Psychiatry power point for nursing stdy

Unit one
INTRODUCTION TO PSYCHIATRY

• Module title: Mental Health Nursing
• Module Code: NursM-3053
• EtCTS. = 8
• Prerequisite: Foundation I, II , MSN I, II theory and practice
• Module summary
• Duration 4 weeks
• Total classroom-based teaching hrs. (Lecture, SDL, PBL.) = 2 weeks
(85hr)
• Exam =1week
• Clinical practice = 40hr/week

Module Description:
This module is designed to prepare nursing students to assess, diagnose,
plan and manage common psychiatric disorders. The module is also
intended to help the students in understanding human behavior and
differentiating between normal and abnormal behavior. It also will help
students to develop skills in therapeutic communication and developing a
nurse-patient relationship to manage, support, and rehabilitate patients with
mental illness in hospitals and communities.

Module competency:
After the end of this module nursing students will be able to;
Conduct complete mental health assessment and apply DSM-5
common mental health problems.
 Provide mental health services at institutional and community
settings.
Module objective:
After completion of this module the students will be able to assess,
diagnose, and manage common mental health problems based on
DSM-5 and the nursing process as a framework.

Supportive Objectives:
• At the end of this module the students will be able to: Specific: At the
end of this module the students will be able to:
Differentiate mental health, mental illness, and common psychiatric
disorders
 Identify the general principles of psychiatry interview
Perform mental health nursing assessment (history taking and MSE)
Demonstrate skills in therapeutic communications
Describe etiological factors, psychopathology, clinical features,
diagnostic criteria and treatment modalities used for mental disorders
Differentiate psychiatric disorders

Apply the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5)
Manage common psychiatric disorders
Refer cases that require further investigation and treatment
Apply psychiatry case formulation by using Biopsychosocial model
Manage patients with psychiatric emergencies
Apply the preventive, curative, and promote methods of mental health
including rehabilitative care

Assessment
• Summative assessment of the overall module
1. Class room-based teaching =40%
2. Clinical and community practice = 60%

Chapter One
Introduction to mental health Nursing

Objectives
At the end of this unit the students will be able to :
Define mental health and mental illness
Describe factors of mental health
Identify common misconception
Describe historical perspective of psychiatry

Definition
Psychiatry is the branch of medicine focused on the
diagnosis, treatment and prevention of mental, emotional
and behavioral disorders.
Mental health and mental illness are difficult to define
precisely.
The culture of any society strongly influences its values and
beliefs, and this in turn affects how that society defines
health and illness.
What one society may view as acceptable and appropriate,
another society may see as maladaptive and inappropriate.

Mental Health
No single universal definition of mental health exists.
Generally, a person’s behavior can provide clues to his or her mental
health.
Because each person can have a different view or interpretation of
behavior, the determination of mental health may be difficult.
In most cases, mental health is a state of emotional, psychological, and
social wellness evidenced by satisfying interpersonal relationships,
effective behavior and coping, positive self-concept, and emotional
stability.

Mental illness
According to APA Mental illnesses are health conditions involving changes
in Emotion, Thinking or behavior (or a combination of these).
Mental illnesses are associated with distress and/or problems functioning
in social, work or family activities.

Psychiatric nursing historical development
People of ancient times believed that any
sickness indicated displeasure of the gods
Those with mental disorders were viewed as
being either divine or demonic, depending on
their behaviour.
Aristotle (382–322 BC) attempted to relate
mental disorders to physical disorders
In early Christian times (1–1000 AD), primitive

Psychiatric nursing historical development
All diseases were again blamed on demons, and the mentally ill
were viewed as possessed. Priests performed exorcisms to rid evil
spirits.
Those considered harmless were allowed to wander the
countryside

Period of Enlightenment and Creation of Mental Institutions
This a time when moral treatment of the mentally ill was began
and asylum was started
The period of scientific study and treatment of mental disorders began with
Sigmund Freud (1856–1939)
Development of Psychopharmacology
It is a time around 1950 when psychotropic drugs were developed
Chlorpromazine (Thorazine), an antipsychotic drug, and lithium, an ant
manic agent, were the first drugs to be developed.

Epidemiology of Mental Disorders…
 Over 150 million people suffer from depression
 50 million from epilepsy
 37 million people from Alzheimer's Disease
 24 million people from schizophrenia
 10-20% of children
 Billions abuse substances
 800,000 people die from suicide each year and over ½ of these are
young people.
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Mental Health Burden in Ethiopia

ETIOLOGY OF MENTAL DISORDERS
Unknown or incompletely understood.
Caused by a combination and interaction of several factors.
Single cause may lead to several effect.
Complex and ambiguous.
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Classification of causes
 A single disease may result from several causes
 Predisposing factors are those that render the person vulnerable and
are present over a long period of time.
 Precipitating factors are events that precede clinical onset.
 Perpetuating factors are factors that prolong the course of a disorder
after it has been provoked.
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PREDISPOSING FACTORS
1. Genetics:-
E.g. schizophrenia, BPD, dementia
2. Age:-
E.g. Adolescence, middle life, old age
3. Gender:-
E.g. Alcohol (M>F)
Physical, psychological and social factor early in life and premorbid
personality is important.
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PRECIPITATING FACTORS
1. Environment:- Emotional as well as physical milieu
 Family interactions (engagement, marriage, discord, separation,
death, becoming a parent)
 Other interpersonal relationship (Difficulties with friends or
neighbors)
 Living circumstances (immigration)
 Financial affairs (inadequate finances)
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PRECIPITATING FACTORS
 Legal affairs (Being arrested )
 Occupation – stress related to job (e.g. conflict with a superior)
2. Physical illness
 Personal (pain, discomfort)
 Financial (cost of treatment)
 Emotional (feeling of depression)
 Body image (breast amputation)
 Endocrinal (hyperthyroidism)
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Perpetuating factors
o Substance use/abuse
o Non-adherence with treatment
o Ongoing psychosocial stressors
o Lack of social support (supportive network)
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Factors of mental health
Mental health is a dynamic, or ever-changing, state.
It is affected by factors that can be categorized as individual, interpersonal,
and social/cultural.
Individual/personal/factors include :
A person’s biologic makeup
Autonomy and independence
self-esteem and capacity for growth

Individual/personal/factors…
Vitality
Ability to find meaning in life
 Emotional resilience
Sense of belonging
Reality orientation
Coping or stress management abilities.

Interpersonal/relationship/factors include :
Effective communication
Ability to help others
 Intimacy
A balance of separateness and connectedness.

Social/cultural, or environmental, factors include:
 A sense of community
 Access to adequate resources
 Intolerance of violence
support of diversity among people
 Mastery of the environment, and a positive, yet realistic, view of one’s world.

Characteristics of people with mental illnesses
Disturbed thoughts, feelings, and behaviors
Functional impairment
Distress and suffering
Variety of symptoms:
Depending on the specific mental disorder, symptoms can include
mood swings, anxiety, depression, hallucinations, delusions, obsessive
thoughts, and suicidal ideation.
Social withdrawal
Changes in daily habits

Common misconception about mental illness
People with mental illness are incompetent
 People with mental illness are usually violent
Taking medication for mental health will alter your personality
Mental illness is incurable and lifelong

Common Signs and Symptoms…
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Disorders of perception
• Perception is the process of becoming aware of one’s environment
through the sense organs
• Extra sensory perception are forms of perception that are not
dependent on the five primary senses e.g. telepathy

• Hallucination and illusions are the commonest disorders of perception
• Hallucination is Perceptions experienced in the absence of an external
stimulus to the corresponding sense organ.
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 Types of hallucination
According to sensory modalities
A. Auditory hallucination hearing voices in the absence of external stimuli
According to complexity
1. Complex music , song , speeches
2. Simple whistle , noises
Auditory hallucination can be
Commanding
Commenting

Praising
Derogatory
Threatening
Second person
Third person
B. Visual hallucination seeing in the absence of external
stimuli
Types of Visual hallucination
1. Autoscopic Visual hallucination
 Seeing one’s own image projected in front
2. Extracampain Visual hallucination
 Seeing out of the field of vision
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3. Lilliputian Visual hallucination(Micropsia)
 Seeing images of persons , animals or objects in their dwarf form
4. Macropsia
 Seeing images of persons , animals or objects in their huge form
 Macropsia and Micropsia are more common in a patient with
substance abuse

C. Olfactory hallucination Sense of smell in the
absence of external stimuli
D. Gustatory hallucination perceive unusual taste
in the absence of external stimuli
E.Tactile(somatic , haptic) hallucination may be
experienced as sensations of being Pricked ,
Touched, or strangled
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 Hallucinations are not restricted to the mentally ill.
 A few of normal persons experience them, especially
 when they are tired and
 in transition from sleeping to waking state

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• Hypnagogic hallucinations
• When going to sleep
• Hypnopompic hallucinations
• On awakening
 Both are normal and non-harmful
Illusion is misinterpretation of the external stimuli
 It is most common in a patient with delusion

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Thought disorders include:
I. Stream of thought
II. Content of thought
III. Form of thought
 Thinking is the capacity to understand, process and
interpret information and understanding of a person to
himself or others

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I. Disorders of stream of thought
Pressure of thought:
 Ideas arise in an unusual variety and abundance and
 Pass through the mind rapidly
Poverty of thought:
 Few thoughts in the person’s mind that lack variety and
 Move through the mind very slowly

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Thought blocking:
 Abrupt and complete emptying of the mind
 That leads to abrupt interruption of conversation

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II. Disorder of Content of thought
 Delusion is a false belief which is firmly held without adequate ground
and contrary to evidences
Themes of delusion
1. Delusion of persecution
o False belief of being followed or persecuted by other people
o Most common delusion

2. Delusion of grandeur
oA belief that one is great and has special gift of power,
wealth, beauty, brilliance, identity or love
3. Delusion of jealousy (infidelity)
oA belief that one’s sexual partner is unfaithful.
oAlso called Othello’s syndrome
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4. Delusion of reference
oA belief that one has been a topic of discussion and everything
happening in the environment refers to him. Idea of reference???
5. Delusion of sin , guilt or worthlessness
oA belief that one has committed unforgivable sin and deserved death

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6. Delusion of errotomania / sexual or amorous delusion
oA belief that someone who is specially a prominent public figure has
fallen in love with the subject
7. Religious delusion
oA belief that one is a prophet and has the mission of preaching and
saving the world

8. Delusion of hypochondriasis
oAre false beliefs about having an illness.
9. Delusion of nihilism /delusions of negation
oA delusional belief that the patient has died or no
longer exists or that the world has ended or is no
longer real.
10. Delusion of poverty
oA belief that one is penniless(poor), stupid or ugly
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Bizarre Vs. non-bizarre delusion
 Bizarre delusion
False belief that can not potentially happen in reality
Example -invaders from space have implanted electrodes in a person's
brain
 Non-bizarre delusion
Content is usually within the range of possibility

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III. Disorders of form of thought
1. Flight of idea
 Thoughts and conversation move quickly from one topic to another,
 One train of thought is not completed before the next is taken up.
2. Clang association
 Speaking words that have similar sound

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3. Loosening of association (Derailment):
 Lack of logical connection between train of thoughts,
 Which is unexplainable by the process described under flight of ideas,
 Person’s conversation becomes muddled and hard to follow

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4. Perseveration
 Repeating the same responses to consecutive questions
5. Circumstantiality
 Over inclusion of unnecessary details in speech
 Goal of thinking is not completely lost

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6. Tangentiality:
 Patient always seems to get near to the matter in hand
but never reaches it.
 Goal of thinking is lost

7. Word salad(Incoherence)
 Speaking a collection of words that do not make up a
statement. Example
“Birds are...trees green...then I said....now
the destroyer...this was a nice...almost....”
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8. Verbigeration
 Meaningless and stereotyped repetition of words or phrases
 Common in schizophrenia

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Disorders of speech
 Disorders of speech are seen in a broad range of psychiatric and
neurological disorders.
 They include stuttering, mutism, neologisms and aphasia.

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1. Stuttering
 Talk with continued involuntary repetition of sounds, especially initial
consonants
 May only become noticeable when the person is anxious for any
reason

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2. Mutism
 Complete loss of speech
 May occur in hysteria , depression, schizophrenia or organic brain
disorders.

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3. Neologisms
 Usage of words or phrases invented by the person himself or herself
4. Aphasia
 Inability to comprehend language

Disorders of mood
Mood is sustained or subjective or internal feeling that covers the
person’s life
Affect is emotional expression or the reflection of feeling or mood
1. Depression: feeling miserable ,unhappy , sad , gloomy , pessimism ,
losing hope
2. Elation: cheerfulness , happiness , optimism
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3. Euphoria: elation with feeling of omnipotence , over activity,
talkativeness , laughing loudly ,over sociability disinhibited behavior
4. Anxiety: Feeling of apprehension due to anticipation of danger
which may be internal or external
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5. Fear: anxiety due to consciously recognized and realistic danger
6. Lability: frequent change of emotion/Excessively rapid and abrupt
emotional change
7. Apathy: lack of interest , unresponsiveness , withdrawal

8. Anhedonia: failure to experience pleasure
9. Agitation: feeling of restlessness , failure to sit or stand still , pacing
the ground and wringing hands
10. Constricted: When the total normal variation of emotion is reduced
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11. Blunting:a severe reduction in the intensity of feeling
12. Flattening: absence of emotion or feeling
13. Incongruity or inappropriateness: emotional reaction contrary to
the situation

Disorders of motor behavior
Motor behavior is the aspect of the psyche includes motivation ,
drive , instinct , movement , posture
1. Tics
 Is an irregular repeated movement that involves several muscles e.g.
touching one’s hair , pricking one’s nose ,clearing the throat
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2. Mannerism
 Regular and repeated movement that appears to have functional
significance e.g. saluting
3. Stereotypy
 Irregular and repeated movement that appears to have no functional
significance e.g. rocking to and fro

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3. Negativism
 Doing the opposite of what a person is told to do
5. Rigidity
 Assumption of a position and resistance of moving the part

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6. Posturing
 Assumption of a bizarre posture and maintaining it for long duration
e.g. raising the head above the pillow , standing on one leg
7. Echolalia
 Repetition of words or parts of sentences that are spoken by others.

8. Cataplexy
 Temporary sudden loss of muscle tone, causing
weakness and immobilization
9. Ambitendence
 Having contradicting/opposing movements at the
same time
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10. Catalepsy
 A condition in which persons maintain the body position into which
they are placed. Also called waxy flexibility
11. Echopraxia
 Imitating movement of another person
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Chapter TWO
Mental health assessment

Learning objectives
Upon accomplishing this session, the students will be able to:
• Explain the interview technique in psychiatry
• Describe the components of psychiatric assessment

Introduction to Psychiatric Assessment
• Psychiatric History
Not very different from history in general medical practice
More emphasis given to this part as there are few special
investigations to reach at the diagnosis
It may sometimes be difficult to obtain adequate history from the
patient
• Collateral history (Corroboration)
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Interview technique
• Interview room that provides privacy & no interruption.
• Seats:- arranged diagonally and of equal level.
• Both the health professional and the patient should have access to exits
• Length of the interview is usually 30min to one hour (average 50min)
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Interview Con’d
• Welcome the pt. in a calmly and politely
• Introduce yourselves by name
• Explain in a simple language: the purpose of the interview & level of
confidentiality he/she can expect
• Begin with open ended questions
• Let the pt speak about the problems for the first few minutes without
interrupting
• Observe the patient’s behavior
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Interview Con’d
• Ask specific closed questions later
• Don’t impose your own moral values, beliefs etc.
• Ask regarding substance, suicide
• Ask the pt if s/he has something to say before wrapping up the interview
• Explain in plain language the clinical problem & the treatment plan
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Interview Con’d
Important interview skills
• Maintaining good eye contact with the patient
• Adopting a relaxed posture
• Using facilitator utterances and gestures
• Detecting verbal and non verbal cues
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Interview Con’d
AVOID:
• Premature false reassurance of the patient
• Normalizing the patient’s experience
• Impatience during the interview
• Appearing inattentive to your patient during the
interview
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Components of Psychiatric Assessment
1. History
2. Mental state Examination
3. Physical Examination
4. Case Summary
5. DSM-V Diagnosis
6. Investigations
7. Management
8. Prognosis/suicide risk assessment
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1. History
IDENTIFICATION
• Name
• Age
• Sex
• Address
• Occupation
• Religion
• Education
• Marital Status
• Previous psychiatric
admissions
• Living circumstance
• Who brought the patient
• Source of the history
• Source of referral and
reasons for referral
• reliability
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History Con’d
• Chief Complaints:- the main reason for visiting at
this time should be noted in the patient’s own words
• Examples: “I am thinking to kill myself”
“I am not sick”
• Write the duration of the Chief Complaint
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History Con’d
• HPI:- elaborate the C.C in terms of mode of onset,
time of onset, course, aggravating and alleviating
factors.
• What precipitated the current symptoms
• Effect of illness on work, relationship, academic life
• Mood(low or high)
• Excessive worry/history of trauma
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History Con’d
• Psychosis(delusions or hallucinations)
• Use of psychoactive substances(Alcohol,Chat,..)
• Look for any Suicidal or Homicidal ideas!!!
• Any treatments sought and the effect of such treatment on the
symptoms
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History Con’d
• Past Psychiatric History
Psychiatric admissions, treatments, suicidal attempts,
aggression, substance abuse
• Past medical History
Major medical and surgical illnesses, Medications
allergies
• Family History
Mental illness, Substance use, suicide, epilepsy,
aggression etc.
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History Con’d
Personal History
• Helps to understand the patient as a person
• It is usually divided into:
 Perinatal
 Infancy & Early childhood
 Middle childhood
 Puberty & Adolescence
 Adulthood
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History Con’d
Perinatal
• Was the child wanted?
• Pregnancy and delivery
• Maternal emotional and physical state at the time of the patient's birth
• Maternal alcohol or substance abuse during her pregnancy
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History Con’d
Early Childhood
• Infant and mother relationship
• Problems with feeding and sleep
• Significant milestones
Standing/walking
First words/two-word sentences
Bowel and bladder control
• Unusual behaviors (e.g., head-banging)
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History Con’d
Middle Childhood:
• Discipline & punishments
• Early school experiences
Tolerance to separation
Earliest friendships
Aggression, phobias, bed-wetting, etc.
• Major illnesses
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History Con’d
Puberty & Adolescence:
• Age of menarche, the circumstance of its onset, and preparations
(females)
• Growth of pubic and axillary hair (males)
• Early experiences in dating, first sexual experiences, and any
confusion or discomfort about sexual orientation
• Experimentation with drugs (alcohol, illicit drugs…)
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History Con’d
Adulthood
• Interference of psychiatric illness with the capacity for sustained
productive work.
• What patients do with their free time
• Financial status and living arrangements
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History Con’d
• Premorbid personality (traits)
How do you describe yourselves as a person?
How do you think others describe you as a person?
• Military History: behavior problems, premature discharge, etc.
• Forensic History: legal difficulties, imprisonment
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2.Mental state examination
 Analogous to the physical examination in physical
medicine
General Description
Appearance: the pt’s appearance & overall physical
impression as reflected by posture, gait, clothing, eye
contact,etc
Behavior & Psychomotor Activity: quantitative &
qualitative aspects of pt’s motor behavior. Agitation,
rigidity, echopraxia, hyperactivity, hypoactivity…
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Mental state con’d
Attitude: pt’s attitude towards the examiner can be described as
cooperative, hostile, indifferent, evasive,
suspicious,friendly,overfamiliar,etc.
Mood:- pervasive and sustained emotional state as described by the
patient (Subjective)
• Mood is recorded in verbatim “I feel cheerful”, “I am feeling
anxious”, “I feel good/ normal”
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Affect:- the pt’s present emotional state as inferred
from the pt’s facial expression.
 Intensity & range: normal, constricted, blunted, or
flat.
 Quality: smiling, anxious, tearful, apathetic, angry,
etc.
 Stability: stable, labile
 Appropriateness:- assessed in the context of the
subject the patient is discussing
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Speech: describes the physical production of speech,
not the ideas being conveyed.
• Quantity: scanty, talkative, copious, mute
• Rate: rapid, slow, pressured, hesitant, normal rate
• Spontaneity: spontaneous Vs. non-spontaneous
• Volume: low, high/ loud
• Quality: prosodic, monotonous, slurred, stuttering etc.
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 Thought form(process) refers to the way in which ideas are linked, not
the ideas themselves.
 Normally thoughts are logically associated and goal directed.
Examples: flight of ideas, clang association, tangentiality,
circumstantiality.
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Thought Content refers to what a person is actually
thinking about: ideas, beliefs, preoccupations,
obsessions, suicidality, homicidality
Perception:- abnormalities in the various modalities of
sensations through sense organs. E.g. hallucinations,
illusions
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Cognitive Functions
Alertness: describes the degree of wakefulness.
• Alert, somnolence, lethargy, stupor, coma
Orientation: is conventionally described in three
spheres: time, place, and person.
Concentration: describes the ability to sustain attention
over time.
• Formal assessment: serial 7s; reciting months of the
year backwards; spell “WORLD” backwards
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Memory: the ability to register, store and retrieve information.
• Immediate/ registration: repeat random numbers after the examiner
e.g. 5, 3, 7, 1, 4 (also called digit span)
• Recent :- the ability to remember information registered after five
minutes.
• Remote: Asking place of birth, date of birth…
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Fund of knowledge: Questions about current events, key
geographical facts (what ocean lies between South America and
Africa?) can be used.
Abstract reasoning: describes the ability to mentally shift back and
forth between general concepts and specific examples. E.g. Proverbs,
similarities (Orange and Mango), etc.
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Insight: Patient’s degree of awareness and understanding about being
ill.
Judgment: ability to make rational decisions, understand
consequences of one’s behavior
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3. Physical examination
• Vital signs
• Complete physical examination for inpatients and
patients with medical complaints
4. Case summary
5. DSM-Diagnosis
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6. Investigations –E.g. baseline investigations
like TFT,CBC,LFT,RFT etc…
7. Management- E.g. admission, psychotherapy,
drugs
8.Prognosis/Suicide risk assessment
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• Suicide is the act of self destruction
• Most mental illness result in suicide
• Assessment of suicide risk can be carried out
through an acronym SAD PERSONS Scale
• The score is calculated from ten yes/no questions,
with one point for each affirmative answer:
• S: Male sex
• A: Older age
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• D: Depression
• P: Previous attempt
• E: Ethanol abuse
• R: Rational thinking loss
• S: Social supports lacking
• O: Organized plan
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• N: No spouse
• S: Sickness
 This score is then mapped onto a risk assessment
scale as follows:
0-2 mild
3-6 moderate
7-10 Severe
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Deribachew H/mariam(Asst. professor)
Department of nursing, Wolkite University
Chapter 4: Therapeutic Communication
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Communication
• Is the fundamental element of the nurse-client relationship
• Is the process of transmitting thoughts, feelings, facts, and other
information, includes verbal and nonverbal behavior
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Communication
• Is the process of transmitting message
• Includes verbal and nonverbal behavior
• Has the following components
oSender
oMessage
oChannel
oReceiver
oFeedback
11/30/2024 107

Factors Influencing Communication
• Perception
• Perception is a person’s sensing and
understanding of the world
• “Perceptions are influenced by our culture,
socialization, education, and experience”
• Cultural Context
• Space and Distance
• Proxemics is the study of distance zones between
people during communication
• Each person has an invisible buffer zone or
personal space.
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• Time
• The study of the effects of time on the communication process is
referred to as chromatics
• Levels of Communication
• Intrapersonal Level
• Interpersonal Level
Is the process that occurs between two people
11/30/2024 109

• Group Communication Level
occurs between three or more people
The study of the events that take place during group
interaction is called group dynamics
MODES OF COMMUNICATION
• Verbal Messages
• Nonverbal Messages
• Facial Expression
• Posture
• Gestures
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Therapeutic Communication
• Is the use of communication for the purpose of
creating a beneficial outcome for the client.
• It facilitates the establishment of the nurse-client
relationship
• It forms a connection between client and nurse
Principles of Therapeutic Interaction
• Plan to interview at an appropriate time
• Assure privacy
• Establish guidelines for the therapeutic interaction
• Provide for comfort during the interaction
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Cont…
• Accept the client exactly as is
• Encourage spontaneity
• Focus on the client and on the leads and clues
presented
• Encourage the expression of feelings
• Be aware of your own feelings during the interaction
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THE GOALS OF THERAPEUTIC
COMMUNICATION
Establish rapport with the client by being
empathetic,
genuine, caring, and unconditionally accepting of
the
client regardless of his or her behavior or beliefs.
Actively listen to the client to identify the issues
of
concern and to formulate a client-centered goal
for the interaction.

THE GOALS OF THERAPEUTIC COMMUNICATION
Gain an in-depth understanding of the client’s
perception of the issue, and foster empathy in the
nurse–client relationship.
 Explore the client’s thoughts and feelings.
Facilitate the client’s expression of thoughts and
feelings.
Guide the client to develop new skills in problem
solving.
 Promote the client’s evaluation of solutions.

Advantage of Therapeutic communication
Establish a therapeutic nurse–client relationship.
 Identify the most important client concern at that
moment(the client-centered goal).
Assess the client’s perception of the problem as it
unfolds.
Facilitate the client’s expression of emotions.
Teach the client and family necessary self-care skills.
 Recognize the client’s needs.
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Advantage…
 Implement interventions designed to address
the
client’s needs.
 Guide the client toward identifying a plan of
action to a
satisfying and socially acceptable resolution.
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Skills that demonstrate listening
• Reflecting.
• Acknowledging.
• Summarizing.
• Empathizing.
• Paraphrasing.
• Checking.
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BARRIERS TO THERAPEUTIC INTERACTION
• Language Differences
• Cultural Differences
• Gender
• Developmental Level
• Knowledge Differences
• Emotions
• Daydreaming
• Health Status
• Use of Healthcare Jargon
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