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Module 6 (Psych Mental Health) > Nurse-Patient Relationships > Flashcards

Nurse-Patient Relationships Flashcards

(73 cards)

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1
Q

Miscommunication is the ____th leading cause of medical deaths

A

4th - error 1/4 of the deaths
- btw staff and pts
- need empathy to help pts

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2
Q

Standards of practice for PMH Nursing

A

Assessment
Diagnosis
Outcome Identification
Planning
Implementation
Evaluation

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3
Q

What is the nurse observing int the assessment?

A

Physical behavior
Verbal and nonverbal communication
Appearance
Speech
Thought content
Cognitive ability - rpocess
Current lifestyle
Resources
Family
Friends
Education
Work experience

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4
Q

Assessments are done in what fashion?

A

cyclical
with EMPATHY
- immediate needs

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5
Q

primary source

A

patient

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6
Q

Secondary source

A

family
medical records
anything not from the patient

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7
Q

Children’s considerations for assessments

A

ACEs
developmental level
interview/observe

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8
Q

Adolescent’s considerations for assessments

A

confidentially
interview w/o parent/guardian present - privacy

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9
Q

Elderly’s considerations for assessments

A

physical limitation
pre-existing conditions

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10
Q

Psychiatric Nursing Assessments

A

rapport
chief complaint in own words
baseline VS
Safety precautions - suicide. self-harm, homicide
mental state and psychosocial
tx goals
plan of care (prioritize immediate needs)
doc

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11
Q

When gathering data what do you obtain?

A

Head-to-toe
labs
MSE (mental status examination) - daily
Psychosocial, spiritual, culture

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12
Q

Mental Status Examination obtains what type of data?**

A

most objective tool to gather data
during interview

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13
Q

Can life expectancy be lowered if the patient has a psych disorder?

A

yes by 10-17.5 years
- Bipolar and schizo
- fail to tx other problems

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14
Q

During the assessment phase, the tx team needs to work out what before considering a psych diagnosis? and why?

A

need to rule out medical dx
Failure to treat the diagnosis – by missing other physical disorders

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15
Q

What lab data is obtained in gathering data for psych patients?

A

thyroid - mood disorders
liver enzymes
BUN
electrolytes (irritable/depression)
ammonia (high = confusion)
toxicology (Rx or illicit)

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16
Q

High thyroid levels can lead to what disorder?

A

depression
mania

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17
Q

MSE assesses what

A

physical behavior
nonverbal communication
appearance
speech
mood/affect
thought content
perceptions
cog ability
insight
judgment

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18
Q

The psychosocial assessment is the most _________ tool of assessment

A

subjective
- c/o
hx of suicidal, homicidal, self-harm
abuse
stressors and coping
QUALITY of ADLs
background
goals for tx
beliefs

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19
Q

Spiritual/Religious Assessment

A

influences
decrease stress, and distress from neg life events
keep them grounded or grandeur

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20
Q

Cultural/Social Assessment decreases

A

Stereotyping
Stigma
Labeling

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21
Q

Cultural/Social Assessment increases

A

Understanding
Rapport
Patient outcomes

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22
Q

Risk Dx for

A

High probability of occurrence in the future
Intended to prevent the occurrence
Ensures patient safety

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23
Q

Outcome Identification with

A

Specific
Measurable
Achievable
Realistic
Timely

  • coping skills by d/c
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24
Q

Planning is based on

A

Evidence-based practice
safety
appropriate
individualized

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25
Inmplementation of the nursing process focuses on
Establishing trust Giving positive feedback Boost self-esteem Encourage independence
26
Basic Level of Interventions include
cordination with care teaching and promoting therapies and medications Milieu (quiet, calm, and dark) relationship and counseling
27
What is the most neglected part of the nursing process?
evaluation - systemiatic -ongoing (cyclical) - criteria based
28
Berlo's Communication Model
stimulus sender message media receiver feedback repeat
29
Therapeutic communication needs to be
professional goal and evidence based revolve of help for pt - developers a relationship
30
What type of statements should never be used for therapeutic communication?
I statements (That must have been very distressing to feel like that. Tell me about that)
31
Therapeutic Communication Should be
honest respect genuine empathy compassion
32
Factors affecting communciation
personal (emotional, social, cognitive) environment (physical and societal determinants) relationship (symmetrical and complimentary)
33
Symmetrical relationships
friends peers
34
Complementary relationships
power imbalance
35
Verbal communication
words/language = content of message - tone can be misleading clarification and agree on content to minimize miscommunication
36
Nonverbal communication
body expressions eye cast observable responses (shaking, restless, sweating) appearance
37
Effective communciation skills
silence - reflection and space to open up active listening - present and offering yourself to the space - being in the moment clarifying techniques
38
Paraphrasing
restate the message and simplify the terms (own words, active listening, and empathy)
39
Restating
– same key words as the sender (careful with repetition and restate for them to hear own words)
40
Reflection of feelings
know the challenges (sharing observations)
41
Exploring
examine idea more deeply
42
Projective questions
-what if?, imagine in another situation
43
Presupposition- miracle questions
if everything was good and what would be different
44
Non-therapeutic communciation
excessive questions approval/disapproval (no aruging) dismissive - no closed questions advising "why" = negativity
45
Communicating across cultures
competence differ beliefs interpreter styles of communication expression of emotion eye contact touch
46
Issues communicating in PMH
delusion thinking - false belief Hallucination Paranoia - distrust Self-concept - different perception than us or reality (do not play in with the delusion)
47
Therapeutic relationship in medical
Knowledge of anatomy, physiology, and chemistry ith caring in a relationship with pts **patient-centered partner ship
48
Goals of a Therapeutic Relationship
facilitating assisting problem-solving help with alternatives self-care
49
Patient-centered relationship requires
strong communication skills understanding human behavor empathy
50
nurse Roles
liaison role model **teaching**
51
Interpersonal Interactions
accountable focus on needs competence delay judgment
52
Helping Relationship
needs of pt alternate problem-solving new coping encourage behavior chnages
53
What does not work when helping a therapeutic relationship?
inconsistency unavailable arguing, minimize, challenge criticism
54
Establish boundaries can occur by
overhelping controlling narcissism transference countertransference emotional attachment
55
Transference
pt subcons. Doesn’t like you ( pt to nurse)
56
Countertransference
response as personal (nurse to pt)
57
Peplau's phases of the nurse-patient relationship
preorientation orientation working termination
58
Preorientation phase
Review background information safety protocols address staff fears
59
orientation phase
rapport and trust time frame and schedule confidentiality **termination with d/c teachings**
60
working phase
maintain relationship assessments promote problem-solving, self-esteem, language positive behavio chnage no resistance eval promote practice and expression of alternate adaptive
61
termination phase
achievements incorporate into daily life, coping review exchange memories **learn they are important to staff
62
What helps a PMH patient improve to the termination phase
**consistency** pacing listening initial impressions comfort factors for patients - check regularly and schedule interviews
63
What hinders a patient to improve in hospital
unavailability inconsistency
64
Who leads the clicnial interviews
patient - decide content and direction nurse - therapeutic and active listening
65
Interview goals to help the patient
feel safe, understand, and comfort identify problems healthy coping **goal is satisfying interpersonal relations**
66
Clinical settings when preparing for an interview
quiet safe private visible
67
Seating in an interview
same ht avoid face-to-face - across table and to the side at 90 degrees comfort and safety avoid barriers
68
You should let the pt know about this during confidentiality?
disclosure about harming others or past experience
69
Initiating an Interview should start with ehat type of statement
- open ended “Tell me what brings you here.” “Where should we start?” “Tell me about what has been going on with you.” “What has been concerning you lately?”
70
Offer leads
“Go on” “Tell me more about that”
71
Statements of acceptance in an interview
“Uh-huh” “I see” “Okay”
72
Helpful Guidelines in an interview include
breifly say nothing if you don't know what to say **When in doubt, focus on feelings** avoid advice don't rely on questions nonverbals focus on patients
73
Attending Behaviors
eye contact body language vocal qualities verbal tracking

Module 6 (Psych Mental Health) (12 decks)

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