Psychiatric Nurse Roles & Relationships

• Focus is on the psychiatric nurse's evolving role from custodial care to a vital part of the healthcare team

Seven Roles of a Psychiatric Nurse

• The Stranger: Involves initial interactions where the nurse respects the patient as an individual
• The Resource Person: The nurse provides understandable information about healthcare
• The Teacher: Identifies learning needs and provides relevant information
• The Leader: Encourages the patient to be an active participant in their care
• The Surrogate: Acts as a substitute for a mother figure, sibling, or teacher
• The Technical Expert: Possesses skills needed for medical procedures
• The Counselor: The nurse helps patients understand and cope with their situation

Therapeutic Nurse-Patient Relationships

• Building on Peplau's ideas, Travelbee emphasizes seeing each other as unique human beings
• Human-to-human relationships are based on meeting needs
• Trust helps in earning patient respect and building a strong nurse-patient relationship
• The "therapeutic use of self" uses the nurse’s personality to build a caring relationship
• Self-awareness and understanding of beliefs and emotions are important

Trust in Therapeutic Relationship

• Building trust is fundamental for rapport and honest communication
• Patients need to feel safe to share experiences and concerns
• Trust is earned through warmth, caring, and reliability
• Trust enables exploring the patient's needs and positive changes

Self-Awareness

• Self-awareness is essential for forming healthy relationships and understanding values
• Key elements include understanding values, feelings, and attitudes

Core Elements

• Values: Core beliefs about right and wrong that guide behavior and are developed early in life
• Beliefs: Ideas accepted as true, either rational or irrational
• Attitudes: Feelings or opinions that influence how one perceives the world, can also lead to biases

Values Clarification

• Values clarification helps become aware of values and helps in identifying core principles
• Understanding values, beliefs, and attitudes is essential for strong relationships in nursing

Impact of Personal Values

• Personal values shape interactions and influence a nurse’s approach to care
• Honesty promotes transparency, while respect encourages understanding
• Personal values affect responses to challenging situations
• Recognizing personal values helps nurses become compassionate and effective

Johari Window Model

• Model to understand self-awareness, dividing the self into quadrants
• The "Unknown Self" is the portion one is unaware of
• Increasing self-awareness grows the "Open Self" to share more openly

Personal Values and Johari Window

• Unknown Self: Reflects unexamined values, hidden motivations
• Open Self: Values influence revealing information, while honesty promotes open sharing
• Hidden Self: Self-awareness makes one aware of potentially moving values and examine to reveal

Rapport

• Rapport is the foundation for successful relationships
• It involves creating harmony, warmth, and understanding
• See patients as unique individuals and appreciate their personality

Trust

• Essential for relationships beyond the superficial and allows open sharing
• Developing rapport and trust needs patience and genuineness
• Establishing rapport starts with non-health topics to create a safe space

Establishing Rapport

• Introduce yourself and clearly explain the role to set a professional stage
• Welcoming tone involved eye contact and friendly voice to create comfort and trust
• Active listening shows genuine interest in patient questions
• Emphasizing comfort and adjusting temperature when needed
• Discuss non-medical conditions
• Respect cultures
• Use simple words

Respect

• Respect in nurse-patient is based on worth and dignity as a human
• Unconditional positive regard involves a concept by Carl Rogers
• Psychiatric patients struggle with self-esteem due to illness and negative experience

Nurses' Role

• Nurses foster patient self-respect by unconditional positive regard
• Respect goes beyond behavior as all deserve
• Unconditional positive regard means accepting the patient for who they are
• Building self-respect demonstrates respect
• Provide examples
• Empathy and understanding are essential to show that you care

Respect in Healthcare

• Includes treating patients as valuable humans and withholding judgment based on behavior or diagnosis
• Focus on perspectives and being empathetic towards difficult situations

Genuineness

• Genuineness in nurse-patient means your inner experience is reflected in behavior
• Congruence means alignment between the way you feel and express
• Truth and honesty are important in communicating properly

Elements of Genuineness

• Self-Disclosure: Sharing experience or feelings to help patient
• Human Connection: Helps with human connection to create human connection by vulnerabilty
• Trust and Growth: Authenticity is essential for growing trust

Empathy

• Empathy is needed to understand a situation from another's perspective
• Empathetic nurses listen
• Sympathy feels sorry

Clinical Setting

• In clinical settings, empathy is crucial for:

Keys

• Validating the patient's experience
• Developing a strong therapeutic relationship
• Helping to reduce emotional burnout

Goals

• Empathy is more effective
• Sympathy diminish feelings

Phases of Therapeutic

• The therapeutic nurse-patient relationship in psychiatric involves identifying resolutions
• Relationship-based intervention sees relationships as central to approach
• Origins stem from issues

Phases

• The four phases include pre-interaction, orientation, working, and termination
• The preinteraction involves gathering information
• Orientation get acquainted
• The working phase involves bulk work
• Termination is when relationships are brought to close

Preinteraction phase

• A first stage that involves prep and reflection
• Gathering information: Review of the patient's family chart
• Self-reflection requires nurses to examine each patient
• Prevent counter feelings from nurses and patient

Orientation Phase

• Called the introductory phase, the second stage builds a successful working field
• Building Trust/Rapport: Establishes the safe environment
• Establishing a contact in both parties involved.
• Collecting Information: Gathers from strengths and weaknesses
• Goal Setting: Sets patient specific values
• Exploring Feelings: Creates open stages

Goals of Phases

• The important thing is that the nurse and patient feel valued
• The working phase focuses on healing
• Main trust and report
• Empower the patient
• Resolve problems
• Address difficult issues

Ending

• There are many reasons for ending a therapeutic relationship
• They include achieving hospital goals
• The challenges includes ending on a good note
• The goals of termination are for help and care.
• Managing the anxiety with empathy

Transference

• Is a tendency for patients that shows feelings for a parent to those in the current setting
• Transfer positive or negative feelings
• Share perceptions and feelings
• Increasing the knowledge

Impact

• Help determine the cause of patients issue
• Minimizes impact on patients if they are having a hard time
• Increase growth over the time

Countertransference

• Complex concepts
• Unconscious transfer of emotions
• Triggers on behavior
• Not aware
• Understand feelings

Managing

• Is key
• Ask to be open with others
• Learn your pattern

Boundaries

• Boundaries keep the nurse patient good relationship

• Types of values: - Material and social values

• Healthcare are important

• Professional relationships are good with pre relationship but should not happen with nurse patient relationship Warning Signs of Boundaries:

• Boundary crossings can impact relationship

• Maintain professional integrity using self awareness

The 'Therapeutic Use of Self'

• Successful nursing depends on relationship with other people
• Know emotions

Keys Concepts

• Know seven roles
• Important ingredients like respect
• Understand steps to the process