Psychosocial Nursing Techniques Flashcards
Therapeutic Use of Self
rooted within one’s individual, genuine way of being with another person..based upon one’s personal values and beliefs of humanity
implicates the nurse’s ability to critically reflect on self (values, biases, thoughts, language and actions)
Therapeutic Relationship
- trust, respect, professional intimacy, empathy, power
- attention to inherent power imbalance
- involves the nurse critically reflecting on self
- respect for boundaries
Transference
unconscious projection of attitudes and feelings from past relationships and others in their personal life onto the nurse
Countertransference
nurse’s response to the client’s attitudes and feelings, based on his/her own unconscious attitudes and feelings toward the client
CAUTION: at risk of crossing boundaries
Power Struggles
- expressions are vying for dominance
- may or may not be intentional
- setting boundaries and clarifying roles are important
Opening Up Therapeutic Communication
- creating a safe space (rapport, boundaries, privacy)
- active listening (being present, listening for content and process)
- using silence
- asking questions
- touch (beware of cultural norms, presence, can be counterproductive)
Barriers to communication
- physical environment
- excessive questioning
- mental distractions
- own agenda or assumptions, biases
- false reassurance
- giving advice
- jumping to conclusions
- moralizing
- value judgments
- trite responses
- changing the subject
Crisis
an emotional upset arising from situational, developmental, biological, psychological, sociocultural and/or spiritual factors, temporary inability to cope
Crisis Intervention
focus on resolution of immediate problem
alleviate stressors and bolster coping mechanisms
intervene rapidly and prevent further deterioration
3 Core Components of Crisis
Precipitating/stressful event
- a stressful event itself does not constitute a crisis, personal and circumstances determine crisis
Perception of event
- subjective distress, feelings or emotions that are overwhelming or confusing
- crisis only if functioning is impaired
Coping methods/supports
- crisis occurs if these fail
Crisis Resolution
a. realistic perception (reframing)
b. adequate supports
c. adequate coping mechanisms
Nursing Interventions for Crisis
- patient safety
- listen carefully
- identify needs
- identify coping skills
- explore realistic, acceptable interventions
- plan and promote problem solving skills
- offer crisis management techniques or skills
ABC Model in CBT
Activating event - avoid situations that leads to trouble - recognize triggers Belief - stop, think and identify negative beliefs - challenge your thoughts Consequences (emotional or behavioural) - relaxation and meditation techniques to manage emotions - identify patterns in behaviour
problem-oriented approach, review evidence about beliefs
CBT Techniques
a. socratic technique (ask questions to clarify position)
b. test and reframe beliefs
c. weigh evidence
d. alternative explanations
e. behavioural experiments
f. distancing (bird’s eye view)
g. decentering (remove self from focal point)
h. authenticating conclusions (test against reality)
Mindfulness Meditation
cultivating conscious awareness and attention
see more deeply into the cause and effect and connectedness of things
connect with the fullness of our possibilities now
let the present moment sink in, learn from it and move on
3 Building blocks of MM
a. paying attention on purpose and in a particular way
b. being present in the moment
c. being non-judgmental
involves self-directed empathy and self-acceptance
benefits:
- increased insights into thought pattern
- distanced and decentred from thoughts and feelings
- see feelings as events rather than identifying with them
Dialectical Behaviour Therapy
- for people with BPD and suicidality
- combines CBT and mindfulness
- emphasis on awareness of thoughts and actively shaping them
- increase person’s ability to mange distress and improve QoL behaviours
Use of Limit Setting
use of communication…restraint and seclusion
purpose:
1. safety for patients, staff and environment
2. promote pt’s development and growth
Correcting - aimed at changing the person’s behaviour by external control
Acknowledging - people are seen as capable of changing themselves from within, value person’s integrity, seeing pt as a resource of own treatment
** after setting limits, acknowledge feelings and address concerns
Motivational Interviewing
a directive, client-centred counseling style for eliciting behaviour change by helping clients to explore and resolve ambivalence
Open Questions
Affirm
Reflect
Summarize
Open Questions
- allow for open-ended answers
- help to focus the conversation
Affirm
- mentioning something we appreciate about the client
- credit the effort they are making
- acknowledging a success
- validate and affirm their strengths
- be honesty and specific
Reflective listening
- repeat, rephrase, paraphrase
- reflection of feeling
- checking and confirming understanding
Summarize
- collect material that has been offered
- link something just said with something discussed earlier
- clarify
- use along the way
What to do (Motivational Interviewing)
- work with the pt to set goals and tasks
- reflect what the client is saying
- affirm specific strengths and abilities to support self-efficacy
- summarize key themes
What not to do (Motivational Interviewing)
- assume to know best ideas about what needs to be done
- direct the client to the solutions you have for them
- focus on negatives or cheerlead blindly
- wander from client statements
Relaxation Techniques
a. deep breathing exercises
b. progressive muscle relaxation
c. relaxation response
d. reduction of caffeine
e. meditation
f. guided imagery
g. biofeedback
h. physical exercise and outdoor activity
i. CBT
j. journaling
k. humour
Mental health services for Indigenous people
blends therapeutic and psycho-educational groups with cultural programming and ceremonies as part of a holistic approach to care
Sweat Lodges
- space dedicated to traditional healing practices
- improves spiritual and emotional well-being
- sweat ceremony intended as a spiritual reunion with creator, purging toxins out of body
- mental, spiritual and physical healing
culture is treatment
