Chapter 5 MH

one of the most important skills a nurse can develop
crucial to success of interventions with clients requiring psychiatric care
rapport & trust = easier for them to listen to reccommendations

trust -> builds when client is confident in nurse -> shows integrity and reliability
genuine interest
empathy -> communicate understanding of client's feelings to client (walk w them through their journey)
acceptance -> accept client regardless of outbursts (put aside belief to take care of someome, no judgement)
positive regard -> unconditional nonjudgmental attitude (care about their wellbeing)

empathy

values (sense of right and wrong, code of conduct for living
beliefs
attitudes
cultural awareness (ask pt preferences)

use of aspects of personality, experience values, feelings, intelligence, needs, coping skills, perceptions to establish a relationship with clients

preconceptions
ways of observing, understanding client interactions

Empirical -> derived from nursing science, scientific research (case studies)
Personal -> personal experience
Ethical -> no harm to pt
Aesthetic -> art of nursing, putting aside "tasks" in order to focus on pt

unknowing -> understanding you (nurse) do not know exactly how they feel

the client with panic disorder begins to have an attack
panic attacks will raise pulse rate

the client's face shows the panic

Although the nurse's shift has ended, they remain with the client

Although the client shows outward signals now, the nurse has previously sense the client's jumpiness and subtle differences in the client's demeanor and behavior

purpose: friendship, socialization, comapnionship, or task accomplishment
sharing ideas; shifting roles; outcomes rarely assessed

emotional commitment of two persons
individual needs met; assistance with helping each other meet needs

focus on needs, experiences, feelings, ideas of client only
nurse's use of communication skills, personal strengths, understanding of human behavior
joint agreement on areas to work on; outcome evaluation (the pt wants)
nurse's level of self-awareness can benfit or hinder the relationship

Orientation
Working -> identification, exploitation
Termination

meeting nurse, client
establishment of roles (work on/ help with)
discussion of purposes, parameters of future meetings
identification of client's problems
clarification of exxpectations
nurse-ckuent contracts, confidentiality, self disclosure

when someone tells you their means and method to commit suicide

problem identification -> client identifies issues or concerns
exploitation -> examination of feelings and responses, development of better coping skills, more positive self-image, behavioral change, independ
possible transference and countertransference

you remind me of my sister and I hate her

overly friendly and comfortable with patient due to feeling
OR someone you don't like

begins when client's problems are resolved
ends when relationship is ended
client may feel termination as impending loss
clients often try to avoid termination

inappropriate boundaries (becomes social or intimate)
feelings of sympathy, encouraging client dependency
nonacceptance and avoidance -> they will do it regardless of what I do
warning signs of abuse of the nurse-client relationship

teacher
caregiver
advocate
parent surrogate

nurse's self-awareness: crucial to developing therapeutic relationships
compassion fatigue
helpful activities: values clarification, journaling, group discussions, reading