MH exam 2 Ch. 3,4,12,27-29
❖ Clarification techniques to determine needs and wants
This technique is used to determine if the message received was accurate
Restating: Uses the client's exact words
Reflecting: Directs the focus back to the client in order for the client to examine their
feelings
Paraphrasing: Restates the client's feelings and thoughts for the client to confirm what
has been communicated
Exploring: Allows the nurse to gather more information regarding important topics
mentioned by the client
The shortest, simplest communication is usually most effective.
The client can have difficulty understanding communication that is long and complex.
➢ What is it that you need?
➢ Would you like to talk about it?
➢ How can I help?
➢ Tell me more…
➢ So you’re feeling…
➢ I agree that would be…
❖ Give instructions and directions when a patient is agitated and losing control; will help
them regain self-control “I expect that you will stay in control”
❖ If patient is escalating, verbally abusive, the nurse deescalates, stay slow and low
➢ Always stay approximately 1 foot farther than the patient can reach with arms or
legs. Be sure you have left yourself an escape route if necessary. Make sure that
the patient is not between you and the door.
❖ Have staff and/or security assistance or standby(out of sight) if needed but may escalate
the situation with some patients
❖ Important to first set behavioral limits with patients who have a recent history of violence
❖ Notice and respond at first signs of escalation, some intervention usually needed UNLESS
immediate danger to yourself.
➢ Steps to handle aggressive and/or escalating behavior in a mental health setting
include the following
■ Responding quickly
■ Remaining calm and in control
■ Encouraging the client to express feelings verbally, using therapeutic
communication techniques (reflective techniques, silence, active listening)
■ Allowing the client as much personal space as possible
, ■ Maintaining eye contact and sitting or standing at the same level as the
client
■ Communicating with honesty, sincerity, and nonaggressive stance
■ Avoiding accusatory or threatening statements
■ Describing options clearly and offering choices
■ Reassuring the client that staff members are present to help prevent loss of
control
❖ If in immediate danger, go away!!!! DO NOT put yourself into a dangerous situation if
there is an option to get away. Get away is the appropriate intervention.
❖ Do NOT go into a dangerous situation!!!!
❖ Violence comorbid and more likely to happen if the perpetrator has
➢ History of PTSD
➢ Substance abuse
➢ Coexists with:
■ Anxiety
■ Psychosis
■ Personality Disorders
➢ Poor coping skills
➢ Poor impulse control
➢ History of aggression
➢ Alzheimers
❖ Characteristics of perpetrators of abuse: may isolate target
➢ Possible use of threats and intimidation to control the vulnerable person
➢ Usually an extreme disciplinarian who believes in physical punishment
➢ Poor impulse control
➢ Perceives the victim as bad
➢ Violent outbursts
➢ Poor social/ coping skills
➢ Low self-esteem
➢ Feelings of worthlessness
➢ “Attitudes, values, beliefs” (punishment, violence)
➢ Factor most likely to predict violence between strangers is a history of violence
and criminal activity
➢ Possible substance use disorder or history
❖ Survivors of abuse need access to their support system like friends and family
❖ Clarification techniques to determine needs and wants
This technique is used to determine if the message received was accurate
Restating: Uses the client's exact words
Reflecting: Directs the focus back to the client in order for the client to examine their
feelings
Paraphrasing: Restates the client's feelings and thoughts for the client to confirm what
has been communicated
Exploring: Allows the nurse to gather more information regarding important topics
mentioned by the client
The shortest, simplest communication is usually most effective.
The client can have difficulty understanding communication that is long and complex.
➢ What is it that you need?
➢ Would you like to talk about it?
➢ How can I help?
➢ Tell me more…
➢ So you’re feeling…
➢ I agree that would be…
❖ Give instructions and directions when a patient is agitated and losing control; will help
them regain self-control “I expect that you will stay in control”
❖ If patient is escalating, verbally abusive, the nurse deescalates, stay slow and low
➢ Always stay approximately 1 foot farther than the patient can reach with arms or
legs. Be sure you have left yourself an escape route if necessary. Make sure that
the patient is not between you and the door.
❖ Have staff and/or security assistance or standby(out of sight) if needed but may escalate
the situation with some patients
❖ Important to first set behavioral limits with patients who have a recent history of violence
❖ Notice and respond at first signs of escalation, some intervention usually needed UNLESS
immediate danger to yourself.
➢ Steps to handle aggressive and/or escalating behavior in a mental health setting
include the following
■ Responding quickly
■ Remaining calm and in control
■ Encouraging the client to express feelings verbally, using therapeutic
communication techniques (reflective techniques, silence, active listening)
■ Allowing the client as much personal space as possible
, ■ Maintaining eye contact and sitting or standing at the same level as the
client
■ Communicating with honesty, sincerity, and nonaggressive stance
■ Avoiding accusatory or threatening statements
■ Describing options clearly and offering choices
■ Reassuring the client that staff members are present to help prevent loss of
control
❖ If in immediate danger, go away!!!! DO NOT put yourself into a dangerous situation if
there is an option to get away. Get away is the appropriate intervention.
❖ Do NOT go into a dangerous situation!!!!
❖ Violence comorbid and more likely to happen if the perpetrator has
➢ History of PTSD
➢ Substance abuse
➢ Coexists with:
■ Anxiety
■ Psychosis
■ Personality Disorders
➢ Poor coping skills
➢ Poor impulse control
➢ History of aggression
➢ Alzheimers
❖ Characteristics of perpetrators of abuse: may isolate target
➢ Possible use of threats and intimidation to control the vulnerable person
➢ Usually an extreme disciplinarian who believes in physical punishment
➢ Poor impulse control
➢ Perceives the victim as bad
➢ Violent outbursts
➢ Poor social/ coping skills
➢ Low self-esteem
➢ Feelings of worthlessness
➢ “Attitudes, values, beliefs” (punishment, violence)
➢ Factor most likely to predict violence between strangers is a history of violence
and criminal activity
➢ Possible substance use disorder or history
❖ Survivors of abuse need access to their support system like friends and family
