Psychiatric Nursing 4.

Termination: moving
(NORMAL) forward-›assess for regressive
behaviors (going back to the
Nurse-Client Relationship (2 way: give previous dev stage) >re-assess,
and take process) modify, re-evaluate
⁃ series of interaction between Therapeutic Communication
the nurse and the client
(consistency) ⁃ dynamic process of
exchanging information
⁃ GOAL: Positive behavioral
change ⁃ verbal and non verbal
Q1: When does the therapeutic Elements:
relationship begin? >orientation ⁃ Sender/Encoder: source of
Q2: The only tool available for the the message
nurse?->SELF (SELF AWARENESS) ⁃ Message: information being
transmitted
Elements of Therapeutic Nurse-Client ⁃ Receiver/Decoder: recipient
Relationship (TRUST) of the message
T-rust
⁃ Feedback: receiver's
R-apport
response
U-nconditional positive regard
***Barriers: factors that inhibits the
(acceptance)
communication process
S-et limits
T-herapeutic use of self (theracomm)
Non verbal communication
Q3: When is trust established?-
SHARING ⁃ proxemics: physical space
between the nurse and the
Therapeutic Behaviors client (3-6 ft)
1. Genuineness: sincerity and ⁃ kinetics: body movements
honesty (matter of fact/reality (gestures, facial expression
based) and mannerisms)
2. Concreteness: ability to ⁃ touch: intimate physical
identify client's feelings contact (consent) >conveys
3. Respect: consideration of the empathy
patient as a unique being ⁃ silence: conveys
listening/interest >encourages
Phases of Therapeutic Relationship the patient to talk
1. Pre-interaction/Pre-orientation: ⁃ paralanguage: "voice quality"
no contact, DATA: secondary
(tone, inflection, how the
sources, SELF AWARENESS
message is delivered)
2. Interaction/Orientation: establish
TRUST, assess the client, mutual
agreement (informing about
termination)
Verbal communication
3. Working: longest, achieving
-Effective: therapeutic, appropriate,
goals/sharing facts, resolve the
simple, adaptive, concise and credible
problems
 1. Offering self: Let me sit here - Exemption: Suicidal-›direct
with you for 5 minutes questioning
(realistic)
2. Active listening: ah huh, Spheres
yes, no 1. ID: pleasure principle,
3. Exploring: You said Hannah irrational (primitive instincts) >
was the best, can you increase in id can lead to
describe her? antisocial personality
4. Broad openings: Where disorders
would you like to begin... 2. EGO: reality based, SANITY
5. Making observations: I 3. SUPER EGO: conscience,
noticed you have combed EGO IDEAL > increase se
your hair today can lead to OCPD
6. Summarizing: In the past 15
minutes we have talked DEFENSE MECHANISMS
about... Note: illusion (with 1. Repression - unconsciously
stimuli) hallucinations (without forgetting (di sadya) due to traumatic
stimuli) events
7. Encouraging description of 2. Suppression- consciously forgetting
perception: What are the (sadya) for example utang
voices telling you? - content 3. Reaction formation - plastic
8. Presenting reality: I know 4. Rationalization - reasoning
that the voices seem real to out/making excuses
you, but there are no voices 5. Projection - blaming others
here. 6. Introjection - blaming self/exact
9. Seeking clarification: Do replica
you mean... 7. Identification- idolization/certain
10. Reflecting features lang ang ginaya (hairstyle,
11. Restating: Rephrasing (Pt: I clothes and so on…)
feel down... Nurse: Are you 8. Compensation - weak on one
depressed?) aspect, strong on another aspect
12. General leads: Go on.../tell 9. Denial - unacceptance of the truth
me more... 10. Displacement - channeling of
13. Focusing: Let us look at it anxiety (pinagalitan ka so nagdabog
more closely... ka)
11. Regression- going back to the
Non Therapeutic Communication previous developmental stage
- giving advise 12. Undoing - hugas kamay, relieve
- talking about self (client centered) guilt feelings
13. Conversion - anxiety convert to
- telling the client is wrong- physical symptoms
>dispute>argument->loss of trust 14. Intellectualization - reasoning with
- FALSE REASSURANCE detailed references/talking without
- Asking WHY-›demands an emotions
answer-›arouses deep seated 15. Substitution - unavailable
feelings gagawing available
16. Sublimation- unacceptable 6. Flight of ideas - slightly related,
gagawing acceptable (mahilig kang with meaning
manuntok so sumali ka sa boxing 7. Loose associations - not related,
para keri lang manakit) without meaning
8. Perseveration - persevere one topic
Crisis only
1. Maturational or developmental - 9. Echolalia - parrot like imitation
predictable/expected 10. Palilalia - repetition of stereotyped
2. Situational - words (first words, last syllable)
unpredictable/unexpected 11. Verbigeration - repetition of the
3. Adventitious or social - acts of same words over and over again
God/calamities, hideous crimes 12. Coprolalia - copro means feces;
lalia means logic/speech, shit talking
Stages of Death and Dying laging nagmumura
Denial/shock/disbelief: unacceptance 13. Neologism - new words (skibidi)
of the truth 14. Blocking - sudden cessation of
Anger: project/introject thought ( mental block)
Bargaining: making unrealistic offers 15. Word salad - mixture of unrelated
Depression: dangerous stage, prone to words
suicidal (safety), hopeless, loss of 16. Clang associations - rhyming
interaction with others
Acceptance: moving forward Disturbances in Perception
1. Delusions - fixed false beliefs
Disturbances in Appearance 2. Magical thinking
1. Automatisms - repeated 3. Paranoia - extreme suspiciousness
purposeless behaviors and distrust
2. Psychomotor retardation - slowed 4. Religiosity - obsession with
movements (depressed) religious ideas
3. Catatonia - maintenance of an 5. Phobia - irrational fear
awkward posture (ginalaw mo 6. Obsession - repetitive thoughts
babalik sa dating posisyon) 7. Compulsion - repetitive actions
4. Waxy flexibility - maintenance of an 8. Preoccupation - idea with intense
awkward posture (ginalaw mo desire
irrretain nya) 9. Thought broadcasting - others
5. Echopraxia - purposeless imitation know what I am thinking
10. Delusions of reference - talk of the
Disturbances in Communication town/main character
1. Mutism - mute
2. Negativism- always naka NO (form
of regression)
3. Circumstantiality - beating around
the bush (with answer)
4. Tangentiality - beating around the
bush (without answer)
5. Stilted language - flowery words