week 3 substance abuse Flashcards
What are some Important Principles of Therapeutic Communication?
- Client is primary focus
- Professional attitude sets the tone
- Use self-disclosure cautiously & only when it serves a therapeutic purpose
- Avoid social relationships with clients
- Maintain client confidentiality
- Assess competence to determine level of understanding
- Non-judgemental attitude
- Guide client
- Use clarifying statements.
what is the communication process?
-self-awareness
-verbal
-nonverbal
-empathic linkages
Therapeutic Communication Skills: Non-verbal
Silence
Active listening
Gestures
Facial expressions
Body language
Leaning forward
Therapeutic Communication Skills: Verbal
Offering a General Lead
Broad General Statements
Providing information
Seeking clarification
Seeking consensual validation
Encouraging comparison
Giving recognition
Encouraging description of perception
Accepting
Encouraging evaluation
Paraphrasing
Restating
Sharing Observations
Verbalizing implied thoughts and feelings
Placing the event in time or in sequence
Reflecting
Reframing
Reflecting
Potential Blocks to Therapeutic Communication
Giving Advice
Asking personal questions/probing Automatic Responses/Cliches Giving approval/disapproval Agreeing/Disagreeing
Asking for explanations/”why questions Inappropriate Self-disclosure Defensive Responses Changing the Subject
Arguing
Important Differences Between Personal & Therapeutic Relationships
PERSONAL RELATIONSHIP
Social communication
Personal or intimate relationship
Identification of needs may not occur
Personal goals may or may not be discussed
Constructive or destructive dependency may occur
THERAPEUTIC RELATIONSHP
Therapeutic communication
Professional relationship with defined boundaries
Needs are identified by the client or with the help of the nurse as required
Personal goals are set by the client
independence ks promoted
no specialized skills required
Specialized nursing skills are used
Essential Conditions for Establishing, Maintaining & Terminating Therapeutic Relationships in Nursing
Unconditional positive regard (Acceptance and caring)
Congruence
(genuineness and realness)
Empathy
(Being listened to and being understood)
Therapeutic Nurse-Client Relationships
POWER-imbalance of power-in favour of nurse
TRUST-nurse has the requisite knowledge, skills and abilities to provide care
PERSONAL CLOSENESS-has clear boundaries
RESPECT-ability to respect a client regardless of their race, religion, ethnic origin, age, gender, sexual orientation, social or health status
Therapeutic Nurse Client Relationship Stages & Tasks
Orientation Phase
First meeting
Build trust & rapport Confidentiality in the relationship Setting parameters Testing the relationship
Working Phase
Problems and issues are identified
Plans are made to address problems and act on them
Ongoing assessment
Termination Phase
Last meeting
Celebrate goals that have been met
Acknowledge loss that may accompany ending of the therapeutic relationship
Validate plans for the future
What’s Therapeutic about Therapeutic Nurse-Client Relationships
Therapeutic relationships require indepth personal knowledge of service recipients which is acquired only with time, understanding and skill
* Knowing the whole person is key to enhancing the therapeutic potential of relationships
Transference & Countertransference
TRANSFERENCE
A client’s expectations, feelings and desires for a person in their past unconsciously transferring and being redirected to a nurse counsellor
When transference occurs, the client may start to interact with the nurse as though they are the individual in their past
Common types of transference include maternal transference, paternal transference, sibling transference and non-familial transference
COUNTERTRANSFERENCE
A nurse’s expectations, feelings and desires for a person in their past unconsciously transferring and being redirected to a client
When countertransference occurs, the nurse may start to interact with the client as though they are the individual in their past
Common types of countertransference include maternal countertransference, paternal countertransference, sibling countertransference and non-familial countertransference
Managing Transference & Countertransference in Therapeutic Relationships
Mindfulness
Clear boundaries
Empathy
Managing Transference & Countertransference
Continual self- reflection
Peer support
Bio/Psycho/Social/Spiritual Assessment
BIOLOGICAL FACTORS
* Physical, physiological, chemical, neurological or genetic conditions/factors
PSYCHOLOGICAL FACTORS
* Factors related to psychological processing of thoughts, feelings, and behaviour sense of self and well-being
SOCIAL FACTORS
* Factors that account for the influence of social forces encompassing the patient, family, and community within cultural settings.
SPIRITUAL
* Relates to the core of whom we are; the essence of our being
Assessment as a Process
A purposeful, systematic, and dynamic process that is ongoing throughout the nurse’s relationship with individuals in her or his care
Involves the collection, validation, analysis, synthesis, organization, and documentation of client health illness information
A comprehensive assessment
A comprehensive assessment includes a complete health history and physical examination; considers the psychological, emotional, social, spiritual, ethnic, and cultural dimensions of health; attends to the meaning of the client’s health–illness experience; and evaluates how all of this affects the individual’s daily living.
comprehensive vs focused assessment
Comprehensive assessment (Table 10.1)
* Includes a complete health history, physical, and diagnostic testing
* Screening: recognize symptoms, risk factors, or emotional difficulties
* Develops a holistic understanding of the individual’s problems
Focused assessment
* A collection of specific information about a particular need
* Briefer, narrower in scope, and more present oriented
* Two key factors: the immediate needs of the client and the practice setting
Components of a Psychiatric Interview
1.Chief Complaint
2.History of Present Illness
3.Psychiatric Review of Symptoms 4.Psychiatric History
5.Suicide and Homicide Risk Assessment 6.Medical History
7.Family History
8.Social history
9.Substance use
10.Mental Status Examination
** come back to this
Biopsychosocial/Psychiatric/Spiritual Mental Health Nursing Assessment
Begins with assumption that humans are whole, integrated beings who live in constant and reciprocal relationship with their physical and social environments
* Types and sources of information
* Objective data (also called signs) are directly observable and measurable.
* Subjective data (symptoms) are neither directly observable nor measurable.
Documentation
- Generally speaking, there are two common approaches to documentation.
- Source oriented
- Problem oriented
- Information may be entered in the client record in several ways.
- Includes fill-in forms, flow sheets, checklists, and narrative notes.
- Electronic medical records are becoming more common.
Assessment: Biologic Domain
- Health history
- Health history and significance to psychiatric and mental health problems
- Table 10.1
- Physical examination
- Process by which a clinician collects objective information about the client’s health
- Includes height and weight, vital signs, examination of all body systems, and diagnostic testing appropriate to the individual’s age, level of risk, and sex
- Selected hematologic measures and their relevance to psychiatric disorders
Assessment: Psychological Domain
- Includes manifestations of PMH problems/disorders; mental status; stress and coping; and risk assessment.
- An important part of assessing the psychological domain is to explore the individual’s experience of illness.
- The mental status examination is a systematic assessment of an individual’s appearance, affect, behaviour, and cognitive processes.
- Reflects “a snapshot” of the examiner’s observations and impressions at the time of the interview
- Evaluates developmental, neurologic, and psychiatric disorders.
Assessment: Psychological Domain Key Areas
Includes manifestations of PMH problems/disorders
* Mental status
* Stress and coping
* Risk assessment
Mental Status Examination
The Mental status examination (MSE) is a set of standardized observations and questions designed to evaluate sensorium, perception, thinking, feeling and behavior
* The MSE records observed behavior, cognitive abilities and inner experiences expressed during a psychiatric interview
* The MSE yields information that is critical for making a diagnostic assessment and initiating or modifying a course of treatment
Mental Status Examination (MSE) #1
General observations
* Appearance, psychomotor behaviour/activity, attitude toward interviewer
* Mood and affect
* Euthymic, euphoric, dysphoric
* Speech
* Perception
* Thought
