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. What would you like to do?
- A state of psychological and emotional
mentally healthy person?
- to achieve balance in physical, emotional, social, and spiritual spheres
- able to cope effectively with normal stresses in life and function productively
- to meet individual, family, community needs.
basic types of communication
- Takes place between the nurse and client
- and focus is on the client’s--
Roles and expectations
role in therapeutic communication
The nurse uses active listening
- The nurse’s goal is to help the client as
- they work to
- and gain insight into their mental illness or other related issues
- them as they work to change
is social communication?
Social communication is
- 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.
type of communication is used by the nurse?
- Although nurse-client relationships may
- involve some social communication, the main component is therapeutic
nurse and client are discussing their favorite movies
discussion is about medication side effects
of therapeutic communication
3.Gain the client’s perspective
- 4.Explore the client’s thoughts and
5.Guide the client toward problem-solving
of therapeutic communication
- Using open-ended questions
- Restating and reflecting
- Asking for elaboration
of nontherapeutic communication
aspects of communication
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
- from other internal mental activities and concentrating exclusively on what is
- being said.
behaviors that indicate active listening
- facing the client
- forward toward the client
- of eye contact
- squarely facing the client
- an “open posture” with arms and legs uncrossed and being “open” to what the
- client is saying
- the speaker’s nonverbal actions as he or she communicates
- nurse-client interaction that is directed toward improving the client’s
- client may be an individual, a family, a group, or a community
(Videbeck, Chapter 5)
of a therapeutic relationship
- phase involves assessment and analysis
- nurse establishes trust
- nurse assesses the client
- nursing diagnosis is formulated
- agreed upon goals are established
- working phase involves planning outcomes and applying interventions to help the
- client achieve their goals
- nurse encourages expression of problems, thoughts, and feelings
- is collaboration and mutual problem-solving
- techniques are taught or recognized
- behaviors are implemented
- Termination or resolution is the endpoint
- of the relationship
- should be solved at this point
- nurse evaluates outcomes for the entire relationship
- the client show regression?
roles in the therapeutic relationship
- 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
- the client experiences an emotional reaction toward the nurse based on past
- the nurse responds to the client with
- feelings from based on feelings from their past.
- the client as a person or individual or biopsychosocial being
- 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.
- in God or a higher power
- beliefs and practices
- with the environment
- serve as a source of comfort during stressful or traumatic times
- Respect for the individual--regardless of
- cultural differences. Nursing care demonstrates awareness, knowledge, and
- respect for the client’s culture.
- A person can become fully functioning
- when they are unconditionally valued
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
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
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
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
Period of psychotropic drugs
1950’s—thorazine and tricyclic antidepressants.
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
What rights do clients under protective
- All civil rights except THE RIGHT TO
- LEAVE THE HOSPITAL
- 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”
Restrictions may occur but are physician
and/or court mandated such as
- visitors may be restricted
- require supervised telephone calls
Types of prevention
- Primary—prevent problem from ever
Secondary—early diagnosis and treatment
- Tertiary—continued support and
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
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*
- *According to text—practical or clinical
- applications may vary
- Belief that one’s own culture is superior
- to others and the standard or norm by which all other cultures are measured
When a nurse is ethnocentric…the
client may feel
….out of sync,
- 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
- Belief that all cultures are equally
- valid and equally deserving of respect
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.
What is a labile mood
- When the client exhibits unpredictable
- and rapid mood swings—example: from depressed to euphoria
- clinical disorder that is the focus of
- treatment such as major depression, autism
personality disorders, mental retardation
general medical conditions such asthma
- psychosocial and environmental problems
- such as educational deficits, housing problems, financial difficulties, etc.
- 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
What would you like to do?
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