(mental) Ch 9: The Nurse-Patient Relationship

deteriorating

A _____________________ relationship is also nontherapeutic, and has been shown to have predictable phases: -withholding phase: The nurse is perceived as "withholding" nursing support. The patient feels uncomfortable, anxious, frustrated, and guilty about being ill, and does not develop a sense of trust. -avoiding and ignoring phase: the patient and nurse avoid each other. -struggling with and making sense of phase: the patient struggles with and tries to understand the unsatisfactory relationship. The patient feels hopeless and frustrated as a result of the lack of support received by the nurse.

C (The nurse's response must let the client know in clear terms that the relationship is professional while not demeaning or ridiculing the client. Stating "we just met" presents an excuse, rather than a professional boundary. The nurse should avoid focusing his or her feelings, which would be the case if the nurse said, "It makes me feel good." Stating, "We are not friends. This is strictly professional" is a true statement, but the bluntness is likely to harm rapport.)

A nurse and client are engaged in a discussion. The client says, "I feel really close to you. You are the only true friend I have." Which response by the nurse would be most therapeutic? A) "I am sure there are other people in your life who are your friends; besides, we just met." B) "It makes me feel good that you trust me so much; it is important for the work we are doing together." C) "Since ours is a professional relationship, let's explore other opportunities in your life for friendship." D) "We are definitely not friends. This is strictly professional."

B (A warning sign that the nurse is experiencing a lack of self-awareness includes when the nurse believes that he or she is the only person who can help a client, that is, having "rescue fantasies.")

At the end of a 12-hour shift, the nurse overhears that a client that the nurse has cared for before is being readmitted to the mental health facility. The nurse says to the charge nurse, "I better stay around for a couple of hours. I am the only one the client will talk to." This is a warning sign that the nurse is experiencing which obstacle to establishing a therapeutic relationship? A) Judgmental attitudes B) Lack of self-awareness C) Excessive probing D) Partnership

A

Avoiding which outcome is the primary reason for establishing professional boundaries with clients? A) The loss of therapeutic effectiveness B) The possibility of losing control of the milieu C) The likelihood of a client becoming too dependent on the nurse D) The possibility of inappropriate sexual tension developing

untherapeutic

In a ________________ relationship, the nurse and patient both feel very frustrated and keep varying their approach with each other in an attempt to establish a meaningful relationship. This is different from a prolonged orientation phase in that the efforts are not sustained, but rather, vary constantly. -Feelings of frustration leads to grappling and struggling to reach a common ground leads to mutual withdrawal

c (The use of empathy in a therapeutic relationship is central to psychiatric-mental health nursing. Empathy is sometimes confused with sympathy, which is the expression of compassion and kindness. Empathy is the ability to experience, in the present, a situation as another did at some time in the past.)

The PMH-RN is preparing to meet with a new patient. Which action should the nurse prioritize when developing a therapeutic relationship with this patient? A.Sympathy B.Compassion C.Empathy D.Kindness

transitional

The ______________ relationship model: -eases the transition from hospital to community/transitional care setting -The therapeutic relationship should be extended until a new relationship forms with another care provider -Trained peer support (often through a consumer-survivor group) by a psychiatric survivor who has successfully transitioned into the community. -Reduces time spent in hospital and number of readmissions

orientation

The ________________ phase begins when the nurse and patient meet and ends when the patient begins to identify problems to be examined. -goal: to develop trust and security within the nurse-patient relationship. -the nurse listens intently to the patient's history and perception of problems, begins to understand the patient, and identifies themes. -The use of empathy facilitates the development of a positive therapeutic relationship. -outlining the responsibilities of the nurse and patient is important

nurse patient relationship

The __________________ is a dynamic process that changes with time. It can be viewed in steps or phases with characteristic behaviors for both the patient and the nurse. -orientation phase -working phase -resolution phase

resolution

The final stage of the nurse-patient relationship is the _______________ phase. -problems are resolved -the patient is redirected toward a life without this specific therapeutic relationship -Direct patient toward community resources -Do not address new problems -This phase can be stressful for the patient

A (The client stating feelings of worthlessness and having no real use in life demonstrates comfort with the nurse-client relationship. The other statements indicate that the client is not comfortable with the nurse and does not want to share information or take up much of the nurse's time.)

The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established? A) "I feel worthless and have no real use in life." B) "I really don't want to talk about that right now." C) "What difference does it make what I say to you?" D) "I know you are busy. I don't have much to say now."

working

When the patient begins identifying problems to work on, the _____________ phase of the relationship has started. -Trust has developed -Nurse will use various verbal and nonverbal techniques to help patient examine problems and support patient through healing process -transference and countertransference may be an issue -avoid starting rehabilitation plans too soon

A (During the orientation phase, the relationship is tested. Identifying the problems and engaging in problem solving occur during the working phase. The relationship terminates during the resolution phase.)

Which activity occurs during the orientation phase of the nurse-patient relationship? A.Testing the relationship B.Resolving the problem C.Engaging in problem solving D.Identifying problems

empathy

_____________ is the ability to experience, in the present, a situation as another did at some time in the past. The nurse does not actually need to have had the experience for themselves, but must be able to imagine the feelings associated with it. -The use in a therapeutic relationship is central to psychiatric-mental health nursing. -there must be a "giving of self" to the other individual, as well as a reciprocal desire to know each other personally.

empathic linkage

_______________ is the direct communication of feelings -for example: a nurse may be speaking with a patient who is highly anxious, and the nurse may notice that his or her own speech is becoming more rapid in tandem with the patient's, or the nurse may have subjective feelings of anxiety.

Rapport

________________ is the development of interpersonal harmony characterized by understanding and respect, and is important in developing a trusting, therapeutic relationship. -Helps lessen patient loneliness -Increases sense of sharing

Motivational Interviewing (MI)

_______________________ is a clinical method intended to engage a patient's own decision-making ability. -Engages a patient's own decision-making ability by focusing and reinforcing the client's own arguments for change -Collaborative process of directed counseling and focused discussions -Success can be influenced by external factors, may not be appropriate for all patients -features include: Openness to be collaborative with clients, proficiency in client-centered counseling, recognition of key aspect of client speech, eliciting and strengthening client change talk, rolling with resistance, negotiating change plans, consolidating client commitment, and switching flexibly between MI and other intervention styles

boundaries

indications that a nurse-client relationship professional ________________ are being crossed: -Exchanging gifts -Defending the patient to colleagues -Keeping secrets -Spending more time with a specific patient -Feeling "I'm the only one who understands the patient" -When concerns arise related to therapeutic boundaries, the nurse must seek clinical supervision, or transfer the care of the patient immediately.