The document discusses therapeutic communication and the therapeutic nurse-patient relationship. It defines communication and describes the elements and types of communication. Therapeutic communication is defined as an interaction between a nurse and patient to exchange information and establish a relationship. The goals, principles, and techniques of therapeutic communication are outlined. The therapeutic nurse-patient relationship aims to help patients by establishing rapport, warmth, empathy and genuineness. The relationship progresses through phases including pre-interaction, orientation, working, and termination. Challenges like resistance, transference, and testing behaviors are addressed.
This document discusses therapeutic communication and the therapeutic nurse-patient relationship. It defines therapeutic communication as an interpersonal interaction focused on meeting the patient's needs. Elements of communication include the sender, receiver, message, and feedback. Therapeutic communication techniques include active listening, open-ended questions, reflection, clarification, and sharing perceptions. Non-therapeutic techniques include giving advice or judgment. A therapeutic nurse-patient relationship is based on trust, rapport, empathy and acceptance, and progresses through pre-interaction, orientation, working, and termination phases.
Psychiatric mental health nursing is a specialized area of nursing practice focused on promoting mental health through assessing, diagnosing, and treating behavioral problems, psychiatric disorders, and related conditions. The goals of psychiatric nursing are to promote mental health, prevent mental disorders, treat clients with mental disorders, and help restore their health. Psychiatric nurses work in a variety of clinical settings and perform activities like health promotion, screening and evaluation, case management, crisis intervention, and rehabilitation.
The document discusses the roles of various professionals that make up a multidisciplinary team for treating psychiatric patients. The team includes a psychiatrist, psychiatric nurse, clinical psychologist, psychiatric social worker, occupational therapist, pharmacist, dietician, and counselor. Each member has specialized training and is accountable for specific services, such as medical diagnosis and treatment, nursing care, psychological assessments and therapy, social work, recreational activities, medication management, and dietary needs. Together they collaborate to provide comprehensive care through interdisciplinary team meetings and treatment planning.
The document discusses the therapeutic nurse-patient relationship. It defines the relationship as an ongoing communication between nurse and patient built on mutual respect and trust. The goals are to help patients gain insight, change behaviors, and achieve developmental goals. Key aspects include empathy, genuineness, respect, concern and good communication skills. Challenges include resistance, transference, and countertransference, which the nurse must manage to maintain a therapeutic relationship.
Conceptual model and the role of a nurseTejal Virola
This document defines conceptual models and describes four major models that influence current nursing practice: existential, psychoanalytic, behavioral, and interpersonal. It provides an overview of each model, including its basic assumptions, therapeutic approaches, roles of patient and therapist, and applications to nursing. The existential model focuses on present experiences rather than past ones. The psychoanalytic model views behavior as caused and driven by unconscious forces. The behavioral model assumes all behavior is learned and can be changed. The interpersonal model sees personality developing through social interactions and relationships.
The basic about the principles of psychiatric nursing , what all are the basic we have to follow while providing care to the psychiatric patients in hospital and in the community area
The document outlines 11 standards for psychiatric and mental health nursing. Standard I discusses applying relevant theories to explain phenomena and provide treatment bases. Standard II covers continuously collecting comprehensive data through assessments. Standard III involves utilizing nursing diagnoses and classifications to identify health issues. Standard IV requires developing individualized nursing care plans with goals and interventions.
Group therapy is a type of psychotherapy wherein therapisr treats a group of people together. Group members meet at regular sessions to resolve their symptoms or conflicts.
This document discusses therapeutic communication and the therapeutic nurse-patient relationship. It defines therapeutic communication as an interpersonal interaction focused on meeting the patient's needs. Elements of communication include the sender, receiver, message, and feedback. Therapeutic communication techniques include active listening, open-ended questions, reflection, clarification, and sharing perceptions. Non-therapeutic techniques include giving advice or judgment. A therapeutic nurse-patient relationship is based on trust, rapport, empathy and acceptance, and progresses through pre-interaction, orientation, working, and termination phases.
Psychiatric mental health nursing is a specialized area of nursing practice focused on promoting mental health through assessing, diagnosing, and treating behavioral problems, psychiatric disorders, and related conditions. The goals of psychiatric nursing are to promote mental health, prevent mental disorders, treat clients with mental disorders, and help restore their health. Psychiatric nurses work in a variety of clinical settings and perform activities like health promotion, screening and evaluation, case management, crisis intervention, and rehabilitation.
The document discusses the roles of various professionals that make up a multidisciplinary team for treating psychiatric patients. The team includes a psychiatrist, psychiatric nurse, clinical psychologist, psychiatric social worker, occupational therapist, pharmacist, dietician, and counselor. Each member has specialized training and is accountable for specific services, such as medical diagnosis and treatment, nursing care, psychological assessments and therapy, social work, recreational activities, medication management, and dietary needs. Together they collaborate to provide comprehensive care through interdisciplinary team meetings and treatment planning.
The document discusses the therapeutic nurse-patient relationship. It defines the relationship as an ongoing communication between nurse and patient built on mutual respect and trust. The goals are to help patients gain insight, change behaviors, and achieve developmental goals. Key aspects include empathy, genuineness, respect, concern and good communication skills. Challenges include resistance, transference, and countertransference, which the nurse must manage to maintain a therapeutic relationship.
Conceptual model and the role of a nurseTejal Virola
This document defines conceptual models and describes four major models that influence current nursing practice: existential, psychoanalytic, behavioral, and interpersonal. It provides an overview of each model, including its basic assumptions, therapeutic approaches, roles of patient and therapist, and applications to nursing. The existential model focuses on present experiences rather than past ones. The psychoanalytic model views behavior as caused and driven by unconscious forces. The behavioral model assumes all behavior is learned and can be changed. The interpersonal model sees personality developing through social interactions and relationships.
The basic about the principles of psychiatric nursing , what all are the basic we have to follow while providing care to the psychiatric patients in hospital and in the community area
The document outlines 11 standards for psychiatric and mental health nursing. Standard I discusses applying relevant theories to explain phenomena and provide treatment bases. Standard II covers continuously collecting comprehensive data through assessments. Standard III involves utilizing nursing diagnoses and classifications to identify health issues. Standard IV requires developing individualized nursing care plans with goals and interventions.
Group therapy is a type of psychotherapy wherein therapisr treats a group of people together. Group members meet at regular sessions to resolve their symptoms or conflicts.
The document discusses several key concepts in psychotherapy including resistance, transference, countertransference, gift giving, and boundary violations. It provides definitions and examples of each concept. For resistance, it describes primary and secondary resistance and their causes. For transference and countertransference, it explains how they occur unconsciously and how they can impact the therapeutic relationship if not addressed. Throughout, it emphasizes the importance of self-analysis for nurses and supervision to help overcome therapeutic impasses.
Principles of Mental Health (Psychiatric) NursingAjeshkumar Tk
The document outlines 12 general principles of mental health nursing:
1) Patients should be accepted as they are without judgment.
2) Nurses should use self-understanding as a therapeutic tool to understand patients' strengths and limitations.
3) Consistency in routines and staff attitudes contributes to patients' security.
The document discusses developing a therapeutic relationship between a nurse and client. It outlines the goals of such a relationship as helping the client develop social and coping skills, reduce anxiety, and take risks. Key characteristics for the nurse include empathy, warmth, genuineness, respect, concreteness, immediacy, and self-disclosure. The relationship progresses through phases including pre-interaction, orientation, working, and termination phases. During the working phase, the nurse helps the client gain insight, link thoughts and actions, set goals, and test new behaviors.
The document discusses therapeutic relationships between nurses and clients. It defines a therapeutic relationship as an interactive relationship that is caring, clear, boundaried, positive and professional. Therapeutic relationships differ from social and intimate relationships in that the nurse focuses on maximizing skills to enhance the client's growth. Key components of therapeutic relationships include establishing rapport, demonstrating empathy, showing warmth, and being genuine. Nurses have ethical responsibilities to respect clients' autonomy, beneficence, veracity and dignity.
Historical perspectives and trends of mental health nursingMonika Kanwar
Mental Health Nursing, also called psychiatric nursing, is among the newest of the recognized fields within the nursing profession. Mental Health Nursing focuses on those patients who have mental distresses. Psychiatric nursing is a speciality that has changed throughout history and has drastically changed through time.
Therapeutic nurse patient relationship in psychiatryVincent Ejakait
This document discusses the nurse-patient relationship and the different phases it progresses through. It outlines the pre-orientation, orientation, working, and termination phases. It also discusses transference and countertransference, as well as the importance of viewing the patient in a holistic, non-judgmental manner to build rapport and trust. Finally, it briefly touches on the concepts of mental hygiene, mental health maintenance, and rehabilitation as approaches to promoting mental health.
The document discusses the classification of mental disorders according to two major systems - ICD-10 and DSM-IV. ICD-10 is the World Health Organization's classification system that codes psychiatric disorders from F00 to F99. DSM-IV is the diagnostic manual published by the American Psychiatric Association that uses a multi-axial system with five axes to evaluate patients. Some key differences between the two systems are that ICD-10 is intended for clinical work, research, and primary care globally while DSM-IV is in English only and includes social consequences in its diagnostic criteria.
Roles of the psychiatric mental health nurse in contemporary mental health careNursing Path
The document discusses the various roles of psychiatric-mental health nurses. It begins by introducing the generalist registered nurse and specialist clinical nurse specialist. It then describes several specialty roles including community mental health nurse, psychiatric home care nurse, forensic psychiatric nurse, psychiatric consultation-liaison nurse, nurse case manager, geropsychiatric nurse, parish nurse, telehealth nurse, nurse researcher, nurse educator, nurse administrator/manager, collaborative roles on interdisciplinary teams, and nurse psychopharmacologist. These roles demonstrate the expanding scope of practice for psychiatric nurses.
Etiological theories of mental helth illnessNURSING WAY
This document discusses various etiological theories of mental illness. It covers biological theories including biochemical theories related to neurotransmitters like dopamine and genetics. It also discusses psychodynamic theories such as developmental theories related to Freudian psychosexual stages, family theories involving dysfunctional family systems and attachment, and psychosocial theories focused on psychological and social factors.
Functions of mental health nurse in various settin gsNursing Path
This document outlines the roles and responsibilities of psychiatric nurses in various clinical settings. Nurses provide assessments, medication management, therapies, education and support across inpatient, outpatient, emergency and community settings. Duties include ensuring safety, monitoring symptoms, assisting with treatments, counseling patients and families, and coordinating care.
The document traces the history of psychiatry and psychiatric nursing from ancient times to the present. It discusses how mental illness was viewed and treated in early civilizations, then outlines key periods in the history of psychiatry including periods of persecution, segregation, and the development of more humane and scientific approaches. It notes important developments and individuals that advanced the field of psychiatry as well as the professionalization of psychiatric nursing.
Psychopatho physiology of human behaviourAmbika Gaur
Mental illness and abnormal human behavior can take many forms. A senior nursing tutor named Ambika Gaur Bhatt wrote about psychopathology and the psychology of human behavior. The document focused on understanding abnormal human behavior and mental illness.
This document outlines standards for mental health and forensic nursing practice. It discusses 15 standards for professional practice in areas such as theory, data collection, diagnosis, planning, intervention, and evaluation. It also discusses 7 standards for professional performance, including peer review, continuing education, and interdisciplinary collaboration. Finally, it discusses standards for holistic nursing practice, including addressing patients' spiritual needs related to meaning, faith, hope, love, and forgiveness, as well as the role of religion. The overall purpose is to fulfill the nursing profession's obligation to provide high quality care.
1. Psychiatric–mental health nursing is a specialized area of nursing committed to promoting mental health through assessing, diagnosing, and treating behavioral problems, psychiatric disorders, and comorbid conditions using a combination of nursing skills, psychosocial interventions, and neurobiological research.
2. Psychiatric nurses work in a variety of clinical settings across the continuum of care providing services like health promotion, case management, providing therapeutic environments, administering treatment regimens, crisis intervention, and psychiatric rehabilitation.
3. Registered psychiatric nurses provide psychiatric care to individuals, families, and groups to help them function at an optimal level of psychological wellness through more effective behaviors and increased resilience to stress.
Stress adaptation model
Marudhar
Nims nursing college
Introduction
Stuart Stress Adaptation Model is a model of psychiatric nursing care, which integrates biological, psychological, sociocultural, environmental, and legal-ethical aspects of patient care into a unified framework for practice.
Assumptions
"Nature is ordered as a social hierarchy from the simplest unit to the most complex and the individual is a part of family, group, community, society, and the larger biosphere."
"Nursing care is provided within a biological, psychological, sociocultural, environmental, and legal-ethical context."
Health/illness and adaptation/maladaptation (nursing world view) are two distinct continuums.
The model includes the primary, secondary, and tertiary levels of prevention by describing four discrete stages of psychiatric treatment: crisis, acute, maintenance, and health promotion.
Nursing care is based on the use of the nursing process and the standards of care and professional performance for psychiatric nurses.
Concepts
Bio psychosocial approach - a holistic perspective that integrates biological, psychological, and sociocultural aspects of care.
Predisposing factors -risk factors such as genetic background.
Precipitating stressors - stimuli that the person perceives as challenging such as life events.
Appraisal of stressor - an evaluation of the significance of a stressor.
Coping resources - options or strategies that help determine what can be done as well as what is at stake.
Adaptation/maladaptation -
cont….
Levels of Prevention
Primary
Secondary
Tertiary
Four stages of psychiatric treatment & nursing care
Crisis stage
Acute stage
Maintenance stage
Health promotion stage
This document discusses psychiatric assessment. It describes the purpose of assessment as making a diagnosis for clinical, forensic, or medico-legal reasons. Methods of assessment include taking patient history, conducting a mental status examination, mini mental status examination, physical examination, investigations, and using assessment tools. A nursing assessment also includes risk assessment and obtaining background health information.
Personality disorder ppt MENTAL HEALTH NURSINGvihang tayde
Most definition of normal personality includes some or all of the following features,
Present since adolescence.
Stable overtime despite fluctuations in mood.
Manifest in different environment.
Recognizable to friends and acquaintance.
This document discusses therapeutic communication and the nurse-patient relationship. It defines therapeutic communication as an interpersonal interaction between the nurse and patient where the nurse focuses on meeting the patient's specific needs to effectively exchange information. The goals of therapeutic communication are to establish a therapeutic relationship, identify the patient's most important needs, assess how the patient views their problem, and help the patient express their emotions. The document outlines various techniques used in therapeutic communication including listening, informing, reflecting, and suggesting. It also discusses the components that make up a therapeutic nurse-patient relationship, such as rapport, empathy, warmth, and genuineness. The relationship aims to help patients communicate distressing thoughts/feelings and problem solve with alternative behaviors.
The document discusses the therapeutic relationship between nurses and patients. It defines three types of relationships - social, intimate, and therapeutic. The therapeutic relationship is goal-oriented and focuses on helping the patient. Key aspects of an effective therapeutic relationship include rapport, empathy, warmth, and genuineness. The relationship progresses through pre-interaction, orientation, working, and termination phases. Challenges that can arise include resistance, transference, countertransference, boundary violations, and gift giving. Managing these challenges requires skills like active listening, clarification, and maintaining open communication with supervisors.
This document reviews factors that influence personality development. It discusses biological factors such as heredity, endocrine glands, physique, and the nervous system. Environmental factors that shape personality include family, school, teachers, peer groups, sibling relationships, mass media, and culture. The review describes how each of these biological and environmental influences can impact personality formation and the development of behavior patterns.
Unit 4- Therapuetic communication.pptx coomunication, process recordingS.DHIVYALAKSHMI
Communication refers to the giving and receiving of information. Communication is the means by which people influence the behaviour of another, leading to the successful outcome of nursing intervention.
THERAPEUTIC COMMUNICATION – Principles or Characte.docxkallasharon1
Therapeutic communication is an interpersonal interaction between a nurse and patient that focuses on understanding the patient's needs to effectively exchange information. It helps nurses establish relationships with patients, identify important needs, and assess problems from the patient's perspective. Principles of therapeutic communication include maintaining patient privacy and confidentiality, using active listening and non-judgmental attitudes. Common techniques include listening, open-ended questions, reflection, clarification, and identifying themes to help patients explore issues. Non-therapeutic communication includes failing to listen, giving conflicting messages, making judgments, or changing topics if uncomfortable.
The document discusses several key concepts in psychotherapy including resistance, transference, countertransference, gift giving, and boundary violations. It provides definitions and examples of each concept. For resistance, it describes primary and secondary resistance and their causes. For transference and countertransference, it explains how they occur unconsciously and how they can impact the therapeutic relationship if not addressed. Throughout, it emphasizes the importance of self-analysis for nurses and supervision to help overcome therapeutic impasses.
Principles of Mental Health (Psychiatric) NursingAjeshkumar Tk
The document outlines 12 general principles of mental health nursing:
1) Patients should be accepted as they are without judgment.
2) Nurses should use self-understanding as a therapeutic tool to understand patients' strengths and limitations.
3) Consistency in routines and staff attitudes contributes to patients' security.
The document discusses developing a therapeutic relationship between a nurse and client. It outlines the goals of such a relationship as helping the client develop social and coping skills, reduce anxiety, and take risks. Key characteristics for the nurse include empathy, warmth, genuineness, respect, concreteness, immediacy, and self-disclosure. The relationship progresses through phases including pre-interaction, orientation, working, and termination phases. During the working phase, the nurse helps the client gain insight, link thoughts and actions, set goals, and test new behaviors.
The document discusses therapeutic relationships between nurses and clients. It defines a therapeutic relationship as an interactive relationship that is caring, clear, boundaried, positive and professional. Therapeutic relationships differ from social and intimate relationships in that the nurse focuses on maximizing skills to enhance the client's growth. Key components of therapeutic relationships include establishing rapport, demonstrating empathy, showing warmth, and being genuine. Nurses have ethical responsibilities to respect clients' autonomy, beneficence, veracity and dignity.
Historical perspectives and trends of mental health nursingMonika Kanwar
Mental Health Nursing, also called psychiatric nursing, is among the newest of the recognized fields within the nursing profession. Mental Health Nursing focuses on those patients who have mental distresses. Psychiatric nursing is a speciality that has changed throughout history and has drastically changed through time.
Therapeutic nurse patient relationship in psychiatryVincent Ejakait
This document discusses the nurse-patient relationship and the different phases it progresses through. It outlines the pre-orientation, orientation, working, and termination phases. It also discusses transference and countertransference, as well as the importance of viewing the patient in a holistic, non-judgmental manner to build rapport and trust. Finally, it briefly touches on the concepts of mental hygiene, mental health maintenance, and rehabilitation as approaches to promoting mental health.
The document discusses the classification of mental disorders according to two major systems - ICD-10 and DSM-IV. ICD-10 is the World Health Organization's classification system that codes psychiatric disorders from F00 to F99. DSM-IV is the diagnostic manual published by the American Psychiatric Association that uses a multi-axial system with five axes to evaluate patients. Some key differences between the two systems are that ICD-10 is intended for clinical work, research, and primary care globally while DSM-IV is in English only and includes social consequences in its diagnostic criteria.
Roles of the psychiatric mental health nurse in contemporary mental health careNursing Path
The document discusses the various roles of psychiatric-mental health nurses. It begins by introducing the generalist registered nurse and specialist clinical nurse specialist. It then describes several specialty roles including community mental health nurse, psychiatric home care nurse, forensic psychiatric nurse, psychiatric consultation-liaison nurse, nurse case manager, geropsychiatric nurse, parish nurse, telehealth nurse, nurse researcher, nurse educator, nurse administrator/manager, collaborative roles on interdisciplinary teams, and nurse psychopharmacologist. These roles demonstrate the expanding scope of practice for psychiatric nurses.
Etiological theories of mental helth illnessNURSING WAY
This document discusses various etiological theories of mental illness. It covers biological theories including biochemical theories related to neurotransmitters like dopamine and genetics. It also discusses psychodynamic theories such as developmental theories related to Freudian psychosexual stages, family theories involving dysfunctional family systems and attachment, and psychosocial theories focused on psychological and social factors.
Functions of mental health nurse in various settin gsNursing Path
This document outlines the roles and responsibilities of psychiatric nurses in various clinical settings. Nurses provide assessments, medication management, therapies, education and support across inpatient, outpatient, emergency and community settings. Duties include ensuring safety, monitoring symptoms, assisting with treatments, counseling patients and families, and coordinating care.
The document traces the history of psychiatry and psychiatric nursing from ancient times to the present. It discusses how mental illness was viewed and treated in early civilizations, then outlines key periods in the history of psychiatry including periods of persecution, segregation, and the development of more humane and scientific approaches. It notes important developments and individuals that advanced the field of psychiatry as well as the professionalization of psychiatric nursing.
Psychopatho physiology of human behaviourAmbika Gaur
Mental illness and abnormal human behavior can take many forms. A senior nursing tutor named Ambika Gaur Bhatt wrote about psychopathology and the psychology of human behavior. The document focused on understanding abnormal human behavior and mental illness.
This document outlines standards for mental health and forensic nursing practice. It discusses 15 standards for professional practice in areas such as theory, data collection, diagnosis, planning, intervention, and evaluation. It also discusses 7 standards for professional performance, including peer review, continuing education, and interdisciplinary collaboration. Finally, it discusses standards for holistic nursing practice, including addressing patients' spiritual needs related to meaning, faith, hope, love, and forgiveness, as well as the role of religion. The overall purpose is to fulfill the nursing profession's obligation to provide high quality care.
1. Psychiatric–mental health nursing is a specialized area of nursing committed to promoting mental health through assessing, diagnosing, and treating behavioral problems, psychiatric disorders, and comorbid conditions using a combination of nursing skills, psychosocial interventions, and neurobiological research.
2. Psychiatric nurses work in a variety of clinical settings across the continuum of care providing services like health promotion, case management, providing therapeutic environments, administering treatment regimens, crisis intervention, and psychiatric rehabilitation.
3. Registered psychiatric nurses provide psychiatric care to individuals, families, and groups to help them function at an optimal level of psychological wellness through more effective behaviors and increased resilience to stress.
Stress adaptation model
Marudhar
Nims nursing college
Introduction
Stuart Stress Adaptation Model is a model of psychiatric nursing care, which integrates biological, psychological, sociocultural, environmental, and legal-ethical aspects of patient care into a unified framework for practice.
Assumptions
"Nature is ordered as a social hierarchy from the simplest unit to the most complex and the individual is a part of family, group, community, society, and the larger biosphere."
"Nursing care is provided within a biological, psychological, sociocultural, environmental, and legal-ethical context."
Health/illness and adaptation/maladaptation (nursing world view) are two distinct continuums.
The model includes the primary, secondary, and tertiary levels of prevention by describing four discrete stages of psychiatric treatment: crisis, acute, maintenance, and health promotion.
Nursing care is based on the use of the nursing process and the standards of care and professional performance for psychiatric nurses.
Concepts
Bio psychosocial approach - a holistic perspective that integrates biological, psychological, and sociocultural aspects of care.
Predisposing factors -risk factors such as genetic background.
Precipitating stressors - stimuli that the person perceives as challenging such as life events.
Appraisal of stressor - an evaluation of the significance of a stressor.
Coping resources - options or strategies that help determine what can be done as well as what is at stake.
Adaptation/maladaptation -
cont….
Levels of Prevention
Primary
Secondary
Tertiary
Four stages of psychiatric treatment & nursing care
Crisis stage
Acute stage
Maintenance stage
Health promotion stage
This document discusses psychiatric assessment. It describes the purpose of assessment as making a diagnosis for clinical, forensic, or medico-legal reasons. Methods of assessment include taking patient history, conducting a mental status examination, mini mental status examination, physical examination, investigations, and using assessment tools. A nursing assessment also includes risk assessment and obtaining background health information.
Personality disorder ppt MENTAL HEALTH NURSINGvihang tayde
Most definition of normal personality includes some or all of the following features,
Present since adolescence.
Stable overtime despite fluctuations in mood.
Manifest in different environment.
Recognizable to friends and acquaintance.
This document discusses therapeutic communication and the nurse-patient relationship. It defines therapeutic communication as an interpersonal interaction between the nurse and patient where the nurse focuses on meeting the patient's specific needs to effectively exchange information. The goals of therapeutic communication are to establish a therapeutic relationship, identify the patient's most important needs, assess how the patient views their problem, and help the patient express their emotions. The document outlines various techniques used in therapeutic communication including listening, informing, reflecting, and suggesting. It also discusses the components that make up a therapeutic nurse-patient relationship, such as rapport, empathy, warmth, and genuineness. The relationship aims to help patients communicate distressing thoughts/feelings and problem solve with alternative behaviors.
The document discusses the therapeutic relationship between nurses and patients. It defines three types of relationships - social, intimate, and therapeutic. The therapeutic relationship is goal-oriented and focuses on helping the patient. Key aspects of an effective therapeutic relationship include rapport, empathy, warmth, and genuineness. The relationship progresses through pre-interaction, orientation, working, and termination phases. Challenges that can arise include resistance, transference, countertransference, boundary violations, and gift giving. Managing these challenges requires skills like active listening, clarification, and maintaining open communication with supervisors.
This document reviews factors that influence personality development. It discusses biological factors such as heredity, endocrine glands, physique, and the nervous system. Environmental factors that shape personality include family, school, teachers, peer groups, sibling relationships, mass media, and culture. The review describes how each of these biological and environmental influences can impact personality formation and the development of behavior patterns.
Unit 4- Therapuetic communication.pptx coomunication, process recordingS.DHIVYALAKSHMI
Communication refers to the giving and receiving of information. Communication is the means by which people influence the behaviour of another, leading to the successful outcome of nursing intervention.
THERAPEUTIC COMMUNICATION – Principles or Characte.docxkallasharon1
Therapeutic communication is an interpersonal interaction between a nurse and patient that focuses on understanding the patient's needs to effectively exchange information. It helps nurses establish relationships with patients, identify important needs, and assess problems from the patient's perspective. Principles of therapeutic communication include maintaining patient privacy and confidentiality, using active listening and non-judgmental attitudes. Common techniques include listening, open-ended questions, reflection, clarification, and identifying themes to help patients explore issues. Non-therapeutic communication includes failing to listen, giving conflicting messages, making judgments, or changing topics if uncomfortable.
This document discusses therapeutic nurse-patient relationships and communication skills. It defines a therapeutic relationship as one where the nurse uses professional knowledge and skills to help patients physically, socially, and emotionally. The document outlines Peplau's phases of a therapeutic relationship: pre-interaction, orientation, working, and termination. It also discusses concepts like empathy, rapport, warmth, genuineness, acceptance, and understanding that are important for developing therapeutic relationships. Effective communication skills for nurses discussed include listening, using open-ended questions, restating, and clarifying.
The document discusses interpersonal relationships and the nurse-patient relationship. It defines the nurse-patient relationship as an interaction process where the nurse uses their professional knowledge and skills to help patients physically, socially, and emotionally. A meaningful relationship is based on ongoing communication, mutual respect, and trust. The purpose of the therapeutic relationship is to promote insight, behavioral change, self-realization, and help identify nursing approaches to achieve patient goals. Conditions like rapport, trust, respect, genuineness, and empathy are important for building an effective therapeutic relationship.
Therapeutic communication is a process that focuses on advancing a patient's physical and emotional well-being. It involves establishing trust and respect between the nurse and patient to effectively exchange information and address the patient's needs. Therapeutic communication utilizes both verbal and non-verbal techniques, including active listening, open-ended questions, reflecting, clarifying and informing. The goal is to develop a therapeutic relationship in order to help patients understand and cope with their health issues. Key aspects of this relationship include empathy, support, and facilitating patient expression while maintaining objectivity.
Therapeutic nurse patient relationship in psychiatryChandni Narayan
The document discusses the therapeutic nurse-patient relationship. It defines this relationship as a series of interactions where the nurse assists the patient to attain positive behavioral changes. There are four phases to the nurse-patient relationship: pre-orientation where the nurse prepares, orientation where rapport is established, working where problems are identified and resolved, and termination where the relationship ends gradually. Qualities of an effective relationship include genuineness, respect, empathy, and good communication. Problems that can affect the relationship are transference where patients displace feelings onto nurses, and countertransference where nurses displace their own feelings onto patients.
THERAPEUTIC COMMUNICATION AND NURSE-PATIENT-RELATIONSHIP.pdfTejal Virola
Therapeutic communication is a technique used by healthcare professionals, particularly in the field of mental health and counseling, to establish a supportive and trusting relationship with clients or patients. Its primary goal is to promote healing, foster understanding, and facilitate positive changes in a person's thoughts, feelings, and behaviors. Effective therapeutic communication is essential for building rapport, encouraging self-expression, and facilitating the healing process.
A therapeutic nurse-patient relationship is a professional relationship established between a nurse and a patient with the aim of promoting the patient's well-being, health, and healing. This relationship is built on trust, respect, communication, empathy, and collaboration to meet the patient's healthcare needs effectively. It's a fundamental aspect of nursing practice, especially in providing holistic and patient-centered care.
this ppt contains therapeutic communication and therapeutic nurse patient relationships which is part of basic B.Sc. and M.Sc. nursing
This document discusses therapeutic communication and nurse-patient relationships. It defines therapeutic communication as strategies that support a patient's well-being. It describes different types of communication including verbal, nonverbal, and the goals of the nurse-patient relationship which include helping the patient cope with problems and find new solutions. The document outlines the phases of developing a therapeutic relationship from the pre-interaction to working and termination phases and challenges that may occur. It also discusses dynamics like transference, countertransference, and maintaining proper boundaries.
The document discusses therapeutic communication between nurses and patients. It defines therapeutic communication as an interaction where the nurse focuses on the patient's needs to effectively exchange information. The goals of therapeutic interactions are to help patients with self-realization, identity, relationships, functioning, and goal achievement. Verbal communication conveys facts while non-verbal communication includes vocal, physical, and touch cues. Skills discussed include listening, reflection, clarification, and humor. Barriers and issues like resistance, transference, and boundaries are also covered.
This document discusses therapeutic communication and the nurse-patient relationship. It covers key aspects like the goals of therapeutic communication including establishing trust and identifying patient needs. It also describes the different phases of the therapeutic relationship from orientation to termination. Specific techniques for therapeutic communication are provided, such as active listening, reflection, clarification and self-disclosure. The importance of self-awareness for nurses and understanding dynamics using models like the Johari Window are also highlighted. Maintaining privacy, respect and using touch appropriately are emphasized as important aspects of effective therapeutic communication.
Therapeutic Communication and Nurse – Patient Interaction 1.pptxWaldoGoesWild
Therapeutic communication is a type of professional communication defined as the purposeful, interpersonal, information-transmitting process that leads to client understanding and participation.
This document discusses the importance of developing a therapeutic relationship between nurses and patients. It defines a therapeutic relationship as a mutual learning experience based on respect and acceptance. The key elements of a therapeutic relationship are identified as acceptance, effective communication, trust, empathy, rapport, respect, and genuineness. Different types of relationships like social, intimate, and therapeutic are also compared. Finally, the document outlines the different phases in developing a therapeutic relationship with patients.
The document discusses communication and therapeutic communication. It defines communication as the exchange of information between individuals so that the message is understood. Therapeutic communication aims to support a patient's well-being by identifying health issues and facilitating expression of emotions. Various techniques are described like listening, questioning, reflecting, and role playing. The purpose, principles, and types of relationships like nurse-patient relationships are also outlined.
This document discusses therapeutic communication techniques used in mental health nursing. It defines therapeutic communication and its purpose in establishing a nurse-patient relationship and identifying patient needs. Some key techniques discussed include active listening, open-ended questioning, reflection, and role playing. The document also examines principles of therapeutic relationships and potential issues that can arise such as transference, resistance, and boundary violations. Interventions for overcoming therapeutic impasses focus on self-awareness, clear communication, and supervision.
Hildegard Peplau developed the interpersonal relations theory of nursing, which focuses on the nurse-patient relationship and its phases. Peplau identified four phases of the relationship: orientation, identification, exploitation, and resolution. She also described six nursing roles that emerge in the relationship: stranger, resource person, teacher, counselor, leader, and surrogate mother. Peplau's theory views nursing as a significant therapeutic process where the nurse helps the patient through communication to reduce anxiety and move toward productive health.
Physician-patient communication is important for improving patient satisfaction and health outcomes. Good communication involves listening to the patient, understanding their perspective on their illness, and discussing treatment options empathetically. It also requires providing information to patients about their diagnosis, prognosis, and recommended tests or procedures. Formal training in communication skills can help physicians communicate more effectively with patients.
Rapport and doctor patient relationship in psychiatryDr. Rakesh Mehta
The doctor-patient relationship is core to the practice of medicine, with the patient seeking help and sharing information depending on how respected and considered they feel by the physician. Developing rapport through understanding, trust, and a nonjudgmental attitude increases patient comfort and the amount of information shared. Key components of a strong relationship include conveying understanding of what the patient states and feels, answering personal questions genuinely, and making the interview patient-centered rather than focused on the doctor's goals. This helps strengthen the therapeutic alliance.
The document discusses therapeutic communication between nurses and clients. It states that the interaction helps develop mutual understanding and is a learning experience for both. Effective communication establishes trust, allows clients to openly share thoughts and feelings, and helps nurses identify problems and plan, implement and evaluate solutions. It discusses different types of communication including intrapersonal, interpersonal, transpersonal, small group and public. It also outlines verbal and nonverbal communication as well as the stages of the nurse-client interaction process.
This document discusses the principles and standards of psychiatric nursing. It begins by defining key terms like mental health, psychiatry, psychology, and psychiatric nursing. It then outlines 12 general principles of mental health nursing which focus on accepting clients, understanding oneself, ensuring client security, giving reassurance, avoiding increases in anxiety, objective observation, maintaining therapeutic relationships, and modifying procedures based on individual needs. The document also discusses 5 professional practice standards for psychiatric nursing: applying relevant theory, comprehensive assessment, utilizing diagnoses, developing individualized care plans, and implementing therapeutic interventions.
The document discusses the nurse-patient relationship and the therapeutic relationship. It defines the nurse-patient relationship as the foundation of nursing care and one where both parties see each other as unique individuals. The therapeutic relationship is goal-oriented and aims to help the patient regain inner strength and cope with life challenges. The summary describes the different types of relationships, phases of the nurse-patient relationship including pre-orientation, orientation, working, and termination phases, and conditions needed for a therapeutic relationship like trust, empathy and respect.
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Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
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Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
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𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) Curriculum
Therapeutic communication and Therapeutic Nurse patient relationship
1. TOPIC: THERAPEUTIC COMMUNICATION
AND THERAPEUTIC NURSE PATIENT
RELATIONSHIP
SECTION:3rd BSc NURSING
PRESENTATION CLASS BY
SATHISHA R
2ND YEAR MSC NURSING
DEPARTMENT OF MHN
2. OVERVIEW
DEFINITION OF COMMUNICATION
ELEMENTS AND TYPES OF COMMUNICATION
DEFINITION OF THERAPEUTIC COMMUNICATION
GOALS OF THERAPEURIC COMMUNICATION
PRINCIPLES /CHARACTERSTICS OF THERAPEUTIC
COMMUNICATION
TECHNIQUES OF THERAPEUTIC COMMUNICATION
THERAPEUTIC NURSE-PATIENT RELATIONSHIP
GOALS OF TNPR
COMPONENTS OF THERAPEUTIC NURSE-PATIENT RELATIONSHIP
CHARACTERISTICS OF TNPR
PHASES AND TASKS OF TNPR
THERAPEUTIC IMPASSES
PROCESS RECORDING
3. Definition of Communication
Communication is interchange of thoughts,opinions or
informations by Speech, writing or signs
–Robert Anderson.
Its refers to the giving and recieving of information
which helps establish therapeutic relationship .
5. Types of Communication
On the Basis of deliver the message
1. Verbal communication : Its type of communication by
using words it may be by writting or spoken words. It
needs the help of any language which both sender and
reciever can understand.
2. Non verbal communication : Its a type of
communication by using Body movements ,
postures, gestures and Facial expressions . Here no
need of any Language.
6. On the basis of Pattern
1. One way communication: In this type
communication is unidirectional, No chance to give
feedback. ex Lecturing
2. Two way communication : Here communication is
Bidirectional . Chance of feedback and discussion
will be there between sender and receiver . ex
Discussion
7. On the basis of purposes
1. Formal communication: It follows the line of
Authority such as organizational meetings.
2.Informal communication: Its a casual communication
such as Gossips
3.Therapeutic communcation: Its formal
communication process where the patient and
health care provider get an opportunity to learn
about each other to modify patients behavior
8. THERAPEUTIC COMMUNICATION.
Its an Interpersonal interaction between Nurse and
patient during which nurses can focuses on the specific needs
to promote an effective exchange of information.
Goals of Therapeutic communication
1.To establish therapeutic nurse patient relationship.
2.To identify most important needs of patient.
3.To Assess the patients perception of problem.
4.To facilitates the patients expression of emotions.
5.To implement interventions designed to reach the patient
needs.
9. Principles /Characteristics Therapeutic Communication
1.Patient should be primary focus of interaction.
2.Avod social relationship with patient.
3.Maintain patient confidentiality
4.Assess the patient intellectual competence to determine the level of
understanding.
5.Implement interventions from theoretic base.
6.Maintain Non judgemental attitude .
7.Guide the patient to reinterpret his or her experiences rationally.
8.A Professional attitude sets the tone of therapeutic relationship.
10. Techniques of Therapeutic communication
1.Listening: Its an active process of recieving information.
Responses on the part of nurse such as maintaining eye to
eye contact , nodding , gesturing and other forms of
receptive non-verbal communication. These acts convey
the patient he is being listened and understood.
Therapeutic value-Non verbally communicates to the
patient the nurses interest and acceptance.
2. Broad openings: Encourage the patient to select topics
for discussion . for ex What are you thinking about ?
Therapeutic value-Indicates acceptance by nurses and
value the patients initiative.
11. 3. Restating: Repeating the main thought expressed by the
patient. For example,
"You say that your mother left you when you were 5-year-
old.“
Therapeutic value: Indicates that the nurse is listening and
validates, reinforces or calls attention to something important
that has been said.
4. Clarification: Attempting to put vague ideas or unclear
thoughts of the patient into words to enhance the nurse's
understanding or asking the patient to explain what he means.
For example, "I am not sure what you mean. Could you tell me
about that again?"
Therapeutic value: It helps to clarify feelings, ideas and
perceptions of the patient and provides an explicit correlation
between them and the patient's actions.
12. 5. Reflection: Directing back the patient's ideas, feelings, questions
and content.
For example, "You are feeling tense and anxious and it is related to a
conversation you had with your husband last night."
Therapeutic value: Validates the nurse's understanding of what the
patient is saying and signifies empathy, interest and respect for the
patient.
6. Humor: The discharge of energy through comic enjoyment of the
imperfect.
For example, "That gives a whole new meaning to the word 'nervous"
said with shared kidding between the nurse and the patient.
Therapeutic value: Can promote insight by making repressed material
conscious, resolving paradoxes, tempering aggression and revealing
new options, and is a socially acceptable form of sublimation.A
13. 7. Informing: The skill of information giving.
For example, "I think you need to know more about your
medications.
" Therapeutic value: Helpful in health teaching or patient
education about relevant aspects of patient's well-being and self-
care.
8. Focusing: Questions or statements that help the patient
expand on a topic of importance.
For example, "I think that we should talk more about your
relationship with your father.
" Therapeutic value: Allows the patient to discuss central issues
and keeps the communication process goal-directed.
14. 9. Sharing perceptions: Asking the patient to verify the nurses
understanding of what the patient is thinking or feeling.
For example, "You are smiling, but I sense that you are really very angry
with me."
Therapeutic value: Conveys the nurse's understanding to the patient
and has the potential for clearing up confusing communication.
"I notice
10. Theme identification: This involves identification of underlying
issues or problems experienced by the patient that emerge repeatedly
during the course of the nurse-patient relationship.
For example, I noticed that you said, you have been hurt or rejected by
the man. Do you think this is an underlying issue?
" Therapeutic value: It allows the nurse to promote the patient's
exploration and understanding of important problems.
15. 11. Silence: Lack of verbal communication for a therapeutic reason.
For example, sitting with a patient and non-verbally
communicating interest and involvement.
Therapeutic value: Allows the patient time and to think and gain
insight, slows the pace of the interaction and encourages the patient
to initiate conversation while enjoying the nurse's support,
understanding and acceptance.
12. Suggesting: Presentation of alternative ideas for the patient's
consideration relative to problem solving.
For example, "Have you thought about responding to your boss in a
different way when he raises that issue with you? You could ask him
if a specific problem has occurred"
Therapeutic value: Increases the patient's perceived notions or
choices.
16. THERAPEUTIC NURSE-PATIENT RELATIONSHIP
A relationship is defined as a state of being related or a state
of affinity between two individuals.
Types of relationships.
•Social relationships
•Intimate relationships
• Therapeutic relationships
Social Relationships -A social relationship can be defined as a
relationship that is primarily initiated with the purpose of
friendship, socialization, enjoyment or accomplishing a task.
For example, participants share ideas, feelings and experiences.
17. Intimate Relationships -An intimate relationship occurs
between two individuals who have an emotional
commitment to each other. Those in an intimate relationship
usually react naturally with each other.
Therapeutic relationship{TNPR} -The nurse–client
relationship is an interaction between a nurse and "client"
(patient) aimed at enhancing the well-being of the client,
who may be an individual, a family, a group, or a community
18. Goals of therapeutic relationship
Facilitating communication of distressing
thoughts and feelings
Assisting the patient with problem-solving
Helping patients examine self-defeating
behaviors and test alternatives
Promoting self-care and independence
19. Components of Therapeutic Nurse-Patient Relationship
1.Rapport :Rapport is a relationship or communication,
especially when useful and harmonious. It is the crux of a
therapeutic relationship between the nurse and the patient. It is
● A willingness to become involved with another person
● Growth towards mutual acceptance and understanding of
individuality
• The end result of one's care and concern for another.
The nurse establishes rapport through demonstration of
understanding, warmth and non-judgmental attitude.
20. 2.Warmth :Warmth is the ability to help the patient feel
cared for and comfortable. It shows a unique acceptance of
the patient as individual. It involves a non-possessive caring
for the patient as a person and a willingness to share the
patient's joys and sorrows.
3.Genuineness: Genuineness involves being one's own
self. This implies that the nurse is aware of her thoughts,
feelings, values and their relevance in the immediate
interaction with a patient. The nurse's response to the patient
is sincere and reflects her internal response.
21. 4.Empathy
Its ability to understand another persons thoughts and
feelings in a situation from their point of view ,rather than your
own. It is the ability to put oneself in another person's
circumstances and feelings.
The nurse need not necessarily have to experience it, but has to
be able to imagine the feelings associated with the experience.
Sympathy is often confused with empathy. In sympathy, the
nurse actually showing consern about the patient problems.
In sympathy the nurse becomes focused on relief of personal
distress rather than on assisting the patient to resolve the
problem. With empathy while understanding the patient's
thoughts and feelings, the nurse is able to maintain sufficient
objectivity to allow the patient to achieve problem resolution
with minimal assistance.
22. Characteristics of Therapeutic Nurse-
Patient Relationship
1.The therapeutic relationship is the cornerstone of
psychiatric-mental health nursing, where observation and
understanding of behavior and communication are of great
importance.
2.It is a mutual learning experience and a corrective emotional
experience for the patient.
3.The nature of the therapeutic relationship is characterized by
the mutual growth of individuals who "dare" to become related
to discover love, growth and freedom.
23. 4. In a therapeutic relationship, the nurse and patient work
together towards the goal or assisting the patient to regain
the inner resources in order to meet life challenges and
facilitate growth.
5.The interaction is purposefully established, maintained
and carried out with the anticipated outcome of helping the
patient to gain new coping and adaptation skills.
24. Phases and Tasks of Therapeutic Relationship
Four phases of relationship process have been identified:
1. Pre-interaction phase
2. Introductory or orientation phase
3. Working phase
4. Termination phase
25. 1. Pre-interaction Phase
This phase begins when the nurse is assigned to initiate
a therapeutic relationship and includes all that the nurse
thinks, feels or does immediately prior to the first interaction
with the patient. The nurse's initial task is one of self-
exploration. The nurse may have misconceptions and
prejudices about psychiatric patients and may have feelings
and fears common to all novices. Many nurses express
feelings of inadequacy and fear of hurting or exploiting the
patient. Another common fear of nurses is related to the
stereotyped psychiatric patients' abusive and violent
behavior.The nurse should also explore feelings of inferiority,
insecurity, approval-seeking behaviors, etc. This self-analysis
is a necessary task because, to be effective, she should have a
reasonably stable self-concept and an adequate amount of
self-esteem.
26. Nurse's Tasks in the Pre-interaction Phase
Explore own feelings, fantasies and fears
Analyze own professional strengths and
limitations
Gather data about patient whenever possible
Plan for first meeting with patient
Problems encountered
1 Anxiety:
2.Difficulty in self-analysis and acceptance
Apart from anxiety, the nurse may also experience boredom,
anger, indifference, and depression. The cause of such feelings
must be identified, which is the first step in devising ways to
cope with them.
27. .
Ways to Overcome
The nurse needs help from her supervisor and peers in self-
analysis and facing reality in order to help patients do likewise.
This provides an opportunity to explore feelings and fears and
develop useful insight into one's professional role.
The nurse may, in consultation with her supervisor, identify in
writing goals for the initial interaction, and decide the methods to
be used in achieving the goals.
The nurse also needs to be consciously aware of the reasons for
choosing a particular patient. She may also attempt to assess the
patient's anxiety level as well as her own. The nurse who is able to
analyze herself and recognize her assets and limitations, is able to
use this information in relating to patients in a natural, congruent
and relaxed manner.
28. 2. Introductory or Orientation phase:
It is the phase that the nurse and the patient meet for the
first time. One of the nurse's primary concerns is to find out why
the patient sought help. This forms the basis of the nursing
assessment and helps the nurse to focus on the patient's problem
and to determine patient's level of motivation.
Nurse's Tasks in the Orientation Phase:
1. Establish rapport, trust and acceptance
2. Establish communication; assist in theverbal expression of
thoughts and feelings
3. Gather data, including the patient's feelings, strengths and
weaknesses
4. Define patient's problems; set priorities for nursing
intervention
5. Mutually set goals
29. Problems Encountered:
The major problem encountered during this phase is
related to the manner in which the nurse and patient
perceive each other.
Problems related to establishing an agreement or pact
between the nurse and patient: The patient may feel that
since the nurse is here only for a few weeks much help
cannot be expected from her in the short span of time.
30. Ways to Overcome
The nurse must be willing to relate honestly to her
perceptions, thoughts and feelings, and to share the data
collected during the nurse-patient interaction with her
supervisors. The supervisor must provide an atmosphere in
which the nurse feels free to reveal self without any fear of
criticism.
Difficulties may be faced in assisting a nurse who perceives a
patient as if he were someone from her past life. She is
usually not aware of doing so, since most of this behavior is
unconsciously determined. An alert supervisor can usually
detect that the nurse is distorting the patient by viewing him
as someone else.
31. Formulating a contract: It is a mutual process. It begins
with the introduction of the nurse and patient, exchange
names, and explanation of roles. An explanation of roles
includes the responsibilities and expectations of patient
and nurse, with a description of what the nurse can and
cannot do.
Elements of a nurse-patient contract
Exchanging names of nurse and patient
Explanation of roles of nurse and patient
Explanation of responsibilities of nurse and patient
Discussion of purpose 0f Discussion , date, time and
place
Description of meeting conditions for termination
Confidentiality.
32. 3. Working Phase
Most of the therapeutic work is carried out during the
working phase. The nurse and the patient explore relevant
stressors and promote the development of insight in the patient.
By linking perceptions, thoughts, feelings and actions, the nurse
helps the patient to master anxieties, increase independence and
coping mechanisms. Actual behavioral change is the focus of
attention in this phase of the relationship.
Nurse's Tasks in the Working Phase
• Gather further data; explore relevant stressors.
•Promote patient's development of insight and use of
constructive coping
mechanisms.
33. •Facilitate behavioral change, encourage him to evaluate the
results of his behavior.
•Provide him with opportunities for independent functioning .
•Evaluate problems and goals and redefine as necessary
Problems Encountered
Testing of the nurse by the patient:
Progress of the patient:
The nurse's fear of closeness:
Life stresses of the nurse:
34. Resistance behaviors: Resistance is the patient's attempt to
remain unaware of anxiety-producing aspects within him.
Resistance may take different forms and some of them were
identified by Wolfberg as follows:
Suppression and repression of relevant information.
Intensification of symptoms .
A helpless outlook on the future.
Breaking appointments, coming late to his sessions, being
forgetful, silent and sleepy during the interactions.
Acting out or irrational behavior
Expressing an excessive liking for the nurse and claiming that
nobody can replace her.
Reporting physical symptoms which may occur only during the
time the patient is with the nurse.
Hostility, dependence, provocative remarks, sexual interest in the
nurse.
35. Transference and counter transference reactions:
These are, in fact, a form of resistance behavior. Transference is the
unconscious transfer of qualities or attributes (characters) originally
associated with another individual by the patient. Transference occurs
because the patient brings frustrations, conflicts and feelings of
dependence from a past relationship into the therapeutic relationship.
The patient may express feelings of aggression, rejection or hostility
that are too intense for the current situation. These responses are often
not appropriate for the nurse-patient relationship.
Counter transference is the reverse of transference. The nurse may have
unresolved problems from an earlier relationship. She may
unconsciously transfer inappropriate attributes to a patient that was
experienced in that earlier relationship. The patient's transference
provokes the nurse's counter transference reactions.
.
36. Ways to Overcome:
Conferences with the supervisors and group discussions
with other members of the team, staff are the ways in which
the nurse can best be assisted to overcome the barriers
encountered during the working phase. It is this phase that
the supervisor helps the nurse to increase her ability to
collect and interpret data, apply concepts and synthesize the
data obtained.
There will be times when the nurse believes she is making
little or no progress, either in helping the patient or in
gaining knowledge. It is at such times that emotional support
is needed, and it is the task of the supervisor to encourage
the nurse to persevere.
37. At one time or another, most nurses may exhibit a reluctance
(Unwillingness)to write and analyze process records or to engage in a
discussion with the supervisor about the content of records, due to
many reasons. For instance fatigue, boredom, discouragement or an
apparent impasse in interacting with a patient may cause reluctance.
Handling resistances: The nurse may find the experience of
transference and counter transference particularly difficult.
The first thing the nurse must do in handling resistance is to listen.
When she recognizes the resistance, she then uses clarification and
reflection of feelings; clarification helps to give the nurse a more
focused idea of what is happening, while reflection of content helps
the patient to become aware of what has been going on in his own
mind. It is not sufficient to merely identify that resistance is
occurring; the behavior must be explored and possible reasons for its
occurrence As analysed.
38. 4. Termination Phase
This is the most difficult, but most important phase of the
therapeutic nurse-patient relationship. The goal of this phase is
to bring a therapeutic end to the relationship.
Criteria for Determining patients Readiness for
Termination.
Patient experiences relief from improved the presenting
problems
Patient's social function has improved and isolation has
decreased
Patient's ego functions are strengthened and he has attained a
sense of identity
Patient employs more effective and productive defense
defence mechanism
Patient has achieved the planned treatment goals
39. Nurse's Tasks in the Termination Phase
Establish reality of separation
Mutually explore feelings of rejection, loss, sadness, anger
and related behavior
Review progress of therapy and attainment of goals
Formulate plans for meeting future therapy needs.
Problems Encountered.
It is the task of the nurse to prepare the patient for
termination of the relationship. However, patients differ in
their reactions to the nurse's attempts to prepare them for
termination. An ill person who has experienced trust,
support and the warmth of caring may be reluctant to
discontinue the nurse-patient contact
40. Some behaviors exhibited in this regard can
• Patients may perceive termination desertion and may
demonstrate angry behavior.
• Some patients attempt to punish the nurse for this desertion by
not talking during the last few interactions or by ignoring
termination completely; they may act as if nothing has changed
and the interactions will go on as before.
•Other patients react to the threatened loss by becoming
depressed or assuming an attitude of not caring.
•Fault-finding is another behavior; the patient may state that the
therapy is not beneficial or not working; he may refuse to follow
through on something that has been agreed upon before.
41. • Resistance often comes in the form of "flight to health", which
is exhibited by a patient who suddenly declares that there is no
need for therapy; he claims to be all right and wants to
discontinue the therapeutic relationship; this may be form of
denial or fear of the anticipated grief over separation.
•"Flight to illness" occurs when a patient exhibits sudden return
of symptoms this is an unconscious effort to show that
termination is inappropriate and that the nurse is still needed;
the patient may disclose new information about him or more
problems or even threaten to commit suicide in an attempt to
delay parting.
.
.
42. Ways to Overcome
The nurse should be aware of the patient's feelings and be
able to deal with them appropriately. The nurse can assist the
patient by openly eliciting his thoughts and feelings about
termination.
During this phase, the supervisor may notice that the nurse is
showing less interest in the patient than shown earlier and may
be disengaging self from the patient several days before the
final interaction. This may be a psychological defense
mechanism by which she tries to decrease or delay the anxiety
she is experiencing as a result of the impending termination of
relationship.
43. Therapeutic Impasses
Therapeutic impasses are blocks in the progress of the nurse-
patient relationship. Impasses provoke intense feelings in both
the nurse and the patient, which may range from anxiety and
apprehension to frustration, love or intense anger.
1. Resistance: Resistance is the patient's attempt to remain
unaware of anxiety producing aspects within the self. Page
113 lists form of resistance displayed by patients.
44. 2. Transference: Transference is an unconscious response in
which the patient experiences feelings and attitudes toward the
nurse that were originally associated with significant figures in
the patient's early life. For example, a patient perceives the
nurse as acting the way that his mother did, regardless of how
the nurse is truly acting. Transference can be positive if patients
view the nurse as helpful and caring. Negative transference is
more difficult because of unpleasant emotions that interfere
with treatment such as anger and fear.
3. Counter transference refers to a specific emotional response
by the nurse towards the patient that is inappropriate to the
content and context of the therapeutic relationship or
inappropriate in its emotional intensity. Counter transference
reactions are usually of three types: Reactions of intense love or
caring, reactions of intense hostility or hatred and reactions of
intense anxiety often in response to a patient's resistance.
45. Forms of countertransference displayed by nurses.
Difficulty in empathizing with patient in certain problem areas
Recurrent anxiety, unease, or guilt related to patient
Personal or social relationship with patient
Encouraging patient's dependency, praise or affection
Sexual or aggressive fantasies towards patient
Arguing with patient or tendency to "push" patient before he is
ready
Feeling angry or impatient because of patient's unwillingness
to change.
46. 4.Boundary violation:
Occurs when a nurse goes outside the boundaries of the
therapeutic relationship and establishes a social, economic
or personal relationship with a patient.
Possible boundary violations
accepts free gifts from patient.
Nurse Having personal or social relationship with patient.
Nurse attends a social function of patient.
Nurse regularly reveals personal information to patient.
Nurse routinely hugs or has physical contact with patient.
Nurse does business with or purchases services from
patient.
47. Interventions to Overcome Therapeutic Impasses
Nurse must have knowledge of the impasses and recognize
behaviors that indicate their existence.
Nurse must reflect on feelings, explore reasons behind
such behavior.
Co-workers are more likely than others to recognize the
phenomenon initially and give feedback to the nurse about
it.
Nurses must examine their strengths, weaknesses,
prejudices, and values before they can interact more
appropriately with patients.
The transference reactions of patients must also be
examined, gently but directly.
48. Nurses must be open and clear about their genuine
reactions when patients misperceive behavior.
Nurses should also state actions that they can and cannot
take to meet patient's needs.
Limit setting is useful when patients act inappropriately
towards the nurse.
Maintain open communication with her supervisor, who
can then guide her in making adequate progress in
handling such resistance reactions.
49. PROCESS RECORDING
Recording is an important and necessary function of any
organization, whether it is an industry, a business enterprise, a
hospital or for that matter even farming. Recording is done in
different ways in different organizations and situations.
recording is the method of recording used in psychiatric wards
by nurses.
Definition: Process recording is a written account or verbatim
recording of all that transpired, during and immediately
following the nurse-patient interaction.
In other words, it is the recording of the conversation during
the interaction or the interview between the nurse and the
patient in the psychiatric setup with the nurse's inference. It
may be written during the interaction or immediately after the
one-to-one interaction.
50. Purpose and Uses
The aim of process recording is to improve the quality of the
interaction for better effect to the patient and as a learning
experience for nurse to continously improve her clinical
interaction pattern. When correctly used, it assists the nurse or
student to plan, structure and evaluate the interaction on a
conscious rather than an intuitive level
Assists her to gain competency in interpreting and synthesizing
raw data under supervision.
Helps to consciously apply theory to practice
Helps her to develop an increased awareness of her habitual,
verbal and nonverbal communication pattern and the effect of
those patterns on others
51. Helps the nurse to learn to identify thoughts and feelings in
relation to self and others
Helps to increase observational skills, as there is a conscious
process involved in thinking, sorting and classifying the
interaction under the various headings
Helps to increase the ability to identify problems and gain
skills in solving them.
After a few exercises, these skills will become so in-built that
she will keep using them automatically even when it is not
specifically required or when she does not have the time to do
it. Thus process recording is an
Educative tool,
Teaching tool
Diagnostic tool
Therapeutic tool, and a prerequisite for nursing process
52. Prerequisites for Process Recording
● Physical setting
● Getting consent of the patient for the possibility of cassette
recording
•Confidentiality
53. Suggested Outlines for Process Recording
1.Introductory Material
This should include a short description of the patient,
his name, age, educational level, health problems and length
of stay in the hospital. The date, time, place of interaction
and a short description of the milieu of the ward
immediately prior to the interaction will be helpful in
understanding the thoughts and feelings of the patient. It is
also helpful to record the thoughts and feelings of the nurse
just before the interaction. Reason for choosing the patient
and the duration of the nurse-patient relationship should
also be included. To understand the patient in a better way,
process recording also includes personal history, family
history, socio-economic history, medical history, present
complaints, past psychiatric history if any, and provisional
diagnosis.
54. 2.Objectives
Objectives should be formulated prior to meeting. It should be
specific, readily measurable change in the patient behavior and
function as a guide for interaction. They can be different on
different days of the interview. For example, in the beginning,
setting short-term goals may be more appropriate. In the
second stage (working phase), the objectives can be more long
term in nature, focusing on corrective psychodynamics,
including rehabilitation, follow-up and preparing the family
for future plans.
3.Context of the Interaction
Describe where the interaction took place, activities involving
the patient that occurred before the interaction, the patient's
physical appearance and how the interaction began, i.e.
whether the patient approached you or you initiated the
interaction.
55. 4. Record of Interaction between Nurse and the Patient
This should include truthful recording of what the nurse
said and did and what the patient said and did, including
any non-verbal behavior of the patient, such as changing
the position, looking at various things, eye contact, biting
the nails, pacing, tone of voice, rate of speech and changes
in facial expressions. What the nurse did also includes her
non-verbal behavior. The nurse's thoughts and feelings also
should be recorded so that a self-evaluation can be made as
to how these influence her behavior. Periods of silence are
also important to record.
56. 5. Analysis of the Interaction
An analysis of the interaction should include the interpretation
of the verbal and nonverbal behavior and patient's thoughts
and feelings as evident from the process.
communication techniques used by the nurse and evaluation of
the technique in terms of its effect on the patient and in terms of
the planned objectives also should be included. The nurse's
thoughts and feelings at the end of the interaction and the plans
made for further interactions should be stated. can be written as
short Process recording notes during the interaction and
rewritten immediately after it. Total time spent on the recording
can be around 30 minutes. The active time can be 20 minutes,
with 10 minutes for conclusion and recording. Although video or
tape recorders give more accurate recording, the impact of this
equipment on the interaction will make an unnatural influence.
57. 6.Summary
The recording process should end with a brief summary to
evaluate whether initial objectives for the interaction were
met. If the objectives were not met, provide a brief analysis of
the reasons thereof. This provides an opportunity to modify
the conversation. (See Appendix 5 for process recording
format)