1. PT20E Therapeutic Communications and Relationships PowerPoint #4

2. 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

3. Stages of TxNPR Orientation Stage Working Stage Termination Stage

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

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

6. Orientation stage Initiating conversations Non-confrontational

7. Orientation stage Establish a contract – Expectation – responsibilities

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

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

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

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

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

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

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

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 Orientation stage Providing structure: If the pt loses control – take temporary control If the patient is withdrawn – Spending time The major task of providing structure is – limit-setting

16. Orientation stage Crisis – Providing support – Managing emotions

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

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

19. Objective #24 List the steps in problem identification

20. Working Stage Observation: – Describe the problem

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

22. Working Stage Analysis: – Encourages accuracy in pts conclusions

23. Working Stage Interpretation: – Change is necessary – Explore solutions

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

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

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

27. Working Stage Evaluation – assess success

28. Working Stage Feedback – Constructive

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

30. Working Stage Reality testing: – Presenting another point of view

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

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

33. 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.”

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

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

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

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

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

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

40. Termination Stage Discussion of termination:

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

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

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

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

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

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

47. Course Objective #27 Relate the nursing process to psychiatric nursing

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

49. Nursing process in psychiatric nursing… Patient centered Individualized

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

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

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

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

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

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

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

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

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

59. Treatment Team Patient: – Participate

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

61. 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

62. Documentation Proof Law

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

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

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

66. SOAP Charting O: Objective Data: – Direct observation

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

68. SOAP Charting P: Plan: – Actions / treatments

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

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

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

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

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