jessem30

• A state of psychological and emotional
• well-being

• Strives
• to achieve balance in physical, emotional, social, and spiritual spheres

• Is
• able to cope effectively with normal stresses in life and function productively
• to meet individual, family, community needs.

Therapeutic

Social

• Takes place between the nurse and client
• and focus is on the client’s--

Thoughts

Feelings

Behavior

Roles and expectations

The nurse uses active listening

• The nurse’s goal is to help the client as
• they work to

• Explore
• their feelings

• Understand
• and gain insight into their mental illness or other related issues

• Assist
• them as they work to change

Social communication is

• Less
• goal-oriented

• More
• superficial

• Usually
• does not involve the expectation of helping the client regarding emotional concerns—be
• aware in some cases, an emotional concern will arise during the conversation.

• Although nurse-client relationships may
• involve some social communication, the main component is therapeutic
• communication

Social

Therapeutic

1.Establish rapport

2.Actively listen

3.Gain the client’s perspective

• 4.Explore the client’s thoughts and
• feelings

5.Guide the client toward problem-solving

• Using open-ended questions
• Restating and reflecting
• Focusing
• Asking for elaboration

Seeking clarification

Offering self

Making observations

Translating

Advising

• Belittling
• feelings

Disapproving

• Changing
• the subject

Interrupting

Moralizing

Proxemics

• Active
• listening

Observation

• Body
• language

• nEye
• contact

nSilence

nTouch

• Intimate space—up to 18 inches—usually
• the space reserved for parents and children, those desiring closeness. It is threatening to invade this space

• Personal space—18 inches to 4
• feet—comfortable for family and friends conversing

• Social-consultative space—9 to 12
• feet—social, work, and business contexts

• Public space—up to 12 to 25 feet—speaker
• to audience, small groups, informal groups

• Refraining
• from other internal mental activities and concentrating exclusively on what is
• being said.

• Position
• facing the client

• Open
• posture

• Leaning
• forward toward the client

• Establishment
• of eye contact

• Relaxed
• body language

• S—Sit
• squarely facing the client

• O—Observe
• an “open posture” with arms and legs uncrossed and being “open” to what the
• client is saying

• L—Lean
• forward

• E—Establish
• eye contact

R—Relax

• Watching
• the speaker’s nonverbal actions as he or she communicates

Social

Intimate

Therapeutic

• A
• nurse-client interaction that is directed toward improving the client’s
• well-being

• The
• client may be an individual, a family, a group, or a community

(Videbeck, Chapter 5)

• Phase
• I—orientation

• Phase
• II—working

• Phase
• III—termination

• Initial
• phase involves assessment and analysis

• The
• nurse establishes trust

• The
• nurse assesses the client

• A
• nursing diagnosis is formulated

• Problems
• are prioritized

• Mutually
• agreed upon goals are established

• The
• working phase involves planning outcomes and applying interventions to help the
• client achieve their goals

• The
• nurse encourages expression of problems, thoughts, and feelings

• There
• is collaboration and mutual problem-solving

• Coping
• techniques are taught or recognized

• Adaptive
• behaviors are implemented

• Termination or resolution is the endpoint
• of the relationship

• Problems
• should be solved at this point

• The
• nurse evaluates outcomes for the entire relationship

• Mutual
• agreement

• Does
• the client show regression?

Teacher

Caregiver

Advocate

• Parent
• surrogate

• The
• purpose of the nurse-client relationship is to create a safe climate where the
• client feels free to express themselves and try out new ways to cope

• the client experiences an emotional reaction toward the nurse based on past
• experiences

• the nurse responds to the client with
• feelings from based on feelings from their past.

• Considering
• the client as a person or individual or biopsychosocial being

• The
• essence of a person’s being and his or her beliefs about the meaning of life
• and purpose of living—self awareness is very important.

• Belief
• in God or a higher power

• Practice
• of religion

• Cultural
• beliefs and practices

• Relationship
• with the environment

• Should
• serve as a source of comfort during stressful or traumatic times

• Respect for the individual--regardless of
• cultural differences. Nursing care demonstrates awareness, knowledge, and
• respect for the client’s culture.

• A person can become fully functioning
• when they are unconditionally valued

Started her career in 1873

• Believed that mentally ill persons were
• entitled to the same standard of care that the physically ill received

• Credited with improving nursing care and
• starting educational programs

• 1882—custodial focusing on nutrition,
• hygiene, and activities while practicing tolerance and kindness

• Later roles included assisting with
• insulin shock and psychosurgery

Counseling

• Milieu therapy—maintains therapeutic
• environment, teaches skills, promotes communication, and uses role-modeling

• Self-care focus—direction to promote the
• clients’ self esteem, independence, health practices, and promotion

Pharmacologic issues

Case management

• Dorothea Dix, a school teacher,
• recognized the value of England’s system of “asylum” for mentally ill persons.

• She is credited with setting up a similar
• system in the United States and 32 “state” hospitals were opened

1949—lithium

1950’s—thorazine and tricyclic antidepressants.

• The client is institutionalized against
• their will

• Generally, these clients have posed a
• threat to themselves or others

• State guidelines specify time limits and
• conditions for evaluation and care.

• If the client is committed for extended
• care-- ongoing legal hearings are specified

• All civil rights except THE RIGHT TO
• LEAVE THE HOSPITAL

• Examples of rights include—the client may
• send and receive mail, have or refuse visitors, telephone privileges, and may
• refuse medication or treatment*.

Unless medications are “court ordered”

• Suicide
• precautions

• Certain
• visitors may be restricted

• May
• require supervised telephone calls

• Primary—prevent problem from ever
• occurring

Secondary—early diagnosis and treatment

• Tertiary—continued support and
• rehabilitation

• Chapter
• 4

Is the client dangerous to others?

• Is the danger the result of a serious
• mental illness?

Is the danger imminent?

• Is the danger targeted at identifiable
• victims

• Remember, the typical rules for
• confidentiality and medical records do not apply here

• Once the information is obtained the
• following should be notified*

Intended victim(s)

Law enforcement

Nursing supervisor

Attending physician

• *According to text—practical or clinical
• applications may vary

• Belief that one’s own culture is superior
• to others and the standard or norm by which all other cultures are measured

….out of sync,

Misunderstood,

Alienated, and

• In “conflict” with their provider
• Additionally—clients are deprived of the
• benefit of a therapeutic relationship—labeled as noncompliant, and

May not understand their treatment plan

• Belief that all cultures are equally
• valid and equally deserving of respect

• Yes, this type of question is helpful
• when specific information is required or when the client is unable to organize
• their thoughts.

• When the client exhibits unpredictable
• and rapid mood swings—example: from depressed to euphoria

• clinical disorder that is the focus of
• treatment such as major depression, autism

personality disorders, mental retardation

general medical conditions such asthma

• psychosocial and environmental problems
• such as educational deficits, housing problems, financial difficulties, etc.

• Global Assessment of Functioning
• (GAF). Assigns a numerical value
• representing the client’s current level of functioning compared to the highest
• level of functioning during the past year.
• Expressed as a fraction such as 45/70