NLE Foundations of Psychiatric & Mental Health Nursing — Therapeutic Communication & the Nurse-Patient RelationshipConcept Map

Concept

Communication Foundations

Sub Concepts

• Verbal Communication
• Nonverbal Communication
• Therapeutic Attitudes
• Space and Territory
• Congruence Between Channels

Relationship To Central

Provides the fundamental channels and attitudes that make therapeutic use of self possible

Concept

Therapeutic Communication Techniques

Sub Concepts

• Silence and Presence
• Active Listening
• Open-Ended Statements
• Restating and Reflecting
• Clarifying and Focusing
• Presenting Reality
• Acknowledging and Validating

Relationship To Central

Operationalizes therapeutic use of self through specific verbal and nonverbal skills that encourage client expression and build trust

Concept

Non-Therapeutic Blocks

Sub Concepts

• False Reassurance
• Giving Advice
• Giving Approval or Disapproval
• Why Questions
• Probing
• Changing Subject
• Minimizing Feelings
• Defending
• Stereotyped Responses
• Value Judgments

Relationship To Central

Barriers that prevent therapeutic use of self and shut down therapeutic communication

Concept

The Nurse-Patient Relationship (Peplau's Model)

Sub Concepts

• Pre-Interaction Phase
• Orientation Phase
• Working Phase
• Termination Phase

Relationship To Central

Structures the therapeutic use of self into defined phases with specific goals and tasks

Concept

Relationship Phenomena

Sub Concepts

• Transference
• Countertransference
• Self-Awareness
• Resistance

Relationship To Central

Psychological dynamics that emerge within the therapeutic relationship and require nurse awareness and management

Concept

Boundaries and Professional Relationship

Sub Concepts

• Appropriate Self-Disclosure
• Gift-Giving Boundaries
• Role Clarity
• Boundary Violations
• Professional vs. Social Relationship

Relationship To Central

Defines the parameters that maintain therapeutic relationship integrity and protect both client and nurse

Concept

Milieu Therapy

Sub Concepts

• Safety and Structure
• Therapeutic Community
• Client Involvement
• Consistency and Limit-Setting
• Containment, Support, Involvement, Validation

Relationship To Central

Extends therapeutic use of self to the entire environmental context to promote healing

Concept

Nursing Management and NLE Priorities

Sub Concepts

• Establishing Trust
• Using Therapeutic Techniques
• Managing Nonverbal Cues
• Maintaining Boundaries
• Managing Countertransference
• Reality Orientation

Relationship To Central

Translates therapeutic concepts into priority nursing actions aligned with professional standards and Philippine nursing practice (RA 9173)

To

Communication Foundations

From

Therapeutic Use of Self

Strength

strong

Relationship

Therapeutic use of self is operationalized through understanding verbal and nonverbal channels and adopting therapeutic attitudes

To

Therapeutic Communication Techniques

From

Therapeutic Attitudes

Strength

strong

Relationship

Genuine attitudes (genuineness, respect, empathy, concreteness) make therapeutic techniques effective; without them, techniques are mechanical and fail to build trust

To

Therapeutic Communication Techniques

From

Nonverbal Communication

Strength

strong

Relationship

Active listening and observing attend to nonverbal cues; techniques like sharing observations depend on noting and validating nonverbal messages

To

Therapeutic Communication Techniques

From

Non-Therapeutic Blocks

Strength

strong

Relationship

Non-therapeutic responses are the inverse of therapeutic techniques; awareness of blocks helps nurses eliminate them from their own speech

To

Orientation Phase

From

Therapeutic Communication Techniques

Strength

strong

Relationship

Therapeutic techniques are applied throughout all phases but are foundational in orientation to build trust and negotiate the contract

To

Working Phase

From

Orientation Phase

Strength

strong

Relationship

Trust and contract established in orientation are prerequisites for the deeper work, problem exploration, and insight development that occur in working phase

To

Transference and Countertransference

From

Working Phase

Strength

strong

Relationship

Relationship dynamics typically emerge during the working phase when client explores problems and nurse responds; these become therapeutic material

To

Orientation Phase

From

Termination Phase

Strength

moderate

Relationship

Termination is planned during orientation; the nurse discusses duration and expected ending from the start, preparing client for eventual closure

To

All Phases

From

Boundaries and Professional Relationship

Strength

strong

Relationship

Maintaining firm, consistent boundaries that protect both client and nurse is essential across all four phases of the relationship

To

Self-Awareness and Supervision

From

Countertransference

Strength

strong

Relationship

Managing countertransference requires the nurse to recognize her own displaced feelings and seek clinical consultation; self-awareness is the antidote

To

Working Phase

From

Transference

Strength

moderate

Relationship

When transference is identified and named, it becomes valuable therapeutic material that helps client understand past relationship patterns

To

Therapeutic Use of Self

From

Milieu Therapy

Strength

moderate

Relationship

Milieu therapy extends therapeutic use of self to the entire environmental context; the unit itself becomes a healing agent

To

Containment Goal

From

Safety and Structure in Milieu

Strength

strong

Relationship

A secure, predictable environment with clear rules achieves containment, keeping clients safe and managing crises

To

Community Meetings

From

Client Involvement in Milieu

Strength

strong

Relationship

Client participation in community decisions and meetings fosters responsibility, autonomy, and ownership of recovery

To

Hallucinations and Delusions

From

Presenting Reality

Strength

strong

Relationship

When clients experience hallucinations or delusions, the nurse presents reality without arguing: acknowledges experience, states own perception, offers support

To

Nonverbal Communication

From

Congruence Check

Strength

strong

Relationship

When verbal and nonverbal messages conflict, the nurse trusts and explores the nonverbal channel, which is more reliable indicator of true feeling

To

Managing Countertransference

From

Pre-Interaction Self-Assessment

Strength

moderate

Relationship

Self-assessment before meeting the client helps identify biases and fears that could lead to countertransference during the relationship

To

Therapeutic Communication Techniques

From

Giving Information vs. Giving Advice

Strength

moderate

Relationship

Teaching facts and providing information is therapeutic; telling client what to do (advice) fosters dependence and is non-therapeutic

To

Gift-Giving and Social Contact

From

Professional Relationship Boundaries

Strength

moderate

Relationship

Avoiding gifts and social contact outside the professional context protects the relationship from boundary violation and role blurring

To

Boundary Maintenance and Confidentiality

From

RA 9173 Philippine Nursing Practice Law

Strength

strong

Relationship

Philippine nursing practice law requires nurses to maintain confidentiality within the limits of safety and to establish firm professional boundaries