The Helping or Therapeutic Relationship

Question 1

A Helping Relationship

Answer 1

Therapeutic Relationship

Question 2

What is a process through which one person promotes the development of another person by fostering the latter’s maturation, adaptation, integration, openness, and ability to find meaning in the present situation?

Answer 2

Therapeutic Relationship

Question 3

What emerges from purposeful encounters characterized by effective communication?

Answer 3

Therapeutic Relationship

Question 4

In which relationship does the nurse respects the individual’s values, attends to concerns, and promote positive change by encouraging self-expression, exploring behaviour patterns and outcomes, and promoting self-help?

Answer 4

Therapeutic Relationship

Question 5

What is the foundation of clinical nursing practice?

Answer 5

Therapeutic Relationship

Question 6

What is the essential element of quality care with every individual in every situation?

Answer 6

Therapeutic Relationship

Question 7

Techniques, technology, interventions, and contexts differ, but the relational aspect of nursing practice produces a cohesive unity, allowing each nurse to see people ___ and as unique individuals.

Answer 7

holistically

Question 8

What has many components that are most germane to relationships that extend over time but can apply to even brief encounters?

Answer 8

Therapeutic Relationship

Question 9

Characteristics of the Therapeutic Relationship

Characteristics Associated With Therapeutic Effectiveness

• Self-___ and self-
• Openness
• Self-___ and strength
• Genuineness
• ___ for the individual
• ___ for the individual
• Knowledge
• Ability to ___
• Sensitivity
• Acceptance
• Creativity
• Ability to focus and confront

Answer 9

awareness, reflection

confidence

Concern

Respect

empathize

Question 10

Characteristics of the Therapeutic Relationship

___ communication means that the nurse focuses communication on a particular goal.

Answer 10

Purposeful

Question 11

Characteristics of the Therapeutic Relationship

___ chitchat, communication without a goal, should not make up the bulk of therapeutic interaction.

Answer 11

Social

Question 12

Characteristics of the Therapeutic Relationship

This does not mean that the nurse should never discuss a social topic; nonetheless, there should be some ___.

For example, discussing the weather with a somewhat disoriented older individual serves the ___ of orienting that person to the environment.

Discussing the Stanley Cup with a hockey fan may provide valuable assessment data and engage the person in a current topic of social interest.

___ guide the nurse in focusing communication.

Answer 12

purpose x 2

Goals

Question 13

Characteristics of the Therapeutic Relationship

What is a harmony and an affinity between people in a relationship?

Answer 13

Rapport

Question 14

Characteristics of the Therapeutic Relationship

What does letting the person know that his or her concerns are of interest and that working together may alleviate some of his or her difficulties build?

Answer 14

Rapport

Question 15

Characteristics of the Therapeutic Relationship

What does encouraging growth by being genuine, open, and concerned build?

Answer 15

Rapport

Question 16

Characteristics of the Therapeutic Relationship

What is the reliance on a person to carry out responsibilities and promises, based on a sense of safety, honesty, and reliability?

Answer 16

Trust

Question 17

Characteristics of the Therapeutic Relationship

What does the nurse promote by modelling and structuring the relationship appropriately?

Answer 17

Trust

Question 18

Characteristics of the Therapeutic Relationship

The following strategies promote trust:

• Anticipating that the individual will do as promised
• Clearly defining the relationship parameters and expectations, particularly the ___ and specifics of time, place, and anticipated behaviour
• Being consistent
• Examining ___ that interfere with trust

Answer 18

purpose

behaviours

Question 19

Characteristics of the Therapeutic Relationship

What is the ability to understand another’s feelings without losing personal identity and perspective?

Answer 19

Empathy

Question 20

Characteristics of the Therapeutic Relationship

___ nurses draw on emotions and experiences that enable them to place themselves in the other person’s situation.

Answer 20

Empathic

Question 21

Characteristics of the Therapeutic Relationship

While the person senses increasing understanding and acceptance from the nurse through ___, the individual’s distress decreases.

Answer 21

empathy

Question 22

Characteristics of the Therapeutic Relationship

Nurses do not empathize by switching the focus of the interaction to themselves or by ___ (e.g., “I know exactly how you feel; that happened to me once”).

Answer 22

sympathizing

Question 23

Characteristics of the Therapeutic Relationship

What is evident when nurses use clinical and personal experience to appreciate the individual’s feelings and experiences: they try to imagine themselves in the person’s situation?

Answer 23

Empathy

Question 24

Characteristics of the Therapeutic Relationship

Using personal understanding based on some shared aspect of experience such as a loss while maintaining boundaries is the essence of ___ in the helping relationship.

Answer 24

empathy

Question 25

Characteristics of the Therapeutic Relationship

With ___ understanding, the nurse acknowledges the affective domain of personal experiences and uses this knowledge to appreciate the person’s reactions.

Answer 25

empathic

Question 26

Characteristics of the Therapeutic Relationship

What enables the listener to share human experiences as the basis for providing care?

Answer 26

Empathy

Question 27

Characteristics of the Therapeutic Relationship

Although most human relationships focus on mutual benefit, a helping relationship exists solely to meet some need or to promote the growth of the ___.

Although the nurse may benefit from the interaction, the relationship is centred on the ___.

Answer 27

recipient x 2

Question 28

Characteristics of the Therapeutic Relationship

What are formulated as desired individual behaviours/outcomes?

Answer 28

Goals

Question 29

Characteristics of the Therapeutic Relationship

Which goals are likely to be achieved within 10 days to 2 weeks?

Answer 29

Short-Term

Question 30

Characteristics of the Therapeutic Relationship

Which goals are likey to be acheived after 2 weeks?

Answer 30

Long-Term

Question 31

Characteristics of the Therapeutic Relationship

What should be stated in measurable terms and should focus on a positive change or on the decrease of problematic behaviour/health indicators?

Answer 31

Goals

Question 32

Characteristics of the Therapeutic Relationship

Ideally, a person works with the nurse to establish ___. However, some individuals, such as those who are seriously ill, depressed, psychotic, or cognitively impaired, may be unable to establish mutual ___.

When an individual is unable to negotiate appropriate ___, the nurse establishes realistic ___ and shares them to the degree possible with the person, who is free to participate or to reject efforts to reach these ___.

In some circumstances when the care recipient is unable to collaborate regarding care decisions, then a family member or another designee/health care proxy may be the appropriate person for such communication.

Answer 32

goals x 5

Question 33

Which decision making is closely linked with the goal-directed nature of helping relationships?

Answer 33

Ethical

Question 34

Which issues are present in human interactions whenever behaviour may affect others, actions involve conscious choices of methods and ends, and actions can be evaluated in reference to standards of right and wrong?

Answer 34

Ethical

Question 35

Frequently, the nurse may wish to set goals that the individual does not want to reach; the nurse must remember that the problem belongs to the person, as does the choice of care alternatives.

The nurse assists the individual in decision making, with the decision based on the individual’s value system. However, the nurse should not take a ___ ___ approach and avoid assisting the person.

The nurse’s responsibility is to help the individual to examine values, identify conflicts, and prioritize goals and desired health care outcomes.

Answer 35

laissez-faire

Question 36

What follows from understanding values and the best available information?

Answer 36

Action

Question 37

Both the individual and the nurse must bring interpreted facts and personally clarified ___ to the interaction to establish goals.

Answer 37

values

Question 38

The nurse must clarify personal ___, subsequently respect the individual’s rights, and act to support and protect the integrity of the person, family, group, or community.

Answer 38

values

Question 39

Which communication also involves safeguarding protected health information?

Answer 39

Ethical

Question 40

The individual’s right to ___ motivated the passage of the Personal Information Protection and Electronic Documents Act, which was established in 2004, and which is supported and endorsed by all provincial governing bodies, as well as by the CNA Code of Ethics.

Answer 40

privacy

Question 41

Information that is protected by law includes ___ data that relates to the individual’s past, present, or future physical or mental health or condition; the ___ of health care to the individual, or the past, present, or future ___for the ___ of health care to the individual; and information that ___ the individual or for which there is a reasonable basis to believe can be used to ___the individual.

Answer 41

demographic

provision

payment

provision

identifies

Question 42

Individually ___ health information includes many common ___ (e.g., name, address, birth date, Social Insurance Number).

Answer 42

identifiable

identifiers

Question 43

Sharing personal health information (PHI) can be understood on the basis of “___ ___ ___” so as to care for the person.

Answer 43

need to know

Question 44

Stuart’s (2012) concept of the ___ of confidentiality provides a helpful guideline to nurses:

Within the ___, patient information may be shared.

Those outside the ___ require the patient’s permission to receive information.

Within the ___ are treatment team members, staff supervisors, health care students and their faculty (only if they are working with the patient), and consultants who actually see the patient.

Adhering to the rules concerning protection of identifiable health information is both an ethical and a legal requirement for the nurse.

Answer 44

circle x 4

Question 45

Guidelines for Ethical Interpersonal Communication

Ethical interpersonal communication involves:

• Being aware and ___ to changing concepts of self and others
• Attending to role responsibilities; individual sacrifice, when it is required to make a “good” decision; and emotions, while guarding against letting emotions be the sole guide of our behaviour
• Sharing personal views candidly and clearly
• Communicating information accurately, with minimal loss or distortion of intended meaning
• Communicating verbal and nonverbal messages with ___ meanings
• Sharing responsibility for the consequences among communicators
• Recognizing the multicultural context of all communication
• Respecting the ___ of every person
• Avoiding ___ and use of power in communicating
• Being sensitive to gender and cultural contexts of communication and interpretation
• Building context for intercultural dialogue that is open with conditions of security and mutual respect
• Eliminating any elements of your communication that denigrates, stereotypes, or devalues patients
• Facilitating open and accurate communication among professional groups, professionals, staff and families, clinical care unit and department staffs or administrators, and clinical care facilities

Answer 45

open

congruent

dignity

coercion

Question 46

Guidelines for Ethical Interpersonal Communication

Unethical communication involves:

• Purposefully deceiving
• Intentionally blocking communication-for example, changing subjects when the other person has not finished communicating, cutting a person off, or distracting others from the subject under discussion
• ___ or unnecessarily condemning others
• Lying or deceiving that causes intentional or unintentional harm
• Verbally “___ ___ ___ ___” by taking advantage of another’s vulnerability
• Violating the ___ ___ ___ as set out by the provincial governing bodies and the Canadian Nurses Association (CNA) Code of Ethics

Answer 46

Scapegoating

hitting below the belt

standards of practice

Question 47

Therapeutic Techniques

The first step to therapeutic communication is ___ on the individual and the reason that the interaction is occurring.

The nurse is not the ___; the person is.

Although an overly business-like style fails to communicate concern and support, delving into one’s own personal life to the extent that it diverts attention from the other person’s concern is also problematic.

Avoiding nurse-directed conversation can be difficult; a useful rule of thumb is to answer or respond to obvious questions and to switch the ___ back to clinical concerns when other questions are asked.

For example:

Individual (looks at female nurse’s wedding ring):

“Are you married?”

Nurse: “Yes, I am.”

Individual: “What does your husband do for a living?”

Nurse: “Rather than get distracted by a discussion about me, let’s get back to planning how you will manage at work.”

Keeping ___ on the person’s concerns includes identifying the portion of the message that is clear and relevant to the purpose of the interaction, seeking validation, and helping the individual to clarify the rest of the message.

Answer 47

focusing

focus x 2

Question 48

Therapeutic Techniques

A crucial step in using the therapeutic relationship effectively is to assist the individual to ___ a particular experience or concern.

Answer 48

describe

Question 49

Therapeutic Techniques

What is enhanced when the nurse prompts the person to clarify?

Answer 49

Description

Question 50

Therapeutic Techniques

Use of who, what, where, and when questions helps the person to ___ and expand the content and meaning of what is communicated.

Answer 50

clarify

Question 51

Therapeutic Techniques

Phrases such as “tell me,” “go on,” “describe to me,” “explain it to me,” and “give me an example” are also likely to elicit ___ of important content and to diminish distracting generalizations and abstractions.

Answer 51

description

Question 52

Therapeutic Techniques

By seeking ___, the nurse helps the individual to explain the meaning further.

Answer 52

feedback

Question 53

Therapeutic Techniques

In clarifying the meaning, the nurse should avoid threatening, detective-like questions. Questions that begin with “___” often increase the person’s anxiety because they demand reasons, conclusions, analysis, or causes.

Answer 53

why

Question 54

Therapeutic Techniques

Rather than telling the person what is wrong and how to fix it, the nurse’s primary goal is helping the person to ___ the problem and formulate solutions in partnership.

Answer 54

describe

Question 55

Therapeutic Techniques

What is the restatement of what the individual has said in the same or different words?

Answer 55

Reflection

Question 56

Therapeutic Techniques

What technique can involve paraphrasing or summarizing the person’s main point to indicate interest and to focus the discussion?

Answer 56

Reflection

Question 57

Therapeutic Techniques

Which approach does not include frequent, parrot-like repetition of the individual’s statements but is the selective paraphrasing or literal repetition of the person’s words to underscore the importance of what has been said, to summarize a main concern or theme, or to elicit elaborated information?

Answer 57

Reflection

Question 58

Therapeutic Techniques

The Process of Reflection

Answer 58

Question 59

Therapeutic Techniques

What means to point out a specific behaviour and then help to examine the meaning or consequences of the behaviour?

For example:

Nurse: “You missed your appointment for the consultation we had scheduled.”

Individual: “Oh, I did not notice the date.”

Nurse: “You are usually very aware of time and appointments. What do you think was going on with you that you did not notice the date this time?”

Answer 59

Confronting

Question 60

Therapeutic Techniques

Which type of confrontation is not an angry exchange but a purposeful way of helping the person examine personal actions and their meaning?

Answer 60

Constructive

Question 61

Therapeutic Techniques

Individuals misuse ___ by refer to we, us, they, she, he, him, and her, without clearly identifying the referent, and by making vague statements such as “they don’t like me. They told me I was useless.”

Others may use general nouns, such as everyone, people, doctors, and nurses, to avoid clear communication about specific persons.

Answer 61

pronouns

Question 62

Therapeutic Techniques

What are clarified by asking, “Who are they?” or “Who is the person?”

Answer 62

Pronouns

Question 63

Therapeutic Techniques

The nurse must be careful to use separate pronouns when speaking of herself or himself and the individual, particularly when the person has disordered thinking.

For example, when communicating with an individual who is confused or exhibits disordered or psychotic thinking, the nurse should say “___” and “___,” rather than “us” or “we,” to promote clear thinking and communication and to assist the individual to maintain personal boundaries.

Answer 63

you

I

Question 64

Therapeutic Techniques

A ___-centred approach encourages nurses to explore and understand an individual’s social conditions and how they wish to be addressed.

Answer 64

patient

Question 65

Therapeutic Techniques

Manzer, O’Sullivan and Doucet explored the myths and misunderstandings as nurse practitioners in New Brunswick working with LGBTQ2 individuals.

Their findings included the importance of the careful use of language in fostering a therapeutic nurse–patient relationship by utilizing neutral language that is more inclusive, such as “___” or “significant other,” rather than traditional language surrounding marriage or boyfriend/girlfriend.

They recommended having a non-judgemental attitude and asking the person how they wished to be addressed (such as he, she, or otherwise) to allow the interaction to be as respectful as possible.

Answer 65

partner

Question 66

Therapeutic Techniques

Allowing a thoughtful ___ at intervals helps the individual to talk at his or her own pace without pressure to perform for the nurse.

Answer 66

silence

Question 67

Therapeutic Techniques

What permits time for reflection and is particularly helpful to the depressed or physically ill person?

Answer 67

Silence

Question 68

Therapeutic Techniques

What can reduce pressure and conserve energy?

Answer 68

Silence

Question 69

Therapeutic Techniques

After several moments of ___, phrases like “Try putting your thoughts into words,” “Tell me what are you thinking or feeling now,” or “I will be here when you feel ready to talk” can be acceptable.

Answer 69

silence

Question 70

Therapeutic Techniques

What is a person-centred communication approach used widely in health care and life coaching to assist individuals to make behavioural changes regarding a wide variety of lifestyle and health issues?

Answer 70

Motivational Interviewing (MI)

Question 71

Therapeutic Techniques

Key components of Motivational Interviewing (MI) are:

___ - involving the individual in talking about issues, worries, and desires, and to establish the basis for a trusting relationship.

___ - narrowing the focus to habits or patterns that individuals wish to change.

___ - eliciting motivation for change by increasing the sense of the importance of change, confidence, and readiness to change.

___ - developing practical steps that the individual wants to use to create the desired changes.

Answer 71

Engaging

Focusing

Evoking

Planning

Question 72

Therapeutic Techniques

Steps in Promoting Problem-Solving

___ the Experience or Event of Concern

Helpful Verbal Nursing Strategies

• “Tell me what happened”
• “Describe the experience to me”

Analyze the Parts of the Experience and See the Relationships to Other Events

Helpful Verbal Nursing Strategies

• “What meaning does this have for you?”
• “What pattern is there?”

Formulate the ___

Helpful Verbal Nursing Strategies

• “In what way is this problematic?”
• “What do you want to see changed?”

___ the Formulation

Helpful Verbal Nursing Strategies

• “Do you mean…?”
• “Let me tell you what I understand you to be saying”

Use the Formulation to Identify Ways to Solve or Manage the Difficulty

Helpful Verbal Nursing Strategies

• “What would you do the next time?”
• “In what way has your view changed?”
• “What actions are needed to solve the problem that you have identified?”

Try Out the Solutions, Judge the ___, and Adjust the Plan Accordingly

Helpful Nursing Strategies

Encourage application in new situations through role playing or through practice in appropriate settings; help the individual cycle through the preceding sequence as needed to evaluate the outcome and make adjustments to the plan.

Answer 72

Describe

Problem

Validate

Outcomes

Question 73

What occurs when the nurse fails therapeutic techniques?

Answer 73

Barrier

Question 74

Lack of knowledge or experience can limit the nurse’s ability to assess the individual’s needs and repertoire of skills. Supervision and study can help the nurse apply the steps of the ___ process by using effective intervention approaches.

Answer 74

nursing

Question 75

Communication ineffective when some part of the communication–___ loop breaks down.

Answer 75

feedback

Question 76

Failure to send a clear message, receive and interpret the message correctly, or provide useful ___ can interfere with communication.

Diagnosing the source of the communication breakdown, taking steps to correct it, and using knowledge of the ___ process and appropriate ___ techniques are the nurse’s responsibility.

Answer 76

feedback

communication

therapeutic

Question 77

Barriers to Effective Communication

What can be the cause of altered perception and ability to communicate effectively during an interaction?

Answer 77

Anxiety

Question 78

Barriers to Effective Communication

Defence mechanisms, such as denial, projection, and displacement, reduce ___ but block understanding of the true meaning of an interaction.

Answer 78

anxiety

Question 79

Barriers to Effective Communication

Severe ___ and defence mechanisms distort reality and lead to disordered communication.

Answer 79

anxiety

Question 80

Barriers to Effective Communication

To enhance interpersonal communication, the nurse identifies the feeling of ___ and its source and uses ___-reducing interventions.

Answer 80

anxiety

Question 81

Barriers to Effective Communication

When the nurse fails to examine his or her ___ toward the person, negativity may be communicated and perceptions of the interaction may be distorted.

Answer 81

attitudes

Question 82

Barriers to Effective Communication

What is disruptive behaviour, inappropriate behaviour, confrontational, or conflict which can manifest as verbal abuse, physical assault, or sexual harassment or abuse?

Answer 82

Bullying

Question 83

Barriers to Effective Communication

What do the words incivility, lateral violence, and horizontal violence describe?

Answer 83

Bullying

Question 84

Barriers to Effective Communication

What results in a high rate of nurse absenteeism, lowered morale, loss of productivity, increased staff turnover, increased sick leave, additional recruitment costs, payouts and legal fees?

Answer 84

Bullying

Question 85

Barriers to Effective Communication

Nurses are responsible for addressing such behaviours in a timely and confidential manner if they witness or are the victim of a bully to both the individual who is bullying and to a manager.

Depending on the culture of the workplace, a majority of health care facilities have addressed this phenomenon by implementing codes of ___ conduct and by establishing organizational expectations, and through ongoing staff education.

Answer 85

professional

Question 86

Barriers to Effective Communication

Related to attitudinal barriers, ___ in gender, age, socioeconomic background, ethnicity, race, religion, or language can block functional communication between the nurse and the individual.

Answer 86

differences

Question 87

Barriers to Effective Communication

What factor can cause differences in perception and block mutual understanding?

Answer 87

Gaps

Question 88

Barriers to Effective Communication

To reduce language ___, nurses can question unclear verbal or written communications, seek clarification or assistance from translators, and explore the ways in which perceptions may differ and meanings can be clarified.

Answer 88

gaps

Question 89

Barriers to Effective Communication

Generation ___ between faculty and student nurses can interfere with effective development of the interpersonal skills required for therapeutic nurse–person relationships.

That said, nurses may need to learn how to adapt their ___-mediated modes of communication to the styles and skills of older-generation persons and those who may not have had the same access to ___ when communicating with persons in the health care system and in professional situations.

Answer 89

gaps

technology x 2

Question 90

Barriers to Effective Communication

What comprises all phenomena that inhibit the flow of thoughts, feelings, and memories in an interpersonal encounter and behaviours that interfere with therapeutic goals?

Answer 90

Resistance

Question 91

Barriers to Effective Communication

What arises from anxiety when a person feels threatened; the person implements this behaviour to divert the focus, most often in the form of avoidance, such as being late, changing the subject, forgetting, blocking, or becoming angry?

Answer 91

Resistance

Question 92

Barriers to Effective Communication

Exploration of possible threats in the relationship, goals, context, or a particular topic can lead to understanding the source of the ___ and finding the ability to handle these difficulties.

Answer 92

resistance

Question 93

Barriers to Effective Communication

Which behaviour is often dealt with through anxiety reduction?

Answer 93

Resistance

Question 94

Barriers to Effective Communication

What is reacting to another person in an exchange as though that person were someone from the past?

Answer 94

Transference

Question 95

Barriers to Effective Communication

What is another term for transference?

Answer 95

Distorting

Question 96

Barriers to Effective Communication

What is best understood as a process that distorts a current relationship or interaction on the basis of past learning, expectations, and/or relationships?

Answer 96

Transference

Question 97

Barriers to Effective Communication

What may involve a host of feelings that generally are classified as positive (love, affection, or regard) or negative (anger, dislike, or frustration)?

Answer 97

Transference

Question 98

Barriers to Effective Communication

Which reactions typically involve an important figure from the past such as a mother or father, at times, all authority figures?

Answer 98

Transference

Question 99

Barriers to Effective Communication

What response is triggered by something about another person’s characteristics, behaviour, or position, in combination with individual dynamics and context?

Answer 99

Transference

Question 100

Barriers to Effective Communication

Which feelings do people in a therapeutic relationship often develop toward the helping professional, arising from the interaction’s intensity and the care provider’s authoritative or nurturing role?

Answer 100

Transference

Question 101

Barriers to Effective Communication

When ___ reactions interfere with the current relationship (i.e., when reactions are out of proportion to the actual situation such as excessive anger in response to a nurse’s suggestion), they require gentle probing by pointing out the reaction and asking about the associated thoughts and feelings, and possible past reactions in similar circumstances (e.g., responses to authority figures).

Answer 101

transference

Question 102

Barriers to Effective Communication

What is basically the same phenomenon and involves distorting, but it is experienced by the health care provider rather than the person?

Answer 102

Countertransference

Question 103

Barriers to Effective Communication

If a nurse has strong feelings about the person and thinks that the person cannot possibly function after discharge without the nurse’s assistance, the nurse is likely to ___ the person’s abilities, encourage a childlike dependency, and interfere with the person’s progress.

Answer 103

distort

Question 104

Barriers to Effective Communication

When the individual has ___ limitations, the nurse may need to use extra skill in communicating.

Use of the other ___ to send or receive messages should be attempted.

Special help is often available from trained therapists and teachers; for example, many agencies have access to interpreters for deaf people, and visual aids may be useful.

Nurses must be as creative as possible, learn from others who are skilled in alternative forms of communication, and make referrals as necessary.

Answer 104

sensory

senses

Question 105

Barriers to Effective Communication

Failure to meet the individual’s ___ or to recognize the individual’s ___ is the most serious barrier to effective interaction.

This failure can arise from inadequate assessment, lack of knowledge, inability to separate the nurse’s ___ from the individual’s ___, and confusion between friendship and a helping relationship, including unrecognized or unresolved sexual issues.

Answer 105

needs

concerns

needs x 2

Question 106

Barriers to Effective Communication

Nurses, particularly novice nurses and those transitioning to a new role (e.g., from staff nurse to nurse practitioner after graduate school), need to demand mentorship/clinical supervision that is not tied to ___ evaluation.

In other words, a supportive mentoring/supervisory relationship with a more senior nurse is a necessary ingredient in helping nurses to be effective.

Cost-cutting efforts in today’s health care system often neglect such needs.

Yet consider the cost of a failed hire or ineffective relationships with care recipients.

Answer 106

performance

Question 107

The most important aspect of any ___ is that the nurse and the individual are able to attend to each other. The nurse’s attention to the person helps create this atmosphere.

Answer 107

setting

Question 108

What do factors such as lighting, noise, temperature, comfort, physical distance, and privacy represent?

Answer 108

Setting

Question 109

Occasionally the nurse has only minimal control over the ___, as in a busy clinic, health centre, inpatient unit, emergency department, or the individual’s home.

Although far from the ideal of a quiet, pleasant, well-lit private office, these typical clinical ___ can be used effectively by creating a sense of private space.

Curtains can be drawn, doors shut, and two chairs pulled to a corner to shape an environment for interaction.

Answer 109

setting

settings

Question 110

When possible, nurses seek offices or rooms to establish ___ during significant communication or when imparting important or complex health information.

Answer 110

privacy

Question 111

What are the sequential phases that therapeutic relationships follow which may overlap, differ in length, or involve issues that appear over time rather than in a set sequence?

Answer 111

phases

Question 112

Which three phases have been identified ny reasearches and clinicians?

Answer 112

Orientation (Introductory)

Working

Termination

Question 113

Originally these relationship ___ were identified from clinical interactions that developed over a prolonged period. However, they can be observed in brief encounters that are effective: that is, interactions that meet individuals’ needs rather than therapeutic interactions that have been reduced to little more than quick question-and-answer sessions.

Answer 113

stages

Question 114

Whether the nurse is engaged in a long-term or short-term relationship with an individual, attention to the relationship ___ is important.

Answer 114

stages

Question 115

Which therapeutic relationships will telescope the stages and is therefore particularly important that the nurse focuses on meeting the key demands of each relationship phase?

Answer 115

Brief

Question 116

A relationship exists even when the nurse and the individual do not see each other for an extended period, and each encounter occurs within the trajectory of the relationship ___.

Answer 116

stages

Question 117

Stages

Which phase begins when the nurse and the individual meet?

Answer 117

Orientation (Introductory)

Question 118

Stages

Which phase typically involves some feeling of anxiety because neither party knows what to expect?

Answer 118

Orientation (Introductory)

Question 119

Stages

Which phase includes discussion of issues and establishes a contract or pact?

Answer 119

Orientation (Introductory)

Question 120

Stages

Which phase involves a mutual understanding of the parameters of the relationship and an agreement to work together?

Answer 120

Orientation (Introductory)

Question 121

Stages

Which phase, if not successfully transitioned, is most likely to result in an unmet treatment goal and a lack of a working alliance?

Answer 121

Orientation (Introductory)

Question 122

Stages

Which phase includes consistency, sensitive pacing of communication, active listening, conveying concern and warmth, and paying attention to comfort and control help to establish a connection?

Answer 122

Orientation (Introductory)

Question 123

Stages

Which phase is hampered by inconsistency, unavailability, individual factors associated with trust, nurses’ feelings about the other person, confrontation of delusions or strongly held views, and unrealistic expectations?

Answer 123

Orientation (Introductory)

Question 124

Stages

Which phase may appear less distinct and the topics noted irrelevant when the therapeutic relationship is not structured primarily as counselling with a specific number of sessions?

Answer 124

Orientation (Introductory)

Question 125

Stages

Except in true emergencies, initial encounters should always include introductions by ___, discussion of the ___, and presentation of a ___ for ongoing care or specific follow-up.

Answer 125

name

purpose

plan

Question 126

Stages

In which stage of the therapeutic relationship would the following topics be discussed?

• What to call each other
• Purpose of meeting
• Location, time, and length of meetings
• Termination date or time for review of progress through follow-up
• Confidentiality (with whom clinical data will be shared)
• Any other limits related to the particular setting

Answer 126

Orientation (Introductory)

Question 127

Stages

Which phase of the therapeutic relationship emerges when the nurse and the individual collaborate as partners in promoting the person’s health?

Answer 127

Working

Question 128

Stages

Which phase may last for only a brief time to establish a treatment plan, may last for an established number of sessions, as in brief psychotherapy, or may extend over a longer period if the nurse is the primary care provider, care manager, or long-term caregiver in any setting or context for an individual or family?

Answer 128

Working

Question 129

Stages

Which phase includes setting goals and working mutually toward accomplishment?

Answer 129

Working

Question 130

Stages

Which phase includes interventions that are tailored to specific situations and health needs of the person and the family?

Answer 130

Working

Question 131

Stages

Which phase includes solving problems, coping with stressors, and gaining insight?

Answer 131

Working

Question 132

Stages

Which phase includes the nurse and the individual recognizing each other’s uniqueness and establishing trust (the first step)?

Answer 132

Working

Question 133

Stages

Which phase is the most likely to encounter resistant behaviours while the nurse and the individual become closer and work on potential anxiety-producing problems?

Answer 133

Working

Question 134

Stages

Which phase is the most likely to have a person pull away through the use of defence mechanisms because change can be difficult?

Answer 134

Working

Question 135

Stages

Which phase includes overcoming resistance as an important nursing task?

Answer 135

Working

Question 136

Stages

Which phase marks the end of the relationship established in the therapeutic contract or negotiated in accordance with the limits of the contract?

Answer 136

Termination

Question 137

Stages

Which phase represents a loss and therefore, may trigger feelings of sadness, frustration, and anger?

Answer 137

Termination

Question 138

Stages

Which phase is the loss of a relationship and the loss of future involvement, with its attendant realistic expectations or fantasies?

Answer 138

Termination

Question 139

Stages

Which phase reawakens feelings of previously unresolved losses, such as a death or divorce?

Answer 139

Termination

Question 140

Stages

Which phase helps the nurse and the individual gain practice in ending relationships and in exploring reactions, which can be most helpful when future losses occur?

Answer 140

Termination

Question 141

Stages

Interventions for Use During the ___ Phase of the Therapeutic Relationship

• Let the person know why the relationship is to be ___
• Remind the person of the date and how many meetings or appointments are left
• Collaborate with other staff so that they are aware of how the person is reacting and any special needs that the person may have
• Help the person to identify sources of support and other people with whom a relationship is possible
• Review the gains and the remaining goals
• Discuss the pros and cons experienced during the relationship to help the person develop a realistic appraisal
• Make referrals for follow-up care as needed

Answer 141

Termination

terminated

Question 142

Stages

___ constraints in practice are unavoidable.

Although challenging, ___ therapeutic encounters can be meaningful and useful.

Answer 142

Times

breif

Question 143

Stages

Limited ___ is not a valid reason to avoid interviewing or interacting with individuals.

Rather, nurses purposefully can structure ___ interactions to achieve specific clinical outcomes.

Answer 143

times

brief

Question 144

Stages

An effective 15-minute (or shorter) interview is feasible if nurses plan to ___ themselves, state the ___ of meeting, ___ understanding with the person or the family, ___ parameters such as time, ___ and listen, and elicit significant individual and family ___.

Most important, the ___ of the interaction must be realistic and clearly defined.

For example, the ___ may be to elicit a family’s view of the problem for which the person has sought care or to prioritize problems to be treated.

Even when time is limited, the interview is structured to provide an opportunity for the person or the family to engage in dialogue as an active participant in care, and the nurse’s attention is completely ___ on the individual.

Answer 144

introduce

purpose

validate

clarify

focus

data

goal

purpose

focused

Question 145

Stages

Key Ingredients for a 15-Minute (or Shorter) Family Interview

• Use manners to engage or re-engage family members. Make an ___ by offering your name and role. Orient family members to the ___ of a brief family interview.
• Assess significant areas of internal and external structure and function (obtain information from a genogram concerning basic family composition and external support data)
• Ask family members three ___ questions.
• Commend the family on one or two strengths
• Evaluate usefulness and conclude

Answer 145

introduction

purpose

key