Mental Health Exam 2
Unit 3
Chapter 7: Nursing Process and Standards for Care
QSEN= Quality and Safety Education in Nursing
Standards: Assessment, Diagnosis, Outcomes Identification (identifying expected outcomes),
Planning, Implementation, Evaluation
Chapter 8: Therapeutic Relationships
Boundaries
o Legal, ethical, and professional standards
Over-involvement= boundary crossing, violations, sexual misconduct,
blurring of roles (transference/countertransference)
Transference versus Countertransference
o “Transference occurs when the patient unconsciously and inappropriately
displaces (transfers) onto the nurse feelings and behaviors related to significant
figures in the patient’s past. The patient may even say, “You remind me of my
[mother, sister, father, brother, etc.].”
Patient places bias on nurse
o “Countertransference is transference in reverse. It occurs when the nurse
unconsciously displaces feelings related to significant figures in the nurse’s past
onto the patient.”
Nurse places bias on patient
Peplau’s Model of Nurse-Patient Relationship (Pg 129)
o The four phases are:
1. Preorientation phase: Assignment Prep
2. Orientation phase: Initial interview, establish rapport
3. Working phase: Interventions, evaluations, data gathering (re-
evaluations)
4. Termination phase: Bye-bye
, Empathy versus Sympathy
o “In empathy, we understand the feelings of others, and in sympathy, we feel pity
or sorrow for others” (pg 132)
Positive Regard
o “Positive regard is respecting a person and viewing another person as being
worthy of caring about and as someone who has strengths and achievement
potential. Positive regard is usually communicated indirectly by attitudes and
actions rather than directly by words.” (pg 132)
Attitudes, Actions, Attending
Chapter 9: Therapeutic Communication
Peplau’s Interpersonal Theory
o 2 principles: clarity +. Continuity
Clarity = ensuring meaning is understood
Continuity = promotes connections through feelings/events
“At the heart of this relationship is a commitment to clear
communication. The two main principles that guide the
communication process are: (1) clarity, which ensures that the
meaning of the message is accurately understood by both parties,
and (2) continuity, which promotes connections among ideas,
feelings, events, and themes. Peplau also recommends nondirective
listening. Using this form of communication allows nurses to
provide reflective and nonjudgmental feedback, thereby helping
patients to clarify their thoughts.” (pg 138)
Verbal vs Non-verbal Communication
Therapeutic Techniques!!
o Silence, Active Listening, Questions (open-ended, projective)
o Clarifying Techniques (pg 141)
Paraphrasing: restating in a different/ fewer words
Restating: restate in a question for clarity
Reflecting: reflect pt’s feelings
Exploring: ask for examples
o Miracle Question: Goal setting question (pg 143)
o DON’T ASK “WHY” QUESTIONS
Cultural Consideration
o Perception of Touch: Is this uncomfortable to the patient?
o Communication Style:
o Use of Eye Contact:
o Cultural Filters: bias/prejudice
Unit 3
Chapter 7: Nursing Process and Standards for Care
QSEN= Quality and Safety Education in Nursing
Standards: Assessment, Diagnosis, Outcomes Identification (identifying expected outcomes),
Planning, Implementation, Evaluation
Chapter 8: Therapeutic Relationships
Boundaries
o Legal, ethical, and professional standards
Over-involvement= boundary crossing, violations, sexual misconduct,
blurring of roles (transference/countertransference)
Transference versus Countertransference
o “Transference occurs when the patient unconsciously and inappropriately
displaces (transfers) onto the nurse feelings and behaviors related to significant
figures in the patient’s past. The patient may even say, “You remind me of my
[mother, sister, father, brother, etc.].”
Patient places bias on nurse
o “Countertransference is transference in reverse. It occurs when the nurse
unconsciously displaces feelings related to significant figures in the nurse’s past
onto the patient.”
Nurse places bias on patient
Peplau’s Model of Nurse-Patient Relationship (Pg 129)
o The four phases are:
1. Preorientation phase: Assignment Prep
2. Orientation phase: Initial interview, establish rapport
3. Working phase: Interventions, evaluations, data gathering (re-
evaluations)
4. Termination phase: Bye-bye
, Empathy versus Sympathy
o “In empathy, we understand the feelings of others, and in sympathy, we feel pity
or sorrow for others” (pg 132)
Positive Regard
o “Positive regard is respecting a person and viewing another person as being
worthy of caring about and as someone who has strengths and achievement
potential. Positive regard is usually communicated indirectly by attitudes and
actions rather than directly by words.” (pg 132)
Attitudes, Actions, Attending
Chapter 9: Therapeutic Communication
Peplau’s Interpersonal Theory
o 2 principles: clarity +. Continuity
Clarity = ensuring meaning is understood
Continuity = promotes connections through feelings/events
“At the heart of this relationship is a commitment to clear
communication. The two main principles that guide the
communication process are: (1) clarity, which ensures that the
meaning of the message is accurately understood by both parties,
and (2) continuity, which promotes connections among ideas,
feelings, events, and themes. Peplau also recommends nondirective
listening. Using this form of communication allows nurses to
provide reflective and nonjudgmental feedback, thereby helping
patients to clarify their thoughts.” (pg 138)
Verbal vs Non-verbal Communication
Therapeutic Techniques!!
o Silence, Active Listening, Questions (open-ended, projective)
o Clarifying Techniques (pg 141)
Paraphrasing: restating in a different/ fewer words
Restating: restate in a question for clarity
Reflecting: reflect pt’s feelings
Exploring: ask for examples
o Miracle Question: Goal setting question (pg 143)
o DON’T ASK “WHY” QUESTIONS
Cultural Consideration
o Perception of Touch: Is this uncomfortable to the patient?
o Communication Style:
o Use of Eye Contact:
o Cultural Filters: bias/prejudice
