The Nurse-Client Relationship in Psychiatric/Mental Health Nursing

This flashcard set summarizes key concepts, facts, and details outlined in the lecture notes on the nurse-client relationship in psychiatric/mental health nursing.

What are the necessary components involved in building the nurse-client relationship?

Trust, genuine interest, empathy, acceptance, and positive regard.

What is self-awareness in the context of nursing?

The ability to observe, pay attention to, and understand one's own responses and reactions in client interactions.

What does therapeutic use of self refer to?

Using one's self as a therapeutic tool to establish relationships and promote client growth.

What are the goals of therapeutic communication?

To establish rapport, actively listen, explore client feelings, and guide problem-solving.

What can erode trust in the nurse-client relationship?

Dishonesty or artificial behavior from the nurse.

Difference between empathy and sympathy?

Empathy involves understanding the client's feelings, while sympathy is feeling pity for the client.

What are examples of self-disclosure in nursing?

Sharing personal experiences or feelings that relate to the client's situation.

Why is self-disclosure sometimes helpful for clients?

It can build rapport and normalize their feelings.

What is the Johari window?

A tool for improving self-awareness and communication.

What is values clarification?

A process to help individuals identify and prioritize their values.

How does the nurse's self-awareness affect the nurse-client relationship?

It can either enhance or hinder the relationship.

What are the three phases of a therapeutic relationship?

Orientation, working, and termination.

What happens during the orientation phase of the therapeutic relationship?

The nurse and client meet to establish roles and clarify expectations.

What does the working phase involve?

Problem identification and the examination of feelings to promote better coping skills.

What is intended by the term 'termination' in a therapeutic relationship?

The phase when the relationship ends after achieving the treatment goals.

What is the importance of boundaries in the nurse-client relationship?

They maintain professional integrity and prevent dual relationships.

What is the role of confidentiality in the nurse-client relationship?

To respect the client's right to privacy regarding their health information.

What is transference?

When a client projects feelings onto the nurse based on past relationships.

What is countertransference?

When a nurse's personal feelings influence reactions towards a client.

Goals of therapeutic communication include establishing what?

Rapport with the client.

What are some nonverbal communication cues?

Body language, facial expressions, and tone of voice.

What is proxemics?

The study of personal space and distance in communication.

What are the characteristics of assertive communication?

Expressing thoughts and feelings openly while respecting others' rights.

What differentiates therapeutic communication from nontherapeutic communication?

Therapeutic communication facilitates interaction, while nontherapeutic impedes it.

How do cultural factors affect the nurse-client relationship?

They influence communication, beliefs, and the understanding of mental health.

What is the importance of cultural awareness in nursing?

It prevents assumptions and promotes respect for individual differences.

What role do social determinants of health play in client responses?

They affect how clients respond to illness and treatment based on socioeconomic factors.

What is an important aspect to consider when conducting a client interview?

Creating a comfortable, private, and safe environment.

What is a mental status examination?

An assessment of cognitive abilities and emotional state of a client.

What baseline data is utilized in a psychosocial assessment?

Client's emotional state, mental capacity, and behavioral function.

What is the process of values clarification used for?

To help individuals recognize what is most important to them.

What is the outcome when a nurse demonstrates acceptance towards a client?

It helps in building trust and improving client relationships.

Why are communication skills important in psychiatric nursing?

They are essential for establishing therapeutic relationships and effective treatment.

What can impact a client's adherence to treatment?

Health literacy, barriers to compliance, and support systems.

What common physiological functions may be impaired in clients with mental disorders?

Eating and sleeping patterns, attention and comprehension.

What is the focus of the nurse-client relationship?

The client's needs, experiences, feelings, and ideas.

What is the therapeutic benefit of using silence in communication?

It allows the client time to reflect and formulate thoughts, and permits the nurse to observe nonverbal cues.

What is the primary risk associated with 'boundary blurring' in the nurse-client relationship?

It can lead to dual relationships and misuse of professional power, undermining the therapeutic goals.

What is the nurse's priority action when identifying countertransference?

Seek clinical supervision to understand the origin of the feelings and ensure professional boundaries are maintained.

What are characteristics of passive communication?

A style characterized by avoiding conflict, failing to express feelings, or allowing others to infringe upon one's rights.

List the major categories assessed during a Mental Status Examination (MSE).

Appearance and behavior, speech, mood and affect, perception, thought process and content, cognition, and insight/judgment.

What is the primary distinction between a therapeutic and a social relationship?

The therapeutic relationship is client-centered, goal-directed, and professional, whereas a social relationship is mutual and focused on shared interests.

When utilizing 'clarification' as a therapeutic technique, what is the nurse seeking?

To ensure mutual understanding by seeking to verify the meaning of the client's message.

In the Mental Status Examination (MSE), how is 'mood' differentiated from 'affect'?

Mood is the client's sustained, subjective emotional state, while affect is the nurse's immediate, objective observation of emotional expression.

What nontherapeutic communication technique is exemplified by phrases like 'Don't worry, everything will be fine'?

Giving false reassurance, which minimizes the client's distress and blocks further communication.

What is the difference between a boundary crossing and a boundary violation in the nurse-client relationship?

A boundary crossing is a deviation from established practice that may or may not benefit the client, while a boundary violation is harmful or exploitative due to blurring professional roles.

What is the therapeutic communication technique 'offering self'?

Making oneself available and showing interest in the client's feelings and needs, demonstrating a desire to understand.

What action is crucial for a nurse to take when a client exhibits distrust or artificial behavior?

The nurse must examine their own behavior and ensure consistency and honesty to rebuild trust.

What is the 'unknown' quadrant of the Johari Window?

Information about the person known neither to the individual nor to others, often subconscious material.

What is the primary task of the client during the working phase of the therapeutic relationship?

To express feelings and begin to examine and

What is the primary establishment made between the client and nurse during the orientation phase?

The therapeutic contract, outlining roles, responsibilities, time, and initial goals.

Define 'Restating' as a therapeutic communication technique.

Repeating the main idea of what the client has said using different words to verify the message and encourage the client to continue.

According to Proxemics, what is the optimal distance for therapeutic conversations with a client?

Within the personal zone, generally ranging from 1.5 to 4 feet, which allows for therapeutic interaction without feeling intrusive.

If a nurse experiences a conflict between their personal values and a client's behaviors, what professional action should they take?

Acknowledge the conflict, use self-awareness to maintain objectivity, and continue to provide nonjudgmental, accepting care focused on the client's needs.

What is a key intervention utilized by the nurse during the working phase to address ineffective client behaviors?

Teaching and practicing new coping skills and encouraging the client to implement behavioral changes in real-life situations.

What is 'focusing' in therapeutic communication?

A technique used to direct the client's attention to a single topic or point to help them expand and clarify, preventing them from jumping between subjects.

Why is asking 'Why' questions generally avoided in therapeutic communication?

They can sound judgmental or accusatory, making the client feel defensive and often leading to a block in further disclosure.

How is 'abstract thinking' assessed during a Mental Status Exam (MSE)?

By asking the client to interpret common proverbs (e.g., 'Don't cry over spilled milk') or identify similarities between two items (e.g., an apple and an orange).

Define 'insight' as part of the Mental Status Exam (MSE).

The client's internal understanding of their own illness and their recognition of the need for psychiatric treatment or help.

What is the 'intimate zone' in proxemics?

The space ranging from 0 to 18 inches (0 to 1.5 feet); it is usually reserved for close family and performing physical procedures.

What is the 'social zone' in proxemics?

The space ranging from 4 to 12 feet, which is common for casual social, business, or professional interactions.

What is 'congruence' in communication?

When a person's verbal and nonverbal messages match, conveying a clear and consistent message to the receiver.

What is 'circumstantial thinking'?

A pattern of speech where a person includes excessive and unnecessary details but eventually returns to the original point.

What is 'tangential thinking'?

A pattern of speech where the client veers off-topic and never returns to the original point or answers the initial question.

How does 'judgment' differ from 'insight' in an MSE?

Insight is understanding the illness itself, whereas judgment is the ability to make logical decisions and behave appropriately in social situations.

What occurs during the therapeutic technique of 'exploring'?

Attempting to delve deeper into a subject, idea, or experience to gather more comprehensive information about the client's perspective.

What is the therapeutic communication technique of 'reflecting'?

Directing the client's feelings, questions, or ideas back to them to encourage recognition and ownership of their own emotions.

What is the 'process' component of communication?

The nonverbal cues, behavior, and underlying meanings that accompany the words being spoken (content).

What constitutes the 'spiritual' portion of a psychosocial assessment?

Assessing the client's beliefs, values, and religious or secular practices that provide meaning, purpose, and hope to their life.

What is 'validation' as a communication technique?

Acknowledging and accepting the client's feelings as real and valid without necessarily agreeing with their interpretation or behavior.

What is the 'Public Zone' in proxemics?

Distances greater than 12 feet (typically extending to 25 feet), used for impersonal communication such as public speaking.

Contrast 'closed-ended questions' with 'open-ended questions'.

Closed-ended questions require specific, one-word answers (e.g., 'yes' or 'no'), while open-ended questions encourage the client to share descriptive and elaborative information.

What is the risk of the nontherapeutic technique of 'giving advice'?

It discourages independent problem-solving, may reinforce a sense of inadequacy, and can make the client feel dependent on the nurse's decision-making.