Chapter 9: Therapeutic Relationships Flashcards
Which of the following actions best represents the basis or foundation of all other psychiatric nursing care?
a. Nursing assessment is an important constituent of nursing care, but the foundation of care is the therapeutic relationship.
b. Interventions are an important constituent of nursing care, but the foundation of care is the therapeutic relationship.
c. The basis of psychiatric nursing care is fundamentally within the therapeutic relationship, and spending time with a withdrawn patient—even communicating presence in silence—best represents the foundational aspects of psychiatric nursing care.
d. Interdisciplinary practice is an important constituent of nursing care, but the foundation of care is the therapeutic relationship.
c. The basis of psychiatric nursing care is fundamentally within the therapeutic relationship, and spending time with a withdrawn patient—even communicating presence in silence—best represents the foundational aspects of psychiatric nursing care.
A male patient frequently inquires about the female student nurse’s boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behaviour?
a. Avoiding addressing the importance of the boundaries of the therapeutic relationship by simply requesting a different assignment is counterproductive and does not enable healthy resolution and development of the nurse–patient relationship.
b. Respectfully and productively addressing the blurring of the boundaries of the therapeutic relationship is the responsibility of the nurse. Addressing the roles and goals of the therapeutic relationship will promote positive mental health outcomes.
c. While refocusing on the patient’s issues is important, the nurse’s simply stating she cannot talk about her personal life does not anchor the importance of the roles in a therapeutic relationship and may hamper rapport, setting up a more dictatorial and authoritarian relationship.
d. Explaining that the onus is entirely on the patient to change and threatening to end the therapeutic relationship is damaging to nurse–patient rapport. The nurse must accept responsibility for supporting the establishment of appropriate boundaries and maintaining an encouraging attitude toward growth of both the therapeutic relationship and therapeutic outcomes.
b. Respectfully and productively addressing the blurring of the boundaries of the therapeutic relationship is the responsibility of the nurse. Addressing the roles and goals of the therapeutic relationship will promote positive mental health outcomes.
Mary, a patient in the psychiatric unit, had a very rejecting and abusive father and a difficult childhood, but from age 10 on was raised by a very warm and supportive grandmother who recently passed away. Mary frequently comments on how hard her nurse, Jessa, works and on how other staff do not seem to care as much about their patients as Jessa does. Jessa finds herself agreeing with Mary and appreciating her insightfulness, recalling to herself that except for her former head nurse, other staff do not seem to appreciate how hard she works and seem to take her for granted. Jessa enjoys the time she spends with Mary and seeks out opportunities to interact with her. What phenomenon is occurring here, and which response by Jessa would most benefit her and the patient?
a. Mary is not experiencing transference, which is the patient’s transferring or displacement of feelings onto the therapist. Jessa would confuse the issue by explaining this scenario as transference or displacement.
b. The concern is not Jessa’s idealizing Mary but rather Jessa’s own unmet needs’ being displaced into the therapeutic relationship. Jessa is indeed intended to be the professional in this situation and must self-reflect to maintain the therapeutic relationship, so distancing herself from Mary would counter the therapeutic relationship.
c. The concern is not that Mary is overidentifying with Jessa’s situation but rather that Jessa has displaced feelings into her relationship with Mary. Labelling the concern as overidentifying on Mary’s part would shift Jessa’s focus away from developing more self-awareness, which is required in this situation.
d. Jessa is misplacing her need for acknowledgement and misreading the expression of her patient’s appreciation—a form of counter-transference. It is the responsibility of the nurse (Jessa) to self-reflect and explore the situation.
d. Jessa is misplacing her need for acknowledgement and misreading the expression of her patient’s appreciation—a form of counter-transference. It is the responsibility of the nurse (Jessa) to self-reflect and explore the situation.
Which of the following statements would be appropriate during the orientation phase of the nurse–patient relationship? Select all that apply.
a. An introduction to each other and to the roles within the therapeutic relationship are essential in the orientation phase.
b. This invitation to meet at a particular time establishes a sense of trust, which builds rapport and is appropriate to the orientation phase of the therapeutic relationship.
c. Inquiring about interventions for treatment is an element of the working phase of the therapeutic relationship.
d. Evaluation of an intervention strategy, such as asking about a plan to improve sleep, is part of the working phase and may also lead into the final evaluation of the therapeutic experience seen in the termination phase.
e. Establishing the plan and structure of therapeutic interactions, such as a time to meet, is part of the orientation phase of the therapeutic relationship. The invitation to talk if the patient would like to allows the patient to set the pace, which also builds rapport in the orientation phase.
f. Inquiring about the thoughts and feelings the patient may have keeps the focus on the patient, which sets the tone at the outset. This question also provides basic information helpful in the orientation phase and allows the nurse to express qualities, such as empathy and respect, essential to the start of the therapeutic relationship.
A, B, E, and F
A student nurse exhibits the following behaviours or actions while interacting with her patient. Which of these are appropriate as part of a therapeutic relationship?
a. Having empathy and respect for the pacing and current experience of the patient is important in establishing a therapeutic relationship. Sometimes the tone is quiet and the pace is slow (e.g., sitting in moments of silence); however, much respect and trust can be communicated even in a silent interaction.
b. Providing advice takes power from the patient in a manner that is counter to the therapeutic relationship. It does not allow the patient to come to his or her own conclusions and gain power and mastery of the situation.
c. Selecting topics for the interactions does not respect the needs and concerns of the patient and would damage the rapport between the nurse and patient.
d. It is disrespectful to deny the patient a personal understanding of his or her concerns and priorities. Accelerating the discussion of certain topics or closing topics of conversation would, similar to the selection of topics for the patient, rob the patient of a level of power and control in the therapeutic relationship.
a. Having empathy and respect for the pacing and current experience of the patient is important in establishing a therapeutic relationship. Sometimes the tone is quiet and the pace is slow (e.g., sitting in moments of silence); however, much respect and trust can be communicated even in a silent interaction.
