Therapeutic communication
This response can be used when a patient states "Do you want to be my girlfriend?"
What is "remember, we have a professional relationship."
This essential task must be performed prior to establishing a therapeutic relationship.
What is clarification of personal attitudes, values, and beliefs?
A nurse administers an extra dose of narcotic tranquilizer to a client and the coworker observes the action but does nothing. What is the ethical interpretation of the coworkers lack of involvement?
What is taking no action is still consider an action?
This is the best action for working with a newly admitted suspicious patient?
What is slowly and matter-of-factly stating your role and showing the patient their room?
Avoid touch, invading personal space, and being overly friendly. Paranoia is common and pervades many disorders. Adjust your approach accordingly.
This part of the nervous system plays a major role in stress.
What is the sympathetic nervous system (SNS)? The SNS prepares the body for the fight or flight response.
A nurse states "things will look better tomorrow after a good nights sleep" or "everything will be fine after surgery" represent what kind of communication technique?
What is false reassurance?
False reassurance is nontherapeutic. It invalidates the patients feelings and conveys that the nurse already knows the outcome of the situation. It could discourage the patient from further expressing their feelings because they may believe they are being ridiculed or feelings are downplayed.
This is the nurse's best action when a client demonstrates transference.
What is helping the client to clarify the meaning of the current nurse-client relationship?
Remember, transference occurs when the patient redirects their feelings from a past relationship onto the nurse. An example of this: the patient believes the nurse can fix their all of their problems. This stems from memories of relationships with their early caregivers.
This statement accurately represents when a healthcare provider can override a patient's right to refuse treatment.
What is when the patient is actively suicidal or homicidal?
Remember, psychiatric patients have the right to refuse treatment including medication unless immediate intervention is required to prevent death or serious harm to the patient or another person. The US Constitution and several amendments affirm this right.
A nurse finds a suicide note from a client that is very specific. What is the nurse's action?
What is placing the patient on suicide precautions due to the specificness of the plans?
The more specific the plan, the higher the risk ESPECIALLY IF the patient has the means, such as access to a firearm, or a large amount of medication that is lethal in overdose.
Remember, not all medication ODs will be lethal. A stockpile of lithium will cause greater harm than a stockpile of sertraline (Zoloft).
This stage of the general adaptation syndrome occurs when the body responds to prolonged exposure to a stressor.
What is the exhaustion phase?
Adaptive energy is depleted and the individual can no longer draw from resources in the first two stages. Diseases such as coronary artery disease, ulcers, or colitis may occur.
A patient discusses how he takes out his anger on his kids or dog and smiles during the statements. The nurse states, "I notice you are smiling as you discuss this behavior." What therapeutic communication technique is this an example of?
What is making observations?
This will encourage the patient to recognize specific behaviors and make comparisons with the nurse's perceptions. Remember, the goal is to change behavior and making observations will promote exploration of a problematic issue.
This is a priority nursing action during the orientation phase of the nurse-client relationship.
What is establishing rapport and developing mutually agreeable goals?
During the orientation or introductory phase, the nurse and the patient become acquainted. Essential tasks include creating an environment for establishing trust and rapport, establishing a contract for intervention that details the responsibilities of both parties, setting goals, and developing nursing diagnoses.
This is the ethical principle of one's duty to always be truthful and not intentionally deceive or mislead patients.
What is veracity?
Differentiate sympathy from empathy.
Sympathy involves taking on the other's needs and problems as if they were your own and becoming emotionally involved to the point of losing your objectivity. Sympathy is nontherapeutic. An example of sympathy: A patient who is overweight is called "fatso" by another patient. the nurse says "I've been overweight my entire life, too."
Empathy is the ability to see a situation from the other person's point of view. To empathize rather than sympathize, you must show feelings but not get caught up in feelings or overly identify with the patient's concerns or situation. Empathy is considered to be one of the most important characteristics of the therapeutic relationship.
An empathetic response to the above situation could be "You feel angry and embarrassed about what happened." The nurse wouldn't dwell on their feelings about being overweight, but focuses on the patient's feelings and their immediate needs.
This level of prevention aims to prevent complications of mental illness and promotes rehab.
What is tertiary prevention?
Examples include follow-up care in an outpatient setting (medication management).
The nurse recognizes that this is the foundation of patient-centered care.
What is the therapeutic relationship?
The nurse-patient relationship is the FOUNDATION on which psychiatric nursing is established. Mutual learning and hopefully problem solving occurs.
This is the primary goal during the preinteraction phase.
What is exploring self-perceptions?
Examining one's feelings, fears, and anxieties about working with a particular patient. For example, the nurse may have been raised in a family where a parent abused alcohol and now has ambivalent feelings about caring for a patient who is dependent on alcohol. All of us bring attitudes and feelings from our experiences into the clinical setting. We need to be aware of how these preconceptions may affect our ability to care for patients.
Restraints in psychiatry should be assessed IN PERSON by this individual at this point after application.
What is within one hour?
The Joint Commission is a regulatory body for hospitals and regulates ordering requirements for behavioral restraints (for violent or self-destructive behavior). An in-person evaluation by a licensed provider must occur within one hour and the order must be renewed every four hours.
(This does not apply to medical restraints, such as those used to prevent someone in an ICU setting from dislodging their ventilator tube).
This is the proper method of documentation.
What is being as descriptive and objective as possible?
Document observations and subjective data obtained from the nursing assessment. This may include using the patient's statements because this is indicative of their mental state. It also documents their progress for all treatment members. For example, the patient who is manic may state "I'm not supposed to be here, it's my neighbor's fault!!" After five days of mood stabilizers, the patient states "I'm sorry for how I acted, I stopped taking my medication."
This is critical for the patient being discharged after treatment for suicidal intent.
What is verbalizing a plan for safety and support at home?
Developing a comprehensive collaborative safety plan concretizes resources and management strategies. The patient knows who to call/what to do if feeling unsafe and a plan to restrict access to lethal means is identified.
This technique encourages the patient to continue with minimal input from the nurse.
What is a general lead?
Examples include "yes, I see."
"Go on."
The nurse expects this outcome during the working phase of the relationship.
What is the client gains insight and incorporates alternative behaviors?
The "meat" of the hospitalization occurs during the working phase. Patients come to the hospital with maladaptive behaviors, for example. Insight into maladaptive behaviors and problem-solving will be promoted during the working phase. The patient will ideally overcome resistance behaviors and gain insight into their behaviors.
This is a tort.
What is a violation of civil law in which an individual has been wronged?
Further differentiate intentional versus unintentional torts. Unintentional are malpractice and negligence actions. An intentional tort is a deliberate action that violates a patient's rights or causes harm. An example would be assault (threatening) or battery (touching w/o consent such as unjustified application of restraints).
Command auditory hallucinations (CAH) are concerning due to this risk.
What is risk for injury?
Auditory hallucinations that command patients to do something can be dangerous. Patients with CAH are at high risk for self-harm or injuring someone else. It's always important to inquire further such as "What are the voices saying?"
This is the priority for suicidal patients.
What is maintaining safety?
This is both a short- and long-term goal. Creating a safe environment for the patient, such as removing any harmful objects, and monitoring for changes in the patient's status are critical. Be alert for suicidal and escape attempts, watch patients take their medications to avoid overdose/stockpiling, and make rounds at frequent, irregular intervals (especially at night, toward early morning, shift changes, etc) because patients observe when staff are busy/least available.