Nursing Self-Awareness and Therapeutic Use

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Questions and Answers

What is the primary purpose of keeping a diary or journal in the context of self-awareness?

To document personal achievements only

To eliminate negative emotions completely

To create a narrative for others to read

To track experiences and related feelings for pattern recognition (correct)

Which of the following best describes 'Therapeutic Use of Self'?

Using medications to treat clients effectively

Maintaining professional distance at all times

Offering clients solutions without emotional involvement

Established relationships based on the nurse's insights and personality (correct)

What does the Johari Window primarily help individuals to achieve?

Creating comprehensive treatment plans

Assessing clinical skills of nurses

Facilitating self-learning and self-discovery (correct)

Understanding complex medical concepts

Which pattern of knowing in nursing is derived from the science of Nursing?

Empirical Knowing Signup and view all the answers

What is meant by 'preconception' in the context of nurse-client relationships?

Personal biases that block relationship building Signup and view all the answers

What is the focus of 'Ethical Knowing' in nursing?

Moral principles and values in nursing practice Signup and view all the answers

How does engaging in formal clinical supervision contribute to self-awareness?

It provides new insights and approaches to practice. Signup and view all the answers

What does the 'Blind/Unaware' quadrant of the Johari Window represent?

Self qualities perceived by others but not recognized by oneself Signup and view all the answers

What was the primary view of mental illness in ancient times?

A punishment for sins and wrongdoing. Signup and view all the answers

Which theorist contributed significantly to the nurse-client relationship in psychiatric nursing?

Hildegard Peplau Signup and view all the answers

What treatment methods were used in the 19th century for mental disorders based on the imbalance of bodily fluids?

Bloodletting, starving, and purging. Signup and view all the answers

In early Christian times, mentally ill individuals were often treated how?

By performing exorcisms and incarceration. Signup and view all the answers

Which of the following is NOT one of the essential qualities of a mental health nurse?

Authority Signup and view all the answers

What perspective on mental illness emerged in the late 1800s?

It began to be seen as a medical problem. Signup and view all the answers

Which approach was commonly used for treatment of mental disorders in ancient civilizations?

Spiritual rituals Signup and view all the answers

What aspect of psychiatric nursing primarily evolved during the 20th century?

Recognition of the importance of the nurse-client relationship. Signup and view all the answers

What was the general perception of mental illness during the Renaissance period in England?

They were viewed as criminals and imprisoned. Signup and view all the answers

Who is credited with the initiation of reform for the treatment of mental illness in the United States?

Dorothea Dix Signup and view all the answers

What significant change occurred in the United States mental health system during the 1960s?

The Enactment of Community Mental Health Centers Construction Act. Signup and view all the answers

What was one of the results of deinstitutionalization in the 1980s?

An increase in repeat hospital admissions without adequate follow-up. Signup and view all the answers

Which of the following was NOT an objective of Healthy People 2020 regarding mental health?

Ensure mandatory hospitalization for all mental illness cases. Signup and view all the answers

What concept did Philippe Pinel and William Tuke contribute to in the 1790s?

The idea of an asylum as a safe refuge. Signup and view all the answers

How did the treatment of individuals with mental illness evolve after the 1775 period?

They continued to be treated as less than human. Signup and view all the answers

Which development in the 1950s addressed the management of symptoms related to mental illness?

Development of psychopharmacology. Signup and view all the answers

What should a student do if a client displays inappropriate sexual behavior?

Clarify the boundaries of the professional relationship. Signup and view all the answers

What is the recommended action for a student when dealing with potentially aggressive clients?

Sit in an open area with space and request staff presence. Signup and view all the answers

How should a student respond if they encounter someone they know being treated on the unit?

Assure the client about confidentiality and notify the instructor. Signup and view all the answers

What should a student do if they recognize similarities between themselves and a client’s problems?

Maintain professional boundaries and avoid discussing personal issues. Signup and view all the answers

Why should students avoid handling clients directly?

They lack the training and experience to do so safely. Signup and view all the answers

What is an essential task of the working phase in the nurse-client relationship?

Promoting a positive self-concept Signup and view all the answers

During the working phase, the nurse should primarily focus on which of the following?

Facilitating behavior change Signup and view all the answers

What phenomenon occurs when a client unconsciously transfers feelings from significant others to the nurse?

Transference Signup and view all the answers

What should a nurse avoid during the termination phase of the nurse-client relationship?

Meeting the client outside therapy Signup and view all the answers

Which task is not typically included in the specific tasks of the working phase?

Making unilateral decisions for the client Signup and view all the answers

What is a critical aspect for nurses to ensure a productive therapeutic relationship?

Maintaining self-awareness Signup and view all the answers

In the working phase, which of the following is essential for promoting a positive self-image?

Allowing the client to openly analyze their feelings Signup and view all the answers

How should a nurse respond if a client expresses a desire to prolong the therapeutic relationship during the termination phase?

Encourage the client to explore their feelings of attachment Signup and view all the answers

What is an essential attitude a nurse should maintain when interacting with a client?

Open and nonjudgmental Signup and view all the answers

Which of the following is NOT a common concern for nursing students in a psychiatric clinical rotation?

Handling excessive workloads Signup and view all the answers

What is the primary role of interpersonal skills in mental health care?

To foster patience and understanding Signup and view all the answers

Which personal quality is essential for a nurse working in psychiatric care?

Assertiveness Signup and view all the answers

How should nurses address personal questions with clients during their first interactions?

Wait until rapport is established Signup and view all the answers

What is a recommended approach when dealing with a client exhibiting bizarre behavior?

To seek immediate guidance from the Charge Nurse Signup and view all the answers

What should nursing students do if they feel anxious about interacting with clients?

Build confidence through practice Signup and view all the answers

What is a key element of developing a therapeutic nurse-client relationship?

Building trust over time Signup and view all the answers

Study Notes

Course Information

Course title: Care of Clients with Maladaptive Patterns of Acute and Chronic Behaviour
Course code: NCM 117
Session: 1, First week
Duration: 4 hours
Intended audience: BSN III students

Learning Objectives

Introduction to Psychiatric Nursing
Evolution of mental-health-psychiatric nursing practice
The Mental Health Nurse: Her Role and essential qualities
Interdisciplinary Mental Health Team
Mental Health- Illness Continuum

Introduction to Psychiatric Nursing

Psychiatric Nursing was recognized in the late 1800s, but required in nursing education programs only from 1950 onward.
Influenced by Hildegard Peplau and June Mellow's work on nurse-client relationships, anxiety, nurse therapy, and interpersonal nursing theory.
Historically, mental illness was viewed as demonic possession, sin, or weakness, often punished accordingly.
Today, mental illness is considered a medical problem with symptoms affecting personal growth, characteristics, relationships, and coping skills.

Evolution of Mental-Health-Psychiatric Nursing Practice

(Images/pictures to be inserted) - details omitted

Mental Disorders: Ancient Times

Ancient people believed illness to be displeasure from the Gods, punishment for sins or demonic acts.
Punishments could include ostracism, burning at the stake.
Aristotle (382-322 BC) believed imbalances of blood, water, yellow, and black bile controlled emotions, contributing to illness.
Treatment methods included starving, bloodletting, and purging in the 9th century.

Early Christian Times (1-1000 AD)

Strong superstitions and primitive beliefs that those with mental illness were possessed by evil spirits.
Treatment involved exorcism, and even brutal measures like incarceration in dungeons, flogging, and starvation if exorcisms failed.

Renaissance (1300-1600) Period in England

Mental illness was considered a crime.
People with mental illness were often incarcerated, chained, starved, and treated as less than human.
Notable example of incarceration: St. Mary of Bethlehem (1547).

1790s: Period of Enlightenment & Creation of Mental Institutions

Philippe Pinel in France and William Tuke in England advocated for asylums as safe havens. Early treatment involved just beating, whipping and starvation.
Dorothea Dix (1802-1887) in the United States advocated for reform in treatment of mental illness, promoting better conditions for patients, after visiting a similar institution in England.

Development of Psychopharmacology

1950s witnessed the development of psychopharmacology.
This helped to reduce psychotic thinking and agitation.

1963 Enactment of Community Mental Health Centers Construction Act

This marked a shift from institutional care to community-based services.
Services included emergency care, screening, education, partial hospitalization, and outpatient services.

Mental Illness in the 21st Century

Healthy People 2020 objectives aimed to increase diagnosis, treatment, and support for those with mental illness.
Goals were to reduce rates of suicide and homelessness and increase employment opportunities.

Psychiatric Nursing Practice Overview

Hildegard Peplau (1952) and Interpersonal Techniques: The Crux of Psychiatric Nursing
Peplau described the phases and tasks of the therapeutic nurse-client relationship, particularly focusing on anxiety.
June Mellow (1968) emphasized focusing on client's psychosocial needs with daily activities.

Summary of Specific Areas of Practice

Box 1.2, Box 1.3 in Videbeck (Page reference omitted).

Self-Awareness and Therapeutic Use of Self

Self-awareness is a process of understanding one's values, beliefs, and attitudes.
Values are abstract standards defining right and wrong conduct, a key element of self-awareness.
Value Clarification is a process of building self-awareness, identifying beliefs, and considering different perspectives.
Three-step process of value clarification: Choosing, Prizing, and Acting..
Beliefs are ideas considered true, but can be irrational without evidence.
Attitudes are the general feelings around knowledge.

Cultural Awareness

The purpose is to understand how values, beliefs and attitudes might impact client care

Self-Awareness in Nursing Practice

Keeping a journal on one's experiences is a method of self-awareness practice.
Talking about experiences with trusted sources or in clinical supervision is part of self-awareness.
Learning to take the client's perspective is another aspect of self-awareness and effective practice.
Avoiding judgments on one's own values, beliefs, and attitudes is also key to be effective.

Therapeutic Use of Self

Understanding one's own attitudes, experiences, values, and perceptions helps form therapeutic relationships.
The Johari window is a technique that can help explore one's self-awareness.
The potential for preconceptions to hinder therapeutic relationships were also addressed
Countertransference is when the nurse's unconscious needs and conflicts influence the relationship.

Pattern of Knowing: Preconception

Preconceptions, including personal biases and beliefs, can hinder therapeutic relationships.
An example: a client refusing an assignment to a male nurse, due to preconceived stereotypes.

Casper's Pattern of Nursing Knowledge (Table 5.1 pg 85)

Four patterns in nursing are outlined:
- Empirical Knowledge (science of nursing)
- Ethical Knowledge (moral knowledge of nursing)
- Personal Knowledge (life experiences)
- Aesthetic Knowledge (Art of Nursing)

Johari Window (pg. 85)

Four quadrants showcasing self-awareness:
- Open/Public quadrant
- Blind/Unaware quadrant
- Hidden/Private quadrant
- Unknown quadrant

Types of Relationships

Social relationship: initiated for tasks, such as weather and news.
Intimate relationship: involving emotional connection, has no place in a nurse-client relationship.

Therapeutic Relationship

Focuses on client's needs, experiences, and feelings.
Nurse uses communication skills, personal strengths, and understanding of human behavior to interact with the client.
Client preferences and likes are irrelevant.

Phases of Establishing Therapeutic Relationships

Orientation phase: introduction, gathering information, assessing preconceptions

During Orientation Phase

Building trust and understanding with the client and conveying sympathy/empathy.
Listening attentively to the client's history, perceptions, and misconceptions.

Nurse-Client Contracts

Agreements about time, place, duration, and termination of sessions.
Defining roles and responsibilities of both nurse and client.
Agreement on treatment plan and if family/support team should be involved.
Maintaining confidentiality.

Working Phase

Identifying client issues and concerns
Guiding client to examine feelings and responses.
Developing coping skills
Improving self-image
Avoiding value judgments, focusing on exploring and elaborating on patient concerns; refraining from offering advise.

Specific Tasks of the Working Phase

Maintaining relationships
Gathering data (client history & current state)
Exploring client perceptions of reality
Developing coping mechanisms
Promoting positive self-concept
Encouraging verbalizations of feelings
Facilitating behavior change
Using therapeutic skills

Working Through Resistance

Evaluating progress and readjusting goals as needed
Providing opportunities to apply learned coping skills
Fostering independence

Transference and Countertransference

Transference: client unconsciously transferring feelings from significant others to the nurse
Countertransference: nurse projecting his/her own unconscious needs and conflicts to clients

Termination or Resolution Phase

Client issues are resolved
Ending the relationship appropriately.
Acknowledging and valuing the time spent in therapy

Psychiatric Mental Health Nurses

The second-largest group of behavioral health professionals.
They have autonomy but also work within a larger healthcare team.

Mental Health Interdisciplinary Team

Professionals in the team include, but are not limited to, Pharmacist, Psychiatrist, Psychologist, Psychiatric Nurse, Psychiatric Social Worker, Occupational Therapist, Recreation Therapist, and Vocational Rehabilitation Specialist

Core Skills of the Team

Interpersonal skills (tolerance, patience, acceptance, empathy, genuineness),
Understanding mental disorders, behavior, and symptoms are also important.
Communication skills and team cooperation
Risk assessment and management skills
Personal qualities like consistency, assertiveness, and problem-solving ability

Student Concerns and Questions to consider as a student nurse

The purpose of the session is to prepare students to start a psychiatric clinical rotation and reflect on self-awareness.
Common concerns:
What if I say the wrong thing?
What will I be doing?
What if no one will talk to me?
Am I prying when I ask personal questions?
How will I handle bizarre or inappropriate behaviors?
What happens if a client asks me for a date or displays inappropriate sexual behavior?
Questions:
Safety of the student, considerations of patient safety, professionalism and boundaries.
Confidentiality consideration.
Potential problems and concerns regarding client interaction and professionalism in mental health, including the importance of handling inappropriate behaviour.

Next steps

Mental Health- Illness Continuum (Part 2 - to be covered in the next slide show)

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Description

Explore the essential concepts of self-awareness in nursing through this quiz. Questions cover the Johari Window, ethical knowing, and the historical perspectives of mental illness. Enhance your understanding of therapeutic relationships and the significance of self-reflection in nursing practice.