How should clients be treated?
Treat clients with R-E-S-P-E-C-T.
- be considerate of cultural, spiritual and religious beliefs
- use appropriate limits and boundaries
- use therapeutic communication
What is the goal of the nurse-client relationship?
To assist client with problem-solving and coping skills to help make them well.
What are the 4 phases of a nurse-client relationship?
- pre-interaction phase
- orientation or introductory phase
- working phase
- termination or separation phase
What is the pre-interaction phase?
The pre-interaction phase is what occurs before the nurse meets with the client. The nurse:
- gets a comfortable environment set up before the client arrives
- anticipates problems the client may be dealing with
- determines how to approach the client
- self reflects on own biases that could affect relationship
What is the orientation or introductory phase?
The orientation or introductory phase is when the nurse first meets the client:
- establishes trust and boundaries
- identifies strengths and needs
- collects data and makes goals or a contract with client
- begins to prepare client that relationship will end
What is the working phase?
When the nurse is actively working with the client:
- active listening, so client can express thoughts and feelings
- encourages self-direction
- work on problem-solving
What is the termination or separation phase?
When the relationship ends:
- prepares for separation and feelings
- evaluates goals and progress
- anticipates follow up care
- makes referrals for support groups
What role do family members play in a client's care?
Family members are active members in the care of the client.
Include family when possible.
What is a mental health problem?
A mental health problem is when the client has thoughts or behavior that impair normal life functioning and causes distress.
What are defense mechanisms?
Defense mechanisms are what a client uses to cope with unmanageable stress and to decrease anxiety.
What is denial?
Denial is a defense mechanism when the client ignores the unpleasant or intolerable thoughts, feelings, needs or impulses.
Example: a husband ignores his wife's infidelity even though there are obvious signs.
What is displacement?
Displacement is a defense mechanism when the client directs their feelings to another less-threatening person or object.
Example: an angry client hits the wall instead of a person.
What is projection?
Projection is a defense mechanism when the client transfers their own feelings on to someone else.
Example: a hostile husband will blame his hostility on his wife and will say she has an anger management problem.
What is rationalization?
Rationalization is a defense mechanism when a client attempts to make unacceptable feelings and behaviors acceptable by justifying the behavior.
Example: a rude person will justify behavior by saying the bad traffic from the morning commute caused it.
What is regression?
Regression is a defense mechanism when the client returns to an earlier developmental behavior to deal with anxiety.
Example: A ten-year-old is in the hospital to get his tonsils removed and begins sucking his thumb like he did when he was a toddler.
What is repression?
Repression is a defense mechanism when the client unconsciously blocks the unacceptable thoughts or ideas.
Example: a child who is abused by a parent later has no recollection of the events, but has trouble forming relationships.
What is compensation?
Compensation is a defense mechanism when the client uses a lot of extra effort on strengths to make up for deficiencies.
Example: a client that fails in relationships will put in extra effort to be extremely physically fit.
What is therapeutic communication?
Therapeutic communication is face-to-face interaction that focuses on advancing the physical and emotional well-being of a client.
It is frequently used to get the client to open up about concerns and reflect on a situation for problem-solving.
What is active listening?
Active listening is a therapeutic communication technique that shows that the nurse is actively listening to the client.
Example: repeat key points, nod, or ask open-ended questions.
What is an open-ended question?
An open-ended question is a therapeutic communication technique the encourages conversation because it gets the client to open up and requires more than one-word answers.
Example: "Tell me about your relationship with your children."
What is restating?
Restating is a therapeutic communication technique that repeats what the client has said to give the client an opportunity to agree, disagree, or clarify the message further.
Example: a severely anorexic client says, "I am ready to eat breakfast today."
The nurse responds with, "Did I hear that you are ready to eat today?"
What is silence?
Silence is a therapeutic communication technique where nothing is said by the nurse, but sits with the client silently.
This allows time for thoughts to formulate before discussing them.
What is presenting reality?
Presenting reality is a therapeutic communication technique where the nurse states the facts to show the client there is a problem.
Example: the nurse states to the client, "you say you are not an alcoholic but you drink a 6-pack of beer every night."
What is NON-therapeutic communication?
NON-therapeutic communication is ineffective communication. This type of communication doesn't focus on the client and closes off communication.
- "Nice weather we are having."
- "I'm fine. How are you?"
- "Don't worry, I think you'll be fine."
- "You need this procedure or you won't get better."
What is approval?
Approval is a non-therapeutic communication technique. It is implying that the client is doing or not doing the right thing and may focus on what pleases the nurse instead of what is best for the client.
Example: the nurse states, "That's so good!"
What is changing the subject?
Changing the subject is non-therapeutic communication. The client's feelings, thoughts, and concerns are avoided.
Example: The client states, "I want to die!".
The nurse responds with, "Did your parents visit you today?"
What are closed-ended questions?
Closed-ended questions are non-therapeutic communication. These questions elicit a yes/no response and prevent the client from opening up.
Example: "Do you feel bad about what happened?" (Sometimes the nurse needs to ask a close-ended question if the client is showing signs of harming themselves are someone else. An example would be "Do you have a plan for suicide?")
What is false reassurance?
False reassurance is a non-therapeutic communication technique. It's when a statement is made that the client has no reason to be worried.
Example: the nurse states, "Don't worry, you'll be fine."
What is giving advice?
Giving advice is a non-therapeutic communication. It assumes that the client cannot think for themselves. This prevents problem-solving.
Example: the nurse states, "I think you should just listen to your father and do what he says."
What are "why" questions?
"Why" questions are non-therapeutic communication. Starting a question with "why? can cause the client to feel defensive. In general, if the client knew "why?", then they would not be making the statement.
Example: "Why are you so depressed?"
What are value judgments?
Value judgments are non-therapeutic communication. A comment is made that addresses their morals and can cause anger or guilt.
Example: the nurse states, "I think you should always listen to your parents even if you don't like what they say."
What are some important client rights?
The client has the right to:
- refuse care
- be treated
- communicate with those outside the hospital
What is a voluntary admission?
A voluntary admission is when the client (or guardian) seeks admission for care.
What is an involuntary admission?
An involuntary admission is when a client is admitted against their will.
This occurs because the client is an imminent danger to themselves or others.
If a client is involuntarily admitted what is the proper legal procedure?
An order from the court, psychiatrist, or primary health care provider is necessary.
If the admission is an immediate emergency, the order can then be gotten later.
If a client is involuntarily admitted, what must be provided to the client?
Legal counsel must be provided to the client who is involuntarily admitted.
When can a client lose their right to refuse treatment?
The client loses the right to refuse treatment when they are in immediate danger to self or others.
What is "discharge against medical advice"?
Discharge against medical advice is when the voluntary client is discharged even though the HCP had advised against leaving.
What is milieu therapy?
Milieu therapy is the environment in which a client is empowered by setting their own goals and developing relationships with the staff to achieve these goals.
What is behavior therapy?
Behavior therapy is when the client changes their negative behavior with positive behavior.
What is group therapy?
Group therapy is when a therapist leads a small group of individuals all experiencing the same problem.
The group setting allows for feedback and support of each other.
Should you ever argue with a client?
Never argue with a client.