week 2 Flashcards
what is recovery? what factors influenced the recovery movement?
the act, process, or event of recovering [in general]; hard to define, but meaning depends on the person (ex: being able to live independently, having a job, finding a new purpose in life, etc.)
recovery focuses on optimal functioning in ALL areas of living
factors that influenced the recovery movement:
- writings of people w/ mental illness
- development of evidenced based practice on recovery (of people w/ mental illness)
what is the recovery-oriented approach/practice?
uses the biomedical model; assumes that mental disorders are brain diseases & emphasizes pharmacological tx to target presumed biological abnormalities
recovery = may not mean a cure; seen as a path to recovery rather than a destination w/ an endpoint
includes understanding personal stories, experiences, hopes & dreams, etc.
what is the difference between clinical recovery vs. personal recovery?
clinical recovery: involves getting rid of symptoms & restoring social functioning, etc.
personal recovery: deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, &/or roles *it’s a way of living a satisfying, hopeful, & contributing life even w/in limitations caused by illness; based on what an individual perceives as a “meaningful life”
what’s the main difference???
- source of expertise
what are the 5 dimensions of recovery?
Clinical recovery: improvement/getting rid of symptoms
Existential recovery: having a sense of hope, empowerment, & spiritual well-being
Physical recovery: enhancing the physical health of ppl w/ mental illness; pursuing better health & a healthy lifestyle (ex: exercise, diet)
Social recovery: ppl w/ mental illness often lose contact w/ those close to them (ex: regain relationships, make friends, etc.)
Functional recovery: being able to maintain functions that most people take for granted (ex: valued societal roles & responsibilities; having a job, able to go to school, living independently)
*best way to understand recovery: read primary sources written by those who have mental illness & went through the recovery process themselves
list examples of recovery-orientated practices.
- asking pts. what they’re hoping to get after admission/discharge
- supporting pts. by finding out their knowledge & what can help speed their recovery process (individualized; focus on the WHOLE person)
- encouraging social/family support; family acceptance, attending peer support groups, & confiding in peer support workers (can help speed one’s recovery process)
- encouraging pts. to be involved in purposeful activities to boost recovery (ex: learning new skills, reading, doing something outdoors, doing music/art, etc.)
what is the most important element to the recovery process & one’s growth?
hope; this is the main way to recovery (hard to go on w/ life w/o hope)
true or false: authority can direct treatment plans & how ppl live their lives
false; authority can only direct tx plans, but NOT how one lives their own life
what are the 5 key points in recovery-oriented practice?
- Concept of recovery-focused care is highlighted in many mental health policies
- Recovery-focused care helps professionals understand client’s needs
- Involving family in care & discussing how mental illness affects all parts of a person’s life helps build trust
- Lack of time is often a reason for nurses not focusing on recovery; remember to communicate w/ pts. (even short conversations)
- Provide person-centered care by involving clients in their own care by allowing them to make decisions r/t care
what is mental health promotion?
the process of improving the capacity of individuals & communities to be able to take control over their lives & improve their mental health
TLDR; promoting mental health through certain interventions to improve one’s mental health
what are the 3 main themes in recovery oriented practice?
- hope
- person-centered care
- consideration of the client’s perspective
what is a wellness planner & what is its the purpose?
a client’s medical records in booklet form
purpose is to increase:
- sense of empowerment
- perceived QOL
- satisfaction w/ mental health care services
- perception of continuity of care
what is relational practice?
basically, interpersonal communication skills; focuses on relational skills including listening, questioning, empathy, mutuality, reciprocity, self-observation, reflection & sensitivity to emotional contexts *focuses on building good connections w/ family
Relational practice surrounds therapeutic nurse-client relationships & relationships among HCPs
what does “therapeutic use of self” mean?
using self to help foster a safe environment to aid clients to overcome their difficulties; everyone uses their personality & ways of being in a different way in the helping process.
what are the components of a therapeutic relationship (CRNM)?
- Respect: responsibility to understand the dignity & rights of clients
- Empathy: the expression of understanding, validating & resonating w/ the client in terms of their health care experience.
- Trust: obliges the nurse to act in the client’s best interest
- Power: there’s an imbalance of power favoring the nurse
- Professional intimacy: client discloses personal information, therapeutic closeness; in this case, it’s not a friendship (this is a workplace relationship w/ the HC team)
what are the PHASES of a therapeutic relationship [peplau]?
- Orientation phase (how you start)
- first meeting (explaining self & role)
- getting to know pt. (listening to their stories, things in common, asking how they’re feeling, making them comfy, etc.) *establish rapport
- talk about discharge
- talk about personal strengths
- establishing trust
- discuss confidentiality/boundaries - Working phase
- identifying & working on pt. problems
- outcomes & interventions are planned w/ pt.
- goals are developed (clinical/personal recovery goals)
- expect defense mechanisms to surface - Termination phase (where relationship ends)
- summarize goals achieved in the relationship
- review situations that occurred during the nurse-pt. relationship
what are the 3 guiding principles of therapeutic communication?
Individuality: seeing pts. as individual ppl beyond their mental illness; demonstrating respect *promoting person-centered care
Providing support: providing support, hope, concern; helping clients feel safe & comfortable *being genuine
Being present/accessible: investing time in the pt.
traits of a good listener? bad listener?
good listener
- maintaining eye contact (depending on culture)
- allow pt. to speak & not asking questions as they speak (let them express own thoughts)
- “you don’t need to apologize”
- can use open/closed ended questions (yes/no questions)
bad listener
- speaking over pt.
- being on phone
- no eye contact
- looking uninterested
potential barriers to communication?
- disturbances in perceptions, processing &/or expression (ex: d/t anesthesia)
- disease/disorders (ex: schizophrenia)
- culture
- language barriers
therapeutic communication technique: exploring
Examination of certain ideas, experiences, or relationships more; if pt. chooses not to elaborate by saying no, nurse doesn’t pry – we respect their personal wishes
Helps the pt. feel free to talk & examine their personal issues “tell me more about what happened before your admission.”
Examples:
“tell me more about that”
“would you describe that more fully?”
“could you talk about how you learned your mom was dying of cancer?”
therapeutic communication technique: giving information
Makes available the facts the pt. needs
Gives knowledge from which decisions/conclusions can be made
Examples:
“this medication is for…”
“the test will determine…”
“my purpose for being here is…”
therapeutic communication technique: attempting to translate words into feelings (A.K.A. decoding)
Responding to the feelings expressed by pt. & not just the content
- Done to understand the deeper meaning of words said by pt.
Example:
- Pt: “I’m dead inside.”
- Nurse: “Are you saying you feel lifeless? Does life seem meaningless to you?”
therapeutic communication technique: confrontation
Bringing up a subject that has the potential of being negative, hurtful, &/or sensitive, but doing it in a way that comes across as respectful & constructive
To bring incongruencies/inconsistencies into awareness; encourages nurse & pt. to explore inconsistencies in their communication/behaviour
therapeutic communication technique: seeking clarification
Attempt by nurse to check their own understanding of what’s been said by the pt.
Helps pt. make their thoughts/feelings clearer; helps pts. clarify own thoughts & maximizes mutual understanding between nurse & pt.
Examples:
“I’m not sure I understand you”
“what would you say is the main point of what you just said?”
“give an example of a time you thought…”
therapeutic communication technique: focusing
Concentrates attention on a single point; especially if a pt. is experiencing severe anxiety (nurse shouldn’t persist until anxiety lessens) – redirecting client to an idea of important relevance
Allows client to stay w/ specifics & analyze problems w/o jumping from subject to subject
Examples:
“could we continue talking about your infidelity right now?”
“this point you are making about leaving school seems worth looking at more closely”
“you’ve mentioned many things. let’s go back to your thinking of ‘ending it all’.”
therapeutic communication technique: making observations
The verbalization of what is observed
Calls attention to the pts. behaviour (ex: trembling, nail biting, restless mannerisms) – encourages pt. to notice the behaviour & describe thoughts & feelings for mutual understanding; helpful w/ mute & withdrawn people
Examples:
“you look tense”
“I notice you’re biting your lips”
“you appear nervous whenever john enters the room”
therapeutic communication technique: giving broad openings
Puts pt. in control of the content.
Helps client to choose the topic of the conversation; clarifies that the leader of the conversation is the pt. BUT the nurse discourages chitchats & small talk
Examples:
“tell me what you’re thinking”
“where would you like to start?”
“what are you thinking about?”
“what would you like to discuss?”
therapeutic communication technique: reflection
Directs questions, feelings, & ideas back to the pt.
Acknowledges & encourages the pts. right to have opinions, make decisions & accept their own ideas/feelings (encourage pt. to think of self as a capable person)
Examples:
- Pt: “what should I do about my husband’s affair?”
- Nurse: “what do you think you should do?”
- Pt: “my brother spends all of my money & has the audacity to ask for more”
- Nurse: “you feel angry when this happens?”
therapeutic communication technique: suggesting collaboration
Presenting new ideas of consideration
Emphasizes working w/ pt., not doing things for the pt.; encourages the view that change is possible through collaboration
Examples:
“have you considered the possibility of attending AA meetings?
“perhaps you and I can discover what causes your anxiety”
“perhaps by working together, we can come up with some ideas that might improve your communications with your spouse”
therapeutic communication technique: restating
Repeats the main idea that the pt. expressed; gives pt. idea of what’s been communicated – if the message was misunderstood, pt. can clarify it
Lets pt. know that the nurse is attentive & that the message is understood
Examples:
“you said your mother abandoned you when you were 6?”
“you say that you’re angry w/ your husband?”
- Pt: “I can’t sleep, I stay awake all night”
- Nurse: “you have a hard time sleeping?”
- Pt: “IDK… he always has an excuse for not coming over or keeping our appointments”
- Nurse: “you think he no longer wants to see you?”
therapeutic communication technique: using silence
Providing time for the nurse & client to gather thoughts & reflect.
To non-verbally communicate interest & involvement, giving the pt. time to think before they speak
Ex: encouraging the pt. to talk by waiting for their answers *not rushing them
therapeutic communication technique: encouraging comparison
Brings out recurring themes in experiences or interpersonal relationships
Helps pt. clarify similarities & differences
Examples:
“is this how you felt when…”
“was it something like…”
“has this ever happened before?”
therapeutic communication technique: voicing doubt
Expressing uncertainty as to the reality of what is being communicated or the pts. perceptions; often used when pt. is experiencing delusional thinking
Can help pts. face the reality of their situation; undermines pt. beliefs by not reinforcing the exaggerated/false perceptions
Examples:
“isn’t that unusual?”
“really?”
“that’s hard to believe”
therapeutic communication technique: offering general leads
Allows pt. to take direction in the discussion; indicates interest in what comes next
Encourages pt. to continue talking
Examples:
“yes, I understand.”
“go on.”
therapeutic communication technique: encouraging evaluation
Aids pt. in considering people & events from their own set of values
Examples:
“how do you feel about…”
“what did it mean to you when he said he couldn’t stay?”
therapeutic communication technique: presenting reality
Indicates what’s real; not trying to convince the pt. but just describing facts or personal perceptions in a situation
To help pt. realize what’s reality, but not arguing/trying to convince pt., just describes facts or personal opinions in the situation
Examples:
“your mother is not here; I am a nurse.”
“that was the sound of a car backfiring”
“that was Dr. Smith, not from the mafia”
therapeutic communication technique: accepting
Indicates that the person was understood
Conveys to the pt. that the nurse comprehends the pts. thoughts & feelings; an accepting statement doesn’t necessarily indicate agreement BUT its nonjudgmental (nurse shouldn’t imply understanding when they don’t understand what the pt. is saying.
Examples:
“sounds like this is a hard time for you.”
“yes.”
“I follow/understand what you say”
therapeutic communication technique: offering self
Offers presence, interest, & a desire to understand; not offered to get the pt. to talk or behave in a certain way
Offers the client availability & support
Examples:
“I’ll stay here & sit with you for a while.”
“I’d like to spend time with you”
therapeutic communication technique: giving recognition
Acknowledging something that is occurring at the present moment.
Indicates awareness of change & personal efforts; doesn’t imply good/bad, right/wrong;
Examples:
“good morning, Mr. Carlos.”
“I see you’ve made your bed/eaten your whole lunch”
“you’ve combed your hair today!”
therapeutic communication technique: verbalizing the implied
Voicing what the pt. has directly hinted at or suggested
Gives pt. opportunity to agree/disagree; puts into concrete terms what pt. implies, making the pts. communication clear
Examples:
Pt: “I can’t talk to you or anyone else, it’s a waste of time”
Nurse: “do you feel that no one understands?”
therapeutic communication technique: placing events in time/sequence
Puts events & actions in better perspective
Notes cause-&-effect relationships & identifies patterns of social struggles
Examples:
“what happened before?”
“when did this happen?”
therapeutic communication technique: encouraging description of perception
Increases the nurse’s understanding of the pts. perceptions
Talking about feelings & difficulties can lessen the need to act them out inappropriately
Examples:
“tell me, what do these voices seem to be saying?
“what is happening now?”
“tell me when you feel anxious”
what are boundaries?
why are boundaries/self-disclosure a concern when working in mental health?
parameters of the therapeutic relationship in which RNs provide care to meet the pts. therapeutic needs; the RN is responsible for setting & maintaining boundaries of a therapeutic relationship, regardless of the client’s actions or requests
boundaries/self-disclosure are concerns when working in mental health because talking about mental health makes you vulnerable & allows interventions to be more effective
what is reflective practice?
self-examination to develop self-awareness; this is an ongoing process in your career
think about: beliefs, biases, limits
- how do your beliefs, experiences & culture influence your view of the world?
empathy vs. sympathy
Empathy: shown in how much compassion & understanding we can give to another; this is the ability to understand how someone feels
Sympathy: feeling of pity for another; this is our relief in not having the same problems as the other person
