Therapeutic Communication and Behavioral Management
The American Nurses Association’s Corrections Nursing: Scope and Standards of Practice states that nurses are patient advocates and maintain a therapeutic and professional nurse–patient relationship with appropriate professional role boundaries. To provide quality health care for patients in correctional settings, nurses must be able to communicate with patients, other health care providers, correctional staff and outside providers.
Therapeutic communication is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient. Nurses use therapeutic communication techniques to provide support and information to patients. It may be necessary to use a variety of techniques to accomplish nursing goals in communicating with a patient (see list of common therapeutic communication techniques).
Correctional nurses must attend to the therapeutic nature of the interactions taking place with patients. Caring, the essence of a nurse–patient relationship, must be forefront in determining communication and action. Working among correctional colleagues can lead to an unconscious shift to a custodial relationship with inmates. This dilutes the nurse–patient relationship and can decrease nurse effectiveness. Custodial actions by the nurse are those that are not therapeutic in nature and are not aligned with nursing goals. Correctional nurses need to guard against assimilating into the custodial environment, thus changing the nature of the nurse-patient relationship.
Behavior has three elements: a triggering event (antecedent or cause), the behavior itself and the consequences of the behavior. The nurse must first define the behavior by, for example, describing the action. Next, look for events or other clues to explain what may have triggered the behavior. Finally, consider the consequence, such as changes in the environment or in the behavior of other people.
Behavior management may include medication, group or individual therapy sessions or just communicating with the person or people involved with the behavior. It is important to set realistic, obtainable goals tailored to the individual. You may have to divide your plan and goals into small, easy-to-do parts and be creative. Other behavior management techniques include positive reinforcement, setting boundaries and limits, and being honest with the patient.
Behavior management in correctional health care settings is challenging. In these confined areas, individuals are mixed together who may not be compatible. This is why classification guidelines are used to help minimize potential behavior outbursts. Nurses must establish and maintain effective working relationships with the patient, other health care providers and correctional staff simultaneously, while also assessing the environment for its conduciveness to appropriate or inappropriate behavior. Also, changing behavior is an ongoing process and needs to be reevaluated on a continuous basis.
Changing behavior can be hard work so do not forget to reward yourself and the patient for success, no matter how small.
— Susan Laffan, RN, CCHP-RN, CCHP-A, is co-owner of Specialized Medical Consultants, based in New Jersey, and also works in the emergency department of a hospital in that state. This column is coordinated by Lorry Schoenly, PhD, RN, CCHP-RN, an independent consultant specializing in correctional health care and social media; she is based in Pennsylvania. Both are members of the CCHP-RN task force. For correspondence, write to firstname.lastname@example.org.
[This column appeared in the Spring 2011 issue of CorrectCare.]