Description: It includes both verbal and nonverbal interactions that involve facial expressions, as well as body language, among the nurse, clients, colleagues, and health care providers.
What is it?
Communication is the primary tool used in the delivery of psychiatric nursing care and all nurse–client interactions. Face-to-face: Face-to-face communication involves both the verbal and nonverbal expression of the sender’s thoughts or feelings.
Types of Communication
Verbal: Voice inflection, rate of speech, and words convey cognitive and affective messages. Non-verbal: Nonverbal messages are communicated via body language, eye movements, facial expressions, and gestures.
What are they?
Power of nonverbal messages?
Messages are conveyed by the sender to the recipient through sight, sound, touch, and smell.
Nonverbal messages can be very powerful; for example, wrinkling your nose at a malodorous client conveys a negative and rejecting message (
Acknowledgement: Recognizing the client’s opinions and statements without imposing your own values and judgment. Clarifying:The process of making sure you have understood the meaning of what was said. Confrontation: Should be used judiciously, calling attention to inconsistent behavior. Focusing: Assisting the client to explore a specific topic, which may include sharing perceptions and theme identification.
Communication Techniques pt.2
Open Ended Questions?
Information giving: Feedback about client’s observed behavior.
Open-ended questions: Questions that require more than a yes or no response.
Reflecting/restating: Paraphrasing or repeating what the client has said (be careful not to overuse; client will feel as though you are not listening)
Silence: Can be therapeutic or can be used to control interaction; use carefully with paranoid client; may be misinterpreted or could be used to support paranoid ideation Suggesting: Offering alternatives, such as, “Have you ever considered …?” (THIS IS DIFFRENT FROM ADVICE.)
Coping Styles (Defense Mechanisms)
Description: Coping styles are automatic psychological processes that protect theindividual against anxiety and from awareness of internal and external dangers and stressors.
Awareness: The individual may or may not be aware of these processes.
Defense Mechanisms pt.1
Denial: Unconscious failure to acknowledge an event, thought, or feeling that is too painful for conscious awareness
- A woman diagnosed with cancer tells her family all the ests were negative.
Displacement: The transference of feelings to another person or object.
- After being scolded by his supervisor at work, a mancomes home and kicks the dog for barking.
Identification: Attempt to be like someone or emulate the personality, traits, or behaviors of another person.
- A teenage boy dresses and behaves like his favorite singer.
Intellectualization: Using reason to avoid emotional conflicts.
- The wife of a substance abuser describes in detail the dynamics of enabling behavior yet continues to call her husband’s workplace to report his Monday-morning absences as an illness.
Defense Mechanisms pt.2
Reaction formation? Ex?
Isolation: Separation of an unacceptable feeling, idea, or impulse fromone’s thought process.
- A nurse working in an emergency room is able to care for the seriously injured by isolating or separating thenurse’s feelings and emotions related to the clients’ pain, injuries, or death.
Passive-aggression: Indirectly expressing aggression toward others; a facade of overt compliance masks covert resentment.
- An employee arrives late to a meeting and disruptsothers after being reminded of the meeting earlier that day and promising to be on time.
Projection: Attributing one’s own thoughts or impulses to another person.
- A student who has sexual feelings toward a teacher tells friends the teacher is “coming on to the student.”
Rationalization: Offering an acceptable, logical explanation to make unacceptable feelings and behavior acceptable.
- A student who did not do well in a course says it was poorly taught and the course content was not important anyway.
Reaction- formation: Development of conscious attitudes and behaviors that are the opposite of what is really felt.
- A person who dislikes animals does volunteer work for the Humane Society.
Defense pt 3
Description: Psychiatric and mental health treatment modalities used to promote mental health.
Diffrent Types: Milieu therapy, Behavior modification, Family therapy, Crisis intervention, Cognitive therapy, Electroconvulsive therapy (ECT), Group intervention.
What is it?
Where is it used?
1. The planned use of people, resources, and activities in the environmentto assist in improving interpersonal skills, social functioning, andperforming the activities of daily living (ADLs), as well as safety and protection for all clients.
2. Milieu therapy occurs in inpatient and outpatient settings by providing clients an opportunity to actively participate in treatment, decrease social isolation, encourage appropriate social behaviors, and educate clients in basic living skills.
3. Clients are provided a safe place to learn and adopt mature and responsible behavior through staff limit setting and client responses to maladaptive social responses.
4. Limit setting is a component that requires consistent setting of appropriate limits by all staff, nurses, physicians, and health care workers to work with one another via shared communication to maintain and reestablish limit setting.
Goal of ?
What is it?
Based on what?
The focus of it?
The therapists role?
Congreunt and incongruent communication patterns?
The overall goal?
1. This form of group therapy identifies the entire family as the client.
2. It is based on the concept of the family as a system of interrelated parts
forming a whole.
3. The focus is on the patterns of interaction within the family, not on any
4. The therapist assists the family in identifying the roles assigned to each
member based on family rules.
5. Congruent and incongruent communication patterns and behaviors
6. Life scripts (living out parents’ dreams) and self-fulfilling prophecies
(unconsciously following what one thinks should happen, therefore
setting it up to happen) are identified.
7. The goal is to decrease family conflict and anxiety and to develop
appropriate role relationships.
What make a phrase useful when communicating?
Keep focus on patient
Be aware of your own anxiety level.
Tell me about...
Id like to discuss what your thinking...
What are your thoughts...?
Are you saying that...?
What are you feeling...?
It seems as if...?
What are they?
Never us these especially on the HESI!
youll have to...
if it were me, id....
why dont you...
i think you...
its the policy of the unit...
just a second...?
When does it form?
This therapy is directed at?
iNDIVIDUALS STATE OF MIND?
If in a panic state?
identify? x 2
1. A crisis may develop when previously learned coping mechanisms are
ineffective in dealing with the current problem.
2. This form of therapy is directed at the resolution of an immediate
crisis, which the individual is unable to handle alone.
3. The individual is usually in a state of disequilibrium.
4. If a client is in a panic state as a result of the disorganization, be very
5. Focus on the problem, not the cause.
6. Identify support systems.
7. Identify past-coping patterns used in other stressful situations.
8. The goal is to return the individual to precrisis level of functioning.
9. Crisis intervention is usually limited to 6 weeks.
What is it?
The therapist helps how?
Long term or short term? (how long?)
What is involved?
1. It is directed at replacing a client’s irrational beliefs and distorted
2. It is focused, problem-solving therapy.
3. The therapist and client work together to identify and solve problems
and overcome difficulties.
4. It is short-term therapy of 2 to 3 months’ duration.
5. It involves cognitive restructuring.
Electroconvulsive therapy (ECT)
What is involved?
Who is it used for? x 2
5 Nursing care things to do before ECT?
Nursing Care After ECT?
Common complaints after ECT?
1. ECT involves the use of electrically induced seizures for psychiatricpurposes. It is used with severely depressed clients who fail to respond to antidepressant medications and therapy. It may be used with extremely suicidal clients because 2 weeks are needed for antidepressants to take effect.
2. Nursing care before ECT
a. Prepare client by teaching what the treatment involves.
b. Avoid using the word “shock” when discussing the treatment with client and family.
c. An anticholinergic (e.g., atropine sulfate) is usually given 30 minutes before treatment to dry oral secretions.
d. A quick-acting muscle relaxant (e.g., succinylcholine [Anectine]) or a general anesthetic agent is given to the client before the ECT. This helps to relax the client, thus preventing bone or muscle damage.
e. Provide an emergency cart, suction equipment, and oxygen available in the room.
3. Nursing care after ECT
a. Maintain patent airway; the client is in an unconscious state immediately after ECT.
b. Check vital signs every 15 minutes until the client is alert.
c. Reorient the client after ECT (mild confusion is likely upon awakening, and short-term memory impairment may occur, as is usual when any anesthetic is administered).
d. The client may or may not complain after ECT. However, common complaints that often occur after anesthesia is administered may include
1. Modest Headache
2. Mild Muscle soreness
3. Moderate Nausea
4. Retrograde amnesia
HESI HINT: Vomiting by an unconscious post-ECT client can lead to aspiration. Remember to maintain a patent airway in these clients.
Used with who?
Diffrent types of groups?
The phases in groups?
What does an average group look like?
1. This process is used with two or more clients who develop interactive
relationships and share at least one common goal or issue.
2. The types of groups are as follows:
a. The group may be closed (set group) or open (new
members may join).
b. The group may be small or large (>10 members).
c. There are many types of groups (psychoeducation,
supportive therapy, psychotherapy, self-help).
d. Common nurse-led intervention groups include those
that focus on medications, symptom management, anger
management, and self-care.
3. The phases in groups are as follows:
a. The initial, or orientation, phase is characterized by:
1. High anxiety
2. Superficial interactions
3. Testing the therapist to see if therapist can
b. The middle, or working, phase is characterized by:
1. Problem identification
2. The beginning of problem solving
3. The beginning of the group sense of “we”
c. The termination phase is characterized by:
1. Evaluation of the experience
2. The expression of feelings ranging from
anger to joy
4. The advantages of groups are:
a. The development of socializing techniques
b. The opportunity to try new behaviors
c. The promotion of a feeling of universality (i.e., not being
alone with problems)
d. The opportunity for feedback from the group, which may
correct distorted perceptions
e. The opportunity for clients to look at alternative ways of
analyzing and dealing with problems
CH.7 Psychiatric Nursing
Therapentic Communication ,Coping Styles, Treatment Modalities
Cards 1- 21 [Week 1]