lOMoARcPSD|26582732
Mental Health 1
Chapter 72 – Foundations of
Psychiatric Mental Health Nursing
Nurse-Client
Relationship Principles
• Genuineness, respect, and empathic understanding are characteristics important to the
development of a therapeutic nurse-client relationship.
• The client should be cared for in a holistic manner.
• The nurse considers the client’s cultural and spiritual beliefs and values in assessing the client’s
response to the nurse-client relationship and his or her adaptation to stressors.
• Appropriate limits and boundaries define and facilitate a therapeutic nurse-client relationship.
• Honest and open communication is important for the development of trust, an underpinning of
the therapeutic nurse-client relationship.
• The nurse uses therapeutic communication techniques to encourage the client to express thoughts
and feelings as they address identified problem areas.
• The nurse respects the client’s confidentiality and limits discussion of the client to the
interprofessional health care team.
• The goal of the nurse-client relationship is to assist the client to develop problem-solving
abilities and coping mechanisms.
**The nurse needs to consider the cultural, religious, and spiritual practices of the client and whether
these practices may give the client hope, comfort, and support while healing.
Phases of a Therapeutic Nurse-client Relationship
• Preinteraction Phase
Begins before the nurse’s first contact with the client
The nurse’s task is to focus on his or her own preconceived ideas, stereotypes, biases, and values that
may impinge on the nurse-client relationship. Orientation or Introductory Phase
Acceptance, rapport, trust, and boundaries are established.
Expectations and the time frame of the relationship are identified (establishing a contract).
Client-centered goals are defined.
Termination and separation of the relationship are discussed in anticipation of the time-limited
nature of the relationship.
• Working Phase
Exploring, focusing on, and evaluating the client’s concerns and problems occur; an attitude of
acceptance and active listening assists the client to express thoughts and feelings.
Encouraging independence in the client facilitates recovery and leads to readiness for termination.
Termination or Separation Phase
Prepare the client for termination and separation on initial contact.
Evaluate progress and achievement of goals.
Identify responses related to termination and separation, such as anger, distancing from the
relationship, a return of symptoms, and dependency.
Encourage the client to express feelings about termination.
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Mental Health 2
Identify the client’s strengths and anticipated needs for follow-up care.
Refer the client to community resources and other support systems.
Family as an Extension of the Client
• Family members should be viewed as collaborators in the management of a client’s mental health
needs (maintain confidentiality as necessary).
• Competence and caring focused toward family members enhance the nurse’s ability to identify
client and family needs and to select and implement effective interventions directed toward
promoting adaptive functioning.
• Nurses have a professional obligation to be aware of and sensitive to the cultural, ethnic,
religious, and spiritual factors that affect the structure and resulting needs of the client and his or
her family.
• Educating family members regarding the client’s illness, identification of symptoms, and
effective management of maladaptive behaviors plays a vital role in the client’s quality of life.
Impact of Culture, Ethnicity, Religion, and Spirituality on Client Care
• Cultural competency allows the nurse to recognize the uniqueness of each client and the impact
that culture, values, and religious and spiritual beliefs have on an individual’s mental health as
well as the treatment required for existing mental illness
• A client’s culture, ethnicity, value, and religious and spiritual belief systems can affect all aspects
of mental health care, including medication therapies, and can act as either protective or risk
factors when dealing with the development and/or treatment of psychiatric disorders.
• Nurses must be aware of the impact that their own culture, religious and spiritual beliefs, and
values have on the care they provide and to avoid biases.
• The treatment plan must be agreed upon by both client and nurse and take into consideration the
needs of the client whenever possible.
Therapeutic Communication Process
Principles
1. Communication includes verbal and nonverbal expression
2. Successful communication includes appropriateness, efficiency, flexibility, and feedback.
3. Anxiety in the nurse or client impedes communication.
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Mental Health 3
4. Communication needs to be goal-directed within a professional framework.
Therapeutic
• Clarifying and validating
• Encouraging formulation of a plan of action
• Focusing and refocusing
• Giving information and presenting reality
• Listening
• Maintaining neutral responses
• Maintaining silence
• Providing acknowledgment and feedback
• Providing nonverbal encouragement
• Reflecting
• Restating
• Sharing perceptions
• Summarizing
• Using broad openings and open-ended questions Nontherapeutic Techniques
• Asking the client “Why?”
• Being defensive or challenging the client
• Changing the subject
• Giving advice or approval or disapproval
• Making stereotypical comments
• Making value judgments
• Placing the client’s feelings on hold
• Providing false reassurance
Mental Health
• Mental health is a lifelong process of successful adaptation to changing internal and external
environments.
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Mental Health 4
• A mentally healthy individual is:
O in contact with reality o can relate to people and
situations in their environment o can resolve conflicts within
a problem-solving framework o has psychobiological
resilience.
Psychiatric–Mental Health Illness
Description
1. Psychiatric illness is the loss of the ability to respond to the internal and external
environment in ways that are in harmony with oneself or the expectations of society.
2. It is characterized by thought or behavior patterns that impair functioning and cause
distress. Personality Characteristics 1 . Self-concept is distorted.
2. Perception of strengths and weaknesses is unrealistic.
3. Thoughts and perceptions may not be reality based.
4. The ability to find meaning and purpose in life may be impaired.
5. Life direction and productivity may be disturbed.
6. Meeting one’s own needs may be problematic.
7. Excessive reliance or preoccupation on the thoughts, opinions, and actions of self or others may be
present.
Adaptations to Stress
1. The individual’s sense of self-control may be affected.
2. Perception of the environment may be distorted.
3. Coping mechanisms may not exist or may be ineffective.
Interpersonal Relationships
Interpersonal relationships may be minimally existent or may be negatively affected.
The ability to enjoy sustained intimacy in relationships is impaired.
Coping and Defense Mechanisms
Coping Mechanisms
1. Coping involves any effort to decrease anxiety.
2. Coping mechanisms can be constructive or destructive, task- or problem-oriented in
relation to direct problem solving, cognitively oriented in an attempt to neutralize the meaning of the
problem, or defense- or emotion-oriented, thus regulating the response to protect oneself. Defense
Mechanisms
• As anxiety increases, the individual copes by using defense mechanisms.
• A defense mechanism is a coping mechanism used in an effort to protect the individual from
feelings of anxiety; as anxiety increases and becomes overwhelming, the individual copes by
using defense mechanisms to protect the ego and decrease anxiety.
• Types:
Compensation: Putting forth extra effort to achieve in areas where one has a real or imagined deficiency
Conversion: The expression of emotional conflicts through physical symptoms
Denial: Disowning consciously intolerable thoughts and impulses
Displacement: Feelings about one person are directed to another who is less threatening, satisfying an
impulse with a substitute object
Dissociation: The blocking of an anxiety-provoking event or period of time from the conscious mind
Fantasy: Gratification by imaginary achievements and wishful thinking
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Mental Health 1
Chapter 72 – Foundations of
Psychiatric Mental Health Nursing
Nurse-Client
Relationship Principles
• Genuineness, respect, and empathic understanding are characteristics important to the
development of a therapeutic nurse-client relationship.
• The client should be cared for in a holistic manner.
• The nurse considers the client’s cultural and spiritual beliefs and values in assessing the client’s
response to the nurse-client relationship and his or her adaptation to stressors.
• Appropriate limits and boundaries define and facilitate a therapeutic nurse-client relationship.
• Honest and open communication is important for the development of trust, an underpinning of
the therapeutic nurse-client relationship.
• The nurse uses therapeutic communication techniques to encourage the client to express thoughts
and feelings as they address identified problem areas.
• The nurse respects the client’s confidentiality and limits discussion of the client to the
interprofessional health care team.
• The goal of the nurse-client relationship is to assist the client to develop problem-solving
abilities and coping mechanisms.
**The nurse needs to consider the cultural, religious, and spiritual practices of the client and whether
these practices may give the client hope, comfort, and support while healing.
Phases of a Therapeutic Nurse-client Relationship
• Preinteraction Phase
Begins before the nurse’s first contact with the client
The nurse’s task is to focus on his or her own preconceived ideas, stereotypes, biases, and values that
may impinge on the nurse-client relationship. Orientation or Introductory Phase
Acceptance, rapport, trust, and boundaries are established.
Expectations and the time frame of the relationship are identified (establishing a contract).
Client-centered goals are defined.
Termination and separation of the relationship are discussed in anticipation of the time-limited
nature of the relationship.
• Working Phase
Exploring, focusing on, and evaluating the client’s concerns and problems occur; an attitude of
acceptance and active listening assists the client to express thoughts and feelings.
Encouraging independence in the client facilitates recovery and leads to readiness for termination.
Termination or Separation Phase
Prepare the client for termination and separation on initial contact.
Evaluate progress and achievement of goals.
Identify responses related to termination and separation, such as anger, distancing from the
relationship, a return of symptoms, and dependency.
Encourage the client to express feelings about termination.
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
Mental Health 2
Identify the client’s strengths and anticipated needs for follow-up care.
Refer the client to community resources and other support systems.
Family as an Extension of the Client
• Family members should be viewed as collaborators in the management of a client’s mental health
needs (maintain confidentiality as necessary).
• Competence and caring focused toward family members enhance the nurse’s ability to identify
client and family needs and to select and implement effective interventions directed toward
promoting adaptive functioning.
• Nurses have a professional obligation to be aware of and sensitive to the cultural, ethnic,
religious, and spiritual factors that affect the structure and resulting needs of the client and his or
her family.
• Educating family members regarding the client’s illness, identification of symptoms, and
effective management of maladaptive behaviors plays a vital role in the client’s quality of life.
Impact of Culture, Ethnicity, Religion, and Spirituality on Client Care
• Cultural competency allows the nurse to recognize the uniqueness of each client and the impact
that culture, values, and religious and spiritual beliefs have on an individual’s mental health as
well as the treatment required for existing mental illness
• A client’s culture, ethnicity, value, and religious and spiritual belief systems can affect all aspects
of mental health care, including medication therapies, and can act as either protective or risk
factors when dealing with the development and/or treatment of psychiatric disorders.
• Nurses must be aware of the impact that their own culture, religious and spiritual beliefs, and
values have on the care they provide and to avoid biases.
• The treatment plan must be agreed upon by both client and nurse and take into consideration the
needs of the client whenever possible.
Therapeutic Communication Process
Principles
1. Communication includes verbal and nonverbal expression
2. Successful communication includes appropriateness, efficiency, flexibility, and feedback.
3. Anxiety in the nurse or client impedes communication.
Downloaded by NELSON KIIRU ()
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Mental Health 3
4. Communication needs to be goal-directed within a professional framework.
Therapeutic
• Clarifying and validating
• Encouraging formulation of a plan of action
• Focusing and refocusing
• Giving information and presenting reality
• Listening
• Maintaining neutral responses
• Maintaining silence
• Providing acknowledgment and feedback
• Providing nonverbal encouragement
• Reflecting
• Restating
• Sharing perceptions
• Summarizing
• Using broad openings and open-ended questions Nontherapeutic Techniques
• Asking the client “Why?”
• Being defensive or challenging the client
• Changing the subject
• Giving advice or approval or disapproval
• Making stereotypical comments
• Making value judgments
• Placing the client’s feelings on hold
• Providing false reassurance
Mental Health
• Mental health is a lifelong process of successful adaptation to changing internal and external
environments.
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
Mental Health 4
• A mentally healthy individual is:
O in contact with reality o can relate to people and
situations in their environment o can resolve conflicts within
a problem-solving framework o has psychobiological
resilience.
Psychiatric–Mental Health Illness
Description
1. Psychiatric illness is the loss of the ability to respond to the internal and external
environment in ways that are in harmony with oneself or the expectations of society.
2. It is characterized by thought or behavior patterns that impair functioning and cause
distress. Personality Characteristics 1 . Self-concept is distorted.
2. Perception of strengths and weaknesses is unrealistic.
3. Thoughts and perceptions may not be reality based.
4. The ability to find meaning and purpose in life may be impaired.
5. Life direction and productivity may be disturbed.
6. Meeting one’s own needs may be problematic.
7. Excessive reliance or preoccupation on the thoughts, opinions, and actions of self or others may be
present.
Adaptations to Stress
1. The individual’s sense of self-control may be affected.
2. Perception of the environment may be distorted.
3. Coping mechanisms may not exist or may be ineffective.
Interpersonal Relationships
Interpersonal relationships may be minimally existent or may be negatively affected.
The ability to enjoy sustained intimacy in relationships is impaired.
Coping and Defense Mechanisms
Coping Mechanisms
1. Coping involves any effort to decrease anxiety.
2. Coping mechanisms can be constructive or destructive, task- or problem-oriented in
relation to direct problem solving, cognitively oriented in an attempt to neutralize the meaning of the
problem, or defense- or emotion-oriented, thus regulating the response to protect oneself. Defense
Mechanisms
• As anxiety increases, the individual copes by using defense mechanisms.
• A defense mechanism is a coping mechanism used in an effort to protect the individual from
feelings of anxiety; as anxiety increases and becomes overwhelming, the individual copes by
using defense mechanisms to protect the ego and decrease anxiety.
• Types:
Compensation: Putting forth extra effort to achieve in areas where one has a real or imagined deficiency
Conversion: The expression of emotional conflicts through physical symptoms
Denial: Disowning consciously intolerable thoughts and impulses
Displacement: Feelings about one person are directed to another who is less threatening, satisfying an
impulse with a substitute object
Dissociation: The blocking of an anxiety-provoking event or period of time from the conscious mind
Fantasy: Gratification by imaginary achievements and wishful thinking
Downloaded by NELSON KIIRU ()
