Nurse-Patient Relationships Flashcards
Miscommunication is the ____th leading cause of medical deaths
4th - error 1/4 of the deaths
- btw staff and pts
- need empathy to help pts
Standards of practice for PMH Nursing
Assessment
Diagnosis
Outcome Identification
Planning
Implementation
Evaluation
What is the nurse observing int the assessment?
Physical behavior
Verbal and nonverbal communication
Appearance
Speech
Thought content
Cognitive ability - rpocess
Current lifestyle
Resources
Family
Friends
Education
Work experience
Assessments are done in what fashion?
cyclical
with EMPATHY
- immediate needs
primary source
patient
Secondary source
family
medical records
anything not from the patient
Children’s considerations for assessments
ACEs
developmental level
interview/observe
Adolescent’s considerations for assessments
confidentially
interview w/o parent/guardian present - privacy
Elderly’s considerations for assessments
physical limitation
pre-existing conditions
Psychiatric Nursing Assessments
rapport
chief complaint in own words
baseline VS
Safety precautions - suicide. self-harm, homicide
mental state and psychosocial
tx goals
plan of care (prioritize immediate needs)
doc
When gathering data what do you obtain?
Head-to-toe
labs
MSE (mental status examination) - daily
Psychosocial, spiritual, culture
Mental Status Examination obtains what type of data?**
most objective tool to gather data
during interview
Can life expectancy be lowered if the patient has a psych disorder?
yes by 10-17.5 years
- Bipolar and schizo
- fail to tx other problems
During the assessment phase, the tx team needs to work out what before considering a psych diagnosis? and why?
need to rule out medical dx
Failure to treat the diagnosis – by missing other physical disorders
What lab data is obtained in gathering data for psych patients?
thyroid - mood disorders
liver enzymes
BUN
electrolytes (irritable/depression)
ammonia (high = confusion)
toxicology (Rx or illicit)
High thyroid levels can lead to what disorder?
depression
mania
MSE assesses what
physical behavior
nonverbal communication
appearance
speech
mood/affect
thought content
perceptions
cog ability
insight
judgment
The psychosocial assessment is the most _________ tool of assessment
subjective
- c/o
hx of suicidal, homicidal, self-harm
abuse
stressors and coping
QUALITY of ADLs
background
goals for tx
beliefs
Spiritual/Religious Assessment
influences
decrease stress, and distress from neg life events
keep them grounded or grandeur
Cultural/Social Assessment decreases
Stereotyping
Stigma
Labeling
Cultural/Social Assessment increases
Understanding
Rapport
Patient outcomes
Risk Dx for
High probability of occurrence in the future
Intended to prevent the occurrence
Ensures patient safety
Outcome Identification with
Specific
Measurable
Achievable
Realistic
Timely
- coping skills by d/c
Planning is based on
Evidence-based practice
safety
appropriate
individualized
Inmplementation of the nursing process focuses on
Establishing trust
Giving positive feedback
Boost self-esteem
Encourage independence
Basic Level of Interventions include
cordination with care
teaching and promoting
therapies and medications
Milieu (quiet, calm, and dark)
relationship and counseling
What is the most neglected part of the nursing process?
evaluation
- systemiatic
-ongoing (cyclical)
- criteria based
Berlo’s Communication Model
stimulus
sender
message
media
receiver
feedback repeat
Therapeutic communication needs to be
professional
goal and evidence based
revolve of help for pt
- developers a relationship
What type of statements should never be used for therapeutic communication?
I statements
(That must have been very distressing to feel like that. Tell me about that)
Therapeutic Communication Should be
honest
respect
genuine
empathy
compassion
Factors affecting communciation
personal (emotional, social, cognitive)
environment (physical and societal determinants)
relationship (symmetrical and complimentary)
Symmetrical relationships
friends
peers
Complementary relationships
power imbalance
Verbal communication
words/language = content of message
- tone can be misleading
clarification and agree on content to minimize miscommunication
Nonverbal communication
body
expressions
eye cast
observable responses (shaking, restless, sweating)
appearance
Effective communciation skills
silence
- reflection and space to open up
active listening
- present and offering yourself to the space
- being in the moment
clarifying techniques
Paraphrasing
restate the message and simplify the terms (own words, active listening, and empathy)
Restating
– same key words as the sender (careful with repetition and restate for them to hear own words)
Reflection of feelings
know the challenges (sharing observations)
Exploring
examine idea more deeply
Projective questions
-what if?, imagine in another situation
Presupposition- miracle questions
if everything was good and what would be different
Non-therapeutic communciation
excessive questions
approval/disapproval (no aruging)
dismissive
- no closed questions
advising
“why” = negativity
Communicating across cultures
competence
differ beliefs
interpreter
styles of communication
expression of emotion
eye contact
touch
Issues communicating in PMH
delusion thinking - false belief
Hallucination
Paranoia - distrust
Self-concept - different perception than us or reality (do not play in with the delusion)
Therapeutic relationship in medical
Knowledge of anatomy, physiology, and chemistry ith caring in a relationship with pts
**patient-centered partner ship
Goals of a Therapeutic Relationship
facilitating
assisting problem-solving
help with alternatives
self-care
Patient-centered relationship requires
strong communication skills
understanding human behavor
empathy
nurse Roles
liaison
role model
teaching
Interpersonal Interactions
accountable
focus on needs
competence
delay judgment
Helping Relationship
needs of pt
alternate problem-solving
new coping
encourage behavior chnages
What does not work when helping a therapeutic relationship?
inconsistency
unavailable
arguing, minimize, challenge
criticism
Establish boundaries can occur by
overhelping
controlling
narcissism
transference
countertransference
emotional attachment
Transference
pt subcons. Doesn’t like you ( pt to nurse)
Countertransference
response as personal (nurse to pt)
Peplau’s phases of the nurse-patient relationship
preorientation
orientation
working
termination
Preorientation phase
Review background information
safety protocols
address staff fears
orientation phase
rapport and trust
time frame and schedule
confidentiality
termination with d/c teachings
working phase
maintain relationship
assessments
promote problem-solving, self-esteem, language
positive behavio chnage
no resistance
eval
promote practice and expression of alternate adaptive
termination phase
achievements
incorporate into daily life, coping
review
exchange memories
**learn they are important to staff
What helps a PMH patient improve to the termination phase
consistency
pacing
listening
initial impressions
comfort
factors for patients
- check regularly and schedule interviews
What hinders a patient to improve in hospital
unavailability
inconsistency
Who leads the clicnial interviews
patient - decide content and direction
nurse - therapeutic and active listening
Interview goals to help the patient
feel safe, understand, and comfort
identify problems
healthy coping
goal is satisfying interpersonal relations
Clinical settings when preparing for an interview
quiet
safe
private
visible
Seating in an interview
same ht
avoid face-to-face
- across table and to the side at 90 degrees
comfort and safety
avoid barriers
You should let the pt know about this during confidentiality?
disclosure about harming others or past experience
Initiating an Interview should start with ehat type of statement
- open ended
“Tell me what brings you here.”
“Where should we start?”
“Tell me about what has been going on with you.”
“What has been concerning you lately?”
Offer leads
“Go on”
“Tell me more about that”
Statements of acceptance in an interview
“Uh-huh”
“I see”
“Okay”
Helpful Guidelines in an interview include
breifly
say nothing if you don’t know what to say
When in doubt, focus on feelings
avoid advice
don’t rely on questions
nonverbals
focus on patients
Attending Behaviors
eye contact
body language
vocal qualities
verbal tracking
