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Mental Health > 2.1 Therapeutic Nurse-Patient Relationship > Flashcards

2.1 Therapeutic Nurse-Patient Relationship Flashcards

1
Q

Nurse-Patient Relationship

A
  • Foundation of psychiatric nursing
  • Nurse and patient must both recognize each other as unique and important
  • Relationship where mutual learning occurs
  • Therapeutic interpersonal relationship is the process where nurses provide care to patients in need of psychosocial intervention

Therapeutic use of self - Instrument for delivery of care
Interpersonal communication - tools of psychosocial intervention

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2
Q

Therapeutic Relationship

A
  • Interaction between 2 people where both contribute to a climate of healing, growth promotion, and/or illness prevention
  • Nurse and patient both perceive each other as a human being
  • GOAL ORIENTED WHERE BOTH PARTIES DECIDE ON THE GOAL
  • Most often goal is learning/growth to bring about positive change
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3
Q

Problem Solving Model

A
  • Goals of Therapeutic Relationship
  1. Identify the problem
  2. Discuss the desired change (promote patient to discuss changes they desire)
  3. Discuss which changes are possible and which are not
  4. Discuss alternate strategies for creating change
  5. Weigh the benefits/consequences of each alternative
  6. Assist patient with selecting an alternative
  7. Encourage patient to implement change
  8. Provide positive feedback for patient’s change attempts
  9. Assist patient in evaluating the outcomes of the change
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4
Q

Therapeutic Use of Self

A
  • Ability to use one’s own personality to establish relate ableness and structure nursing interventions
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5
Q

Conditions of Establishing a Therapeutic Relationship

A
  1. Empathy - Ability to see beyond outward behavior and understand a situation from a patients point of view. Used to understand a patients thoughts and feelings
  2. Genuineness - Ability to be honest, open and real in interactions. Be real means aware of what someone is experiencing internally and to make it apparent in the relationship
  3. Respect - Believe in dignity and worth of an individual despite unacceptable behavior. Unconditional and nonjudgmental respect.
  4. Trust - Confidence in a persons presence, reliability, integrity, and sincere desire to provide assistance when requested. BASIS OF THERAPEUTIC RELATIONSHIP
  5. Rapport - Special feeling between both patient and nurse based on acceptance, warmth, friendliness, common interest, trust, and nonjudgmental attitude.
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6
Q

Phases of Therapeutic Nurse-Patient Relationship

A
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7
Q

Stage 1 - Pre-interaction

A
  • When you first meet the patient
  • Assess and obtain information from the patient
    (Charts, significant others, feelings)
    (Examine own feelings of fear and anxiety about working with a patient)
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8
Q

Stage 2 - Orientation

A
  • Nurse and patient become acquainted with each other
  • Create environment to establish trust and rapport
  • Establish contract that details expectations/responsibilities of both parties
  • Gather assessment
  • Identify strengths/limitations of patient and formulate nursing diagnoses
  • Set mutually agreed upon goals
  • Develop plan of action that is realistic
  • Explore feelings of both patient and nurse
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9
Q

Stage 3 - Working

A
  • Therapeutic work of the relationship
  • Maintain trust/rapport
  • Promote the patients insight/perception of reality
  • Problem-solving
  • Overcome resistance behaviors of patient
  • Continuous evaluation

TRANSFERENCE
- Patient displaces feelings of their past onto the nurse. This includes anger, hostility, uncooperativeness, resistance, or overwhelming affection/dependency. This interferes therapeutic relationships.

COUNTERTRANSFERENCE
- Nurse’s behavior/emotional response to patient. Can be due to unresolved feelings towards a significant other from the nurses past or from transference feelings from the patient.

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10
Q

Stage 4 - Termination

A
  • End of nurse-patient relationship
  • Due to goals being met, patient being discharged
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11
Q

Therapeutic Conclusion of Relationship

A
  • Progress has been made towards attainment of goals
  • Plan of action for more adaptive coping in the future has been established
  • Feelings of termination of relationship is recognized and have been explored
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12
Q

Boundaries in Nurse-Patient Relationship

A
  • Determines the extents of acceptable limits
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13
Q

Professional Boundaries

A
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14
Q

Self-Disclosure

A
  • Appropriate only when information may therapeutically benefit the patient
  • Never ok to meet nurses needs
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15
Q

Gift Giving

A
  • May be part of the culture/value of a patient
  • NEVER ACCEPT FINANCIAL GIFTS (sometimes it is okay to donate the money to charity of patient’s choice)
  • If acceptance of a small gift is appropriate, the nurse can share the gift with other staff members
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16
Q

Touch

A
  • Required for therapeutic procedures

Caring Touch - Touching of patient when there is no physical need

  • Touching/hugging can be beneficial if deemed within therapeutic intent
17
Q

Friendship/Romantic Association

A
  • Nurse should withdraw from nurse-patient relationship if patient and nurse are acquainted and they have issues keeping it professional
  • ROMANTIC AND SEXUAL RELATIONSHIPS ARE NEVER APPROPRIATE
18
Q

WARNING SIGNS OF BREENCHING PROFESSIONAL BOUNDARIES

A
  • Favoring one patients care over another
  • Swapping patient assignments to care for a particular patient
  • Frequent thinking of patient when out of work
  • Keeping secrets with the patient
  • Giving special attention to a patient
  • Sharing personal information with a patient
  • Changing dress styles when working with a patient
  • Spending free time with a patient
  • Continued contact with a patient even after discharge
19
Q

Interpersonal Communication

A
  • Both participants perceive each other, listen to each other, and are mutually involved in creating a relationship
  • Both sender and receiver bring certain pre-existing conditions to the exchange that influence the intended messages and how they are interpreted
20
Q

Values and Attitudes and Beliefs

A
  • Learned ways of thinking
  • Children gain value systems from their parents
  • These ways of thinking are usually retained until adulthood or develop new attitudes as they mature
  • Influences communication (prejudice expressed verbally through negative stereotyping)
21
Q

Culture/Religion

A
  • Cultural norms or ideas provide basis for our way of thinking
  • Learned and differ from society to society
  • Influence communication (symbolic gestures such as a cross around the neck can communicate religious beliefs)
22
Q

Social Status

A
  • High-status person are associated with gestures that communicate their higher-power position
  • Examples include less eye contact, relaxed posture, louder voice, greater height, when communicating with those of lower status
23
Q

Gender

A
  • Gender signals recognized as either masculine or feminine.
24
Q

Age/Developmental Level

A
  • Adolescents use words such as “dude” or “groovy”
  • Developmental communication such as sign language for those who are deaf or blind people who never learn non-verbal gestures with words which can change the connotation of a word.
25
Q

Environment

A
  • Place where communication occurs

Territoriality - Innate tendency to own space. Influence interactions when it takes place in an environment “owned” by one or another.

Density - Number of people in a given space. Prolonged high-density situations may influence aggression, stress, criminal activity, hostility, towards others and deterioration of mental health.

Distance - Various cultures use space to communicate

26
Q

Distance

A

Intimate distance - Closest distance between individuals
Personal distance - Close conversations (with friends or colleagues)
Social distance - Distance when conversating with strangers/acquaintances
Public distance - Distance when speaking in public or yellowing to someone a distance away

27
Q

NONVERBAL COMMUNICATION

A
28
Q

Physical Appearance/Dress

A
  • Physical appearance and dress influence interpersonal responses and are primary determinants of such responses.
  • Clothing, hair, tattoo, cosmetics, jewlery
29
Q

Body Movement and Posture

A
  • The way an individual positions their body communicates self-esteem, gender identity, status, interpersonal warmth/coldness
30
Q

Touch

A
  • Powerful communication tool
  • Can elicit positive/negative reactions
  • Appropriateness is culturally determined
31
Q

Facial Expressions

A
  • Reveals emotional states.
  • Serve to compliment other communication behaviors and can even take the place of verbal communication
32
Q

Eye Behavior

A
  • Connection occurs through eye contact
  • Eye contact can convey interest in American culture
  • Eye contact indicates communication channel is open and is usually the initiating factor in verbal interactions
33
Q

Vocal Cues and Paralanguage

A
  • Pitch, tone, and loudness of spoken messages, or rate of speaking
  • Greatly influence how people interpret verbal messages

Mental Health (57 decks)

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