Flashcards and Answers – psych ch 9

The therapeutic nurse-patient relationship is the basis of all psychiatric nursing treatments. The first connections between the nurse and the patient are to establish an understanding that the nurse is: Safe, confidential, reliable, and consistent. Maintaining clear and appropriate boundaries. The nurse-patient relationship is a creative process. Each person brings his or her own uniqueness to the nurse-patient relationship. Is historically referred to as the therapeutic use of self.

first contact initial encounter, developing trust, established as significant other, establish verbal

most of work done- therapeutic tasks, help acquire tasks, problem solving interventions, understand feelings and behaviors, help them learn new behaviors and skills, promote insight and acceptance

Termination- end the nurse patient relationship, explore outcomes developed in orientation phase, summarize their achievements, transition them to next level of care, integrate their experience so they can use what they learned for future relationships. Patients can become afraid and anxious during this part of the relationship- so do not allow them to come up with new issues which will prevent discharge- explain to them that you're here for crisis stabilization, this issue is a great way you can start with your new therapist- don't dismiss but transition patient.

Includes friendship and socialization. Mutual needs are met. May include giving advice. Basic needs are met. Content is superficial. Roles may shift. Little evaluation of interaction occurs.

Nurse maximizes communication skills, understanding of human behaviors, and personal strengths to enhance patient's growth. Patient needs are addressed. Language is straightforward. Focus is on the patient's ideas.

Respect Information sharing Patient and family participation Compliance Collaboration Trust Demonstration of clear and appropriate boundaries Positive alliance (therapeutic relationship)

Disrespectful Does not share information Taxed and exhausted family Noncompliance Isolation (no collaboration)- common issue (some organizations do not require pt to go to group) Distrust Demonstrates lack of clear and appropriate boundaries Negative alliance (nontherapeutic relationship)

Facilitating (therapeutic communication) Assisting patient in: Alternate problem solving Developing new coping skills Helping Promoting independence Focusing on patient's problems Encouraging behavioral changes

Blocking (nontherapeutic communication) Does not assist patient in: Alternate problem solving Developing new coping skills Controlling Promoting dependence Focusing on nurse's needs Enabling negative behaviors

Consistency Pacing (patient sets pace) Listening Initial impressions Comfort Balancing control Inconsistency Unavailability Mutual avoidance Lack of self-awareness

Is "temporarily living in the other's life." Empathy vs. sympathy In empathy, we understand the feelings of others. In sympathy, we feel the feelings of others.

Self-awareness of one's feelings occurs; develops the ability to communicate when appropriate.

Displays respect; has the ability to view another person as worthy. Patient will try and test you to see if you will run.

Willingness to work with patients: Nurse takes the patient relationship seriously. Experience is viewed as not "just a job" but as an opportunity.

Maintaining respect. Attending. Suspending value judgments. Helping patients develop their own resources.

Safe, confidential, reliable, and consistent. Conducted within appropriate and clear boundaries.

Transference Countertransference See definitions on Slide 15

Person unconsciously and inappropriately displaces (transfers) those emotional reactions that originated from significant figures in childhood onto another individual. The patient may say, "You remind me of ______________.

Tendency of the nurse to displace feelings related to people in his or her past onto a patient. Frequently, the patient's transference to the nurse evokes countertransference feelings in the nurse.

Although the boundaries of the nurse-patient relationship are generally clearly defined, they can become blurred. This blurring can be insidious and may occur on an unconscious level. Usually, the transference and countertransference phenomena are operating when boundaries are blurred.

Feel understood and comfortable. Identify and explore problems relating to others. Discuss healthy ways of meeting emotional needs. Experience a satisfying interpersonal relationship.

Preparing for the interview Permit the patient to set the pace. Setting Enhance feelings of security. Seating Ensure ease of communication. Making introductions Initiating the interview Offering leads Making statements of acceptance

Helpful Guidelines Speak briefly. When you do not know what to say, say nothing. When in doubt, focus on feelings. Avoid giving advice. Avoid relying on questions. Note nonverbal cues. Keep the focus on the patient.

Abstract standards that represent ideal, either positive or negative

Presents a vivid example of values in action—role models.

What happens when the nurse's beliefs, values, and interpretive system are very different from those of a patient?

Reflect our own culture. Are derived from a range of choices. Are those we have chosen for ourselves from a variety of influences and role models.

Understand and accept our own values and beliefs. Are sensitive to and accepting of the unique and different values and beliefs of others.

A meaningful therapeutic relationship is facilitated when values and cultural influences are considered. It is the nurse's responsibility to seek to understand the patient's perceptions.