THERAPEUTIC COMMUNICATION TECHNIQUES TECHNIQUES Using silence Accepting EXAMPLES Yes Hh hmm I follow what you said Nodding

Good morning, Mr. S. You look nice today Ill sit with you a while Im interested in your comfort Is there something you would like to talk about? Where would you like to begin? Go on Tell me about it Was this before or after? When did this happen? You seem tense Are you uncomfortable when you. What is happening Tell me Was this something like? Have you had similar symptoms. Client: I cant sleep, I stay awake all night. Nurse: You have difficulty sleeping? Client: Do you think I should tell the doctor? Nurse: Do you think you should. This symptom seems worth discussing a little bit more. Tell me more about... Would you describe it more fully?

Giving Recognition Offering Self Giving Broad Openings Offering General Leads/Facilitation Placing the Event in Time or Sequence Making Observations Encouraging Description of Perception Encouraging Comparisons Restating Reflecting Focusing Exploring

Seeking Clarification

Im not sure that I follow.... What would you say is the main point of what you said? Isnt that unusual? Really? Tell me whether my understanding agrees with yours? Perhaps together we can figure this out. Have I got this straight? Youve said that During the past 15 minutes weve discussed.

Voicing Doubt Consensus Validation Collaboration Summarizing

TECHNIQUES FOR COMMUNICATING WITH ELDERLY CLIENTS I. Factors Influencing Communication with the Elderly Client Factors A. Anxiety: Many elderly clients may function continually at a high level of anxiety. Thus, the increased stress of a new situation may lead to intense arousal, impairing the elderly persons ability to communication effectively. B. Sensory Deprivation: Hearing loss is a widespread problem among the elderly. Its affects men more than women and occurs in some 30% of all elderly. Hearing loss is potentially the most difficult sensory loss for the elderly client. Although 80% of the elderly have fair to adequate vision, some visual problems may occur. C. Cautiousness: Older clients tend to make few errors of commission but are likely to make errors of omission. When taking a history, the nurse must be aware that elderly clients may omit important aspects of their illnesses. Elderly clients take longer to respond to inquires. D. Persistent Themes: The elderly client may concentrate on particular themes: Somatic Concerns: Clients may spend much time complaining of ailments or recounting detailed histories of bodily functions. At a time when friends and loved ones have died and sensory input is decreased, the body, in many ways, keeps the client company. It is, therefore quite usual for the elderly client to be somatically oriented. Loss Reactions: The elderly client may spend considerable time discussing the many losses experienced in later life. These include loss of friends and loved ones, loss of activities, and loss of self esteem. Life Review: There is tendency in the elderly to reflect and reminisce. This is a normal process brought about by disillusion and realization that death is approaching. Fear of Losing Control: Many elderly clients agonize over the loss of physical and mental functions, including physical strength, bowel and bladder control, motor functions, and especially, the ability to regulate ones thoughts and emotions. One of the greatest fears of late life is the fear of going crazy.

Death: The elderly are not, as a rule, obsessed with approaching death. It nevertheless, is a frequent topic of conservation. The major fear is of being alone at the end of life. Nurse Factors: A. Attitudes toward the Elderly: It is quite common to find fears of aging and death among members of our youth oriented society. The recognition of such fears and of the nurses personal feelings about these issues is of utmost importance in establishing effective communication with the elderly. B. Lack of Understand: The nurse must attempt to separate myths about aging from reality. For example, the labeling and stereotyping of the elderly may be a significant barrier to communication. The elderly are especially sensitive to being labeled senile, mentally ill, for hypochondriac. The nurse should try to empathize with the elderly client. Putting your self in the other persons shoes is an ability not easily taught by text books and can only be learned through personal experiences. II. Techniques of Effective Communication Approach the Elderly Client with Respect: The nurse should knock before entering the clients room and approach the client from the front. Greet the client by surname, (Mr. Smith, Mrs. Rose) rather than by given name (Johnny, Mary), unless the client wishes to be addressed by a given name. Position Yourself Near the Elderly Client: The nurse should be close enough to the client to be able to reach out and touch the client if desired. The most comfortable arrangement of chairs for both parities is at a 45 degree angle to each other. If possible, chairs should be the same height and the nurse should not stand or walk during the conservation. Speak Clearly and Slowly: The elderly client may have a hearing problem or may not understand a nurses accent. Clarity of speech and the use of simple sentences is most effective in communicating with an elderly client. Inquire Actively and Systematically into the Problem Presented: The nurse should inquire into common physical symptoms of later life (such as visual and auditory defects, falls, and weight loss) and typical psychosocial problems (death of a loved one, change in living arrangements, recent retirement, financial setback, feelings of decreased self esteem, hopelessness, and anxiety).

Pace the Interview: The elderly client must be give enough time to respond to the nurses questions. The elderly are not, as a rule, uncomfortable with silences, which give them an opportunity to formulate answers to questions, and to elaborate on certain points. A slow and relaxed pace in the interview will do much to decrease anxiety. Pay Attention to Nonverbal Communication: The nurse should be alert for changes in facial expression, gestures, postures, and touch as auxiliary methods of communication in the elderly. These nonverbal signs can provide considerable information about conditions such as depression or anxiety. Touch: Touch may also be an effective way to relax and make contact with the elderly client. As a rule, the elderly are less inhibited about physical touch. Holding the clients hand or resting your hand on his arm may be very reassuring. Be Realistic but Hopeful: Nurses who work with the elderly often deny the problems of later life. But neither the client nor the nurse believe phrases like Youll live to be a hundred, or Its nothing to worry about, and the nurse should avoid using them. The nurse should never abandon all hope for an elderly client, but should work in the here and now. Avoiding unrealistic expectations, three pain free days may be most rewarding to the client dying of cancer, a fact too often overlooked.

TOPIC: Age Group Toddlers

TECHNIQUES FOR COMMUNICATING WITH CHILDREN Characteristics Limited vocabulary & verbal skills Communication Techniques Make explanations brief and clear. Use childs own vocabulary words for basic are activities (urinate = pee pee, tinkle), learn and use self name of child. Get to know child first before approaching child. Show you can be a friend with mommy. Rephrase childs message in a simple complete sentence: avoid baby talk. Allow ambulation when possible. Put child in a wagon if child is not mobile. Allow child some control. Reassure child if he or she displays some regressive behavior. (Example: If child wets his pants, say, We will get a dry pair of pants and lets find something fun to do). Allow child to express anger and to protest about his care (Example: Say its OK to cry when you are angry or hurt). Allow to sit up or walk, as often as possible and as soon as possible after intrusive or hurtful procedures, say, Its all over and we can do something more fun). Show hands (free of hurtful items) and say. There is nothing to hurt you. I came to play/talk. Allow child to be self oriented and accepted. Use distraction if another child wants the same item or toy rather than expect child to share. Use non-directive approach. Sit down and join the parallel play of child. Accept protesting when parents leave. Hug, rock the child, and say You miss mommy and daddy, They miss you too. Use simple vocabulary; avoid lengthy explanations. Focus on the present. Use play therapy and drawings. Use some eye contact. Sit or stoop and use slow, soft tone of voice. Use play therapy. Use sensory data. Use music.

Speaks in phases Kinesthetic Struggling with issues of autonomy and control

Fear of Bodily Injury Egocentrism

Direct Questions Separation Anxiety Preschoolers Speaks in sentences but unable to comprehend abstract ideas. Unable to tolerate direct eye to eye contact. Short attention span and imaginative stage

Concrete sense of humor Need for control School Age

Early Adolescent

Tell corny jokes and laugh with child Provide for many choices. Do you want to get dressed now or after breakfast? Developing ability to Include child in concrete explanations comprehend about condition, treatment, protocols. Use draw a person. Use sensory information in giving explanations. Increased responsibility for Reinforce basic care activities in health care. teaching. Increased need for privacy. Respect privacy; knock on door before entering room: tell client when and for what reasons you will need to return to his/her room. Increased comprehension Verbalize issues about treatment about possible negative protocols requiring giving up immediate threats to life or body gratification for long term gain. Explore integrity, yet some difficulty alternative options. in adhering to long term goals. Confidentiality Struggling to establish identify and be independent Beginning to demonstrate abstract thinking. Uses colloquial language Sexual Awareness and maturation Reassure about confidentiality of your discussion, but clearly state limits of confidentially. Allow participation in decision making. Actively listen. Accept regression. Avoid judgmental approach. Use clarifying and qualifying approach. Use abstract thinking, but look for nonverbal clues that indicate lack of understanding. Touch your dialogue with the use of some of clients own words. Offer self and willingness to listen. Provide value free, accurate information.

Example of a Therapeutic Conversation Expressing Empathy

Client: I can't believe the terrible job I did on that project. Clinician: You seem too feel a deep sense of shame about your project. Client: Yes, I do feel ashamed. I just always screw things up.

Clinician: You're sounding really frustrated with yourself. Client: Yes, I am. I mean, it's not just at my job. I screwed up my relationship with my son. I screwed up my exercise program by stopping only two weeks into it. Clinician: You're blaming yourself for all those things. Help me understand that better. I wonder if you ever feel like you screwed things up in our work together. Client: Yes, I did. Remember when I called you at home when my sister had hurt herself again and was admitted to the hospital? I was so upset and really felt like I needed to talk to you even though it was not a scheduled appointment. Clinician: Sounds like you felt like that wasn't okay with me. I wonder how you thought I reacted to the call? Client: Well, you didn't sound annoyed. I remember you tried to help me. Still, I felt I had done a stupid thing.

Example of a Similar Conversation, Expressing Sympathy

In this example, instead of the therapeutic skill of empathy, the "clinician" expresses sympathy, which further entrenches the client in a downward spiral of bad feelings. This example is given to show the importance of empathy in the therapeutic alliance. Client: I can't believe the terrible job I did on that project. Clinician: I'm sorry you did so poorly. Client: Yes, I am too. I guess I just don't have a good work ethic. I should just accept that this job is above me. Clinician: That's really a shame. Client: Yes, I really needed this higher salary. My wife and kids are kind of depending on me. Clinician: How unfortunate that you might let them down like that. Empathy is an essential part of the therapeutic conversation. Sympathy, on the other hand, is not.

Example of a Therapeutic Conversation

Clinician: One thought you had was that your son was failing out of school. What led you to have that thought? Client: Well, he wouldn't show me his report card. It makes me think he failed something. Clinician: He may have. Does he have a history of failing classes? Client: No. He usually gets "As" and "Bs." Clinician: So this is the first time you have suspected that he may have failed a class? Client: Yes. Clinician: And what is your definition of "failing out of school?" Client: I guess it would be someone who has failed several classes so that the person was not asked back to the school. Clinician: And does that sound like your son? Client: No, I guess I overreacted when I said he was failing out of school. Clinician: And what about your thought that you are to blame for his behavior? What led you to think that? Client: I'm his parent. Aren't I the biggest influence in his life? Clinician: Yes, your role certainly is an important one. How might you have encouraged your son to fail out of school? Client: I don't know what you mean. Clinician: I wonder if you have failed out of school yourself. Client: No, of course not. Clinician: Perhaps you condone failure, or didn't try to teach him that school success is important?

Client: No. Just the opposite. I have very strong feelings about the importance of education. I always tried to show my son by example how to succeed. Clinician: I'm confused, then, about how you may have caused him to fail. Client: I guess I was just feeling bad and wanted to find an explanation. But I can see that I certainly never taught him to fail.

Restating
Restating what the patient has said shows him that the nurse has listened to and understands what he has articulated. It may also give the patient a new perspective on his situation. Patient: "I won't ever be able to use this electric wheelchair!" Nurse: "You're concerned that you won't be able to use the devices on your new wheelchair." Healthcare Safety (CHSP) Certified Healthcare Safety Professional - Self-Study Course www.ibfcsm.org/chsp.php Sponsored Links

Open-Ended Question
In this scenario, the psychiatrist asks the patient an open-ended question to facilitate the opportunity for a broad response. As opposed to a closed-ended question, this type of communication avoids the perception of judgment and allows the patient to speak what is truly on his mind regarding the topic. Psychiatrist: "What kind of relationship did you have with your mother?" Patient: "She was horrible to me but good to my brother and I was the one who tried to please her." A closed-ended question may be non-therapeutic in this circumstance: Psychiatrist: "Did you have a good relationship with your mother?" Patient: "It was all right."

Stating Observations
The therapist may make an observation when he notices that the patient isn't talking about how he feels. This may help the patient verbalize his feelings, explains NurseReview.org. Therapist: "You seemed angry with your son today." Patient: "Yes, he really hurt my feelings by telling people that I'm crazy. Who does he think he is? I worked 12 hours a day putting him through school and now he treats me like this."

Acceptance
The doctor may use verbal and nonverbal cues to convey unconditional acceptance of the patient's feelings. This allows the patient to feel understood and comfortable to continue to explain her feelings. Not arguing with the patient's point of view gives her the opportunity to fully consider the issue without feeling defensive. Patient: "I am so disappointed that my husband put me in this nursing home." Doctor: "I understand." The doctor makes eye contact with the patient and nods his head. Patient: "I guess I can sort of understand it. His arthritis keeps him in a lot of pain, making it hard for him to take care of me."

Silence
Being silent gives the patient an opportunity to consider his thoughts, explains Michael Zychowicz, a Mount Saint Mary College faculty member. The psychologist shows the patient her support by sitting quietly with him as he collects his thoughts, fostering the therapeutic relationship. The psychiatrist is silent or says, "I will sit quietly with you; I can tell you have something serious on your mind." Therapeutic Technique 1. Offering Self

making self-available and showing interest and concern. I will walk with you

2. Active listening

paying close attention to what the patient is saying by observing both verbal and non-verbal cues. Maintaining eye contact and making verbal remarks to clarify and encourage further communication.

3. Exploring

Tell me more about your son

4. Giving broad openings

What do you want to talk about today?

5. Silence

Planned absence of verbal remarks to allow patient and nurse to think over what is being discussed and to say more.

6. Stating the observed

verbalizing what is observed in the patient to, for validation and to encourage discussion You sound angry

7. Encouraging comparisons

asking to describe similarities and differences among feelings, behaviors, and events. Can you tell me what makes you more comfortable, working by yourself or working as a member of a team?

8. Identifying themes

asking to identify recurring thoughts, feelings, and behaviors. When do you always feel the need to check the locks and doors?

9. Summarizing

reviewing the main points of discussions and making appropriate conclusions. During this meeting, we discussed about what you will do when you feel the urge to hurt your self again and this include

10. Placing the event in time or sequence

asking for relationship among events. When do you begin to experience this ticks? Before or after you entered grade school?

11. Voicing doubt

voicing uncertainty about the reality of patients statements, perceptions and conclusions. I find it hard to believe

12. Encouraging descriptions of perceptions

asking the patients to describe feelings, perceptions and views of their situations. What are these voices telling you to do?

13. Presenting reality or confronting

stating what is real and what is not without arguing with the patient. I know you hear these voices but I do not hear them. I am Lhynnelli, your nurse, and this is a hospital and not a beach resort.

14. Seeking clarification

asking patient to restate, elaborate, or give examples of ideas or feelings to seek clarification of what is unclear. I am not familiar with your work, can you describe it further for me. I dont think I understand what you are saying.

15. Verbalizing the implied

rephrasing patients words to highlight an underlying message to clarify statements. Patient: I wont be bothering you anymore soon. Nurse: Are you thinking of killing yourself?

16. Reflecting

throwing back the patients statement in a form of question helps the patient identify feelings. Patient: I think I should leave now. Nurse: Do you think you should leave now?

17. Restating

repeating the exact words of patients to remind them of what they said and to let them know they are heard. Patient: I cant sleep. I stay awake all night. Nurse: You cant sleep at night?

18. General leads

using neutral expressions to encourage patients to continue talking. Go on You were saying

19. Asking question

using open-ended questions to achieve relevance and depth in discussion. How did you feel when the doctor told you that you are ready for discharge soon?

20. Empathy

recognizing and acknowledging patients feelings. Its hard to begin to live alone when you have been married for more than thirty years.

21. Focusing

pursuing a topic until its meaning or importance is clear. Let us talk more about your best friend in college You were saying

22. Interpreting

providing a view of the meaning or importance of something. Patient: I always take this towel wherever I go. Nurse: That towel must always be with you.

23. Encouraging evaluation

asking for patients views of the meaning or importance of something. What do you think led the court to commit you here? Can you tell me the reasons you dont want to be discharged?

24. Suggesting collaboration

offering to help patients solve problems. Perhaps you can discuss this with your children so they will know how you feel and what you want.

25. Encouraging goal setting

asking patient to decide on the type of change needed. What do you think about the things you have to change in your self?

26. Encouraging formulation of a plan of action

probing for step by step actions that will be needed. If you decide to leave home when your husband beat you again what will you do next?

27. Encouraging decisions

asking patients to make a choice among options. Given all these choices, what would you prefer to do.

28. Encouraging consideration of options

asking patients to consider the pros and cons of possible options. Have you thought of the possible effects of your decision to you and your family?

29. Giving information

providing information that will help patients make better choices. Nobody deserves to be beaten and there are people who can help and places to go when you do not feel safe at home anymore.

30. Limit setting

discouraging nonproductive feelings and behaviors, and encouraging productive ones. Please stop now. If you dont, I will ask you to leave the group and go to your room.

31. Supportive confrontation

acknowledging the difficulty in changing, but pushing for action. I understand. You feel rejected when your children sent you here but if you look at this way

32. Role playing

practicing behaviors for specific situations, both the nurse and patient play particular role. Ill play your mother, tell me exactly what would you say when we meet on Sunday.

33. Rehearsing

asking the patient for a verbal description of what will be said or done in a particular situation. Supposing you meet these people again, how would you respond to them when they ask you to join them for a drink?.

34. Feedback

pointing out specific behaviors and giving impressions of reactions. I see you combed your hair today.

35. Encouraging evaluation

asking patients to evaluate their actions and their outcomes. What did you feel after participating in the group therapy?.

36. Reinforcement

giving feedback on positive behaviors. Everyone was able to give their options when we talked one by one and each of waited patiently for our turn to speak.

Avoid pitfalls: 1. Giving advise 2. Talking about your self 3. Telling client is wrong 4. Entering into hallucinations and delusions of client 5. False reassurance 6. Clich 7. Giving approval 8. Asking WHY? 9. Changing subject 10. Defending doctors and other health team members. Non-therapeutic Technique 1. Overloading

talking rapidly, changing subjects too often, and asking for more information than can be absorbed at one time. Whats your name? I see you like sports. Where do you live?

2. Value Judgments

giving ones own opinion, evaluating, moralizing or implying ones values by using words such as nice, bad, right, wrong, should and ought. You shouldnt do that, its wrong.

3. Incongruence

sending verbal and non-verbal messages that contradict one another. The nurse tells the patient Id like to spend time with you and then walks away.

4. Underloading

remaining silent and unresponsive, not picking up cues, and failing to give feedback. The patient ask the nurse, simply walks away.

5. False reassurance/ agreement

Using clich to reassure client. Its going to be alright.

6. Invalidation

Ignoring or denying anothers presence, thoughts or feelings. Client: How are you? Nurse responds: I cant talk now. Im too busy.

7. Focusing on self

responding in a way that focuses attention to the nurse instead of the client. This sunshine is good for my roses. I have beautiful rose garden.

8. Changing the subject

introducing new topic inappropriately, a pattern that may indicate anxiety. The client is crying, when the nurse asks How many children do you have?

9. Giving advice

telling the client what to do, giving opinions or making decisions for the client, implies client cannot handle his or her own life decisions and that the nurse is accepting responsibility. If I were you Or it would be better if you do it this way

10. Internal validation

making an assumption about the meaning of someone elses behavior that is not validated by the other person (jumping into conclusion). The nurse sees a suicidal clients smiling and tells another nurse the patient is in good mood.

Other ineffective behaviors and responses: 1. Defending Your doctor is very good. 2. Requesting an explanation Why did you do that? 3. Reflecting You are not suppose to talk like that! 4. Literal responses If you feel empty then you should eat more. 5. Looking too busy. 6. Appearing uncomfortable in silence. 7. Being opinionated. 8. Avoiding sensitive topics 9. Arguing and telling the client is wrong 10. Having a closed posture-crossing arms on chest

11. Making false promises Ill make sure to call you when you get home. 12. Ignoring the patient I cant talk to you right now 13. Making sarcastic remarks 14. Laughing nervously 15. Showing disapproval You should not do those things. One of the most important skills of a nurse is developing the ability to establish a therapeutic relationship with clients. For interventions to be successful with clients in a psychiatric facility and in all nursing specialties it is crucial to build a therapeutic relationship. Crucial components are involved in establishing a therapeutic nurse-patient relationship and the communication within it which serves as the underpinning for treatment and success. It is essential for a nurse to know and understand these components as it explores the task that should be accomplish in a nurse-client relationship and the techniques that a nurse can utilize to do so. TRUST Without trust a nurse-client relationship would not be established and interventions wont be successful. For a client to develop trust, the nurse should exhibit the following behaviors:

Friendliness Caring Interest Understanding Consistency Treating the client as human being Suggesting without telling Approachability Listening Keeping promises Providing schedules of activities Honesty

GENUINE INTEREST Another essential factor to build a therapeutic nurse-client relationship is showing a genuine interest to the client. For the nurse to do this, he or she should be open, honest and display a congruent behavior. Congruence only occurs when the nurses words matches with her actions. EMPATHY For a nurse to be successful in dealing with clients it is very essential that she empathize with the client. Empathy is the nurses ability to perceive the meanings and feelings of the client and communicate that understanding to the client. It is simply being able to put

oneself in the clients shoes. However, it does not require that the nurse should have the same or exact experiences as of the patient. Empathy has been shown to positively influence client outcomes. When the nurse develops and utilizes this ability, clients tend to feel much better about themselves and more understood. Some people confuse empathizing with sympathizing. To establish a good nurse-patient relationship, the nurse should use empathy not sympathy. Sympathy is defined as the feelings of concern or compassion one shows for another. By sympathizing, the nurse projects his or her own concerns to the client, thus, inhibiting the clients expression of feelings. To better understand the difference between the two, lets take a look at the given example. Clients statement: I am so sad today. I just got the news that my father died yesterday. I should have been there, I feel so helpless. Nurses Sympathetic Response: I know how depressing that situation is. My father also died a month ago and until now I feel so sad every time I remember that incident. I know how bad that makes you feel. Nurses Empathetic Response: I see you are sad. How can I help you? When the nurse expresses sympathy for the client, the nurses feelings of sadness or even pity could influence the relationship and hinders the nurses abilities to focus on the clients needs. The emphasis is shifted from the clients to the nurses feelings thereby hindering the nurses ability to approach the clients needs in an objective manner. In dealing with clients their interest should be the nurses greatest concern. Thus, empathizing with them is the best technique as it acknowledges the feelings of the client and at the same time it allows a client to talk and express his or her emotions. Here a bond can be established that serves as a foundation for the nurse-client relationship.
Therapeutic Communication Techniques 1. Using silence Examples The client says: "We drink and smoke a lot here." The student thinkshow can that bedrinking alcohol in a state hospital? But says nothingusing silencethe client then says: "yes we drink a lot of cokes and smoke a lot." "Yes" or "I follow what you said"

2. Accepting

3. Giving Recognition 4. Offering self 5. Using Broad Openings

"I notice you combed your hair." "I'll sit with you awhile." "What would you like to talk about?" "Tell me what's bothering you."

6. Using General Leads (using neutral expressions to encourage continued talking by the client)

"Go on.

" Ummm..I am listening"

"Tell me about it" 7. Placing he event in time or sequence "Was this before or after?" "What seemed to lead up to?" 8. Making Observations "You appear tense" "I notice you are biting your lips." 9. Encouraging Description of Perceptions "What do you think is happening to you right now?" Client: "I can't sleep. I stay awake all night." Nurse: "You have difficulty sleeping" 11. Reflecting Patient: "Do you think I should tell the doctor?" Nurse: "Do you think you should tell the doctor?" 12. Focusing "This point seems worth looking at more closely." "You said something earlier that I want you to go back to." 13. Exploring 14. Giving Information 15. Seeking Clarification "Would you describe that more fully." "My name isI am a student nurse.." "What would you say is the main point of what you said?" "Your mother is not hereI am a nurse." Patient: "Did you bring my car today?" Nurse: "No, you do not have a car. I drove my car

10. Restating

16. Presenting Reality

here today." 17.. Voicing Doubt "That's hard to believe." "Really?" 18. Seeking Consensual Validation 19. Verbalizing the Implied 20. Encouraging Evaluation (asking for the client's view of the meaning or importance of something) 21. Attempting to Translate Into Feelings

"How important is it for you to change this behavior?" " From what you say, I suspect you are feeling relieved." "Let's see if we can figure this out.." " Let's see, so far you have said..." "What will it take to reach your goal of not hitting anyone?" "So what do you do each time you drink too much and it's time to go home?" What is the major feeling you have about all men?"

22. Suggested Collaboration 23. Summarizing 24. Encouraging Formulation of a Plan of Action

25. Identifying themes ..asking client to identify recurrent patterns in thoughts, feelings, and behaviors

Nursing Process in Psychiatric Nursing Mrs. Jyoti Beck, RN, RM,DPN RINPAS, Ranchi, India This page was last updated on March 8, 2011

Outline

Introduction Assessment Nursing Diagnosis Outcome Identification Planning Implementation Evaluation Components of Assessment Sample of Nursing Care Plan References

Introduction

The nursing process is an interactive, problem-solving process. It is systematic and individualized way to achieve outcome of nursing care. The nursing process respects the individuals autonomy and freedom to make decisions and be involved in nursing care. The nursing process is accepted by the nursing profession as a standard for providing ongoing nursing care that is adapted to individual client needs. The nurse and the patient emerge as partner in a relationship built on trust and directed toward maximising the patients strengths, maintaining integrity, and promoting adaptive response to stress. In dealing with psychiatric patients, the nursing process can present unique challenges. Emotional problems may be vague, not visible like many physiological disruptions. Emotional problems can also show different symptoms and arise from a number of causes. Similarly, past events may lead to very different form of present behaviours. Many psychiatric patients are unable to describe their problems. They may be highly withdrawn, highly anxious, ,or out of touch with reality. Their ability to participate in the problem solving process may also be limited if they see themselves as powerless.

Nursing process aims at individualized care to the patient and the care is adapted to patients unique needs. Nursing process the following steps;

Assessment

Mental Health Quiz ECT Quiz-I ECT Quiz-II EEG Quiz Antipsychotics Quiz Antidepressants Quiz Psychopharmacology QuizI Psychopharmacology QuizII Psychopharmacology QuizIII Psychopharmacology QuizIV Psychopathology Quiz -I Psychopathology Quiz -II Psychopathology Quiz III Psychopathology Quiz -IV Psychopathology Quiz-V Psychopathology Quiz-VI Psychopathology Quiz-VII Psychopathology Quiz-VIII Psychopathology Quiz-IX Psychopathology Quiz -X Psychiatric Nursing History Quiz-I

Psychiatric Nursing History Quiz-II

About Us l Privacy Policy l Ad Policy l Disclaimer

Hosted with support from AIPPG Copyright 2011@Current

The first use of convulsive therapy for the treatment of a psychiatric disorder in modern times is attributed to A. Ladislaus von Meduna B. A. E. Bennett C. Egas Moniz D. Kurt Schneider Answer Key 2. The first therapeutic use of electrically induced seizures in the treatment of mental disorders is related to A. Harold Sackeim B. Luigi Bini and Ugo Cerletti C. D. Goldman D. G. Holmberg and S. Thesieff Answer Key 3. The sequece of administration of medications in anesthesia for ECT is: A. Atropine---thiopentone/methohexitol---succinylcholine B. Succinylcholine---atropine---thiopentone/methohexitol C. Atracurium---succinylcholine---atropine D. Atropine--- succinylecholine---thiopentone/methohexitol Answer Key 4. As per the current evidence, which statement is NOT correct? A. Bilateral ECT is superior in efficacy to unilateral ECT. B. Unilateral ECT is more likely to cause cognitive deficits. C. Brief-pulse ECT delivery is associated with decreased cognitive deficits.

D. Unilateral ECT is administered to the non-dominant hemisphere Answer Key 5. Which of the following drugs is associated with lower seizure thresholds when administering ECT? A. Lithium B. Anticonvulsants C. Benzodiazepines D. Barbiturates Answer Key 6. What is the minimum seizure duration required for effectiveness of ECT? A. 1 to 3 seconds B. 5 to 10 seconds C. 30 to 90 seconds D. 180 to 200 seconds Answer Key 7. What is the best accepted placement of electrodes in unilateral ECT? A. Bifrontotemporal B. Paritotemporal C. Occipital D. D'Elia position Answer Key 8. What is considered as the gold standard for confirmation of seizure in ECT?

A. Cuff method B. Electroencephalography (EEG) C. Electromyogram (EMG) D. Galvanic Skin Response (GSR) Answer Key 9. What is the average mortality rate with ECT (modified)? A. 3-4 per 100,000 B. 10-25 per 100,000 C. 10-20 per 10,000 D. 50-60 per 1000,00 Answer Key 10. Factors predisposing to postictal confusional state include, all EXCEPT: A. Sine wave ECT B. High-dose ECT C. Existing CNS disease D. Multiple ECT E. A younger age group Answer Key 11. Which is the best unit for quantification of ECT stimuli? A. Millicoulombs (mC) B. Joules C. Watts D. Volt

Answer Key 12. Which of the following is NOT a recommended preparation for ECT procedure? A. Informed consent in writing B. Pre-ECT investigations C. Morning bath, cleaning the oil from the head, overnight fast D. Premedication with an anticholinergic agent E. Administration of an anticonvulsant 30 minutes before ECT Answer Key 13. The most common indication of ECT is: A. Schizophrenia B. Generalized Anxiety Disorder C. Manic episodes D. Major depression Answer Key 14. rTMS is found to have antidepressant properties when applied to A. Temporal parietal regions of the cortex B. Dorsolateral prefrontal cortex (DLPFC) C. Occipital cortex D. Parieto-occipital cortex Answer Key 15. The most persistent adverse effect of ECT is A. Retrograde amnesia

B. Fractures C. Seizures D. Hypertension Answer Key ANSWER KEY 1. A 6. C 11. A Reference 1. Andrade C. Electrical Aspects of ECT. in Handbook of Psychiatry by Bhugra D, Ranjith G, Patel V. Byword Viva Publishers, New Delhi, 2005. 2. Kaplan HI, Sadock BJ. Synopsis of Psychiatry , Behavioral Sciences/ Clinical Psychiatry. 9th ed. Hong Kong :William and Wilkinson Publishers ;1998. BACK TO TOP Back to Quiz Corner Home

2. B 7. D 12. E

3. A 8. B 13.D

4. B 9. A 14. B

5. A 10. E 15. A

ECT Quiz-I ECT Quiz-II EEG Quiz Psychopathology Quiz -I Psychopathology Quiz -II Psychopathology Quiz III Psychopathology Quiz -IV Psychopathology Quiz-V Psychopathology Quiz-VI

Psychopathology Quiz-VII Psychopathology Quiz-VIII Psychopathology Quiz-IX

About Us l Privacy Policy l Ad Policy l Disclaimer