Mental Health NUR2459 Module 4 EXAM 1 review guide
You need to study and UNDERSTAND!
Role of the psychiatric Nurse
o Work closely with treatment teams to develop individualized patient plans, aiming
to maximize care and help patients live productive lives. They also provide
individual counseling to patients and families to help them understand the illness.
o Stranger
Accepting the patient as he is
Treating the patient as an emotionally able stranger and relating to him on
this basis until evidence shows him to be otherwise.
o Resource person
In the role of resource person, the nurse explains, in language that the
patient can understand, information related to the patient’s health care.
o Teacher
the nurse identifies learning needs and provides information required by
the patient or family to improve the health situation.
o Leader
Autocratic leadership promotes overvaluation of the nurse and patients’
substitution of the nurse’s goals for their own. Laissez-faire leaders
convey a lack of personal interest in the patient.
o Surrogate
Outside of their awareness, patients often perceive nurses as symbols of
other individuals. They may view the nurse as a mother figure, a sibling, a
former teacher, or another nurse who has provided care in the past. This
perception occurs when a patient is placed in a situation that generates
feelings similar to ones he or she has experienced previously.
o Technical expert
The nurse understands various professional devices and possesses the
clinical skills necessary to perform interventions that are in the best
interest of the patient.
o Counselor
The nurse uses “interpersonal techniques” to assist patients in adapting to
difficulties or changes in life experiences.
Counseling in nursing has to do with helping the patient to remember and
to understand fully what is happening to him in the present situation, so
that the experience can be integrated with, rather than dissociated from,
other experiences in life.
Therapeutic use of self
o strategic, useful tool for mental health professionals to improve empathy and
identification with patients.
o the ability to use one’s personality consciously and in full awareness in an attempt
to establish relatedness and to structure nursing intervention.”
, o Use of the self in a therapeutic manner requires that the nurse possess self-
awareness and self-understanding, which are achieved by developing a
philosophical belief about life, death, and the overall human condition.
Phases of the therapeutic nurse patient relationship
o Therapeutic relationships are always goal oriented.
o Pre-interaction
Obtaining valuable info about client from chart, SO, family, or healthcare
team.
Examining one’s feelings, fears, and anxieties about working with this
patient.
o Orientation
Introduction
Create environment of trust and rapport
Establish boundaries
Assess patient
Identify strengths and limitations
Formulate nursing diagnosis
Set goals for patient
Develop plan of action
Explore feelings of both patient and nurse
o Working phase
Maintain trust and rapport
Promote client insight and perception of reality.
Problem-solving
Overcome resistance behaviors
Evaluate progress toward established goals.
Transference:
This occurs when the client unconsciously displaces or transfers to
the nurse feelings formed toward another person from his/her past.
These can be positive or negative feelings.
Common phenomena that may occur during the working phase and
can interfere with the therapeutic relationship.
Countertransference:
This refers to the nurse’s behavioral and emotional response to the
client.
The nurse is to recognize the occurrence of this phenomenon and
remain professional at all times.
Common phenomena that may occur during the working phase and
can interfere with the therapeutic relationship.
o Termination phase
Progress has been made toward attainment of the goals.
A plan of action for more adaptive coping with future stressful situations
has been established.
Feelings about termination of the relationship are recognized and
explored.
, Barriers to the therapeutic nurse patient relationship
o Giving reassurance: “Everything is going to be fine.”
o Rejecting: “That’s not possible.”
o Approving/disapproving: “I think that is a great idea.” “I don’t think that is such a
great idea.”
o Agreeing/disagreeing: “That’s right.” “That’s wrong.”
o Giving advice: “I think you should…”
o Probing: The nurse is persistent in questioning.
o Defending: “We are all here to help you.”
o Requesting an explanation (Why?): Asking the client to defend his/her thoughts.
o Indicating the existence of an external source of power: “What made you act like
that?”
o Belittling feelings expressed: Client- “I have nothing to live for.” Nurse-
“Everyone gets down in the dumps sometimes.”
o Making stereotyped comments: “Hang in there.”
o Using denial: Client- “I’m nobody.” Nurse- “Of course, you are somebody.”
o Interpreting: “What you mean is…”
o Introducing an unrelated topic: the nurse changes the subject.
Boundaries in the Nurse client relationship and complicates if boundaries are
breeched
o Nurses must be consistently conscientious in avoiding any circumstance in which
they might achieve persona gains.
o Concerns regarding the nurse boundaries with the client include self-disclosure,
and gift giving and receiving.
o In mental health nursing, touch is generally avoided. This approach is often
inappropriate with clients with mental health disorders. It can be misinterpreted as
affection or aggression.
o Types of boundaries
Material
Social
Personal
Professional
Self-disclosure
Gift-giving and receiving
Touch
Friendship or romantic association
Application of the nursing process through the care of clients with mental health
risks and management
o Mental Health Status
o General Description
Appearance
You need to study and UNDERSTAND!
Role of the psychiatric Nurse
o Work closely with treatment teams to develop individualized patient plans, aiming
to maximize care and help patients live productive lives. They also provide
individual counseling to patients and families to help them understand the illness.
o Stranger
Accepting the patient as he is
Treating the patient as an emotionally able stranger and relating to him on
this basis until evidence shows him to be otherwise.
o Resource person
In the role of resource person, the nurse explains, in language that the
patient can understand, information related to the patient’s health care.
o Teacher
the nurse identifies learning needs and provides information required by
the patient or family to improve the health situation.
o Leader
Autocratic leadership promotes overvaluation of the nurse and patients’
substitution of the nurse’s goals for their own. Laissez-faire leaders
convey a lack of personal interest in the patient.
o Surrogate
Outside of their awareness, patients often perceive nurses as symbols of
other individuals. They may view the nurse as a mother figure, a sibling, a
former teacher, or another nurse who has provided care in the past. This
perception occurs when a patient is placed in a situation that generates
feelings similar to ones he or she has experienced previously.
o Technical expert
The nurse understands various professional devices and possesses the
clinical skills necessary to perform interventions that are in the best
interest of the patient.
o Counselor
The nurse uses “interpersonal techniques” to assist patients in adapting to
difficulties or changes in life experiences.
Counseling in nursing has to do with helping the patient to remember and
to understand fully what is happening to him in the present situation, so
that the experience can be integrated with, rather than dissociated from,
other experiences in life.
Therapeutic use of self
o strategic, useful tool for mental health professionals to improve empathy and
identification with patients.
o the ability to use one’s personality consciously and in full awareness in an attempt
to establish relatedness and to structure nursing intervention.”
, o Use of the self in a therapeutic manner requires that the nurse possess self-
awareness and self-understanding, which are achieved by developing a
philosophical belief about life, death, and the overall human condition.
Phases of the therapeutic nurse patient relationship
o Therapeutic relationships are always goal oriented.
o Pre-interaction
Obtaining valuable info about client from chart, SO, family, or healthcare
team.
Examining one’s feelings, fears, and anxieties about working with this
patient.
o Orientation
Introduction
Create environment of trust and rapport
Establish boundaries
Assess patient
Identify strengths and limitations
Formulate nursing diagnosis
Set goals for patient
Develop plan of action
Explore feelings of both patient and nurse
o Working phase
Maintain trust and rapport
Promote client insight and perception of reality.
Problem-solving
Overcome resistance behaviors
Evaluate progress toward established goals.
Transference:
This occurs when the client unconsciously displaces or transfers to
the nurse feelings formed toward another person from his/her past.
These can be positive or negative feelings.
Common phenomena that may occur during the working phase and
can interfere with the therapeutic relationship.
Countertransference:
This refers to the nurse’s behavioral and emotional response to the
client.
The nurse is to recognize the occurrence of this phenomenon and
remain professional at all times.
Common phenomena that may occur during the working phase and
can interfere with the therapeutic relationship.
o Termination phase
Progress has been made toward attainment of the goals.
A plan of action for more adaptive coping with future stressful situations
has been established.
Feelings about termination of the relationship are recognized and
explored.
, Barriers to the therapeutic nurse patient relationship
o Giving reassurance: “Everything is going to be fine.”
o Rejecting: “That’s not possible.”
o Approving/disapproving: “I think that is a great idea.” “I don’t think that is such a
great idea.”
o Agreeing/disagreeing: “That’s right.” “That’s wrong.”
o Giving advice: “I think you should…”
o Probing: The nurse is persistent in questioning.
o Defending: “We are all here to help you.”
o Requesting an explanation (Why?): Asking the client to defend his/her thoughts.
o Indicating the existence of an external source of power: “What made you act like
that?”
o Belittling feelings expressed: Client- “I have nothing to live for.” Nurse-
“Everyone gets down in the dumps sometimes.”
o Making stereotyped comments: “Hang in there.”
o Using denial: Client- “I’m nobody.” Nurse- “Of course, you are somebody.”
o Interpreting: “What you mean is…”
o Introducing an unrelated topic: the nurse changes the subject.
Boundaries in the Nurse client relationship and complicates if boundaries are
breeched
o Nurses must be consistently conscientious in avoiding any circumstance in which
they might achieve persona gains.
o Concerns regarding the nurse boundaries with the client include self-disclosure,
and gift giving and receiving.
o In mental health nursing, touch is generally avoided. This approach is often
inappropriate with clients with mental health disorders. It can be misinterpreted as
affection or aggression.
o Types of boundaries
Material
Social
Personal
Professional
Self-disclosure
Gift-giving and receiving
Touch
Friendship or romantic association
Application of the nursing process through the care of clients with mental health
risks and management
o Mental Health Status
o General Description
Appearance
