Mental Health Week 2
Therapeutic Communication Examples:
Silence: Gives time to collect thoughts
Accepting-Indicates that person has been understood
Offering self-Offers presence, interest & desire to understand.
Giving broad openings- Allows pt to take lead.
Open-ended qs- Encourage pt to share & elaborate on information.
Restating- Repeats the main idea expressed; if message has been misunderstood, pt can clarify.
Reflecting- Directs as, feelings, ideas back to the pt.
Exploring- Examines certain ideas more fully; if pt does not elaborate, the nurse does not probe-respect pt wishes.
Giving info- supplies knowledge.
Summarizing-Brings together important points of discussion to enhance understanding.
NON-Therapeutic Communication Techniques examples:
Giving premature advice – Assumes nurse knows best and patient cannot think for themselves; fosters dependency
Minimizing feelings – Patient feelings and experiences are belittled
Falsely reassuring – Underrates a patient’s feelings and belittles their concerns
Making judgments – Makes patient feel guilty, angry, misunderstood, not supported
Asking “why” questions – Implies criticism; makes patient feel defensive
Asking excessive questions – This is not interrogation
Agreeing or Giving approval – Implies patient is doing the right thing; patient focus on pleasing the clinician
Disagreeing or Disapproving – makes patient defensive
Changing the subject – invalidates patient feelings and needs; can increase isolation and feelings of hopelessness
Closed-Ended Questions – Elicits “yes” or “no” response, which can inhibit interview. when used sparingly, can give specific &
needed information
Defense Mechanism (DM)
Protects people from anxiety (lowers anxiety)
Maintains self-image by blocking feelings, conflicts, and memories
DM operates all the time, BUT they are not always apparent to the person using them
Most DM can be used in both healthy and unhealthy ways (Table 15-2)
Compensation – used to counterbalance deficiencies by emphasizing strengths
Denial – escaping unpleasant thoughts and feelings by ignoring their presence
Displacement – transfer of emotions associated w/ a particular person to another non-threatening person, object, or
situation
Dissociation – disruption in consciousness, memory (> compartmentalizing uncomfortable aspects of self)
Humor- emphasis on ironic or amusing components of a crisis, conflict, or stressor.
Intellectualization - overuse of abstract thinking or generalizations to control or minimize painful feelings
Projection – unconscious rejection of emotionally unacceptable features and attributes them to others
Rationalization – justifying
, Reaction formation – unacceptable feelings/behaviors are controlled & kept out of awareness by developing opposite
feelings/behaviors
Regression – reverting to earlier, more primitive, and child-like pattern of behavior
Repression – unconscious exclusion of unwanted feelings from conscious awareness
Sublimation – unconscious process of substituting mature & socially acceptable activity for immature & unacceptable
impulses
Suppression – conscious denial of disturbing situation/feeling
Undoing – making up for a previous behavior: Will require two interactions to take place. 1st interaction could be good or
bad. 2nd interaction will undo the 1st interaction.
Who is on the Mental Health Team?
Staff RN Occupational Therapist (OT) Marriage Family Therapist (MFT)
Psych Tech Recreational Therapist (RT) Advanced Practice Nurse (CNS, NP)-Psychotherapy.
Psychologist (PhD) Movement Therapist Psychiatrist (MD) Psych Social Worker (LSW)
Therapeutic Boundaries
Set of rules that establish the relationship between the staff and client’s/families.
Focus client’s energy on goals and protect from misperceptions which could result in harm or liability.
Unequal power balance between staff and client.
Nursing privy to confidential information (HIPAA) Personal care issues (bathing, changing clothes)
Power of staff derived from patient’s trust
Type of Boundary Violation: (examples):
Self-disclosure - discussing personal issues w/ client, Give client’s/families personal information (address, phone, or e-mail)
Dual Relationships - friends/family relationship (transfer care)
Becoming Friends - seeing client outside of hospital
Physical contact (hugs, kisses, hand holding)
Gift giving - do not accept $, gift acceptance changes relationship between the nurse and the client, culture may play a role,
what does gift giving mean to the client must be explored
Sexual contact
WARNING SIGNS OF VIOLATIONS
Staying late to speak with clients, going on beyond allotted time for therapy.
Engage in conversation that could be interpreted as sexual.
Favoring/Special attention to one client over others
Secrets or sharing personal information
Swapping client assignments
Dressing for a particular client
Frequently thinking about a client when not at work
Receiving gifts or corresponding from a discharged client
Ultimately, it is your responsibility as the professional to know and maintain boundaries.
What is the MSE, Mental Status Examination?
Fundamental to mental health assessment (But also done in all areas of medicine)
Analogous to a physical examination in general medicine
For acutely ill patients, mental health clinicians (including nursing) perform MSE at least once a shift
Purpose: to evaluate individual’s current cognitive processes (Aids in collecting and organizing objective data)
Therapeutic Communication Examples:
Silence: Gives time to collect thoughts
Accepting-Indicates that person has been understood
Offering self-Offers presence, interest & desire to understand.
Giving broad openings- Allows pt to take lead.
Open-ended qs- Encourage pt to share & elaborate on information.
Restating- Repeats the main idea expressed; if message has been misunderstood, pt can clarify.
Reflecting- Directs as, feelings, ideas back to the pt.
Exploring- Examines certain ideas more fully; if pt does not elaborate, the nurse does not probe-respect pt wishes.
Giving info- supplies knowledge.
Summarizing-Brings together important points of discussion to enhance understanding.
NON-Therapeutic Communication Techniques examples:
Giving premature advice – Assumes nurse knows best and patient cannot think for themselves; fosters dependency
Minimizing feelings – Patient feelings and experiences are belittled
Falsely reassuring – Underrates a patient’s feelings and belittles their concerns
Making judgments – Makes patient feel guilty, angry, misunderstood, not supported
Asking “why” questions – Implies criticism; makes patient feel defensive
Asking excessive questions – This is not interrogation
Agreeing or Giving approval – Implies patient is doing the right thing; patient focus on pleasing the clinician
Disagreeing or Disapproving – makes patient defensive
Changing the subject – invalidates patient feelings and needs; can increase isolation and feelings of hopelessness
Closed-Ended Questions – Elicits “yes” or “no” response, which can inhibit interview. when used sparingly, can give specific &
needed information
Defense Mechanism (DM)
Protects people from anxiety (lowers anxiety)
Maintains self-image by blocking feelings, conflicts, and memories
DM operates all the time, BUT they are not always apparent to the person using them
Most DM can be used in both healthy and unhealthy ways (Table 15-2)
Compensation – used to counterbalance deficiencies by emphasizing strengths
Denial – escaping unpleasant thoughts and feelings by ignoring their presence
Displacement – transfer of emotions associated w/ a particular person to another non-threatening person, object, or
situation
Dissociation – disruption in consciousness, memory (> compartmentalizing uncomfortable aspects of self)
Humor- emphasis on ironic or amusing components of a crisis, conflict, or stressor.
Intellectualization - overuse of abstract thinking or generalizations to control or minimize painful feelings
Projection – unconscious rejection of emotionally unacceptable features and attributes them to others
Rationalization – justifying
, Reaction formation – unacceptable feelings/behaviors are controlled & kept out of awareness by developing opposite
feelings/behaviors
Regression – reverting to earlier, more primitive, and child-like pattern of behavior
Repression – unconscious exclusion of unwanted feelings from conscious awareness
Sublimation – unconscious process of substituting mature & socially acceptable activity for immature & unacceptable
impulses
Suppression – conscious denial of disturbing situation/feeling
Undoing – making up for a previous behavior: Will require two interactions to take place. 1st interaction could be good or
bad. 2nd interaction will undo the 1st interaction.
Who is on the Mental Health Team?
Staff RN Occupational Therapist (OT) Marriage Family Therapist (MFT)
Psych Tech Recreational Therapist (RT) Advanced Practice Nurse (CNS, NP)-Psychotherapy.
Psychologist (PhD) Movement Therapist Psychiatrist (MD) Psych Social Worker (LSW)
Therapeutic Boundaries
Set of rules that establish the relationship between the staff and client’s/families.
Focus client’s energy on goals and protect from misperceptions which could result in harm or liability.
Unequal power balance between staff and client.
Nursing privy to confidential information (HIPAA) Personal care issues (bathing, changing clothes)
Power of staff derived from patient’s trust
Type of Boundary Violation: (examples):
Self-disclosure - discussing personal issues w/ client, Give client’s/families personal information (address, phone, or e-mail)
Dual Relationships - friends/family relationship (transfer care)
Becoming Friends - seeing client outside of hospital
Physical contact (hugs, kisses, hand holding)
Gift giving - do not accept $, gift acceptance changes relationship between the nurse and the client, culture may play a role,
what does gift giving mean to the client must be explored
Sexual contact
WARNING SIGNS OF VIOLATIONS
Staying late to speak with clients, going on beyond allotted time for therapy.
Engage in conversation that could be interpreted as sexual.
Favoring/Special attention to one client over others
Secrets or sharing personal information
Swapping client assignments
Dressing for a particular client
Frequently thinking about a client when not at work
Receiving gifts or corresponding from a discharged client
Ultimately, it is your responsibility as the professional to know and maintain boundaries.
What is the MSE, Mental Status Examination?
Fundamental to mental health assessment (But also done in all areas of medicine)
Analogous to a physical examination in general medicine
For acutely ill patients, mental health clinicians (including nursing) perform MSE at least once a shift
Purpose: to evaluate individual’s current cognitive processes (Aids in collecting and organizing objective data)
