Exam 2 Flashcards by Maira Alaniz

what is the goal of the pre-interaction phase

explore self-awareness

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what is the goal of the orientation phase

establish trust

formulate contract for intervention

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what is the goal of the working phase

promote client change

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what is the goal of the termination phase

evaluate goal attainment

Ensure therapeutic closure

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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

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this occurs when the client unconsciously displaces or transfers to the nurse feelings formed toward a person from his or her past

transference

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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

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this is an interactive process of transmitting information between two or more entities

communication

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this is a transaction between the sender and the receivers with both persons participating simultaneously

interpersonal communication

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this is the innate tendency to own space; individuals law claim to areas round them as their own

territoriality

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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

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this type of touch is still rather impersonal but it conveys an affirmation or acceptance of the other person
Ex: a handshake

social-polite

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this determines what is right or good within a society

legislation

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this is a branch of philosophy that deals with systematic approaches to distinguishing right from wrong behavior

ethics

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is the term applied to these principles when they refer to concepts within the scope of medicine, nursing and allied health

bioethics

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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

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personal beliefs about what is important and desirable, what we value

values

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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

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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

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this is a right on which the society has agreed and formalized into law.

legal right

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this is a moral principle or a set of moral principles that can be used in assessing what is right or wrong

ethical theory

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the basis of this theoretical perspective is the greatest-happiness principle

utilitarianism

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theory that promotes action based on the end result that produces the most good (happiness) for the most people.

utilitarianism

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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

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this theory perspective is directly opposed to utilitarianism

Kantianism

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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

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this theoretical theory suggests that decisions and actions are bound by a sense of duty.

Kantianism

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what is another name for Kantianism

Deontology

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what is the golden rule associated to Christian ethics

do onto others as you would have them do unto you

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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

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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

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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

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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

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this happens when a situation requires the nurse to make a choice between two equally favorable alternatives

ethical dilemmas

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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

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an ___ ____ arises when there is no clear reason to choose one action over another.

ethical dilemma

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in most ethical dilemmas taking no action is considered an ___ __

action taken

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these are fundamental guidelines that influence decision making

ethical principles

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what are the ethical principles

autonomy 
beneficence 
nonmaleficence 
justice 
veracity

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this ethical principle views persons as autonomous moral agents whose right to determine their destinies should always be respected

autonomy

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this ethical principle presumes that individuals are always capable of making their own independent choises

autonomy

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the right to self-determination

autonomy

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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

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this ethical principle refers to ones duty to benefit or promote the good of others
DO GOOD

Beneficence

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Peplau recognized this as an essential role for the psychiatric nurse and means acting in another’s behalf as a supporter or defender

advocacy

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this ethical principle is the requirement that health care providers do no harm to their clients, either intentionally or unintentionally; DO NO HARM

Nonmaleficence

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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

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when this ethical principle is applied to healthcare it means that medical services are to be distributed equally to all people.

Justice

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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

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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

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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

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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

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in this step for making an ethical decision you identify the conflict between two or more alternative actions

problem identification

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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

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in this step for making an ethical decision you act on the decision made, and communicate the decision to others

implementation

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in this step for making an ethical decision you evaluate the outcomes

evaluation

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anyone who is admitted to the hospital has the right to ___

treatment

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legally patients have the right to ___ treatment including medication unless immediate intervention is required to prevent death or serious harm to the patient

refuse

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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

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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

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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

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this act define the legal parameters of professional and practical nursing

Nurse Practice Act

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most nurse ___ __ are general in their terminology and do not provide specific guidelines for practice

practice acts

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what are the two categories of law that are of most concern to nurses

statutory law

common law

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Law that has been enacted by a legislative body (city council, U.S. congress)
Example of this is the nurse practice acts

statutory law

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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

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common and statutory laws can either be ___ or ___

civil

criminal

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Protects the private and property rights of individuals and business

civil law

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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

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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

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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

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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

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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

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what amendments protect an individual’s privacy

4,5,14

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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

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this doctrine grants certain professionals priviledges under which they may refuse to reveal info about communications with clients

priviledged communication

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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

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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

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what are the exceptions to confidentiality and right to privacy

duty to warn

suspected child or elder abuse

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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

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this allows all individuals to have the right to decide whether to accept or reject medical treatment

informed consent

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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

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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

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in this element the client has received adequate info on which to base their decision to provide informed consent

knowledge

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in this informed consent element the individual’s cognition is not impaired to an extent that would interfere with decision making

competency

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in this informed consent element the individual has given consent voluntarily without pressure or coercion

free will

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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

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___ are never to be used as punishment or for the convenience of staff

restraints

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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

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seclusion or restraint is ___ as soon as possible regardless of when the order is schedule to expire

discontinued

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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

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an in person ___ has to be done within 1 hour of beginning restraints or seclusion

evaluation

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patients who both restrained and secluded must be ___ monitored through audio or video

continuously

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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

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this is the deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means

false imprisonment

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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

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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

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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

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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

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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 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

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

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

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

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

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

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

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