1
Q
What are the four phases of the therapeutic relationship?
A
- pre-interaction
- orientation
- working
- termination
2
Q
What is the pre-interaction phase?
A
- planning stage
- decide what you want to focus on during interview
- check pt chart and review data/pt hx
- explore your own biases/triggers
3
Q
What is the orientation phase?
A
- sets the tone for relationship
- clarifies the problem
- goal setting
- building trust and rapport
- discuss termination
4
Q
What is the working phase?
A
- exploring and understanding client’s thoughts and feelings
- discuss core issues
- take action to meet goals
5
Q
What is the termination phase?
A
- summarize
- begin closing down the interview
- new problems are not discussed
- if applicable, set up time to see client again
- thank client for sharing
6
Q
Purposes Psychiatric Interview
A
- teaching
- gathering info
- counselling
- assessing results of PNUR care
- planning care
7
Q
Goals of Psychiatric Interview:
A
- est sound engagement of patient/therapeutic alliance
- collect psychiatric and nursing assessment data
- develop ongoing, compassion understanding of the client
- develop assessment from which nursing dx can be made
- collaboratively address problems and set goals
- develop appropriate assessment/tx plan
- begin healing process by decreasing anxiety and pain
- provide hope and ensure client will return for next appointment
8
Q
PNUR Conceptual Framework:
A
Physiological variable: physical wellness/illness
Psychological variable: self-esteem, emotional state, cognition
Developmental variable: client’s age and stage of life
Sociocultural: cultural affiliations, social support systems
- spiritual variable: purpose and meaning in life
9
Q
Legal rights and client confidentiality
A
- confidentiality guided by ethics and legal legislation
- FIPPA: can share info with HC team
- can breach if client intends to harm self or others, emergency situations, child or elder abuse, judge/court order
10
Q
What is warmth? How does an RPN convey warmth?
A
- attribute that RPNS convey to clients demonstrating caring
- sense of welcoming, enhances closeness, can ease client anxiety
- can be displayed entirely thru non-verbal communication
- SOLER
11
Q
What does S.O.L.E.R stand for?
A
S: face client squarely
O: open posture
L: leaning towards
E: eye contact
R: relax posture, avoid fidgeting
12
Q
What is genuiness? How can an RPN convey genuineness?
A
- conveys sincerity and honesty, appreciation
- suggests the clinician is at ease with self and client
- responsiveness, spontaneity, consistency
- “I” messages convey genuineness
- use empowering statements instead of accusatory
13
Q
What is respect? How does a RPN convey respect?
A
- sends message to clients that they are valuable, worthwhile, and important to us
- we work with a marginalized and vulnerable community, extra important
- appropriate eye contact
- ask client how they would like to be addressed
- ask for permission to sit
- show respect for belongings and their space
- give undivided attention, acknowledge the time you have available
- research any sociocultural and spiritual practices necessary
- advocate for client well-being
14
Q
What is tracking?
A
- ability of clinician to follow up client statements in a sensitive manner that are relevant to what is being discussed.
- important skill for being a good listener
- demonstrates use of Q’s that are pertinent to client’s emotional state
15
Q
What are professional boundaries? How are they maintained?
A
- avoids exploitation of client
- nurse does not unnecessarily self-disclose
- some clients will struggle with boundaries bc of illness; nurses who violate boundaries are misusing their power
- RPNS need to role-model boundaries
- they empower the client
16
Q
What is the importance of non-verbal communication?
A
- is constitutes about 90% of communication
- eye contact, gestures, expressions, body language
- RPNs must be aware of how they present non-verablly: genuineness
17
Q
What are displacement activities?
A
- non-verbal communications
- body movements that release tension
- hair twirling, nail picking/biting, any nervous habit
- indicates anxiety
18
Q
Non-verbal communication to avoid
A
- eye rolling
- talking over shoulder
- crossing legs or arm
- snapping gum/chewing w/ mouth open
- shifting eyes
- shifting back and forth
- engaged in other activities, like texting, during convo
- not making eye contact
19
Q
What is the importance of silence as a therapeutic tool?
A
- allows the client to fill the space
- gives time for therapist to reflect
- therapist appears more confident and composed
- forces you to listen carefully
- conveys acceptance
20
Q
Giving and receiving critical feedback:
A
- effective communication to minimize conflict and maximize group efficiency
- respectful, direct, courteous, caring
- leadership skills
21
Q
How do you give effective feedback? (9)
A
- keep goal in mind
- give positive feedback
- don’t avoid corrective feedback
- be specific
- focus on behaviour rather than traits
- indicate impact of behaviour on client
- provide hints for better performance
- be brief
- use dialogue
22
Q
Passive vs. aggressive vs. assertive communication styles
A
- non assertive behaviour may be passive or aggressive
23
Q
What is the importance of assertiveness?
A
- ability to communicate w/ colleagues and clients directly, confidently, non-judgementally
24
Q
How do you be assertive?
A
use a nonthreatening tone, respect others, use direct statements of feeling (“I” statements)
25
What is empathy? How does the RPN convey empathy?
- ability to recognize emotional perspective of another while maintaining your own perspective
- communicates we have listened
- involves active listening
- convey you heard the person and what they are telling you
26
Steps to help you convey empathy: (6)
1. clear head
2. focus on speaker
3. attend to clients thru verbal and non-verbal behaviour
4. "what does this person want me to hear?"
5. verbally reflect on speakers feelings and reason for them
6. check client's reaction to see if empathy was effective
27
What is blending? How does the RPN use this skill?
- behavioural and emotional cues that suggest engagement is effective
- the client and the clinician are getting along
- depends on clinician's skill and patient's psychopathology
28
What is engagement? How does the RPN use this skill?
- ongoing development of safety and respect
- client feels safe to share problems
- client is confident that nurse understands them
29
Styles of questions:
- open ended
- close ended
- gentle commands/indirect
30
What are open-ended questions?
- open to client interpretation
- gives them freedom to express
- who, what, where, when, how
31
What are gentle commands/indirect qs?
- clarifying
begins with words such as: tell me, describe for me
- can increase blending
- encourage client to respond more openly
32
What are close-ended questions?
- AKA direct qs
- used sparingly; limited usefulness
- elicit one or two word responses
- does it, can you, is, are you
- useful for factual info
33
Why avoid "Why?" questions?
- sounds judgemental
- client feels "interrogated/on the spot"
34
What is paraphrasing?
- restating message in own words
- shows you are trying to understand and are actively listening
- allows client to correct misunderstandings
- don't parrot back verbatim
35
What is summarizing?
- restating main points
- helps client see the big picture and prioritize their concerns
- can regain focus in interview when it seems stuck
- can be used at the end of a meeting to review discussion
- can be used at the beginning of session to provide focus
- can be used in middle of interview to re-focus a client
36
How does the RPN go about terminating the relationship?
- established 1st day; nurse explains length of time they will be working together
- identify and normalize feelings of anxiety
- reassure client of strengths and coping skills
- do not continue relationship outside professional setting
- leave client with hope
- thank client for sharing: respect and warmth
37
What is motivational interviewing?
- person centered, collaborative style of interacting
- empowering the client to help themselves
- not to be used with patients in acute stage of mania, psychosis, delirium
- useful for ambivalent clients, medication adherence, finding personal motivation
38
Four principles of motivational interviewing:
1. resist "righting reflex"; our nature to want to problem solve
2. understand and explore client's motivation to change
3. listen w/ empathy
4. empower the client
39
What is OARS in motivational interviewing?
- Open-ended questions
- Affirmations
- Reflecting
- Summarizing
40
What is the Stages of Change Model?
- based on the premise that ppl pass through a series of stages during change
- helps nurse individualize tx; match to current state
- client can bounce b/t any stage at any point in time; not 100% procedural
41
What are the phases in the Stages of Change Model?
1. pre-contemplation
2. contemplation
3. preparation
4. action
5. maintenance
6. relapse
7. begin again at some point in the model
42
What is pre-contemplation?
no intention of changing behavior
43
What is contemplation?
person still using substances but has opposing positive and negative feelings about their use
44
What is preparation?
person has decided to change, but has not yet begun
45
What is action?
Person has actively begun to change their substance using behaviour
PNUR 2121 TR
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