Exam 2 Flashcards
what is the goal of the pre-interaction phase
explore self-awareness
what is the goal of the orientation phase
establish trust
formulate contract for intervention
what is the goal of the working phase
promote client change
what is the goal of the termination phase
evaluate goal attainment
Ensure therapeutic closure
These are ____ signs that professional boundaries of the nurse-patient relationship may be in jeopardy
Favoring one patient’s care over another’s
Keeping secrets with a client
Changing dress style when working with a particular client
Swapping patient assignments to care for a particular patient
Giving special attention or treatment to one patient over others
Spending free time with a patient
Frequently thinking about the patient when away from work
Sharing personal information or work concerns with the patient
Receiving of gifts or continued contact and communication with the patient after discharge
warning
this occurs when the client unconsciously displaces or transfers to the nurse feelings formed toward a person from his or her past
transference
refers to the nurse’s behavioral and emotional responses to the client in which the nurse transfers feelings unconsciously about past experiences or people onto the patient
Countertransference
this is an interactive process of transmitting information between two or more entities
communication
this is a transaction between the sender and the receivers with both persons participating simultaneously
interpersonal communication
this is the innate tendency to own space; individuals law claim to areas round them as their own
territoriality
this type of touch is impersonal and businesslike and used to accomplish a task
Ex: a tailor measuring a customer for a suit or a physician examining a client
functional-professional touch
this type of touch is still rather impersonal but it conveys an affirmation or acceptance of the other person
Ex: a handshake
social-polite
this determines what is right or good within a society
legislation
this is a branch of philosophy that deals with systematic approaches to distinguishing right from wrong behavior
ethics
is the term applied to these principles when they refer to concepts within the scope of medicine, nursing and allied health
bioethics
Conduct that results from us critically thinking about how we should treat others moral behavior is reflected by how you respect other people and your individual beliefs of autonomy, freedom, justice, honesty, and confidentiality
moral behavior
personal beliefs about what is important and desirable, what we value
values
we self-evaluate and identify our own personal values; this is a process of self-explorations through which individuals identify and rank their own personal values, increases awareness about why individuals behave in certain ways; this is important in nursing because it helps understand why certain choices and decisions are made over others and how values affect nursing outcomes
values clarification
is a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and an entitlement of a benefit or service; this is an absolute when there is no restriction whatsoever on the individual’s entitlement
rights
this is a right on which the society has agreed and formalized into law.
legal right
this is a moral principle or a set of moral principles that can be used in assessing what is right or wrong
ethical theory
the basis of this theoretical perspective is the greatest-happiness principle
utilitarianism
theory that promotes action based on the end result that produces the most good (happiness) for the most people.
utilitarianism
this principle holds that actions are right to the degree that they tend to promote happiness and are wrong as then tend to produce the reverse of happiness
utilitarianism
this theory perspective is directly opposed to utilitarianism
Kantianism
this theoretical perspective argues that it is not the consequences or end results that make an action right or wrong; rather it is the principle or motivation on which the actions is based that is the morally decisive factor
Kantianism
this theoretical theory suggests that decisions and actions are bound by a sense of duty.
Kantianism
what is another name for Kantianism
Deontology
what is the golden rule associated to Christian ethics
do onto others as you would have them do unto you
the imperative demand of ___ ___ is that all decisions about right and wrong should be centered in love for God and in treating others with the same respect and dignity with which we would expect to be treated
Christian Ethics
this theory is is based on the idea that decisions about right vs. wrong are self-evident and determined by human nature
“do god and avoid evil”
we know the difference between good and evil and this knowledge directs our decision making
natural law theory
this theoretical perspective says that what is right and good is what is best for the individual making the decision. what is best for this person to do even is it may not be the best for anyone else involved
ethical egoism
An operating room nurse asks a psychiatric nurse, “How can you work with the mentally ill day in and day out?” The psychiatric nurse replies, “It’s just the right thing to do.” The psychiatric nurse is operating from which ethical framework? A. Kantianism B. Christian ethics C. Ethical egoism D. Utilitarianism
A.
this happens when a situation requires the nurse to make a choice between two equally favorable alternatives
ethical dilemmas
there is evidence to support both moral rightness and moral wrongness related to a certain action and the individual who must make the choice experiences conscious conflict regarding the decision
ethical dilemmas
an ___ ____ arises when there is no clear reason to choose one action over another.
ethical dilemma
in most ethical dilemmas taking no action is considered an ___ __
action taken
these are fundamental guidelines that influence decision making
ethical principles
what are the ethical principles
autonomy beneficence nonmaleficence justice veracity
this ethical principle views persons as autonomous moral agents whose right to determine their destinies should always be respected
autonomy
this ethical principle presumes that individuals are always capable of making their own independent choises
autonomy
the right to self-determination
autonomy
health care workers must make sure that respect for an individual’s ____is not disregarded in favor of what another person may view as best for the client
autonomy
this ethical principle refers to ones duty to benefit or promote the good of others
DO GOOD
Beneficence
Peplau recognized this as an essential role for the psychiatric nurse and means acting in another’s behalf as a supporter or defender
advocacy
this ethical principle is the requirement that health care providers do no harm to their clients, either intentionally or unintentionally; DO NO HARM
Nonmaleficence
this ethical principle is referred to as the “justice as fairness” principle or distributive justice says that individuals have the right to be treated equally and fairly regardless of race, gender, marital status, medical diagnosis, social standing, economic level, or religious belief.
Justice
when this ethical principle is applied to healthcare it means that medical services are to be distributed equally to all people.
Justice
This ethical principle refers to ones duty to always be truthful; “requires the health-care provider to tell the truth and not intentionally deceive or mislead clients
veracity
True or false: There are times when limitations must be placed on veracity such as when the truth would produce harm or interfere with the recovery process of a patient.
TRUE
The following steps may be used in making an ethical decision and resemble the steps of the nursing process
assessment problem identification plan implementation evaluation
during this step you gather the subjective and objective data about a situation; consider personal values and values of others involved in the dilemma
assessment
in this step for making an ethical decision you identify the conflict between two or more alternative actions
problem identification
in this step for making an ethical decision you explore the benefits and consequences of each alternative
consider principles of ethical theories
select an alternative
planning
in this step for making an ethical decision you act on the decision made, and communicate the decision to others
implementation
in this step for making an ethical decision you evaluate the outcomes
evaluation
anyone who is admitted to the hospital has the right to ___
treatment
legally patients have the right to ___ treatment including medication unless immediate intervention is required to prevent death or serious harm to the patient
refuse
what are the 3 criteria that must be met to force medication without the client consent
- client must show behavior that is dangerous to self or others
- the medication order must have a reasonable chance of providing help to the client
- client who refuse medication must be judged incompetent to evaluate the benefits of the treatment in questions
this right means that clients who can be adequately treated in an outpatient setting should not be hospitalized and if they are they shouldn’t be sedated, restrained or secluded unless less restrictive measures were unsuccessful
right to least restrictive treatment
with this right the patient basically has the right to whatever level of treatment is effective and least restricts his or her freedom
right to least restrictive treatment
this act define the legal parameters of professional and practical nursing
Nurse Practice Act
most nurse ___ __ are general in their terminology and do not provide specific guidelines for practice
practice acts
what are the two categories of law that are of most concern to nurses
statutory law
common law
Law that has been enacted by a legislative body (city council, U.S. congress)
Example of this is the nurse practice acts
statutory law
Derived from decisions made in previous cases that have come up and evolved from other court cases
Will differ from state to state: example might be how different states deal with nurses who refuse to treat specific patients
common laws
common and statutory laws can either be ___ or ___
civil
criminal
Protects the private and property rights of individuals and business
civil law
in civil law private individuals or groups may bring legal action to court for breach of civil law and these legal actions are of two basic types: ___ and ___
torts
contracts
this is a violation of a civil law in which an individual has been wronged, one party says the other has caused harm and seek compensation, may be intentional or unintentional
tort
in a ___ action one party asserts that the other, in failing to fulfill an obligation, has breached the contract and either compensation or performance of the obligation is sought as remedy
contract
this law provides protection from conduct deemed injurious to the public welfare: example is the theft by hospital employee of supplies or drugs
criminal law
what are some legal issues in psychiatric mental health nursing
confidentiality and right to privacy
- health insurance portability and accountability act HIPAA
- doctrine of privileged communication
what amendments protect an individual’s privacy
4,5,14
under this act individuals have the rights to access their medical records, to have corrections made to their records, and to decide with whom their medical information may be shared; the document belongs to the facility but the info belongs to the patient
HIPAA
this doctrine grants certain professionals priviledges under which they may refuse to reveal info about communications with clients
priviledged communication
in most states the right to privacy of records is __ in civil or criminal proceedings so it’s important that nurses document with this in mind
exempted
this is an exception to the laws of privacy and confidentiality where you have the duty to divulge what clients have told you when others can be harmed
duty to warn
what are the exceptions to confidentiality and right to privacy
duty to warn
suspected child or elder abuse
what are the guidelines for therapists to follow in determining their obligation to take protective measures
- assessment of a threat of violence by a client towards another individual
- identification of the intended victim
- ability to intervene in a feasible meaningful way to protect the intended victim
this allows all individuals to have the right to decide whether to accept or reject medical treatment
informed consent
what should be included in order for someone to receive informed consent
- alternative to treatment
- why the HCP believes the treatment is most appropriate
- the possible outcomes, risks, and adverse effects
- the possible outcomes if treatment is not received
legal liability for informed consent lies with the physician and the nurse must ensure the the following major elements of informed consent have been addressed
knowledge
competency
free will
in this element the client has received adequate info on which to base their decision to provide informed consent
knowledge
in this informed consent element the individual’s cognition is not impaired to an extent that would interfere with decision making
competency
in this informed consent element the individual has given consent voluntarily without pressure or coercion
free will
refers to a set of leather straps used to restrain the extremities of an individual whose behavior is out of control and who poses an immediate risk to the physical safety and psychological well-being of him or herself and others.
restraints
___ are never to be used as punishment or for the convenience of staff
restraints
this is another type of physical restraint in which the client is confined alone in a room from which he or she is unable to leave
seclusion
seclusion or restraint is ___ as soon as possible regardless of when the order is schedule to expire
discontinued
orders for restraint or seclusion must be renewed every __ hours for 18 and> and every ___ hours for children and 9-17 and every hour for children <9
4
2
an in person ___ has to be done within 1 hour of beginning restraints or seclusion
evaluation
patients who both restrained and secluded must be ___ monitored through audio or video
continuously
True or false: staff who are involved in restraining and secluding patients are trained to monitor the physical and psychological well being or the patient
TRUE
this is the deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means
false imprisonment
means the individual makes direct application to the institution for services and may stay as long as treatment is necessary and leave at any time unless it is determined that the client may be harmful to self or others
voluntary admissions
this process is conducted with respect to state and federal law through the court or in NM a police officer can have you committed if they feel like they have to
involuntary hospitalization or commitment
why would a person be involuntarily hospitalized
- person is dangerous to themselves
- person is danger to others
- person is unable to take of basic personal needs
these commitments are sought when an individuals manifests behavior that is clearly and imminently dangerous to self or others usually started by a relative
emergency commitments
another type of involuntary commitment is for the observation and treatment of ___ person in need of treatment
last longer than emergency ones
mentally ill
states have definitions of what constitutes ___ ___
-unable to make informed decisions about treatment
likely to cause harm to self or others
unable to fulfill basic personal needs necessary for health and safety
mentally ill
this is a court ordered mechanism used to compel a person with mental illness to submit to treatment on an outpatient basis
involuntary outpatient commitment
this is defined as a condition in which an individual as a result of mental illness, is in danger of serious physical harm resulting from inability to provide for basic needs such as food or clothing and personal safety
gravely disabled
true or false: inability to care for oneself can’t be established by showing that the lack the resources to meet the necessities of life but rather the inability to make use of available resources
TRUE
the failure to exercise the standard of care that a reasonably prudent person would have done in a similar situation
negligence
this is a specialized form of negligence caused only by professionals and is an instance of negligence or incompetence on the part of the professional
malpractice
True or false: to succeed in a malpractice claim, a plaintiff must also prove proximate cause and damages
TRUE
True or false: most decisions of negligence in the professional setting are based on legal decisions that have been made previously about similar cases rather than on any specific action taken by legislature
TRUE
What are the basic elements of a nursing malpractice suit that a client must prove (every single one)
- a duty to the patient existed
- a breach of duty occurred
- the client was injured
- the injury was directly caused by the breach of a standard of care
A nurse may be charged with ___ __ ____ for revealing aspects about a client’s case or even for revealing that an individual has been hospitalized if the client can show that making this information known resulted in harm
breach of confidentiality
written defamation
libel
oral defamation
slander
when shared information is detrimental to the client’s reputation, the person sharing the info may be liable for ___ __ ___
defamation of character
Is an act that results in a person’s genuine fear and apprehension that he or she will be touched without consent
assault
This is the unconsented touching of another person
These charges can result when a treatment is administered to a client against his or her wishes and outside of an emergency situation; harm or injury need not to have occurred for these charged to be legitimate
battery
this is a charge that may result when a client is searched without probably cause
invasion of privacy
As a last resort, an agitated, physically aggressive patient is placed in four-point restraints. The patient yells, “I’ll sue you for assault and battery.” The unit manager determines that the nurses are protected under which condition?
A. The client is voluntarily committed and poses a danger to others on the unit.
B. The client is voluntarily committed and has a history of being a danger to others.
C. The client is voluntarily committed because of a history of violent behavior.
D. The client is involuntarily committed and is refusing treatment.
A.
A nurse gave a patient 5 mg of haloperidol (Haldol) for agitation. The patient’s chart was clearly stamped “Allergic HALDOL.” The client suffered anaphylactic shock and died. How would the nurse’s actions be labeled? A. Intentional tort B. Negligence C. Battery D. Assault
B.
Catalano suggests proactive nursing actions in an effort to avoid nursing malpractice and lawsuit risk.
Which are what?
Effective communication
Accurate and complete documentation in the medical record
Complying with the standards of care
Knowing the client
Practice within the nurse’s level of competence and scope of practice
An interaction between two people (usually a caregiver and a care receiver) in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention
therapeutic relationship
Peplau identified several sub roles within the nursing role which are
- the strangers
- the resources person
- the teachers
- the leader
- the surrogate
- the technical expert
- the counselor
in this subrole within the nursing role a nurse is at first a stranger to the client and the client is a stranger to the nurse
the stranger
in this subrole within the nursing role this person Provides specific answers to questions usually formulated with relation to a larger problem; in this role the nurse explains, in a language that the client can understand, info related to the patient’s health care
the resource person
in this subrole the nurse identifies learning needs and provides information required by the client or family to improve the health situation
the teacher
in this subrole the democratic leadership in nursing situations implies that the patient will be permitted to be an active participant in designing nursing plans for them
the leader
in this subrole clients perceive nurses as symbols of other individuals
May view nurse as mother, sibling or former teacher or another nurse who has provided care in the past
surrogate
in this subrole the nurse understands various professional devices and possesses the clinical skills necessary to perform interventions that are in the best interest of the client
technical expert
in this subrole the nurses uses interpersonal techniques to assist clients in adapting to difficulties or changes in life experiences
counselor
Therapeutic nurse-patient relationships occur when each views the other as a unique ___ ___ was proposed by Travelbee
human being
Therapeutic nurse-patient relationships occur when each views the other as a unique human being.
When this occurs, both participants have ____ met by the relationship.
needs
Therapeutic relationships are ___-oriented and directed at learning and growth promotion.
goal
goals in a therapeutic nurse-patient relationship are often achieved through use of the ___-solving model
problem
Which is the primary nursing goal when establishing a therapeutic relationship with a client?
A. To promote client growth
B. To develop the nurse’s personal identity
C. To establish a purposeful social interaction
D. To develop communication skills
A.
Travelbee described the instrument for delivery of interpersonal nursing as the ___ ____ __ ___
Therapeutic use of self
What is the therapeutic use of self
The ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention
The use of self in a therapeutic manner requires that the nurse have a great deal of self-awareness and self-understanding
knowing and understanding oneself enhances the ability to form satisfactory interpersonal relationship. self-awareness requires that an individuals recognize and accept what they value and learn to accept the uniqueness of and differences in others
values clarification
this is an idea that one holds true and it can take any of several forms
belief
these are ideas that an individual holds as true despite the existence of objective contradictory evidence
irrational belief
this is a frame of reference around which an individual organized knowledge about his or her world
attitude
these are abstract standards, positive or negative that represent an individual’s ideal mode of conduct and ideal goals
values
what four concepts are involved in gaining self-awareness through values clarification
- beliefs
- attitudes
- values
values differ from attitudes and beliefs in that they are ___ oriented or ___ producing
action
action
Several characteristics that enhance the achievement of a therapeutic relationship have been identified.
These are:
- rapport
- trust
- respect
- genuineness
- empathy
this characteristic is the development between two people in a relationship of special feelings based on mutual acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude
rapport
Getting acquainted and establishing ___ is the primary task in relationship development
rapport
To ____another, one must feel confidence in that person’s presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested
One way in which you can do this is by letting them know that they are safe
Basis of therapeutic relationship
trust
To show respect is to believe in the dignity and worth of an individual regardless of his or her unacceptable behavior
Recognize that they’re unconditionally accepted and respected as unique, valuable individuals can elevate feelings of self-worth and self-respect
respect
this is the ability to be open, honest, and “real” in interactions with others, the awareness of what one is experiencing internally and the ability to project the quality of this inner experiencing in a relationship
genuineness
a nurse who is ___ responds to the patient with truth and honesty rather than with responses they may consider more professional
genuine
genuineness calls for a degree of ___ ___ on the part of the nurse
self-disclosure
this is the ability to see beyond outward behavior and understand the situation from the patient’s point of view; attempting to understand what someone is going through
empathy
what is the major difference between empathy and sympathy
with empathy the nurse accurately perceives or understands what the client is feeling and encourages the client to explore those feelings
with sympathy the nurse shares what the client is feelings and experiences a need to alleviate the stress
Nursing intervention that promotes ___ in an individual who is thinking concretely
Providing a blanket when the client is cold
Providing food when the client is hungry
Keeping promises
Being honest
Simply and clearly providing reasons for certain policies and rules
Providing a written, structured schedule of activities
Attending activities with the client if reluctant to go alone
Being consistent in adhering to unit guidelines
Listening to the client’s preferences, requests, and opinions and making collaborative decisions concerning his or her care
Ensuring confidentiality
trust
The nurse can convey an attitude of ___ by:
Calling the client by name
Spending time with the client
Allowing sufficient time to answer the client’s questions
Promoting an atmosphere of privacy
Always being open and honest with the client
Listening to the client’s ideas, preferences, and opinions
Striving to understand motivation behind client’s behavior
respect
when one is ___ there is congruence between what is felt and what is expressed
genuine
what are the phases of relationship development
Preinteraction phase
Orientation (introductory) phase
Working phase
Termination phase
this phase of the relationship development involves preparation for the first encounter with the client
Preinteraction phase
during this phase of relationship development you about info about the patient for their chart, family or other health team members, and you begin initial assessments; the nurse examines one’s feelings, fears, and anxieties about working with a particular client; nurse needs to be aware of hose preconceptions can affect their ability to care for clients
preinteraction phase
during this phase of relationship development the nurse and client become acquainted and tasks include
- creating an environment for establishment of trust and rapport
- expectations and responsibilities of both parties are established
- identify the client’s strengths and limitations
- formulate nursing diagnoses
- setting goals both agree on
- develop a plan of action that is realistic for meeting goals
- explore feelings of both client and nurse
orientation (introductory) phase
during this phase of relationship development the therapeutic work of the relationship is established and tasks include
- maintain the trust and rapport established
- promote the client’s insight and perception of reality
- problem solving
- overcoming resistance behaviors as the level of anxiety raises in response to discussion of painful issues
- continuously evaluating progress toward goal attainment
working phase
Transference could affect therapeutic relationship when the feelings expressed include ___ and ___
anger
hostility
When transference take on the form of anger it can be can be manifested toward the nurse by uncooperativeness and ___ to therapy
resistance
Transference can also take the form of overwhelming ___ for or excessive dependency on the nurse
affection
interventions for ___ include:
The nurse should work with the patient in sorting out the past from the present, assist the patient into identifying the transference and reassign a new and more appropriate meaning to the current nurse-patient relationship
Goal is to guide them toward independence by teaching them to assume responsibility for their own behaviors and assign the correct meanings to their relationship.
transference
these feelings which occur with ____ can interfere with the therapeutic relationship:
Nurse over-identifies with patient’s feelings, as they remind him or her of problems from the nurse’s past or present.
Nurse and patient develop a social/personal relationship.
Nurse gives advice or attempts to rescue the patient.
Nurse encourages and promotes patient’s dependence.
Nurse’s anger engenders feelings of disgust toward the patient.
Nurse feels anxious and uneasy in presence of the patient.
Nurse is bored and apathetic in sessions with the patient.
Nurse has difficulty setting limits on the patient’s behavior.
Nurse defends client’s behavior to other staff members.
countertransference
A client threatens to kill himself, his wife, and their children if the wife follows through with divorce proceedings. During the preinteraction phase of the nurse-patient relationship, which interaction should the nurse employ?
A. Acknowledging the patient’s actions and encouraging alternative behaviors
B. Establishing rapport and developing treatment goals
C. Providing community resources on aggression management
D. Exploring personal thoughts and feelings that may adversely impact the provision of care
D.
during this phase of relationship development the mutually agreed on goals may have been reached, the client may be discharged, or clinical rotation ends
tasks include bringing therapeutic conclusion to the relationship and occurs when
-progress have been made towards set goals
-a plan for continuing care is established
-feelings about termination of the relationship are recognized and explored
termination phase
this indicates a border that determines the extent of acceptable limits.
boundary
these the many types of \_\_\_\_ Material boundaries Social boundaries Personal boundaries Professional boundaries
boundaries
these are warning signs that ___ ___ of the nurse-patient relationship may be in jeopardy
Favoring one patient’s care over another’s
Keeping secrets with a client
Changing dress style when working with a particular client
Swapping patient assignments to care for a particular patient
Giving special attention or treatment to one patient over others
Spending free time with a patient
Frequently thinking about the patient when away from work
Sharing personal information or work concerns with the patient
Receiving of gifts or continued contact and communication with the patient after discharge
professional boundaries
concerns within professional boundaries are related to the following issues
Self-disclosure
Gift-giving
Touch
Friendship or romantic association
these are boundaries where physical property can be seen
material boundaries
these boundaries are established within a culture and define how individuals are expected to behave in social situations
social boundaries
these are boundaries that individuals define for themselves
personal boundaries
these are boundaries that limit and outline expectations for appropriate professional relationships with clients
professional boundaries
the role of the nurse is to provide the client with the opportunity to accomplish the following
___ and explore problems in relating to others.
Discover healthy ways of meeting emotional needs.
Experience a satisfying interpersonal relationship.
identify
this is an interactive process of transmitting information between two or more entities
communication
communication is achieved through both ___ and ___ communication techniques
verbal
nonverbal
interpersonal communication is a ___ between the sender and the receiver
transaction
In the ____ model, both participants perceive each other, listen to each other, and simultaneously engage in the process of creating meaning in a relationship.
transactional
Both sender and receiver bring certain preexisting conditions to the exchange that influence the intended message and the way in which the message is interpreted which include what
values attitudes beliefs culture religion social status gender age or developmental level environment
these are learned ways of thinking that can influence communication in numerous ways
ex: prejudice is expressed verbally through negative stereotyping
values, attitudes, and beliefs
Cultural mores, norms, ideas, and customs provide the basis for ways of thinking.
culture and religion
studies of nonverbal indicators of ___ status or power have suggested that high-___ persons are associated with gestures that communicate their higher power such as hands on hips, power dressing, greater height, and more distance when communicating with individuals considered to be of lower social status.
social
status
____ influences messages conveyed in communication with others and it includes masculine and feminine gestures that provide a basis for distinguishing between members of each gender
gender
___ influences communication and an example is how a unique patter of communication changes from generation to generation words like dude and cool
age
true or false: the place where communication occurs influences the outcome of the interactions and is considered a preexisting condition
TRUE
___, ___, and distance are aspect of environment that communicate messaged
territoriality
density
interpersonal communication is more successful if the interaction takes place in a ___ area
neutral
refers to the number of people within a given environmental space which influences interpersonal interaction
density
this is the means by which various cultures use space to communicate.
distance
there are ___ kinds of distance in interpersonal interactions
four
this is is the closest distance that individuals allow between themselves and others. (0-18 inches)
intimate distance
this is is the distance for interactions that are personal in nature, such as close conversation with friends. (18-40 inches)
personal distance
this is the distance for conversation with strangers or acquaintances. (4-12 feet)
social distance
this is the distance for speaking in public or yelling at someone some distance away. (exceeds 12 feet)
public distance
The unit manager needs to meet with a client who is exhibiting escalating hostility. Which would be the most appropriate location for the nurse to meet with this client? A. The client’s room with the door shut B. A quiet corner of the day room C. The nurses’ station D. The unit’s treatment room
B.
About 70-80% of all communication is ___
nonverbal
other component of\_\_\_\_ communication include: Physical appearance and dress Body movement and posture Touch Facial expressions Eye behavior Vocal cues or paralanguage
nonverbal
this is part of nonverbal communication; an individual whose posture is slumped with head and eyes down, conveys a message of low self-esteem
body movement and posture
touch at this level indicates a strong liking for the other persons, a feeling that they are a friend
ex: laying one’s hand on the shoulder or another
friendship-warmth
this type of touch conveys an emotional attachment or attraction for another person
ex: engaging in a strong mutual embrace
love intimacy
touch at this level is an expression of physical attraction only
ex: touching another in the genital region
sexual arousal
this is the gestural component of the spoken work and consists of pitch, tone and loudness of spoken languages; the rate of speaking; expressively places pauses; and emphasis assigned to certain words
paralanguage
includes caregiver verbal and nonverbal techniques that focus on the care receiver’s needs and advance the promotion of healing and change.
Therapeutic communication encourages exploration of feelings and fosters understanding of behavioral motivation.
It is nonjudgmental, discourages defensiveness, and promotes trust.
therapeutic communication
this is a therapeutic communication technique
Allows patient to take control of the discussion, if he or she so desires, to collect their thoughts, to think through a point
using silence
this is therapeutic communication technique
Conveys an attitude or reception and positive regard
ex: yes I understand what you said, eye contact, nothing
accepting
this is a therapeutic communication technique
acknowledging, indicating awareness is better than complimenting which reflect the nurse’s judgement
ex: I see you made you bed
giving recognition
this is a therapeutic communication technique
making oneself available on an unconditional basis which helps increase the client’s self-worth
ex: I’m interested in talking with you
offering self
this is a therapeutic communication technique
allows client to select the topic; emphasizes the importance of the client’s role in the interaction
ex: tell me what you’re thinking
giving broad openings
this is a therapeutic communication technique
encourages client to continue, leads or prompts patient
ex: Go on
offering general leads
this is a therapeutic communication technique
clarifies relationship of events in time enables the nurse and client to view them in perspective
ex: was this before or after…?
placing the event in time or sequence
this is a therapeutic communication technique
verbalizing what is observed or perceived encourages client to recognize specific behaviors and compare perceptions with nurse
ex: you seem tense
making observation
this is a therapeutic communication technique
asking the client to verbalize what is being perceived; used when having hallucinations
ex: what do the voices seem to be saying
encouraging description of perceptions
this is a therapeutic communication technique
asking client to compare similarities and differences in ideas, experiences, or interpersonal relationships
ex: how does this compare with the time when…
encouraging comparison
this is a therapeutic communication technique
repeating the main idea of what the client has said lets client know whether an expressed statement has been understood
ex: client says-I can’t study, my mind keeps wandering; nurse says-you have trouble concentrating
restating
this is a therapeutic communication technique directs questions of feelings back to the client so that they may be recognized and accepted so that client can recognize that their point of view has value
ex: client says-my sister won’t help with my mom’s care I have to do it all!
Nurse says-you feel angry when she doesn’t help
reflecting
this is therapeutic communication technique but NOT with an anxious patient, this should NOT be pursued until anxiety is subsided
taking notice of a single idea or even a single word
ex: this point seems worth looking at more closely, perhaps you and I can discuss it together
focusing
this is a therapeutic communication technique
delving further into a subject, idea, experience, or relationship
DO NOT push is patient doesn’t choose to disclose
ex: tell me more about that particular situation
exploring
this is a therapeutic communication technique
striving to explain what is vague and searching for mutual understanding
ex: tell me if my understanding agrees with yours
seeking clarification and validation
this is a therapeutic communication technique
clarifying misconceptions that the client may be expressing; when the client has a misperception of the environment, the nurse defines reality or indicates their perception of the situation for the patient
ex: there is no one else in the room but you and me
I understand that the voices seem real to you but I do not hear any voices
presenting reality
this is a therapeutic communication technique
expressing uncertainty as to the reality of the patient’s perception often used when they experience delusional thinking
ex: I understand that you believe that to be true, but I see the situation differently
voicing doubt
this is a therapeutic communication technique
putting into words what patient has only implied or said indirectly
clarifies that which is implicit rather than explicit, used with mute patients
ex: patient says it is a waste to be here nurse says are you feeling that no one understand patient is mute and nurse says it must have been difficult for you when your husband died
verbalizing the implied
this is a therapeutic communication technique
putting into words the feelings the client has expressed only indirectly to find underlying true feelings
ex: patient says I’m way out in the ocean and nurse says you must be feeling very lonely
attempting to translate words into feelings
this is a therapeutic communication technique
striving to prevent anger or anxiety from escalating to unmanageable level when stressor recurs
ex: what could you do to let your anger out harmlessly?
formulating a plan of action
this is a nontherapeutic communication technique
may discourage patient from further expression of feelings if patient believes the feelings will only be downplayed or ridiculed
ex: everything will be okay, I wouldn’t worry about that
INSTEAD say we will work on the problem together
giving false reassurance
this is a nontherapeutic communication technique
refusing to consider patient’s ideas or behavior
ex: let’s not discuss, I don’t want to hear about
rejection
this is a nontherapeutic communication technique
implies that the nurse has the right to pass judgement on the goodness or badness of patient’s behavior
ex: that’s good I am glad that you or that’s bad I rather you..
INSTEAD say let’s talk about how your behavior invoked anger in the other clients
approving or disapproving
this is a nontherapeutic communication technique
implies that the nurse has the right to pass judgement on whether the patient’s ideas or opinions are right or wrong
ex: that’s right I agree or that’s wrong I disagree
INSTEAD say let’s discuss what you feel is unfair about the new community rules
agreeing or disagreeing
this is a nontherapeutic communication technique
implies that the nurse knows what is best for the patient and that the patient is incapable of any self-direction
ex: I think you should or shouldn’t
INSTEAD say what do you think you should do
giving advice
this is a nontherapeutic communication technique
pushing for answers to issues that the patient doesn’t wish to discuss causes the patient to feel used and valued only for what is shared with the nurse
ex: tell me how your mother abused you when you were a child
INSTEAD a better technique is to be aware of the client’s response and discontinue the interaction at the first sign of discomfort
probing
this is a nontherapeutic communication technique
to defend what patient has criticized implies that the patient has no right to express ideas, opinions or feelings
ex: no one here would lie to you, we all have your best interest
INSTEAD say I will try to answer your questions and clarify some issues regarding your treatment
defending
this is a nontherapeutic communication technique
asking why implies that the patient must defend his or her behavior or feelings
ex: why do you think that way
INSTEAD say described what you were feeling just before that happened
requesting an explanation
this is a nontherapeutic communication technique
encourages patient to project blame for his or her thoughts or behaviors on others
ex: what makes you say that, what made you do that
INSTEAD say you became angry when your brother insulted your wife
indicating the existence of an external source of power
this is a nontherapeutic communication technique
causes patients to feel insignificant or unimportant
ex: patient says I have nothing to live for I wish I was dead and nurse says everybody gets down in the dumps at times I feel that way sometimes
INSTEAD say you must be very upset tell me what you are feelings now
belittling feelings
this is a nontherapeutic communication technique
clichés and trite expressions are meaningless in a nurse-patient relationship
ex: keep your chin up, hang in there it’s for your own good
making stereotyped comments
this is a nontherapeutic communication technique
blocks discussion with patient and avoids helping patient identify and explore areas of difficulty
ex: patients says I’m nothing and nurse says of course you’re something
INSTEAD say you’re feeling like no one care about you right now
using denial
this is a nontherapeutic communication technique
results in the therapist telling patient the meaning of his or her experience
ex: what you really mean is
INSTEAD the nurse must leave interpretation of the client’s behavior to the psychiatrist
interpreting
this is a nontherapeutic communication technique
causes the nurse to take over the direction of the discussion
ex: patient says I don’t have anything to live for and nurse says did you have visitors this weekend
INSTEAD the nurse must remain open and free to hear the client and to take in all that is being conveyed
introducing an unrelated topic
The nurse is performing an initial assessment on a newly admitted patient who is oriented times four. Which of the following communication techniques would best facilitate obtaining accurate and complete patient data? A. Closed-ended questions B. Requesting an explanation C. Open-ended questions D. Interpreting
C.
To listen ____ is to be attentive to what patient is saying, both verbally and nonverbally.
actively
Several nonverbal behaviors have been designed to facilitate attentive listening.
These are identified by the acronym ____
SOILER
What does SOLER stand for
S: Sit squarely facing the patient O: Observe an open posture L: Lean forward toward the patient E: Establish eye contact R: Relax
this is an evidence-based, patient-centered style of communicating that promotes behavior change by guiding the patient to explore their own motivation for change and the advantages and disadvantages of their decisions.
motivational interviewing
this was originally developed for use with patients who were struggling with substance use disorders.
This style of communication may decrease defensive patient responses.
Focuses on what the client wants rather than on what the nurse think should be the next steps in behavior change
motivational interviewing
these are written reports of verbal interactions with clients and are written by the nurse or student as a tool for improving communication techniques
process recordings
this is a method of communication for helping the client consider behavior modification by providing information about how he or she is perceived by others
feedback
characteristics of useful ___ include the following
Descriptive rather than evaluative and focused on the behavior rather than on the client
Specific rather than general
Directed toward behavior the client has the capacity to modify
Imparts information rather than offers advice
Is well-timed
feedback
what are the nursing process steps
Assessment Diagnosis Outcome Identification (Criteria) Planning Implementation Evaluation
