1
Mental Health Exam 1 Study Guide
The evolution of psychiatric-mental health nursing (Hildegard Peplau) roles and functions
Interpersonal Nursing identified by Peplau
Stranger: the role assumed by both the nurse and patient when they first meet
Resource person: provides health information to a patient who has assumed the consumer role
Leader: helps the patient participate in a democratically implemented nursing process
Surrogate: assumes roles that have been assigned by the patient, based on significant past relationships,
as in the psychoanalytical phenomenon of transference
Counselor: helps the patient integrate the facts and feelings associated with an episode of illness into
the patient total life experience
Peplau defined nursing as a significant therapeutic process. She clarified psychiatric nursing position
and identified the heart of nursing as the role of counselor or psychotherapist.
She clarified the differences between general practioners and psychiatric nurses who were specialists and
expert clinical practioners.
Theoretical framework of psychiatric nursing
o Psychosocial, Biophysical, personality behavior and human behavior.
The nature of contemporary psychiatric-mental health nursing practice
o Patient may be an individual, family, group, organization or community.
o elements include clinical competence, consumer-family advocacy, fiscal responsibility,
interprofessional collaboration, social accountability and legal ethical parameters.
o Other Concepts
Delegating= direct care, management
Teaching= direct care, communication
Collaboration= communication, management
Effective skills of therapeutic communication and techniques and ability to identify nontherapeutic techniques
and responses
o The key therapeutic tool of the psychiatric nurse is the use of oneself
o Awareness:
Psychological- knowledge of emotions, motivations, self-concept, and personality. Being
sensitive to feelings and outside events that affect those feelings.
Physical- personal and general physiology, body sensations, image and physical potential
Environmental- sociocultural, relationships with others and knowledge of the relationships
between humans and nature
Philosophical- life having meaning
o Increasing self-awareness- listen to self, others and self-disclosing.
o Value clarification
Choosing- relies on cognitive abilities: freely from alternatives after thoughtful considerations of
the consequences
Prizing- emotional or affective level: cherishing, being happy with choice and willing to affirm
publicly
Acting- behavioral focus- doing with choice. Repeatedly in some pattern of life
o Skills:
o Exploration of feelings- aware and in control of feelings to help patients
o Role models- Model adaptive growth producing behaviors
o Altruism- concern and welfare for others.
o Ethics and Responsibility- accountability, commitment, risk and justice
o Denotative: actual or concrete meaning of word
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Mental Health Exam 1 Study Guide
o Connotative: implied of suggested meaning.
o Congruent communication- sender is communication the same message on both ends of verbal
and nonverbal
Two requirements for therapeutic communication:
o Self-respect of both individuals
o Communication of understanding and acceptance prior to suggestions or advice
Affective: related to the relationship aspect of the message
Cognitive response is related to the informational part of the message
Both deal with evaluation of a message
Therapeutic communication skills: activates are carried out with the patient, not for the patient
WHY questions are avoided and ineffective that can be answered as a yes or no. Consequence is that the pat. Do
not take the initiative and are discouraged or prevented from engaging in the process of self-exploration.
BOX 2-7THERAPEUTIC COMMUNICATION TECHNIQUES
Listening Informing
Definition: an active process of receiving information and Definition: the skill of information giving
examining reaction to the messages received
Example: “I think you need to know more about how
Example: maintaining eye contact and receptive nonverbal your medication works.”
communication
Therapeutic value: helpful in health teaching or patient
Therapeutic value: nonverbally communicates to the patient the education about relevant aspects of patient's well-being
nurse's interest and acceptance and self-care
Nontherapeutic threat: failure to listen Nontherapeutic threat: giving advice
Broad Openings Focusing
Definition: encouraging the patient to select topics for discussion Definition: questions or statements that help the patient
expand on a topic of importance
Example: “What are you thinking about?”
Example: “I think that we should talk more about your
Therapeutic value: indicates acceptance by the nurse and the relationship with your father.”
value of the patient's initiative
Therapeutic value: allows the patient to discuss central
Nontherapeutic threat: domination of the interaction by the issues and keeps the communication process goal
nurse; rejecting responses directed
Restating Nontherapeutic threat: allowing abstractions and
Definition: repeating the main thought the patient expressed generalizations; changing topics
Example: “You say that your mother left you when you were 5 Sharing Perceptions
years old.” Definition: asking the patient to verify the nurse's
understanding of what the patient is thinking or feeling
Therapeutic value: indicates that the nurse is listening and
validates, reinforces, or calls attention to something important that Example: “You're smiling, but I sense that you are
has been said really very angry with me.”
Nontherapeutic threat: lack of validation of the nurse's Therapeutic value: conveys the nurse's understanding to
interpretation of the message; being judgmental; reassuring; the patient and has the potential for clearing up
defending confusing communication
Clarification Nontherapeutic threat: challenging the patient;
Definition: attempting to put into words vague ideas or unclear accepting literal responses; reassuring; testing;
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Mental Health Exam 1 Study Guide
thoughts of the patient to enhance the nurse's understanding or defending
asking the patient to explain what he means
Theme Identification
Example: “I'm not sure what you mean. Could you tell me about Definition: underlying issues or problems experienced
that again?” by the patient that emerge repeatedly during the course
of the nurse-patient relationship
Therapeutic value: helps to clarify feelings, ideas, and
perceptions of the patient and provides an explicit correlation Example: “I've noticed that in all of the relationships
between the nurse and the patient's actions that you have described, you've been hurt or rejected by
the man. Do you think this is an underlying issue?”
Nontherapeutic threat: failure to probe; assumed understanding
Therapeutic value: allows the nurse to best promote the
Reflection patient's exploration and understanding of important
Definition: directing back the patient's ideas, feelings, questions, problems
or content
Nontherapeutic threat: giving advice; reassuring;
Example: “You're feeling tense and anxious, and it's related to a disapproving
conversation you had with your husband last night?”
Silence
Therapeutic value: validates the nurse's understanding of what Definition: lack of verbal communication for a
the patient is saying and signifies empathy, interest, and respect therapeutic reason
for the patient
Example: sitting with a patient and nonverbally
Nontherapeutic threat: stereotyping the patient's responses; communicating interest and involvement
inappropriate timing of reflections; inappropriate depth of feeling
of the reflections; inappropriate to the cultural experience and Therapeutic value: allows the patient time to think and
educational level of the patient gain insights, slows the pace of the interaction, and
encourages the patient to initiate conversation, while
conveying the nurse's support, understanding, and
acceptance
Nontherapeutic threat: questioning the patient; asking
for “why” responses; failure to break a nontherapeutic
silence
Humor Suggesting
Definition: the discharge of energy through the comic enjoyment Definition: presentation of alternative ideas for the
of the imperfect patient's consideration relative to problem solving
Example: “That gives a whole new meaning to the Example: “Have you thought about responding to your
word nervous,” said with shared kidding between the nurse and boss in a different way when he raises that issue with
patient. you? For example, you could ask him whether a specific
problem has occurred.”
Therapeutic value: can promote insight by making conscious
repressed material, resolving paradoxes, tempering aggression, Therapeutic value: increases the patient's perceived
and revealing new options; a socially acceptable form of options or choices
sublimation
Nontherapeutic threat: giving advice; inappropriate
Nontherapeutic threat: indiscriminate use; belittling patient; timing; being judgmental
screen to avoid therapeutic intimacy
PHASES OF THE RELATIONSHIP
Mental Health Exam 1 Study Guide
The evolution of psychiatric-mental health nursing (Hildegard Peplau) roles and functions
Interpersonal Nursing identified by Peplau
Stranger: the role assumed by both the nurse and patient when they first meet
Resource person: provides health information to a patient who has assumed the consumer role
Leader: helps the patient participate in a democratically implemented nursing process
Surrogate: assumes roles that have been assigned by the patient, based on significant past relationships,
as in the psychoanalytical phenomenon of transference
Counselor: helps the patient integrate the facts and feelings associated with an episode of illness into
the patient total life experience
Peplau defined nursing as a significant therapeutic process. She clarified psychiatric nursing position
and identified the heart of nursing as the role of counselor or psychotherapist.
She clarified the differences between general practioners and psychiatric nurses who were specialists and
expert clinical practioners.
Theoretical framework of psychiatric nursing
o Psychosocial, Biophysical, personality behavior and human behavior.
The nature of contemporary psychiatric-mental health nursing practice
o Patient may be an individual, family, group, organization or community.
o elements include clinical competence, consumer-family advocacy, fiscal responsibility,
interprofessional collaboration, social accountability and legal ethical parameters.
o Other Concepts
Delegating= direct care, management
Teaching= direct care, communication
Collaboration= communication, management
Effective skills of therapeutic communication and techniques and ability to identify nontherapeutic techniques
and responses
o The key therapeutic tool of the psychiatric nurse is the use of oneself
o Awareness:
Psychological- knowledge of emotions, motivations, self-concept, and personality. Being
sensitive to feelings and outside events that affect those feelings.
Physical- personal and general physiology, body sensations, image and physical potential
Environmental- sociocultural, relationships with others and knowledge of the relationships
between humans and nature
Philosophical- life having meaning
o Increasing self-awareness- listen to self, others and self-disclosing.
o Value clarification
Choosing- relies on cognitive abilities: freely from alternatives after thoughtful considerations of
the consequences
Prizing- emotional or affective level: cherishing, being happy with choice and willing to affirm
publicly
Acting- behavioral focus- doing with choice. Repeatedly in some pattern of life
o Skills:
o Exploration of feelings- aware and in control of feelings to help patients
o Role models- Model adaptive growth producing behaviors
o Altruism- concern and welfare for others.
o Ethics and Responsibility- accountability, commitment, risk and justice
o Denotative: actual or concrete meaning of word
, 2
Mental Health Exam 1 Study Guide
o Connotative: implied of suggested meaning.
o Congruent communication- sender is communication the same message on both ends of verbal
and nonverbal
Two requirements for therapeutic communication:
o Self-respect of both individuals
o Communication of understanding and acceptance prior to suggestions or advice
Affective: related to the relationship aspect of the message
Cognitive response is related to the informational part of the message
Both deal with evaluation of a message
Therapeutic communication skills: activates are carried out with the patient, not for the patient
WHY questions are avoided and ineffective that can be answered as a yes or no. Consequence is that the pat. Do
not take the initiative and are discouraged or prevented from engaging in the process of self-exploration.
BOX 2-7THERAPEUTIC COMMUNICATION TECHNIQUES
Listening Informing
Definition: an active process of receiving information and Definition: the skill of information giving
examining reaction to the messages received
Example: “I think you need to know more about how
Example: maintaining eye contact and receptive nonverbal your medication works.”
communication
Therapeutic value: helpful in health teaching or patient
Therapeutic value: nonverbally communicates to the patient the education about relevant aspects of patient's well-being
nurse's interest and acceptance and self-care
Nontherapeutic threat: failure to listen Nontherapeutic threat: giving advice
Broad Openings Focusing
Definition: encouraging the patient to select topics for discussion Definition: questions or statements that help the patient
expand on a topic of importance
Example: “What are you thinking about?”
Example: “I think that we should talk more about your
Therapeutic value: indicates acceptance by the nurse and the relationship with your father.”
value of the patient's initiative
Therapeutic value: allows the patient to discuss central
Nontherapeutic threat: domination of the interaction by the issues and keeps the communication process goal
nurse; rejecting responses directed
Restating Nontherapeutic threat: allowing abstractions and
Definition: repeating the main thought the patient expressed generalizations; changing topics
Example: “You say that your mother left you when you were 5 Sharing Perceptions
years old.” Definition: asking the patient to verify the nurse's
understanding of what the patient is thinking or feeling
Therapeutic value: indicates that the nurse is listening and
validates, reinforces, or calls attention to something important that Example: “You're smiling, but I sense that you are
has been said really very angry with me.”
Nontherapeutic threat: lack of validation of the nurse's Therapeutic value: conveys the nurse's understanding to
interpretation of the message; being judgmental; reassuring; the patient and has the potential for clearing up
defending confusing communication
Clarification Nontherapeutic threat: challenging the patient;
Definition: attempting to put into words vague ideas or unclear accepting literal responses; reassuring; testing;
, 3
Mental Health Exam 1 Study Guide
thoughts of the patient to enhance the nurse's understanding or defending
asking the patient to explain what he means
Theme Identification
Example: “I'm not sure what you mean. Could you tell me about Definition: underlying issues or problems experienced
that again?” by the patient that emerge repeatedly during the course
of the nurse-patient relationship
Therapeutic value: helps to clarify feelings, ideas, and
perceptions of the patient and provides an explicit correlation Example: “I've noticed that in all of the relationships
between the nurse and the patient's actions that you have described, you've been hurt or rejected by
the man. Do you think this is an underlying issue?”
Nontherapeutic threat: failure to probe; assumed understanding
Therapeutic value: allows the nurse to best promote the
Reflection patient's exploration and understanding of important
Definition: directing back the patient's ideas, feelings, questions, problems
or content
Nontherapeutic threat: giving advice; reassuring;
Example: “You're feeling tense and anxious, and it's related to a disapproving
conversation you had with your husband last night?”
Silence
Therapeutic value: validates the nurse's understanding of what Definition: lack of verbal communication for a
the patient is saying and signifies empathy, interest, and respect therapeutic reason
for the patient
Example: sitting with a patient and nonverbally
Nontherapeutic threat: stereotyping the patient's responses; communicating interest and involvement
inappropriate timing of reflections; inappropriate depth of feeling
of the reflections; inappropriate to the cultural experience and Therapeutic value: allows the patient time to think and
educational level of the patient gain insights, slows the pace of the interaction, and
encourages the patient to initiate conversation, while
conveying the nurse's support, understanding, and
acceptance
Nontherapeutic threat: questioning the patient; asking
for “why” responses; failure to break a nontherapeutic
silence
Humor Suggesting
Definition: the discharge of energy through the comic enjoyment Definition: presentation of alternative ideas for the
of the imperfect patient's consideration relative to problem solving
Example: “That gives a whole new meaning to the Example: “Have you thought about responding to your
word nervous,” said with shared kidding between the nurse and boss in a different way when he raises that issue with
patient. you? For example, you could ask him whether a specific
problem has occurred.”
Therapeutic value: can promote insight by making conscious
repressed material, resolving paradoxes, tempering aggression, Therapeutic value: increases the patient's perceived
and revealing new options; a socially acceptable form of options or choices
sublimation
Nontherapeutic threat: giving advice; inappropriate
Nontherapeutic threat: indiscriminate use; belittling patient; timing; being judgmental
screen to avoid therapeutic intimacy
PHASES OF THE RELATIONSHIP
