Ch 9 - Working with an Individual Patient

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1. Therapeutic nurse offers presence & engages in 9. Peplau's Stages orientation

Relationships a relationship to support the pt's of working
challenges & to recognize unique Development termination
strengths Entire relationship is for promoting growth
use of caring to promote pt's & a learning experience for nurse & pt
growth
10. Orientation pt recognizes needs & seeks help
2. Collaboration Pts have the right to make own Stage nurse helps pt to understand problems &
decisions about care provides available help by fostering trust &
recognize problem developing the relationship
showing desire to change
11. Building Trust honesty regarding intentions
asking for help
consistency
most effective & enduring method
following through on actions
to promote change
mutual respect
3. What is not an coercion warmth, interest, concern
effective way to congruency in words & body language
promote change?
12. Communication specific communication decreases
4. Social vs. Therapeutic therapeutic relationships establish & in Orientation confusion & suspicion
Relationship maintain objectivity, goal directive Stage nurse must reach out & initiate
discussions/activities conversation w/ pt in a non-
pts may misinterpret the nurse's confrontational manner
interests follow HIPAA standards in terms of
remind the pt of nurse's role & need privacy
for friendship, love, & support
13. Beginning assess pt needs, coping strategies,
maintaining the nurse's role is
Assessment defense mechanisms, & adaption styles
paramount
note recurrent thoughts, feelings, &
5. Nurse's Basic knowledge & skills for a therapeutic behaviors
Knowledge relationship assess pt's awareness of problems &
advanced practice nurses provide motivation/ability to change
therapy in formalized, ongoing note suicidal/homicidal thoughts,
sessions that are process oriented hallucinations, self-mutilation, & behavioral
patterns
6. Therapeutic take place to assist in discussing
Relationship problems & practical solutions in 14. Managing help pt from feeling overwhelmed
Characteristics brief encounters (planned, pt- Emotions feelings are natural (how it is expressed
centered, goal directed) can cause problems)
provide validation & feedback belittling/minimizing emotions is not ok
false reassurance is not therapeutic
7. Informal/Recreational give the nurse the opportunity to
distract pt from topic if getting too intense
Encounters observe inappropriate social
behaviors 15. Empathy pt views their situation w/ an objective
provide opportunities to understanding
demonstrate ways of handling important part of therapeutic relationship
situations
16. Sympathy nurse has same feelings as pt
8. Brief Self-Disclosure help pts clarify specific issues objectivity is lost
facilitates comfort
17. Providing confirm pt worth & rights
honesty & openness
Support avoid value judgments of the pt
risk taking
acknowledge that making mistakes is ok
never burdens pts w/ nurse's
focuses realistically on pt
problems
abilities/strengths
18. Providing taking temporary control if pt loses 27. Discrepancy cognitive dissonance between pt's current
Structure control of thoughts, feelings, or behaviors behavior & desired goals
offering needed PRN meds conflict in this helps build foundation for
directing pts to a quieter, less stimulating motivation
place help explore reasons for change
staying at a comfy distance be supportive while pt feels resistance
spend time w/ pts even in silence instill hope & avoid confrontation to
limit setting problem solve
point out negative behaviors
28. Stages of 1. precontemplation (no plan to change)
suggest alternative behaviors
Change 2. contemplation (finds problem & thinks,
Use restraints/seclusion if these are
Process ambivalence)
ineffective
3. preparation (ready to work on change)
19. Behaviors that verbal/physical aggression 4. action (initiates change)
Need Immediate self-destructive 5. maintenance (meets goals & avoids
Intervention setting fires relapse)
noncompliance w/ rules & meds
29. Termination Resolution Stage
alcohol/drug use
Stage focus on growth & helping pt develop
manipulation of others
self-responsibility for setting new goals
inappropriate touching of others
reinforce changes in strengths
indecent exposure
attempt to leave hospital w/out 30. Talking about nurse provides written discharge
permission Termination instructions, including referrals (need to be
failure to eat/sleep in pt's native language)
discuss reactions to therapeutic
20. Working Stage clarification of perceptions &
relationship
expectations is identified
ends by saying "goodbye" & "I'm glad I
problems & solutions are further defined
had a chance to work with you"
pt ready to work toward change
stabilization w/ meds, reduction of 31. Violent stay out of striking distance
symptoms Behaviors avoid touching w/out approval
change topic if it escalates
21. Reality Testing helps see reality clearly & objectively in
suggest a time out
order to consider options
avoid entering alone if pt is out of control
constructive feedback helps
leave area temporarily if needed
goal is cognitive restructuring
call for staff help if losing control
22. Cognitive helping pts cope w/ negative thoughts &
32. Hallucinations comment on behavior
Restructuring beliefs
ask for more info if pt hears something
recognize other viewpoints that help
assess for themes of powerlessness,
toward realistic conclusions
hatred, guilt, or loneliness
23. Writing & a release for emotions & can facilitate an focus unnecessary in content is known
Journaling objective analysis of issues distract & teach pt to do it
teach pt to avoid acting on harmful
24. Promoting motivational interviewing
commands
Change ambivalence
express empathy 33. When would when pts have dementia or severe
roll w/ resistance you "ignore & cognitive impairments
support self-efficacy distract?"
25. Motivational pt-centered, directive approach for 34. Delusions clarify meaning
Interviewing enhancing motivation to change by don't argue w/ pt about them (it may
exploring & resolving ambivalence strengthen the pt's belief in them)
watch pt to prevent harm to self/others
26. Ambivalence conflicting feelings
important to explore b/c lasting change
can't happen until pt wants change
35. Conflicting Values understand the pt's POV as the pt 42. Suspiciousness communicate clearly, simply, &
sees it congruently
encourage pts to examine the clarify misinterpretations
effects or outcomes of their beliefs offer rationale for rules, activities,
on their lives occurrences, & noises
supportive confrontation helps pts encourage participation in the milieu
to examine the effect of maladaptive do not force patients to participate
behavior on their lives
43. Hyperactivity upsetting to other patients, to staff,
36. Severe Anxiety & clarify meaning of the and to the patient
Incoherent Speech communication unintentionally harm themselves or
Patterns key into their feelings & underlying others
themes place pt in a quiet area w/ minimal
spend frequent & brief time intervals auditory & visual stimulation
to offer support, & build trust remains calm, speak slowly & softly
respect pt's personal space
37. Manipulation address what is happening or had
offer PRN meds as needed
happened in the nurse-pt relationship
limit setting is useful 44. Transference unconscious emotional reaction that
a power struggle is useless pts in a current situation base on
help pts express their needs directly previous relationships & experiences
can be positive/negative & can
38. Crying allow & encourage
interfere w/ treatment
verbally/nonverbally
it can relieve tension 45. Countertransference may occur in response to a pt's
provide privacy transference
be quiet & unobtrusive
encourage discussion of the
circumstance that precipitated the
tears
39. Sexual Innuendo or ask the pt to stop the behavior
Inappropriate Touch remind the pt that the action is
inappropriate
discuss the underlying need
set limits
refrain from touching pt w/ sexual &
boundary issues
nurse is responsible for maintaining
professional boundaries
40. Denial & Lack of listen
Cooperation clarify
verbalize thoughts to identify
underlying causes
discuss causes, fears, & outcomes of
pt's behavior
nurse's role is to use therapeutic
communication to increase trust
41. Depressed Affect, use patience, frequent contact, &
Apathy, & empathy to assist the pt to recognize
Psychomotor the need for change.
Retardation pt may not have energy to make the
change quickly
improvement in personal hygiene,
proper nutrition, & gradual increase in
activities are encouraged