Chap 5 and 6 mental health

CHAPTER 5 — Therapeutic nurse-patient relationship

A professional, goal-directed relationship focused entirely on the patient's healthcare needs rather than the nurse's personal needs.

CHAPTER 5 — Social vs. therapeutic relationship

A social relationship meets both people's needs; a therapeutic relationship is focused on the patient's needs.

CHAPTER 5 — Therapeutic use of self

The nurse consciously uses personality, self-awareness, and communication skills to establish a relationship and provide effective interventions.

CHAPTER 5 — Rapport

A sense of harmony and connection created through acceptance, warmth, friendliness, trust, common interest, and a nonjudgmental attitude.

CHAPTER 5 — Trust

Confidence that the nurse is reliable, honest, consistent, sincere, and willing to help.

CHAPTER 5 — Nursing actions that build trust

Keep promises, follow through, meet basic needs, explain rules clearly, maintain confidentiality, listen, be honest, and remain consistent.

CHAPTER 5 — Concrete thinking

Literal interpretation of words with difficulty understanding abstract ideas; the nurse should communicate simply, clearly, and concretely.

CHAPTER 5 — Respect

Believing in the dignity and worth of the patient regardless of whether the nurse approves of the patient's behavior.

CHAPTER 5 — Unconditional positive regard

Carl Rogers's term for accepting and respecting a person as worthwhile without requiring the person to meet certain behavioral standards.

CHAPTER 5 — Ways to communicate respect

Use the patient's preferred name and pronouns, provide privacy, listen without judgment, allow time for questions, be honest, and include the patient in decisions.

CHAPTER 5 — Genuineness

Being open, honest, and real so the nurse's words, behavior, and internal feelings are congruent.

CHAPTER 5 — Appropriate self-disclosure

Limited personal information shared only when it benefits the patient; the focus must quickly return to the patient.

CHAPTER 5 — Empathy

Understanding the patient's thoughts and feelings from the patient's perspective while remaining objective.

CHAPTER 5 — Sympathy

Becoming emotionally involved in the patient's distress, which can cause the nurse to lose objectivity.

CHAPTER 5 — Preinteraction phase

Before meeting the patient, the nurse reviews information, examines personal feelings and biases, identifies possible countertransference, and plans the first interaction.

CHAPTER 5 — Orientation phase

The nurse and patient establish trust, clarify roles and boundaries, discuss confidentiality, identify problems, set goals, create a contract, and discuss termination.

CHAPTER 5 — Working phase

The nurse and patient explore feelings and stressors, identify unhealthy behaviors, develop coping and problem-solving skills, practice change, and evaluate progress.

CHAPTER 5 — Termination phase

The relationship ends; the nurse reviews progress, discusses feelings about separation, identifies future coping strategies, and avoids promises of personal contact.

CHAPTER 5 — Possible reactions to termination

Sadness, anger, anxiety, denial, regression, or renewed dependency.

CHAPTER 5 — Transference

The patient unconsciously transfers feelings about a significant person from the past onto the nurse.

CHAPTER 5 — Countertransference

The nurse unconsciously transfers personal feelings about someone from the past onto the patient.

CHAPTER 5 — Material boundaries

Professional limits involving money, possessions, services, and gifts.

CHAPTER 5 — Social boundaries

Limits that keep the therapeutic relationship from becoming a friendship or social relationship.

CHAPTER 5 — Professional boundaries

Limits established by the nurse's professional role, ethical standards, and responsibility to the patient.

CHAPTER 5 — Personal boundaries

The nurse's and patient's physical, emotional, and private limits.

CHAPTER 5 — Boundary warning signs

Favoring one patient, spending excessive time together, keeping secrets, excessive self-disclosure, inappropriate gifts, social meetings, or feeling responsible for saving the patient.

CHAPTER 5 — Confidentiality

The nurse protects patient information but must disclose information when required by law or needed to protect the patient or others from serious harm.

CHAPTER 5 — Territoriality

A person's need to claim and defend a particular space.

CHAPTER 5 — Density

The number of people within a given amount of space.

CHAPTER 5 — Four communication distances

Intimate, personal, social, and public distance; culture affects preferences for personal space.

CHAPTER 5 — Paralanguage

How words are spoken, including tone, pitch, rhythm, speed, volume, pauses, and inflection.

CHAPTER 5 — Verbal and nonverbal conflict

When spoken words and nonverbal behavior disagree, the nonverbal message is often considered more accurate.

CHAPTER 5 — Silence

A therapeutic technique that gives the patient time to think, organize thoughts, experience feelings, and continue speaking.

CHAPTER 5 — Offering self

Making oneself available without demanding a response, such as "I'll stay with you."

CHAPTER 5 — Broad opening

Allows the patient to choose the topic, such as "What would you like to talk about?"

CHAPTER 5 — General lead

Encourages the patient to continue, such as "Go on" or "And then?"

CHAPTER 5 — Making observations

Verbalizing what the nurse notices, such as "You appear tense."

CHAPTER 5 — Restating

Repeating the main idea of the patient's message to confirm understanding and encourage continuation.

CHAPTER 5 — Reflecting

Directing the patient's feelings, ideas, or questions back to the patient to encourage independent thinking.

CHAPTER 5 — Clarifying and validating

Clarifying seeks explanation of an unclear message; validating confirms that the nurse understood the patient correctly.

CHAPTER 5 — Focusing

Concentrating on one important point instead of allowing the interaction to remain vague or scattered.

CHAPTER 5 — Exploring

Examining a topic, idea, experience, or relationship more deeply.

CHAPTER 5 — Presenting reality

Acknowledging the patient's experience while stating what is real, such as "I understand you hear voices, but I do not hear them."

CHAPTER 5 — Voicing doubt

Expressing uncertainty about an unrealistic perception without arguing, such as "That seems difficult to believe."

CHAPTER 5 — Verbalizing the implied

Putting into words what the patient has indirectly suggested.

CHAPTER 5 — Translating words into feelings

Identifying the emotion suggested by the patient's words or behavior.

CHAPTER 5 — Formulating a plan of action

Helping the patient identify what to do when a stressful situation occurs again.

CHAPTER 5 — Motivational interviewing

A patient-centered strategy that uses open questions and empathy to help the patient resolve uncertainty and identify personal reasons for behavior change.

CHAPTER 5 — Principles of motivational interviewing

Express empathy, avoid arguing, develop discrepancy between behavior and goals, work with resistance, and support the patient's ability to change.

CHAPTER 5 — Common nontherapeutic techniques

Giving advice, false reassurance, "why" questions, probing, judging, approving or disapproving, defending, rejecting, minimizing, interpreting, clichés, and changing the subject.

CHAPTER 5 — False reassurance

A nontherapeutic response that dismisses concerns with unsupported statements such as "Everything will be fine."

CHAPTER 5 — Responding to hallucinations or delusions

Do not argue or reinforce the belief; acknowledge the patient's experience, present reality, explore feelings, and assess safety.

CHAPTER 5 — Active listening

Giving complete attention while using an open posture, culturally appropriate eye contact, silence, observation, clarification, reflection, and summarization.

CHAPTER 5 — Process recording

A written analysis of a nurse-patient interaction that includes spoken words, nonverbal behavior, the nurse's thoughts and feelings, and evaluation of each response.

CHAPTER 5 — Effective feedback

Feedback should be specific, timely, respectful, descriptive rather than judgmental, and focused on behavior the patient can change.

CHAPTER 6 — Nursing process sequence

Assessment, Diagnosis, Outcome identification, Planning, Implementation, and Evaluation—remember ADOPIE.

CHAPTER 6 — Assessment

Systematic collection and analysis of subjective and objective information from the patient, family, observation, examination, records, and healthcare team.

CHAPTER 6 — Subjective data

Information reported by the patient, such as "I feel hopeless."

CHAPTER 6 — Objective data

Information observed or measured by the nurse, such as pacing, crying, vital signs, or disorganized speech.

CHAPTER 6 — Five social determinants of health

Economic stability; education access and quality; healthcare access and quality; neighborhood and built environment; social and community context.

CHAPTER 6 — Mental status assessment areas

Appearance, behavior, attitude, speech, mood, affect, thought process, thought content, perception, cognition, orientation, memory, concentration, insight, judgment, and safety.

CHAPTER 6 — Priority psychiatric assessment

Assess immediate safety, including suicidal thoughts, homicidal thoughts, self-harm, aggression, hallucinations, severe withdrawal, and ability to meet basic needs.

CHAPTER 6 — Nursing diagnosis

A clinical judgment describing the patient's actual or potential response to a health condition or life process and guiding nursing interventions.

CHAPTER 6 — Medical vs. nursing diagnosis

A medical diagnosis identifies a disease; a nursing diagnosis identifies the patient's response to the disease or situation.

CHAPTER 6 — Priority setting order

Immediate life and safety threats first, followed by physiological needs, risk of harm, severe functional problems, and then psychosocial or long-term needs.

CHAPTER 6 — Outcome identification

Establishing measurable, realistic, patient-focused goals that describe the expected change in the patient.

CHAPTER 6 — Characteristics of a strong outcome

Specific, measurable, attainable, relevant, time limited, and focused on the patient rather than the nurse.

CHAPTER 6 — Nursing Outcomes Classification (NOC)

A standardized system of names and measures used to describe and evaluate patient outcomes.

CHAPTER 6 — Planning

Prioritizing problems and choosing individualized, evidence-based nursing interventions to achieve short- and long-term outcomes.

CHAPTER 6 — Implementation

Carrying out planned nursing interventions, coordinating care, teaching, protecting safety, administering treatments, advocating, and documenting responses.

CHAPTER 6 — Nursing Interventions Classification (NIC)

A standardized system of names for nursing interventions.

CHAPTER 6 — Evaluation

Determining whether outcomes were achieved and whether the care plan should be continued, modified, or ended.

CHAPTER 6 — Action when an outcome is not achieved

Reassess the patient, determine why the plan was ineffective, and modify the diagnosis, outcome, or interventions rather than blaming the patient.

CHAPTER 6 — Psychiatric nursing care principles

Care should be patient-centered, recovery-focused, trauma-informed, culturally responsive, evidence-based, collaborative, and safety-focused.

CHAPTER 6 — Interdisciplinary treatment team

Professionals from multiple disciplines collaborate to assess the patient, plan and provide care, evaluate progress, and coordinate services.

CHAPTER 6 — Nurse's role on the treatment team

Contribute assessment findings, implement and evaluate care, monitor safety and progress, communicate changes, educate, and advocate for the patient.

CHAPTER 6 — Case management

Coordinating providers, services, referrals, resources, discharge, and transitions to promote quality, continuity of care, and cost control.

CHAPTER 6 — Critical pathway of care

A multidisciplinary plan listing expected treatments, interventions, and outcomes for a condition within a specified time frame.

CHAPTER 6 — Variance

A difference between the patient's actual progress and the expected critical pathway.

CHAPTER 6 — Concept mapping

A visual method connecting assessment findings, diagnoses, interventions, treatments, disciplines, and outcomes to support clinical judgment and prioritization.

CHAPTER 6 — Qualities of proper documentation

Accurate, objective, timely, complete, relevant, confidential, and free of judgmental language.

CHAPTER 6 — SOAPIE documentation

Subjective data, Objective data, Assessment, Plan, Intervention, and Evaluation.

CHAPTER 6 — Focus Charting DAR format

Data, Action, and Response; the focus can be a problem, behavior, symptom, event, or change in condition.

CHAPTER 6 — PIE documentation

Problem, Intervention, and Evaluation.

CHAPTER 6 — Benefits of electronic health records

Improved access, communication, efficiency, decision support, safety monitoring, quality measurement, and reduced duplication.

CHAPTER 6 — Risks of electronic health records

Privacy breaches, copying incorrect or outdated information forward, and documenting in the wrong patient's record.

CHAPTER 6 — Assessment step example

The nurse collects data, such as noting that the family reports a recent suicide attempt.

CHAPTER 6 — Diagnosis step example

The nurse identifies the patient as being at risk for suicide based on the assessment findings.

CHAPTER 6 — Outcome step example

The nurse establishes a measurable patient goal, such as the patient will not harm self during hospitalization.

CHAPTER 6 — Planning step example

The nurse prioritizes maintaining a safe environment and selects appropriate suicide-prevention interventions.

CHAPTER 6 — Implementation step example

The nurse carries out the plan by collaborating on a safety plan and implementing suicide precautions.

CHAPTER 6 — Evaluation step example

The nurse determines whether the interventions were effective and whether the patient achieved the expected safety outcome.