Refresher: Psychiatric Nursing 1 Flashcards
What is a nurse-client relationship?
2-way; series of interaction between the nurse and the client
What is the GOAL of the nurse-client relationship?
GOAL: Positive behavioral change
What are the 5 elements of therapeutic relationship?
T - rust
R - apport
U - nconditional positive regard (Acceptance)
S - etting limits
T - herapeutic communication/therapeutic use of self
Therapeutic Behaviors:
sincerity and honesty
Therapeutic Behaviors:
Genuineness
Therapeutic Behaviors:
ability to identify one’s feelings
Therapeutic Behaviors:
Concreteness
Therapeutic Behaviors:
consideration to the pt as a unique human being; Acceptance
Therapeutic Behaviors:
Respect
Phases of Therapeutic Relationship:
no contact with the client; datas are from secondary sources (chart, book, journals)
= Self awareness
Phases of Therapeutic Relationship:
Pre-interaction
Phases of Therapeutic Relationship:
establish trust: assess the client; establish mutual agreement (goals, plans); informing about termination
Phases of Therapeutic Relationship:
Orientation
Phases of Therapeutic Relationship:
longest phase; achieving goals and sharing facts; resolve the problem
= highly individualized
Phases of Therapeutic Relationship:
Working
Phases of Therapeutic Relationship:
moving towards independence; observe regressive behaviors (going back to previous state)
Management:
- reinforce the previous management
Phases of Therapeutic Relationship:
Termination
- defined as “dynamic” (changing) process of exchanging info
= Adaptive - composed of verbal and non verbal techniques (should be combined)
Therapeutic Communication
What are the 4 elements of the Therapeutic Communication?
- Sender - encoder/source of the message
- Message - actual info being transmitted
- Receiver - decoder/recipient of the message
- Feedback - receiver’s response
What inhibits communication process?
Barriers
ex. noise
Non-verbal communication:
“physical space” between nurse and pt/sender and receiver; not too far, not to near (3-6ft/one arm and half)
Non-verbal communication:
Proxemics
Non-verbal communication:
body movements such as gestures, facial expressions, mannerisms
Non-verbal communication:
Kinetics
Non-verbal communication:
intimate physical touch; always ask for Consent
Non-verbal communication:
Touch
Non-verbal communication:
agreeing; listening; encourages the pt to talk
Non-verbal communication:
Silence
Non-verbal communication:
“voice quality” (tone, inflection); how the message is delivered
Non-verbal communication:
Paralanguage
Describe therapeutic verbal communication
therapeutic, appropriate, simple, adaptive, concise, and credible
Therapeutic Verbal Communication: S - pecific M - measurable A - ttainable R - ealistic T - imebounded
Ex: “Let me sit here with you for 5 mins”
Therapeutic Verbal Communication:
Offering Self
Therapeutic Verbal Communication:
such as “ah huh, yes, no”
Therapeutic Verbal Communication:
Active listening
Therapeutic Verbal Communication:
Ex: “You said Hannah was the best. can you describe her?”
Therapeutic Verbal Communication:
Exploring
Therapeutic Verbal Communication:
You are giving the pt an opportunity to open up
Therapeutic Verbal Communication:
Broad Openings
Therapeutic Verbal Communication:
Ex: “I noticed you have combed your hair today”
Therapeutic Verbal Communication:
Making observation
Therapeutic Verbal Communication:
Ex: “ In the past 15 mins, we have talked about…”
Therapeutic Verbal Communication:
Summarizing
Therapeutic Verbal Communication:
Pt: I am hearing voices
Ex: “What are the voices telling you?”
Therapeutic Verbal Communication:
Encouraging description of perception/Acknowledging
Therapeutic Verbal Communication:
Pt: I am hearing voices
Ex: “I know that the voices are real to you, but there are no voices here”
Therapeutic Verbal Communication:
Presenting reality
Therapeutic Verbal Communication:
Ex: “Do you mean?”
Therapeutic Verbal Communication:
Seeking clarification
Therapeutic Verbal Communication:
help the pt in solving the problem, but not solve the problem for them
Therapeutic Verbal Communication:
Reflecting
Therapeutic Verbal Communication:
make it clearer
Pt: I am down
Ex: “You feel depressed?”
Therapeutic Verbal Communication:
Restating
Therapeutic Verbal Communication:
Ex: “Go on../Tell me more..”
Therapeutic Verbal Communication:
General leads
Ex: “Let us look at it more closely”
Therapeutic Verbal Communication:
Focusing
What are the common pitfalls (mistakes) in non Therapeutic Communication?
- giving advice
- talking about self
- telling the client is wrong (dispute, aggression) = lost of trust
- false reassurance
- asking WHY: demands an answer, arouses deep seated feelings
- Except: Suicidal (direct questioning because time is of the essence)
Spheres:
pleasure, principle, irrational
= Antisocial personality disorder
Spheres:
ID
Spheres:
reality-based
Spheres:
EGO
Spheres:
conscience, ego ideal
= Obsessive-compulsive personality disorder
Spheres:
SUPEREGO
Defense mechanisms: unconsciously forgetting (di sinasadya)
Defense mechanisms:
Repression
Defense mechanisms: consciously forgetting (sinasadya)
Defense mechanisms:
Suppression
Defense mechanisms:
plastic/plastik/orocan
what it says is different deep inside
Defense mechanisms:
Reaction formation
Defense mechanisms:
reasoning out/making excuses (nagdadahilan)
Ex: “Bumagsak ako kasi pachill chill lang ako e.”
Defense mechanisms:
Rationalization
Defense mechanisms:
blaming others
Ex: “Yung TopRank kasi pinabayaan kami..”
Defense mechanisms:
Projection
Defense mechanisms:
blaming self
Ex: “ Kung sana ginawa ko lang yung best ko”
Defense mechanisms:
Introjection
Defense mechanisms:
idolization (certain features)
Ex: Idol yung papa, ginaya yung porma
Defense mechanisms:
Identification
Defense mechanisms:
weak on one aspect but strong on another aspect
Ex: weak on sports, bumawi on acads
Defense mechanisms:
Compensation
Defense mechanisms:
unacceptable of the truth
Ex: “Why am I here, I am not sick and I don’t have any health problems.”
Defense mechanisms:
Denial
Defense mechanisms:
channeling of anxiety (divert)
Ex: Nagaway ang magbebe, sinuntok ang pader sa galit instead na siya
Defense mechanisms:
Displacement
Defense mechanisms:
going back to the previous developmental stage
Defense mechanisms:
Regression
Defense mechanisms:
hugas kamay; trying to relieve guilt feeling
Ex: Niloloko ang asawa, tuwing umuuwi nagdadala ng favorite food ni Mrs.
Defense mechanisms:
Undoing
Defense mechanisms:
anxiety turned to physical symptom
Ex: kinakabahan tapos naiihi
Defense mechanisms:
Conversion
Defense mechanisms:
- reasoning “detailed” manner/references
- using high level of words
Defense mechanisms:
Intellectualization
Defense mechanisms:
the unavailable makes available
Ex: Gusto mag med school pero kulang sa pera, so naghanap ng other school
Defense mechanisms:
Substitution
Defense mechanisms:
the unaccepctable makes acceptable
Ex: gusto manakit physically, so pumasok ng boxing
Defense mechanisms:
Sublimation
Crisis:
predictable (expected)
Ex: monthly bills, marriage, pregnancy, graduation
Crisis:
Maturational/Developmental
Crisis:
unpredictable (unexpected)
Ex: accidents, unwanted pregnancy
Crisis:
Situational
Crisis:
calamities/acts of God
Ex: rape, abuse, tsunami, flood
Crisis:
Adventitious/Social
Stages of Death and Dying:
unacceptable of the truth (shock/disbelief)
Stages of Death and Dying:
D - enial
Stages of Death and Dying:
projection (blaming others)/introjection
Stages of Death and Dying:
A - nger
Stages of Death and Dying:
bargain, unrealistic offers
Ex: “Lord, ako na lang po wag na lang po ang anak ko.”
Stages of Death and Dying:
B - argaining
Stages of Death and Dying:
Suicidal (ensure safety precautions)
- most dangerous
Stages of Death and Dying:
D - epression
Stages of Death and Dying:
moving forward
Stages of Death and Dying:
A - cceptance
Disturbances of Appearance:
repeated purposeless behaviors (neurotransmitter problem)
Is different from mannerism (muscle memory)
Disturbances of Appearance:
Automatism
Disturbances of Appearance:
slowed movements
common to depressed and manic pts
Disturbances of Appearance:
Psychomotor retardation
Disturbances of Appearance:
maintenance of an awkward posture
the movement is molded
to differentiate with catatonia, move the pt
Disturbances of Appearance:
Waxy flexibility
maintenance of an awkward posture
whatever the movement, movements came back
to differentiate with waxy flexibility, move the pt
Catatonia
Disturbances of Appearance:
purposeless imitation
whatever you do, the pt copies/imitates (mirror-like imitation)
Disturbances of Appearance:
Echopraxia