Mental Health Nursing Chapter 8

Questions and Answers

What is the best analysis of the scenario where a nurse invites a patient, diagnosed with a mental illness, to the annual staff picnic?

The nurse's action assists the patient's integration into community living.

The invitation facilitates dependency on the nurse.

The invitation is therapeutic for the patient's diversional activity deficit.

The nurse's action blurs the boundaries of the therapeutic relationship. (correct)

The nurse's statement 'I am the only one who truly understands this patient. Other staff members are too critical.' indicates what?

Advocacy.

Positive regard.

Sexual harassment.

Boundary blurring. (correct)

Which descriptors exemplify consistency regarding nurse-patient relationships? (Select all that apply)

Having the same nurse care for a patient on a daily basis. (correct)

Offering solutions to a patient's problems.

Encouraging a patient to share initial impressions of staff.

Providing a schedule of daily activities to a patient. (correct)

Setting a time for regular sessions with a patient. (correct)

Which actions by the nurse should be included in the termination phase when ending a relationship with a patient? (Select all that apply)

Help the patient express feelings about the relationship with the nurse. Signup and view all the answers

Which are the best ways for a novice psychiatric nurse with a parent having bipolar disorder to cope with feelings of embarrassment about the parent's behavior? (Select all that apply)

Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. Signup and view all the answers

Which behaviors will help a novice nurse convey to patients that they are interested and want to listen? (Select all that apply)

Introducing self to a patient and identifying own role. Signup and view all the answers

Which response is the nurse demonstrating when assessing a confused older adult and feeling sadness, reflecting, 'The patient is like one of my grandparents...so helpless.'?

Countertransference Signup and view all the answers

Which statement shows a nurse has empathy for a patient who made a suicide attempt?

You must have been very upset when you tried to hurt yourself. Signup and view all the answers

After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?

The nurse feels unusually happy when the patient's mood begins to lift. Signup and view all the answers

How should the nurse respond when a patient says, 'Please don't share information about me with the other people.'?

I will not share information with your family or friends without your permission, but I share information about you with other staff. Signup and view all the answers

What should the nurse do when interrupted during a session with a patient by another patient who needs to talk?

Tell the interrupting patient, 'This session is 5 more minutes; then I will talk with you.' Signup and view all the answers

Termination of a therapeutic nurse-patient relationship has been successful when the nurse:

Discusses with the patient changes that happened during the relationship and evaluates outcomes. Signup and view all the answers

What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate:

Rapport and trust with the nurse. Signup and view all the answers

During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?

Working Signup and view all the answers

At what point in the nurse-patient relationship should a nurse plan to first address termination?

During the orientation phase Signup and view all the answers

A nurse introduces the matter of a contract during the first session with a new patient because contracts:

Spell out the participation and responsibilities of each party. Signup and view all the answers

Which is the nurse's best response when a patient gives a necklace as a gift?

I'm glad I could help you, but I can't accept the gift. My reward is seeing you with a renewed sense of hope. Signup and view all the answers

Which remark by a patient indicates passage from orientation to the working phase of a nurse-patient relationship?

I want to find a way to deal with my anger without becoming violent. Signup and view all the answers

A nurse explains how a nurse-patient relationship differs from social relationships. Which is the best explanation?

The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient. Signup and view all the answers

Which action demonstrates genuineness with a patient diagnosed with schizophrenia?

Use congruent communication strategies. Signup and view all the answers

What should a nurse do when feeling anger toward a suspicious patient?

Discuss the anger with a clinician during a supervisory session. Signup and view all the answers

Which action by a nurse demonstrates valuing autonomy?

Discusses options and helps the patient weigh the consequences. Signup and view all the answers

What is the nurse's best action when a patient gives a card of appreciation at discharge?

Recognize the effectiveness of the relationship and patient's thoughtfulness. Accept the card. Signup and view all the answers

What is the nurse's best response when a patient requests to change their off-unit activity restrictions?

That's a good topic for you to discuss with your doctor. Signup and view all the answers

When a novice nurse begins work with a patient previously cared for by another nurse, what is the starting point for the relationship?

Begin at the orientation phase. Signup and view all the answers

Study Notes

Therapeutic Relationships in Mental Health Nursing

Countertransference occurs when a nurse's emotional responses are influenced by their own past experiences and feelings linked to a patient.
Empathy is demonstrated when a nurse accurately reflects the patient's feelings, allowing the patient to feel understood and validated.
Monitoring emotional responses is crucial to maintain objectivity and prevent issues such as countertransference.

Communication and Boundaries

Nurses must clearly communicate the limits of confidentiality to patients, ensuring they understand what information might be shared with other staff.
Respecting the patient's right to privacy builds trust and fosters a therapeutic relationship.
Effective responses to interruptions during a session should maintain boundaries and adhere to the established schedule to prevent feelings of abandonment.

Phases of Nurse-Patient Relationships

The orientation phase focuses on building rapport and trust, which is vital before progressing to the working phase.
The working phase is where identified patient issues are actively explored and strategies for coping are developed.
Termination involves discussing the relationship's end, evaluating progress, and minimizing dependency on the nurse.

Contracts and Autonomy

Contracts in therapeutic relationships outline roles and responsibilities, ensuring both the nurse and patient understand their commitments.
Valuing patient autonomy involves discussing options with patients and supporting them in their decision-making process.

Professionalism and Boundaries

Accepting gifts from patients can blur the lines between professional and personal relationships and should typically be declined graciously.
Affirming the patient's gratitude while maintaining a professional boundary emphasizes the importance of therapeutic integrity.

Trust and Communication Styles

Nonjudgmental responses by nurses encourage patients to express their feelings and explore their thoughts without fear of criticism.
Genuineness in communication fosters a strong therapeutic relationship, where patients feel acknowledged and respected.

Transitioning Between Relationships

When a new nurse begins working with an established patient, they must restart at the orientation phase, as previous relationships must be acknowledged and respected.
Maintaining professionalism is crucial when moving away from therapeutic relationships, such as avoiding informal social invitations that might confuse roles.

Consistency in Care

Consistency in nurse-patient interactions (same nurse, regular schedules) promotes stability and security for patients, enhancing their comfort in the therapeutic process.
Predictable routines and engagement strategies are essential for effective therapeutic relationships, especially for patients with mental health disorders.

Handling Emotional Responses

Strong emotional responses towards patients should be openly discussed in supervision, aiming for professional objectivity and effective care strategies.
Recognizing and managing feelings such as anger or frustration towards patients is part of maintaining professionalism and therapeutic effectiveness.### Termination Phase in Patient-Nurse Relationships
In the termination phase, focus dialogues with the patient on potential future problems.
Assist the patient in expressing feelings about the relationship for closure.
Reinforcing expectations and relationship parameters is crucial during termination.

Coping with Personal Experiences in Psychiatric Nursing

Novice nurses with personal experience (like a parent with bipolar disorder) can use this understanding to empathize with patients.
Recognizing unhealthy feelings is important; suppression is not a productive strategy.
Acknowledging these feelings can enhance sensitivity in nursing practice, but supervision is essential.

Effective Communication Techniques in Nursing

Building rapport with patients involves introducing oneself and clarifying the nurse's role.
Positive facial expressions significantly enhance the message of interest and encouragement.
An open body posture and techniques like mirror imaging foster comfort and promote open communication.
Avoiding physical barriers (like desks) and using less intense angles in body orientation helps reduce discomfort in interactions.

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Test your knowledge on therapeutic relationships in nursing with this quiz on Chapter 8. Focus on concepts like transference and countertransference as you work through flashcards designed for nursing students. Perfect for those looking to enhance their understanding of patient interactions.