interaction btwn pt and caregiver promotes health
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.
- primary task
of relationship development
- trust, common interests, nonjudgemental
- demonstrated by warmth and caring
- how psychiatric pt's think
- specifics rather than generalities
- immediate needs rather than eventual outcomes
interventions to promote trust in concrete thinkers(4)
- immediate needs = cold-warm blanket, hunger-food
- trust = honesty, clear/simple reasons, keeping promises
- activities = provide written schedule, attend events pt doesn't want to go to alone
- respect = adhere to unit guidelines, consider pt's preferences when possible, CONFIDENTIALITY
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
- sympathetic- (NOT DESIRABLE) feeling what the pt is feeling, and wanting to alleviate their distress
- Empathetic- understanding pt's pov, maintaing objectivity
4 phases and goal of relationship development
- preinteraction- exploring own perceptions
- orientation- establish trust, formulate contract for intervention
- working- promote client goals
- termination- evaluate goal attainment, and ensure therapeutic closure
- info from charts
- evaluate own responses that may effect care
orientation(introductory) phase
- build trust, rapport
- contract of pt and rn expectations and goals
- explore feelings from intro period
- recognize pt's strengths, limitations
- formulate nrsing dx that are realistic, beneficial to nurse and pt, and agreeable by both
- maintain trust, rapport
- promote pt's views of reality
- overcoming resistance behaviors while problem solving painful issues
- evaluate progress towards goals
- FORM NURSING DX
when pt transfers feelings negative/positive from past on to RN
Interventions and goal for Transference
- Relationship doesnt need to be terminated, except if unsafe
- help pt sort between past and present
- help pt id transferrence and reassign appropriate meanings
- Goal - Pt take responsibility of thoughts, behaviors, feelings, and correct relationship meaning
nurses negative or positive reaction to pt, usually unconscious, sometimes based on past people/experiences
interventions for countertransferrence
- relationship doesnt need to be terminated
- supported assitively by other staff to examine phenomenon
termination phase occurs when:
- progress has been made towards goals
- feelings of separation are explored by pt and rn
- a plan of continued care is established for stressful times of life
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
- native americans and asians may be uncomfortable
- high anxiety pt's
when are romantic/personal with pt's ok?
warning signs of personal boundary breaches(unproffesional)
- favoring pt
- changing work cycle to favor one pt
- continuing contact after discharge
- sharing personal or work concerns with pt
territoriality and its implications for therapeutic communication
- tendency for individuals to own space/laying claim
- communication can be more effective if takes place in neutral space
- interview room rather than pt room or rn's office
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
relationship? A Acknowledge the client’s actions and generate alternative behaviors B Establish rapport and develop treatment goals C Attempt to find alternative placement D Explore how thoughts and feelings about this client may adversely impact ca
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
characterized by an agreement to continue to meet and work on setting client-centered goals? A Preinteraction B Orientation C Working D Termination
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.”
B. “I might have a hard time working with you. You remind me of my
mother.”
C. “I really don’t want to talk any more about my childhood abuse.”
D. “I’m not sure that I can count on you to protect my confidentiality.”
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
C. “You seem depressed. It was a difficult decision to make. Would you like to talk about it?” D. “I know this is a difficult time for you. Would you like a prn medication for anxiety?”
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.”
B. “You are sad, but you must be strong for your other children.”
C. “Once you cry it all out, things
will seem so much better.”
D. “It must be horrible to lose a child; I’ll stay with you until your husband arrives.”
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
B. Genuineness
C. Sympathy
D. Rapport
On which task should a nurse place priority during the working phase of relationship development? A. Establishing a
contract for intervention
B. Examining feelings about working with a particular client
C. Establishing a plan for continuing aftercare
D. Promoting the client’s insight and perception of reality
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. “Remember, we have a professional relationship. Are you feeling uncomfortable?”
C. “We have discussed this before. I am not allowed to date clients.”
D. “I think you should discuss your fantasies with your therapist.”
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.
B. The client is using the defense mechanism of denial.
C. The client is having trouble
terminating the relationship.
D. The client is using “splitting” as a way to remain dependent on the nurse.
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.
C. The nurse monitors the administration of medications and watches for signs of “cheeking.”
D. The nurse explains, in language the client can understand, information related to the client’s health
care.
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.
B. The nurse plays cards with a small group of clients.
C. The nurse discusses childhood events that may affect personality development.
D. The nurse provides a safe social environment.
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.”
B. “A longterm goal for someone your age would be to develop better job skills.”
C. “Which identified problems would you like for us to initially address?”
D. “I think first we need to focus on your relationship issues.”
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.
Resolution of the client’s problems
C. Using therapeutic communication to clarify perceptions
D. Helping the client access outpatient treatment
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
me talk to your supervisor.”
C. “I don’t seem to be able to relate to people. I would rather stay in my room and be
by myself.”
D. “My mother is the source of my problems. She has always told me what to do and what to say.”
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.
D. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit.
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
together.”
C. “Reviewing the changes that have happened during our time together has helped me
put things in perspective.”
D. “I don’t know
how comfortable I will feel when talking to someone else.”
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
B. When the nurse has a duty to warn
C. When the nurse feels emotionally indebted toward the client
D. When it is judged that the information may benefit the client
D Selfdisclosure on the part of the nurse may be appropriate when it is judged that the information
may
therapeutically benefit the client. It should never be undertaken for the purpose of meeting the
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. Ensuring therapeutic termination
C. Promoting client insight into problematic behavior
D. Collaborating to
set appropriate goals
E. Meeting both the physical and psychological needs of the client
B, C, D, E The nurse–client therapeutic relationship should include ensuring therapeutic termination,
promoting client insight into problematic behavior, collaboration to set appropriate goals, and
meeting the physical and psychological needs of the client. The nurse’s psychological needs
should not be addressed within the
nurse–client relationship.
- Sit square, facing pt
- Open body
- Lean towards pt
- Establish direct eye contact
- Relax
Verbatim account of verbal and nonverbal interaction between student and pt. NOT documentation- used for learning and analysis
- Information given to pt to help modify behavior
- Focus on behavior, NOT client
- Be descriptive, objective
- No judgement(don't evaluate)
- No advice
- Specific
- As close to event that needs feedback as possible
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