2/24/25, 1:07 PM
LUSL4084 Mental Health
Readings - Saunders
Comprehensive Review
for the Nclex-Rn
Examination
about:blank 1/66
,2/24/25, 1:07 PM
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
about:blank 1/66
,2/24/25, 1:07 PM
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.
◻ 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
about:blank 2/66
, 2/24/25, 1:07 PM
Mental Health 2
◻ 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.
about:blank 3/66
LUSL4084 Mental Health
Readings - Saunders
Comprehensive Review
for the Nclex-Rn
Examination
about:blank 1/66
,2/24/25, 1:07 PM
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
about:blank 1/66
,2/24/25, 1:07 PM
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.
◻ 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
about:blank 2/66
, 2/24/25, 1:07 PM
Mental Health 2
◻ 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.
about:blank 3/66
