Test 1 - Chapter 1: Science and the Therapeutic Use of Self in Psychiatric Mental Health Nursing (ONLY page 7)

Which patient statements identify qualities of nursing practice with high therapeutic value? "My nurse: (Select all that apply.) a. "The nurses talk in language I can understand." b. "The nursing staff helps me keep track of my medications." c. "My nurse is willing to go to social activities with me." d. "The staff lets me do whatever I choose without interfering." e. "My nurses look at me as a whole person with different needs."

ANS: A, B, E Each correct answer demonstrates caring is an example of appropriate nursing foci: communicating at a level understandable to the patient, using holistic principles to guide care, and providing medication supervision. The incorrect options suggest a laissez-faire attitude on the part of the nurse when the nurse should instead provide thoughtful feedback and help patients test alternative solutions or violate boundaries. Page 7 Caring Caring is a natural, essential, and fundamental aspect of human existence. An early survey by Schoenhofer and colleagues (1998) used a group process method to synthesize what was meant by caring to the participants. The following three themes emerged: 1. Caring is evidenced by empathic understanding, actions, and patience on another's behalf. 2. Caring for another through actions, words, and presence leads to happiness and touches the heart. 3. Caring is giving of self while preserving the importance of self. The caring nurse is first and foremost a competent nurse. Without knowledge and competence, the demonstration of compassion and caring alone is powerless to help those under a nurse's care. Without a base of knowledge and skills, care alone cannot eliminate another person's confusion, grief, or pain, but a response of care can transform fear, pain, and suffering into a tolerable, shared experience (Smith et al., 2013). Comforting as a part of caring includes providing social, emotional, physical, and spiritual support for a patient consistent with holistic nursing care. [...]

A bill introduced in Congress would reduce funding for the care of people diagnosed with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attending c. Recovery d. Evidence-based practice

ANS: A An advocate defends or asserts another's cause, particularly when the other person lacks the ability to do that for him or herself. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the individuals with mental illness; the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs. Page 7 Advocating Advocacy in nursing includes a commitment to patients' health, well-being, and safety across the life span; the alleviation of suffering; and the promotion of a peaceful, comfortable, and dignified death (ANA, 2017). Patient advocacy can occur on many levels, including providing direct patient care; pleading for a course of action; and supporting change in institutional, global, and legislative arenas. The following are examples of patient advocacy activities: • Providing informed consent, including refusal of treatment • Respecting patient decisions, even those with which we disagree • Protecting against threats to well-being • Being informed about best practices These are especially critical when patients lack the knowledge, skills, or ability to speak for themselves. The nurse must be alert to and take appropriate action regarding any instances of incompetent, unethical, illegal, or impaired practices(s) by any member of the health team or the health care system itself, or any action on the part of others that places the rights or best interest of the patient in jeopardy. (ANA, 2015, 3.5) Advocating demonstrates respect and value for human life while saving lives or bringing comfort to those who are dying.

Which scenario best demonstrates empathic caring? a. A nurse provides comfort to a colleague after an error of medication administration. b. A nurse works a fourth extra shift in 1 week to maintain adequate unit staffing. c. A nurse identifies a violation of confidentiality and makes a report to an agency's privacy officer. d. A nurse conscientiously reads current literature to stay aware of new evidence-based practices.

ANS: A Caring is evidenced by empathic understanding, actions, and patience on another's behalf; actions, words, and presence that lead to happiness and touch the heart; and giving of self while preserving the importance of self. Comforting is a part of caring, which includes social, emotional, physical, and spiritual support.

A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurse's most caring comment. a. "Let's discuss healthy means of coping when you have suicidal feelings." b. "I understand why you're so depressed. When I got divorced, I was devastated too." c. "You should forget about your marriage and move on with your life." d. "How did you get so depressed that hospitalization was necessary?"

ANS: A The nurse's communication shows evidence of caring and a commitment to work with the patient. This commitment lets the patient know the nurse will help. Probing and advice are not helpful for therapeutic interventions. Page 7 Caring Caring is a natural, essential, and fundamental aspect of human existence. An early survey by Schoenhofer and colleagues (1998) used a group process method to synthesize what was meant by caring to the participants. The following three themes emerged: 1. Caring is evidenced by empathic understanding, actions, and patience on another's behalf. 2. Caring for another through actions, words, and presence leads to happiness and touches the heart. 3. Caring is giving of self while preserving the importance of self. The caring nurse is first and foremost a competent nurse. Without knowledge and competence, the demonstration of compassion and caring alone is powerless to help those under a nurse's care. Without a base of knowledge and skills, care alone cannot eliminate another person's confusion, grief, or pain, but a response of care can transform fear, pain, and suffering into a tolerable, shared experience (Smith et al., 2013).

A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurses most caring comment. a. Lets discuss some means of coping other than suicide when you have these feelings. b. I understand why youre so depressed. When I got divorced, I was devastated too. c. You should forget about your marriage and move on with your life. d. How did you get so depressed that hospitalization was necessary?

ANS: A The nurses communication should evidence caring and a commitment to work with the patient. This commitment lets the patient know the nurse will help. Probing and advice are not helpful or therapeutic interventions.

A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction reported by a patient indicates this nurse is most effective? a. Feeling less distrustful of others b. Sensing a connection with others c. Experiencing only minimal uneasiness about the future d. Being somewhat encouraged with efforts to improve

ANS: B A patient is likely to respond most to caring with a sense of connectedness with others. The absence of caring can make patients feel some degree of distrustful, disconnection, unease, and discouragement. Page 7 Caring Caring is a natural, essential, and fundamental aspect of human existence. An early survey by Schoenhofer and colleagues (1998) used a group process method to synthesize what was meant by caring to the participants. The following three themes emerged: 1. Caring is evidenced by empathic understanding, actions, and patience on another's behalf. 2. Caring for another through actions, words, and presence leads to happiness and touches the heart. 3. Caring is giving of self while preserving the importance of self. The caring nurse is first and foremost a competent nurse. Without knowledge and competence, the demonstration of compassion and caring alone is powerless to help those under a nurse's care. Without a base of knowledge and skills, care alone cannot eliminate another person's confusion, grief, or pain, but a response of care can transform fear, pain, and suffering into a tolerable, shared experience (Smith et al., 2013). Comforting as a part of caring includes providing social, emotional, physical, and spiritual support for a patient consistent with holistic nursing care. [...] However, caring is both an attitude that one communicates (a way of being with a patient) and also a set of skills that can be learned and developed. Listening to patients takes time, but with practice and experience, nurses can develop the ability to attend to emotional and spiritual needs and get to know their patients while completing an assessment or other tasks.

In which scenario is it most urgent for the nurse to act as a patient advocate? a. An adult cries and experiences anxiety after a near-miss automobile accident on the way to work. b. A homeless adult diagnosed with schizophrenia lives in a community expecting a category 5 hurricane. c. A 14-year-old girl's grades decline because she consistently focuses on her appearance and social networking. d. The parents allow the prescription to lapse for 1 day for their 8-yearold child's medication for attention-deficit/hyperactivity disorder.

ANS: B Although all of the scenarios present opportunities for a nurse to intervene, the correct response presents an imminent danger to the patient's safety and well-being.

In the shift-change report, an off-going nurse criticizes a patient who wears extremely heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy? a. "This is a psychiatric hospital, so we expect our patients to behave bizarrely." b. "Let's all show acceptance of this patient by wearing lots of makeup too." c. "Your comments are inconsiderate and inappropriate. Keep the report objective." d. "Our patients need our help to learn behaviors that will help them get along in society."

ANS: D Accepting patients' needs for self-expression and seeking to teach skills that will contribute to their well-being demonstrate respect and are important parts of advocacy. The on-coming nurse needs to take action to ensure that others are not prejudiced against the patient. Humor can be appropriate within the privacy of a shift report but not at the expense of respect for patients. Judging the off-going nurse in a critical way will create conflict. Nurses must show compassion for each other. Page 7 Advocating Advocacy in nursing includes a commitment to patients' health, well-being, and safety across the life span; the alleviation of suffering; and the promotion of a peaceful, comfortable, and dignified death (ANA, 2017). Patient advocacy can occur on many levels, including providing direct patient care; pleading for a course of action; and supporting change in institutional, global, and legislative arenas. The following are examples of patient advocacy activities: • Providing informed consent, including refusal of treatment • Respecting patient decisions, even those with which we disagree • Protecting against threats to well-being • Being informed about best practices These are especially critical when patients lack the knowledge, skills, or ability to speak for themselves. The nurse must be alert to and take appropriate action regarding any instances of incompetent, unethical, illegal, or impaired practices(s) by any member of the health team or the health care system itself, or any action on the part of others that places the rights or best interest of the patient in jeopardy. (ANA, 2015, 3.5) Advocating demonstrates respect and value for human life while saving lives or bringing comfort to those who are dying.

A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is an example of "attending"? a. "We all have stress in life. Being in a psychiatric hospital is not the end of the world." b. "Tell me why you felt you had to be hospitalized to receive treatment for your depression." c. "You will feel better after we get some antidepressant medication started for you." d. "I'd like to sit with you for a while, so you may feel more comfortable talking with me."

ANS: D Attending is a technique that demonstrates the nurse's commitment to the relationship and reduces feelings of isolation. This technique shows respect for the patient and demonstrates caring. Generalizations, probing, and false reassurances are nontherapeutic. Page 7 Attending Attending refers to an intensity of presence, being there for and in tune with the patient. The experience of emotional or physical suffering can be isolating. When patients perceive that the nurse is there for them, a human connection is made, and the patient's sense of isolation is minimized or eliminated (Dossey & Keegan, 2013). Being present requires entering the patient's experience. Attending behaviors include active listening skills, such as body posture and eye contact, touching, or giving attentive physical care (Dossey & Keegan, 2013). It is through effective communication that we can fully understand another person's immediate experience, fears, perceptions, and concerns. Attending behaviors are learned and are inherent in a true therapeutic relationship. Chapter 9 discusses attending behaviors in more detail within the context of the nurse-patient relationship.

An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patient's perception that his or her nurse is caring? a. "My nurse always asks me which type of juice I want to help me swallow my medication." b. "My nurse explained my treatment plan to me and asked for my ideas about how to make it better." c. "My nurse told me that if I take all the medicines the doctor prescribes, I will get discharged soon." d. "My nurse spends time listening to me talk about my problems. That helps me feel like I'm not alone."

ANS: D Caring evidences empathic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The incorrect options give examples of statements that demonstrate advocacy or giving advice. Page 7 Caring Caring is a natural, essential, and fundamental aspect of human existence. An early survey by Schoenhofer and colleagues (1998) used a group process method to synthesize what was meant by caring to the participants. The following three themes emerged: 1. Caring is evidenced by empathic understanding, actions, and patience on another's behalf. 2. Caring for another through actions, words, and presence leads to happiness and touches the heart. 3. Caring is giving of self while preserving the importance of self. [...] Comforting as a part of caring includes providing social, emotional, physical, and spiritual support for a patient consistent with holistic nursing care. The provision of comfort measures can be lifesaving and is a basic component of good care. Economic strain and nursing shortages are barriers to the practice of caring and comforting because nurses are burdened with greater workloads and higher-acuity patients. However, caring is both an attitude that one communicates (a way of being with a patient) and also a set of skills that can be learned and developed. Listening to patients takes time, but with practice and experience, nurses can develop the ability to attend to emotional and spiritual needs and get to know their patients while completing an assessment or other tasks.