CA2_Psychia (PART 2)

Crisis

is a turning point in an individual’s life that produces an overwhelming emotional response

Maturational

Adventitious

Situational

What are the categories of crisis?

M - A - S

Maturational

What category of crisis is this: developmental crises, are predictable events.

• Ex: entering preschool, high school, adolescence, college, marriage, having a child, mid-life transitions, or retirement

Adventitious

What category of crisis is this: are rare, unexpected events that disrupt daily life and are often beyond an individual's control.

• Ex: social crisis; natural disaster, rape, violent crimes, murder

Situational

What category of crisis is this: are sudden, unexpected events that disrupt a person's life and can cause emotional distress.

• Ex: death, loss of job, illness, are unanticipated

• event

• emotional

• coping mechanisms

Factors that influence whether an individual experiences crisis:

• The individual’s perception of the _______

• The availability of _______ supports

• The availability of adequate _______ _______

Focus of Crisis Intervention

Stabilization, reduction of symptoms and prevention of relapse that will require inpatient care.

Directive Intervention

Supportive Intervention

What are the techniques for Crisis Intervention?

Directive Intervention

use to assess the person’s health status and promote problem solving.

• Offering new information, knowledge, or meaning

• Raising the person’s self-awareness by providing feedback about behavior

• Directing the person’s behavior by offering suggestions or course of action

Supportive Intervention

aim at dealing with the person’s needs for empathetic understanding

• Discuss feeling

• Serving as a sounding board for the person

• Affirming the person’s self-worth

Therapeutic relationship

Is at the very core of nursing and is established using knowledge and skills as well as applying caring attitudes and behaviors.

Therapeutic relationship

• It is objective

• The intent is for the patient behavior to change

Therapeutic relationship

It is goal oriented, directed toward learning and growth promotion to facilitate a change in the client’s life this relationship is a nurse-client interaction that focuses on the client needs and is goal specific.

True

True or False: Establishing of a therapeutic relationship is a basis of all nursing care of the clients with mental illness.

psychiatric unit

serves as a social system in its own right.

Therapeutic environment

• Promotes a fundamental respect of individuals, clients, and staff alike

• Uses opportunities for communication between the client and staff for maximum therapeutic benefit

• Encourages clients to act at a level equal to their ability and to enhance self esteem

• Promotes socialization

• Provides opportunities for clients to be part of the unit’s management.

Safety

Trust

What are the 2 important factors in therapeutic environment?

Counselor

Teacher

Resource person

Leader

Surrogate

Stranger

The nurse assumes multiple roles in interpersonal relationship with patients, what are these?

C - T - R - L - SS

Counselor

working with patient on current problems

Teacher

offering information and helping the patient learn

Resource person

interpreting medical plans for the client

Leader

working with the patient democratically

Surrogate

figurative standing in for a person in the patient’s life

Stranger

accepting the patient objectively

Meta communication

role expectation in communication; knowing what is about to say based on non-verbal cues

Counter transference

Anger

Transference

Sympathy

What are the issues involved in the Nurse-Patient relationship?

C - A - T - S

Counter transference

nurses conscious or unconscious displacement upon the client of feelings or attitudes in the past

Anger

the nurse may feel angry with the client’s behavior (past/present)

Transference

client’s unconscious displacement upon the nurse of feelings or attitude experienced in another relationship

Sympathy

the nurse feels what the patient feels leads to loss of objectivity, comforting, reassuring, or pitying patients

Genuine Interest

Acceptance

Positive Regard

Trust

What are the components of a therapeutic relationship?

G - A - P - T

Genuine Interest

• When the nurse is comfortable with himself/herself, aware of her strengths and limitations, clearly focused

• Nurse displays congruent behavior

• Nurse is open and honest

Acceptance

Avoiding judgments of the person, no matter what the behavior, acceptance of the person as worthy

Positive Regard

• unconditional nonjudgmental attitude

• the nurse who appreciates the client as a unique worth-while human being can respect the client regardless of his/her behavior, background, lifestyle

• calling client by name

• spending time with client

• listening and responding openly

• considering the client’s ideas and preferences when planning care

Trust

• Is built when the client is confident in the nurse and when the nurse’s presence conveys integrity and reliability

• Behaviors the nurse can exhibit to help build client’s trust

• Caring, interest, understanding, consistency, honesty, keeping promises, listening to the client

Self-awareness

The process of developing an understanding of one’s own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths and limitations and how these qualities affect others.

Values

abstract standards that give a person a sense of right and wrong and establish a code of conduct for living (ex. Hard work, honesty, sincerity, cleanliness, orderliness)

Beliefs

ideas that one holds to be true

Attitude

• General feelings or a frame of reference around which a person organizes knowledge about the world

• (Ex. Hopeful, optimistic, pessimistic, positive, negative)

• A positive mental attitude occurs when a person chooses to put a positive spin on an experience, a comment, judgment

Johari Window

It's a framework that divides a person's self into four quadrants based on what they and others know about them: Open, Blind, Hidden, and Unknown. This helps individuals understand themselves better and build stronger relationships. 

Quadrant 1: Open/Public

What quadrant is this in Johari Window:

• self qualities one knows about oneself and others also know

Quadrant 2: Blind/Unaware

What quadrant is this in Johari Window:

• self qualities known only to others

Quadrant 3: Hidden/Private

What quadrant is this in Johari Window:

• self qualities known only to oneself

Quadrant 4: Unknown

What quadrant is this in Johari Window:

• an empty, undiscovered by oneself or others

Social Relationship

Intimate Relationship

Therapeutic Relationship

What are the types of relationship?

S - I - T

Social Relationship

• Primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of task

• Communication is superficial, focus on sharing ideas, feelings and experiences

• Advice is often given

Intimate Relationship

• Involves 2 people who are commonly committed to each other.

• Both parties are concerned about having their needs meet.

Therapeutic Relationship

• Focuses on the needs, experiences, feelings and ideas of the client only.

• Nurses uses communication skills, personal strengths and understanding of human behavior to interact with the client

• With clear parameters: the focus is the client’s needs

Orientation phase

Working phase

Termination phase

What are the phases of therapeutic relationship?

Orientation phase

• (major emphasis is establishing trust)

• TRUST is facilitated by the use of: genuineness, empathy, positive regard, consistency, offering assistance in alleviating the client’s problems or pain

• Build trust and security is the level of any interpersonal experience

Orientation phase

Essential issues:

• Parameters of the relationship

• Formal or informal contacts

• Confidentiality

• Termination

Be aware to themes:

• Content (what the patient is saying)

• Process (how the patient interacts)

• Mood

• Interaction (did the client ignore you, was the patient submissive, did the patient dominate the conversation)

• Observe and assess patient’s strength and positive aspect on personality

• Identify problems, nursing diagnosis, formulate plan of care

Working phase

• focus is here and now

Specific tasks:

• Maintain the relationship

• Gather further information

• Promote the client’s problem-solving skills, self-esteem and the use of language

• Facilitate behavioral changes

• Overcome resistance behaviors

• Evaluate problems and goals: redefine as needed

• Promote practice and expression of alternative adaptive behaviors

Set priorities when determining patient needs:

• Preserve life and safety- is patient suicidal, not eating, smoking in bed while medicated, acting out behavior harmful to others?

• Modify behavior that is unacceptable to others such as: acting out, hostile verbalization, bizarre behavior, withdrawal, poor hygiene, inadequate social skills

• Identify with patient those behaviors client is willing to change. This will increase sense of self-worth and help patient accept need for growth

Termination phase

Reasons to terminate the therapeutic relationship:

• Symptom relief

• Improved social functioning

• Increased sense of identity

• Development of adaptive behavior

• Achievement of goals

• Impasse in therapy – the nurse is unable to help the client further resolve issues

• Forced termination- change in staff, client is discharged

Methods of decreasing involvement:

• Space your contacts farther apart

• Reduce the usual length of time spend with client

• Change emotional tone of the interactions

• Focusing on future-oriented material

• Not responding to or following up clues that led to new areas to investigate

Impasse in therapy

the nurse is unable to help the client further resolve issues

Forced termination

change in staff, client is discharged

Therapeutic communication

Is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specific needs to promote effective exchange of information.

Proxemics

the study of distance zones between people during communication

0-18 inches

What is the distance in Intimate zone?

Intimate zone

This amount of space is comfortable for parents withyoung children, people who mutually desire personal contact, or people whispering.

Personal zone

This distance is comfortable between family and friends who aretalking

18-36 inches

What is the distance in Personal zone?

Social zone

This distance is acceptable for communication in social, work, andbusiness settings

4-12 ft

What is the distance in Social zone?

Public zone

This is an acceptable distance between a speaker and an audience,small groups, and other informal functions

12-25 ft

What is the distance in Public zone?

Functional-professional touch

A type of touch that is used in examinations or procedures

Social-polite touch

An example of this type of touch is handshake

Friendship-warmth

An example of this type of touch are: hug in greeting, an arm thrown around the shoulder of a good friend

Facial expression

Eye behavior

Nonverbal Communication

Therapeutic use of self

Preexisting conditions

Environment

What are the Influences of Therapeutic Communication?

Nonverbal Communication

Therapeutic use of self

it involves making appropriate communication responses that facilitate the client’s growth

Preexisting conditions

this refers to values, attitudes, beliefs, culture, social status, age, gender

Environment

this refers to territoriality, density, distance

Offering Self

Active listening

Silence

General leads

Restating

Clarification

Making Observation

Encouraging description of perception

Encouraging comparisons

Reflecting

Focusing

Exploring

Seeking clarification and validation

Presenting reality

Voicing doubt

Verbalizing the implied

Suggesting collaboration

Summarizing

What are the types of therapeutic techniques?

Offering self

making self-available

• Example: “I’ll sit with you”

Active listening

paying close attention to patterns of thinking, feelings, and behavior

Active listening

Example: Face the patient, maintain eye contact; be open, alert and patient, respond appropriately

Silence

planned absence of verbal remarks to allow patient and nurse to think over what is being discussed and to say more

General leads

using neutral expressions to encourage patients to continue talking

General leads

Example: “Go on I’m listening”

Restating

repeating the exact words of patients to remind them of what they said and to let them know they are heard.

Restating

Example: “You say you are going home soon”

Clarification

asking patient to restate, elaborate, or give examples of ideas or feelings to seek clarification of what is unclear

Clarification

Example: Give me an example of feeling lost

Making Observation

verbalizing what is observed in the patient to, for validation and to encourage discussion

Making Observation

Example: “You seem restless”

Encouraging description of perception

asking the patients to describe feelings, perceptions and views of their situations.

Encouraging description of perception

Example: “What do you think is the issue with your wife”

• “What are these voices telling you to do”

Encouraging comparisons

asking to describe similarities and differences among feelings, behaviors, and events

Encouraging comparisons

Example: “Have you felt like this before?”

Reflecting

throwing back the patient’s statement in a form of question helps the patient identify feelings

Reflecting

C: “What should I do about my child’s acting out behavior?”

N: “What do you think you should do?”

Focusing

pursuing a topic until its meaning or importance is clear

Focusing

Example: “You were saying…”

Exploring

“Tell me more about your son”

Seeking clarification and validation

asking patient to restate, elaborate, or give examples of ideas or feelings to seek clarification of what is unclear.

Seeking clarification and validation

Example: “I don’t think I understand what you are saying”

Presenting reality

“I know you hear these voices, but I do not hear them”

Presenting reality

stating what is real and what is not without arguing with the patient

Voicing doubt

uncertainty about the reality of patient’s statements, perceptions and conclusions.