interaction btwn pt and caregiver promotes health Show
Peplau's Theory of Interpersonal Nursing a rn working with pt to find solution, results in respect as two DIFFERENT people work towards same goal- health Travelbee's Theory of interpersonal nursing creating a human to human(not seeing pt as illness) relatonship is a significant experience using personality, as a tool to establish progress towards goals. must possess self awareness and beliefs.
interventions to promote trust in concrete thinkers(4)
unconditional positive regard respecting a client, who's behavior has had them rejected before, valuing their uniqueness and accepting them as is nursing by being "real" not saying just what a client wants to hear, or what is professional, but being human sympathetic vs empathetic nursing
4 phases and goal of relationship development
orientation(introductory) phase
when pt transfers feelings negative/positive from past on to RN Interventions and goal for Transference
nurses negative or positive reaction to pt, usually unconscious, sometimes based on past people/experiences interventions for countertransferrence
termination phase occurs when:
when is self-disclosure appropriate with pt only when therapeutically beneficial to pt, and not to nurse never acceptable if financial, must be in line with institutional policies, and intent of gift giver examined when is it unacceptable to touch
when are romantic/personal with pt's ok? warning signs of personal boundary breaches(unproffesional)
territoriality and its implications for therapeutic communication
density and behavioral implications higher amt of people in space results in more aggression 0-18 inches, avg space for intimiate individuals to communicate for friends, 18-40 inches for strangers, in public 4-12 feet 12-25 feet, interactions with public figures What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? A To clarify personal attitudes, values, and beliefs B To obtain thorough assessment data C To determine the client’s length of stay D To establish personal goals for the interactio A The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding one’s own attitudes, values, and beliefs is called self-awareness A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. A nurse streamlines the assessment, verbally assures safety, and provides a warm meal. What is the nurse promoting by these actions? A Sympathy B Trust C Veracity D Manipulation B The nurse is promoting trust by streamlining the assessment, assuring safety, and providing a warm meal. Trust implies a feeling of confidence in that a person is reliable and sincere and has integrity and veracity. Trustworthiness is demonstrated though nursing interventions that convey a sense of warmth and caring to the clien Which is the best nursing action when a client demonstrates transference toward a nurse? A Promoting safety and immediately terminating the relationship with the client B Encouraging the client to ignore these thoughts and feelings C Immediately reassigning the client to another staff member D Helping the client to clarify the meaning of the current nurse–client relationshi D The nurse should respond to a client’s transference by clarifying the meaning of the nurse–client relationship based on the current situation. Transference occurs when the client unconsciously displaces feelings toward the nurse about a person from the past. The nurse should assist the client in separating the past from the present What is the priority nursing action during the orientation (introductory) phase of the nurse–client B The priority nursing action during the orientation phase of the nurse–client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurse–client relationship
Which client response should a nurse expect during the working phase of the nurse–client relationship? A The client gains insight and incorporates alternative behaviors. B The client and nurse establish rapport and mutually develop treatment goals. C The client explores feelings related to reentering the community. D The client explores personal strengths and weaknesses that impact behavior A The nurse should expect that the client would gain insight and incorporate alternative behaviors during the working phase of the nurse–client relationship. The client may also overcome resistance, problem solve, and continually evaluate progress toward goal What should be the nurse’s primary goal during the preinteraction phase of the nurse–client relationship? A To evaluate goal attainment and ensure therapeutic closure B To establish trust and formulate a contract for intervention C To explore self-perceptions D To promote client change C The nurse’s primary goal of the preinteraction phase should be to explore self-perceptions. The nurse should be aware of how any preconceptions may affect his or her ability to care for individual clients. Another goal of the preinteraction phase is to obtain available client informatio Which phase of the nurse–client relationship begins when the individuals first meet and is B The orientation phase is when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals. There are four phases of relationship development: preinteraction, orientation, working, and termination Which pt should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse–client relationship? A. “I can’t bear the thought of leaving here and failing.” C The nurse should identify that the client statement, “I really don’t want to talk any more about my childhood abuse.” reflects that the client is in the working phase of the nurse–client relationship. The working phase includes overcoming resistant behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issue A client has made the decision to leave her alcoholic husband. She is feeling very depressed. Which nontherapeutic statement by the nurse conveys sympathy? A. “You are feeling very depressed. I felt the same way when I decided to leave my husband.” B. “I can understand you are feeling depressed. It was a difficult
decision. I’ll sit with A The nurse’s statement, “You are feeling very depressed. I felt the same when I decided to leave my husband,” is a nontherapeutic statement that conveys sympathy. Sympathy implies that the nurse shares what the client is feeling and by this personal expression alleviates the nurse’s distress A mother notified that her child was killed in a tragic car accident states “I can’t bear to go on with my life.” , Which nursing statement conveys empathy? A. “This situation is very sad, but time is a great healer.” D The nurse’s response, “It must be horrible to lose a child; I’ll stay with you until your husband arrives.” conveys empathy to the client. Empathy is the ability to see the situation from the client’s point of view. Empathy is considered to be one of the most important characteristics of the therapeutic relationship If an individual is “twofaced,” which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing? A. Respect On which task should a nurse place priority during the working phase of relationship development? A. Establishing a
contract for intervention D The nurse should place priority on promoting the client’s insight and perception of reality during the working phase of relationship development. Establishing a contract for intervention would occur in the orientation phase. Examining feelings about working with a client should occur in the preinteraction phase. Establishing a plan for aftercare would occur in the termination phase A client diagnosed with paranoid schizophrenia becomes agitated when asked to play a game. The client responds, “Do you want to be my girlfriend?” Which nursing response is most appropriate? A. “You are upset now. It would be best if you go to
your room until you feel better.” B The nurse should promote the client’s insight and perception of reality by confirming appropriate roles in the nurse–client relationship and identifying what is troubling the client in this situatio A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, “You’re the only one who can make me well.” What does this client response indicate to the nurse? A. The client is using manipulation to receive secondary gain. C Termination should begin in the orientation phase to minimize feelings of loss when the nurse– client relationship ends. When a client feels sadness and loss, behaviors to delay termination may become evident. According to
Peplau, which nursing action demonstrates the nurse’s role as a resource person? A. The nurse balances a safe therapeutic environment to increase the client’s sense of belonging. B. The nurse holds a group meeting with the clients on the unit to discuss common feelings about mental illness. D According to Peplau, a resource person provides specific answers to questions usually formulated with relation to a larger problem According to Peplau, which nursing intervention is most appropriate when the nurse is functioning in the role of a surrogate? A. The nurse functions as a nurturing parent in order to build a trusting
relationship. A According to Peplau, when a client is acutely ill, he or she may incur the role of infant or child while the nurse is perceived as the mother surrogate As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurse’s most therapeutic statement? A. “I want to assure you that I will maintain your confidentiality.” C When moving on a continuum from the orientation to working phase of the nurse–client relationship, identified goals are addressed through mutual therapeutic work to promote client behavioral change What is the main goal of the working phase of the nurse–client therapeutic relationship? A. Role modeling to improve interaction with others B The goal of the working phase of the nurse–client therapeutic relationship is to resolve client problems by promoting behavioral change Which client statement may indicate a transference
reaction? A. “I need a real nurse. You are young enough to be my daughter and I don’t want to tell you about my personal life.” B. “I deserve more that I am getting here. Do you know who I am and what I do? Let A Transference occurs when a client unconscientiously displaces, or “transfers,” to the nurse feelings formed toward a person from the past. Which nursing action demonstrates the role of the teacher in a therapeutic milieu? A. The nurse implements a selfaffirmation exercise during a onetoone client interaction. B. The nurse holds a group meeting to
present common side effects of psychiatric medications. C. The nurse introduces the concept of fair play while playing cards with a group of clients. B The nurse, in the role of teacher, identifies learning needs and provides information required by the client or family to improve the client’s health Which client statement indicates that termination of the therapeutic nurse–client relationship has been handled successfully? A. “I know I can count on you for continued support.” B. “I am looking forward to discharge, but I am surprised that we will no longer work C Termination should begin in the orientation phase to minimize feelings of loss when the nurse– client relationship ends. Bringing a therapeutic conclusion to the relationship occurs when progress has been made toward attainment of mutually set goals When is selfdisclosure by the
nurse appropriate in a therapeutic nurse–c lient relationship? A. When it is judged that the information may benefit the nurse and client D Selfdisclosure on the part of the nurse may be appropriate when it is judged that the information The nurse–client therapeutic relationship includes which of the following characteristics? (Select all that apply.) A. Meeting the psychological needs of the nurse and the client B, C, D, E The nurse–client therapeutic relationship should include ensuring therapeutic termination,
Verbatim account of verbal and nonverbal interaction between student and pt. NOT documentation- used for learning and analysis
purpose of therapenutic silence allows client to take advantage of discussion therapeutic purpose of giving broad openings allows client to select topic therapeutic purpose of restating whether an expressed statement has or has not been understand therapeutic purpose of reflecting directs feelings back to clients so they may be recognized or understood therapeutic purpose of voicing doubt expresses uncertainity tas to reality of pt's perception
therapeutic purpose of verbalizing the implied puts into words what client is implied therapeutic purpose of formulating plan of action striving to prevent anger/anxiety from escalating to unmanageable level when stressor occurs why nontherapeutic: reassurance may discourage client from further expression why nontherapeutic: rejecting refusing to consider client's ideas or behavior why nontherapeutic: approving/disapproving implies rn has right to pass judgement of goodness or badness of client's behavior why nontherapeutic: agreeing/disagreeing rn is not to pass judgement on whether ideas are right or wrong why nontherapeutic: giving advice implies rn knows what is best for pt why nontherapeutic: probing makes client feel like they are only being used for information why nontherapeutic: defending to defend what pt criticizes implies pt doesnt have right to express feelings why nontherapeutic: explanation asking why implies pt must defend feelings why nontherapeutic: indicating existence of external sources of power allows pt to project blame for thoughts/behaviors on third party why nontherapeutic: belittling causes pt to feel unimportant why nontherapeutic: making stereotype comments, cliches meaningless in rn-pt reationship why nontherapeutic: denial blocks discussion to areas that of difficulty Which of the following is the most appropriate topic during the orientation phase of nurse patient relationship?The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals.
What do you do during orientation phase?The goal of the orientation phase is to build trust and respect. During this phase, the roles and limitations of the relationship are communicated through pleasant greetings, eye contact, and mindfulness of the patient's boundaries.
What is the most important information the nurse should share with the patient during the orientation phase?3. What is the most important information the nurse should share with the patient during the orientation phase? A During the orientation phase the nurse shares his or her name, credentials, and extent of responsibilities.
What should be built with the client and the nurse during the orientation phase?Nurse Patient Relationship : Example Question #2
Explanation: During the orientation phase the nurse should establish acceptance, trust, and boundaries with the client, which will be built upon in later phases.
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Which of the following is the most appropriate topic during the orientation phase of nurse
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