NURS 406 – Psychiatric Mental Health Nursing Final Exam Study Sheet
Mods 1-8
Module 1: Intro to Psychiatric-Mental Health Nursing
Communication and the Therapeutic Relationship: (Chapter 9)
Therapeutic Communication:
➢ Communication: exchange of information
• Verbal
o Content: literal words spoken
o Context: environment, circumstances, situation in which communication occurs
• Nonverbal:
o Process: all messages used to give meaning, context to message
o Messages: Congruent or incongruent
➢ Therapeutic Communication: interpersonal interactions focusing on client’s needs; encompasses goals that facilitate the
nursing process
• Goals of Therapeutic Communication:
o Establish therapeutic nurse–client relationship
o Identify the most important client’s concerns; assess client’s perceptions
o Facilitate client’s expression of emotions
o Teach client and family the necessary self-care skills
o Recognize client’s needs
o Implement interventions to address client’s needs
o Guide client toward acceptable solutions
• Proxemics: Distance zones; most comfortable when nurse and patient are 3 to 6 ft apart
o Intimate (0–18 in)
o Personal (18–36 in)
o Social (4–12 ft)
o Public (12–25 ft)
• Touch: comforting and supportive when welcome and permitted; Can be possible invasion of intimate and
personal space; nurse must evaluate use of touch based on the client’s preferences; five types of touch:
1. Functional: professional
2. Social: polite
3. Friendship: warmth
4. Love: intimacy
5. Sexual: arousal
• Active listening: concentrating exclusively on what patient says; helps nurse id the most important issue
• Active observation: watching nonverbal actions as speaker communicates; helps nurse id the most important issue
➢ Verbal Communication Skills: need for concrete, not abstract, messages; exploring, focusing, restating, reflecting, etc.
• Avoidance of nontherapeutic techniques: Advising, belittling, challenging, probing, reassuring, why questions
• Interpretation of signals or cues
o Overt: clear, direct statements
o Covert: vague, indirect messages
➢ Nonverbal Communication Skills:
• Facial expression: expressive, Impassive, Confusing
• Body language: closed body position vs open posture
• Vocal cues:
• Eye contact: can promote empathy
• Silence: can be useful to promote more sharing by the client
➢ Therapeutic Communication Session:
• Identification of Major Concern:
o Nondirective role: broad openings, open-ended questions
o Directive role: direct yes-or-no questions; usually for clients with suicidal thoughts, in crisis, or who are
out of touch with reality
• Open-ended: questions versus yes-or-no questions
• Proper phrasing: of questions; using <think= versus <feel=
1
, • Active listening skills: building on client’s responses to open-ended questions
• Techniques: include clarification and placing an event in time or sequence.
• Asking for clarification
• Addressing client’s avoidance of anxiety-inducing topic
• Guiding the client in problem-solving and change
➢ Assertive Communication: expression of positive and negative feelings/ideas in an open, honest, direct way
• Uses calm, specific, factual statements
• Focuses on <I= statements
• Possible responses:
o Aggressive
o Passive–aggressive
o Passive
o Assertive
• Broken record technique
• Rehearsing responses
Therapeutic Relationships:
• Therapeutic Relationship: one of the most important skills a nurse can develop; crucial to success of interventions with
psychiatric pts
➢ Components of Therapeutic Relationship:
• Trust: behaviors such as caring, interest, understanding, consistency, honesty, keeping promises, and listening
• Genuine interest: client can detect dishonest behavior
• Empathy: ability to perceive client’s meanings and feelings, to communicate that understanding
• Acceptance: no judgments; set boundaries
• Positive regard: unconditional, nonjudgmental attitude
➢ Self-Awareness: Know self
• Values (Choosing, Prizing, Acting)
• Beliefs
• Attitudes
• Cultural awareness
➢ Therapeutic Use of Self: use of aspects of personality, experience, values, feelings, intelligence, needs, coping skills,
perceptions to establish relationships with clients
• Johari window: tool to learn about oneself
➢ Patterns of Knowing: preconceptions; ways of observing, understanding client interactions
• Four patterns of knowing: (Carper, 1978) Empirical, Personal, Ethical, Aesthetic
• Fifth pattern: unknowing (Munhall, 1993); nurse admits lack of knowledge of client or understanding of client’s
subjective world.
➢ Types of Relationships:
• Social: purpose of friendship, socialization, companionship, or task accomplishment
• Intimate: Emotional commitment of two persons
• Therapeutic: Focus on needs, experiences, feelings, ideas of client only
➢ Establishing a Therapeutic Relationship:
• Peplau’s model of three phases: overlapping, interlocking of phases
1. Orientation:
2. Working: Identification/Exploitation
3. Termination: ensure pt knows when/how it will occur
➢ Behaviors That Diminish Therapeutic Relationships:
• Inappropriate boundaries (relationship becomes social or intimate)
• Feelings of sympathy, encouraging client dependency
• Nonacceptance and avoidance
• Nursing boundaries
➢ Therapeutic Roles of the Nurse in a Relationship:
• Teacher: coping, problem-solving, medication regimen, community resources
• Caregiver: therapeutic relationship, physical care
• Advocate: ensuring privacy and dignity, informed consent, access to services, safety from abuse and exploitation
• Parent surrogate: Must ensure relationship remains therapeutic
2
, Cognitive Interventions in Psychiatric Nursing: (Chapter 12)
• Cognition: an internal process of perception, memory, and judgment through which an understanding of oneself and the
world is developed
• Cognitive interventions: change or reframe an individual’s automatic thought patterns that develop over time and that
interfere with the ability to function optimally
➢ Development of Cognitive Therapies:
• Albert Ellis: first to develop and implement cognitive therapy; refined and developed theory and therapeutic
approach called Rational Emotive Behavior Therapy (REBT)
• Aaron Beck: Cognitive Behavioral Therapy (CBT)
• Steven de Shazer and Insoo Kim Berg: Solution-Focused Brief Therapy (SFBT)
Cognitive Behavioral Therapy: used to alter distorted beliefs and problem behaviors; negative and inaccurate thoughts identified
and replaced; rewards for behavior changed
➢ Assumptions:
• People disturbed by the perception of event, not the event
• Whenever or however the belief develops, the individual believes it
• Work and practice can modify beliefs, creating difficulties
➢ Cognitive Processes involved in Mental Disorder Development:
• Cognitive triad: thoughts about oneself, the world, and the future
• Cognitive distortions: <twisted thinking= (overgeneralization, polarize thinking, catastrophizing)
• Schemas: individual’s life rules acting as a filter; developed in early childhood and fixed by middle childhood
➢ Implementing CBT: engagement and assessment
• Intervention framework:
o Identify the underlying belief
o Explore the evidence that supports or refutes the belief about the event
o Identify alternative explanations for the event
o Examine the real implications if the belief is true
• Evaluation and termination
Rational Emotive Behavior Therapy: (REBT) a form of CBT with emphasis on changing irrational beliefs (self-defeating) that cause
emotional distress into thoughts that are more reasonable and rational (self-constructive)
➢ Framework:
• Activating event that triggers automatic thoughts and emotions
• Beliefs that underlie the thoughts and emotions
• Consequences of this automatic process
• Dispute or challenge unreasonable expectations
• Effective outlook developed by disputing or challenging negative belief systems
Solution-Focused Brief Therapy: (SFBT) focus on solutions rather than problems; problems best understood in relation to solutions;
view of the patient as an individual with a collection of strengths and successes rather than as a diagnosis and collection of
symptoms
➢ Assumptions:
• Change is constant and inevitable
• Not necessary to know a lot about the complaint to resolve it
• No right or wrong way to see things
• Therapist’s job to identify and amplify change
• Therapist and patient cocreate reality
• Therapist maintains expectation of change and movement
➢ Interventions: focus on achievement of specific, concrete, and achievable goals; techniques utilized include…
• Miracle question: an intervention used to explore clients' hidden resources or solutions for their present problems
Example: <Suppose tonight, while you slept, a miracle occurred. When you awake tomorrow, what would be some of the things you
would notice that would tell you life had suddenly gotten better?"
3
Mods 1-8
Module 1: Intro to Psychiatric-Mental Health Nursing
Communication and the Therapeutic Relationship: (Chapter 9)
Therapeutic Communication:
➢ Communication: exchange of information
• Verbal
o Content: literal words spoken
o Context: environment, circumstances, situation in which communication occurs
• Nonverbal:
o Process: all messages used to give meaning, context to message
o Messages: Congruent or incongruent
➢ Therapeutic Communication: interpersonal interactions focusing on client’s needs; encompasses goals that facilitate the
nursing process
• Goals of Therapeutic Communication:
o Establish therapeutic nurse–client relationship
o Identify the most important client’s concerns; assess client’s perceptions
o Facilitate client’s expression of emotions
o Teach client and family the necessary self-care skills
o Recognize client’s needs
o Implement interventions to address client’s needs
o Guide client toward acceptable solutions
• Proxemics: Distance zones; most comfortable when nurse and patient are 3 to 6 ft apart
o Intimate (0–18 in)
o Personal (18–36 in)
o Social (4–12 ft)
o Public (12–25 ft)
• Touch: comforting and supportive when welcome and permitted; Can be possible invasion of intimate and
personal space; nurse must evaluate use of touch based on the client’s preferences; five types of touch:
1. Functional: professional
2. Social: polite
3. Friendship: warmth
4. Love: intimacy
5. Sexual: arousal
• Active listening: concentrating exclusively on what patient says; helps nurse id the most important issue
• Active observation: watching nonverbal actions as speaker communicates; helps nurse id the most important issue
➢ Verbal Communication Skills: need for concrete, not abstract, messages; exploring, focusing, restating, reflecting, etc.
• Avoidance of nontherapeutic techniques: Advising, belittling, challenging, probing, reassuring, why questions
• Interpretation of signals or cues
o Overt: clear, direct statements
o Covert: vague, indirect messages
➢ Nonverbal Communication Skills:
• Facial expression: expressive, Impassive, Confusing
• Body language: closed body position vs open posture
• Vocal cues:
• Eye contact: can promote empathy
• Silence: can be useful to promote more sharing by the client
➢ Therapeutic Communication Session:
• Identification of Major Concern:
o Nondirective role: broad openings, open-ended questions
o Directive role: direct yes-or-no questions; usually for clients with suicidal thoughts, in crisis, or who are
out of touch with reality
• Open-ended: questions versus yes-or-no questions
• Proper phrasing: of questions; using <think= versus <feel=
1
, • Active listening skills: building on client’s responses to open-ended questions
• Techniques: include clarification and placing an event in time or sequence.
• Asking for clarification
• Addressing client’s avoidance of anxiety-inducing topic
• Guiding the client in problem-solving and change
➢ Assertive Communication: expression of positive and negative feelings/ideas in an open, honest, direct way
• Uses calm, specific, factual statements
• Focuses on <I= statements
• Possible responses:
o Aggressive
o Passive–aggressive
o Passive
o Assertive
• Broken record technique
• Rehearsing responses
Therapeutic Relationships:
• Therapeutic Relationship: one of the most important skills a nurse can develop; crucial to success of interventions with
psychiatric pts
➢ Components of Therapeutic Relationship:
• Trust: behaviors such as caring, interest, understanding, consistency, honesty, keeping promises, and listening
• Genuine interest: client can detect dishonest behavior
• Empathy: ability to perceive client’s meanings and feelings, to communicate that understanding
• Acceptance: no judgments; set boundaries
• Positive regard: unconditional, nonjudgmental attitude
➢ Self-Awareness: Know self
• Values (Choosing, Prizing, Acting)
• Beliefs
• Attitudes
• Cultural awareness
➢ Therapeutic Use of Self: use of aspects of personality, experience, values, feelings, intelligence, needs, coping skills,
perceptions to establish relationships with clients
• Johari window: tool to learn about oneself
➢ Patterns of Knowing: preconceptions; ways of observing, understanding client interactions
• Four patterns of knowing: (Carper, 1978) Empirical, Personal, Ethical, Aesthetic
• Fifth pattern: unknowing (Munhall, 1993); nurse admits lack of knowledge of client or understanding of client’s
subjective world.
➢ Types of Relationships:
• Social: purpose of friendship, socialization, companionship, or task accomplishment
• Intimate: Emotional commitment of two persons
• Therapeutic: Focus on needs, experiences, feelings, ideas of client only
➢ Establishing a Therapeutic Relationship:
• Peplau’s model of three phases: overlapping, interlocking of phases
1. Orientation:
2. Working: Identification/Exploitation
3. Termination: ensure pt knows when/how it will occur
➢ Behaviors That Diminish Therapeutic Relationships:
• Inappropriate boundaries (relationship becomes social or intimate)
• Feelings of sympathy, encouraging client dependency
• Nonacceptance and avoidance
• Nursing boundaries
➢ Therapeutic Roles of the Nurse in a Relationship:
• Teacher: coping, problem-solving, medication regimen, community resources
• Caregiver: therapeutic relationship, physical care
• Advocate: ensuring privacy and dignity, informed consent, access to services, safety from abuse and exploitation
• Parent surrogate: Must ensure relationship remains therapeutic
2
, Cognitive Interventions in Psychiatric Nursing: (Chapter 12)
• Cognition: an internal process of perception, memory, and judgment through which an understanding of oneself and the
world is developed
• Cognitive interventions: change or reframe an individual’s automatic thought patterns that develop over time and that
interfere with the ability to function optimally
➢ Development of Cognitive Therapies:
• Albert Ellis: first to develop and implement cognitive therapy; refined and developed theory and therapeutic
approach called Rational Emotive Behavior Therapy (REBT)
• Aaron Beck: Cognitive Behavioral Therapy (CBT)
• Steven de Shazer and Insoo Kim Berg: Solution-Focused Brief Therapy (SFBT)
Cognitive Behavioral Therapy: used to alter distorted beliefs and problem behaviors; negative and inaccurate thoughts identified
and replaced; rewards for behavior changed
➢ Assumptions:
• People disturbed by the perception of event, not the event
• Whenever or however the belief develops, the individual believes it
• Work and practice can modify beliefs, creating difficulties
➢ Cognitive Processes involved in Mental Disorder Development:
• Cognitive triad: thoughts about oneself, the world, and the future
• Cognitive distortions: <twisted thinking= (overgeneralization, polarize thinking, catastrophizing)
• Schemas: individual’s life rules acting as a filter; developed in early childhood and fixed by middle childhood
➢ Implementing CBT: engagement and assessment
• Intervention framework:
o Identify the underlying belief
o Explore the evidence that supports or refutes the belief about the event
o Identify alternative explanations for the event
o Examine the real implications if the belief is true
• Evaluation and termination
Rational Emotive Behavior Therapy: (REBT) a form of CBT with emphasis on changing irrational beliefs (self-defeating) that cause
emotional distress into thoughts that are more reasonable and rational (self-constructive)
➢ Framework:
• Activating event that triggers automatic thoughts and emotions
• Beliefs that underlie the thoughts and emotions
• Consequences of this automatic process
• Dispute or challenge unreasonable expectations
• Effective outlook developed by disputing or challenging negative belief systems
Solution-Focused Brief Therapy: (SFBT) focus on solutions rather than problems; problems best understood in relation to solutions;
view of the patient as an individual with a collection of strengths and successes rather than as a diagnosis and collection of
symptoms
➢ Assumptions:
• Change is constant and inevitable
• Not necessary to know a lot about the complaint to resolve it
• No right or wrong way to see things
• Therapist’s job to identify and amplify change
• Therapist and patient cocreate reality
• Therapist maintains expectation of change and movement
➢ Interventions: focus on achievement of specific, concrete, and achievable goals; techniques utilized include…
• Miracle question: an intervention used to explore clients' hidden resources or solutions for their present problems
Example: <Suppose tonight, while you slept, a miracle occurred. When you awake tomorrow, what would be some of the things you
would notice that would tell you life had suddenly gotten better?"
3
