Mental Health Chapter 5

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

Loss of therapeutic effectiveness

Beliefs

ideas that one holds to be true

A nurse is interacting with a client who is expressing feelings about the client's child's insensitive behavior. Which statement made by the nurse indicates the nurse is empathizing with the client? Choose the best answer

"It sounds like this is very difficult for you, I can see why it causes you stress."

The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self?

"What types of dresses do you like wearing?"

A nurse is speaking to a client with a soft smile and eye contact. Which statement said by the nurse would indicate a congruent message?

"Your hard work and determination has helped you recover."

Advocacy

- the process of acting on the client's behalf when he or she cannot do so

Which clinical situation provides an example of transference?

A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.

The nurse engage in ________ when acting on the client's behalf when the client isn't able to do so.

Advocacy

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

Evaluation of mutually identified goals

Congruence refers to differences between an individual's verbal and non-verbal communication.

False, congruence is where an individual's verbal and non-verbal communication match.

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?

Lack of self-awareness

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?

Orientation phase

________ are existing ideas that an individual may have regarding how anther person may speak and behave.

Preconceptions

During the __________ identification phase in the therapeutic relationship, the client identifies issues and concerns.

Problem

_______ is the ability to develop an understanding of one's own beliefs, values, strengths and limitations.

Self-awareness

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.

What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?

Shifting the emphasis to the nurse

The client may view the nurse as a parent surrogate within the therapeutic relationship

TRUE

Which observation should lead the nurse manager to recognize that countertransference is affecting the therapeutic effectiveness of an individual nurse on the unit?

The nurse frequently refers to an elderly, cognitively impaired client as "my granny"

A client reveals in a therapy session that the client has thought about killing a neighbor. What is the therapist's obligation regarding this revelation?

The therapist must notify authorities and the potential victim.

Positive regard is the unconditional nonjudgmental attitude demonstrated by the nurse to the client.

True

A nurse notices that a neighbor has been admitted to an inpatient psychiatric unit. The nurse understands that the nurse may not discuss this with any of the nurse's family or neighbors, because doing so would breach the client's confidentiality. Confidentiality is a component of which element of the therapeutic relationship?

Trust

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

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

Working

Acceptance

avoiding judgments of the person, no matter what the behavior

A psychiatric nurse tells a client that the nurse will return in 15 minutes to talk with the client. The nurse goes to a meeting that runs overtime and returns in an hour, apologizing for being late. This behavior may have an impact between the nurse and the client in the area of ...

establishing trust in the introductory phase of the relationship.

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.

interrupting the client arguing with a client over agreed upon plans minimizing the client's concerns

Therapeutic use of self

nurses use themselves as a therapeutic tool to establish the therapeutic relationship with clients and to help clients grow, change, and heal

Congruence

occurs when words and actions match.

Problem identification

part of the working phase of the nurse-client situation, when the client identifies the issues or concerns causing problems

Empathy

the ability to perceive the meanings and feelings of another person and to communicate that understanding to that person.

Orientation phase

the beginning of the nurse-client relationship; begins when the nurse and client meet and ends when the client begins to identify problems to examine

Duty to warn

the exception to the client's right to confidentiality; when healthcare providers are legally obligated to warn another person who is the target of the threats or plan by the client, even if the threats were discussed during therapy sessions otherwise protected by confidentiality.

Patterns of knowing

the four patterns of knowing in nursing are empirical knowing (derived from the science of nursing), personal knowing (derived from life experiences), ethical knowing (derived from moral knowledge of nursing), and aesthetic knowing (derived from the art of nursing); these patterns provide the nurse with a clear method of observing and understanding every client interaction

Exploitation

the phase of the nurse-client relationship, identified by Peplau, when the nurse guides the client to examine feelings and responses and to develop better coping skills and a more positive self-image; this encourages behavior change and develops independence; part of the working phase.

Preconception

the way one person expects another to behave or speak; often a roadblock to the formation of an authentic relationship

Genuine interest

truly paying attention to the client, caring about what he or she is saying; only possible when the nurse is comfortable with himself or herself and aware of his or her strengths and limitations

Positive regard

unconditional, nonjudgmental attitude that implies respect for the person

Unknowing

when the nurse admits she does not know the client or the client's subjective world; this opens

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."

During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, "I know I am doing the wrong thing for my kids, but I just can't stop using drugs." The nurse maintains eye contact and nods occasionally. The nurse responds by saying, "You're going through a difficult time." The nurse's actions and words are an example of:

Empathy

________ Is the ability of a nurse to perceive the meaning and feelings of a client and to convey this to him or her.

Empathy

Therapeutic relationships are similar to social relationships in that they are primarily initiated for companionship or accomplishment of a task.

False, therapeutic relationships differ from social or intimate relationship in many ways because it focuses on the needs, experiences, feelings, and ideas of the client only.

Self-disclosure is appropriate in all nurse-client interaction

False, though it may help the client feel more comfortable and more willing to share thoughts and feelings, or help the client gain insight into his or her situation, the nurse must also consider cultural factors. Some clients may deem self-disclosure inappropriate or too person, causing the client to be uncomfortable.

A nursing instructor is teaching a class on empathy. The instructor determines that the class needs additional education when the students identify that empathy involves what?

Feeling the same emotions that the client is feeling at a given time

Explain the purpose of motivational interviewing (MI) to foster a person making healthy changes to improve quality of life.

The purpose of MI is the approach designed to help people find the motivation to make a positive behavior change. This is a client centered approach is particularly effective for people who have mixed feelings about changing their behavior. Enhance the patient's motivation for behavior change and to explore their mixed feelings in order change their self-care rountie. The 4 elements are Engaging, focusing, evoking, and planning. The 5 principles are express and show empathy towards the client, support and develop discrepancy, deal with resistance, support self-efficacy, and developing autonomy.

Compare and Contrast therapeutic and non-therapeutic communication with clients.

Therapeutic communication like reflection, restatement, and clarification. Trust - behaviors such as caring, interest, understanding, consistency, honesty, keeping promises and listening. Congruence. Geninue Interest - self comfort, self-awareness of strengths and limitations, clear focus. Client can detect dishonest behavior. Empathy - ability to perceive client's meanings and feelings, to communicate that understanding. Client and Nurse giving "gift of self". Different from sympathy (feelings of concern or compassion; may project nurse's personal feelings). Acceptance (no judgements; sets boundaries). Positive regard (unconditional, nonjudgmental attitude.) Non-therapeutic communication - not setting professional boundaries. Not acting warly and empathetically, and acts as friends with the client. Sharing personal information with he client that can harm the therapeutic relationship. Self awareness - know self. Values: choosing, prizing, acting), beliefs, attitudes and cultural awareness.

The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason?

To prevent the client from viewing the nurse as a friend rather than health care provider

A nursing student is working with a client who has a history of abusing alcohol. Although the nurse has an aversive feeling toward people who abuse alcohol, the nurse feels that the client is worthy of respect and attention regardless of the nurse's own personal feelings. Which correctly describes the nurse's response to the client?

Unconditional positive regard

Intimate relationship

a relationship involving two people who are emotionally committed to each other; both parties are concerned about having their individual needs met and helping each other to meet needs as well; the relationship may include sexual or emotional intimacy as well as sharing of mutual goals

Compassion fatigue

a type of secondary trauma or stress resulting from helping others work through traumatic stress; experienced by those in the helping professions

Values

abstract standards that give a person a sense of right and wrong and establish a code of conduct for living

Termination or resolution phase

he final stage in the nurse-client relationship; it begins when the client's problems are resolved and concludes when the relationship ends

Attitudes

general feelings or frame of reference around which a person organizes knowledge around the world.

Working phase

in the therapeutic relationship, the phase where issues are addressed, problems identified, and solutions explored; both nurse and client work to accomplish goals; contains Peplau's phases of problem identification and exploitation

Social relationship

primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of a task

Therapeutic relationship

professional, planned relationship between the client and the nurse that focuses on client needs, feelings, problems, and ideas; interaction designed to promote client growth, discuss issues, and resolve problems; includes the three phases of orientation: working (identification and exploitation) and termination (resolution); also called therapeutic nurse-patient relationship

Confidentiality

respecting the client's right to keep private any information about his or her mental and physical health and related care.

Self-disclosure

revealing personal information such as biographical information and personal experiences, ideas, thoughts, and feelings about oneself