exam 1: therapeutic communication

direct leadership

group; behavior that enables the leader to control the interaction by giving directions and information and allowing little discussion - pscyhoeducaiton

indirect leadership

group; the leader primarily reflects the group members discussion and offers little guidance or information to the group

size

the _______ of groups will depend on the overall group goals and patients' abilities

empathy

the ability to understand and share feelings of another person - need to work on being nonjudgmental

partnerships

3 keys to all caring relationships; - "let's work together to get you better" - Working WITH a person is different from working ON a patient - less likely to be defensive - When someone feels defensive, they react with fight or flight responses (AMA) - Your job is easier when your patient sees you as a partner, not an enemy

trust

3 keys to all caring relationships; - Invite requests ("what can I do for you?") - Warmth - Respect your patient as a person - Use active listening techniques (hearing the theme) - Respond with information and action (tell people what is going on, getting them water) - Keep your word - Promise what you can deliver and delivery what you promise - Do not take ANYTHING personally (this will form a barrier)

safety

3 keys to all caring relationships; - Your patient is in a very strange place (as we're used to the hospital) - Your patient is afraid for his life (read horror stories on the news about spontaneous deaths, etc.) - Every time you reinforce this, you put yourself in the role of his HELPER - When he sees you as his HELPER, he's more likely to cooperate with reasonable requests

assessing; verifying

Effective use of your Inner Psych Nurse includes ___________ our patient's emotional state by being aware of our OWN emotions and then _____________ our assessment by observing or asking the patient about their mood.

self-awareness

Effective use of your Inner Psych Nurse leads to continual improvement in the quality of your interactions with patients, using... - take time to think about your convo with your patient (evaluation)

theme

____________ of a message are the details of what the client talks about (ex.) "my family didn't visit me again today" --> I'm feeling lonely - responding to this rather than just the topic shows you understand the patient and care about them; strengthens the relationship

topic

____________ of a message are what it means for the client (ex.) "my family didn't visit me again today" --> family not visiting

reaction

a nurse's thoughts and feelings are going to impact the ____________ of the patient - pay attention to verbal, nonverbal, and preverbal aspects

mindfulness

advanced communication; based on the belief that being in the "here-and-now" is not where we experience anxiety (breathing, relaxation, yoga)

motivational interviewing

advanced communication; goal is to get the client to initiate the change/motivate the client - not giving advice - need to understand where the person is in the present situation - starts with good empathetic listening - transtheoretical model

empathetic responding

advanced communication; using reflection of feelings and experiences to help the individual to become aware of their OWN experiences - helps the process of fully understanding the person's situation and desires/goals for the future BEFORE setting up actions - the basis of most other interventions

automatic

cognitive-behavioral interventions focus on what people think (cognitions) that then causes them to feel a certain way, ultimately causing them to behave in a certain way. goal is to change ______________ thoughts and stop the cascade from dysfunctional thoughts to feelings to behavior

time

communication is a process that continues over _________ - every message builds on previous conversations or interactions (strengthens the trust and confidence the patient has on their nurse)

emotionally

self-awareness; every person connects _________________ as well as verbal when interacting with others. be aware of your emotional response in the moment

mirroring (pacing, matching)

synchronizing or matching another person's verbal and nonverbal behavior. this builds trust, empathy, and can be used to de-escalate a situation - make's person feel understood - matching rate of breathing or activity level can be used as INTERVENTION

inhibit

techniques that _______ communication include... - giving advice - agreement - challenging a patient's experiences - reassurance that everything will be alright - disapproval/being judgmental

acceptance

techniques that facilitate communication; being nonjudgmental

validation

techniques that facilitate communication; clarifying understanding - using summarization and paraphrasing

confrontation

techniques that facilitate communication; presenting a different reality, pointing out discrepancies - "you say you want to be less depressed, but don't seem to be taking your medication"

interpretation

techniques that facilitate communication; putting words to what the patient is implying or feeling - reflection of feelings - do not make it from your own perspective - "I'm getting the sense you are feeling frustrated"

reflection

techniques that facilitate communication; redirecting, stating what the patient is implying, putting feelings and experiences together

restatement

techniques that facilitate communication; repeating the idea expressed

silence

techniques that facilitate communication; showing interest but remaining quiet allows the patient to talk more to fill the void, or being a comfort

observation

techniques that facilitate communication; simply describing what is seen

doubt

techniques that facilitate communication; used cautiously when you are uncertain about a patient's description or a situation - recognize the emotions because this is a patient's reality in their delusions - don't condescend!

group

the purpose of the ________ will dictate the amount of structure and types of activities. in all, nurses maintain professional boundaries

medication group

type of group; a group that is nurse-led and can primarily be used to transmit information about medications, such as action, dosage, and side effects, or it can focus on issues regarding medications (compliance, management of side effects, and lifestyle modifications)

task group

type of group; focus on completion of specific activities. members are strongly committed to completing a task and the leader encourages equal participation, cohesiveness promotes satisfaction and higher performance

age-related group

type of group; group interventions for specific ages for the developmental needs of the group members, any physical and mental impairments, social ability, and cognitive level

psychotherapy group

type of group; group that treat individuals' emotional problems and can be implemented from various theoretic perspectives, including psychoanalytic, behavioral, and cognitive - focus on examining emotions and helping individuals face their life situations - can be extremely intense - provides an opportunity for patients to examine and resolve psychological and interpersonal issues within a safe environment - mental health specialists only (minimum of a master's degree)

psychoeducation group

type of group; group used to enhance knowledge, improve skills, and solve problems to focus transmission of information necessary for making some type of change and providing a process for making the change - formally planned and members are purposefully selected - time limited (few sessions)

self-help group

type of group; groups led by people who are concerned about coping with a specific problem or life crisis - these groups DO NOT explore psychodynamic issues in depth - professionals usually do not attend - (ex.) Alcoholics Anonymous, overeaters anonymous, grief groups

closed group

type of group; members begin the group at one time, and no new members are admitted. if a member leaves, no replacement member joins - participants get to know each other very well and can develop close relationships - (ex.) outpatient smoking cessation, psychotherapy, psychoeducation

reminiscence group

type of group; members in the group are encouraged to remember events from past years and is easily implemented. used to spark memories - usually associated with patients who have dementia, intergenerational interventions - valuable for older clients

large group

type of group; more than 8 to 10 members, effective for specific problems or issues such as smoking cessation and medication information - often used in the workplace - can be ongoing and open-ended - potential interactions and relationships can form, causing difficulty in determining the feelings and thoughts of the participants - subgroups can form

open group

type of group; new members may join, and old members may leave the group at different sessions - typical on inpatient units

anger management group

type of group; nurse-led group often in an inpatient setting to discuss the concept of anger, identify antecedents of aggressive behavior, and how to deal with anger

self-care group

type of group; nurse-led, recovery-oriented psychiatric group where people often have self-care deficits and benefit from structure that a group provides. - challenging because members usually know how to perform daily tasks (ADLs) but illnesses can cause them to lose motivation - reinforcing basic self-care activities

decision-making group

type of group; psychiatric nurse often leads this type of group that plan activities, develop unit rules, and select learning materials - nurse should observe the process for any signs of group-think (tendency for group members to avoid conflict and adopt a normative pattern of thinking often consistent with the group leader)

symptom management group

type of group; recovery-oriented groups that focus on helping patients deal with a severe and persistent mental illness - handling hallucinations - being socially appropriate - staying motivate to complete activities - how to avoid relapse

supportive therapy group

type of group; usually less intense than psychotherapy groups and focus on helping individuals cope with their illnesses and problems - one of the basic functions of the psychiatric nurse - nurse focuses on helping members cope with situations that are common for other group members - counseling strategies are used - family caregivers also benefit

small group

type of group; usually no more than 7 or 8 members, become more cohesive, are less likely to form subgroups, and can provide a richer interpersonal experience - ideal for patients who are highly motivated to deal with complex emotional problems

coleadership

type of group; when two people share responsibility for leading the group, useful in most groups as long as there is open communication

relationships

what are considered the essence of nursing?

trust, safety, partnerships

what are the 3 keys to ALL caring relationships? - apply to every conversation you have with every patient - equivalent to standard precautions (no matter the circumstance)