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Chapter 6 page1 FACTORS CONTIBUTING TO MENTAL ILLNESS

A. INDIVIDUAL:
Mental health nursing is a specialty of nursing that 1. Bio_____
focuses on __________, __________ and __________ individuals of 2. Anx____
ixteenth century: The mentally ill were locked up in jails, dungeons, or 3. Worr____
lunatic asylum where the curious could pay to watch the 4. Fea___
“performance” of the sick inmates. The harmless inmates were forced 5. Loss of mea______in one’s life.
to seek charity on the streets as beggars. distress. 6. Dishar______ in life.

I. Historical Perspective: B. INTERPERSONAL:

Prehistoric times: In the prehistoric times, mentally ill persons were 1. Ine_______ communication
treated by __________s. If this failed, they were left alone to die of 2. Excessive depen_______
starvation or to be attacked by wild __________. 3. With______ from relationship
4. L____ of emotional control
Greek and Roman Era: Their t______s were used to house mentally ill
persons that have fresh air, pure water and sunlight. Sometimes they CULTURAL AND SOCIAL:
were treated with kindness, while at times treatment was harsh and 1. Lack of reso_____
________. They were treated by bleeding and purging. 2. Viol____
3. Homele_____s
Middle ages: The treatment of the mentally ill was left to the 4. Pove____
__________ the superstitious beliefs flourished. They were flogged, 5. Discrim______
fettered scourged and starved in the belief that the devils that
_________ them could be driven out. PSYCHO_______Y: It is a systemic study of mental disorder.

Sixteenth century: The mentally ill were locked up in _______, PSY_____C N____SING: It is a process where in a nurse assist a
dungeons, or lunatic asylum where the curious could pay to watch the per__ , ind_____l, or in group to develop a posi____e selfconcept,
“performance” of the sick inmates. The harmless inmates were forced satisfying inter______l relationship and satisf______role in a
to ________ on the streets as beggars. society.

Seventeenth century: God and S _______ were still thought to be PSYCHOTHERAPEUTIC MANAGEMENT IN THE CONTINUUM OF
engaged in a battle for the ______ of one’s soul. The dungeons were CARE:
the only place where violent m_______ ill person could be
committed. P________ and bleeding was the favorite therapeutic A. THERAPEUTIC NURSE-PATIENT RELATIONSHIP:
procedures done. The w___p was religiously applied by the cell 1. Commun_______ skills:
keepers. 2. Men___ mecha____
3. Adapt_____ styles
N century: The most shocking to people of today was placing 4. Cop____ strategies
the p__r and the mildly demented on the a____n block, where those 5. Therap______ interv_____ skills.
with a strongest back and the weakest mind were sold to the highest
bidder. The returns of the sale are being kept in the town’s treasury. B. PSYCHOPHARMA______:
1. Therap_____ and the toxic effect.
D____hea D_x, a te___er raised money to b____d suitable hospital 2. Drug used during preg_____.
for mentally ill persons. The institution was designed to provide a 3. D____ used with the eld____.
h_______e environment that would also be s__e. And because of
4. Drug’s side e_____s.
the remote__ss of the setting the institution had to produce its own
food,… it provided meaningful activity, which increased their sense 5. Patient health t______
of s______ and group cohesiveness. Having n_ contact with the
outside world the patient adapted to their surroundings and their MILIEU MANAGEMENT:
roles in the hospital to the extent that they resisted returning to 1. Safe__
their homes. 2. Struc____
3. No___
20th century: O__rt change in the hospital system of m___l health 4. Setting li____s
care began. The go_____t believed that it was necessary to acquire 5. Balance between in_____ and dependence
more k_______e concerning the c_____, p______ and treatment of 6. Environmental modif_______.
mental illness and professionally trained workers were needed to
improve the care and treatment of the mentally ill persons.

MENTAL HEALTH: Is a “state of c_____e physical, m___ l, and s____l

wellness, not merely the absence of disease” The person is in a state
of e______l, physical, and social well-being fulfills life r________s,
function effectively in daily life, and are satisfied with their
inter______l relationships and to themselves.

MENTAL ILLNESS: Mental d_____r is a behavior or p______n that

occurs in an individual associated with present distress or with an
increased risk of suffering d__th, pain, d___bility or an important loss
of fr____om.
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Chapter 6 page 2
MOST COMMON ADOPTED PATIENT RIGHTS:
1. Right to treat____ using the least restri_____ alternative
environ____.
2. Right to confid________ of records.
3. Right to free____ from restr____ and secl____
4. Right to give or re___ consent to treatment.
5. Right to acce__ to personal belo_____.
6. Right to dai__ exer____.
7. Right to have vis____.
8. Right to use of writ___ materials and uncen____ mail.
9. Right to use of tele____.
10. Right to access cour__ and attorneys.
11. Right to employ____ compen______
12. Right to be infor___ of R____.
13. Right to ref__ ECT or p____osurgery.
RESTR______: It is a direct appli____ of physical force to a person
with or wit____ their permission with the use of a mecha____ device
to contr___ their physical activity.
SECLU____: It is an involun____ confinement or isol____ of a person.
NURSING RESPONSIBILITY OF A PSYCHIATRIC NURSE IN
RESTRAINING AND ISOLATING A PATIENT:
1. Document____ has to be justi___.
2. . Alterna_____ was consid____ and attempted.
3. It has to be ord____ by the physic___.
4. ____ the type of restr____ used.
5. Note the t___ and durat___.
6. Check the patient every 15 m___.
7. ____ every 2 hrs. for contin___ needs.
8. Offer fluid e___ hour.
9. Ex_____ patients li___ every 2 hrs.
10. Snacks and m____ are off___ to the patient.
11. Assi__ the pt. to the com____ room.
TYPES OF PSYCHIATRIC ADMISSION:
1. Vol____- the patient or guardian request for treatment and
willingly signed an application for treatment.
2. __voluntary- the patient refu___ to sign c____ and is involuntarily
detained for treatment.
3. Exten__- the patient is admit___ with unspeci____ period of time
MEMBERS OF THE MENTAL HEALTH CARE TEAM:
The health care team consists of health care professionals who have
their own special____:
1. Psychiatric nurse- a registered n___ that gives compre_____ care
to the patient.
2. Psychia___t- a physi____ is the lead_ of the team, ordering the
medica____ and making the medical diag____
3. Cli____ psychologist- a person invol__ in diagno___ and treat___
an emotionally person. They use a complex de___ to assist them in
diagnosing a patient. Which is called the “Rors____ test” that consist
of 10 pict____s of ink blots,5 bl_ck and w_ite, 3 bla_k and red,
2 m_lti-c_loured.
4. Psychia___ s_cial wor_r- a person skil__ in assess____ a family,
environ___, and social fac___ that can contri__ to the
dysfunct______ behavior of the individ___ and the family. They
pl_n and impl_ment foll_w up care for the patient.
5. Activ___ ther_pist- a skilled nurse who pr_v_des activities to a
sp_cific patient to ass___ their behavior
ROLES AND FUNCTIONS OF THE NURSE:
1. A cr_ator of a th_rapeut_c env_ronment
2. A sociali___ agent
3. A c_unselor (know pt feelings)
4. A t_acher
5. A s_rrogate (if pt. don’t know how to groom teach them)
6. A th_rapist
7. T_chnical nursing role (call)
NURSE’S RESPONSIBILITY: The nurse c_ring for a m_ntally ill
patient is exp__ted to kn_w and ant_cipate the v_arious types of
h_z_ards which may d_velop as a res___ of the ind_vidual
patient’s men__ status. The nurse can be held l_able if, in the
opinion of the court, the nurse was negli___ in pr_viding
protec___ and care c_nstituting preven___ against the
d_velopment of any situation inju___ to the patient. S_icide
attempts as well as acc_dental injuries, occurring in the hospital.
Duty to w___: To inf_rm health c_re team of any h_rm the
patient m_ght do/plan.
SELF AWAR________: It is the pr_cess by which the nurse g_ins
r_c_gnition of his own f_elings, b_liefs, and att_tudes. The nurse
must learn to acc___ the diff_r_nc_s among people and view the
patient as a w_rthwhile person regard____ of his opin__n or
l_f_style. Self-awareness can be accomplished through reflect___,
spending t_me f_cusing on how one feels, their v_lues and
b_liefs. The nurse needs to dis___ himself, what he b_lieves in
before trying to help others with d_ff_rent views. As a st_dent
nurse make sure p_rsonal f_elings and b_liefs do not int_rfere
with or h_nder the client’s c_re. As a psych_atric n_rse you need
to be prepared to make posit___ use of your o_n personality,
your primary tool as you work th_rapeut_cally with clients.
Psychotherapeutic therapeutic management in the continuity of
patient care.
A. Environment
S_f_ – avoid d_nger/harm
Str_ct_re – s_ttings and ward schedules
Setting l_m_ts – limitations in the ward
B_l_nce – __dependent and dependent beha__
M_d_f_cation – physical f__tures of the ward
N_rms – clients behavior
B. Therapeutic N-P relationship
C_mm_n_cation skills
C_p_ng strategies
Th_r_peutic int_rv_ntion
T_iad of Needs:
A. Phys_c_l – n_trition, cl_thing, sh_lter, exercise and
pr_tection from body h_rm.
B. Psych_l_gical – love, trust and affection.
C. . S_cial – feeling of being a member of a group and
feeling of being v_lued member of a family.
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Chapter 4 page 1
THEORETICAL MODELS
PSYCH_ANALYTIC MODEL: S. FR_UD
The theory s_pp_rts the n_tion that all h_man b_havior has a c_use
and can be expl_ined
TH_ORY OF P_RSONALITY:
1. ID: composed of the unt_med, unc_ltured pr_m_tive
drives and impulses of the person. Unc_ntrolled ID shows a
person who are ant_s_cial and l_wless.
2. EGO: the c_nscious s_lf that test and deals with r_ality.
It is also called as the m_derator. A person with
und_veloped ego will exp_rience interpersonal and
intr_personal conflict.
3. SUPEREGO: to be the cr_t_cal cens_ring portion of one’s
p_rsonality. It is referred often as the c_nscience because it
ch_cks the expr_ssion of s_cially un_cceptable id dr_ves and
imp_lses. Strong superego wherein the p_rsons l_fe is
dom_nated by its r_striction on behavior are inhibited,
unhappy and with lots of g_ilt.
FUNCTIONS OF EGO:
1. C_ntr_l and r_gulate inst_nctual dr_ves.
2. M_diate b_tween the id and s_perego.
3. R_ality t_sting evaluates and j_dge ext_rnal world.
4. St_re up exp_riences in “memory”.
5. D_rect mot_r act_vity and act_on
6. It s_lves problem.
7. Uses d_f_nse mechanism to pr_tect self.
LEVELS OF AWARENESS (freud)
1. C_NSCIOUS: p_rt of the m_nd that f_nction when a person is
aw_ke, caus_ng the individual to be aw_re of himself, his th_ughts,
f_elings, p_rception, and his env_ronment.
2. PR_CONSCIOUS: referred to as s_bc_nscious mind. It is situated
b_tween the c_nscious and unc_nscious portion of the ps_che. It
contains some p_rtly remembered, partly f_rgotten experiences
which can usually be r_called sp_ntaneously and v_luntarily.
3. UNC_NSCIOUS: The largest portion of the ps_che. It contains the
m_mories of one’s p_st life, particularly those unpl_asant and
em_tionally painful, stored away from the conscious awareness and
d_fficult to recall except under certain circumstances. It is also the
area of the mind in which a great deal of ind_pendent activity, of
which the individual is not aware. It is believed to function when the
person is asleep as well as when awake.
DEVELOPMENTAL STAGE: S. FREUD
1. ORAL: 0-18 m_nths (inf_ncy) Children are s_tisfied with the
use of their m_uth. D_pendent, eats, cries and bites.
2. ANAL: 18 months-3 yrs. (t_ddler) Ch_ldren are h_ppy thr_ugh
el_mination or r_tention of f_ces. Amb_valent, concern with
cl_anliness and b_ing dirty.
3. PH_LIC/OEDIPAL: 3-6 yrs. old (pr_school) Children seek
pl_asure through their g_nitals by h_lding it, er_tic att_chment to
p_rents of opp_site sex. Develop f_ar of punishment by parent of
same sex, g_ilt and s_xual identity.
4. L_TENCY: 6-12 yrs. old (sch_ol age) A child gains n_w skill in
s_cial rel_tionship, kn_wledge and is ind_strious. Learns to
c_ntrol aggr_ssiveness, destr_ctive behavior and acq_ire new
friends
5. G_NITAL: 12-20 yrs. old (ad_lescence and y_ung ad_lthood)
The s_xual pl_asure is through the g_nitals, r_sponsible for their
self, more ind_pendent. Develops s_xual identity, they learn to
l_ve and work.
ERIK. ERIKSON
The th_ory supports that d_velopmental st_ges have g_als. The
challenge in each stage is to resolve conflict.
DEVELOPMENTAL TASK (Erickson)
1. TR_ST v/s M_STRUST :0-18 months
Children learn to trust others and s_lf. v/s w_thdrawal
to str_ngers
2. A_TONOMY v/s SH_ME and DOUBT: 18 months-3yrs.
Children learn self control v/s compulsive compliance
or defiance.
3. IN_TIATIVE v/s G_ILT: 3-5 yrs. old C
Children learn to influence environment v/s fear of
doing wrong, lack of self confidence.
4. IND_STRY v/s INF_RIORITY: 6-12 yrs. old
Children learn to be creative and competent v/s
feeling of inadequacy
5. ID_NTITY v/s R_LE D_FFUSION: 12-20 yrs. old
Develop sense of self, planning for adult roles v/s
doubts relating to sexual identity, occupation and
career.
6. INT_MACY v/s IS_LATION: 18-25 yrs. old
D_velop int_mate rel_tionship with others and
c_mmitment to their career v/s av_oid a relationship
work and life-style.
7. G_NER_TIVITY v/s ST_GNATION: 21-45 yrs. old
They are pr_ductive, uses their t_me to g_ide next
g_neration. v/s lack of int_rest and concern with own
needs.
8. INT_GRITY v/s D_SPAIR: 45 yrs. to end of life.
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They believe that l_fe has been w_rthwhile v/s lack of
meaning to life and f_ar death
Chapter 4 page 2
ADULT BEHAVIORS REFLECTING MASTERY OF THE DEVELOPMENTAL
STAGE v/s THE ADULT BEHAVIOR REFLECTING BEHAVIORAL
PROBLEMS:
1. Tr_sting ones_lf and others, c_nfident, optimistic and sh_res with
others.
-V/S Suspicious, fear of criticism, withdrawal
-OR overtly trusting others and shares to quickly.
2. Has s_lf-control, will p_wer and c_operation.
-V/S Self-doubt, self-conscious, dependent on others, fears of being
attacked and jealous.
-OR excessive independent, denies problem, unwilling to ask for help,
impulsive, reckless and unable to wait.
3. Has an ad_quate c_nscience, curiosity, healthy competitiveness,
with sense of direction and appr_priate social behavior.
-V/S passivity, ap_thy, self-r_striction, excessive guilt and
embarrassment for action or mistakes, assuming role as a victim,
absence of sense of direction
-OR with good plans but l_cks follow up, little sense of g_ilt despite
actions, expansive expression of emotions and excessive
competitiveness.
4. Has sense of c_mpetence, cooperates, and inv_lves himself in
activities, balance of work and play.
-V/S feeling of unw_rthy, poor work history, inadequate problem-
solving skills, uncooperative and lack of friends of the same sex.
-OR overly h_gh achiev_ng, reluctant to try new things for fear of
failing, feeling of un_ble to gain love or affection unless totally
successful, perfectionist, workaholic and with little time for
recreation.
5. Has self-confidence, em_tionally stable, committed to his career,
with good relationship with the opposite sex, and a responsible
sexual behavior. Development of personal values and testing out
adult roles.
-V/S lack of beliefs, values, confidence, undecided, superficial short-
term relationship with the opposite sex
-OR dramatic over confidence, acting out behavior, alcohol and drug
use showy display of sex role behaviors.
6. Has the ability to give and receive love, committed, mutuality with
others of both sexes, sacrifices for others and with responsible sex
behavior.
-V/S isolates, distant to commitments, many carrier changes and
seeks intimacy through sexual encounter.
-OR imposing too much togetherness in opposite sex relationships.
Possessive, jealous, dependent on parents, to spouse or both. Abusive
to love ones
7. Has the ability to be productive, constructive, create an activity,
personal and professional growth. Societal and parental responsible.
V/S self-centered, exaggerated concern for appearance and
possession, lack of interest in the welfare of others, lack of
involvement in the community and lack of interest in marriage.
OR too many activities too little time for self and family
8. Has sense of dignity, worth, importance, self-acceptance,
adaptation to life according to limitations, values one’s life and shares
wisdom.
V/S helpless, hopeless. worthless, meaningless and loneliness.
Focusing on pass mistakes. Sense of being too old to start all over.
Suicidal ideas.
OR inability to reduce activity appropriately, overtaxing strength
and abilities, feeling in dispensable
THERAPEUTIC NURSE-CLIENT RELATIONSHIP:
H. PEPLAU
The theory supports that a th_rapeutic r_lationship is b_tween
the nurse and the client. The goal is to w_rk togeth_r to assist
client to gr_w and to res_lve problems.
THERAPEUTIC USE OF SELF AS A NURSE:
1. F_cus is on the cl_ents n_ed, but the nurse should also be
aw_re of his own n_eds.
THREE PHASES OF NURSE CLIENT RELATIONSHIP:
1. ORIENTATION PHASE: goal to develop trust
TASK:
A. Expl_in relationship to the client. Explain your r_le as his
nurse and his role as the client.
B. T_ll the client what is exp_cted from the r_lationship
and what can be d_ne for him.
C. Nurse expl_ins to the client when and where the future
meetings will take place.
D. Assess the client and d_velop a plan of care b_sed on his
d_agnosis.
E. Setting l_mitation or boundaries should be enforced
which will be beneficial to the client.
F. Explain the r_utines done in the hospital.
G. . Tell client that his c_operation is needed
2. WORKING PHASE: TASK: goal help client identify and resolve
his problem
A. The client’s pr_blems and n_eds are id_ntified and
explored. Rationale: To develop m_tual acc_ptance.
B. Therapeutic technique is to be employed.
Rationale: To reduce anx_ety.
C. The g_als set for the client are evaluated as work
proceeds. Rationale: To ch_nge as the treatment
pr_gresses.
3. TERMINATION PHASE: goal review what was learned in the
hospital and may transfer the knowledge to others
TASK:
A. Summarization of r_lationship and gr_wth in the nurse
and client.
B. Client may become anx_ous, h_stile, and w_thdrawn.
C. R_actions are discussed with the client. Spend time
l_stening and talk to the client to help him channel their
feeling to a more constructive activity.
FACTORS THAT DIMINISH THE NURSE-CLIENT RELATIONSHIP:
1. U_clear boundaries.
2. Feeling of s_mpathy and clients d_pendency.
3. N_n-acceptance and av_iding the client:
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Module 4 page 3

H_MAN N_ED MODEL:

A . MASLOW
B_sic needs of an individual has to be m_t first because this
d_minates the client’s behavior.

1. PHYS_OLOGIC N_EDS: oxygen, food, water, sleep and sex.

2. S_FETY N_EDS: security, protection and freedom from

anxiety.

3. L_VE and B_LONGING: freedom from loneliness.

4. EST_EM and R_COGNITION: freedom from sense of

worthlessness, inferiority, and helplessness.

5. S_LF-ACT_ALIZATION: self-fulfillment and creativity

P_RSONALITY T_MPERAMENT:
D. JUNG
… that the m_nner of inv_sting life en_rgy is distinguished in each
type.

1. EXTR_VERT: actively aggr_ssive, ambitious, uninhibited,

expresses feelings and relates to other person readily. This has
been linked to a manic-depressive disorder.

2. INTR_VERT: r_served, quiet, shy, serious, studious, limits

social relations and creative. This has been linked to a
schizophrenic disorder.
3.
4. AMB_VERT: possesses the characteristics of b_th equally.
Most persons manifest this type.
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5. Responding with w_rmth.

TYPES OF COMMUNICATION: 1. Verbal 2. Nonverbal

LEVELS OF COMMUNICATION: 1. Intrapersonal 2. Interpersonal
2. Public

CHARACTERISTIC OF SUCCESSFUL COMMUNICATION:

Chapter 3 (page 1) 1. F_edback
Therapeutic Communication 2. Appr_priateness
3. Eff_ciency
COMMUNICATION: 4. Fl_xibility
Communication involves the giving and receiving of information.
Three elements of communication: Over control - It is the fr_quent c_ecking and counterchecking of
1. the sender what the patient said during the interview.
2. the message
3. the receive. The sender creates the message and sends the Under control - It is when the patient does and say what he wants
message to a receiver or a listener who then decodes it. The to. They d_sregard the above characteristic of successful
receiver may now return a message to the initiator of the communication.
message.
BLOCKS TO COMMUNICATION:
1. Ch_nging the subject of conversation.
TH_RAP_UTIC C_MMUNICATION: 2. Stating one’s idea and p_rsonal op_nion.
An int_rpersonal interaction between the nurse and the patient which 3. Giving false or inappropriate r_assurances.
focuses on the specific needs of the patient 4. Jumping to c_nclusion or off_ring solution to patients
problem. 5. Making in_ppropriate use of medical or nursing
GOALS TO ACC_MPLISH IN USING A TH_RAPEUTIC knowledge
COMMUNICATION:
1. Est_blish a therapeutic N-P relationship. VERBAL COMMUNICATION SKILLS:
2. Id_ntify patients concern. (pt. centered) In a verbal communication, the nurse should use concrete
3. Ass___ patients p_rception of the problem. messages and not abstract messages. This will help us get
4. R_cognize the patients und_rlying needs. accurate information from the patient.
5. Guide the patient toward id_ntifying p_thways to a satisfying and
s_cially acc_ptable solution. CUES: This is a non verbal and verbal message that gives
us hint or suggestion from the patient.
Ov_rt cues: It is a cl_ar statement of what the
ESSENTIAL COMPONENTS OF THERAPEUTIC COMMUNICATION: patient intended to do.
C_vert cues: Vague or h_dden messages
1. Confidentiality 2. Self-disclosure 3. Privacy and respecting which the nurse needs to interpret
boundaries
How to promote privacy: NONVERBAL COMMUNICATION:
a. T_lk sl_wly 1. Facial expression
b. P_lling curtains a. Expr_ssive
c. St_ying in a q_iet room with wide space or outside when b. Imp_ssive
the weather is nice with suitable sites for interaction. c. Conf_sing
2. Body language
Pr_xemics – it is the study of the d_stance z_ne between a. Cl_se body position
two people communicating. b. Acc_pting body position
4 DISTANCE ZONE: (Invisible boundary)
a. Int_mate (0-18 in.) 3. Eye contact
b. P_rsonal (18-36 in.) a. V_sual learners are those who learn best by seeing things.
c. S_cial (4-12 ft.) b. A_ditory learners are those who learn best by hearing.
d. P_blic (12-25ft) c. K_nesthetic learners are those who best by doing things.

4.T_uch – it is a process of holding a person, to comfort and support 4. Vocal cues or paralanguage: refers to how something is said
them when it is permitted. rather than what is said.
TYPES OF TOUCH: This includes the:
a. f_nctional - professional volume (loudness)
b. S_cial - polite tone (quality)
c. . Fr_endship - warmth pitch (high/low)
d. L-ve - intimacy e. sexual - arousal intensity (strength/importance)
6. Act_ve l_stening and active observation emphasis (accent)
Note: avoid internal mind activity. speed and pause

ESSENTIAL INGREDIENTS TO FACILITATE COMMUNICATION: SPEECH PATTERNS:

1. Responding with emp_thy. 1. C_rcumst_ntiality - It is a speech with a long-winded
2. Responding with r_spect. description.
3. Responding with g_nuineness.
4. Responding with imm_diacy.
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2. Pr_ssured speech - It is a l_ng talking wherein the patient doesn’t
want to be X interrupted. Slowly and ceremonious delivery.
Chapter 3 (page 2)
UNDERSTANDING THE LEVELS OF MEANING:
As a nurse one of your responsibilities is to discover or understand
what the patient really wanted to impart. This is done by:
1. S_rface listening – It is hearing the act_al message.
2. D_pth listening – It is interpreting the unsp_ken action and words
of the patient.
What do you need to do in response to clients behavior:
Crying: St_y with the client: r_inforce that it is alr_ght to cry.
-Asks to keep a secret: A nurse CANNOT make such a 23. ACT_VE LIST_NING - assessment  Maintaining eye contact
promise.
-Leaving before the session is over: Inform the client you
will wait for him until his time is over. Never engage in conversation
with any client or nurse. When time is up, approach the client and
inform him about the next meeting
-Interruption during your time with a selected client keep your
contract with the selected client. Keeping it means that the session is
important.
-Suicidal/Elope Consider the seriousness of the situation, inform
the client about the harm that can happen and the need to be
reported.
-Client who says he does not want to talk: spend time
without talking. spend short, frequent periods of time with the client
-Client prolong the interview setting limits reinforce the
original contract
-NOTE: AVOID Double Bind Communication
Inconsistent AND incongruent
THERAPEUTIC COMMUNICATION TECHNIQUE
1. US_NG S_LENCE - assessment  Encouraging a client to talk by
waiting for the answer
2. ACC_PTING - assessment  Yes, I follow what you say
3. G_VING R_COGNITION  Good morning Mr. Tee, I notice that you
wear the new shirt
4. OFF_RING SELF - assessment  I will stay with you for a while
5. OFFERING G_NERAL LEADS - assessment  Tell me more about it.
Go on. And then?
6. G_VING BR_AD OPENING - assessment  What do you want to talk
about?
7. PL_CING THE EVENT IN TIME/S_QUENCING – nsg. diagnosis 
When did this happen?
8. M_KING OBS_RVATION – nsg. diagnosis  You appear nervous
when the doctor entered.
9. ENC_URAGING DESCRIPTION OF P_RCEPTION – nsg. diagnosis 
What are these voices telling you?
10. ENCOURAGING C_MPARISON – nsg. diagnosis  Has this ever
happened before
11. R_STATING - assessment  Patient: I can’t eat, it started
yesterday. Nurse: You have a poor appetite?
12. . R_FLECTING - implementation  Patient: I think I should go now.
Nurse: Do you think you should go now?
13. F_CUSING – nsg. diagnosis  Let us talk more about your family,
you were saying….
14. EXPL_RING  Tell me more about that. Would you describe it
fully?
15. G_VING INF_RMATION - planning  My purpose of being
here is. Or This medication is for
16. S_EKING CL_RIFICATON - assessment  I don’t think I
understand what you were saying
17. PR_SENTING R_ALITY – nsg. diagnosis  Your mother is
not here, I am your nurse Pedro
18. V_ICING D_UBT – nsg. diagnosis  That’s hard to
believe
19. SEEKING C_NSENSUAL V_LIDATION  Tell me if my
understanding agrees with yours
20. V_RBALIZING THE IMPL_ED - assessment  Patient: I cannot
talk to you or anyone else. It is a waste of time. Nurse: Do you
feel no one understands?
21. ENC_URAGING EV_LUATION -evaluation  Can you tell me
the reasons you do not want to be discharge?
22. S_GGESTING C_LLABORATION - planning  Perhaps you can
discuss this with your parents so that they will know how you
feel about it.
which encourage further communication
24. ASK_NG Q_ESTION - assessment  How did you feel when
you were visited by your family?
25. ENC_URAGING D_CISIONS -planning If that is your choices,
what would you prefer to do?
26. L_MIT S_TTING - implementation  Please stop now. If you
don’t I will ask you to leave and go to your room.
27. F_EDBACK - implementation  I see you consumed your
meal.
28. R_LE PLAYING - implementation  I will play as your sister
and tell me what you would say to her when you will meet her
tomorrow.
29. R_HEARSING - implementation  Supposing you will go in the
same place and see those people, how would you respond?
30. S_MMARIZING – nsg. diagnosis  During the past hour you
and I have discuss…
NON THERAPEUTIC COMMUNICATION
1. R_ASSURING  Don’t worry everything will be alright.
2. G_VING APPROVAL  That’s good…
3. R_JECTION  Let us not discuss that.
4. ADV_SING  I think you should or If I were you…
5. PR_BING  Come on, tell me more about your husband.
6. CH_LLENGING  If you are not crazy, how come you are in
the hospital.
7. T_STING  What day is today, do you know?
8. D_FENDING  For sure, no one here would lie to you.
9. R_QUESTING AN EXPL_ANATION  Why did you do that?
10. B_ELITTLING FEEL_NGS EXPRESSED  Patient: I wish I was
dead. Nurse: I know what you mean, I feel that way sometimes.
11. M_KING ST_REOTYPICAL COMMENT  It is for your own
good or I’m fine, how are you.
12. OV_RLOADING  What’s your name? I see you are busy. How
are you?
13. V_LUE J_DGMENTS  You should not do that. It’s wrong.
14. INC_NGRUENCE  I like to spend time with you, but the nurse
walks away.
15. UND_RLOADING  The patient asks but the nurse would just
keep quiet.
16. F_LSE ASS_RANCE  Just be calm and everything will be
alright.
17. F_CUSING ON SELF  I like the color of this shirt, it is fits to
my complexion.
18. CH_NGING THE S_BJECT  Patient: I am worried with the
result of my blood exam. Nurse: How are you related to that lady.
19. L_OKING TOO BUSY/IGNORING THE PATIENT  I have a lot
of things to do at present.
Chet
20. ARG_ING  I know I am right and you are wrong.
21. SH_WING A CLOSE P_STURE  Crossing of legs and arms on
chest.
22. M_KING Fz-LSE PROMISES  I will visit you tomorrow, but nurse
failed to.
23. D_SAPPROVING  That’s not the way how it is done.
24. L_UGHING N_RVOUSLY or inappropriately
1. S_cial relationship: this is initiated for the purpose of being
friendly, socializing, companionship and accomplishment of a
task. The basic needs are met in this relationship.
2. Int_mate relationship: this involves two people who are
emotionally committed, helping each other meet their needs. This
relationship has no place in a nurse-patient relationship.

-----------E N D--------- 3. Th_rapeutic relationship: this relationship focuses on the

patient needs, feelings and ideas.

CHAPTER 2 page1
SELF AWARENESS AND THERAPEUTIC USE OF SELF:
THE THERAPEUTIC NURSE-PATIENT RELATIONSHIP
The nurse who is confident is ready to establish a therapeutic
The most important skills a nurse can develop are the ability to relationship with the patient. Awareness of one’s strength,
develop and est_blish therapeutic r_lationship and c_mmunication feelings, beliefs values and limitations is a good start.
skills. A therapeutic nurse-patient relationship is a helping
relationship that is based on mutual trust and respect. The nurturing 1. V_lues: knowing what is right and wrong.
of faith and hope, being sensitive to self and others, assisting with the
gratification of the patients physical, emotional and spiritual needs 3 Steps of values clarification process:
through your knowledge and skills a. choosing - feeling of choosing the value that feels
right.
ELEMENTS INVOLVE IN A THERAPEUTIC RELATIONSHIP: b. prizing - considering, cherishing the right value.
1. Tr_st: this is built when the patient relies and feels confident to be c. acting - is when the person puts the value into
with the nurse. action.
a. Cons_stency- consistent in your own words and actions.
b. Cong_uency- this occurs when action and words match. Avoid 2. Beliefs: it is the idea that one holds to be true.
double-bind communication.
3. Attitude: a feeling of being optimistic and hopeful.
Trusting behaviors:
1. K_eping promises -----------E N D---------
2. Int_rest
3. H_nesty
4. Fr_endly
5. C_ring
6. Und_rstanding
7. Cons_stent
8. Appr_achable
9. List_ning
10. Tr_at patient as human being
11. S_ggest without telling
12. Pr_vide schedule of activities

2. G_nuine interest: when a nurse is comfortable with himself, knows

his limitation, strength and is focused, the patient will see you as a
true person.

3. Emp_thy: is the ability to listen to the patient, sensing the

importance of his problem without becoming emotionally involved.

4. Acc_ptance: the ability to tolerate the patient’s behavior no

matter how verbally offensive it might be

5. P_sitive regard: accepting the patient as a unique individual which

include his behavior, background and lifestyle. This implies respect to
your patient. Give care unconditionally and with nonjudgmental
attitude.

WAYS OF SHOWING RESPECT TO THE PATIENT:

1. Call them by their names.
2. Spend time with your patient.
3. Listening and responding to your patient.

TYPES OF RELATIONSHIP:
Chet
CHAPTER 8 page 1
TERMINOLOGY
Ab_se - excessive use of a substance that differs from societal norms.
Aff_ct - emotional range attached to ideas outwardly manifested.
Blunt - slow or dull.
Flat - absence or near absence of any signs of affective
expression.
Inappropriate - incongruent between the emotional feeling
Labile - unstable mood with rapid change.
Ag_tate - to excitement with severe motor restlessness.
Ak_thisia - motor restlessness generally expressed as the inability to
sit still.
Ak_nesia – absence of movement.
Al_gia - inability to speak.
Amb_valent – opposing feelings/emotions. (love and hate) Anhedonia
- feeling of no joy.
An_iety - feeling of apprehension or tension. (fear of the unknown)
Ap_thy - lack of feeling, interest, concern or emotion.
Ass_ciative l_oseness - disorganized thinking that jumps from one
idea to another with no evident relation between the
thoughts. (“cannot see the sky…oh my love…just asking…
mmm maybe tomorrow”
C_rcumstantiality - client eventually answers the question being
asked, but only after giving an excessive amount of unnecessary
details.
Nurse: “Where are you going for the weekend?”
Patient: “I feel like visiting my sister…I just remembered she
ask me a favor…a picnic maybe, in the beach, in hours it
gets crowded. That is why I don’t prefer in that place. So, I
decided instead to go to my brothers place a nice and big
house but now I prefer to stay in my own house.”)
Cl_ng association-rhyming of words (“I am reading a book, in a shady
nook, with the food I cooked”)
C_nfused - bewildered, unclear.
C_prolalia – repeating words socially unacceptable.
C_nf_bulation - unconscious filling of gaps in memory or untrue
experiences that a person believes but have no basis in
reality. Detailed fantasy. (Nurse: “How are you Tess?” (who
spent the day in her apartment) (Tess: “Well, I came from
my friends house who just arrived from Canada. She gave
me a lot of gifts, we ate out…it was a wonderful day. I will
be going with her when she goes back.”)
Cycl_thymia - mood swings of hypomania and depression.
Compulsion - repetitive behavior that a person is obliged to do to
decrease anxiety. Neologism – inventing new words which is
meaningful only to the person. (“I cannot stay with you cause you are
a nic-no-kets”)
D_pendence - a state where a drug user take or increases dose of a
drug in order to prevent the onset of symptoms or withdrawal.
D_sinhibited - a state in which a person is unable to suppress urges or
statement which is socially unacceptable.
Dis_rientation – disturbances in orientation of time, place or
person. D_sthymia – a 2 years chronic depressed mood
disturbances
D_lusion - fixed false beliefs that have no basis in reality.
P_ranoid – (“somebody is going to kill me”)
Gr_ndiose – false belief that one is powerful (“I am the
most handsome male in my class”)
R_ligious – (“The devil told me to do this”)
S_matic – (“I might get sick”) Ideas of reference – (“I
hurt my neighbor. The lady I saw in the television told
me to do it”
D_pression - a mood disorder characterized by sadness, despair,
apathy and discouragement.
D_nial - avoidance of disagreeable realities, refused to recognize.
Dysk_nesia – abnormal involuntary skeletal movement usually
producing a jerky motion.
Dyst_nia – ridigity of muscle that controls posture, gait and ocular
movement
Ech_lalia - repetition of words heard. Nurse: “Can you please
keep the door open.” Patient: “Can you please keep the door
open.”
Ech_praxia - repetitive, meaningless movement or imitating
others.
E_phoria - a subjective, exaggerated feeling of well-being
characterized by confidence, elation and assurance.
EPSE – Extra Pyr_midal side effects. A drug induced
parkinsonism. Exh_bitionism – display of body parts to attract
others.
F_ar – a response to objective threat/external. Fear of the known.
F_tishism – adoring something which serves as a substitute of the
original love object.
Fl_ght of ideas - flow of verbalization jumps from unrelated one
topic to another. There is a connection between some topics but
it is difficult to identify. (“What is today?…might not be taking a
bath…I will be cooking at home…the dog kept on barking… there
are flowers around me…the food for sure will be delicious)
G_it – manner of progression in walking
H_llucination - false sensory perception without external stimuli.
Visual: (seeing thing that are not there)
Auditory: (hearing voices which is not present)
Olfactory: (smelling things that does not exist)
T_ctile: (feeling touched but absence of stimuli)
G_statory: (experiencing taste in the absence of stimuli)
H_lplessness – incapable and powerless.
H_pelessness - despairing, no hope.
Hyp_rvigilant - alert to danger.
Hyp_mania – elevated state that is less intense than full mania.
Hyp_rsomnia – increased and prolonged sleeping.
Ins_mnia – inability to sleep or disrupted sleep patterns.
Ill_sion - misinterpretation of the real sensory stimulus. (Patient
insists a gray sock on the floor is a mouse)
L_bido – energy usually associated with sexual instinct.
L_cid intervals – patients reasoning and judgment appears to be
normal for a brief period.
Chet
M_lingering – deliberately pretends an illness or disability.
M_nia - a mood disorder characterized by irritability, elation and
hyperactivity.
M_sochism – gaining sexual pleasure from being physically hurt.
M_tism - refusal to speak.
T_c - involuntary, recurrent muscular spasm. Motor and vocal tics
W_rd s_lad - combining of words or phrases that do not have
connection & no sense. (I am fine….apple tree…books…toys for
sale…be okay)
W_rthlessness - having no value

Negativism – motiveless resistance to all instruction.

Oculogyric Crisis – eyes rolled back in a locked position.

Obsession - recurrent disturbing thoughts which is difficult to push
out of the mind.
Chapter 8 page 2
N_ologism – inventing new words which is meaningful only to the
person. (“I cannot stay with you cause you are a nic-no-kets”)

P_ranoid – extreme suspiciousness of others and their action.

P_ca – ingestion of non-edible food.
Ph-bia – exaggerated fear of non-dangerous object or situation.
P_stpartum depression – occurs 30 days or less in the postpartum
period.
Psych_motor r_tardation - slow speech and body movement.
Psych_sis - mental illness during which the patients lose contact with
reality and demonstrate bizarre behavior.
Ps_che – the mind.
Pr_mary gain – relieving anxiety by an individual to feel better.
S_condary gain – relieving anxiety with the help of others

P_rseveration - resistance to change the topic, verbally repeating of a

sentence.
N – How are you?
P - I am fine.
N – From, where are you?
P – I am fine. N – What is your name?
P – I am fine
Pr_occupied - engrossed.

R_ligiosity - preoccupied of or with religious idea or content.

R_silience - it is the capacity of the individual to move forward
despite psychosocial diversity or genetic vulnerability.

S_dism – gaining sexual pleasure by inflicting pain to the partner.

S_matic – adjective referring to the body
S_mnambulism – it is when a person sleepwalks.
St_reotype - persistent repetition of senseless act or words.
S_icide - a self-inflicted death. Sialorrhea – excessive drooling of saliva

Xerostomia – reduction of saliva

T_rdive Dysk_nesia (TD)– an irreversible neurologic disorder.

T_lerance - to increase amount of substance to achieve the same
effects.
Tr_nsference – unconscious emotional reaction to a current situation
that is actually based on previous experience.
C_untertransference – a reaction based on the nurses past
experience

Th_ught blocking - sudden cessation of thought in the middle of a

sentence, unable to continue the train of thought. (“ I am going to buy
a new bag.”………I forgot to say what is next)
Chet
5. Balance
6. Environmental modification

Democratic environment:
It is an environment involving the patient to participate in any
activities provided by the hospital,
which will help them use their judgment and help them know
their goals and limitations.

CHAPTER 6 page 1
THERAPEUTIC MILIEU

Th_rapeutic m_lieu:
It is a treatment environment managed in such a way that the
environment itself is therapeutic. And the major responsibility of a
nurse is to create and maintain it to be therapeutic
for the patient.
Purposes of therapeutic milieu:
1. To improve patient’s behavior.
2. Involve patient in decision making of unit.
3. Increase patient’s sense of autonomy.
4. Increase communication among patients and between patients and
staff.
5. Set structure of unit and behavioral limits.
6. Form a sense of community.
Role of the nurse in therapeutic milieu:
1. Involve patient in decision making.
2. Promote involvement of all staff.
3. Promote development of social skills of a patient.
4. Encourage sense of community in staff and patients.
The different therapist in a psychiatric setting:
1. O.T - focuses on vocational skills and ADL.
2. Educational therapist - continuing education for hospitalized
students with emotional and
behavioral problems.
3. Art therapist - assist the patient in analysing their expressive
works.
4. Musical therapist - focus on the expression of self through
music.
5. Psychodrama therapist - role playing therapist.
6. Recreational therapist - focus on remotivating the patient.
7. Play therapist - a therapist that observes the behavior of a
certain child.
8. Speech therapist - focus on patient with developmental
language disorder.
9. Nutritionist - nutritional counselor for patient with eating
disorder.
10. Auxiliary personnel - the volunteers who are in charge of the
housekeeping.

The goals of a therapeutic environment:

1. To increase patient’s self or personal worth and self-esteem.
2. To improve his skills to relate to others.
3. To help him work and be useful and live effectively in the
community.
4. Help him learn to trust others.

Characteristics of therapeutic environment:

1. Meet the patient’s physical needs.
2. Encourage the patient to express his needs, rights and opinion.
3. Protect the patient from injury to self and to others.
4. Let patient make the freedom to choose and make decision.
5. Maintain as structured environment which is flexible.
6. Staff and personnel should remain consistent.
7. Provide respect and dignity to the patient.
8. Continue assessing and evaluating patient’s progress. Modify
treatment and intervention if
needed.

Elements of therapeutic environment:

1. Safety
2. Unit structure
3. Norms
4. Limit setting