NSG 212
UNIT 2 OBJECTIVES
SPRING 2023
CHAPTR 6: LEGAL AND ETHICAL BASIS FOR PRACTICE
1. Identify the five basic principles of bioethics:
a. Beneficence: This principle emphasizes the importance of promoting the well-being of
patients and doing good for them. It requires healthcare providers to act in the best interests of
their patients, to prevent and remove harm, and to promote their welfare.
b. Autonomy: This principle recognizes the right of individuals to make their own decisions
about their health and medical treatment. It requires healthcare providers to respect patients'
decisions, and to provide them with adequate information and support to make informed
choices.
c. Justice: This principle emphasizes the need to treat all individuals fairly and equally, and to
distribute healthcare resources fairly. It requires healthcare providers to address healthcare
disparities and to work towards ensuring that healthcare resources are allocated based on need,
rather than other factors such as wealth or social status.
d. Fidelity (nonmaleficence): This principle requires healthcare providers to uphold their
commitments to their patients, to avoid causing harm, and to prevent harm from occurring.
e. Veracity: This principle requires healthcare providers to be truthful and honest with their
patients, and to respect their right to know the truth about their health and medical condition. It
also requires them to maintain confidentiality and to protect patients' privacy
2. Evaluate the differences between voluntary and involuntary admission and discharge
procedures
Voluntary admission and discharge procedures occur when patients willingly seek medical
treatment or choose to leave the facility. In contrast, involuntary admission and discharge
procedures occur when patients are admitted to or discharged from a healthcare facility
without their consent, often due to concerns for their safety or well-being. Involuntary
admission typically involves a legal process, and patients may be held for observation and
evaluation. In cases where patients refuse to comply with treatment or pose a danger to
themselves or others, healthcare providers may need to seek a court order to discharge the
patient involuntarily.
3. Acknowledge client rights under the law:
a. Right to treatment: Clients have the right to receive adequate and appropriate medical
treatment, which may include medication, therapy, or other interventions that are necessary
for their well-being.
b. Right to refuse treatment: Clients have the right to refuse medical treatment, even if it is
recommended or considered necessary by healthcare providers. This includes the right to
refuse medication, therapy, or other interventions.
c. Right to informed consent: Clients have the right to receive information about their medical
condition, treatment options, and potential risks and benefits of treatment. Healthcare
providers are required to obtain clients' informed consent before providing any medical
treatment or procedure.
d. Rights regarding involuntary commitment and psychiatric advance directives: Clients who
are subject to involuntary commitment have certain rights, including the right to legal
representation, the right to receive treatment in the least restrictive environment possible,
and the right to challenge their commitment in court. Clients also have the right to create
psychiatric advance directives, which are legal documents that specify their treatment
preferences in the event that they become unable to make decisions for themselves.
e. Rights regarding restraint and seclusion: Clients have the right to be free from unnecessary
restraint and seclusion. Healthcare providers are required to use these interventions only
when necessary to prevent harm to the client or others, and to use the least restrictive
measures possible. Clients also have the right to be informed about the reasons for their
restraint or seclusion, and to receive appropriate medical care and monitoring while they are
restrained or secluded.
Recognize the importance of maintaining client confidentiality
The act of keeping client information private and secure, known as client confidentiality, is of
utmost importance in healthcare settings. It establishes trust between the client and
healthcare provider, which is crucial for a therapeutic relationship. Breaches of confidentiality
can lead to severe consequences for the client, such as loss of employment, discrimination,
and social stigma, and can negatively impact the client's willingness to seek treatment.
Maintaining client confidentiality is not only an ethical responsibility, but it is also required by
law in most countries. In summary, maintaining client confidentiality is essential for
promoting the client's well-being, complying with legal and ethical requirements, and building
and maintaining trust in the healthcare relationship
4. Respond to the unsafe practice of a health care professional (e.g., intervene, report)
When faced with the unsafe practice of a healthcare professional, it is important to take
action to ensure the safety and well-being of clients and prevent harm.
Intervening in the moment may involve stopping the unsafe practice and providing immediate
assistance to the client if necessary. This may also involve addressing the healthcare
professional's behavior and communicating the concerns regarding the unsafe practice.
Reporting the incident to the appropriate authorities or supervisors is also essential. This may
include notifying the healthcare facility's administration, regulatory bodies, or professional
associations. Reporting the incident can help ensure that appropriate action is taken to
address the unsafe practice, and can also help to prevent similar incidents from occurring in
the future.
It is important to remember that reporting an unsafe practice is not an act of retaliation or
punishment, but rather a way to promote accountability and ensure the safety and well-being
of clients. Healthcare professionals have a responsibility to report any unsafe practices they
witness and to take action to prevent harm.
5. Describe situations that would require the health care professional to break client
confidentiality
When a client is at risk of harm to themselves or others: Healthcare professionals may be
required to disclose information to prevent harm to the client or others. This may include
notifying family members, healthcare providers, or law enforcement authorities.
When there is suspicion of abuse or neglect: Healthcare professionals are required to report
suspected cases of abuse or neglect to the appropriate authorities, even if it means breaking
client confidentiality.
When there is a legal requirement: In some cases, healthcare professionals may be required
by law to disclose information, such as in the case of a court order or a subpoena.
When there is a public health risk: Healthcare professionals may be required to disclose
information to prevent the spread of a communicable disease or to protect public health.
6. Demonstrate understanding of tort law applied to psychiatric settings
a. Intentional torts
i. Battery
ii. Assault
iii. False imprisonment
b. Negligence/Malpractice
c. Defamation of character
i. Slander
ii. Libel
Tort law refers to the legal system that governs civil wrongs or injuries caused by one party to
another. In psychiatric settings, tort law may be applied in cases where a healthcare provider
breaches their duty of care to a client, causing harm or injury. There are several types of torts that
may be relevant in psychiatric settings, including intentional torts, negligence/malpractice, and
defamation of character.
Intentional torts refer to actions taken with the intent to harm the client, and can include:
Battery: The intentional touching of a client without their consent, or beyond the scope of their
consent, resulting in harm.
Assault: The intentional act of causing the client to fear imminent harm or physical contact.
False imprisonment: The intentional confinement or restraint of a client without their consent or
without legal justification.
Negligence/malpractice refers to a breach of the duty of care owed to a client, resulting in harm or
injury. Negligence may occur when a healthcare provider fails to provide the standard of care that a
reasonable and prudent healthcare provider would provide in similar circumstances.
Defamation of character involves making false statements about a client that damage their
reputation. It can be divided into two categories:
Slander: Verbal statements that are false and damaging to the client's reputation.
Libel: Written statements that are false and damaging to the client's reputation.
7. Understand what to do when professional colleague’s practice unethical or illegal practices
When a professional colleague's practice involves unethical or illegal practices, it is important
to take action to ensure the safety and well-being of clients and prevent harm. This may
include:
Confronting the colleague: If possible, it may be appropriate to speak directly to the colleague
about your concerns and provide them with an opportunity to address the issue. It is
important to approach the situation in a respectful and professional manner.
Reporting the colleague to a supervisor or regulatory authority: If confronting the colleague is
not possible or does not resolve the issue, it may be necessary to report the unethical or
illegal practices to a supervisor or regulatory authority. This may include notifying the
healthcare facility's administration, regulatory bodies, or professional associations.
Seeking legal advice: In some cases, it may be necessary to seek legal advice to ensure that
your actions are appropriate and protect you from potential legal or professional
consequences.
It is important to remember that reporting a colleague's unethical or illegal practices is not an
act of retaliation or punishment, but rather a way to promote accountability and ensure the
safety and well-being of clients. Healthcare professionals have a responsibility to report any
unethical or illegal practices they witness and to take action to prevent harm
CHAPTER 7: THE NURSING PROCESS IN PSYCHIATRIC-MENTAL HEALTH NURSING
1. Understand what is included in the psychiatric nursing assessment
Psychiatric nursing assessment is the process of gathering information about a client's mental
health status, including their psychological, social, and biological factors that may be
influencing their mental health. The assessment is typically conducted during the client's
initial visit to a psychiatric facility, and it serves as the foundation for developing a
comprehensive treatment plan. The following components may be included in a psychiatric
nursing assessment:
Biographical data: This includes the client's name, age, gender, marital status, occupation,
and other relevant demographic information.
Chief complaint: This refers to the primary reason why the client is seeking psychiatric care
and may include symptoms such as depression, anxiety, or hallucinations.
Mental status examination: This is an assessment of the client's cognitive functioning,
including their level of consciousness, memory, orientation, mood, affect, and thought
processes.
Psychiatric history: This includes any prior psychiatric diagnoses, treatment history,
hospitalizations, medication use, and family history of mental illness.
Substance use history: This includes an assessment of the client's use of alcohol, illicit drugs,
and prescription medications.
Medical history: This includes any relevant medical conditions, medications, and allergies.
Social history: This includes an assessment of the client's living situation, support system,
occupation, and education.
Family history: This includes an assessment of the client's family members' mental health
status.
Cultural considerations: This includes an assessment of the client's cultural background,
beliefs, and values that may influence their mental health.
Risk assessment: This includes an assessment of the client's risk for self-harm or harm to
others.
2. Understand objective and subjective data gathered in the psychiatric nursing assessment
Objective data:
Vital signs (blood pressure, heart rate, respiratory rate)
Laboratory test results (e.g., blood tests, urine tests)
Observation of physical behavior (e.g., pacing, agitation, lethargy)
Medication list and dosages
Medical history (e.g., past surgeries, illnesses)
Subjective data:
Client's chief complaint (e.g., "I feel sad all the time")
History of mental illness and treatment (e.g., "I was diagnosed with depression a year ago
and have been taking medication since then")
Client's self-report of mood, emotions, and thoughts (e.g., "I feel hopeless and helpless")
Family history of mental illness (e.g., "My mother also struggled with depression")
Cultural considerations (e.g., "In my culture, mental health is not talked about openly")
3. Discuss and understand the components of the psychosocial assessment
Presenting problem: This refers to the client's main concern or reason for seeking treatment,
and includes information on the onset and duration of the problem, the frequency and
intensity of symptoms, and how the problem affects the client's daily life.
Mental status exam: This is a structured assessment of the client's current mental state,
including their appearance, behavior, mood, affect, speech, thought process, and cognitive
functioning.
Psychiatric history: This component of the assessment includes a detailed history of the
client's psychiatric symptoms, past treatment, and medication use.
Medical history: This includes information about the client's past medical problems, current
medical conditions, and medication use.
Substance use history: This includes information about the client's past and current use of
alcohol and drugs, including frequency and amount of use, and any previous treatment for
substance abuse.
Family history: This component of the assessment includes information about the client's
family history of mental illness and substance use, as well as any history of abuse or trauma.
Social history: This includes information about the client's living situation, employment
status, education level, social support, and any legal or financial problems.
Cultural and spiritual beliefs: This includes information about the client's cultural and
spiritual background, beliefs, and practices, and how they may impact their mental health
and treatment.
Assessment of risk: This involves assessing the client's risk of harm to themselves or others,
as well as any history of suicidal or homicidal thoughts or attempts.
Treatment goals and plan: Based on the information gathered from the assessment, the
mental health professional will work with the client to develop a treatment plan that
addresses their specific needs and goals
4. Identify principles used by the psychiatric mental health nurse when planning patient care
Patient-centered care: This principle emphasizes the importance of involving the patient in
the planning process and tailoring care to their unique needs, preferences, and goals.
Evidence-based practice: This principle involves using the best available evidence to guide
clinical decision-making and provide the most effective and efficient care.
Holistic care: This principle recognizes the interconnectedness of the physical, psychological,
social, and spiritual aspects of a patient's health and well-being, and aims to address each of
these areas in the care plan.
Collaborative care: This principle emphasizes the importance of working collaboratively with
other members of the healthcare team, including other nurses, physicians, social workers,
and therapists, to ensure comprehensive and coordinated care.
Cultural competence: This principle involves recognizing and respecting the unique cultural
values, beliefs, and practices of each patient and incorporating these factors into the care
plan.
Ethical practice: This principle involves upholding the ethical principles of the nursing
profession, such as respect for patient autonomy, confidentiality, and beneficence, in all
aspects of care
5. Discuss the effects of adverse childhood experiences (ACEs) in the nurse-client relationship
Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in
childhood and can have significant long-term effects on an individual's physical and mental
health. ACEs can include experiences such as physical, emotional, or sexual abuse, neglect,
parental divorce, substance abuse, mental illness, or incarceration of a family member.
In the nurse-client relationship, the effects of ACEs can impact both the nurse and the client.
Clients who have experienced ACEs may have difficulty trusting others, establishing healthy
relationships, and may have ongoing mental health concerns such as depression, anxiety, or
post-traumatic stress disorder. These experiences can also impact a client's ability to
communicate effectively with their nurse, and they may struggle to disclose sensitive
information or engage in care.
For the nurse, working with clients who have experienced ACEs can be emotionally
challenging and may require additional training and support to effectively care for these
clients. Nurses may also experience vicarious trauma or compassion fatigue, which can
impact their own mental health and job satisfaction.
To address the effects of ACEs in the nurse-client relationship, it is essential to create a safe,
supportive, and non-judgmental environment that encourages open communication and
fosters trust. Nurses should also have an understanding of the potential effects of ACEs on
mental health and be prepared to address the unique needs of clients who have experienced
trauma. This may include incorporating trauma-informed care principles, using evidencebased interventions, and providing ongoing emotional support and resources to clients and
their families.
6. Contribute to the development of basic level interventions in mental health nursing:
a. Coordination of care
b. Health teaching and health promotion
c. Pharmacological, biological, and integrative therapies
d. Milieu therapy
e. Therapeutic relationship and counseling
a. Coordination of care: This involves working collaboratively with other members of the healthcare
team, as well as community resources, to ensure that your clients receive comprehensive and
coordinated care. This may include making referrals to other providers, coordinating medical
appointments, and advocating for your clients' needs.
b. Health teaching and health promotion: As a mental health nurse, you can educate your clients
about healthy lifestyle choices, stress management techniques, and other strategies to promote
physical and mental well-being. This may include providing resources and information about healthy
eating, exercise, sleep, and stress reduction.
c. Pharmacological, biological, and integrative therapies: Depending on the client's needs and
preferences, you may be involved in administering and monitoring medications, coordinating
biological treatments such as electroconvulsive therapy, or facilitating the use of complementary and
alternative therapies such as meditation, acupuncture, or aromatherapy.
d. Milieu therapy: This involves creating a therapeutic environment that is safe, supportive, and
conducive to healing. As a mental health nurse, you can contribute to milieu therapy by promoting a
sense of community among clients, facilitating group activities, and ensuring that the physical
environment is conducive to recovery.
e. Therapeutic relationship and counseling: Building a therapeutic relationship with your clients is
essential to promoting their mental health and well-being. As a mental health nurse, you can provide
counseling and support to your clients, help them develop coping skills, and facilitate their
engagement in therapy and other mental health services.
7. Recognize legal considerations for documentation of care
a. Accuracy and completeness: Documentation should accurately reflect the care provided to
the patient and should be complete to ensure that all aspects of the care are recorded.
b. Timeliness: Documentation should be done in a timely manner and should reflect the
actual time of the event. Late documentation can be viewed as suspect and may create legal
and ethical problems.
c. Confidentiality: Patient information should be kept confidential and should be protected
from unauthorized access. It is important to ensure that documentation is stored securely
and can only be accessed by authorized individuals.
d. Use of appropriate language: Documentation should use appropriate language and avoid
any derogatory or discriminatory language. It should also avoid the use of subjective
language and should be objective.
e. Risk management: Documentation should include information that helps manage risk,
such as patient care plans, progress notes, and incident reports. This helps to identify
potential risks and take corrective action to prevent future occurrences.
f. Legal and ethical considerations: Documentation should adhere to legal and ethical
standards and guidelines. This includes ensuring that documentation is accurate, complete,
and truthful, and that it follows the legal and ethical principles of informed consent, privacy,
and confidentiality.
By adhering to these legal considerations, psychiatric nurses can ensure that they are
providing safe and effective care to their patients while also meeting their legal and ethical
obligations.
CHAPTER 8: COMMUNICATION SKILLS: MEDIUM FOR ALL NURSING PRACTICE
8. Understand the communication process including verbal and nonverbal communication
Effective communication is an essential component of psychiatric nursing care. The
communication process involves the exchange of messages between two or more individuals.
It includes both verbal and nonverbal communication.
Verbal communication refers to the use of words to convey a message. It can be expressed
through spoken or written words. Some examples of verbal communication in psychiatric
nursing include using therapeutic communication techniques such as active listening, openended questions, and providing information and feedback.
Nonverbal communication refers to the use of body language, gestures, facial expressions,
and tone of voice to convey a message. Nonverbal communication can often convey more
information than verbal communication. In psychiatric nursing, nonverbal communication
can be used to establish rapport, convey empathy, and build trust with the patient.
Effective communication in psychiatric nursing involves both verbal and nonverbal
communication. It requires active listening, empathy, and respect for the patient's values and
beliefs. It is important to recognize that communication is a two-way process, and it involves
both sending and receiving messages.
In addition, it is important to understand cultural and linguistic differences that may impact
communication. Psychiatric nurses should strive to use clear and concise language, avoid
jargon or technical terms, and adapt their communication style to meet the needs of the
patient.
Overall, effective communication is essential in psychiatric nursing practice and is crucial for
building a therapeutic relationship with the patient
9. Recognize and use effective therapeutic communication skills for nurses
a. Active listening
b. Clarifying techniques
i. Restating
ii. Reflecting
iii. Exploring
Active listening: Active listening is the process of fully concentrating on what the patient is saying
without interrupting or making assumptions. It involves making eye contact, using open body
language, and nodding to show that you are listening. Active listening also includes asking clarifying
questions and summarizing what the patient has said to ensure understanding.
Clarifying techniques: Clarifying techniques are verbal communication skills that help nurses clarify
what the patient is saying to gain a better understanding of their situation. Three examples of
clarifying techniques are:
Restating: repeating what the patient has said in your own words to ensure understanding.
Reflecting: acknowledging and restating the patient's feelings to demonstrate empathy and
understanding.
Exploring: asking open-ended questions to encourage the patient to elaborate on their thoughts and
feelings.
By using effective therapeutic communication skills such as active listening and clarifying techniques,
psychiatric nurses can build rapport with their patients, establish trust, and create a safe and
supportive environment for the patient to discuss their concerns.
10. Discuss and provide examples of techniques that enhance communication
a. Use of silence
b. Accepting
c. Giving recognition
d. Focusing
e. Suggesting collaboration
Use of silence: Silence can be a powerful tool in communication, particularly in the psychiatric setting. It
can give patients time to think, process their thoughts and feelings, and feel heard. Psychiatric nurses
can use silence by allowing patients to take the lead in the conversation or by pausing before responding
to the patient.
Accepting: Accepting is a communication technique that involves acknowledging the patient's
feelings, thoughts, and experiences without judgment or criticism. This technique helps to build trust
and rapport with the patient. For example, a psychiatric nurse might say, "I understand that this is
difficult for you."
Giving recognition: Giving recognition is a communication technique that involves acknowledging the
patient's efforts, progress, and achievements. This technique helps to boost the patient's self-esteem
and motivation to continue working on their goals. For example, a psychiatric nurse might say, "I
noticed that you've been doing well in your therapy sessions."
Focusing: Focusing is a communication technique that involves redirecting the patient's attention to a
particular topic or issue. This technique can be useful when a patient is feeling overwhelmed or is
talking about multiple issues at once. For example, a psychiatric nurse might say, "Let's focus on how
you're feeling about your medication."
Suggesting collaboration: Suggesting collaboration is a communication technique that involves
working with the patient to come up with solutions and goals together. This technique helps to
empower the patient and promote their autonomy. For example, a psychiatric nurse might say, "Let's
work together to come up with a plan to manage your anxiety."
11. Discuss, provide examples, and recognize more helpful responses to nontherapeutic
communication
a. Giving premature advice
b. Minimizing feelings
c. Falsely reassuring
d. Making value judgment
e. Giving approval/disapproval
a. Instead of giving premature advice, the nurse can ask open-ended questions to help the patient
explore their thoughts and feelings further. For example, instead of saying "You should just leave your
job," the nurse can say "Can you tell me more about what's been happening at work?"
b. Instead of minimizing feelings, the nurse can validate the patient's emotions and help them explore
them further. For example, instead of saying "Don't worry, it's not that bad," the nurse can say "I can
see that you're feeling upset. Can you tell me more about what's causing these feelings?"
c. Instead of falsely reassuring, the nurse can acknowledge the patient's concerns while providing
hope and support. For example, instead of saying "Everything will be fine, don't worry," the nurse can
say "I understand that this is a difficult situation, but we'll work together to find solutions and support
you through this."
d. Instead of making value judgments, the nurse can remain neutral and focus on the patient's
perspective. For example, instead of saying "That's not a good idea," the nurse can say "Can you tell
me more about why you think that would be a good choice?"
e. Instead of giving approval/disapproval, the nurse can remain non-judgmental and focus on the
patient's experiences. For example, instead of saying "I agree/disagree with you," the nurse can say "I
hear what you're saying and understand where you're coming from."
12. Distinguish cultural competence in the use of eye contact and touch
Cultural competence refers to the ability of a healthcare professional to provide care that is
respectful and responsive to the diverse cultural beliefs, values, and practices of their
patients. This includes being aware of how cultural factors influence communication,
including the use of eye contact and touch.
In some cultures, direct eye contact is seen as a sign of respect and attentiveness, while in
others, it may be perceived as rude or aggressive. Similarly, the use of touch can vary widely
across cultures, with some cultures placing a high value on physical touch and others being
more reserved.
As a result, it is important for healthcare professionals to be aware of and respectful of these
cultural differences. This may involve adjusting their communication style, such as avoiding
direct eye contact or asking permission before using touch, to ensure that they are providing
care in a way that is culturally sensitive and appropriate for their patients.
13. Consider the use of information technology in client care
Information technology can improve patient outcomes and increase the efficiency and
accuracy of care delivery. Here are some examples of how information technology can be
used in client care:
Electronic health records (EHRs): EHRs can store comprehensive patient data, including
medical history, medications, lab results, and more. EHRs make it easy for healthcare
providers to access patient information quickly and securely, improving communication and
collaboration between healthcare providers and promoting continuity of care.
Telehealth: Telehealth allows healthcare providers to deliver care remotely using technology,
such as video conferencing or remote monitoring devices. Telehealth can improve access to
care for patients in remote areas or with limited mobility, and can also save time and reduce
costs for both patients and healthcare providers.
Mobile apps: Mobile apps can be used for a variety of purposes, such as medication
reminders, tracking symptoms, and providing self-help resources for mental health. Mobile
apps can help patients manage their health more effectively and can provide healthcare
providers with valuable information about their patients' health status and treatment
progress.
Health information exchanges (HIEs): HIEs are networks that allow healthcare providers to
share patient information securely and efficiently. HIEs can improve care coordination and
patient outcomes by ensuring that all healthcare providers have access to the same
information about a patient's health status and treatment plan.
When using information technology in client care, it is important to ensure that patient
confidentiality is maintained and that patients have access to their own health information.
Healthcare providers should also be trained in the use of information technology and should
use technology that is secure and reliable.
CHAPTER 9: THERAPEUTIC RELATIONSHIPS AND THE CLINICAL INTERVIEW
14. Reflect on the goals in a therapeutic relationship
a. Facilitating
b. Assisting
c. Helping
d. Promoting
a. Facilitating: creating an environment where the client feels safe, comfortable, and respected.
b. Assisting: helping the client to identify their problems and issues, and exploring possible solutions.
c. Helping: supporting the client in developing coping skills, and encouraging personal growth and
development.
d. Promoting: promoting the client's well-being, and helping them to achieve their goals and
objectives.
15. Recognize the difference between a social relationship versus a therapeutic relationship
between nurses and clients
A social relationship between nurses and clients is a non-professional relationship,
characterized by shared interests, social norms, and mutual enjoyment. In contrast, a
therapeutic relationship between nurses and clients is a professional relationship,
established to meet the therapeutic needs of the client.
The therapeutic relationship is goal-oriented, client-focused, and bound by ethical and
professional standards. The nurse uses a range of therapeutic communication skills and
interventions to create a safe, supportive, and empathic environment to help the client
achieve their goals. The relationship is dynamic, with the nurse adapting their approach to
meet the changing needs of the client.
In contrast, a social relationship is based on personal rather than professional interests, and
is not bound by the ethical and professional standards of the therapeutic relationship. The
focus is on mutual enjoyment rather than the client's needs, and communication is less
structured and goal-oriented.
16. Explore behaviors that have relevance in the nurse-patient relationship
a.
b.
c.
d.
e.
Accountability
Focus on the patient needs
Clinical competence
Delaying judgment
Supervision
a. Accountability: This involves the nurse taking responsibility for their actions, decisions, and their
impact on the patient's care.
b. Focus on the patient needs: This involves the nurse prioritizing the patient's needs, listening to their
concerns, and working collaboratively with the patient to develop an individualized care plan.
c. Clinical competence: This involves the nurse having the necessary knowledge, skills, and expertise
to provide safe and effective care to patients.
d. Delaying judgment: This involves the nurse setting aside personal biases and opinions and providing
non-judgmental care to patients.
e. Supervision: This involves the nurse seeking guidance and support from colleagues, supervisors, and
other healthcare professionals to ensure they are providing the best possible care to patients.
17. Identify boundaries, transference, and countertransference related to the nurse-patient
relationship
In the nurse-patient relationship, boundaries refer to the limits and rules that are established
to ensure a safe and appropriate relationship between the nurse and patient. Transference
refers to the patient's unconscious redirection of emotions and feelings towards the nurse,
based on their past experiences and relationships. Countertransference refers to the nurse's
unconscious emotional response to the patient, which is based on their own past experiences
and relationships.
It is important for nurses to recognize and maintain appropriate boundaries in the
therapeutic relationship, while also being aware of the potential for transference and
countertransference. Nurses must strive to remain objective and professional, while also
being empathetic and compassionate towards their patients. It is important to address any
issues of transference or countertransference that may arise in order to maintain a
therapeutic and effective relationship with the patient
Understand how the nurse’s own values and beliefs can affect the nurse-patient relationship
The nurse's own values and beliefs can significantly impact the nurse-patient relationship. A
nurse's personal beliefs, cultural background, and life experiences can influence their
communication style, attitudes, and behavior towards patients. It is essential for nurses to be
aware of their personal biases and how they may affect the care they provide.
If a nurse's values and beliefs differ from their patients, it can create barriers in establishing a
therapeutic relationship. For example, a nurse may hold personal beliefs that conflict with a
patient's lifestyle choices, such as sexual orientation or religious practices. If the nurse is not
aware of these biases, they may unintentionally communicate negative attitudes or
judgments towards the patient, which can harm the nurse-patient relationship.
To provide quality patient care, nurses must remain professional and objective in their
interactions with patients. Nurses need to recognize their personal biases, respect patients'
values, and provide care that is consistent with patients' preferences and needs. The use of
cultural humility and active listening can help nurses understand and empathize with
patients from different backgrounds, thus strengthening the therapeutic relationship.
18. Discuss phases of a therapeutic nurse-client relationship
a. Preorientation phase
b. Orientation phase
c. Working phase
d. Termination phase
e. Review personal characteristics that enhance a therapeutic nurse-patient relationship
f. Genuineness
g. Empathy
h. Positive regard
a. Preorientation phase: This phase begins when the nurse prepares to meet the client and ends when
they meet in person. During this phase, the nurse gathers information about the client from their
chart, other healthcare professionals, or the client's family.
b. Orientation phase: This phase begins when the nurse and the client meet face-to-face and ends
when they establish an agreement regarding the care plan. During this phase, the nurse establishes
trust and rapport with the client, assesses the client's needs, and identifies the client's goals for care.
c. Working phase: This phase begins when the nurse and the client agree on the care plan and ends
when the client achieves their goals or when the relationship is terminated. During this phase, the
nurse implements the care plan, evaluates the client's progress, and adjusts the plan as needed.
d. Termination phase: This phase begins when the client achieves their goals or when the relationship
is terminated and ends when the nurse and the client say goodbye. During this phase, the nurse
evaluates the success of the care plan, helps the client prepare for the future, and provides closure to
the relationship.
e. Personal characteristics that enhance a therapeutic nurse-client relationship include:
Genuineness: The nurse is authentic and sincere in their interactions with the client, and they do not
hide behind a façade or act in a way that is not true to themselves.
Empathy: The nurse is able to understand and share the client's feelings, thoughts, and experiences,
and they communicate this understanding to the client.
Positive regard: The nurse accepts the client unconditionally, without judgment or criticism, and they
communicate this acceptance to the client
19. Discuss attending behaviors as the foundation of interviewing
a. Eye contact
b. Body language
i. Intimate distance
ii. Personal distance
iii. Social distance
iv. Public distance
a. Eye contact: The nurse maintains appropriate eye contact with the client to convey interest,
attentiveness, and respect.
b. Body language: The nurse uses appropriate body language, such as leaning forward and nodding, to
show engagement and active listening.
i. Intimate distance: This is the closest distance used for communication, typically ranging from 0 to 18
inches. This distance is used for intimate or confidential conversations.
ii. Personal distance: This ranges from 18 inches to 4 feet and is used for conversations with family,
friends, and acquaintances.
iii. Social distance: This ranges from 4 to 12 feet and is used for formal or business communication.
iv. Public distance: This ranges from 12 feet and beyond and is used for public speaking or lecturing.
20. Understand steps to take to establish a nonthreatening psychical environment for nurse and
patient during an interview.
Establishing a nonthreatening physical environment for the nurse and patient during an
interview is an important step in building a therapeutic relationship. The following are steps that
can be taken to achieve this:
Choose a private and quiet location for the interview to take place.
Ensure that the lighting is appropriate and that the room is comfortable for both the patient and
the nurse.
Make sure that the seating arrangement is appropriate and conducive to the therapeutic process.
For example, the nurse and patient should be facing each other at a comfortable distance.
Minimize distractions in the environment. For example, turn off any unnecessary electronic
devices or equipment.
Ensure that the patient's privacy is respected at all times. For example, make sure that the door
is closed and that other people cannot overhear the conversation.
21. Discuss tactics to avoid during the patient interview.
nterrupting the patient: Nurses should avoid interrupting the patient while they are speaking,
as this can cause the patient to feel rushed and not fully heard.
Asking leading questions: Nurses should avoid asking leading questions, which are questions
that suggest a particular answer. Instead, open-ended questions should be used to allow the
patient to express their thoughts and feelings.
Using medical jargon: Nurses should avoid using medical jargon that the patient may not
understand. Instead, they should use language that is easily understandable to the patient.
Being judgmental: Nurses should avoid being judgmental of the patient, their experiences, or
their feelings. A non-judgmental attitude will help the patient feel comfortable and more
willing to open up.
Being defensive: Nurses should avoid being defensive if the patient expresses dissatisfaction
or frustration with their care. Instead, they should listen to the patient's concerns and work
to find a solution.
Dominating the conversation: Nurses should avoid dominating the conversation and allow
the patient to speak as much as they need to. The nurse's role is to listen and guide the
conversation, not to control it.
22. Discuss common patient behaviors and nurse responses.
Common patient behaviors in a mental health setting can include resistance, denial,
aggression, withdrawal, and noncompliance. It is important for the nurse to respond in a
therapeutic manner that promotes trust and collaboration.
For example, if a patient is exhibiting resistance or denial, the nurse may try to explore the
reasons behind the resistance and validate the patient's feelings. If a patient becomes
aggressive, the nurse should prioritize safety and de-escalate the situation by remaining calm
and using therapeutic communication techniques to redirect the patient's behavior. If a
patient withdraws or becomes noncompliant, the nurse may try to explore the reasons
behind the behavior and address any concerns or fears the patient may have.
It is important for the nurse to avoid responding in a confrontational or dismissive manner,
which can further exacerbate the patient's behavior and damage the therapeutic
relationship. The nurse should always prioritize the patient's safety and well-being while also
promoting a collaborative and respectful relationship.
23. Understand subjective data gathered in a basic mental status examination
The subjective data gathered in a basic mental status examination includes information that
the patient verbally expresses about their current emotional state, behavior, and cognitive
abilities. Examples of subjective data gathered in a basic mental status examination may
include the patient's description of their mood, affect, thought processes, thought content,
perception, memory, and insight. The patient may also provide information about their past
psychiatric history, family history of mental illness, and any current or past substance abuse.
The subjective data is important in establishing a baseline for the patient's mental health
status and helps the nurse to identify areas of concern that may require further assessment
or intervention.
CHAPTER 10: TRAUMA AND STRESS-RELATED DISORDERS AND DISSOCIATIVE DISORDERS
1. Describe symptoms, interventions, and medications used for posttraumatic stress disorder
(PTSD)
Posttraumatic stress disorder (PTSD) is a mental health condition that can develop after an
individual experiences or witnesses a traumatic or life-threatening event. Symptoms of PTSD
include intrusive thoughts or memories of the event, avoidance of anything related to the
event, negative mood and thoughts, and hyperarousal or heightened startle response.
Interventions for PTSD include various forms of psychotherapy such as cognitive-behavioral
therapy (CBT), eye movement desensitization and reprocessing (EMDR), and prolonged
exposure therapy. These therapies help individuals process and confront their traumatic
memories in a safe and controlled environment. Support groups and self-help strategies such
as mindfulness, exercise, and stress reduction techniques can also be helpful.
Medications such as selective serotonin reuptake inhibitors (SSRIs) and serotoninnorepinephrine reuptake inhibitors (SNRIs) can be prescribed to manage symptoms of
depression, anxiety, and sleep disturbances associated with PTSD. Other medications, such as
antipsychotics and mood stabilizers, may be used in specific cases where an individual
experiences severe symptoms.
Selective serotonin reuptake inhibitors (SSRIs): sertraline (Zoloft), fluoxetine (Prozac), and
paroxetine (Paxil)
Serotonin-norepinephrine reuptake inhibitors (SNRIs): venlafaxine (Effexor) and duloxetine
(Cymbalta)
Atypical antipsychotics: risperidone (Risperdal) and quetiapine (Seroquel)
Benzodiazepines: clonazepam (Klonopin) and lorazepam (Ativan) may be used for short-term
relief of anxiety symptoms, but they are generally not recommended for long-term use due to
the risk of dependence.
Prazosin: is an alpha-blocker that is sometimes used for the treatment of PTSD, particularly for
patients who experience nightmares or other sleep disturbances.
2. Describe symptoms, interventions, and medications used for dissociative disorders
3.
Symptoms:
Depersonalization: feeling detached or disconnected from oneself
Derealization: feeling detached or disconnected from the surrounding environment
Dissociative amnesia: inability to remember important personal information
Dissociative identity disorder (DID): experiencing two or more distinct personality states, also
known as multiple personality disorder.
Interventions:
Psychotherapy: cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and
eye movement desensitization and reprocessing (EMDR) are types of psychotherapy that can
be effective for dissociative disorders.
Creative therapies: art therapy, music therapy, and dance/movement therapy can help
individuals with dissociative disorders express their emotions and improve their ability to
cope with symptoms.
Medications: there are no specific medications that treat dissociative disorders, but
antidepressants, antipsychotics, and anti-anxiety medications may be prescribed to manage
specific symptoms such as depression, anxiety, or sleep problems.
4. Describe interprofessional and teamwork and collaboration in providing care of patients with
PTSD and dissociative disorders
In providing care for patients with PTSD and dissociative disorders, the healthcare team must
work together to assess and manage the patient's symptoms, provide support, and develop
and implement a treatment plan. This plan may include medication management,
psychotherapy, and other interventions such as art therapy, cognitive-behavioral therapy, or
eye movement desensitization and reprocessing (EMDR).
The team must also work collaboratively to address any comorbid conditions, such as
depression or anxiety, that may be contributing to the patient's symptoms. This may involve
referral to other specialists, such as a primary care physician, endocrinologist, or neurologist,
as appropriate
5. Describe symptoms of secondary traumatic stress/compassion fatigue
Secondary traumatic stress (STS), also known as compassion fatigue, is a condition that occurs
in individuals who work with people who have experienced trauma. It is characterized by
symptoms similar to those experienced by individuals who have directly experienced trauma,
such as:
Intrusive thoughts or images related to the trauma of the patients
Avoidance of situations or people that remind them of the trauma
Hypervigilance, including irritability, anxiety, and difficulty sleeping
Emotional numbness or detachment
Feelings of hopelessness, helplessness, or a lack of purpose in life
Physical symptoms such as headaches, gastrointestinal problems, and fatigue.