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Module 6 (Psych Mental Health) > Nurse-Patient Relationships > Flashcards

Nurse-Patient Relationships Flashcards

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1
Q

Miscommunication is the ____th leading cause of medical deaths

A

4th - error 1/4 of the deaths
- btw staff and pts
- need empathy to help pts

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2
Q

Standards of practice for PMH Nursing

A

Assessment
Diagnosis
Outcome Identification
Planning
Implementation
Evaluation

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3
Q

What is the nurse observing int the assessment?

A

Physical behavior
Verbal and nonverbal communication
Appearance
Speech
Thought content
Cognitive ability - rpocess
Current lifestyle
Resources
Family
Friends
Education
Work experience

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4
Q

Assessments are done in what fashion?

A

cyclical
with EMPATHY
- immediate needs

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5
Q

primary source

A

patient

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6
Q

Secondary source

A

family
medical records
anything not from the patient

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7
Q

Children’s considerations for assessments

A

ACEs
developmental level
interview/observe

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8
Q

Adolescent’s considerations for assessments

A

confidentially
interview w/o parent/guardian present - privacy

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9
Q

Elderly’s considerations for assessments

A

physical limitation
pre-existing conditions

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10
Q

Psychiatric Nursing Assessments

A

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

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11
Q

When gathering data what do you obtain?

A

Head-to-toe
labs
MSE (mental status examination) - daily
Psychosocial, spiritual, culture

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12
Q

Mental Status Examination obtains what type of data?**

A

most objective tool to gather data
during interview

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13
Q

Can life expectancy be lowered if the patient has a psych disorder?

A

yes by 10-17.5 years
- Bipolar and schizo
- fail to tx other problems

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14
Q

During the assessment phase, the tx team needs to work out what before considering a psych diagnosis? and why?

A

need to rule out medical dx
Failure to treat the diagnosis – by missing other physical disorders

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15
Q

What lab data is obtained in gathering data for psych patients?

A

thyroid - mood disorders
liver enzymes
BUN
electrolytes (irritable/depression)
ammonia (high = confusion)
toxicology (Rx or illicit)

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16
Q

High thyroid levels can lead to what disorder?

A

depression
mania

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17
Q

MSE assesses what

A

physical behavior
nonverbal communication
appearance
speech
mood/affect
thought content
perceptions
cog ability
insight
judgment

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18
Q

The psychosocial assessment is the most _________ tool of assessment

A

subjective
- c/o
hx of suicidal, homicidal, self-harm
abuse
stressors and coping
QUALITY of ADLs
background
goals for tx
beliefs

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19
Q

Spiritual/Religious Assessment

A

influences
decrease stress, and distress from neg life events
keep them grounded or grandeur

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20
Q

Cultural/Social Assessment decreases

A

Stereotyping
Stigma
Labeling

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21
Q

Cultural/Social Assessment increases

A

Understanding
Rapport
Patient outcomes

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22
Q

Risk Dx for

A

High probability of occurrence in the future
Intended to prevent the occurrence
Ensures patient safety

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23
Q

Outcome Identification with

A

Specific
Measurable
Achievable
Realistic
Timely

  • coping skills by d/c
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24
Q

Planning is based on

A

Evidence-based practice
safety
appropriate
individualized

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25
Q

Inmplementation of the nursing process focuses on

A

Establishing trust
Giving positive feedback
Boost self-esteem
Encourage independence

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26
Q

Basic Level of Interventions include

A

cordination with care
teaching and promoting
therapies and medications
Milieu (quiet, calm, and dark)
relationship and counseling

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27
Q

What is the most neglected part of the nursing process?

A

evaluation
- systemiatic
-ongoing (cyclical)
- criteria based

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28
Q

Berlo’s Communication Model

A

stimulus
sender
message
media
receiver
feedback repeat

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29
Q

Therapeutic communication needs to be

A

professional
goal and evidence based
revolve of help for pt
- developers a relationship

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30
Q

What type of statements should never be used for therapeutic communication?

A

I statements
(That must have been very distressing to feel like that. Tell me about that)

31
Q

Therapeutic Communication Should be

A

honest
respect
genuine
empathy
compassion

32
Q

Factors affecting communciation

A

personal (emotional, social, cognitive)
environment (physical and societal determinants)
relationship (symmetrical and complimentary)

33
Q

Symmetrical relationships

A

friends
peers

34
Q

Complementary relationships

A

power imbalance

35
Q

Verbal communication

A

words/language = content of message
- tone can be misleading

clarification and agree on content to minimize miscommunication

36
Q

Nonverbal communication

A

body
expressions
eye cast
observable responses (shaking, restless, sweating)
appearance

37
Q

Effective communciation skills

A

silence
- reflection and space to open up
active listening
- present and offering yourself to the space
- being in the moment
clarifying techniques

38
Q

Paraphrasing

A

restate the message and simplify the terms (own words, active listening, and empathy)

39
Q

Restating

A

– same key words as the sender (careful with repetition and restate for them to hear own words)

40
Q

Reflection of feelings

A

know the challenges (sharing observations)

41
Q

Exploring

A

examine idea more deeply

42
Q

Projective questions

A

-what if?, imagine in another situation

43
Q

Presupposition- miracle questions

A

if everything was good and what would be different

44
Q

Non-therapeutic communciation

A

excessive questions
approval/disapproval (no aruging)
dismissive
- no closed questions
advising
“why” = negativity

45
Q

Communicating across cultures

A

competence
differ beliefs
interpreter
styles of communication
expression of emotion
eye contact
touch

46
Q

Issues communicating in PMH

A

delusion thinking - false belief
Hallucination
Paranoia - distrust
Self-concept - different perception than us or reality (do not play in with the delusion)

47
Q

Therapeutic relationship in medical

A

Knowledge of anatomy, physiology, and chemistry ith caring in a relationship with pts
**patient-centered partner ship

48
Q

Goals of a Therapeutic Relationship

A

facilitating
assisting problem-solving
help with alternatives
self-care

49
Q

Patient-centered relationship requires

A

strong communication skills
understanding human behavor
empathy

50
Q

nurse Roles

A

liaison
role model
teaching

51
Q

Interpersonal Interactions

A

accountable
focus on needs
competence
delay judgment

52
Q

Helping Relationship

A

needs of pt
alternate problem-solving
new coping
encourage behavior chnages

53
Q

What does not work when helping a therapeutic relationship?

A

inconsistency
unavailable
arguing, minimize, challenge
criticism

54
Q

Establish boundaries can occur by

A

overhelping
controlling
narcissism
transference
countertransference
emotional attachment

55
Q

Transference

A

pt subcons. Doesn’t like you ( pt to nurse)

56
Q

Countertransference

A

response as personal (nurse to pt)

57
Q

Peplau’s phases of the nurse-patient relationship

A

preorientation
orientation
working
termination

58
Q

Preorientation phase

A

Review background information
safety protocols
address staff fears

59
Q

orientation phase

A

rapport and trust
time frame and schedule
confidentiality
termination with d/c teachings

60
Q

working phase

A

maintain relationship
assessments
promote problem-solving, self-esteem, language
positive behavio chnage
no resistance
eval
promote practice and expression of alternate adaptive

61
Q

termination phase

A

achievements
incorporate into daily life, coping
review
exchange memories
**learn they are important to staff

62
Q

What helps a PMH patient improve to the termination phase

A

consistency
pacing
listening
initial impressions
comfort
factors for patients
- check regularly and schedule interviews

63
Q

What hinders a patient to improve in hospital

A

unavailability
inconsistency

64
Q

Who leads the clicnial interviews

A

patient - decide content and direction
nurse - therapeutic and active listening

65
Q

Interview goals to help the patient

A

feel safe, understand, and comfort
identify problems
healthy coping
goal is satisfying interpersonal relations

66
Q

Clinical settings when preparing for an interview

A

quiet
safe
private
visible

67
Q

Seating in an interview

A

same ht
avoid face-to-face
- across table and to the side at 90 degrees
comfort and safety
avoid barriers

68
Q

You should let the pt know about this during confidentiality?

A

disclosure about harming others or past experience

69
Q

Initiating an Interview should start with ehat type of statement

A
  • 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?”
70
Q

Offer leads

A

“Go on”
“Tell me more about that”

71
Q

Statements of acceptance in an interview

A

“Uh-huh”
“I see”
“Okay”

72
Q

Helpful Guidelines in an interview include

A

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

73
Q

Attending Behaviors

A

eye contact
body language
vocal qualities
verbal tracking

Module 6 (Psych Mental Health) (12 decks)

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