Care & Management of the Adult with problems related to Mental Health/Illness Flashcards
- Therapeutic approaches in psychiatric nursing care
Role of the Psychiatric Nurse
* Stranger
* Resource person
* Teacher
* Leader
* Surrogate
* Technical expert
* Counselor
Roles described by Hildegard Peplau; emphasis on “counselor” role
Dynamics of a Therapeutic Nurse-Client Relationship
* Goal-oriented
* Use of Self
* Self-awareness
- Use of self to include self-awareness and self-understanding by the nurse
Conditions Essential to the Development of a Relationship
Rapport > Trust > Respect > Genuineness > Empathy
* Rapport as the primary task in the relationship
* Trust as the basis of the relationship
* Respect as an unconditional positive regard
* Genuineness as being open, honest, and real
* Empathy as most important and to perceive and comprehend the client’s thoughts and feelings
Phases of a Therapeutic Nurse-Client Relationship
Pre-interaction > Orientation > Working > Termination
* Pre-interaction - the initial assessment begins here
* Orientation - nurse and client become acquainted
* Working - maintaining trust and rapport; problem-solving; overcoming resistant behavior; are continuously evaluating progress
Relationship phenomena
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Occurs when the nurse transfers feelings (often unconscious) about past experiences or people onto the patient
Counter-transference
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Occurs when the client unconsciously displaces (or “transfers”) to the nurse feelings formed toward a person from the past
Transference
Boundaries in the Nurse-Client Relationship
* Professional boundaries
* Warning signs
Communication
* Non-verbal
* Verbal
70-80% of communication is non-verbal
Therapeutic Communication Techniques
* Using silence
* Accepting
* Giving recognition
* Offering self
* Giving broad openings
* Offering general leads
* Placing the event in time or sequence
* Making observations
* Encouraging description of perceptions
* Encouraging comparison
* Restating
* Reflecting
* Focusing
* Exploring
* Seeking clarification and validation
* Presenting reality
* Voicing doubt
* Verbalizing the implied
* Attempting to translate words into feelings
* Formulating a plan of action
Nontherapeutic Communication Techniques
* Giving reassurance
* Rejecting
* Approving or disapproving
* Giving advice
* Probing
* Defending
* Requesting an explanation
* Indicating the existence of an external source of power
* Belittling feelings expressed
* Making stereotypical comments
* Using denial
* Interpreting
* Introducing an unrelated topic
Active Listening
SOLER
S = Sit squarely facing the client
O = Observe an open posture
L = Lean forward toward the client
E = Establish eye contact
R = Relax
Motivational Interviewing
* Evidence-based
* Patient-centered
* Explores
* Guides
- A communication style that incorporates active listening and verbal therapeutic communication techniques and is focused on what the client wants versus what the nurse thinks should be the next step in the behavior change
Techniques
Process recordings
- Verbatim
- Are written reports of verbal communication with a client; used as a learning tool for professional development; not a part of the medical record
Feedback
* Descriptive
* Evaluative
Applying the Nursing Process in the Psychiatric Setting
Assessment
- Information gathered from a client, record, family
- Observation
- Consultation with other health team member(s)
- Nursing physical examination
- Mental status exam
Diagnosis
- NANDA
Outcome identification
- Measurable
- Includes a time frame
- Realistic
- Team approach
Planning
- Collaborative care plan
- Identifies safety needs
Implementation
* Specific interventions according to standards of psychiatric-mental health clinical nursing practice
Evaluation
* Are goals being met?
* Revises as needed
