The Therapeutic Milieu

Characteristics of Milieu Therapy​

1. client's health (strengths of each client are identified & fostered) 2. therapeutic intervention (opportunity in every conversation) 3. clients' environment (client owns the environment) 4. clients' personal behavior (clients are responsible for personal behavior) 5. peer pressure (social rules of the group are determined by specific group) 6. inappropriate behaviors (are addressed immediately rather than later) 7. restrictions & punishments (avoided with clients)

Match each therapeutic statement to the correct therapeutic technique. What would you like to talk about today? a. Broad Open b. Accept c. Reflect d. Present Reality e. Verbalize the implied

a. Broad Open

In milieu therapy, _____ physiological needs are fulfilled, and a ______ form of governance exists. Roles within the group are assigned according to _______. The inclusion of family _____ a common practice in attempt to ____discharge. a. basic b. moderate c. advanced a. autocratic b. democratic c. laissez-faire a. diagnosis b. capabilities c. compliance to treatment a. is b. is not a. plan for b. prevent c. speed up

a. basic b. democratic b. capabilities a. is a. plan for Basic physiological needs are fulfilled ​ Physical facilities are conducive to meet goals of therapy​ Democratic form of self-governance exists​ Roles within the group are assigned according to capabilities​ A structured program of social and work-related activities ​ The inclusion of community and family in the program of therapy - while maintaining confidentiality, family is included in an effort to facilitate discharge from treatment

Therapeutic Communication: Broad Openings

allow patients to take initiative e.g., What would you like to talk about today?

Nontherapeutic Communication: Requesting an Explanation

can be very intimidating to ask "why"

Match each therapeutic statement to the correct therapeutic technique. I do not see anyone else in the room. a. Broad Open b. Accept c. Reflect d. Present Reality e. Verbalize the implied

d. Present Reality

Communication that occurs between the nurse and the client is a. not influenced by other variables b. use of jargon c. one party interaction d. the exchange of information

d. the exchange of information The simplest definition of communication is the exchange of information.​​ Jargon is the language used by similar professions or cultures.​​ Two parties are needed for communication, a sender and a receiver.​​ There are many variables that influence communication such as nonverbal communication (voice, eye contact, physical appearance, touch)​

Therapeutic Communication: Exploring

examine topics deeper, delve further into the subject, idea, experience, or relationship e.g., "Tell me more about what led up to your hospitalization."

Nontherapeutic Communication: Defending

protecting anything or anyone indicates that the client can't express own ideas, feelings, etc.​ e.g., Client states "He doesn't know what he is doing. That medication isn't helping a thing!" The nurse responds, "He has been a doctor for many years and has helped many people."

Therapeutic Communication: Formulation a Plan of Action

providing safe alternatives to deal with emotions or situations e.g., Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?"

What are the qualities of a therapeutic relationship? Select all that apply. a. Maintaining boundaries b. Purposeful conversations c. Asking personal questions d. Remaining goal-directed e. Sympathetic tone and statements f. Giving advice for behaviors

a. Maintaining boundaries b. Purposeful conversations d. Remaining goal-directed Therapeutic relationships are goal directed, purposeful, and contain boundaries. Communication is delivered with trust, empathy, and professionalism. Sympathy, giving advice, and asking personal questions are examples of non-therapeutic communication, and should not be part of the therapeutic relationship.​

Which nontherapeutic statement is best matched to the description below? "Why did you try to kill yourself?" a. Requesting an explanation b. Approving/Disapproving c. Belittling feelings d. Making stereotypical comments e. Giving advice

a. Requesting an explanation Can be very intimidating to ask "why."​

Grayson, a 16-year-old client is admitted to the mental health floor from the intensive care unit after attempting to commit suicide by overdose of hydrocodone/acetaminophen. On admission, the client's parents reported, "We had no idea he was upset. His close friend died 3 months ago, but he's always laughing and with his friends all the time. We thought that was the right thing to do so he wasn't isolated." Medical history is negative. Surgical history includes placement of pressure equalization tubes bilaterally at age 2. Vital signs are stable. Awake, alert, oriented x4. When brought to the floor, the client is laughing, joking, and flirting with the nurses as he is transported by wheelchair. He is cooperative and walks to the bed with a steady gait. ​ The charge nurse completes the assessment and notices the client becomes quiet with arms crossed, rolling his eyes at many of the assessment questions. Grayson states, "Oh my god, nothing has changed. Can you just look in the computer? This is so annoying. When can I call my friends? I need to get out of here. My buddy is having a party tomorrow."​ After 12 days on the mental health unit, the interdisciplinary team is planning Grayson's discharge. Which findings are effective, ineffective, or unrelated regarding mental health care? 1. Interaction with group during milieu therapy sessions 2. Agreeing to & actively taking medications for depression 3. Decreased participation in communication with staff 4. Irritability and hostility towards parents in therapy 5. Normal bowel elimination pattern 6. Refusing post discharge counseling 7. Grayson is tearful when talking about his suicide attempt and friend's death

1. Effective 2. Effective 3. Ineffective 4. Effective 5. Unrelated 6. Ineffective 7. Effective It is effective for Grayson to participate in therapy, taking medications for depression, being irritable with his parents (normal anger grief response rather than denial), and being tearful when discussing stressors and suicide attempt. It is ineffective if he decreases participation and refuses post discharge counseling. His bowel habit is appropriate but unrelated to discharge at this point. ​

Therapeutic Communication: Verbalizing the Implied

clarifies what is implicit ​ e.g., You seem very upset about something./ "You seem to be motivated to change your behavior."

Therapeutic Communication: Presenting Reality

necessary for clients who have a misperception of the environment ​ e.g., "I understand that the voices seem real to you, but I do not hear any voices."

Nontherapeutic Communication: Interpreting

nurse makes meaning out of the client's feelings instead of asking & clarifying​

Therapeutic Relationship Phases​: Termination

occurs when a patient is discharged, or the treatment plan goals have been reached i.e., bringing a therapeutic conclusion to the relationship

Therapeutic Techniques: Non-Verbal Communication

● active listening (SOLER) ● using touch ● using silence

Therapeutic Communication

● begins by creating a therapeutic relationship ● is an essential component in working with clients as this is the primary form of treatment in mental health

Therapeutic Communication: Meet a Client's Physical & Emotional Needs​

● caring for mental health clients, this is imperative ● safety is the priority! ● support & presence can go a long way in caring for these clients

Therapeutic Communication: Understand & Collect Data

● nurse must rely on therapeutic communication techniques to gain the information needed ● both verbal & nonverbal data are essential in this process

Therapeutic Communication: Provide Support & Information​

● nurses should provide ample education on current diagnosis, treatment plan, & actions ● this information should also be shared with the family as appropriate ● supporting the client by providing information aids in building trust

Therapeutic Relationships

● purposeful, goal-directed interaction between the health care professional & the client or person receiving professional services maintaining boundaries ● it is one in which professional assistance is rendered with empathy, care, trust, & rapport

Therapeutic Techniques: Translating Emotions

● sharing observations ● sharing empathy ● sharing hope ● sharing humor ● sharing feelings

Nontherapeutic Communication: Belittling Feelings

lack of empathy & client feels insignificant or unimportant​ e.g., "Don't worry. Everything will be alright."

Therapeutic Communication: Active Listening

listening attentively to insure understanding

Therapeutic Communication: Clarifying

make vague topics clear

Grayson, a 16-year-old client is admitted to the mental health floor from the intensive care unit after attempting to commit suicide by overdose of hydrocodone/acetaminophen. On admission, the client's parents reported, "We had no idea he was upset. His close friend died 3 months ago, but he's always laughing and with his friends all the time. We thought that was the right thing to do so he wasn't isolated." Medical history is negative. Surgical history includes placement of pressure equalization tubes bilaterally at age 2. Vital signs are stable. Awake, alert, oriented x4. When brought to the floor, the client is laughing, joking, and flirting with the nurses as he is transported by wheelchair. He is cooperative and walks to the bed with a steady gait. ​ The charge nurse completes the assessment and notices the client becomes quiet with arms crossed, rolling his eyes at many of the assessment questions. Grayson states, "Oh my god, nothing has changed. Can you just look in the computer? This is so annoying. When can I call my friends? I need to get out of here. My buddy is having a party tomorrow."​ Grayson asked several questions, and the nurse's response is included for each. Which nurse response is inappropriate and appropriate? 1. "I don't like being by myself." ​ - "I can sit and talk with you for a while if you'd like." ​ 2. "I just hate feeling like this all the time. Why can't I feel numb and not hurt? ​ - "Your being upset is a normal part of the grieving process." ​ 3. "My parents are never going to trust me again." - ​"Sure they will, just not right now." ​ 4. "I just don't understand why I can't leave and not do therapy." - ​"Tell me more about wanting to leave." ​ 5. "Everyone at school is going to think I'm so stupid because I tried to kill myself." ​- "Some people might think that, but I'm sure your real friends will be okay with it." ​

1. Appropriate 2. Appropriate 3. Inappropriate 4. Appropriate 5. Inappropriate

Which nontherapeutic statement is best matched to the description below? "You should not be upset" a. Requesting an explanation b. Approving/Disapproving c. Belittling feelings d. Making stereotypical comments e. Giving advice

c. Belittling feelings Lack of empathy and client feels insignificant or unimportant​.

What is a characteristic of all communication? a. One-way b. In person only c. Between a sender and receiver d. Only verbal

c. Between a sender and receiver Communication occurs when a sender exchanges information in the form of a message with a receiver(s).​ Communication can be one-way or two-way, verbal or nonverbal, and does not need to be only in person. It can be done on the phone, via electronic messaging, or via video.​​

Grayson, a 16-year-old client is admitted to the mental health floor from the intensive care unit after attempting to commit suicide by overdose of hydrocodone/acetaminophen. On admission, the client's parents reported, "We had no idea he was upset. His close friend died 3 months ago, but he's always laughing and with his friends all the time. We thought that was the right thing to do so he wasn't isolated." Medical history is negative. Surgical history includes placement of pressure equalization tubes bilaterally at age 2. Vital signs are stable. Awake, alert, oriented x4. When brought to the floor, the client is laughing, joking, and flirting with the nurses as he is transported by wheelchair. He is cooperative and walks to the bed with a steady gait. ​ The charge nurse completes the assessment and notices the client becomes quiet with arms crossed, rolling his eyes at many of the assessment questions. Grayson states, "Oh my god, nothing has changed. Can you just look in the computer? This is so annoying. When can I call my friends? I need to get out of here. My buddy is having a party tomorrow."​ During milieu therapy, Grayson is asked to describe his feelings towards his parents. He starts talking and another client asks him why he felt that way. Grayson is angered, throws his chair across the room, and begins to leave the group. What is the best interaction by the nurse? Select all that apply. a. Call for security and have Grayson returned to his room to be alone b. Allow Grayson to exit milieu therapy now and try again later c. Explain to the other client that asking why upset Grayson d. Encourage Grayson to tell the group why he threw the chair e. Calmly ask Grayson to pick up the chair and have a seat

c. Explain to the other client that asking why upset Grayson e. Calmly ask Grayson to pick up the chair and have a seat As the client began to express his feelings, a nontherapeutic comment caused him to become angry and throw a chair. It is important to intervene and address the behavior by Grayson and the other client. Clear boundaries should be reinforced, especially when the behavior is inappropriate. We want to keep Grayson in the group, despite his anger. It is important to speak calmly, asking him to pick up the chair and return. Allowing Grayson to leave therapy is not appropriate nor is it appropriate to fuel his anger asking him to tell why he threw the chair. Addressing the inappropriate behaviors is enough. Calling security is not necessary, and seclusion is not appropriate. ​

Which therapeutic technique is being demonstrated in the mental health setting? "It seems as if you are talking to someone else, but I don't see anyone." a. Voicing doubt b. Restating c. Making an observation d. Focusing

c. Making an observation This is an example of making an observation. It also is providing reality in the client who seems to be having verbal or visual hallucinations. ​

Therapeutic Community

conditions that promote a therapeutic democratic community include: ● basic physiological needs are fulfilled ● physical facilities are conducive to meet goals of therapy​ ● group shares in decision making, establishment of group rules & direction, & equal voice among participants​ ● roles within the group are assigned according to capabilities​ ● a structured program of social & work-related activities ● inclusion of community & family in the program of therapy - while maintaining confidentiality, family is included in an effort to facilitate discharge from treatment

Interdisciplinary Team for Milieu Therapy​

initial client assessment is performed by the RN, HCP, & therapist; additional team members may include (but are not limited to): ● psychiatrist​ ● clinical psychologist​ ● psychiatric clinical nurse specialist​ ● psychiatric nurse​ ● mental health technician​ ● psychiatric social worker​ ● occupational therapist​ ● recreational therapist​ ● art therapist​ ● music therapist​ ● psychodramatist​ ● dietitian​ ● chaplain

Which therapeutic technique is being demonstrated in the mental health setting? "It seems far-fetched to believe that your health care provider is trying to poison you." a. Voicing doubt b. Restating c. Making an observation d. Focusing

a. Voicing doubt Reinforcing that staff is not trying to poison the client is voicing doubt.​

Grayson, a 16-year-old client is admitted to the mental health floor from the intensive care unit after attempting to commit suicide by overdose of hydrocodone/acetaminophen. On admission, the client's parents reported, "We had no idea he was upset. His close friend died 3 months ago, but he's always laughing and with his friends all the time. We thought that was the right thing to do so he wasn't isolated. Medical history is negative. Surgical history includes placement of pressure equalization tubes bilaterally at age 2. Vital signs are stable. Awake, alert, oriented x4. When brought to the floor, the client is laughing, joking, and flirting with the nurses as he is transported by wheelchair. He is cooperative and walks to the bed with a steady gait. ​ The charge nurse completes the assessment and notices the client becomes quiet with arms crossed, rolling his eyes at many of the assessment questions. Grayson states, "Oh my god, nothing has changed. Can you just look in the computer? This is so annoying. When can I call my friends? I need to get out of here. My buddy is having a party tomorrow."​ Which findings below regarding Grayson require follow up by the nurse? Select all that apply. a. attempting to commit suicide by overdose of hydrocodone/acetaminophen b. His close friend died 3 months ago c. right thing to do so he wasn't isolated. d. placement of pressure equalization tubes bilaterally e. "Oh my god, nothing has changed." f. "I need to get out of here. My buddy is having a party tomorrow."

a. attempting to commit suicide by overdose of hydrocodone/acetaminophen b. His close friend died 3 months ago f. I need to get out of here. My buddy is having a party tomorrow." This client has a suicide attempt of overdose on hydrocodone/acetminophen after the recent death of a friend. He wants to know about discharge due to an upcoming event that he wants to attend. The placement of pressure equalization tubes at age 2 is not worthy of follow up, nor is his irritation with the repetitive assessment questions. While his parents allowing him to see his friends prevented isolation, it also fostered avoidance and prevented recognition and coping with the death of the friend.

Match each therapeutic statement to the correct therapeutic technique. What do you think you should do about it? a. Broad Open b. Accept c. Reflect d. Present Reality e. Verbalize the implied

c. Reflect

Nontherapeutic Communication: Using Denial

dismissing a client's feelings, behaviors, or problems blocks discussion

Which nontherapeutic statement is best matched to the description below? "If I were you, I would not take the treatment" a. Requesting an explanation b. Approving/Disapproving c. Belittling feelings d. Making stereotypical comments e. Giving advice

e. Giving advice Implies the nurse knows best and client is not capable of making own decisions​.

Match each therapeutic statement to the correct therapeutic technique. You seem very upset about something. a. Broad Open b. Accept c. Reflect d. Present Reality e. Verbalize the implied

e. Verbalize the implied

Nontherapeutic Communication: Making Stereotypical Comments

encourages the same response from the client; not consistent with professionalism e.g., Client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?"

Therapeutic Communication: Voicing Doubt

explaining uncertainty in client perceptions e.g., altered thinking/reality

Therapeutic Relationship Phases​: Preinteraction

gather client information regarding the patient through report, team, family members, & the chart i.e., preparation for the first meeting with the patient

Therapeutic Communication: Offering General Leads

gives clients the ability to have a prompt to express themselves ​ e.g., "Yes, I see. Go on."

Therapeutic Communication: Using Silence

gives the client time to think & reflect, collect thoughts for additional discussion​

Therapeutic Communication: Encouraging

have the client verbalize what is real vs what is felt or to compare things that can be changed or not​

Nontherapeutic Communication: Giving Advice

implies the nurse knows best & the client is not capable of making their own decisions​

Therapeutic Communication: Accepting

indicate you heard the patient without judgement e.g., I am so sorry about your mastectomy; it must be terrible to lose a breast.

Nontherapeutic Communication: Indicating the Existence of External Sources of Power

indicates outside influences are responsible for actions, thoughts, or feelings

Which therapeutic technique is being demonstrated in the mental health setting? "Let's talk more about those feelings of inadequacy." a. Voicing doubt b. Restating c. Making an observation d. Focusing

d. Focusing Focusing is having the client talk about something specific rather than something that is distracting or unrelated.

Which nontherapeutic statement is best matched to the description below? "Well, you know men are so stubborn." a. Requesting an explanation b. Approving/Disapproving c. Belittling feelings d. Making stereotypical comments e. Giving advice

d. Making stereotypical comments Encourages the same response from client; not consistent with professionalism.

Nontherapeutic Communication: Giving Reassurance

devalues the client's feelings by indicating there is no cause for their feelings e.g., "Things will look better tomorrow after a good night's sleep,"

Interpersonal Relationship

development is used as the primary intervention with persons who struggle with mental illness

Therapeutic Communication: Reflecting

direct patient's thoughts & feelings back to the patient e.g., What do you think you should do about it?/ "You're experiencing feelings of guilt because you weren't able to save your children."

Nontherapeutic Communication: Approving/Disapproving & Agreeing/Disagreeing

indicates the nurse is passing judgement & should remain impartial instead​ e.g., "I'm so proud of you for being assertive. You are so good!"

Milieu Therapy​

is "the scientific structuring of the environment in order to effect behavioral changes & improve the psychological health & functioning of the individual"

Therapeutic Relationship Phases​: Working

most of the therapeutic work is completed & two problems commonly occur → transference & countertransference i.e., promoting patient's insight & problem solving

Essential Part of Managing a Therapeutic Milieu

nurses are involved in all phases of the nursing process of the treatment plan, they are responsible for the following: ● ensuring needs are met ● assessing physical & psychosocial status ● giving medications ● assisting in the development of trusting relationships ● establishing clear limits ● reinforcing education

Nontherapeutic Communication: Probing

persistent questioning when the client isn't comfortable sharing​

Nontherapeutic Communication: Rejecting

refusing to consider a client's ideas or behaviors​

What are the characteristics of milieu therapy? Select all that apply. a. Punishments and restrictions are avoided with clients b. Therapist facilitator owns the environment c. Strengths of each client are identified and fostered d. Clients are responsible for personal behavior e. Inappropriate behaviors are addressed privately later f. Social rules of the group are determined by specific group

a. Punishments and restrictions are avoided with clients c. Strengths of each client are identified and fostered d. Clients are responsible for personal behavior f. Social rules of the group are determined by specific group Milieu therapy is a specific environment structured to affect behavioral change and improve the health of the client. Each client's strengths are identified and fostered, social rules of the group are determined by the group, restrictions/punishments are avoided, and clients are responsible for their own behavior. The client, not the facilitating therapist, owns the environment, and inappropriate behaviors are addressed immediately rather than later. ​

Match each therapeutic statement to the correct therapeutic technique. I am so sorry about your mastectomy; it must be terrible to lose a breast. a. Broad Open b. Accept c. Reflect d. Present Reality e. Verbalize the implied

b. Accept

Which nontherapeutic statement is best matched to the description below? "Oh, that is a good idea for sure!" a. Requesting an explanation b. Approving/Disapproving c. Belittling feelings d. Making stereotypical comments e. Giving advice

b. Approving/Disapproving Indicates nurse is passing judgement and should remain impartial instead​.

Which therapeutic technique is being demonstrated in the mental health setting? "What I hear you saying is that you feel incredibly overwhelmed and anxious." a. Voicing doubt b. Restating c. Making an observation d. Focusing

b. Restating Restaing the client's words is verbalizing what has been said. ​

Therapeutic Relationship Phases​: Orientation

become acquainted with the client to begin to establish trust, as patients will not feel comfortable sharing intimate aspects of their lives unless trust is first established i.e., establishment of trust & development of a rapport

Grayson, a 16-year-old client is admitted to the mental health floor from the intensive care unit after attempting to commit suicide by overdose of hydrocodone/acetaminophen. On admission, the client's parents reported, "We had no idea he was upset. His close friend died 3 months ago, but he's always laughing and with his friends all the time. We thought that was the right thing to do so he wasn't isolated." Medical history is negative. Surgical history includes placement of pressure equalization tubes bilaterally at age 2. Vital signs are stable. Awake, alert, oriented x4. When brought to the floor, the client is laughing, joking, and flirting with the nurses as he is transported by wheelchair. He is cooperative and walks to the bed with a steady gait. ​ The charge nurse completes the assessment and notices the client becomes quiet with arms crossed, rolling his eyes at many of the assessment questions. Grayson states, "Oh my god, nothing has changed. Can you just look in the computer? This is so annoying. When can I call my friends? I need to get out of here. My buddy is having a party tomorrow."​ Grayson's nurse begins his plan of care. For which of the findings would the nurse monitor? Select all that apply. a. Reports of severe pain b. Increased urine output c. Inappropriate Affect d. Anxiety ​ e. Attempted self harm f. Elevated liver enzymes g. Rebound headaches

c. Inappropriate Affect d. Anxiety ​ e. Attempted self harm f. Elevated liver enzymes In Greyson, there is a high likelihood that he could attempt to harm himself again. Since he took hydrocodone, it is important to evaluate liver enzymes. Anxiety and inappropriate affect could be signs that the client is struggling with his choices and needs intervention. Rebound headaches, increased urinary output, and severe pain are not associated with overdose of this medication. ​

Grayson, a 16-year-old client is admitted to the mental health floor from the intensive care unit after attempting to commit suicide by overdose of hydrocodone/acetaminophen. On admission, the client's parents reported, "We had no idea he was upset. His close friend died 3 months ago, but he's always laughing and with his friends all the time. We thought that was the right thing to do so he wasn't isolated." Medical history is negative. Surgical history includes placement of pressure equalization tubes bilaterally at age 2. Vital signs are stable. Awake, alert, oriented x4. When brought to the floor, the client is laughing, joking, and flirting with the nurses as he is transported by wheelchair. He is cooperative and walks to the bed with a steady gait. ​ The charge nurse completes the assessment and notices the client becomes quiet with arms crossed, rolling his eyes at many of the assessment questions. Grayson states, "Oh my god, nothing has changed. Can you just look in the computer? This is so annoying. When can I call my friends? I need to get out of here. My buddy is having a party tomorrow."​ ​​Based on Grayson's assessment data, the nurse determines that the laughing, flirting, and not talking to his parents is due to _______. Grayson staying with friends rather than being alone is likely because he ________, and the suicide attempt is due to ______. a. parental abuse b. avoiding upsetting them c. denial of friend's death d. history of depression a. hates his parents b. has no one else to hang out with c. feels guilty d. does not want to be alone a. severe depression b. peer pressure c. medication adverse effects

c. denial of friend's death d. does not want to be alone a. severe depression Grayson is in denial, acting as if nothing is wrong by laughing, flirting, etc. There is no history of depression or parental abuse. He might not want to upset his parents, but this isn't the most likely cause. Staying with friends all the time is another manifestation of denial and most likely, his not wanting to be alone. When he's alone, the depression can be worse. There is no information that he hates his parents, does not have other friends, or feels guilty. The suicide attempt is most likely a result of depression that has been unacknowledged and untreated. He is not on any medications that we are aware of, and there is not mention of peer pressure.​

Boundaries in the Nurse-Client Relationship​

clients with mental health issues, there can be difficulty in understanding boundaries, so it is incredibly important that the nurse provides clarity, consistency, & reinforcement & while there are many types of boundaries, these are a few examples:​ ● material - physical property​ ● social - appropriate social behaviors in a society​ ● personal - includes physical/personal space as well as the amount of information a person discloses ​ ● professional - limit & outline appropriate behavior by the nurse (ex: Code of Ethics, Facility Policy, etc.)​ ● self-disclosure - must be appropriate when it will therapeutically benefit the client ​ ● gifting - some clients want to express gratitude, & some societies consider it rude to refuse; the nurse should use professional & institutional standards & expectations, which usually indicate that very small tokens are okay ​ ● touch - sometimes caring touch can be beneficial, but it should only be done with consent & comfort from the client​ ● friendship or romantic - romantic, sexual, or other relationships other than professional are not appropriate, & the nurse must excuse if needed from this situation; if a client is a friend, a professional relationship must take precedence

A nurse cares for a client on the mental health unit and quickly develops a bond. The other nurses notice and make comments that the nurse is spending too much time with the client. The nurse realizes that there are romantic feelings that have developed. What is the appropriate behavior by the nurse? a. Identify the feelings and attempt to be professional for the remainder of the shift b. Tell the nurse peers they are mistaken, attempt to remain professional, and do not admit it c. Give the client the nurse's personal contact information for continuation after discharge d. Ask another nurse to assume care for the client and cease all contact that is not professional

d. Ask another nurse to assume care for the client and cease all contact that is not professional It is important to have appropriate boundaries, and developing feelings for a client is not professional. There should be recognition of these feelings, and the nurse should no longer care for the client if at all possible. All communication should be professional, and the relationship should not occur outside the hospital. ​

Therapeutic Communication: Focusing

putting attention into a single topic e.g., "You mentioned your relationship with your father. Let's discuss that further."

Therapeutic Communication: Giving Recognition

recognizing client actions or activities rather than complimenting ​ e.g., "I notice you are wearing a new dress and you have washed your hair."

Therapeutic Communication: Restating

repeat patient's words in a different way to make more clear e.g., Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian."

Nontherapeutic Communication: Introducing an Unrelated Topic

shows disrespect & a lack of caring for what the client has to say, indicates that the nurse's topic is more important

Therapeutic Communication: Offering Self

staying with the client can help alleviate fear & increase confidence​ e.g., "Would you like me to accompany you to your electroconvulsive therapy treatment?"

Therapeutic Communication: Attempting to Translate Words into Feelings

the nurse puts words with expressed feelings i.e., crying translates into feeling sad; crossing arms & frowning translates into anger, etc.

Therapeutic Techniques: Information Verification/Dissemination

● providing information ● clarifying ● focusing ● paraphrasing ● validation ● asking relevant questions