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  1. Definition—Mental
    • A state of psychological and emotional
    • well-being
  2. A
    mentally healthy person?
    • Strives
    • to achieve balance in physical, emotional, social, and spiritual spheres

    • Is
    • able to cope effectively with normal stresses in life and function productively
    • to meet individual, family, community needs.
  3. Two
    basic types of communication

  4. Therapeutic
    • Takes place between the nurse and client
    • and focus is on the client’s--




    Roles and expectations
  5. Nurse’s
    role in therapeutic communication
    The nurse uses active listening

    • The nurse’s goal is to help the client as
    • they work to

    • Explore
    • their feelings

    • Understand
    • and gain insight into their mental illness or other related issues

    • Assist
    • them as they work to change
  6. What
    is social communication?
    Social communication is

    • Less
    • goal-oriented

    • More
    • superficial

    • Usually
    • does not involve the expectation of helping the client regarding emotional concerns—be
    • aware in some cases, an emotional concern will arise during the conversation.
  7. What
    type of communication is used by the nurse?
    • Although nurse-client relationships may
    • involve some social communication, the main component is therapeutic
    • communication
  8. Social
    or therapeutic?
    nurse and client are discussing their favorite movies
  9. Social
    or therapeutic?
    discussion is about medication side effects
  10. Goals
    of therapeutic communication
    1.Establish rapport

    2.Actively listen

    3.Gain the client’s perspective

    • 4.Explore the client’s thoughts and
    • feelings

    5.Guide the client toward problem-solving
  11. Examples
    of therapeutic communication
    • Using open-ended questions
    • Restating and reflecting
    • Focusing
    • Asking for elaboration

    Seeking clarification

    Offering self

    Making observations

  12. Examples
    of nontherapeutic communication

    • Belittling
    • feelings


    • Changing
    • the subject


  13. Non-verbal
    aspects of communication

    • Active
    • listening


    • Body
    • language

    • nEye
    • contact


  14. Proxemics—physical
    distance between communicators
    • Intimate space—up to 18 inches—usually
    • the space reserved for parents and children, those desiring closeness. It is threatening to invade this space

    • Personal space—18 inches to 4
    • feet—comfortable for family and friends conversing

    • Social-consultative space—9 to 12
    • feet—social, work, and business contexts

    • Public space—up to 12 to 25 feet—speaker
    • to audience, small groups, informal groups
  15. Active
    • Refraining
    • from other internal mental activities and concentrating exclusively on what is
    • being said.
  16. Nonverbal
    behaviors that indicate active listening
    • Position
    • facing the client

    • Open
    • posture

    • Leaning
    • forward toward the client

    • Establishment
    • of eye contact

    • Relaxed
    • body language
  17. What
    is SOLER
    • S—Sit
    • squarely facing the client

    • O—Observe
    • an “open posture” with arms and legs uncrossed and being “open” to what the
    • client is saying

    • L—Lean
    • forward

    • E—Establish
    • eye contact

  18. Active
    • Watching
    • the speaker’s nonverbal actions as he or she communicates
  19. Types
    of relationships


  20. Therapeutic
    • A
    • nurse-client interaction that is directed toward improving the client’s
    • well-being

    • The
    • client may be an individual, a family, a group, or a community

    (Videbeck, Chapter 5)
  21. Phases
    of a therapeutic relationship
    • Phase
    • I—orientation

    • Phase
    • II—working

    • Phase
    • III—termination
  22. Phase
    I orientation
    • Initial
    • phase involves assessment and analysis

    • The
    • nurse establishes trust

    • The
    • nurse assesses the client

    • A
    • nursing diagnosis is formulated

    • Problems
    • are prioritized

    • Mutually
    • agreed upon goals are established
  23. Phase
    II working
    • The
    • working phase involves planning outcomes and applying interventions to help the
    • client achieve their goals

    • The
    • nurse encourages expression of problems, thoughts, and feelings

    • There
    • is collaboration and mutual problem-solving

    • Coping
    • techniques are taught or recognized

    • Adaptive
    • behaviors are implemented
  24. Phase
    III termination
    • Termination or resolution is the endpoint
    • of the relationship

    • Problems
    • should be solved at this point

    • The
    • nurse evaluates outcomes for the entire relationship

    • Mutual
    • agreement

    • Does
    • the client show regression?
  25. Nursing
    roles in the therapeutic relationship



    • Parent
    • surrogate

    • The
    • purpose of the nurse-client relationship is to create a safe climate where the
    • client feels free to express themselves and try out new ways to cope
  26. Transference
    • the client experiences an emotional reaction toward the nurse based on past
    • experiences
  27. Countertransference
    • the nurse responds to the client with
    • feelings from based on feelings from their past.
  28. Holistic
    • Considering
    • the client as a person or individual or biopsychosocial being
  29. Spirituality
    • The
    • essence of a person’s being and his or her beliefs about the meaning of life
    • and purpose of living—self awareness is very important.
  30. Forms
    of spirituality
    • Belief
    • in God or a higher power

    • Practice
    • of religion

    • Cultural
    • beliefs and practices

    • Relationship
    • with the environment

    • Should
    • serve as a source of comfort during stressful or traumatic times
  31. Culturally-competent
    nursing care
    • Respect for the individual--regardless of
    • cultural differences. Nursing care demonstrates awareness, knowledge, and
    • respect for the client’s culture.
  32. Client-centered
    • A person can become fully functioning
    • when they are unconditionally valued
  33. Linda Richards—the “Florence
    Nightingale” of mental health
    Started her career in 1873

    • Believed that mentally ill persons were
    • entitled to the same standard of care that the physically ill received

    • Credited with improving nursing care and
    • starting educational programs
  34. Early roles of mental health
    • 1882—custodial focusing on nutrition,
    • hygiene, and activities while practicing tolerance and kindness

    • Later roles included assisting with
    • insulin shock and psychosurgery
  35. Current roles of mental health

    • Milieu therapy—maintains therapeutic
    • environment, teaches skills, promotes communication, and uses role-modeling

    • Self-care focus—direction to promote the
    • clients’ self esteem, independence, health practices, and promotion

    Pharmacologic issues

    Case management
  36. Period of enlightenment
    • Dorothea Dix, a school teacher,
    • recognized the value of England’s system of “asylum” for mentally ill persons.

    • She is credited with setting up a similar
    • system in the United States and 32 “state” hospitals were opened
  37. Period of psychotropic drugs

    1950’s—thorazine and tricyclic antidepressants.
  38. Involuntary inpatient commitment
    • The client is institutionalized against
    • their will

    • Generally, these clients have posed a
    • threat to themselves or others

    • State guidelines specify time limits and
    • conditions for evaluation and care.

    • If the client is committed for extended
    • care-- ongoing legal hearings are specified
  39. What rights do clients under protective
    custody retain?
    • All civil rights except THE RIGHT TO

    • Examples of rights include—the client may
    • send and receive mail, have or refuse visitors, telephone privileges, and may
    • refuse medication or treatment*.

    Unless medications are “court ordered”
  40. Restrictions may occur but are physician
    and/or court mandated such as
    • Suicide
    • precautions

    • Certain
    • visitors may be restricted

    • May
    • require supervised telephone calls
  41. Types of prevention
    • Primary—prevent problem from ever
    • occurring

    Secondary—early diagnosis and treatment

    • Tertiary—continued support and
    • rehabilitation

    • Chapter
    • 4
  42. Duty to warn criteria
    Is the client dangerous to others?

    • Is the danger the result of a serious
    • mental illness?

    Is the danger imminent?

    • Is the danger targeted at identifiable
    • victims
  43. Nursing actions with “duty to
    • Remember, the typical rules for
    • confidentiality and medical records do not apply here

    • Once the information is obtained the
    • following should be notified*

    Intended victim(s)

    Law enforcement

    Nursing supervisor

    Attending physician

    • *According to text—practical or clinical
    • applications may vary
  44. Ethnocentric
    • Belief that one’s own culture is superior
    • to others and the standard or norm by which all other cultures are measured
  45. When a nurse is ethnocentric…the
    client may feel
    ….out of sync,


    Alienated, and

    • In “conflict” with their provider
    • Additionally—clients are deprived of the
    • benefit of a therapeutic relationship—labeled as noncompliant, and

    May not understand their treatment plan
  46. Ethnorelative
    • Belief that all cultures are equally
    • valid and equally deserving of respect
  47. Are close-ended questions
    acceptable when conducting a nursing assessment?
    • Yes, this type of question is helpful
    • when specific information is required or when the client is unable to organize
    • their thoughts.
  48. What is a labile mood
    • When the client exhibits unpredictable
    • and rapid mood swings—example: from depressed to euphoria
  49. Axis I
    • clinical disorder that is the focus of
    • treatment such as major depression, autism
  50. Axis II
    personality disorders, mental retardation
  51. Axis III
    general medical conditions such asthma
  52. Axis IV
    • psychosocial and environmental problems
    • such as educational deficits, housing problems, financial difficulties, etc.
  53. Axis V
    • Global Assessment of Functioning
    • (GAF). Assigns a numerical value
    • representing the client’s current level of functioning compared to the highest
    • level of functioning during the past year.
    • Expressed as a fraction such as 45/70
Card Set:
2012-02-02 20:46:52
Mental Health test

Mental health test 1
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