Therapeutic or Non-Therapeutic? Alternate or Revised Response (if NT) 1.Introductory Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response: 2. Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response: 3. Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response: 4. Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response 5. Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response: 6. Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response: 7. Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response: 8. Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response: 9. Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response: 10.Termination Summary Verbal: Non-verbal: Verbal: Non-verbal: Nurse’s Thoughts: Nurse’s Emotions: Technique used: Rationale: Therapeutic? Alternate or Revised Response: Summary of the Therapeutic Encounter Discuss the influence of your setting on this interaction. Evaluate the overall effectiveness and therapeutic value of exchanges and techniques that were most useful for you. Identify areas for improvement and lessons learned. Reference: