TR 2 midterm

Question 1

phases of TR

Answer 1

pre-interaction
intro
exploration/action
termination

Question 2

goals of psych interview

Answer 2

establish sound engagement of patient in therapeutic alliance
collect psych and nursing assessment data
develop ongoing compassionate understanding of patient
develop assessment from which psych and nursing dx can be made
collab with the patient to outline problems and goals
develop an appropriate asssessment and tx plan for patient
begin healing process by decreasing anxiety and pain in patient
provide hope and ensure patient will return or see you next visit

Question 3

engagement

Answer 3

ongoing development of sense of safety and respect for which patients feel increasingly free to share their problems while gaining an increased confidence in clinician’s potential to understand them

Question 4

blending

Answer 4

represents behavioral and emotional clues from interview that suggest that engagement process is proceeding effectively
active listening, ongoing assessment of blending, empathy, safe environment to share, genuine and natural, competent
2 major elements: nurse’s ability to listen and patient’s psychopathology

Question 5

8 core pains

Answer 5

intense loneliness
feeling worthless or bad
feeling rejected or wronged
sense of failure
loss of external control
loss of internal control
fear of unknown
loss of meaning

Question 6

resistance

Answer 6

refers to reaction of patients in some way feel coerced or may not be ready to address certain issues (core pains)
active or passive

Question 7

points of disengagement

Answer 7

MADs and PDQs

Question 8

MADs

Answer 8

moments of angry disengagement
can appear as confrontational disagreements, oppositional behaviors
passive aggressive attitudes

Question 9

PDQs

Answer 9

potentially disengaging questions
occur when client asks questions that catches nurse off-guard “you’re just a student, what would you know?”
hostile in nature

Question 10

REASONS For resistance

Answer 10

1. feeling abused, let everyone know they have no need for help, little willingness to establish working relationship, often resentful, active attempts to sabotage helping process or terminate
2. involuntary patients, any patient who feels they are treated unfairly become resistive
3. more passive style (covert) may talk about low priority issues, get upset or refuse to talk about mental illness symptoms and health

Question 11

patients who are resistant

Answer 11

-see no reason for help, lack of insight/judgement
-resent being certified under MHA
-have hx or being rebels, dislike authority figures
-developed negative attitudes about helping and helping agencies
-believe that going to a helper is weakness, failure, or inadequacy
- not been invited to participate in helping process or decisions about future
-feel need for personal power and find it thru resisting powerful figure/agency

Question 12

shut down interview

Answer 12

patient displays short duration of utterance, long response time latency, and usually variety of body language indicating things are not going well, eye contact is poor

Question 13

handling resistance

Answer 13

1.determine it is happening
2.may be verbal/nonverbal
3.resistance to change is normal
4.accept and work with resistance
5.examine the quality of communication (open ended, closed, gentle commands)
6.realistic and flexible
7.help patients find incentive for participating in helping process
8.do not see yourself as only helper
9.make covert resistance overt
10.take vantage point of patient. what core pains? listen to concerns
11.do not get defensive
12.see if patient has unanswered questions (fear of unknown) may cause further resistane

Question 14

relationship resistance

Answer 14

patients may have concerns about training, experience, competence, professional affiliation, age, sex, race
no perfect answers

Question 15

content response

Answer 15

directly responding to content of patient’s statement or question

Question 16

process response

Answer 16

identifies core pain that client may have in avoiding topic at hand
example when discussing substance abuse, patient derails convo

Question 17

sidetracking

Answer 17

method of handling resistance in which nurse changes topic to area of high importance for patient, while diverting from intensity of issue causing tension and resistance

Question 18

what qs to ask outside of MSE qs

Answer 18

sleep, ADLs, energy, diet, substances

Question 19

four disengagement points for interviewer

Answer 19

1. frequently appear out of hte blue
2. demand immediate response from interviewer
3. interviewer feels on the spot, clinician’s defenses are often automatically triggered
4. clinician’s feel ungrounded and at a loss