Therapeutic Relationships Ch8 (for more ?'s see p. 135)

Orientation

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? a. preorientation b. orientation c. Working d. Termination

Contract

can be written or verbal. It states date, time, place and duration of meetings. It should also include termination of relationship.

Therapeutic Relationship purpose/ focus? communication style?

purpose: is to focus on the patient and assist patient with solutions to problems communication style: ID clients needs and explore them. establish boundaries help pt with new coping strategies encourage alternate problem solving approaches support behavioral change

genuiness

refers to the nurses ability to be open, honest and authentic while interacting with patients. It is conveyed by listening and communicating clearly

Concepts of patient centered care

respect, dignity, patient/ family cooperation, information sharing, and collaboration/ policy in program development

Empathy

the helper viewing the world from the patients point of view without judgement

Counter-transference

when the helping person (nurse) displays feelings related to significant figures in the nurses past and these feelings are passed on to the patient.

transference

when the patient unconsciously and inappropriately displays on to the nurse feelings and behavior related to significant figures in patients past.

D

A client has been admitted to your inpatient psychiatric unit with suicidal ideation. In a one-to-one session with the nurse, he shares the terrible guilt he feels over sexually abusing his stepdaughter and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship? A. "It's good that you feel guilty. That means you still have a chance of being helped." B. "Of course you feel guilty. You did a horrendous thing. You shouldn't even forget what you did." C. "The biggest question is, will you do it again? You will end up having even worse guilt feelings because you hurt someone again." D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

not seeming genuine to the client

A client states "That nurse never seems comfortable being with me." The nurse can be described as not seeming genuine to the client. transmitting fear of clients. unfriendly and aloof. controlling.

positive transference

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion? Congruence Empathetic feelings Countertransference Positive transference

B

A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference? A. "My patient is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." B. "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" C. "My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA (Alcoholics Anonymous) meetings five times a week after discharge." D. "My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

C

A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which of the following responses by the nurse illustrates empathy? A. "I'm so sorry. My father died 2 years ago, so I know how you are feeling." B. "You need to focus on yourself right now. You deserve to take time just for you." C. "That must have been such a hard situation for you to deal with." D. "I know that you will get over this. It just takes time."

c. Authentic

A term is a synonym for the characteristic of genuineness? a. Respect b. Empathy c. Authentic d. Positive Regard

D

Consider the nurse-patient relationship on an inpatient psychiatric unit. Which of the following statements made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed? A. "You are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." B. "I haven't met my new patient yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." C. "Now that we are working on your problem-solving skills and behaviors you'd like to change, I'd like to bring up the issue of termination." D. "Now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

Social Relationship purpose/ focus? communication style

purpose/focus: friendship, socialization, enjoyment or accomplishment of tasks. communication style: give advice and is superficial. Little emphasis on the evaluation of interaction.

Boundary blurring

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for which characteristic of a dysfunctional nurse-patient relationship? a. Boundary blurring b. Value dissonance c. Covert anger d. Empathy

a,b,d,e,

The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? a. Helping patients examine self-defeating behaviors and test alternatives b. Promoting self-care and independence c. Providing the client with opportunities to socialize d. Assisting patients with problem solving Addressing the client's need to socialize e. Facilitating communication of distressing thoughts and feelings

Decreased Client communication

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome? Enhanced client coping Lessening of client emotional pain Increased hope for client improvement Decreased client communication

Type of responsibility involved

What is the primary difference between a social and a therapeutic relationship? Type of information exchanged Amount of satisfaction felt Type of responsibility involved Amount of emotion invested

Working phase

What phase of the nurse-pt relationship does the following take place: gathering data ID-ing problem solving skills and self esteem provide education about disorder promote symptom management provide medication enducation evaluate progress.

Orientation phase

What phase of the nurse-pt relationship does the following take place: parameters of relationship defined confidentiality rapport formal/informal contract terms of termination

termination phase

What phase of the nurse-pt relationship does the following take place: summarizing goals/ objectives discussing ways for patient to incorporate new coping strategies learned. reviewing situations that occured during the nurse-pt. relationship

Pre-orientation phase

What phase of the nurse-pt relationship does the following take place: viewing pt. chart for mental/ physical eval learning about prescribed meds understanding lab results

b. therapeutic encounter

When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship? a. crisis intervention b. Therapeutic encounter c. autonomous interaction d. pre-orientation phenomenon

A, C, D,

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? Select all that apply. A. In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. B. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient. E. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship, communication remains on a more superficial level, allowing patients to feel comfortable.

d. termination phase.

Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed? a. pre-orientation phase b. orientation phase c. working phase d. termination phase

Attending behavior

a special kind of listening that refers to an intensity of presence or being with patient.

values

are abstract standards and represent an ideal, either positive or negative.

Counseling

face to face meeting that helps a person problem solve, resolve personal complex and feel supported

psychotherapy

formal approach to talk therapy that based on theoretical models

Positive Regard

implies respect. views a person of being worthy of being cared about. It is when someone has strengths and achievement potential.

clinical supervision

mentoring relationships based by feedback and evaluations