Chapter 5 Therapeutic Relationships NCLEX

Values

abstract standards that give a person a sense of right and wrong and establish a code of conduct for living ex- hard work, honesty, sincerity, cleanliness, orderliness

Pam is a nursing student experiencing her first clinical rotation in a psychiatric unit her friends and family have told her that all mentally ill patients are dangerous. Because of their comments, Pam is feeling very anxious about having to talk to the patients on the unit. Which of the following terms is used to describe her feelings with regard to the psychiatric patients in general? A. Attitudes B. beliefs C. Values D. Self-awareness

A. Attitudes

Which of the following patterns of nursing knowledge is being utilized when the nurse remains of the client even though the nurses shift has ended? A. Ethical B. Personal knowing C. Aesthetic D. Empirical

A. Ethical

Hey client who suffers from depression is upset that her grandchildren seem to like concern for her. After some discussion with the nurse, the client began to realize that her communication with her children involves complaining and criticizing. The nurse assesses the clients emotional needs during this interview. What should you expect. The outcome will be of this particular working phase. A. Evaluation of mutually identified go B. discussions of the expectation of the relationship C. Discussion regarding termination of the relationship D. Assessment of the client needs

A. Evaluation of mutually identify goals

Intimate relationship

Involves two people who are emotionally committed to each other

When is it appropriate for the nurse to introduce information regarding the termination of the relationship? A. An orientation phase B. right before the last meeting C. When the goals are being identified D. When the client is emotionally ready

A. Information regarding the termination phase should be introduced during the orientation phase

The nurses role is varied, and one area of the nursing role may supersede another role in importance at any given time during the nurse - client relationship. Which of the following roles is being exhibited when the nurse instruct the client about his medication regime? A. Teacher B. caregiver C. Parent surrogate D. Advocate

A. Teacher

The student nurses are practicing communication techniques with their clients in order to establish a therapeutic method of assessing; planning; implementing; and evaluating the client through the art of communication. Which of the following is true regarding the establishment of a therapeutic relationship? A. The nurse and the client agree about the areas to work on and evaluate the outcomes B. The nurse and the client enter into a mutual social relationship C. The client and the nurse are building a friendship D. A nurse focuses on his or her own needs

A. The nurse and the client agree about areas to work on and evaluate the outcomes

Therapeutic use of the milieu sets The town for the nurse - client relationship. Which phase of the nurse - client relationship provides the nurse with the opportunity to establish a professional therapeutic environment for the patient? A. Orientation B. resolution C. Termination D. Working

A. The orientation phase

One of the clients on the psychiatric unit has made comments to the nursing student that he finds her cute and wants to know more about her. Which of the following terms is applied to the situation when the client unconsciously shows the same types of feelings for the nurse that he or she has for a significant other? A. Transference B. Countertransference C. Exploitation D. Self-disclosure

A. Transference

Which phase of the nurse client relationship includes exploration of the clients feelings and participation in identifying his or her own problems? A. Working B. termination C. Orientation D. Beginning

A. Working

Acceptance

Avoiding judgements of the person no matter what the behavior, being clear without judgement the nurse allows client to feel intact while conveying certain behavior is unacceptable

Even though the client has an active participant, the nurse me assume the role of the counselor and the facilitator to help the client examine problems and to gain insight on achieving solutions. Choose the option that describes his working phase of the nurse - client relationship. A. The nurse assist the client to have a more positive self image B. The client identifies issues or concerns C. The nurse assist the client to develop better coping skills D. The nurse guide the client to examine feelings

B. The client identifies issues or concerns

Which role of the nurse client relationship is being exhibited when the nurse informs the client and then supports him or her and whatever decision he or she makes? A. Caregiver B. advocate C. Parent surrogate D. Teacher

B. advocate

The following our terms used in the art of therapeutic communication between nurses and mental health clients. However which of the following is not considered a step in the values clarification process? A. Choosing B. assessing C. Acting D. Pricing

B. assessing

There were seven student nurses on the psychiatric unit. Mr. P. with a client admitted the diagnosis of paranoid schizophrenia. He had not spoken to anyone in the previous three days of his stay. The students were assigned to engage the clients and therapeutic conversation. Which of the following relationships would be a factor that would encourage Mr. P. To communicate with the student nurses? A. Intimacy B. genuine interest C. Unclear boundaries D. Abuse of power

B. genuine interest

The student nurses are taught that they should have an unconditional and non-judge mental attitude and the relationship with mental health clients. The students are expected to call the client by name and spend time with the client. These actions are examples of which of the following? A. Value B. positive regard C. Empathy D. Excepting

B. positive regard

The mental health psychiatric nurse uses therapeutic use of self while interacting with mentally L clients. So if disclosure is one technique used to convey support, educate clients, and demonstrate any clients anxiety is normal and that many people deal with stress and problems in their own lives. Which of the following actions will the nurse use the technique of self-disclosure? A. To shift the focus from the client to the nurse B. to meet therapeutic goals C. To meet personal goals D. To initiate conversation

B. to meet therapeutic goals

Orientation

Begins when a client meet and ends when the client begins to identify problems to examine Nurse establishes roles, purpose of meeting, & parameters of subsequent meetings; identifies the clients problems and clarifies expectations. Nurse begins to build trust and understanding

Termination (resolution phase)

Begins when problems are resolved and it ends when relationships are ended.

Therapeutic use of Self

By developing self awareness the nurse can use aspects of their own personality, experience, values, feelings, coping skills, perceptions to establish relationships with clients.

The student nurses are talking about a client on the psychiatric unit he looks like the actor George Clooney. During the hours spent with the client, one of the students become physically attracted to him. Which of the following terms describes the relationship that has occurred when the nurse response the client based on personal unconscious needs and conflicts? A. Self-disclosure B. transference C. Countertransference D. Exploitation

C. Countertransference

During which phase of the therapeutic relationship doesn't become the nurses responsibility to define the boundaries of the nurse client relationship? A. Working B. problem identification C. Orientation D. Termination

C. Orientation

Self-awareness is an important concept in the psychiatric - mental health nursing. The nurses must always be aware of their feelings regarding the clients behaviors. Which of the following would be a barrier to the nurse client relationship? A. Trust B. Empathy C. Excepting D. Abuse of power

D. Abuse of power

The students in the concepts and theories course I talked to nursing is better than art and a science. Which pattering of knowing is derived from the art of nursing? A. Ethical B. personal knowing C. Empirical D. Aesthetic

D. Aesthetic is Derived from the art of nursing

Which of the following behaviors occurs when the nurses voice or body language it's consistent with the words he or she speaks A. Empathy B. Genuine interest C. Trust D. Congruence

D. Congruence

Kaplan's social model of behavior supports the theory that social behavior is culturally biased. Behavior that is excepted in one culture may not be excepted by another culture. Which of the following types of behavior are not accepted as part of the nurse - client relationship and the United States? A. Social B. therapeutic C. Professional D. Intimate

D. Intimate

Mr. Lopez, a client, as the preconceived stereotypical idea that all male nurses are homosexual and refuses to have Samuel, a male nurse, take care of him. Samuel has a preconceived stereotypical notion that all Hispanic men you switchblades, so he is relieved that Mr. Lopez has refused to work with him. Which of the following is an accurate statement regarding a preconception? A. It enables the nurse to get an accurate picture of the clients problems B. it allows people to get to know one another C. It provides the nurse at the opportunity to develop a therapeutic relationship with the client D. Is a way of person expects another to behave

D. The way the person expects another to behave

The nurse - client relationships that are formed in a clinical setting are formed for the purpose of helping the client to return to a more healthy state of wellness. Therefore the term used in this type of relationship is classified by the nurse as which type of relationship? A. Social B. intimate C. Friendly D. Therapeutic

D. Therapeutic

Patterns of knowing

Empirical, personal, ethical. aesthetic

Therapeutic Relationship

Focuses on needs, experiences, feelings & ideas of the client ONLY.

Attitudes

General feelings or a frame of reference around which a person organizes knowledge about the world

Working phase-

Has 2 subphases 1) problem identification- client identifies the issues or concerns causing problems 2) Exploitation-nurse guides pt to examine feelings & responses to develop better coping skills & more positive self image- develops independence

Beliefs

Ideas that one holds to be true

State nurse practice act

Include legal responsibility to report boundary violations and unethical conduct on the part of other health-care providers

Positive Regard

Nurse who appreciates the clients as a unique worth-while human being can respect the client regardless of his or her behavior, background, lifestyle and IMPLIES RESPECT - Calling pt by name, spending time with them, and listening + responding to pt all imply positive regard

Congruence

Occurs when words and actions match

Phases of a therapeutic relationship

Orientation Working Termination

Self-awareness

Process of developing an understanding of one's own values, beliefs, thoughts, feelings, attitudes, motivations, prejudice, strengths and limitations & how these qualities affect others - allows nurse to understand responses and reactions of clients when interacting with them

Confidentiality

Respecting clients right to keep private any information about his or her mental and physical health related to care

Self-Disclosure

Revealing personal information such as biographical info, personal ideas thoughts and feelings about one self to clients

Roles of nurse in Therapuetic relationships

Teacher, caregiver, advocate

Parts to therapeutic relationships

Trust, genuine interest, acceptance, positive regard, self-awareness, and therapeutic use of self

Attending

Verbal or non-verbal communication techniques to make client aware that they have full attn

Preconceptions

Ways one person expects another to behave or speak- generally blocks formations of relationships

Social relationships

primarily initiated for purpose of friendship

The nurse is responsible for developing a therapeutic relationship with the client. There are many factors that enhance the nurse client relationship. What is the first step the nurse must take in order to prepare to accomplish this goal?

self-awareness

When the client is confident in the nurse & when the nurse's presence conveys integrity & reliability.

trust

transference

when a client unconsciously got feelings he or she has for significant others