Mental Health - Ch. 9: Pre Lecture, PrepU

Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? A. Hildegard Peplau B. Jean Watson C. Clara Barton D. Florence Nightingale

A. Hildegard Peplau Peplau's theory is based on the nurse-client relationship as a therapeutic tool.

Which phase of the nurse-client relationship involves establishment of a therapeutic environment by the nurse? A. Orientation B. Resolution C. Working D. Termination

A. Orientation The orientation phase of the nurse-client relationship involves the establishment of a therapeutic environment by the nurse. The working phase of the nurse-client relationship includes exploration of feelings and participation in identifying problems. The termination phase is the final stage in the nurse-client relationship.

A client describes panic attacks during which the client rushes to the emergency department with a feeling that death may be imminent. The nurse discloses having had panic attacks during which the nurse also felt very fearful. Which statement about the nurse's self-disclosure is accurate? A. Self-disclosure can help normalize the client's experience. B. Self-disclosure allows the client to see the nurse as a real human being. C. Self-disclosure can help the client feel like a friend. D. Self-disclosure should be detailed so the client doesn't feel unimportant or devalued.

A. Self-disclosure can help normalize the client's experience. Nurses may use self-disclosure in the nurse-client relationship to comfort a client who is feeling frustrated and hopeless, enhance trust, decrease role distancing, facilitate the client's self-disclosure, convey support, or normalize the client's experience.

The client tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." The nurse should recognize this as ... A. Transference B. Confrontation C. Incongruence D. Countertransference

A. Transference Transference is the shifting of an emotion from one person to another. Confrontation is a technique used to highlight the incongruence between a person's verbalizations and actual behavior. Countertransference occurs when the therapist displaces onto the client attitudes or feelings from his or her past. Incongruence occurs when the communication content and process disagree.

Which of the following occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others? A. Transference B. Self-disclosure C. Countertransference D. Exploration

A. Transference Transference occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others. Countertransference occurs when the nurse responds to the client based on personal, unconscious needs and conflicts. During exploration, the client identifies the issues or concerns causing problems. Self-disclosure means revealing personal information, such as biographical data and personal ideas.

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model? A. Identification phase B. Orientation phase C. Termination phase D. Exploitation phase

B. Orientation phase According to the conversation, the nurse is informing the client about the daily schedule of the therapy. This conversation is indicative of the orientation phase of the nurse-client relationship. During this phase, the nurse explains the schedules of meeting, identifies the client's problems, and clarifies the expectations of the client. In the identification phase, the client tries to find the problems that would affect treatment. In the exploitation phase, the client examines the feelings and responses and tries to develop better coping skills and a more positive self-image. The client starts becoming independent in this stage. In the termination phase, the problems of the client are resolved and the nurse-client relationship comes to an end

It is brought to the nurse administrator's attention that a nurse has developed an intimate relationship with a client. Which behavior indicates the nurse has engaged in an intimate relationship with a client? A. The nurse examines the genital area of a client diagnosed with a sexually transmitted infection. B. The nurse is having dinner with a client outside the hospital premises. C. The nurse is talking to the spouse of the client regarding the client's condition. D. The nurse speaks on topics like sports while performing assessment on the client.

B. The nurse is having dinner with a client outside the hospital premises. The nurse having dinner with a client outside the hospital premises indicate that the nurse may have an intimate relationship with the client. The nurse talking to the spouse of the client regarding the client's condition or examining the genital area of a client with venereal disease is indicative of a therapeutic behavior of the nurse. Involving the client in conversation about sports indicates that the nurse is trying to build a social relationship with the client.

Which phase of the nurse-client relationship includes exploration of feelings and participation in identifying problems? A. Orientation B. Working C. Beginning D. Termination

B. Working The working phase of the nurse-client relationship includes exploration of feelings and participation in identifying problems. The orientation phase begins when the nurse and client meet and ends when the client begins to identify problems for examine. The termination phase is the final stage in the nurse-client relationship.

A nurse is communicating with a client who is highly anxious. During the conversation, the nurse notices that the nurse's speech is matching the fast pace of the client's speech, and the nurse's heart rate is increasing. The nurse identifies this as: A. defense mechanism. B. empathetic linkage. C. rapport. D. boundary violation.

B. empathetic linkage. It is important for the nurse to be aware of empathic linkages, the direct communication of feelings (Peplau, 1952). This commonly occurs with anxiety. For example, a nurse may be speaking with a client who is highly anxious, and the nurse may notice his or her own speech becoming more rapid in tandem with the client's. The nurse may also become aware of subjective feelings of anxiety. It may be difficult for the nurse to determine whether the anxiety was communicated interpersonally, or whether the nurse is personally reacting to some of the content of what the client is communicating. Rapport (interpersonal harmony characterized by understanding and respect) is important in developing a trusting, therapeutic relationship. Nurses establish rapport through interpersonal warmth, a nonjudgmental attitude, and a demonstration of understanding. Every individual is surrounded by four different body zones that provide varying degrees of protection against unwanted physical closeness during interactions. A boundary violation would involve intrusion into the comfort zone. Defense mechanisms(also known as coping styles) are defined in the Diagnostic and Statistical Manual of Mental Disorders-V as mechanisms that mediate the client's reaction to emotional conflicts and to external stressors.

The manager schedules a staff nurse to attend a motivational interviewing training session. Which nurse behavior caused the manager to make this decision? Select all that apply. A. restating the client's perception of a problem B. minimizing the client's concerns C. arguing with a client over agreed upon plans D. interrupting the client E. asking the client to clarify a particular issue

B. minimizing the client's concerns C. arguing with a client over agreed upon plans D. interrupting the client The success of motivational interviewing depends upon the quality of interaction between the nurse and client. Strong communication is the cornerstone of this technique and unhelpful defense mechanisms such as interrupting, minimizing, and arguing do not support the motivational interviewing process. Asking for clarification and restating a perception support the motivational interviewing process

A care area is having difficulty implementing the transitional care model. Which observation should the nurse manager address to help facilitate this process? Select all that apply. A. implementing educational modules B. over-reliance on the process C. nurses feeling overwhelmed D. recognizing on-site champions E. focusing on preexisting conflicts

B. over-reliance on the process C. nurses feeling overwhelmed E. focusing on preexisting conflicts Barriers to implementing the transitional care model include feeling swamped or overwhelmed, engaging in death by process or over-reliance on the process, and having preexisting conflicts within teams. Actions to facilitate the process include recognizing on-site champions and using educational modules.

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. "It makes me feel good that you trust me so much; it is important for the work we are doing together." B. "I am sure there are other people in your life who are your friends; besides, we just met." 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."

C. "Since ours is a professional relationship, let's explore other opportunities in your life for friendship." 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 their 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.

During the next meeting during the working phase of the relationship the client brings the nurse homemade chocolate chip cookies and a box of chocolates. Which response should the nurse make to the client about these gifts? A. "How did you know that I'm a chocoholic? Will you have a cookie with me while we talk?" B. "Thank you so much. I will share them with the other nurses." C. "Thank you but I will not accept these gifts because they extend over our discussed boundaries." D. "They look delicious and I love candy but I'm on a diet and really can't accept them."

C. "Thank you but I will not accept these gifts because they extend over our discussed boundaries." During the orientation phase, professional boundaries are set. If the client violates these boundaries, the nurse needs to acknowledge the behavior and reestablish or reinforce the boundaries by not accepting the gifts. Accepting the gifts to share with other nurses or the client violates the professional boundary. Declining the gifts for anything besides the violation of the professional relationship is not honest and may deteriorate the trusting relationship.

What occurs during the working phase of the nurse-client relationship? A. Discussion regarding termination of the relationship B. Discussion of expectations of the relationship C. Evaluation of mutually identified goals D. Rejection of client needs

C. Evaluation of mutually identified goals Evaluation of mutually identified goals occurs in the working phase of the nurse-client relationship. The nurse discusses expectations during the orientation phase. During the working phase, the nurse assesses client needs. Discussion regarding the termination of the relationship occurs during the orientation phase.

A nurse is conducting a 6-week social skills training program. A young adult with schizophrenia asks the nurse to call the client on the weekends so the client has someone to talk to who really cares. Which action should the nurse take? A. Tell the client the nurse will call once per week during office hours so that the client can practice phone skills B. Tell the client to call the office answering service in case of an emergency C. Remind the client about the importance of boundaries to keep the relationship therapeutic D. Call the client once each weekend to build trust

C. Remind the client about the importance of boundaries to keep the relationship therapeutic Nurses need to set limits with clients so that the boundaries of the relationship remain intact. Becoming overly involved with clients in inappropriate ways is evidence of a lack of self-awareness (making extra visits when time does not allow for them or calling clients when off duty).

When engaged in therapeutic communication with a client who has been diagnosed with a mental disorder, which is the most important principle for a nurse to keep in mind? A. The nurse should have an empathetic relationship with the client. B. The client's conversations should be recorded. C. The client is the primary focus of the interaction. D. The nurse should self-disclose when indicated.

C. The client is the primary focus of the interaction. A fundamental principle of therapeutic communication is that the client must be the focus of the interaction. Self-disclosure should be avoided. Empathy is important and develops over time as the nurse receives information from the client with open, nonjudgmental acceptance. The nurse communicates this understanding of the experience so that the client feels understood. Conversations with clients should be kept confidential.

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

C. The loss of therapeutic effectiveness The priority reason the psychiatric nurse is careful to maintain professional boundaries with clients is to avoid the loss of therapeutic effectiveness. While the other options can result during the course of a relationship, none of them is the priority reason the psychiatric nurse is careful to maintain professional boundaries with clients.

During which phase of the nurse-client relationship does the client identify and explore specific problems? A. resolution B. orientation C. working D. debriefing

C. working During the working phase, the client uses the relationship to examine specific problems and learn new ways of approaching them. Debriefing is not a phase of the nurse-client relationship. During the orientation phase the nurse and client get to know each other. The final phase, resolution, is the termination stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.

During the working phase, a client demonstrates open hostility in reaction to the nurse's last question. Which response should the nurse make to avoid countertransference? A. "If you don't want to continue with me, I'll find someone else." B. "I am only trying to help you." C. "I am only doing my job." D. "Tell me why you are angry about what I just said."

D. "Tell me why you are angry about what I just said." Countertransference is an emotional reaction to the client based upon personal unconscious needs and conflicts. The nurse should recognize that countertransference can occur and prevent it from eroding the professional boundaries. One way to prevent countertransference is to ask the client to explain why the statement caused hostility. Defending the statement such as saying, "I am only doing my job," "I am only trying to help you," and "I'll find someone else," demonstrates countertransference.

The client is in the working phase of the therapeutic nurse-client relationship. Which action by the nurse would best help the client to explore problems? A. Comparing past and present coping strategies B. Identifying possible solutions for the client's problems C. Referring the client to a self-help group D. Encouraging the client to clarify feelings and behavior

D. Encouraging the client to clarify feelings and behavior Helping the client to clarify feelings and behavior is a first step in problem identification and exploration. Comparing coping strategies and choosing solutions should follow the identification of problems. Referring the client to a group does not help the client identify problems with the context of a nurse-client relationship.

When engaged in a therapeutic relationship, the nurse's focus is on what? A. The environment B. The self C. The family D. The client

D. The client In a therapeutic relationship, the nurse focuses on the client and client-related issues even when engaging in social activities with that client. This is essential to the most effective nurse-client relationship, one that is client-centered.

The client tells the nurse, "I am regularly doing my sitting breathing exercises. Why do I still feel breathless while walking?" The nurse replies, "Sitting breathing exercises alone may not achieve the desired effects. You also should perform daily deep breathing exercises while walking. This should help you to reduce breathlessness while walking." According to Peplau's model, the nurse and client are in which phase? A. Resolution B. Orientation C. Termination D. Working

D. Working The conversation indicates that the client is trying to understand the problems and trying to solve them by asking for suggestions from the nurse. This behavior is seen in the working phase of the nurse-client relationship. In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies the client's problems, and clarifies expectations. In the resolution phase, actual problems are resolved and the relationship terminates. During the resolution phase, the client is redirected toward a life without this specific relationship. The client connects with community resources, solidifies a newfound understanding, and practices new behaviors. Termination, although it begins on the first day of the relationship, marks the end of the relationship.

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring? A. Orientation B. Resolution D. Mutual withdrawal D. Working

D. Working The nurse is helping the client to examine the feelings and responses and tries to develop better coping skills and a more positive self-image. The conversation indicates that the client is upset about the client's disability and the nurse is trying to motivate the client. Thus, this conversation is indicative of the working phase. In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies themes surrounding the client's problems, and clarifies expectations. In the resolution phase, the problems of the client are resolved and the nurse-client relationship comes to an end. Mutual withdrawal is a phase in a nontherapeutic relationship in which the client and nurse give up on each other due to extreme frustration.

Avoidance is the initial stage of a deteriorating nurse--patient relationship. FALSE TRUE

FALSE

The psychiatric nurse--patient relationship is primarily focused on maintaining emotional boundaries. FALSE TRUE

FALSE

With the help of the nurse, a patient learns to manage identified problems during the working stage of the nurse--patient relationship. TRUE FALSE

FALSE

An essential feature in a trusting, therapeutic relationship is ____________, which is interpersonal harmony characterized by understanding and respect.

Rapport

Termination of the nurse--patient relationship occurs during the resolution stage. FALSE TRUE

TRUE

The nurse--patient relationship is built upon the communication of empathy and rapport. FALSE TRUE

TRUE

The nontherapeutic relationship consists of ____________ major and overlapping phases.

Three

___________ is the provider's emotional reaction to the patient based on personal unconscious needs and conflicts.

countertransference

__________ interviewing is a clinical method that focuses and reinforces the patient's own arguments for change.

motivational

In a ________________ relationship, the nurse and the patient both feel frustrated and keep varying their approach to establish a meaningful relationship.

nontherapeutic