3. Therapeutic Environment & Therapeutic Communication

Question 1

……it can refer to physical, social, and psychological safe spaces that are specifically designed to be healing.

But most often, the term refers to a physical space that is set up to allow individuals to work through and overcome medical issues.

Answer 1

Therapeutic environments

Question 2

Purpose of the therapeutic environment:

Answer 2

• To manage the environment,
• Helping the patient to increase self-esteem, self-worth and self-confidence.
• To make her/him more active in society, business life, and life.
• Developing the ability to relate to other people.

Question 3

The goals and principles of the therapeutic environment:

Answer 3

To meet the basic needs of the patient.
Making the patient express himself/herself
To ensure the patient to benefit from the communication between the patient and the staff at the maximum level
Improving the patient’s relationships with other patients
Increasing the patient’s self-esteem and self-confidence
Ensuring that the patient can control their problematic behavior
Improving the patient’s coping skills
Enabling the patient to use more adaptive social skills
Speeding up her/him socialization
To increase the opportunities to participate in unit management.

Question 4

Elements of the Therapeutic Environment

Answer 4

1. Security
2. Configured Environment
3. Norms
4. Limits
5. Balance
6. Flexibility / Changeability

Question 5

There are four basic elements that make up the structure of the environment:

Answer 5

Physical layout of the unit
A document containing the rules that form the basis for the therapeutic setting
Step system
Group activities carried out regularly.

Question 6

Behaviors that should be limited in psychiatry clinics:

Answer 6

• Self-harm
• Physical aggression
• Non-adherence to treatment
• Use of alcohol and other substances
• Inappropriate sexual behavior
• Smoking
• Escape

Question 7

• This ability…..with clients is one of the most important skills a nurse can develop.

Answer 7

Therapeutic relationships

• Effective interpersonal skills are central to a mental health nurse’s ability to form a sound therapeutic alliance and to the role of mental health nurses.

Question 8

….it differs from the social or intimate relationship in many ways because it focuses on the needs, experiences, feelings, and ideas of the clients only.

• Nurse and client agree about the areas to communicate to work on and evaluate the outcomes.

Answer 8

Therapeutic relationships

Question 9

Trust
Empathy
Acceptance
Positive regard
Self-awareness
Therapeutic use of self

Answer 9

Components of a Therapeutic Relationship

Question 10

….occurs when words and actions match.

Answer 10

Congruence

Question 11

Trust is difficult to establish in the following:

Answer 11

Paranoia
Low self-esteem
Anxiety

Question 12

• This is the ability to perceive the meanings and feelings of the client and to communicate that understanding to the client.
• Both the client and the nurse give a “gift of self” when….occurs.
• Defined as the ability to sense other people’s emotions, coupled with the ability to imagine what someone else might be thinking or feeling.

Answer 12

Empathy

Question 13

What are the Therapeutic communication techniques that help nurses to send empathetic messages to the client?

Answer 13

• Reflection, restatement & clarification.

Question 14

…..it often shifts the emphasis to the nurse’s feelings, hindering the nurse’s ability to view the client’s needs objectively.

• Feelings of pity and sorrow for someone else’s misfortune.

Answer 14

Sympathy

Question 15

TRUE/FALSE

1. The nurse must set boundaries for behavior in the nurse-client relationship.
2. By being clear and firm without anger or judgment, the nurse allows the client to feel intact while still conveying that certain behavior is unacceptable.
3. Acceptance means the acceptance of inappropriate behaviors but acceptance of the person as worthy.
4. Nonverbal techniques: Leaning toward the client, eye contact, being relaxed, having the arms rested at the side, and interested but neutral attitude.
5. Verbally attending: Nurse avoids value judgment about the client’s behavior.
6. Establishing trust; placing boundaries on the relationship and first mention of termination in 6 weeks.

Answer 15

1. True
2. True
3. False
4. True
5. True
6. True

Question 16

This unconditional nonjudgmental attitude is known as…& implies respect.

Answer 16

Positive regard

Question 17

Measures to convey respect and positive regard:

Answer 17

• Calling client by name
• Spending time with client
• Listening and responding openly
• Considering client’s ideas and preferences when planning care.

Question 18

1)….the process of developing an understanding of one’s own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths and limitations and how these qualities affect others.

2)…..is that the nurse begin to use aspects of his or her personality, experiences, values, feelings, intelligence, needs, coping skills and perceptions to establish relationship with clients.

Answer 18

1. Self-awareness
2. Therapeutic Use of Self

Question 19

1. Pre-interaction Phase
2. Orientation Phase
3. Working Phase
4. Termination

Answer 19

Phases of the Nurse-Client Relationship

Question 20

• This phase begins when the nurse is assigned to initiate a therapeutic relationship and included all the nurse thinks, feels or does immediately prior to the first interaction with the patient.

Nurse’s tasks in this phase are:

Answer 20

1. Pre-interaction phase

• Explore own feelings, fantasies and fears.
• Analyses own professional strengths and limitations.
• Gather data about patients whenever possible.
• Plan for the first meeting with patient (before the meeting):
• Read background materials available on the client.
• Become familiar with the medications the client is taking.
• Gather necessary paperwork.
• Arrange for a quiet, private and comfortable setting.
• Self-assessment
• Examine preconceptions about the client and ensure to put them aside and get to know the real person.

Question 21

• This phase begins when the nurse and client meet and ends when the client begins to identify problems to examine.

Activities:

Answer 21

2. Orientation Phase

Establish roles
Establish the purpose of the meeting and the parameters of the subsequent meeting
Identify client’s problems
Clarify expectations.

• Nurse-client Contracts
• Confidentiality
• Self-disclosure

Question 22

This phase is divided into 2 sub-phases:

1. Problem identification: client identifies the issues or concerns causing the problems.
2. Exploration: the nurse guide the client to examine feelings and responses and to develop better coping skills and a more positive self-image.

Answer 22

Working Phase

• Overcoming resistance
• Promoting self-esteem
• Gathering data

Question 23

• This phase is the final stage in the nurse-client relationship.
• It begins when the problems are resolved, and it ends when the relationship is ended.
• Nurse and client usually have feelings about ending the relationship.
• Clients may feel it as an impending loss.

Answer 23

Termination phase

• It is appropriate to tell the client that the nurse enjoyed the time spent with the client and will remember him or her but it is inappropriate for the nurse to agree to see the client outside the therapeutic relationship.
• Sharing of the termination experience with the client demonstrates the partnership and the caring of the relationship

Question 24

Possible Warnings or Signals of Abuse of the Nurse-Client Relationship

Answer 24

• Secrets; reluctance to talk to others about the work being done with the client.
• Sudden increase in phone calls between the nurse and client calls outside the clinical hours.
• Nurse making exceptions for client than normal.
• Change in the nurse’s body language, dress or appearance (with no other satisfactory explanation).
• Extended one-on-one sessions or home visits.
• Spending off-duty time with the client.
• Thinking about the client frequently when away from work.
• Becoming defensive if another person questions the nurse’s care of the client.
• Ignoring agency’s policies.
• Inappropriate gift-giving between client and the nurse.
• Loaning, trading, or selling goods or possessions.
• Nurse disclosure of personal issues or information.
• Inappropriate touching, comforting or physical contact.
• Overdoing, overprotecting, or over identifying with the client.

Question 25

BARRIERS TO COMMUNICATION

Answer 25

AGREEING AND DISAGREEING
BEING DEFENSIVE
CHALLENGING
TESTING
REJECTING
CHANGING TOPICS AND SUBJECTS
UNWANTED REASSURANCE
PASSING JUDGEMENT
GIVING COMMON ADVICE

Question 26

• An interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information.
• Skilled use helps the nurse understand and empathize with the client’s experience.

Answer 26

Therapeutic Communication

Question 27

Goals of Therapeutic Communication

Answer 27

• Establish a therapeutic nurse-client relationship.
  Identify the most important client concern at that moment (the client-centered goal).
• Assess the client’s perception of the problem as it unfolds. This includes detailed actions (behaviors and messages) of the people involved and the client’s thoughts and feelings about the situation, others, and self.
• Facilitate the client’s expression of emotions.
• Teach the client and family necessary self-care skills.
• Recognize the client’s needs.
• Guide the client toward identifying a plan of action to a satisfying and socially acceptable situation.