mental health chp. 5 test review
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Questions and Answers

Which component of a therapeutic relationship is primarily demonstrated through behaviors such as honesty and keeping promises?

  • Empathy
  • Positive regard
  • Acceptance
  • Trust (correct)

    • What differentiates empathy from sympathy in therapeutic relationships?

  • Empathy requires a clinical assessment.
  • Sympathy is a feeling of concern or compassion. (correct)
  • Empathy involves projecting personal feelings.
  • Sympathy includes understanding client's feelings.

    • Which process involves knowing one’s values, beliefs, and attitudes to establish a therapeutic relationship?

  • Empathy evaluation
  • Therapeutic use of self
  • Boundary setting
  • Values clarification process (correct)

    • What is the primary goal of the Johari window in therapeutic relationships?

    <p>Enhance self-awareness</p> Signup and view all the answers

    Which pattern of knowing is derived from nursing science?

    <p>Empirical</p> Signup and view all the answers

    Which type of relationship focuses on emotional commitment and individual needs being met?

    <p>Intimate relationship</p> Signup and view all the answers

    What is essential for a nurse to establish a therapeutic relationship?

    <p>Developing genuine interest</p> Signup and view all the answers

    What aspect of self-awareness involves recognizing personal strengths and limitations?

    <p>Self-comfort</p> Signup and view all the answers

    In the context of therapeutic relationships, what does unconditional positive regard mean?

    <p>Avoiding criticism of the client</p> Signup and view all the answers

    What is a primary focus of a therapeutic relationship?

    <p>The client's needs, experiences, and feelings</p> Signup and view all the answers

    Which statement reflects the concept of 'unknowing' in nursing?

    <p>Nurse acknowledges ignorance about the client’s subjective experiences.</p> Signup and view all the answers

    What occurs during the Orientation Phase of Peplau's model?

    <p>Clarification of roles and expectations</p> Signup and view all the answers

    In the Working Phase, what is the nurse expected to help the client develop?

    <p>Coping skills and positive self-image</p> Signup and view all the answers

    Which of the following describes a risk associated with inappropriate boundaries in therapeutic relationships?

    <p>Transitioning the relationship to a social context</p> Signup and view all the answers

    What is a common emotional response of clients during the Termination Phase?

    <p>Feelings of impending loss</p> Signup and view all the answers

    What role of the nurse involves teaching clients about medication regimens?

    <p>Teacher</p> Signup and view all the answers

    Which behavior should nurses avoid to maintain a therapeutic relationship?

    <p>Promoting client dependency</p> Signup and view all the answers

    During which phase do clients primarily identify their issues or concerns?

    <p>Working Phase</p> Signup and view all the answers

    What is important to discuss during the Orientation Phase regarding confidentiality?

    <p>Expectations for keeping client information private</p> Signup and view all the answers

    Which of the following best describes transference in the therapeutic relationship?

    <p>The client's projection of emotions onto the nurse</p> Signup and view all the answers

    What is the first phase of Peplau's model for establishing a therapeutic relationship?

    <p>Orientation</p> Signup and view all the answers

    During which phase of therapeutic relationships do clients primarily explore their feelings and develop coping skills?

    <p>Working Phase</p> Signup and view all the answers

    What behavior can diminish a therapeutic relationship by creating inappropriate boundaries?

    <p>Becoming overly friendly</p> Signup and view all the answers

    Which of the following is a common emotional response of clients during the Termination Phase?

    <p>Fear of loss</p> Signup and view all the answers

    Which role of the nurse focuses on ensuring the privacy and dignity of the client?

    <p>Advocate</p> Signup and view all the answers

    In the Working Phase, what might the nurse help the client to develop?

    <p>Independence</p> Signup and view all the answers

    What is a potential risk when a nurse has beliefs about their behavior in a therapeutic relationship?

    <p>Inappropriate boundary violations</p> Signup and view all the answers

    What happens to the nurse-client relationship during the termination phase?

    <p>It ends when the client's issues are resolved</p> Signup and view all the answers

    What is a key action that occurs in the Orientation Phase?

    <p>Identification of client’s problems</p> Signup and view all the answers

    Which of the following describes a nurse’s role in providing problem-solving guidance?

    <p>Teacher</p> Signup and view all the answers

    What is the primary characteristic of a therapeutic relationship?

    <p>Establishment of trust and understanding</p> Signup and view all the answers

    Which of the following components differentiates empathy from sympathy?

    <p>Communicating understanding of client feelings</p> Signup and view all the answers

    What best describes 'positive regard' in a therapeutic relationship?

    <p>Unconditional, nonjudgmental acceptance of the client</p> Signup and view all the answers

    In what way does self-awareness contribute to the establishment of therapeutic relationships?

    <p>By enabling clearer communication with clients</p> Signup and view all the answers

    Which statement reflects the purpose of the Johari window in therapeutic interactions?

    <p>To increase self-awareness and understanding of client perceptions</p> Signup and view all the answers

    Which type of relationship primarily focuses on friendship and socialization among individuals?

    <p>Social relationship</p> Signup and view all the answers

    In the context of therapeutic relationships, what does 'unknowing' refer to?

    <p>Admitting lack of knowledge about the client</p> Signup and view all the answers

    What is a key strategy for nurses to build trust with clients?

    <p>Demonstrating consistent honesty and care</p> Signup and view all the answers

    What component of the therapeutic relationship emphasizes the importance of understanding the client's feelings?

    <p>Empathy</p> Signup and view all the answers

    Which of the following best describes the 'acceptance' component in therapeutic relationships?

    <p>Setting boundaries without passing judgment</p> Signup and view all the answers

    The therapeutic relationship between a nurse and client primarily focuses on the nurse's personal experiences and feelings.

    <p>False</p> Signup and view all the answers

    Transference refers to the client's projection of feelings onto the nurse during the Working Phase.

    <p>True</p> Signup and view all the answers

    The Termination Phase begins when the nurse decides to end the relationship.

    <p>False</p> Signup and view all the answers

    During the Orientation Phase, roles and expectations between the nurse and client are not established.

    <p>False</p> Signup and view all the answers

    Client dependency on the nurse can be a sign of a healthy therapeutic relationship.

    <p>False</p> Signup and view all the answers

    The Working Phase includes the identification of client issues and the development of coping skills.

    <p>True</p> Signup and view all the answers

    An appropriate nurse-client relationship should maintain appropriate boundaries, avoiding personal intimacy.

    <p>True</p> Signup and view all the answers

    Inappropriate feelings of sympathy can enhance a therapeutic relationship.

    <p>False</p> Signup and view all the answers

    Trust in a therapeutic relationship includes behaviors such as dishonesty and lack of consistency.

    <p>False</p> Signup and view all the answers

    Empathy is the ability to perceive a client’s meanings and feelings and communicate that understanding.

    <p>True</p> Signup and view all the answers

    The exploitation of feelings and responses occurs during the Working Phase of the therapeutic relationship.

    <p>True</p> Signup and view all the answers

    The client's emotional response during the Termination Phase can include feelings of impending loss.

    <p>True</p> Signup and view all the answers

    Self-awareness in a therapeutic relationship includes understanding personal beliefs and attitudes.

    <p>True</p> Signup and view all the answers

    Positive regard refers to a judgmental attitude towards clients based on their behavior.

    <p>False</p> Signup and view all the answers

    The Johari window is a tool used to limit self-awareness in therapeutic relationships.

    <p>False</p> Signup and view all the answers

    Acceptance in a therapeutic relationship requires setting clear boundaries.

    <p>True</p> Signup and view all the answers

    Empirical knowledge is derived solely from life experiences in nursing practice.

    <p>False</p> Signup and view all the answers

    Intimate relationships in nursing focus on emotional commitment and mutual needs.

    <p>False</p> Signup and view all the answers

    The component of 'unknowing' emphasizes the nurse's comprehensive understanding of a client’s subjective world.

    <p>False</p> Signup and view all the answers

    Congruence in a therapeutic relationship involves aligning communication and behavior of the nurse.

    <p>True</p> Signup and view all the answers

    Study Notes

    Therapeutic Relationships - Key Concepts

    • Essential skill for nurses, crucial to successfully intervening with clients requiring psychiatric care

    Key Components of a Therapeutic Relationship

    • Trust:
      • Caring, interest, understanding, consistency, honesty, keeping promises, and active listening contribute to building trust.
      • Congruence and genuine interest are essential; clients can detect dishonest behavior.
    • Empathy:
      • The ability to perceive the client's meanings and feelings, and to communicate that understanding.
      • Empathy involves a "gift of self" from both the client and the nurse.
      • It differs from sympathy, which involves feelings of concern or compassion but may project the nurse's personal feelings.
    • Acceptance: Not making judgments, while setting boundaries.
    • Positive Regard: Unconditional, nonjudgmental attitude towards the client.

    Self-Awareness: Know Thyself

    • Values: Sense of right and wrong, guiding principles for living.
      • Values clarification process:
        • Choosing
        • Prizing
        • Acting
    • Beliefs: Individual's convictions.
    • Attitudes: Disposition towards people, situations, and ideas.
    • Cultural Awareness: Understanding and respecting diverse cultural backgrounds.

    Therapeutic Use of Self #1

    • H. Peplau's concept: Using aspects of personality, experience, values, feelings, intelligence, needs, coping skills, and perceptions to build relationships with clients.
    • Conscious and unconscious responses: Personal actions stem from both.

    Therapeutic Use of Self #2

    • Johari Window: Tool for self-discovery.
      • Four quadrants:
        • Open/public self: Known to self and others.
        • Blind/unaware self: Unseen by self, but known to others.
        • Hidden/private self: Known to self, but not disclosed to others.
        • Unknown: Unseen by both self and others.
      • Goal: Move qualities from quadrants 2, 3, and 4 into quadrant 1 by increasing self-awareness and transparency.

    Patterns of Knowing

    • Preconceptions: Initial assumptions or biases.
    • Ways of observing and understanding client interactions: Beyond just empirical knowledge.
    • Carper's Four Patterns of Knowing (1978):
      • Empirical: Knowledge derived from nursing science.
      • Personal: Knowledge gained from life experiences.
      • Ethical: Moral knowledge associated with nursing practice.
      • Aesthetic: The art of nursing.
    • Munhall's Fifth Pattern: Unknowing (1993):
      • Acknowledging that the nurse may not fully understand the client or their subjective world.

    Types of Relationships

    • Social:
      • Purpose: Friendship, socialization, companionship, or task accomplishment.
      • Characterized by sharing ideas, shifting roles, and rarely assessed outcomes.
    • Intimate:
      • Purpose: Emotional commitment between two individuals.
      • Focused on meeting individual needs and assisting each other in meeting those needs.
    • Therapeutic:
      • Purpose: Focused solely on the needs, experiences, feelings, and ideas of the client.
      • Involves the nurse's use of communication skills, personal strengths, and understanding of human behavior.
      • Shared agreement on areas for work, with outcome evaluation.
      • The nurse's level of self-awareness can both benefit and potentially hinder the relationship.

    Establishing a Therapeutic Relationship

    • Peplau's Three Phases (see Table 5.2):
      • Orientation: Initial meeting, establishment of roles, discussion of goals, identification of client's problems, clarification of expectations, establishment of nurse-client contracts (confidentiality, self-disclosure).
      • Working:
        • Identification: The client identifies their own issues and concerns.
        • Exploitation: Examination of feelings, responses, development of better coping skills, improved self-image, potential behavioral changes, and increased client independence.
      • Termination: Begins when client's problems are resolved, ends when the relationship formally ends.
    • Overlapping and Interlocking Phases: Stages are not always sequential, and elements may occur simultaneously across different phases.

    Establishing a Therapeutic Relationship: Orientation Phase

    • Meeting of the nurse and client.
    • Establishment of roles.
    • Discussion of purposes and parameters of future meetings.
    • Identification of client problems.
    • Clarification of expectations.
    • Nurse-client contracts, confidentiality, and self-disclosure.

    Establishing a Therapeutic Relationship: Working Phase

    • Problem Identification: Client identifies issues or concerns.
    • Exploitation:
      • Examination of feelings and responses.
      • Development of better coping skills, improved self-image, potential behavioral changes, and increased client independence.
    • Possible Transference/Countertransference:
      • Transference: Client's unconscious feelings toward the nurse.
      • Countertransference: Nurse's unconscious feelings towards the client.

    Establishing a Therapeutic Relationship: Termination Phase

    • Begins when the client's problems are resolved.
    • Ends when the relationship is formally ended.
    • Client may experience termination as an impending loss.
    • Clients often try to avoid termination.

    Avoiding Behaviors That Diminish Therapeutic Relationships

    • Inappropriate Boundaries: The relationship shifts to a social or intimate level.
      • One of the biggest risks is the nurse's belief that they will not engage in nontherapeutic behaviors.
    • Feelings of Sympathy: Encouraging client dependency.
    • Nonacceptance and Avoidance: Failing to show empathy or treat clients with respect.
    • Warning Signs of Abuse of the Nurse-Client Relationship (see Box 5.3):
      • Examples: Sexual, emotional, or psychological abuse.

    Therapeutic Roles of the Nurse in a Relationship

    • Teacher: Provides education on coping skills, problem-solving, medication regimens, and community resources.
    • Caregiver: Establishes a therapeutic relationship and provides physical care.
    • Advocate: Ensures client privacy and dignity, informed consent, access to services, and safety from abuse and exploitation.
    • Parent Surrogate: Provides temporary support or guidance, but must ensure the relationship remains therapeutic.

    Therapeutic Relationships

    • Are crucial for the success of interventions with clients requiring psychiatric care.
    • A therapeutic relationship is built on trust, empathy, acceptance and positive regard.
    • Nurses must be self-aware of their own values, beliefs, attitudes and cultural awareness.

    Components of a Therapeutic Relationship

    • Trust: Demonstrated through caring, interest, understanding, consistency, honesty, keeping promises, and active listening. Congruence, or genuineness, is vital for building trust.
    • Empathy: The ability to perceive the client's feelings and communicate that understanding. It is crucial for establishing a connection.
    • Acceptance: Means non-judgmental approach and setting boundaries.
    • Positive regard: A non-judgmental attitude towards the client.

    Therapeutic Use of Self

    • Developed by H. Peplau, it involves using aspects of personality, experience, values, feelings, intelligence, needs, coping skills, and perceptions to build relationships with clients.
    • It requires self-awareness and the recognition of both conscious and unconscious responses.

    Johari Window

    • A tool for self-awareness.
    • It consists of four quadrants:
      • Open/public self: Known to both the individual and others.
      • Blind/unaware self: Unknown to the individual but known to others.
      • Hidden/private self: Known to the individual but not to others.
      • Unknown: Unknown to both the individual and others.
    • The goal is to move qualities from quadrants 2, 3, and 4 into quadrant 1, increasing self-awareness.

    Patterns of Knowing

    • Developed by Carper:
      • Empirical knowing: Derived from nursing science, relying on evidence-based practice.
      • Personal knowing: Based on life experiences and personal reflections.
      • Ethical knowing: Drawn from moral nursing knowledge and values.
      • Aesthetic knowing: A creative and artistic understanding of nursing derived from the art of practice.
    • Unknowing (Munhall): Acknowledging the limitations of knowledge and recognizing the subjective nature of the client's experience.

    Types of Relationships

    • Social: Purpose is friendship, socialization, companionship, or task accomplishment. Roles may shift and outcomes are rarely assessed.
    • Intimate: A deep emotional commitment between two people where individual needs are met through mutual support.
    • Therapeutic: Focuses solely on the client's needs, experiences, feelings, and ideas. The nurse uses communication skills, personal strengths, and knowledge of human behavior to facilitate the client's growth and well-being.

    Establishing a Therapeutic Relationship

    • Peplau's model consists of three phases:
      • Orientation Phase: Introduction, establishment of roles, discussion of purposes, identification of client's problems, clarification of expectations, and setting of boundaries.
      • Working Phase: Problemidentification, exploration of feelings, development of coping skills and improved self-image, and behavioral change. Transference and countertransference may occur.
      • Termination Phase: Begins when the client's problems are resolved and ends with the conclusion of the relationship. Clients may experience termination as a loss and try to avoid it.

    Avoiding Behaviors That Diminish Therapeutic Relationships

    • Inappropriate boundaries: Social or intimate relationships outside the therapeutic context.
    • Sympathy: Expressing pity or concern rather than empathy, which can foster dependency.
    • Nonacceptance and avoidance: Refusing to acknowledge or address the client's feelings and experiences.
    • Warning Signs of Abuse of the Nurse-Client Relationship:*
    • Excessive self-disclosure
    • Keeping secrets with the client
    • Giving special treatment
    • Fulfilling the role of friend, parent, or lover
    • Becoming overly involved

    Therapeutic Roles of the Nurse in a Relationship

    • Teacher: Facilitates learning about coping strategies, problem-solving techniques, medication regimens, and community resources.
    • Caregiver: Provides therapeutic support and physical care.
    • Advocate: Protects the client's privacy and dignity, ensures informed consent, and facilitates access to services.
    • Parent surrogate: In some situations, the nurse may take on a temporary parental role, ensuring the relationship remains therapeutic.

    Therapeutic Relationships

    • A crucial skill for nurses, especially in psychiatric care
    • Contributes significantly to the success of interventions with clients

    Components of a Therapeutic Relationship

    • Trust: Characterized by caring, interest, understanding, consistency, honesty, keeping promises, and active listening.
    • Congruence: Genuine interest combined with self-awareness of strengths and limitations, clarity of focus, and honest communication.
    • Empathy: Ability to perceive and understand a client's feelings and meanings, effectively communicating that understanding.
      • This involves both the client and nurse sharing their "gift of self."
      • Differs from sympathy, which centers on feelings of concern or compassion but may involve the nurse projecting personal feelings.
    • Acceptance: Non-judgmental attitude with clear boundaries set.
    • Positive Regard: Unconditional, non-judgmental attitude towards the client.

    Self-Awareness

    • Values: A personal code of conduct for living, reflecting a sense of right and wrong.
      • Values clarification involves choosing, prizing, and acting on these values.
    • Beliefs: Personal convictions about the world.
    • Attitudes: Emotional responses towards individuals or things.
    • Cultural Awareness: Understanding and appreciating diverse cultural perspectives.

    Therapeutic Use of Self

    • Using personal aspects - personality, experiences, values, feelings, intelligence, needs, coping skills, and perceptions - to facilitate relationships with clients.
    • Concept developed by Hildegard Peplau.
    • Actions arise from conscious and unconscious responses.

    Johari Window

    • A tool for understanding oneself.
    • Divides personality into four quadrants: open/public self, blind/unaware self, hidden/private self, and unknown.
    • The goal is to expand the "open/public self" quadrant by moving qualities from other quadrants.

    Patterns of Knowing

    • Preconceptions: Existing beliefs and ideas that influence observation and understanding of client interactions.
    • Four Patterns of Knowing (Carper, 1978):
      • Empirical: Knowledge derived from nursing science.
      • Personal: Knowledge gained from life experiences.
      • Ethical: Knowledge based on moral principles in nursing.
      • Aesthetic: Knowledge gained through the artistic aspect of nursing.
    • Fifth Pattern: Unknowing (Munhall, 1993): Accepting the nurse's lack of complete knowledge about the client or their subjective world.

    Types of Relationships

    • Social: Purpose is friendship, socialization, companionship, or task completion.
      • Characterized by sharing ideas, shifting roles, and outcomes rarely being assessed.
    • Intimate: Based on emotional commitment between two individuals.
      • Fulfills individual needs and provides mutual support.
    • Therapeutic: Focuses solely on the client's needs, experiences, feelings, and ideas.
      • Relies on the nurse's communication skills, personal strengths, and understanding of human behavior.
      • Involves joint agreement on areas to work on and outcomes are evaluated.
      • The nurse's self-awareness can positively or negatively impact the relationship.

    Establishing a Therapeutic Relationship

    • Peplau's Model of Three Phases (see Table 5.2):
      • Orientation: Initial meeting between the nurse and client, establishing roles, discussing purpose and future sessions, identifying client problems, clarifying expectations, and establishing nurse-client contracts emphasizing confidentiality and self-disclosure.
      • Working:
        • Identification: Client identifies issues or concerns.
        • Exploitation: Examining feelings and responses, developing coping skills, enhancing self-image, encouraging behavioral change, and promoting independence.
      • Termination: Begins when client's problems are resolved and ends with the termination of the relationship.
        • Clients may experience termination as an impending loss, leading to attempts to avoid it.

    Avoiding Behaviors That Diminish Therapeutic Relationships

    • Inappropriate Boundaries: The relationship becomes social or intimate.
      • This is a significant risk, particularly if the nurse believes they will not act in a nontherapeutic way.
    • Sympathy & Dependency: Nurse expresses sympathy, which can encourage client dependency.
    • Nonacceptance & Avoidance: Nurse exhibits nonacceptance or avoids the client.
    • Warning Signs of Abuse of the Nurse-Client Relationship (see Box 5.3): These signs should be recognized and addressed.

    Therapeutic Roles of the Nurse in a Relationship

    • Teacher: Educates the client on coping strategies, problem-solving techniques, medication regimens, and community resources.
    • Caregiver: Establishes the therapeutic relationship and provides physical care.
    • Advocate: Protects the client's privacy and dignity, ensures informed consent, facilitates access to services, and safeguards the client from abuse and exploitation.
    • Parent Surrogate: This role should be approached cautiously, ensuring the relationship remains therapeutic.

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    Description

    Test your understanding of key concepts in therapeutic relationships essential for psychiatric nursing. Explore elements such as trust, empathy, acceptance, and self-awareness that contribute to effective client-caregiver interactions. This quiz covers the foundational skills necessary for building meaningful connections in nursing practice.

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