Therapeutic Communication: Nurse-Client Relationship
What are the 4 phases of the nurse-client relationship?
1. Pre-interaction
2. Orientation
3. Working
4. Termination
Transference?
Occurs when the pt. has positive or negative reaction to nurse based on pt. past experiences, needs, or conflicts.
1. Auditory hallucinations
2. Class of meds to tx this?
1. False discernment of sound, often voices but may also by music and clicks. This is most common type of disorders in psychiatry.
-Antipsychotics
What is a crisis?
-Sudden event that disturbs homeostasis and one's normal coping skills are not as effective in resolving the problem
Suicidal ideation
Broad term->describe range of contemplations/wishes/preoccupations w/ death and suicide.
Pre-interaction phase
-What is it?
-When does it start?
-Involves preparation for first encounter. Typically report received from off-going nurse or unit pt. is from
-Starts before nurse first contact w/ the pt.
Counter-transference?
Occurs when nurse has an unconscious positive or negative reaction to the pt. based on nurse's past experiences, needs, or conflicts.
Tactile hallucination
False discernment of touch, like something is in or on the skin.
Interventions before seclusion and restraints (S&R)
-Prevention, De-escalation, Reduction in Stimuli
-Prevention: early communication w/ pt., develop plan early
-De-escalation: communicate w/ pt., offer reassurance, use distraction techniques
-Reduction in Stimuli: take away audience, dim lighting, 1 staff should do interaction w/ pt.
Self-injurious behavior
Occurrence of behavior that can result in physical injury to one's own body.
Orientation phase
Hospitalized pt. realizes they need help and are adjusting to their current experience.
Nurses meet pt. and gain info about them as person w/ unique needs and priorities.
Body language (SOLER)
S: Sit squarely, face pt.
O: Open posture
L: Lean forward
E: Eye contact
R: Relax
Visual hallucinations
False discernment of visuals such as unformed and formed images. For instance, people or light flashes.
Can nurse initiate S&R?
Yes. Must have Dr. oder immediately after placing pt. in S&R.
-HCP has limited time to come and see pt. & complete a face-to-face evaluation
Passive death wish
When person desires death but has no specific plan to commit suicide.
-Accounts for majority of nurses' time w/ the pt.
-Nurses complete assessments about pt. during teaching and when participating in interdisciplinary plan of care.
-Role of nurse becomes familiar to pt. as nurse provides education and provides care to pt.
Delusions
Personal beliefs that are false that are not in sync with the person’s cultural background or intelligence. The person still has these beliefs even though there is evident proof that it is irrational or false.
Reinstating orders for S&R age ranges: how many hours between each order can they wait to get another order?
<8:?
9-17:?
>18:?
<8: 1 hour
9-17: 2 hours
>18: 4 hours
Nurse management for suicide pt.
-Assessment
-Communication
-Notification
-Develop safety plan
-Psychiatric consultation
-Sitter: never leave client alone
-Rounding
-Initiate problem solving
-Meds
-Environment modification
Termination phase
Aka discharge planning.
-Success of this phase is dependent on how well pt. and nurse navigated thru orientation and working phases.
-Biggest part of this phase happens when nurses teaches pt. about s/s management and recovery at home.
Psychosis
Mental state where there is loss of contact with reality, which spans hallucination, bizarre behaviors, and delusions.
true/false: When suicide is reported it is not considered an emergency
false
1. true/false: it is ok to accept individual or financial gifts from pts.
2. true/false: it is ok to bring gifts (food, gift cards, money) for pts.
3. true/false: It is ok to accept gifts on behalf of the group
1. false
2. false
3. true