Nur112 292 Final Exam – Blueprint Spring 2018.

NUR112 292 FINAL EXAM – BLUEPRINT SPRING 2018. Nurse-Client relationship: 2 Characteristics of Nurse-Client Relationship  Mutual respect  Client focused  Meets client’s needs  Emotional needs of nurse cannot interfere  Purposeful and goal oriented  Goals mutually established  Collaborative  Shared decision making  Promotes client’s independence  Agreement or contract is established  Boundaries are maintained Phases of the Nurse-Client relationship  Pre-interaction  begins before nurse meets client, nurse reviews data, considers personal feelings and thoughts  Orientation phase  introductory phase, initial encounter, develop trust, establish verbal contract and boundaries, collect data, formulate nursing diagnosis, develop goals, and initial plan of care  Working phase  Termination phase  end of the relationship, evaluate outcomes, express feelings about ending the relationship Conditions essential to developing a therapeutic relationship  Rapport  Trust  Respect  Genuineness  Empathy Transference  client transfers feelings and behavioral dispositions formed towards the nurse from past  Do you have a boyfriend?  Where do you live? Countertransference  nurses behavioral and emotional responses to the client  Poor boundaries  Nurse begins to interfere with patient’s health decisions Conditions that influence the nurse-client relationship Communication & Defense Mechanism Active listening  interactive process between nurse and client, understanding and being understood SOLER  Sit squarely facing client  Observe an open posture  Lean forward toward the client  Establish eye contact  Relax Verbal communication  vocabulary, denotative/connotative meaning, clarity, timing, relevance, pacing, intonation of voice Non-Verbal techniques  facial expression, eye contact, body posture, gestures, appearance, silence Assertive communication  promotes use of I statements, allows client to own feeling, client encouraged to make clear what he or she wants. Passive communication  personal needs are secondary to others, style is apologetic or complaining. Client Factors Nurse factors Religion and culture  Communication varies across cultures  Nurses should clarify personal preferences  Nurses needs to be sensitive and respectful Age/ Developmental level  Communication must be appropriate Emotional maturity  Self-awareness  Emotional intelligence Boundaries  Understand differences between professional and social relationships  Limit self-disclosure  “I am here to help you, this isn’t about me it about you” Touch  Use touch cautiously  Inform clients before touching them Aggressive communication  express needs but in a way that is disrespectful to others, hostile, angry, accusatory Therapeutic communication techniques Non-therapeutic communication techniques Silence reflecting Accepting focusing Recognition exploring Offering self clarifying Broad openings present reality General leads voice doubt Make observations state the implied Description of perceptions Comparisons Restating translate words into feelings Plan of action Reassurance clichés Rejecting denial Approving or disapproving interpreting Agree or disagree changing topic Giving advice Probing Defending Requesting explanations Indicate external source of power Minimize feelings ****** Assessment, mental status, interviewing: 1 Nursing Assessment:  Comprehensive and holistic o Physical o Psychological o Intellectual  executive functioning, illiteracy, capacity to intellectualize  How far did you go in your education?  Did you receive a GED?  Can you read? o Social  support system, social network o spiritual aspects  Evaluation ongoing; diagnosis and treatment plan evolve accordingly Preventive Intervention:  Primary  focuses on reducing the incidence of mental disorders; identify causes o Ex: education  Secondary  focuses on reducing the number of cases; screening; identify health needs; early treatment  Tertiary  focuses on reducing the severity of the mental disorder and its associated disabilities; rehabilitation; vocational training; symptom management; reduce long term effects Assessment:  First step in nursing process  defines client’s problem o why is it today you came in and asked for help? o What happened?  appropriate nursing diagnosis and plan of care  baseline level of functioning o on a scale of 1-10, how do you feel?  client’s self-assessment Psychiatric Nursing Interview  purpose: gather information necessary to understand and treat client  initial interview: focus on eliciting information to help staff provide safe environment  nursing interview: focus on client biopsychosocial history and current mental status  always remember ABC and safety  biopsychosocial history o assessment of client’s lifetime biologic, psychological, social functioning o identifying data o chief complaint o HPI o Psychiatric history  Have they been hospitalized before? o Alcohol and substance use history  High level of comorbidity between mental illness and alcohol or substance abuse o Medical and family history  Does mental illness run in the family?  Has anyone tried to take their life? o Developmental history  Erikson’s stages of development  Where you in special education? o Social history  Are you in touch with your family?