Week 1 Flashcards
Therapeutic Communication is…
Communication geared towards meeting the patient’s needs as opposed to an assessment that is geared towards meeting a nurse’s needs.
What percentage of communication is nonverbal?
90%
Will you say the wrong thing?
Will saying the wrong thing be harmful to the patient?
“Yes, but that is how we will learn to find more useful and effective ways of helping individuals reach their goals”
“Hardly, especially if your intent is honest, your approach is respectful, and you have a genuine concern for the patient”
Therapeutic communication techniques discussed in YouTube video
Q) What would you like to talk about today?
Is an example of…
A) Open ended questions
B) Broad opening remarks
C) Reflection
D) Clarification/Validation
E) Sharing observations
F) Restating
G) Presenting reality/Orienting
B) Broad opening remarks
Therapeutic communication techniques discussed in YouTube video
Q) Can you tell me more about the voices in your head?
Is an example of…
A) Open ended questions
B) Broad opening remarks
C) Reflection
D) Clarification/Validation
E) Sharing observations
F) Restating
G) Presenting reality/Orienting
A) Open ended questions
Therapeutic communication techniques discussed in YouTube video
Q) You seem a little sad to me today
Is an example of…
A) Open ended questions
B) Broad opening remarks
C) Reflection
D) Clarification/Validation
E) Sharing observations
F) Restating
G) Presenting reality/Orienting
E) Sharing observations
Therapeutic communication techniques discussed in YouTube video
Q) Do I understand you correctly when you say _?
Is an example of…
A) Open ended questions
B) Broad opening remarks
C) Reflection
D) Clarification/Validation
E) Sharing observations
F) Restating
G) Presenting reality/Orienting
D) Clarification
Therapeutic communication techniques discussed in YouTube video
Q) Patient: Do you think I should try that new medication?
SRN: Well, do you think you should take those new medications?
Is an example of…
A) Open ended questions
B) Broad opening remarks
C) Reflection
D) Clarification/Validation
E) Sharing observations
F) Restating
G) Presenting reality/Orienting
C) Reflection
Returning the question back to the patient so that they decide for themselves.
Therapeutic communication techniques discussed in YouTube video
Q) Patient: I’m so anxious that I can’t get to sleep
SRN: So your anxiety is keeping you up at night?
Is an example of…
A) Open ended questions
B) Broad opening remarks
C) Reflection
D) Clarification/Validation
E) Sharing observations
F) Restating
G) Presenting reality/Orienting
F) Restating
Therapeutic communication techniques discussed in YouTube video
Q) Patient: Do you hear what she said? The voice?
SRN: I understand that you are hearing a voice, but I do not hear any voice.
Is an example of…
A) Open ended questions
B) Broad opening remarks
C) Reflection
D) Clarification/Validation
E) Sharing observations
F) Restating
G) Presenting reality/Orienting
G) Presenting reality/Orienting
NON-therapeutic communication techniques discussed in YouTube video
Q) SRN: Everything is going to be ok in the end
Is an example of…
A) Giving advice
B) “Why” questions
C) Closed ended questions
D) Passing judgement (approving/disapproving)
E) False reassurance
F) Leading questions
G) Changing the subject
E) False reassurance
NON-therapeutic communication techniques discussed in YouTube video
Q) Patient: Did I do the right thing?
SRN: Yes, you did the right thing
Is an example of…
A) Giving advice
B) “Why” questions
C) Closed ended questions
D) Passing judgement (approving/disapproving)
E) False reassurance
F) Leading questions
G) Changing the subject
D) Passing judgment
NON-therapeutic communication techniques discussed in YouTube video
Q) Patient: What do you think I should do?
SRN: You should…
Is an example of…
A) Giving advice
B) “Why” questions
C) Closed ended questions
D) Passing judgement (approving/disapproving)
E) False reassurance
F) Leading questions
G) Changing the subject
A) Giving advice
NON-therapeutic communication techniques discussed in YouTube video
Q) SRN: Are you feeling sad?
Patient: Yes
Is an example of…
A) Giving advice
B) “Why” questions
C) Closed ended questions
D) Passing judgement (approving/disapproving)
E) False reassurance
F) Leading questions
G) Changing the subject
C) Closed ended questions
NON-therapeutic communication techniques discussed in YouTube video
Q) SRN: Why are you so angry?
Is an example of…
A) Giving advice
B) “Why” questions
C) Closed ended questions
D) Passing judgement (approving/disapproving)
E) False reassurance
F) Leading questions
G) Changing the subject
B “Why” questions
Puts the patient on the defensive when using these type of questions
NON-therapeutic communication techniques discussed in YouTube video
Q) SRN: You don’t smoke…do you?
Is an example of…
A) Giving advice
B) “Why” questions
C) Closed ended questions
D) Passing judgement (approving/disapproving)
E) False reassurance
F) Leading questions
G) Changing the subject
F) Leading questions
NON-therapeutic communication techniques discussed in YouTube video
Q) Patient: I was abused when I was a little boy
SRN: What do you like to do for fun?
Is an example of…
A) Giving advice
B) “Why” questions
C) Closed ended questions
D) Passing judgement (approving/disapproving)
E) False reassurance
F) Leading questions
G) Changing the subject
G) Changing the subject
Therapeutic Techniques Based on the Book
Example: “I would like to spend time with you”; or, “I’ll stay here and sit with you for a while”
A) Using Silence
B) Accepting
C) Giving Recognition
D) Offering Self
E) Offering General Leads
F) Giving Broad Opening Remarks
G) Placing the Events in Time or Sequence
H) Offering Observations
I) Encouraging Description of Perception
D) Offering self
Therapeutic Techniques Based on the Book
Example: “Tell me about it”; or, “And then what happened?”
A) Using Silence
B) Accepting
C) Giving Recognition
D) Offering Self
E) Offering General Leads
F) Giving Broad Opening Remarks
G) Placing the Events in Time or Sequence
H) Offering Observations
I) Encouraging Description of Perception
E) Offering general leads
Therapeutic Techniques Based on the Book
Example: “What do these voices seem to be saying?”; or, “What is happening now?”
A) Using Silence
B) Accepting
C) Giving Recognition
D) Offering Self
E) Offering General Leads
F) Giving Broad Opening Remarks
G) Placing the Events in Time or Sequence
H) Offering Observations
I) Encouraging Description of Perception
I) Encouraging description of perception
Therapeutic Techniques Based on the Book
Example: “Where would you like to begin?”; or, “What would you like to discuss?”
A) Using Silence
B) Accepting
C) Giving Recognition
D) Offering Self
E) Offering General Leads
F) Giving Broad Opening Remarks
G) Placing the Events in Time or Sequence
H) Offering Observations
I) Encouraging Description of Perception
F) Giving broad opening remarks
Therapeutic Techniques Based on the Book
Example: “When did this happen?”; or, “What happened before?”
A) Using Silence
B) Accepting
C) Giving Recognition
D) Offering Self
E) Offering General Leads
F) Giving Broad Opening Remarks
G) Placing the Events in Time or Sequence
H) Offering Observations
I) Encouraging Description of Perception
G) Placing the events in time or sequence
Therapeutic Techniques Based on the Book
Example: Encourage a person to talk by waiting for the answers
A) Using Silence
B) Accepting
C) Giving Recognition
D) Offering Self
E) Offering General Leads
F) Giving Broad Opening Remarks
G) Placing the Events in Time or Sequence
H) Offering Observations
I) Encouraging Description of Perception
Using silence
Therapeutic Techniques Based on the Book
Example: “You appear nervous whenever Mikael enters the room”; or, “You appear tense”
A) Using Silence
B) Accepting
C) Giving Recognition
D) Offering Self
E) Offering General Leads
F) Giving Broad Opening Remarks
G) Placing the Events in Time or Sequence
H) Offering Observations
I) Encouraging Description of Perception
H) Offering observations
Therapeutic Techniques Based on the Book
Example: “I follow what you say”; or, “Okay”
A) Using Silence
B) Accepting
C) Giving Recognition
D) Offering Self
E) Offering General Leads
F) Giving Broad Opening Remarks
G) Placing the Events in Time or Sequence
H) Offering Observations
I) Encouraging Description of Perception
B) Accepting
Therapeutic Techniques Based on the Book
Example: “Good morning, Mr. James”; or, “I noticed that you shaved today”
A) Using Silence
B) Accepting
C) Giving Recognition
D) Offering Self
E) Offering General Leads
F) Giving Broad Opening Remarks
G) Placing the Events in Time or Sequence
H) Offering Observations
I) Encouraging Description of Perception
C) Giving recognition
Therapeutic Techniques Based on the Book
Example: “That was Dr. Todd, not a terrorist stalking and trying to harm you.”; or, “Your mother is not here, I am a nurse”
A) Encouraging Comparison
B) Restating
C) Reflecting
D) Focusing
E) Exploring
F) Giving Information
G) Seeking Clarification
H) Presenting Reality
H) Presenting reality
Therapeutic Techniques Based on the Book
Example: “Tell me more about that”; or, “Would you describe it more fully?”
A) Encouraging Comparison
B) Restating
C) Reflecting
D) Focusing
E) Exploring
F) Giving Information
G) Seeking Clarification
H) Presenting Reality
E) Exploring
Therapeutic Techniques Based on the Book
Example: Patient: “I can’t sleep. I stay awake all night.”
SRN: “You can’t sleep and stay awake all night”
A) Encouraging Comparison
B) Restating
C) Reflecting
D) Focusing
E) Exploring
F) Giving Information
G) Seeking Clarification
H) Presenting Reality
B) Restating
Per Professor Houghton, restating must be verbatim
Therapeutic Techniques Based on the Book
Example: “Has this ever happened before?”; or, “Is this how you felt when…?”
A) Encouraging Comparison
B) Restating
C) Reflecting
D) Focusing
E) Exploring
F) Giving Information
G) Seeking Clarification
H) Presenting Reality
A) Encouraging comparison
Therapeutic Techniques Based on the Book
Example: “This medication is for…”; or, “This test will determine…”
A) Encouraging Comparison
B) Restating
C) Reflecting
D) Focusing
E) Exploring
F) Giving Information
G) Seeking Clarification
H) Presenting Reality
F) Giving information
Therapeutic Techniques Based on the Book
Example: “I am not sure I understand”
A) Encouraging Comparison
B) Restating
C) Reflecting
D) Focusing
E) Exploring
F) Giving Information
G) Seeking Clarification
H) Presenting Reality
G. Seeking clarification
Therapeutic Techniques Based on the Book
Example: “You’ve mentioned many things, lets go back to your thinking of ‘ending it all,’”
A) Encouraging Comparison
B) Restating
C) Reflecting
D) Focusing
E) Exploring
F) Giving Information
G) Seeking Clarification
H) Presenting Reality
D) Focusing
Therapeutic Techniques Based on the Book
Example: Patient: “What should I do about my husband’s affair?
SRN: “What do you think you should do?”
A) Encouraging Comparison
B) Restating
C) Reflecting
D) Focusing
E) Exploring
F) Giving Information
G) Seeking Clarification
H) Presenting Reality
C) Reflecting
Therapeutic Techniques Based on the Book
Example: “I find that hard to believe”; or, “Isn’t that unusual?”
A) Voicing Doubt
B) Seeking Consensual Validation
C) Verbalizing the Implied
D) Encouraging Evaluation
E) Attempting to Translate Into Feelings
F) Suggesting Collaboration
G) Summarizing
H) Encouraging Formulation of a Plan of Action
A) Voicing doubt
Therapeutic Techniques Based on the Book
Example: “What did it mean to you when he said he couldn’t stay?”; or, “How do you feel about…?”
A) Voicing Doubt
B) Seeking Consensual Validation
C) Verbalizing the Implied
D) Encouraging Evaluation
E) Attempting to Translate Into Feelings
F) Suggesting Collaboration
G) Summarizing
H) Encouraging Formulation of a Plan of Action
D) Encouraging Evaluation
Therapeutic Techniques Based on the Book
Example: “Perhaps you and I can discover what produces your anxiety.”
A) Voicing Doubt
B) Seeking Consensual Validation
C) Verbalizing the Implied
D) Encouraging Evaluation
E) Attempting to Translate Into Feelings
F) Suggesting Collaboration
G) Summarizing
H) Encouraging Formulation of a Plan of Action
F) Suggesting collaboration
Therapeutic Techniques Based on the Book
Example: “The next time this comes up, what might you do differently to handle it?”; or, “What could you do to let out your anger harmlessly?”
A) Voicing Doubt
B) Seeking Consensual Validation
C) Verbalizing the Implied
D) Encouraging Evaluation
E) Attempting to Translate Into Feelings
F) Suggesting Collaboration
G) Summarizing
H) Encouraging Formulation of a Plan of Action
H) Encouraging formulation of a plan of action
Therapeutic Techniques Based on the Book
Example: “Tell me whether my understanding agrees with you”
A) Voicing Doubt
B) Seeking Consensual Validation
C) Verbalizing the Implied
D) Encouraging Evaluation
E) Attempting to Translate Into Feelings
F) Suggesting Collaboration
G) Summarizing
H) Encouraging Formulation of a Plan of Action
B) Seeking consensual validation
Therapeutic Techniques Based on the Book
Example: Patient: “I am dead inside”
SRN: “Are you saying that you feel lifeless? Does life seem meaningless to you?”
A) Voicing Doubt
B) Seeking Consensual Validation
C) Verbalizing the Implied
D) Encouraging Evaluation
E) Attempting to Translate Into Feelings
F) Suggesting Collaboration
G) Summarizing
H) Encouraging Formulation of a Plan of Action
E) Attempting to translate into feelings
Therapeutic Techniques Based on the Book
Example: Patient: “I can’t talk to you or anyone else. It’s a waste of time.”
SRN: “Do you feel that no one understands?”
A) Voicing Doubt
B) Seeking Consensual Validation
C) Verbalizing the Implied
D) Encouraging Evaluation
E) Attempting to Translate Into Feelings
F) Suggesting Collaboration
G) Summarizing
H) Encouraging Formulation of a Plan of Action
C) Verbalizing the implied
Therapeutic Techniques Based on the Book
Example: “During the past hour, we discussed…”
A) Voicing Doubt
B) Seeking Consensual Validation
C) Verbalizing the Implied
D) Encouraging Evaluation
E) Attempting to Translate Into Feelings
F) Suggesting Collaboration
G) Summarizing
H) Encouraging Formulation of a Plan of Action
G) Summarizing
NON-Therapeutic Techniques Based on the Book
Example: “How come you still smoke when your wife has lung cancer?”
A) Giving Premature Advice
B) Minimizing Feelings
C) Falsely Reassuring
D) Making Value Judgements
E) Asking “Why” Questions
F) Asking Excessive Questions
G) Giving Approval; Agreeing
H) Disapproving; Disagreeing
I) Changing the Subject
D) Making value judgements
A more appropriate approach would be through the therapeutic communication technique of “Making Observations”
“I notice you are still smoking even though your wife has lung cancer. Is this a problem?”
NON-Therapeutic Techniques Based on the Book
Example: You should definitely break up with your boyfriend”
A) Giving Premature Advice
B) Minimizing Feelings
C) Falsely Reassuring
D) Making Value Judgements
E) Asking “Why” Questions
F) Asking Excessive Questions
G) Giving Approval; Agreeing
H) Disapproving; Disagreeing
I) Changing the Subject
A) Giving premature advice
A more appropriate approach would be through the therapeutic communication technique of, “Encouraging problem solving”
“What are some pros and cons of your relationship?”
“What are some ways you two can prevent this from happening again?”
NON-Therapeutic Techniques Based on the Book
Example: Why did you stop taking your medications?”
A) Giving Premature Advice
B) Minimizing Feelings
C) Falsely Reassuring
D) Making Value Judgements
E) Asking “Why” Questions
F) Asking Excessive Questions
G) Giving Approval; Agreeing
H) Disapproving; Disagreeing
I) Changing the Subject
E) Asking why questions
A more appropriate approach would be through the therapeutic communication technique of, “Asking open-ended questions; giving a broad opening”
“Tell me some of the reasons that led up to you not taking your medications”
NON-Therapeutic Techniques Based on the Book
Example: “You will be just fine, don’t worry” or “Everything will work out in the end”
A) Giving Premature Advice
B) Minimizing Feelings
C) Falsely Reassuring
D) Making Value Judgements
E) Asking “Why” Questions
F) Asking Excessive Questions
G) Giving Approval; Agreeing
H) Disapproving; Disagreeing
I) Changing the Subject
C) Falsely reassuring
A more appropriate approach would be through the therapeutic communication technique of, “Clarifying the patient’s message”
“What specifically are you worried about?”
“What are you concerned might happen?”
NON-Therapeutic Techniques Based on the Book
Example: Patient: “I’d like to die”
SRN: “Are you going to the Alcoholics Anonymous meeting tomorrow?”
A) Giving Premature Advice
B) Minimizing Feelings
C) Falsely Reassuring
D) Making Value Judgements
E) Asking “Why” Questions
F) Asking Excessive Questions
G) Giving Approval; Agreeing
H) Disapproving; Disagreeing
I) Changing the Subject
I) Changing the subject
A more appropriate approach would be through the therapeutic communication technique of “Validating and exploring”
Patient: “I’d like to die”
SRN: “This sounds serious. Have you thought of harming yourself?”
NON-Therapeutic Techniques Based on the Book
Example: Patient: “I wish I were dead”
SRN: “I know what you mean”; or, “Things get worse before they get better”; or, “ You should feel happy you’re getting better”
A) Giving Premature Advice
B) Minimizing Feelings
C) Falsely Reassuring
D) Making Value Judgements
E) Asking “Why” Questions
F) Asking Excessive Questions
G) Giving Approval; Agreeing
H) Disapproving; Disagreeing
I) Changing the Subject
B) Minimizing feelings
A more appropriate approach would be through the therapeutic communication technique of, “Emphasizing and exploring”
“You must be feeling very upset. Are you thinking of hurting yourself?”
NON-Therapeutic Techniques Based on the Book
Example: “You should have shown up for the medication group”; or, “I disagree with that”
A) Giving Premature Advice
B) Minimizing Feelings
C) Falsely Reassuring
D) Making Value Judgements
E) Asking “Why” Questions
f) Asking Excessive Questions
G) Giving Approval; Agreeing
H) Disapproving; Disagreeing
I) Changing the Subject
H) Disapproving; disagreeing
A more appropriate approach would be through the therapeutic communication technique of, “Exploring”
“What was going through your mind when you decided not to come to your medication group?”
NON-Therapeutic Techniques Based on the Book
Example: SRN, “How’s your appetite? Are you losing weight? Are you eating enough?”
Patient: “No”
A) Giving Premature Advice
B) Minimizing Feelings
C) Falsely Reassuring
D) Making Value Judgements
E) Asking “Why” Questions
f) Asking Excessive Questions
G) Giving Approval; Agreeing
H) Disapproving; Disagreeing
I) Changing the Subject
F) Asking excessive questions
A more appropriate approach would be through the therapeutic communication technique of, “Clarifying”
“Tell me about your eating habits since you’ve been depressed”
NON-Therapeutic Techniques Based on the Book
Example: “I’m proud of you for applying for that job”
A) Giving Premature Advice
B) Minimizing Feelings
C) Falsely Reassuring
D) Making Value Judgements
E) Asking “Why” Questions
f) Asking Excessive Questions
G) Giving Approval; Agreeing
H) Disapproving; Disagreeing
I) Changing the Subject
G) Giving approval; agreeing
A more appropriate approach would be through the therapeutic communication technique of, “Making observations”
“I noticed that you applied for that job”
“What factors led you to change your mind about applying for that job?”
Define: Transference
When a patient sees the nurse as someone whom has significant impact on them (ie: Mom, brother, cousin, best friend etc…) and as a result shows the same feelings to the nurse that they would on the person they remind them of.
Define: Countertransference
When a patient reminds the nurse of someone they know which may have an impact on the care that the patient receives.
Define: Countertransference
When a patient reminds the nurse of someone they know which may have an impact on the care that the patient receives.
Phases of the nurse-patient relationship
Orientation phase
Working phase
Termination phase
What occurs in the orientation phase?
Establishing rapport: Learning how to address the patient to their preference and introducing yourself.
Parameters of the relationship: Provide basic information about yourself such as being a student nurse to set parameters.
Formal or informal contract: Not done in our class but essentially is an agreement between patient and student regarding the best time and date for both parties to engage in communication to discuss realistic goals but it is imperative that the agreement is mutual.
Confidentiality: Be aware of the patient’s rights to confidentiality and discuss who else will be given the information shared with the nurse and other providers.
Termination: Termination begins in the orientation phase when setting the contract, the patient will know when the last day will be.
What occurs in the working phase?
Maintaining the relationship
Gathering further data
Promoting the patient’s problem-solving sills, self-esteem, and use of language
Facilitate behavioral change
Overcome resistance behaviors
Evaluate problems and goals, and redefine them as necessary
Promote, practice, and express alternative adaptive behaviors
What occurs in the termination phase?
Summarize the goals and objectives in the relationship
Discuss ways for the patient to incorporate into daily life any new coping strategies learned during the time spent with the nurse
Reviewing situations that occurred during the time spent together
Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship.
Define Pacing in psychiatrist nursing
Letting the patient set the pace and letting the pace be adjusted to fit the patient’s moods.
Define empathy
“entering the private perceptual world of the other and becoming thoroughly at home with it.”
“Meeting the patient at their level”
“Putting yourself in their shoes”
Define complete suicide
An intentional act to self harm resulting in death
Define copy cat suicide
Emulation of a suicide of another individual as seen either in person or in the media.
(This has occurred when celebrities have committed suicide)
Define No-harm plan
When a patient agrees to not do harm to self or others.
Risk factors for suicide
Marital status (Single never married persons, divorces, and widowers)
Gender (70% men use more lethal means but women have more attempts)
Age (Men 45-64 years old)
Adolescents (firearms male, suffocation female)
Severe Insomnia
Affliction with a chronic, painful, or disabling illness (Assisted suicides is legal in some states)
Ethnicity (Caucasian, native Americans, hispanic Americans, asian Americans, African Americans in that order)
Psychiatric illness (Hospitalized more than non hospitalized)
Early in tx with antidepressants (SSRIs)
Hx of previous suicide attempt
True or False
Asking a depressed person about suicide may put the idea in their heads
False
True or False
There’s no point in asking about suicidal thoughts…if someone is going to do it, they won’t tell you
False
True or False
Someone that makes suicidal threats won’t really do it, they’re just looking for attention”
False
Nurse assessment of suicidal ideation should include…
Idea (thoughts)
Plan (intention)
Attempts (behavior)
When the patient has attempted self injury (Distinguish between suicidal self-injury and non-suicidal self-injury
Verbal cues of suicide…
“I can’t take it anymore”
“Everyone would be better off if I died”
“I just want to go to sleep and not wake up”
Behavioral cues of suicide…
Giving away prized possessions
Writing farewell notes
Making out a will
Putting personal affairs in order
Neglecting personal hygiene
Sudden improvement in mood after being depressed or withdrawn
True or False
A more detailed plan = a more lethal plan
True
Lethal means of suicide (4)
Guns
Hanging
Staging a car crash
Carbon monoxide poisoning
Non-lethal plans (2)
Wrist cutting
Overdosing on pills
What is the assessment acronym for SI?
What does it stand for?
IS PATH WARM?
Ideation
Substance abuse
Purposelessness
Anger: Expressess uncontrolled anger
Trapped: Expresses belief that there is no way out of the current situation
Hopelessness
Withdrawn
Anxiety
Recklessness
Mood
What is a Sad Person’s Scale?
What does it stand for? and how many points per section?
SI risk assessment
S: Male sex = 1
A: Age, if less than 19 or more than 45: 1
D: Depression or hopelessness: 2
P: Previous suicidal attempts or psychiatric care: 1
E: Excessive ethanol or drug use: 1
R: Rational thinking loss (Psychotic or organic illness): 2
S: Separated or widowed or divorced: 1
O: Organized plan or serious attempt: 2
N: No social support: 1
S: Stated future intent: 1
What do each section require based on the SAD PERSONS scale
0-5 points on the SAD PERSONS scale
6-8 points on SAD PERSONS scale
> 8 points on SAD PERSONS scale
0-5 Safe for discharge with family or friends with a follow up appointment
6-8 Require an immediate psychiatric consultation
> 8 Requires hospital admission
What do each section require based on the SAD PERSONS scale
0-5 points on the SAD PERSONS scale
6-8 points on SAD PERSONS scale
> 8 points on SAD PERSONS scale
0-5 Safe for discharge with family or friends with a follow up appointment
6-8 Require an immediate psychiatric consultation
> 8 Requires hospital admission
