PSYCH NURSING

PSYFOR NP5

Therapeutic Communication

Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship.

SCARE

sit & silent, clarifying, acknowledging, restating & reflecting, exploring

Offering Self (therapeutic)

"i'll sit with you for a while"

silence

observing for non-verbal clues

broad opening

open-ended questions to ask client

general lead

"go on" "and then?"

Restating or paraphrasing

statement that conveys understanding

clarifying

questions/statements that clears what the client feels

translating into feelings

interpreting what the client says which is usually figures of speech or idioms

verbalizing the implied

putting into words what client has only implied

reflecting

independent decision making

supportive confrontation

acknowledge client's feelings

"why?" is

non therapeutic

"just have a positive attitude"

stereotyping

acceptance

most important element in nurse-patient relationship

"everybody gets down in the dump"

belittling

"everything will be alright"

reassuring

N-P relationship aims to help client develop:

new and effective coping mechanism

Elements of Contract

time, duration, venue of sessions, termination, responsibilities, and participants

How many phases of Nurse-Patient Relationship

4

POWT

pre-orientation, orientation, working, termination

pre-orientation responsibility

read patient's chart

pre-orientation phase is

self-awareness

DARE

determine preconceptions, acknowledge past experiences, resolve past conflicts, explore own thoughts and feelings

self-awareness / introspection to prevent

being judgmental and emotional

problem in pre-orientation phase

reluctance of the nurse

orientation phase responsibilities;

formulate nursing diagnosis

orientation phase goal is

establish trust

problem in orientation phase

resistance of the patient

congruence

words and actions match

Working Phase Responsibilities

promote the client's insights

working phase goal is

for the nurse to explore and for the patient to verbalize

working phase

longest phase

important element in working phase

communciation

problem in working phase

emotional attachment

transference

the patient unconsciously redirects feelings experienced in an important personal relationship toward the therapist (patient to nurse)

patient to nurse

transference

Counter-transference

an emotional reaction of the therapist that reflects the therapist's inner needs and conflicts (nurse to patient)

nurse to patient

counter-transference

interventions in emotional attachment

remind the client about contract, redirect the feelings, encourage verbalization

termination phase responsibilities

determine the client's feelings about the termination

termination phase goal is

to evaluate effectiveness of intervention

problem in termination phase

separation anxiety

prevention of separation anxiety

constantly remind client of end of contract

intervention for separation anxiety

encourage verbalization of feelings

crisis

When coping mechanism are ineffective that results to disequilibrium

types of crisis

Maturational or Situational or adventitious

situational crisis

caused by unexpected event

adventitious / social crisis

caused by natural catastrophe (crime)

maturational / developmental crisis

caused by expected events

duration of crisis in weeks

4-6 weeks

crisis is self -

limiting

goal in crisis management

help client return to pre-crisis level

Gestalt therapy

has the goal of helping the client become aware of his or her thoughts, behaviors, experiences, and feelings and to "own" or take responsibility for them

crisis management focuses on the

present

directive approach

promote problem solving

supportive approach

encourage expression of feelings

factors to consider in crisis

perception, support system, and coping mechanism

3 components of Freud's Structural Theory of Personality

Id, Ego, Superego

ID

pleasure seeker, immediate gratification

ego

The 'reality check' that balances the conflicting demands of the id and superego.

superego

part of the personality that acts as a moral center, moral conscience, guilt

disorder concerning sueprego

OCD , anorexia nervosa

disorder concerning id

antisocial

ego defense mechanism is

subconscious

Denial

failure to admit reality of situation

Regression

A reversion to immature patterns of behavior.

ego defense mechanism of alcoholics

denial

ego defense mechanism of schizophrenic, pt with dementia

regression

identification

imitating others while searching for identity

a child becoming a teacher because she admires her

identification

introjection

accepting other person's attitude, beliefs, and values as one's own

introjection

conforms feelings for approval

Person who dislikes guns becomes an avid hunter, just like a best friend

introjection

projection

unconscious blaming of unacceptable inclinations or thoughts on an external object

an unfaithful husband suspects his wife of infidelity

projection

displacement

ventilation of intense feelings toward persons less threatening

person who is mad at the boss yess at his wife

displacement

if you cant beat them, join them

introjection

thinkers are doers

projection

kick the cat phenomenon

displacement

acrophobia

displacement

reaction formation

Acting the opposite of what one thinks or feels

undoing

Exhibiting acceptable behavior to make up for or negate unacceptable behavior

Person who cheats on a spouse brings the spouse a bouquet of roses

undoing

Person who despises the boss tells everyone what a great boss she is

reaction formation

bipolar disorder

reaction formation

ocd

undoing

suppression

conscious forgetting

repression

unconscious forgetting

dissociation

unconscious forgetting with disintegration of personality, consciousness, memory, identity, and emotion.

Woman has no memory of the mugging she suffered yesterday

repression

Student decides not to think about a parent's illness to study for a tests

suppression

2 types of dissociative disorder

dissociative identity disorder & dissociative fugue

DID

Formerly known as MULTIPLE PERSONALITY DISORDER

DF

different identity in a different environment

Rationalization

Distortion of facts, unjustifiable excuse

"nagdadahilan"

rationalization

intellectualization

acknowledging the facts but not the

emotions