Chapter 5 Flashcards
Essence of how we as nurses “treat” patients in psych nursing:
We use ourselves. Every interaction is a chance to be therapeutic.
Therapeutic communication: the goal
To help the patient “grow”
Practical ways to help a patient achieve goals
Ask patient why they’re there, or inform them if they don’t know. Sometimes they straight up don’t know why they’re in there
Talk about what the pt wants to do
Discuss treatments if the pt expresses interest
Sometimes they want to kill themselves. Redirect their attention to something realistic like just getting out of their room.
A big obvious goal for therapeutic communication…
Getting the patient to talk about feelings
Help a client see alternatives to suicide…
How?
If they think it would be better for them to die, because it would be better for their kids/spouse, inform them that family members who have someone close to them die are more likely to do it themselves.
Encourage talking
Therapeutic use of self
Encourage change in yourself. What ways can I seem more open?
The words will come to you. It’s okay to not know what to say immediately
Rapport
Simply acknowledge patients. Start building good vibes from the start, before they even talk to you. Not everyone will like you for whatever reason.
Trust
If you say you are going to do something make sure you do it for the patients.
Respect
Everyone deserves it. No matter how horrible they are
Genuineness
Be honest to who you are
Empathy
See things from their point of view. Not sympathy.
Phases of the therapeutic nurse-client relationship
Pre interaction phase
Orientation (introductory) phase
Working phase
Termination phase
Pre-interaction phase. What happens in this phase?
Obtain info about the client from the chart, significant others, or other team members
Examine ones own feelings, fears, and anxieties about working with a particular client.
Most of this happens in report. We all have biases, but try to see them as people
Orientation (introductory) phase
Introduce yourself + ask client goals
Create trust & rapport, establish interventions, gather assessment data
Identify client’s strength’s and weaknesses, get diagnoses, set goals together
Explore feelings
Working phase
Help pt gain insight on how to make changes
Constant evaluation
Maintain trust and rapport, promote client’s insight and perception of reality, use problem solving model to work toward accomplishing goals
Overcome resistance behaviors
In the working phase: Transference
Occurs when the client unconsciously displaces (or “transfers”) to the nurse, feelings formed toward a person from the past
In the working phase: Counntertransference
Refers to the nurse’s behavioral and emotional response to the client
Termination phase… Therapeutic conclusion happens when:
Progress has been made toward attainment of the goals
A plan of action for more adaptive coping with future stressful situations is established
Feel is about termination of the relationship are recognized and explored
Patients can spiral b/c of this
Pre-interaction phase: IMPORTANT first step
Look at yourself first, clarify personal attitudes, values, and beliefs. See how they might affect the nurse’s care for a particular client.
Personal boundaries with patients
Obvious: never can have a friendship or romantic relationship
You can give some personal information, but not too much. Can accept drawings but nothing much
Never hug psych patients EVER
Be aware of these different communication influences
Values, attitudes, beliefs… for example prejudice
Culture or religion
Norms, ideas, and customs can affect therapeutic communication
Be aware of these different communication influences cont.
Social status; weird power dynamic… or standing. When possible, sit with patients
Gender; viewed differently by every person (some people like same gender treatment)
Be aware of these different communication influences cont
Age or developmental level
The environment: be aware of surroundings. It’s ok to tell someone to step back
Territoriality
The innate tendency to own space
