Mental health ch. 9 The nurse patient relationship

During the first meeting, a client asks, "What information will be shared with others?" Which response would the nurse make?

"Assessment information and your progress is shared."

nontherapeutic 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

Which of the following occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others?

transference

deteriorating relationship phases

withholding phase avoiding and ignoring phase struggling and making sense of phase

During which phase of the nurse-client relationship does the client identify and explore specific problems?

working

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?

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.

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?

"Thank you but I will not accept these gifts because they extend over our discussed boundaries."

The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established?

"I feel worthless and have no real use in life."

A client explains feelings of sadness and loss after the death of a close friend. Which nursing statement best demonstrates empathy?

"I see this is hard for you. How can I help?"

A client states, "I am just devastated that my marriage is falling apart." Which statement made by the nurse best demonstrates an empathetic response?

"You feel like your world is falling apart right now." Therapeutic communication techniques, such as reflection, restatement, and clarification, help the nurse to send empathetic messages to the client.

The nurse is caring for a client with a psychotic disorder. The family is very supportive and asks, "What is the difference between a delusion and a hallucination. The nurse would include which information in the teaching? Select all that apply.

- Delusion consists of fixed, false ideas/beliefs without appropriate external stimuli. - Delusions are inconsistent with reality and cannot be changed by reasoning. - Hallucinations are not supported by actual environmental stimuli. - Hallucinations are false sensory perceptions that have no relation to reality.

What is the patients role in the resolution phase?

- The patient connects with community resources, solidifies a newly found understanding, and practices new behaviors. The patient takes responsibility for follow-up appointments and interacts with significant others in new ways. - Patients may not show up to the last session and might show anger. - Another typical termination behavior is raising old problems that have already been resolved.

working phase

- The patient uses the relationship to examine specific problems and learn new ways of approaching them. Transference and countertransference become important issues in the working phase.

What are the two essential components of the transitional relationship model?

- Therapeutic relationship should be extended until a new one is established with another care provider. - Trained peer support from a psychiatric survivor who has now successfully transitioned into the community.

orientation phase (honeymoon phase) (few minutes to months)

- When the nurse and the patient meet and get to know each other. Patient develops a sense of trust with the nurse. - A patient may talk nonstop for 15 minutes or may brag of sexual conquests. What the patient chooses to tell or not to tell is significant. - Rambling is not uncommon for the patient to experience for the first few sessions.

rapport

A positive relationship characterized by understanding and respect Nurses establish rapport by demonstrating interpersonal warmth, understanding, and a nonjudgmental attitude.

The nurse has been meeting with a client for several weeks. Which action indicates to the nurse that the relationship is demonstrating signs of being nontherapeutic?

The client and nurse are frustrated with the conversation.

Empathic linkages (Peplau)

An extension of Hildegard Peplau's theory of interpersonal relations defined by the nurse's ability to personally identify with and experience feelings the client experiences. However, being aware of one's own feelings, and having the ability to analyze them, is critical to determining the source of the feelings and to addressing any associated problems.

The nurse learns that a new client is a former significant other and an initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries?

Ask to be reassigned because of having a prior personal relationship with the client.

What is the patients role in the orientation phase?

Attend agreed upon sessions, interact in sessions, participate in nurse-patient relationship.

An advanced practice nurse has chosen to apply motivational interviewing (MI) in the care of a client who will transition back to the community from inpatient treatment. The nurse should begin to apply this method by:

Correct response: validating the client's ability to make decisions and effect change. Explanation: MI begins with focusing and reinforcing the client's ability to change and leveraging the client's own decision-making ability. Each of the other listed actions is an appropriate aspect of care, but none is an explicit component of the MI process.

empathy

Empathy is the ability to experience, in the present, a situation as another did at some point in the past. For empathy to develop, there must be a "giving of the self" to the other individual as well as a reciprocal desire to know each other personally.

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?

Encouraging the client to clarify feelings and behavior

What occurs during the working phase of the nurse-client relationship?

Evaluation of mutually identified goals

Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship?

Hildegard Peplau

Nurse patient initial introduction consists of?

Nurses initiate the introduction by simply explaining their role and their task, introduce oneself, be sensitive to using patient-centered and gender-neutral language. the terms "they/them/their"

What is the nurses role in the orientation phase?

Provide guidance, protect confidential information, and maintain professional boundaries. Explain meeting times, handling of missed sessions, and estimated length of the relationship, how information will be recorded. Alleviate any patient anxieties.

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?

Remind the client about the importance of boundaries to keep the relationship therapeutic

A nurse manager plans for nursing staff to use motivational interviewing when providing client care. On which topic(s) will the manager focus when training the staff about this strategy? Select all that apply.

Self-awareness active listening therapeutic relationships avoiding defense mechanisms

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?

Self-disclosure can help normalize the client's experience.

During a therapeutic communication session, the nurse tells the client of a past experience. Which statement best reflects the nurse's use of self-disclosure?

Self-disclosure on the nurse's part should benefit the client.

The client says to the nurse, "I feel really close to you. You are the only true friend I have." The most therapeutic response the nurse can make is ...

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

Sympathy

Sympathy is acknowledging someone else's pain

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?

The client is the primary focus of the interaction

Avoiding which outcome is the primary reason for establishing professional boundaries with clients?

The loss of therapeutic effectiveness

What is the nurses role in the resolution phase?

The nurse assists the client in strengthening relationships, making referrals, and recognizing and understanding signs of future relapse.

Why and when does a patient test the therapeutic relationship?

The patient begins to test the relationship to become convinced that the nurse will really accept them. Typical "testing behaviors" include forgetting a scheduled session or being late. Testing needs to be understood as a normal way that human beings develop trust.

Countertransference (Freud)

Unconscious feelings the health care worker has toward the patient. EX: reminds them of family, can be good or bad

What are the phases of a deteriorating relationship?

Withholding- Nurse is perceived as withholding nursing support. avoiding and ignoring- PT avoids the nurse. struggling with & making sense of - feels hopeless and frustrated

During the orientation phase of a nurse-client relationship, the nurse notes a change in the client's behavior. The client has forgotten a scheduled session and then accuses the nurse of breaking confidentiality. The nurse interprets this as suggesting what?

acting out The client begins to test the relationship to become convinced that the nurse will really accept the client. Typical acting out includes forgetting a scheduled session, being late, or making an accusation that communicates the client's initial mistrust.

A nurse is assigned to care for a client whose sexual orientation differs from her own. She would need to seek clinical supervision if she attempted to ...

assist the client to change values.

The graduate nurse asks the nurse preceptor to observe them during a new client admission assessment to the inpatient mental health unit. "Can you help me evaluate whether my verbal and nonverbal behavior is congruent?" Which nursing responsibility does this activity represent?

developing self-awareness

The manager is reviewing the implementation of the Transitional Relationship Model (TRM) on a care area. Which data should the manager identify that supports the successful implementation of this model? Select all that apply.

discharge of clients 5 days earlier than in the past number of readmissions down 6% over the last 2 months

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:

empathetic linkage

transference

in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent)

What is a clinical method intended to engage a patient's own decision making ability?

motivational interviewing.

When interacting with a client for the first time, which information would be appropriate for the nurse to disclose?

name reason for being on the unit level of education

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.

nurses feeling overwhelmed over-reliance on the process focusing on preexisting conflicts implementing educational modules

Which phase of the nurse-client relationship involves establishment of a therapeutic environment by the nurse?

orientation

The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship?

orientation The orientation phase is the phase during which the nurse and client get to know each other. The nurse reads background materials available on the client and considers his or her personal strengths and limitations in working with this client.

resolution phase (termination stage)

resolution phase, is the termination stage of the relationship and lasts from the time the problems are actually resolved to the close of the relationship. - Termination begins on the first day of the relationship, when the nurse explains that this relationship is time limited and has been established to resolve the patient's problems and help them handle their problems.

The most important tool of psychiatric nursing is the:

self