PT20E Therapeutic Communications and Relationships PowerPoint #4

Course Objective #21 & 22 List the stages of the therapeutic P.T.—patient relationships. Identify and describe the major tasks of each stage of the P.T.—patient relationship

Stages of TxNPR Orientation Stage Working Stage Termination Stage

Orientation stage Establishing trust and rapport Nurses learns – Concerns Patient learns – Role of the nurse

Orientation stage Create an environment – Honest – consistent, – keeps promises Clear, specific communications Confidentiality explained

Orientation stage Initiating conversations Non-confrontational

Orientation stage Establish a contract – Expectation – responsibilities

Orientation stage Gather assessment information – intake interview Needs coping strategies defense mech. recurring thoughts, feelings, behaviors awareness of problems ability and motivation to change

Orientation stage Gather assessment information Defining goals – Prioritize Needs Coping strategies Defense mech. Recurring T, F, B Motivate to change

Orientation stage Management of emotions: – Fear of losing control – Feelings – Anger

Orientation stage Feelings natural – Expression Empathy – Not alone – Hope

Orientation stage Palliative coping mechanisms – Rest – Nutrition – Exercise – Meditation

Orientation Stage Teaching healthy ways to meet emotional needs – Coping skills – Challenging negative self-images

Orientation stage Providing support: – Realistic hope Abilities Strengths – Worth – Non-judgmental – Dependence  independent

Orientation stage Providing structure: If the pt loses control – take temporary control If the patient is withdrawn – Spending time The major task of providing structure is – limit-setting

Orientation stage Crisis – Providing support – Managing emotions

Working Stage AKA: – Learning Stage – Change Stage Problem-solving – Work toward change – Stabilization

Objective #23 Describe the following techniques that promote change in a patient in the working stage of the nurse-patient relationship.

Objective #24 List the steps in problem identification

Working Stage Observation: – Describe the problem

Working Stage Observation: – Describe the problem – “Participant Observer” Nurses relationship

Working Stage Analysis: – Encourages accuracy in pts conclusions

Working Stage Interpretation: – Change is necessary – Explore solutions

Working Stage Planning: – formulating a plan – assists pts to solve their own problems – Encourage short-term, realistic, achievable, daily goals

Working Stage Testing out: – Trying out new behavior or solution in a safe environment first – Rehearsal

Working Stage Role playing – Practicing behaviors – Nurse plays the role of persons with whom pts are difficulty assess communication & behavior

Working Stage Evaluation – assess success

Working Stage Feedback – Constructive

Working Stage In-depth data collection: – Increased knowledge – Priority issues

Working Stage Reality testing: – Presenting another point of view

Working Stage Cognitive restructuring: – Cope with negative thoughts  – more realistic conclusions redefine reinterpret change perception

Working Stage Supportive confrontation: – Challenging pt’s contradictions, – It challenges pts to Meet their own needs Be accountable for their own – Feelings – Behaviors – Decisions

Supportive Confrontation Example: Pt: “I went out drinking only once last week. At least I’m trying to change.” Nurse: “I can appreciate your effort, but you agreed to abstain from alcohol completely.”

Working Stage Writing/journaling: – Tool – Release emotions – Objective Letters

Working Stage Promoting change: – Pt. initiated change – Support Family & friends Groups – Motivated

Working Stage Teaching new skills: – Desire + Know how – Small steps – Practice – Feedback

Termination Stage Evaluation & summary of progress: – ID changes – Long-term goals – Strengths & weaknesses

Termination Stage Synthesizing what has occurred: – Progress – Indirect outcomes of TxPNR – Encouraged other relationships

Termination Stage Referrals: – ID community resources – Written d/c instructions

Termination Stage Discussion of termination:

Continuum of Care Definition: – levels of care through which a pt can move depending on needs at the time

Course objective #26 Compare and contrast transference and counter-transference

Transference (pt) Unconscious emotional reaction Patient  Nurse Based on past experiences

Transference (pt) Positive – if pts view the nurses as helpful and caring Negative – interfere with treatment

Countertransference (nurse) Unconscious emotional reactions – Nurse  patient – based on the nurse’s past experiences – sympathetic – unable to confront the pt appropriately

Interventions 1 st – Recognize 2 nd – Discuss – Gently & directly

Course Objective #27 Relate the nursing process to psychiatric nursing

What are the 5 steps of the nursing process? Assessment Diagnosis Planning Implementation Evaluation

Nursing process in psychiatric nursing… Patient centered Individualized

Course Objective #28 List key members for a psychiatric treatment team.

Treatment Team Psychiatrist: – MD – Specializes in psychiatry – Lead – Writes medical orders

Treatment Team Psychologist: – PhD in psychology – psychological testing – individual therapy

Psychiatric clinical nurse specialist RN+ Master ( ) I – G – F therapy Education

Treatment Team Clinical Social Worker: – D/C planning/placement – individual therapy – licensed

Treatment Team MFT’s: – Marriage and family therapists – Run groups – Individual therapy

Treatment Team Nursing Staff: – RN’s, LVN’s, PT’s: – manage the milieu – administer meds

Treatment Team Activity Therapists: – AKA: Recreational therapist – Leisure skill – Activity therapy groups

Treatment Team Occupational Therapists: – Training for work skills – ADL’s

Treatment Team Patient: – Participate

Encouraging Description of Perceptions Perceptions are unique so it is important to learn how each person perceives a feeling or interprets situations and events.

Course objective #29 & 30 Define and describe the following: Intake interview, Brief psychiatric rating scale, Nursing care plan, Process recording Define and give examples SOAP and narrative progress notes

Documentation Proof Law

Types of Documentation Progress Notes: – Assessing and analyzing communication skills, identifying pt themes, and evaluating the effectiveness of interventions

Types of Documentation S.O.A.P. Notes: – General narrative of basic nursing care provided to the pt

SOAP Charting S: Subjective Data: – What the pt says: “___” – Reported

SOAP Charting O: Objective Data: – Direct observation

SOAP Charting A: Assessment/Analysis: – interpretation – Conclusions – responses

SOAP Charting P: Plan: – Actions / treatments

Types of Documentation Problem-oriented Recording (POR) – description of a specific intervention, used for a specific problem and evaluates the pts response

P.I.E. Problem-oriented Charting P – Problem I – Intervention E – Evaluation

Types of Documentation Pt Care Plan: – Formal, written plan – Guides pt care Diagnosis Goals Interventions

Types of Documentation Special Procedures Documentation: – Interventions implemented – Timely – Expected level of care

Intake Interview Systematic Mental Status Exam (MSE) Assessments include: – Motivation to change – Coping strategies – Defense mechanisms – Recurring T, F, B’s