Davis Advantage for Psychiatric Mental Health Nursing, Tenth Edition PDF

Davis Advantage for Psychiatric Mental Health Nursing, Tenth Edition. Relationship Development Therapeutic Communication Defense Mechanisms Co...

Davis Advantage for Psychiatric Mental Health Nursing, Tenth Edition. Relationship Development Therapeutic Communication Defense Mechanisms Copyright ©2021 F.A. Davis Company  Objectives for Chapter 6 1. Describe the relevance of a therapeutic nurse-patient relationship. 2. Discuss the dynamics of a therapeutic nurse-patient relationship. 3. Discuss the importance of self-awareness in the nurse- patient relationship. 4. Identify goals of the nurse-patient relationship. 5. Identify and discuss essential conditions for a therapeutic relationship to occur. 6. Describe the phases of relationship development and the tasks associated with each phase. Copyright ©2021 F.A. Davis Company  Core Concepts Term: Therapeutic relationship An interaction between two people in which input from both participants contributes to a climate of healing, Loading… growth promotion, or illness prevention. Therapeutic relationships are goal- oriented and directed at learning and growth promotion. Copyright ©2021 F.A. Davis Company  Role of the Psychiatric Nurse Stranger Resource person Teacher Leader Surrogate Technical expert Counselor Copyright ©2021 F.A. Davis Company  Therapeutic Nurse-Patient Relationship Term: Therapeutic use of self The ability to use one’s personality consciously Loading… and in full awareness in an attempt to establish relatedness Copyright ©2021 F.A. Davis Company  Therapeutic Nurse-Patient Relationship (continued_1) How do you gain self-awareness? “an individual recognize and accept what he or she values and learn to accept the uniqueness of and differences in others” Can't be judgmental Can be influenced by the following: ‒ Beliefs: an idea that one holds true ‒ Attitudes: a frame of reference around which an individual organizes knowledge about his or her world ‒ Values: abstract standards, positive or negative, that represent an individual’s ideal mode of conduct and ideal goal Copyright ©2021 F.A. Davis Company  Therapeutic Nurse-Patient Relationship (continued_7) The Johari Window is divided into four quadrants: a representation of the self and a tool that can be used to increase self-awareness Open or public self Unknowing self Private self Unknown self Copyright ©2021 F.A. Davis Company  Conditions Essential to Development of a Therapeutic Relationship Several characteristics that enhance the achievement of a therapeutic relationship have been identified: Rapport Trust Respect Genuineness Empathy (not sympathy) Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company  Phases of a Therapeutic Nurse-Client Relationship Phases of Therapeutic Nurse-Client Relationship: -Gathering info P report Checking your feelings O Meet patient, establish expectations Plan goals W Plan to reach patient goals Reevaluate process. T Discharge Report-Admission-Stay- Copyright ©2021 F.A. Davis Company Discharge  Phases of a Therapeutic Nurse-Patient Relationship (continued_1) Common phenomena that often arise during the course of a therapeutic relationship: Transference Loading… Reminding the patient of someone ‒ Nursing consideration: Assist the patient in clarifying the meaning of the current nurse-client relationship. Countertransference Remind of someone in patient life Copyright ©2021 F.A. Davis Company  Boundaries in the Nurse-Patient Relationship Boundary: indicates the extent of acceptable limits. Many types of boundaries exist. Material boundaries ‒ boundaries that can be seen (example: walls, fences) Social boundaries ‒ how individuals are expected to behave socially Personal boundaries ‒ boundaries that individuals define for themselves Professional boundaries ‒ “spaces between a nurse’s power and the patient’s vulnerability” ‒ (see concerns on this boundary on the next slide) Copyright ©2021 F.A. Davis Company  Boundaries in the Nurse-Patient Relationship (continued_1) Concerns regarding professional boundaries Self-disclosure Gift-giving Touch Friendship or romantic association Copyright ©2021 F.A. Davis Company  Boundaries in the Nurse-Patient Relationship (continued_2) Warning signs that professional boundaries of the nurse-patient relationship may be in jeopardy Favoring one patient’s care over another’s Keeping secrets with a client Changing dress style when working with a particular client Swapping patient assignments to care for a particular patient Giving special attention or treatment to one patient over others Spending free time with a patient Frequently thinking about the patient when away from work Sharing personal information or work concerns with the patient Receiving of gifts or continued contact and communication with the patient after discharge Copyright ©2021 F.A. Davis Company  Davis Advantage for Psychiatric Mental Health Nursing, Tenth Edition. Chapter 7 Therapeutic Communication Copyright ©2021 F.A. Davis Company  Objectives for Chapter 7 After reading the chapter, student will be able to: 1. Discuss the transactional model of communication. 2. Identify types of preexisting conditions that influence the outcome of the communication process. 3. Define territoriality, density, and distance as components of the environment. 4. Identify components of nonverbal expression. 5. Describe therapeutic and nontherapeutic verbal communication techniques. 6. Describe motivational interviewing as a communication strategy. 7. Describe active listening. 8. Discuss therapeutic feedback. Copyright ©2021 F.A. Davis Company  Core Concepts (continued_1) Communication is: An interactive process of transmitting information between two or more entities Achieved through interpersonal communication techniques (both verbal and nonverbal) Copyright ©2021 F.A. Davis Company  The Impact of Preexisting Conditions Conditions that impact communication: Values Attitudes Beliefs Religion Social Status Gender Age Culture - encompasses shared patterns of belief, feelings, and knowledge; groups are tied together by a shared heritage Copyright ©2021 F.A. Davis Company  Nonverbal Communication “Various studies have identified nonverbal communication as more reliable than verbal communication in expressing one’s attitudes and feelings” – Healthfield, 2019 Examples: Physical appearance and dress Body movement and posture Touch Facial expressions Eye behavior Vocal cues or paralanguage (pitch, tone, loudness) Copyright ©2021 F.A. Davis Company  Therapeutic Communication Techniques caregiver’s verbal + nonverbal techniques that focus on the care receiver’s needs and advance the promotion of healing and change. It is nonjudgmental, discourages defensiveness, and promotes trust. Copyright ©2021 F.A. Davis Company  Non- Therapeutic Communication Techniques Nurses should recognize and eliminate the use of these patterns in their relationships with patients. Avoiding these communication barriers will maximize the effectiveness of communication and enhance the nurse-patient relationship Copyright ©2021 F.A. Davis Company  Therapeutic Communication Techniques Copyright ©2021 F.A. Davis Company  Therapeutic Communication Techniques Copyright ©2021 F.A. Davis Company  Therapeutic Communication Techniques Copyright ©2021 F.A. Davis Company  Therapeutic Communication Techniques Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company  Non- Therapeutic Communication Techniques Copyright ©2021 F.A. Davis Company  Non- Therapeutic Communication Techniques Copyright ©2021 F.A. Davis Company  Non- Therapeutic Communication Techniques Loading… Copyright ©2021 F.A. Davis Company  Other Methods of Communication Active Listening To listen actively is to be attentive to what patient is saying, both verbally and nonverbally. Motivational Interviewing is an evidence-based, patient-centered style of communicating by guiding the patient to explore their own motivation for change and the advantages and disadvantages of their decisions. Copyright ©2021 F.A. Davis Company  Other Methods of Communication Process Recordings They are written by the nurse or student as a tool for improving communication techniques. Feedback Feedback is a method of communication that helps the patient consider a modification of behavior. Feedback gives information to patients about how they are being perceived by others. Copyright ©2021 F.A. Davis Company  Process Recording Examples Copyright ©2021 F.A. Davis Company  Davis Advantage for Psychiatric Mental Health Nursing, Tenth Edition. Chapter 9 Therapeutic Groups Copyright ©2021 F.A. Davis Company  Objectives for Chapter 9 After reading this chapter, the student will be able to: 1. Define a group. 2. Discuss eight functions of a group. 3. Identify various types of groups. 4. Describe physical conditions that influence groups. 5. Discuss therapeutic factors that occur in groups. 6. Describe the phases of group development. 7. Identify various leadership styles in groups. 8. Identify various roles that members assume within a group. 9. Discuss psychodrama as a specialized form of group therapy. 10. Describe the role of the nurse in group therapy. Copyright ©2021 F.A. Davis Company  The Group Group A collection of individuals whose association is founded on shared commonalities ‒ Interests, values, norms, or purpose Membership in a group ‒ Generally by chance, by choice, or by circumstance Copyright ©2021 F.A. Davis Company  Functions of a Group Socialization Support Task Completion Camaraderie Informational Normative Empowerment Governance Copyright ©2021 F.A. Davis Company  Group Therapy in Mental Health Setting A form of psychosocial treatment in which several clients meet together purposes include sharing gaining personal insight improving interpersonal coping strategies. Copyright ©2021 F.A. Davis Company  Group Therapy Copyright ©2021 F.A. Davis Company  Group Therapy Copyright ©2021 F.A. Davis Company  Group Therapy Copyright ©2021 F.A. Davis Company  Phases of Group Development Phase I: Initial or Orientation Phase Phase II: Middle or Working Phase Phase III: Final or Termination Phase Examples of groups inpatient setting group outpatient setting group (longer) Copyright ©2021 F.A. Davis Company  Psychological Adaptation to Stress ANXIETY GRIEF Copyright ©2021 F.A. Davis Company  Psychological Adaptation to Stress (continued_1) Anxiety A feeling of discomfort and apprehension related to fear of impending danger. Copyright ©2021 F.A. Davis Company  Anxiety becomes problematic when the individual is unable to prevent their response from escalating to a level that interferes with the ability to meet basic needs. Copyright ©2021 F.A. Davis Company  Psychological Adaptation to Stress (continued_3) Four levels of anxiety Mild anxiety Taking a test ‒ heightened awareness: restless, irritable, fidgeting Moderate anxiety You need to see professional., medication, conceding trouble concentrating on test. ‒ Perceptual field begins to diminish: unable to concentrate, sweating, tensed muscles Somatic symptoms Severe anxiety stomachache, omitting, patient reeds to be hospitalized. ‒ Perceptual field diminishes greatly: unable to concentrate and problem solve, palpitations Panic anxiety Flight or fight a danger to self and others ‒ The most intense state; unable to learn; pupil dilation; hallucinations and delusions Copyright ©2021 F.A. Davis Company  Mild to Moderate Anxiety: Coping Mechanisms Copyright ©2021 F.A. Davis Company  Mild to Moderate Anxiety: Coping Mechanisms Copyright ©2021 F.A. Davis Company  EXAMPLES OF ADAPTIVE AND MALADAPTIVE COPING SKILLS Copyright ©2021 F.A. Davis Company  ADAPTIVE VS MALADAPTIVE Copyright ©2021 F.A. Davis Company  Mild to Moderate Anxiety: Defense Mechanisms Defense mechanisms: used either consciously or unconsciously as protective devices by the ego to relieve mild-to-moderate anxiety These are self-protective responses to stress and do not need to be eliminated Copyright ©2021 F.A. Davis Company  Ego Defense Mechanism Activity Copyright ©2021 F.A. Davis Company  Psychological Adaptation to Stress (continued_5) Copyright ©2021 F.A. Davis Company  Psychological Adaptation to Stress (continued_5) Copyright ©2021 F.A. Davis Company  Psychological Adaptation to Stress (continued_5) Copyright ©2021 F.A. Davis Company  Psychological Adaptation to Stress (continued_5) Copyright ©2021 F.A. Davis Company  Psychological Adaptation to Stress (continued_15) Grief: a subjective feeling of sorrow and sadness accompanied by emotional, physical, and social responses to the loss of a loved person or thing. Copyright ©2021 F.A. Davis Company  Kübler-Ross’s Five Stages of Grief: DABDA Copyright ©2021 F.A. Davis Company  Psychological Adaptation to Stress (continued_18) Anticipatory grief Experiencing the grief process before the actual loss occurs ‒ Example: anticipation of a death of a loved one that has terminal illness Bereavement overload For some individuals, grief is perceived as difficult or even impossible to overcome. Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company