NURS 3016 FINAL EXAM STUDY GUIDE THE PSYCHIATRIC NURSE PATIENT RELATIONSHIP

NURS 3016 FINAL EXAM STUDY GUIDE THE

PSYCHIATRIC NURSE PATIENT RELATIONSHIP

The Psychiatric Nurse Patient Relationship • Some attributes of mental health o

• Spirituality is one of the highest defense mechanisms we have

▪ Enormous comfort for people especially around loss • Influences that can have an impact on an individual’s mental health o • Mental health continuum of biologically based disorders

o

• Psychosis – patients we will be seeing in inpatient units
• Patients cannot be admitted unless they are imminently a danger to themselves and others

• Key to Recovery in Severe Mental Illness

• Literature Review of 35 studies exploring the lived experience of persons with severe mental illness

disclosed their painful isolation and desire for normalcy.

o Key to recovery is:

▪ Social life and involvement in meaningful activities • All behavior has meaning ▪ Relationships with others based on understanding, trust, acceptance, and valuing of the individual.• Patient is expert in own area of illness • Patient empowerment is key ▪ Treated with respect and given opportunities to be involved in their treatment ▪ “These are remarkably ordinary aspirations that reveal how conspicuously absent these everyday life experiences may be for persons with severe mental illness and how this void may contribute to their experience of suffering. And, while medication will do little to alleviate this kind of suffering, nursing is poised to respond with understanding.” • Definition of a Therapeutic Relationship

• Focus on client issues, problems, and concerns
• Therapeutic Communication Techniques used to identify and explore needs, set goals, assist in

development of new coping skills, encourage behavioral change ▪ Focus on the positives (how have you been managing, etc.)

• Presence and authenticity are key elements when working with those who suffer

▪ Patients will know if you are not listening to them ▪ Need to be an active participant • Establishing a Therapeutic Alliance

• “Psychiatric nurses need to be clear that their role demands both action and stillness. We should not

discount the everyday activities of PMH nurses that bring patients ease during difficult times. Nurses will need to find room for presence so that there is space for the patient's story to emerge.” ▪ Its okay to sit in silent – time to think of what to say and what to do

• RESPECT

▪ Dress and conduct self professionally ▪ Don’t want to trigger patients by our appearance ▪ Want to convey professionalism and our role

• SINCERITY

▪ Be warm but not disingenuous ▪ Be honest

• EMPATHY

▪ Active listening

• Putting the patient at ease

▪ Environment • Privacy yet not in closed isolated space (open area)

• Easily accessible by nursing staff

▪ Interruptions ▪ Appearance and attitude of interviewer • Nonverbal- eye contact, positioning • No touch policy!!• Side of the patient, arms length • Verbal- Confidentiality, sharing information among multidisciplinary team ▪ Context and time • Interviews should be between 30 and 90 minutes ▪ Note-taking • Don’t take notes

• Expressing empathy

▪ Reflection • When you don’t know what to say, reflect on what the patient is saying • “It seems you are afraid you are becoming a burden to your family” ▪ Facilitation • “ Yes, and then? … Go on…” ▪ Silence • Sit in an accepting, supportive environment when affective expression, for instance crying, takes precedence over talk • Some of the most profound things a patient will tell you will be an after a period of silence • Allow the patient the opportunity to collect their thoughts • If the option for MC is “stay with the patient” its most often that answer ▪ Clarification • “When is it you feel most depressed?” ▪ Summation • “Alright, let me be sure I understand everything about what led up to this recent crisis” ▪ Positive Reinforcement • “It must not have been easy to go to work everyday” ▪ Reassurance • Factors Beneficial to Establishing a Therapeutic Alliance

• Consistent, regular, and private interactions with client

▪ Consistency in assigned nurse ▪ Regular routine of activities

• Being honest and congruent
• Letting client set the pace
• Listening to client concerns
• Positive initial attitudes and preconceptions
• Promoting client comfort and balancing control

• Client demonstrating trust and actively participating in relationship

• Phases of the Nurse-Patient Relationship

• Preorientation

▪ Planning for the first interaction with client ▪ Identifying nurse concerns

• Orientation

▪ Compressed due to short hospitalizations; longer in community-based care • Average length is 4-5 days ▪ Issues: trust, parameters of relationship, contract, confidentiality, termination • Phases of the Nurse-Patient Relationship

• Orientation Phase

▪ IDENTIFY YOURSELF AS A STUDENT NURSE FROM BOSTON COLLEGE. PATIENTS HAVE THE

RIGHT TO REFUSE TO BE CARED FOR BY YOU AT ANY TIME.

▪ IF YOU KNOW THE PATIENT PERSONALLY OR SOCIALLY, YOU MUST IMMEDIATELY NOTIFY

YOUR CLINICAL FACULTY AND THE NURSING STAFF.

▪ TO PROTECT THE PATIENT’S RIGHT TO PRIVACY, YOU MAY BE REASSIGNED TO A

DIFFERENT UNIT.

▪ IF YOU HAVE PERSONAL KNOWLEDGE OF A PATIENT OR THEIR FAMILY YOU ARE NOT TO

READ THE PATIENT’S MEDICAL RECORD

• Introductory Phase

▪ Formal introduction and clarification of the purpose of the interview ▪ Observe appearance, psychomotor function, speech, thinking, affect, orientation and memory ▪ 80% of what people communicate to us is non-verbal ▪ Their authenticity is usually reflected in their non-verbal

• Working Phase

▪ Rarely occurs in one time interviews, middle phase of an established therapeutic relationship ▪ Explore unresolved conflicts, expansion of patient’s needs, establishment of new modes of behavior ▪ Establishment of rapport through empathy and compassionate listening ▪ Explore mood, insight, judgment with broad screening questions ▪ Empower patient to make decisions by themselves

▪ Tasks:

• Maintain relationship • Gather further data • Promote client problem-solving skills, self-esteem and communication • Facilitate behavioral change • Overcome resistance behaviors • Evaluate problems and goals and redefine prn • Practice and express alternative adaptive behaviors

• Termination

▪ Set this stage respectfully and in a clear-cut manner • Summarize what has been learned, saying good-bye • Express gratitude to patient in their willingness to share with you • Deal with intense feelings regarding the experience • Summarize goals and objectives achieved • Review client plans for future