NURS 465: Exam 1 Flashcards
Introductory Statement
made at the beginning of a conversation/ meeting with a patient and includes: name, position/credentials, role/function in relation to the patient and approximate time to spend with patient
Closed questions & statements
Can be answered with yes or no statements, one-word answers
Ex: “Did you do your homework?”
Does not use who, what, when, where, and how in the question
Open-ended questions & statements
Can’t be answered with yes/no/one word
Questions start with who, what, when, where and how
Ex: “What’s the reason for not studying?
Exceptions: “could, would” can be used as open ended
General leads
Generic/ basic open questions to help open conversations
Ex: “How are you? Tell me about yourself”
Focusing questions and statements
Done in response to a patient listing several things they may be worried about, or having several problems or feelings
Ex: “Which of the things you mentioned worry you the most?”
“Tell me more about feeling depressed”
Clarification questions & statements
Type of open-ended question/statement used in clarifying the patient’s emotions
Ex: “What do you mean when you say…”
“I don’t quite understand what that means to you”
Emotional metaphor
Metaphor used to convey feelings
Ex: “stressed out, on my last limb”
Mixed feelings
Used in emotional metaphors; these particular emotions and depth of the emotions is not clear
Ex: upset, torn, confused, unsure
Clarifying questions
Appropriate response to emotional metaphors and mixed feelings to get a better understanding of what is being said by patient
Restatement
Simple and brief, repeat of the exact words of the patient’s last statement
Minimal encouragement
Brief verbal utterance
Ex: “Oh.. Mmm. I see”
Paraphrasing
Saying in your own words, and without changing the means, what you hear the patient is saying.
Effective paraphrasing: personalization (patient’s name); most important key words of the patient; distilled, shortened and clarified version of the patient’s statement, which catches the essence of what was said
Reflection of Feelings (ROF)
Reflecting back to the patient an unspoken emotion (feeling)
Complete reflective statement: includes and connects a feeling and a content issue and in some instances, a behavior
2nd type: simple statement or reflection by the nurse about a patient’s affect, or nonverbal communication which suggests an unspoken feeling
Check-out
Closed question that is asked following a paraphrase, reflection, or summarization
Less formal: change voice to a questioning tone at the end of a paraphrase, ROF, summary statement
Expression of empathy (empathic statement)
Short statement to express that you identify with the patient’s situation
Simple observation statement
Making a statement of a simple observation that the nurse has made of the patient’s current behavior, not feelings
Summarizing
Concise, tying together, or review of important thoughts, feelings and behaviors expressed by the patient during the interview
- summarize q2–30 min in the conversation
Circular questioning
Interventive questioning
Used when working with families or groups
Focus on the impact that the illness/injury has had on the functioning of the family system
Self-disclosure
Sharing something about the nurse with the patient that will help the patient toward specific health promotion goals
Must be used sparingly with the patient specific health promotion goals in mind and must be brief
Keeping self-disclosure “therapeutic” involves the following?
- Adhering to the goal of helping the patient open up to you and assist with “reality testing”
- Keeping disclosure brief
- Not implying that your own experience are the same as the patient’s experiences
Reframing
Presenting the patient situation, or what the patient has said from a different perspective
Normalizing
Help with reality testing
Telling patients and families that what they are going through is normal
Concepts of the nurse-patient relationship
Establish that the nurse is safe, confidential, reliable and consistent
Relationship with clear boundaries
Establish boundaries
Physical boundaries; the contract, personal space
Transference
Patient unconsciously and inappropriately displaces onto nurse feelings and behaviors related to significant figures in patient’s past
- intensified in relationships of authority
Countertransference
Nurse displaces feelings related to the people in nurse’s past onto patient
- patient’s transference to nurse results in countertransference in nurse
- Common sign of countertransference in nurse is over-identification with the patient
Peplau’s model of nurse-patient relationship
Orientation phase
Working phase
Termination phase
Orientation phase
Establishing rapport Parameters of the relationship Formal or informal contract Confidentiality Terms of termination
Working phase
Maintain relationship
Gather further data
Promote patient’s problem-solving skills, self-esteem and use of language
Facilitate behavioral change
Overcome resistant behaviors
Evaluate problems and goals (redefine them as necessary)
Promote practice and expression of alternative adaptive behaviors
Termination phase
Summarize goals and objective achieved
Discuss ways for patient to incorporate new coping strategies learned
Review situations of relationship
Exchange memories
Communication Process
Stimulus for information, comfort or advice
- Sender - initiates contact
- Message - sent or expressed
- Variety of media - hearing, visual, touch, small
- Feedback received
Process recording
Written record of a segment of the nurse-patient session that reflects as closely as possible the verbal and nonverbal behaviors of both patient and nurse
Useful tool for identifying communication patterns
MH-4
Filled out by MD after pt is brought to the hospital, through the ER. 48 hr emergency commitment
MH-5
Voluntary admission form signed by adult on admission
MH-5a
Voluntary admission form signed by minor done at the hospital. Family court sends an officer to sign the pt in once the pt is in the hospital
MH-6
Petition for involuntary commitment. MD completes form after 48 hr time period on the MH-4 and pt continues to show signs of dangerousness to self or others and is in need of tx for mental disorder. Max confinement is 90 days
Ethics
Study of philosophical beliefs about what is considered right or wrong in a society
Bioethics
Used in relation to ethical dilemmas surrounding health care
Ethical dilemma
Conflict between >2 courses of action, each with favorable and unfavorable consequences
5 principles of bioethics
Beneficence Autonomy Justice Fidelity/ nonmaleficence Veracity
Informal admission
Sought by Pt
MH-5
Voluntary admission
Sought by pt or guardian
MH-5/ MH-5a
Temporary admission
Person confused or demented
So ill, he/she needs emergency admission
MH-4
Involuntary admission
Without patient’s consent
MH-6
Long-term involuntary admission
Medical certification, judicial review, administrative action
MH-6
Conditional release
Required outpatient treatment for a specified period to determine the pt’s adherence with medication protocols, ability to meet basic needs, and ability to reintegrate into the community
Unconditional release
termination of a patient-institution relationship
Release against medical advice (AMA)
Disagreement between mental health care providers and the pt whether hospital stay is necessary.
Patients’ rights under the law
Right to treatment Right to refuse treatment Right to informed consent Right surrounding involuntary commitment and psychiatric advance directive Rights regarding restraint and seclusion Right to confidentiality
Patient Confidentiality
HIPAA
Confidentiality after death
Confidentiality of professional communications
Confidentiality and HIV status
Exceptions to the rule
- Duty to warn and protect third parties
- Child and elder abuse reporting statuses
Tort
Civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (defendant)
Intentional tort
Willful or intentional acts that violate another person’s rights or property
- assault, battery, false imprisonment, invasion of privacy, defamation of character (slander/libel)
Unintentional tort
Unintended acts against another that produce injury or harm
- negligence, malpractice
Documentation of care
A record’s usefulness is determined by evaluating - when the record is read later - how accurately and completely it portrays the patient’s behavioral status at the time it was written
When doing MSE for children and adolescents, consider:
Consider developmental level; Involves the family; Observational ; Use tools such as toys, play, stories, drawing; Reporting of neglect or abuse
When doing MSE for geriatrics, consider:
Changes in social roles in retirement; Brian changes; Decline of senses; Memory loss; Poly-pharmacy; High risk for suicide
Mental Status Exam (MSE)
Evaluation for medical, psychiatric and neurological disorders
Nurse’s observation of patient’s behavior described in an objective manner
Evaluation of the patient’s current state
MSE: General appearance and behavior
Grooming, level of hygiene, clothing.
Unusual physical characteristics/movements.
Attitude. Ability to interact with interviewer.
Psychomotor activity. Agitation/retardation.
Degree of eye contact.
MSE: Affect
Affect—External range of expression—
quality, range, and appropriateness.
flat—absence of all or most affect
blunted/restricted—moderately reduced range
labile—multiple abrupt changes in affect
full/wide-range—generally appropriate
MSE: Mood
Mood—Internal emotional tone—
dysphoric, euphoric, angry, anxious, euthymic
MSE: Thought Process
Thought Process—quality, quantity of speech. Tone, fluency
Pressured speech. Rapid speech (manic)
Poverty of speech. Minimal response, yes/no.
Blocking. Sudden cessation, often in middle of statement.
Flight of Ideas. thoughts jump idea to idea
Loosening of association. Illogical shifting—unrelated topics.
Tangentiality. wanders from the original point
Circumstantiality. digression, eventually reaches the point
Echolalia. Echoing of words and phrases.
Neologisms. Invention of new words
Clanging. rhyming, punning.
Preservation. Repetiton of phrases or words
Ideas of reference. tv talking directly to them.
MSE: Thought Content
Thought Content—perceptual disturbances
Hallucinations. auditory, visual, tactile, gustatory, olfactory.
Delusions. Persecutory, erotomanic, grandiose, somatic
Derealization. Feelings of unrealness—outer environment
Depersonalization. Observing self from outside the body
Suicidal/Homocidal Ideation—intent, plan
MSE: Cognitive Evaluation
Level of consiousness
Orientation. Person, place, date
attention and concentration. WORLD
short-term memory. Recall 3 objects after 5 minutes
fund of knowledge. Name past 5 presidents, 5 lg cities.
Calculations. Serial seven subtraction, simple math
Abstraction. Proverb interpretation, similarities
MSE: Insight
Able to show understanding of current problems/implication
MSE: Judgment
Ability to make sound decisions regarding daily activities
Best evaluation by pt’s hx of decision making, not hypothetical questions
