Therapeutic relationship - between a nurse and a client
transference - the way a client feels about you
countertransference - the way a nurse feels about a client superficial involvement - pleasant, casual, saying hello companionship - sharing common activities friendship - mutual support and enjoyment of each other romantic love - friendship with shared sexuality functional relationship - commitment, marriage, partnership Hallucinations - respond to senses, inappropriate responses illusion - misconception of reality delusion - fixed false belief Goal of psychotherapy - to help client gain insight Psychiatric Tech - can only pass meds inPsych PHD, MD, MFT, NP, LSW - Can conduct therapy Why - the one question you never ask Therapeutic boundary - there is no reason to maintain a relationship outside of the hospital with clients Pre-interaction phase individual therapy - obtaining info from the chart Orientation/Introduction phase individual therapy - establish goals, build rapport and establish a plan Working Phase Individual therapy - maintain trust promote insight, longest phase Termination phase of individual therapy - determine progress to goal. plan for continuation of care and feelings regarding termination Presenting problem - chief concern, all events up to current encounter most important parts of medical history - heart, lungs, diabetes, drug withdrawal 3 types of genetic psych diseases - depression, bipolar, schizophrenia Behavior - hyper/hypo LOC - should be awake and alert orientation - name, place, date, situation
memory - 3 unrelated objects
mood - "how are you feeling today?" affect - appropriate/inappropriate is expression congruent/incongruent associations - tight/loose going off on a tangent...circumstantial if they come back to the correct answer impulse - good, fair, poor judgement - observe client on unit, what would you do if you found a stamped envelope abstract vs concrete - use a proverb to record an answer triangles - parent ask both parents permission for the same thing scapegoat - target of projection of blame family roles - positions defined by the family power structure - adults usually have the power pseudomutuality - regard pseudohostility - conflict self fulfilling prophecy - an idea or expectation acted out unconciously life script - decided not by fate but by experiences early in life schism - each parent underminds the other and children are forced to pick sides shew - one mate is dysfunctional , lack of partnership enmeshment - diffuse boundaries, the blending of feelings disengagement - abandonment, oblivious to effects of their actions on others reframing - to put problem behavior into positive light paradoxical intervention - engage in behavior they are trying to change catharsis - open expression of feelings (beneficial) high risk patients - one to ones and 15 min checks assertion - expression of self without fear of disapproval from others, taking care of oneself but not at the expense of others passive - avoiding conflict at any cost, even at the expense of one's own happiness aggressive - getting what one wants without considering anyone elses feelings
PREINTERACTION PHASE - OCCURS BEFORE MEETING THE PATIENT
ORIENTATION PHASE - WHEN THE NURSE AND THE PATIENT MEET AND GET TO KNOW EACH OTHER WORKING PHASE - WHEN THE NURSE AND THE PATIENT WORK TOGETHER TO SOLVE PROBLEMS AND ACCOMPLISH GOALS. KINESICS - INVOLVES BODY MOVEMENTS, SUCH AS GESTURES, POSTURE AND BODY CUES, EYE MOVEMENTS AND FACIAL EXPRESSIONS, AND TONE AND RATE OF SPEECH. IT REVEALS INNER FEELINGS, SUCH AS HAPPINESS, SADNESS, FEAR, OR ANGER EXPRESSED THROUGH NON VERBAL LANGUAGE. PROXEMICS - PHYSICAL CLOSENESS) TOLERATED BY MOST PEOPLE. HOW NEAR OR FAR WE PLACE OURSELVES FROM OTHERS TRANSMITS STRONG MESSAGES. EX.MAY BE AFFECTED BY ODORS, SUCH AS POOR PHYSICAL OR DENTAL HYGEIENE, DECAY. PATIENTS MAY BE UPSET BY SMELLS IN THE MEDICAL SETTING (DISINFECTANTS & MEDICAL SCENTS). SYMPATHY - WHEN YOU FEEL PITY AND COMPASSION FOR THE FEELINGS OF ANOTHER EMPATHY - IDENTIFYING WITH AND UNDERSTANDING ANOTHER PERSON ON A DEEPER LEVEL. THERAPEUTIC TOUCH - USING WARM AND CARING HAND IN HEALTHCARE SETTING. USING TOUCH MEANS SHOWING CONCERN AND COMPASSION. CLICHE STATEMENTS - LOOK ON THE BRIGHT SIDE." "IT COULD HAVE BEEN WORSE."THESE STATEMENTS MAKES PATIENTS FEEL THEY ARE NOT VALUED AS INDIVIDUALS. CONTRACTICTING - IT COULD NOT HAVE HAPPENED THAT WAY." "ARE YOU SURE OF WHAT YOU ARE SAYING?" THIS IMPLIES THAT PATIENT IS NOT BEING TRUTHFUL. CRITIZING - YOU KNOW YOU SHOULD HAVE CALLED US AS SOON AS THIS HAPPENED." MAKES PATIENT FEEL GUILTY AND MAY BUILD A DEFENSIVE BARRIER. RIDICULING - "THAT WAS A DUMB THING TO DO." THIS STOPS COMMUNICATION IMMEDIATELY. SARCASM - "OH, GREAT!" "THIS IS JUST WHAT YOU NEED." THIS STATES ONE THING BUT IMPLIES THE OPPOSITE INDIFFERENCE - PATIENTS FEEL THAT YOU DO NOT VALUE THEIR CONCERNS IF THEY SUSPECT YOU ARE NOT FOCUSED ON COMMUNICATION. WATCH YOUR NON VERBAL CUES, GLANCING AT YOUR WATCH, YAWNING, OR STARING OFFI IN THE DISTANCE WHILE THE PATIENT IS TALKING. LECTURING - "YOU KNOW YOU SHOULDN'T BE SMOKING." "WHY AREN'T YOU WATCHING YOUR DIET?"
IDIOM - A WELL KNOWN PHRASE OR SENtence WITH A MEANING COMPLETELY
DIFFERENT FROM its LITERAL TRANSLATION. THESE INCLUDE SAYINGS SUCH AS, "LET'S PLAY IT BY EAR", OR "HE WAS BURNING UP WITH FEVER." THESE DON'T TRANSLATE WELL WITH PATIENTS ESPECIALLY IF ENGLISH IS THEIR SECOND LANGUAGE. RAPPORT - A RELATIONSHIP OF TRUST AND DUNDERSTANING FOR FUTURE INTERACTIONS WITH PATIENTS. COLLOGQUIALISMS - SLANG (REGIONAL LANGUAGE OR TERMS) ARE IMPROPER TO USE IN A HEALTH CARE SETTING. PARALANGUAGE - NON VERBAL QUES, SOUNDS INCLUDE SIGHING, HUMMING, CHUCKLING, OR LAUGHING. INCONGURENCE - INCONSISTENT NONVERBAL CUES (BREAKDOWN IN COMMUNICATION). MATRIARCHAL - OLDEST FEMALE MAKES ALL DECISIONS PATRIARCHAL - IT IS THE OLDEST MALE WHO MAKES ALL THE DECISIONS DYSPHASIA - LOSS OF A FEW WORDS. APHASIA - TOTAL INABILITY TO SPEAK AUTONOMY - IS BEING SELF DIRECTED AND INDEPENDENT IN ACCOMPLOSHING GOALS AND ADVOCATING FOR OTHERS. CARING - A UNIVERSAL PHENOMENON THAT INFLUENCES THE WAY WE THINK, FEEL AND BEHAVE. CHANNELS - ARE MEANS OF CONVEYING AND RECEIVING MESSAGES THROUGH VISUAL, AUDITORY, AND TACTILE SENSES. CONDUCTIVE - HARDENED CERUMENT (EAR WAX). OR OSTOSCLEROISIS (HARDENING OF THE STRUCTURES OF THE EAR). IN MOST CASES IT'S CORRECTABLE. SENSORINEURAL - INVOLVES THE OTIC NERVE AND SOUND TRANSMISSION TOE THE AUDITORY (HEARING) CENTERS OF THE BRAIN. IT'S A NERVE IMPAIRMENT, CAN USE COCHLEAR IMPLANT THAT TRANSMITS SOUND PAST THE OTIC NERVE TO THE BRAIN. MIXED DEAFNESS - HARD TO DIAGNOSE AND TREAT. COMMON IN OLDER PATIENTS AN IS THEN CALLED PRESBYCUSIS (OLD HEARING). HEARING AIDS MAY NOT HELP; RAISING VOICE WILL MAKE IT WORSE. ANACUSIS - TOTAL LOSS OF HEARING. MADELEINE LEININGER THEORY - STUDIED CARING FROM A TRANSCULTURAL PERSPECTIVE, CARING IS AN ESSENTIAL HUMAN NEED. CARING HELPS AN
INDIVIDUAL OR GROUP IMPROVE A HUMAN CONDITION. CARING HELPS TO
PROTECT, DEVELOP, NUTURE, AND SUSTAIN PEOPLE. JEAN WATSON THEORY - (TRANSPERSONAL CARING) PROMOTES HEALING AND WHOLENESS, REJECTS THE DISEASE ORIENTATION TO HEALTH CARE, PLACES CARE BEFORE CURE. EMPHASIZES THE NURSE-PATIENT RELATIONSHIP. KRISTEN SWANSON THEORY - A COMPOSITE OF THREE STUDIES IN A PERINATAL UNIT. DEFINES CARING AS A NURTURING WAY OF RELATING TO A VALUED OTHER, TOWARD WHOM ONE FEELS A PERSONAL SENSE OF COMMITMENT AND RESPONSIBILITY. COMMUNICATION - IS THE MEANS TO ESTABLISH HELPING TRUSTING RELATIONSHIPS. INTRAPERSONAL - OCCURS WITHIN AN INDIVIDUAL INTERPERSONAL - ONE TO ONE INTERACTION BETWEEN TWO PEOPLE. TRANSPERSONAL - INTERACTION WITHIN A PERSON'S SPIRITUAL DOMAIN. SMALL GROUP - INTERACTIONS WITHIN A SMALL NUMBER OF PEOPLE. PUBLIC - INTERACTION WITH AN AUDIENCE REFERENT - MOTIVATES ONE TO COMMUNICATE WITH ANOTHER SENDER AND RECEIVER - ONE WHO ENCODES AND ONE WHO DECODES THE MESSAGE. MESSAGE - CONTENT OF THE COMMUNICATION FEEDBACK - INIDICATES WHETHER THE RECEIVER UNDERSTOOD THE MEANING OF THE SENDER'S MESSAGE. INTERPERSONAL VARIABLES - FACTORS WITHIN BOTH THE SENDER AND THE RECEIVER THAT INFLUENCE COMMUNICATION. ENVIROMENT - THE SETTING FOR SENDER-RECEIVER INTERACTIONS. VOCABULARY - DENOTATIVE AND CONNOTATIVE MEANING. INTONATION - TONE OF VOICE PACING - THINKING BEFORE SPEAKING AND DEVELOPING AWARENESS OF THE RYTHYM OF YOUR SPEECH. NON VERBAL COMMUNICATION - PERSONAL APPEARANCE, POSTURE AND GAIT, FACIAL EXPRESSIONS, EYE CONTACT, GESTURES, SOUNDS. SYMBOLIC - THE VERBAL AND NONVEWRBAL SYMBOLISM USED BY OTHERS TO CONVEY MEANING
METACOMMUNICATION - A BROAD TERM THAT REFERS TO ALL FACTORS THAT
INFLUENCE COMMUNICATION. TERMINATION PHASE - OCCURS AT THE END OF A RELATIONSHIP. ASSESSMENT - THROUGH THE PATIENT'S EYES GATHER INFORMATION SYNTHESIZE APPLY CRITICAL THINKING. PHYSICAL /EMOTIONAL/DEVELOPMENTAL/SOCIOCULTURAL FACTORS PLANNING - GOALS AND OUTCOMES SPECIFIC AND MEASURABLE, SETTING OF PRIORITIES/TEAM WORK AND COLLABORATION. THERAPEUTIC COMMUNICATION - SPECIFIC RESPONES THAT ENCOURAGE THE EXPRESSION OF FEELINGS AND IDEAS AND CONVEY ACCEPTANCE AND RESPECT. ACTIVE LISTENING - MEANS BEING ATTENTIVE TO WHAT A PATIENT IS SAYING BOTH VERBALLY AND NONVERBALLY. SOLER - SIT FACING THE PATIENT:OBSERVE AN OPEN POSTURE/LEAN TOWARD PATIENT/ESTABLISH AND MAINTAIN EYE CONTACT/RELAX EVALUATION - PATIENT OUTCOMES, NURSES AND PATIENTS NEED TO EVALUATE TO DETERMINE WHICH STRATEGIES OR INTERVENTIONS WERE EFFECTIVE. IF EXPECTED OUTCOMES ARE NOT MET, THE PLAN OF CARE NEEDS TO BE MODIFIED. INTIMATE ZONE - 0-18 INCHES PERSONAL ZONE - 18 INCHES TO 4 FEET SOCIAL ZONE - 4 TO 12 FEET NARRATIVE INTERACTION - WHEN A PATIENT SHARES PERSONAL STORIES. HANDS OFF - WHEN A PATIENT MOVES FROM ONE NURSING HOME TO ANOTHER OR IF PATIENT CHANGES FROM ONE DOCTOR TO ANOTHER. CLARITY AND BREVITY - SIMPLE, BRIEF, AND DIRECT CONNOTATIVE MEANING - INTERPRETATION OF A WORD'S MEAING INFLUENCED BY THE THOUGHS AND FELLINGS THAT PEOPLE HAVE ABOUT THE WORD. TIMING - WHEN A PATIENT EXPRESSES AN INTEREST IN COMMUNICATING.