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PHC-MHN-THERAPUTIC NPR-SYNOPSIS

THERAPUTIC NPR

📚 Definition:

A Therapeutic Nurse-Patient Relationship is a professional, goal-directed relationship between a nurse and a patient that focuses on promoting the patient’s emotional well-being, mental health, and personal growth.

  • Introduced by Hildegard E. Peplau, known as the Mother of Psychiatric Nursing.
  • It is based on trust, respect, empathy, and clear professional boundaries.

🧩 Components of Therapeutic Relationship:

  1. Trust – Foundation of the relationship; builds safety and openness.
  2. Respect (Positive Regard) – Accepting the patient as a unique individual without judgment.
  3. Empathy – Understanding the patient’s feelings and experiences from their perspective.
  4. Genuineness – Being honest, open, and sincere in interactions.
  5. Professional Boundaries – Maintaining appropriate emotional and physical limits.

📖 Phases of Therapeutic Relationship (Peplau’s Model):

1️⃣ Pre-Interaction Phase:

  • Before meeting the patient.
  • Nurse prepares by reviewing patient records and reflecting on personal attitudes.

2️⃣ Orientation Phase:

  • First meeting with the patient.
  • Establish trust, clarify roles, define goals, and set boundaries.
  • Example: Explain the purpose of the interaction and confidentiality limits.

3️⃣ Working Phase:

  • The longest and most therapeutic phase.
  • Nurse helps the patient explore feelings, develop coping skills, and work on problem-solving.
  • Encourage participation in therapy and promote behavioral changes.

4️⃣ Termination Phase:

  • Ending the relationship after goals are met or at the time of discharge.
  • Summarize progress, discuss future plans, and provide referrals if needed.
  • Address feelings of separation or dependency.

💡 Importance of Therapeutic Nurse-Patient Relationship:

  • Helps patients express emotions and explore feelings.
  • Promotes trust and emotional security.
  • Facilitates behavioral and emotional change.
  • Encourages patient independence and self-care.
  • Essential for the success of psychotherapy and counseling.
  • Helps prevent feelings of loneliness, isolation, and stigma in mental illness.

📚 One-Liner Revision on Therapeutic Nurse-Patient Relationship

  1. Who introduced the concept of the therapeutic nurse-patient relationship?
    ✅ Hildegard Peplau.
  2. Which is the foundation of a therapeutic relationship?
    ✅ Trust.
  3. In which phase is rapport established with the patient?
    ✅ Orientation Phase.
  4. Which phase involves planning for the end of the relationship?
    ✅ Termination Phase.
  5. What is the primary goal of a therapeutic relationship?
    ✅ To promote the patient’s well-being and independence.
  6. Maintaining professional boundaries helps prevent what?
    ✅ Over-involvement and dependency.
  7. Which component involves understanding the patient’s feelings without becoming emotionally involved?
    ✅ Empathy.
  8. What is the main focus of the working phase?
    ✅ Problem-solving and implementing interventions.
  9. Genuineness in a therapeutic relationship refers to:
    ✅ Being open, honest, and sincere.
  10. Confidentiality can only be breached when:
    ✅ There is a risk of harm to the patient or others.

🎯 MCQs for Practice

  1. Who is considered the Mother of Psychiatric Nursing?
    A) Florence Nightingale
    B) Virginia Henderson
    C) Hildegard Peplau
    D) Dorothea Orem
    ✅ Correct Answer: C) Hildegard Peplau
  1. Which of the following is NOT a component of a therapeutic relationship?
    A) Trust
    B) Over-involvement
    C) Empathy
    D) Confidentiality
    ✅ Correct Answer: B) Over-involvement
  1. During which phase does the nurse implement problem-solving strategies?
    A) Orientation Phase
    B) Working Phase
    C) Termination Phase
    D) Pre-Interaction Phase
    ✅ Correct Answer: B) Working Phase
  1. Which is an example of maintaining professional boundaries?
    A) Sharing personal problems with the patient
    B) Encouraging patient dependency
    C) Avoiding personal disclosure and staying professional
    D) Accepting personal gifts from the patient
    ✅ Correct Answer: C) Avoiding personal disclosure and staying professional
  1. Which component focuses on accepting the patient as a unique individual without judgment?
    A) Trust
    B) Respect
    C) Confidentiality
    D) Genuineness
    ✅ Correct Answer: B) Respect

📚 Definition of Communication:

Communication is the process of exchanging information, thoughts, ideas, emotions, and feelings between individuals through verbal, non-verbal, or written means to achieve understanding.

🧩 Elements of Communication (Communication Process):

  1. Sender/Source – The person initiating the message.
  2. Message – The content or information being conveyed.
  3. Encoding – Process of converting thoughts into communicable form.
  4. Channel/Medium – Method used to send the message (verbal, written, non-verbal).
  5. Receiver – The person for whom the message is intended.
  6. Decoding – Interpretation of the message by the receiver.
  7. Feedback – The response from the receiver, indicating understanding or reaction.
  8. Noise – Any factor that interferes with the communication process (e.g., physical noise, emotional distractions).

📖 Types of Communication:

✅ 1. Verbal Communication:

  • Oral: Spoken words (face-to-face, phone).
  • Written: Notes, reports, emails.

✅ 2. Non-Verbal Communication:

  • Body language (gestures, posture).
  • Facial expressions, eye contact.
  • Tone of voice, silence, touch.

✅ 3. Visual Communication:

  • Charts, diagrams, signs, presentations.

✅ 4. Meta-Communication:

  • Hidden meaning behind the words, influenced by tone, gestures, and context.

📅 Factors Influencing Communication:

  • Physical Factors: Noise, distance, discomfort.
  • Physiological Factors: Hearing or speech impairments, illness, fatigue.
  • Psychological Factors: Emotions, stress, anxiety, mood.
  • Cultural Factors: Language barriers, beliefs, values, customs.
  • Environmental Factors: Privacy, comfort, lighting.
  • Educational and Language Levels: Understanding of terms used.

📝 Recording in Communication (Documentation):

  • Accurate, timely, and objective documentation of patient interactions and care.
  • Follow SOAP Format:
    • S: Subjective Data
    • O: Objective Data
    • A: Assessment
    • P: Plan
  • Use professional language and avoid personal opinions.

🚧 Barriers to Communication (Therapeutic Impasse):

❌ 1. Physical Barriers:

  • Noise, poor lighting, distance.

❌ 2. Psychological Barriers:

  • Anxiety, fear, mistrust, low self-esteem.

❌ 3. Language Barriers:

  • Use of medical jargon or unfamiliar terms.

❌ 4. Cultural Barriers:

  • Different beliefs and values affecting understanding.

❌ 5. Emotional Barriers:

  • Anger, depression, denial.

❌ 6. Non-Therapeutic Communication Techniques (Should Be Avoided):

  • Giving false reassurance.
  • Changing the subject.
  • Giving unsolicited advice.
  • Arguing or challenging the patient.
  • Using closed-ended questions unnecessarily.

📖 Therapeutic Impasse:

  • A situation where communication between the nurse and patient becomes blocked or ineffective.
  • Often caused by unresolved emotions, poor rapport, or communication barriers.
  • Requires use of therapeutic communication techniques to overcome.

📚 One-Liner Revision on Communication Skills

  1. What is the first element of the communication process?
    ✅ Sender/Source.
  2. What does the term “decoding” refer to in communication?
    ✅ Interpreting the message by the receiver.
  3. Which type of communication involves body language and facial expressions?
    ✅ Non-verbal Communication.
  4. What is meta-communication?
    ✅ The hidden or underlying meaning behind verbal messages.
  5. Which factor is a psychological barrier to effective communication?
    ✅ Anxiety and fear.
  6. What is the most important part of therapeutic communication?
    ✅ Active listening and empathy.
  7. What does the ‘F’ in the SOLER model of active listening stand for?
    ✅ Face the patient squarely.
  8. What is therapeutic impasse?
    ✅ A blockage or breakdown in nurse-patient communication.
  9. Which type of question encourages detailed patient responses?
    ✅ Open-ended questions.
  10. Which recording format is commonly used in nursing documentation?
    ✅ SOAP Format (Subjective, Objective, Assessment, Plan).

🎯 MCQs for Practice

  1. Which of the following is an example of non-verbal communication?
    A) Writing a report
    B) Nodding during a conversation
    C) Giving oral instructions
    D) Sending an email
    ✅ Correct Answer: B) Nodding during a conversation
  1. Which factor is a common barrier to effective communication?
    A) Providing privacy
    B) Active listening
    C) Use of medical jargon
    D) Maintaining eye contact
    ✅ Correct Answer: C) Use of medical jargon
  1. Therapeutic impasse occurs when:
    A) The nurse communicates effectively
    B) Communication between the nurse and patient breaks down
    C) The patient is fully satisfied with care
    D) Documentation is completed accurately
    ✅ Correct Answer: B) Communication between the nurse and patient breaks down
  1. Which of the following is a therapeutic communication technique?
    A) Changing the subject
    B) False reassurance
    C) Empathy
    D) Giving advice
    ✅ Correct Answer: C) Empathy
  1. What is the correct order of the communication process?
    A) Message → Sender → Feedback → Receiver
    B) Sender → Message → Channel → Receiver → Feedback
    C) Receiver → Channel → Message → Feedback
    D) Channel → Message → Feedback → Sender
    ✅ Correct Answer: B) Sender → Message → Channel → Receiver → Feedback
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