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Therapeutic Relationships and the Clinical Interview
Chapter 7 MH Nursing
47
Nursing
Undergraduate 3
01/20/2013

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Cards

Term
Therapeutic Nurse-Client Relationship
Definition
  • basis for all psych nsg tx approaches
  • establishes an understanding that the relationship is: safe, confidential, reliable, has clear boundaries
  • research validates therepeutic outcomes
Term
Therapeutic use of self
Definition
Creative process unique to each nurse
Term
Goals and Fx of Therapeutic Relationships
Definition
  • facilitates pt communitcation of prob/feelings
  • assists pt w/ problem solving
  • helps pt examine self-defeating behaviors and test alt
  • promotes pt self-care and independence
Term
Social Relationship
Definition
  • purpose is friendship
  • mutual needs met
  • enjoyment for both participants
  • roles may shift
Term
Therapeutic Relationship
Definition
  • focus on pt problems and needs
  • boundaries and roles remain firm and clear
  • knowledge applied from evidence-based research
  • nonjudgmental attitude of nurse toward pt
  • supervision by experienced clinician essential
Term
Clear (therapeutic) boundaries
Definition
client's needs and role are separated from those of the nurse
Term
Unclear (non-therapeutic/ "boundary blurring")
Definition
  • nurse tries to have own needs met
  • nurse tries to solve pt's problems
  • nurse takes on role of family or friend toward client
Term
Overhelping, Controlling, Narcissism
Definition
What are the three warning signs that a nurse may be blurring boundaries
Term
Overhelping
Definition
Doing for pts what they are able to do for themselves
Term
controlling
Definition
asserting authority and assuming control for "pts own good"
Term
Narcissism
Definition
focus on pt's weaknesses rather than promoting strengths
Term
Transference and countertransference 
Definition
what are two reasons boundary blurring often occurs?
Term
Transference
Definition
pt displaces emotional rx originating in childhood experiences onto helping person in the relationship- often intensified in relationships of authority
Term
Countertransference
Definition
nurse displaces feelings rl/t people in one's past onto pt
Term
  • feeling strongly negative/positive toward pt
  • overidentification w/ pt and pt problems
  • power struggles, competition, or arguments w/ pt
Definition
what are some signs a nurse may be experiencing countertransference?
Term
Orientation, Working, Termination
Definition
What are Peplau's phases of the Nurse-Client relationship?
Term
Preorientation
Definition
In this stage, student may have concerns rl/t initial psychiatric clinical experience
Term
crying, asking to keep secrets, gift giving, suicide threats
Definition
What are some common behaviors by pts that cause concern for students?
Term
Orientation
Definition
  • In this phase of the nurse-client relationship rapport is established
  • parameters are established: clarify role, define nurse/pt responsibilities, define contract issues (setting/times, confidentiality, terms of termination)
Term
Working
Definition
  • Explore areas in pt's life that cause problems
  • gather data, promote pt prob solving
  • facilitate/practice behavioral changes
  • evaluate/redefine problems
Term
Working
Definition
In this phase, expect pts to use defense mechanisms such as: acting out, withdrawal, intellectualization, manipulation, denial.
Term
Termination
Definition

This occurs on pt discharge or end of student clinical rotation

  • tasks include: summarizing goals/objectives, discuss ways to incorporate new coping strategies, review situations during relationship, exchange memories
Term
Reawakening unresolved feelings of loss, abandonment, loneliness, and rejection
Definition
Upon termination, the pt may have difficulties including. . .
Term
Guilt about leaving pt and unresolved feelings of loss
Definition
Upon termination, the nurse may have difficulties including. . .
Term
Encourage discussion of feelings and share own feelings about termination
Definition
What are some things the nurse should do to handle termination difficulties?
Term
Consistency, Pacing, Listening, Positive initial impression, Promoting pt comfort/balancing control
Definition
What are some factors that enhance the Nurse-Patient relationship?
Term
Inconsistency, Unavailability, Lack of self-awareness on nurse's behalf
Definition
Factors that hinder the Nurse-Patient relationship
Term
Genuineness, Empathy, Positive regard
Definition
What are three factors that enhance growth in the psych pt?
Term
Genuineness
Definition
This is key in building trust and includes self-awareness of feelings and ability to communicate
Term
Empathy
Definition
This means to understand the feelings of others.
Term
Sympathy
Definition
This means to feel others' feelings. The nurse loses objectivity.
Term
Positive Regard
Definition
This includes attending behaviors and suspending value judgment
Term
  • pt set pace
  • use a setting conductive to feeling of security
  • use open ended communication
  • offer leads
  • attending behaviors
  • appropriate clinical supervision
Definition
What are the responsibilities of the nurse during the clinical interview?
Term
Attending behaviors
Definition
Examples of this include: eye contact, body language, vocal quality, and verbal tracking.
Term
Vocal qualities
Definition
"It's not what you say, but how you say it". Can be used to show empathy and establish rapport.
Term
Verbal tracking
Definition
Tracking what the pt is saying and giving neutral feedback in the form of restating or summarizing what the pt has already said.
Term
Attending behaviors
Definition
Culturally and individually appropriate care, eye contact, body language, vocal qualities, and verbal tracking are all important parts.
Term
0-18 inches
Definition
The intimate zone
Term
Intimate zone
Definition
This zone is reserved for those we trust most and with whom we feel most safe.
Term
18-40 inches
Definition
Personal distance 
Term
Personal distance
Definition
Reserved for those such as friends or colleagues. 
Term
4-12 feet
Definition
Social distance
Term
Social distance
Definition
This is applied to strangers or acquaintances, often in public places or formal social gatherings.
Term
12+ feet
Definition
Public distance
Term
Public distance
Definition
This rl/t public space 
Term
Speak briefly, when in doubt: say nothing and focus on feelings, keep focus on pt, pay attention to nonverbal communication, avoid relying on Qs, avoid advice, and don't argue
Definition
Helpful tips to remember during the clinical interview.
Term
True
Definition
True or False. It's important for a nurse to set his or her feelings aside when interacting with pts. Use a nonjudgmental attitude and be sensitive.
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