exam i: ch8 - therapeutic relationships Flashcards
the basis of all psychiatric nursing treatment, “facilitates forward movement” - Hildegard Peplau
nurse-patient relationship
what is the purpose of the nurse-patient relationship
to establish a nurse that is
- safe
- confidential
- reliable
- consistent
- with clear boundaries
what is considered the “art” of psychiatric nursing
interpersonal skills
using personality consciously and in full awareness
- establish relatedness
- structures interventions
- positive alliance
- improve adherence to tx and positive outcomes
therapeutic use of self
type of relationship where
- purpose = friendship, socialization, task completion
- mutual needs are met
- communicate for advice
- little evaluation
social relationships
type of relationship where
- purpose: PT NEEDS are id’d and explored
- clear boundaries
- problem solving approaches
- behavioral change, coping skills
therapeutic relationships
when relationship slips into social context, NURSE’S needs are met at expense of pt needs
blurring of boundaries
what are the 3 types of boundary blurs
- boundary crossings
- boundary violations
- professional sexual misconduct
brief excursions across professional lines of behavior that may be inadvertent, thoughtless, or even purposeful, while attempting to meet the needs of the pt (no ethical wrongdoing)
level 1: boundary crossings
- spending long periods of time with patient
- doing personal tasks for patient
- sharing too much personal info
- thinking about pt outside care setting
examples of boundary crossings
when there is confusion between the needs of the nurse and the needs of the patient, causes distress to the pt (adv of pt vulnerability and ethically wrong)
level 2: boundary violations
- Personal disclosure
- Secrecy
- Reversal of roles
examples of boundary violations
extreme form, any behavior that is seductive, sexually demeaning, harassing, or interpreted as sexual
level 3: professional sexual misconduct
patient unconsciously and inappropriately displaces onto the nurse feelings and behaviors related to significant figures in patient’s past
transference
nurses displaces feelings related to people in nurse’s past onto the patient
countertransference
guide us in decision making and taking actions; abstract standards and represent ideals (our judgment)
values
any opinion that you hold true
beliefs
nurses must possess _____ in order to help others
self-awareness
phase of nurse-patient relationship:
prep for assignment, recognizing thoughts and feelings
pre-orientation phase
phase of nurse-patient relationship:
the first time nurse/pt meet
- Establishing rapport
- Parameters of the relationship
- Formal/Informal contract, confidentiality
- Terms of termination
orientation phase
phase of nurse-patient relationship:
nurse and pt ID and explore areas that are causing problems in patient’s life
- Maintain relationship
- Share information
- Gather further data
- Promote pt dev + improve independence
- Eval problems and goals
- Transference and Countertransference can occur here
working phase
in which phase can transference and countertransference occur?
working phase
phase of nurse-patient relationship:
final integral phase, when pt discharged or clinical rotation ends
- Summarize goals and objectives
- Review pt education + handouts
- Review situations that occurred during nurse-patient relationship
- Exchange memories
termination phase
nurse’s ability to be open, honest, authentic in interactions with patients; self awareness of one’s feelings as they arise within relationship
genuineness
implies respect, ability to view another person as being worthy of caring about and someone who has strengths and achievement potential
positive regard
helping person attempts to understand the world from pt perspective (put yourself into their shoes)
empathy
what question can you ask to gain further empathy for someone?
“what thoughts and feelings are you having”
culturally + individually appropriate; being in the moment
attending
