1 2 3 4

PSYCHIATRIC NURSING

6 7

interpersonal process whereby the 9professional nurse practitioner through the 10therapeutic use of self, assists an 11individual,family, group or community to 12promote mental health, prevent mental illness 13and suffering, participate in the treatment and 14rehabilitation of the mentally ill and if necessary 15find meaning in these experiences (Joyce 16Travelbee)
17 18Mental 19 20 21 22 23 24 25 26 27 28

8The

Health Balance in a persons internal life and adaptation to reality. A state of well-being in which a person is able to cope with the normal stresses of daily life and realize his/her potential (WHO, 2005) Refers to the ability of people-couple, families and communities-to respond adaptively to internal and external stressors HYGIENE The science that deals with measures to promote mental health, prevent mental illness and suffering and facilitate rehabilitation of the client. ILL HEALTH

29MENTAL 30 31 32 33 34

35MENTAL

36 37 38 39 40 41 42 43 44 45 46

State of imbalance characterized by a disturbance in a persons thoughts, feelings and behavior. Poverty and abuse are the major factors that increase the risk of development of mental illness at home. A condition manifested by disorganization and impairment of function that arises from various causes such as psychological, neurobiological and genetic factors. AT RISK FOR MENTAL ILLNESS 1. With familial or genetic predisposition to mental illness 2. With poor access to health care 3. Disadvantages (homeless and poor) 4. Misusing substance/substance abuse 5. Undergoing lifestyle changes (pregnancy, adolescence) 6. Victims of violence 7. Elderly poor

47POPULATION 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64

PERSONALITY
Personality is a result of a persons genetic constitution, psychological development and culture. It can be changed and modified at any point in ones life.

65 66 67 68 69 70 71 72 73 74 75 76 77 78

The parent-child relationship is significant in an individuals personality development. Role modeling is the best way to teach children of healthy interpersonal relationships At around age 2, a persons personality initially emerges.

A mature personality is characterized by a balance PSYCHE between the ID, EGO & SUPEREGO (Sigmund Freuds Theory)

PSYCHOANALYTIC THEORY OF PERSONALITY

79

80 81 82

THREE COMPONENTS OF THE PERSONALITY

ID EGO
- partly unconsci ous, partly concious - reality principle - integrator of personali ty - balances the id and the superego

SUPER EGO
- unconscious

BASIS OF FUNCTION

- unconscious

MODE OF OPERATION

- pleasure principle - has no sense of right or wrong - demanding, impulsive - irrational, selfish - narcissistic - omnipotent - pleasureseeking

- morality principle - controls behavior - serves as a censoring force Two aspects: 1. conscience judge of what is right or wrong 2. ego ideal provides rewards

CHARACTERISTIC S

83 84

85 86 87 88 89 90 91

Type A and Type B personality theory

The Type A and Type B personality theory is a personality type theory that describes a pattern of behaviors that were once considered to be a risk factor for coronary heart disease.

92

TYPE

TYPE

Type A individuals can individuals, in Type B be described as contrast, are described impatient, time-

conscious, controlling, as patient, relaxed, and concerned about their easy-going, generally status, highly lacking an overriding competitive, sense of urgency. ambitious, businessBecause of these like, aggressive, characteristics, Type B having difficulty relaxing; andindividuals are often are sometimes disliked by described by Type As as individuals with Type apathetic and B personalities disengaged. There is for the way that they're also a Type AB mixed always rushing. They are often profile for people who highcannot achieving workaholics be clearly categorized. who multi-task, drive themselves with deadlines, and are unhappy about delays. Because of these characteristics, Type A individuals are often described as "stress junkies."
Symptoms of Type A Behavior 1. Time urgency and impatienc e, which causes irritation and exasperati on. 2. Free floating

hostility, which can be triggered by even minor incidents. 3. Competiti ve, this made them oriented towards achieveme nt which caused them to become stressed due to wanting to be the best at whatever it may be i.e. sports or in work.

93

94

95 96

97 98 99 100 101

MELANCHOLIC SANGUINE

CHOLERIC PHLEGMATIC

102 103

104 105 106 107 108 109 110 111 112 113 114 115 116 117 118

COPING MECHANISMS
One group of coping skills are coping mechanisms, defined as the skills used to reduce stress. In psychological terms, these are consciously used skills. Defense mechanisms are their unconscious counterpart. Overuse of coping mechanisms (such as avoiding problems or working obsessively) and defense mechanisms (such as denial and projection) may exacerbate one's problem rather than remedy it.

There are two primary styles of coping with 120problems such as stress.
119 121 122 123 124 125 126 127 128 129

1.

Action-based coping Action-based coping involves actually dealing with a problem that is causing stress. Examples can include getting a second job in the face of financial difficulties, or studying to prepare for exams. Examples of action-based coping include planning, suppression of

130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146Harmful 147 148 149 150 151 152 153 154 155 156 157 158 159

competing activities, confrontation, self-control, and restraint. Emotion-based coping Emotion-based coping skills reduce the symptoms of stress without addressing the source of the stress. Sleeping or discussing the stress with a friend are all emotion-based coping strategies. Other examples include denial, rationalization, repression, wishful thinking, distraction, relaxation, reappraisal, and humor. There are both positive and negative coping methods.

coping methods Some coping methods are more like habits than skills, and can be harmful. Overused, they may actually worsen one's condition. Alcohol, cocaine and other drugs may provide temporary escape from one's problems, but, with excess use, ultimately result in greater problems. Other less extreme cases involve skin biting, nail biting, and hair pulling.

160 161 162

DEFENSE MECHANISM

DEFENSE MECHANISM 1. Denial

DEFINITION
Arguing against an anxiety provoking stimuli by stating it doesn't exist Taking out

EXAMPLE
Denying that your physician's diagnosis of cancer is correct and seeking a second opinion Slamming a door instead of hitting as person, yelling at your spouse after an argument with your boss

2.

Displacement

3. Intellectualization impulses on a
less threatening target
4.

Rationalization

5.

Projection

6.

Reaction formation

Excessive reasoning to avoid feeling; focusing on the Details of a the thinking is funeral as disconnected opposed to the from feelings. sadness and An attempt to grief make unacceptable Stating that you feelings and were fired behavior because you acceptable by didn't kiss up the justifying the boss, when the behavior

7.

Regression

making excuses Transferring ones internal feelings, thoughts and unacceptable ideas and traits to someone else Acting out behaviors opposite to what one really feels Returning to a previous stage of development to deal with anxiety

real reason was your poor performance When losing an argument, you state "You're just stupid

8. Fixation

9.

Sublimation

10. Repression

11. Suppression

Having a bias against a particular race or culture and then embracing that race or culture to the extreme Sitting in a corner and crying after hearing bad news; throwing a temper tantrum when you don't get your way A 7 year old child is continuously attached to a nursing bottle

12. Compensation

13. Conversion
Arrest of maturation at certain stages of development

14. Dissociation

Replacement of Sublimating your unacceptable aggressive

15. Isolation

16. Fantasy

17. Identification

18. Introjection

19. Symbolization

20. Undoing

21. Acting Out

need, attitude or emotion with impulses toward one more a career as a socially boxer; becoming acceptable. a surgeon because of your desire to cut; An unconscious lifting weights to process in release 'pent up' which the client energy blocks undesirable thoughts Unconsciously forgetting sexual The conscious, abuse from your childhood due to deliberate the trauma and forgetting of anxiety unacceptable or painful thoughts, ideas Trying to forget the low scores in and feelings the previous post Putting forth examinations extra effort to achieve in areas in which one An undersized has a real or young man imagined trains well in deficiency shooting Emotional problems are converted to physical symptoms

A young child who witnessed a crime became

blind

22. Altruism
Detachment of certain activities from normal consciousness which then function alone Response in which a person blocks feelings associated with an unpleasant experience Somnambulism (sleep walking), Fugue state (wandering with amnesia)

23. Anticipation

Jane talks about her spouses death with apathetic expression

Gratification by imaginary achievements and wishful thinking The unconscious modeling of one's self upon another person's character and

The BSN student imagines herself as successful and influential nurse in Europe.

An adolescent manifest his behavior to his idolized person over time although he is unaware that his behavior is similar to his idol.

behavior. Mary who idolized a movie star, who A type of committed identification in suicide, also committed which the suicide when individual she reached her incorporates the idols age traits or values of another into Gabby sends his self girlfriends a dozen of red roses to prove his love. Less threatening object is used to represent another After a fight, a man brings his wife out for a candle-light dinner An attempt to erase an act, thought, feeling or desire by engaging in a An employee behavior that is slams his boss face after having pleasing or an intense acceptable to argument. others or oneself Direct

expression of an unconscious wish or impulse in action, without conscious awareness of the emotion that drives that expressive behavior.

Participating in charity programs or volunteer works to aid the poor community.

Constructive service to others that brings pleasure and personal satisfaction

Hurley a graduating BSN student decides to study ahead the common concepts for the Board exam next year.

Realistic planning for future discomfort

163 164 165 166 167

168 169 170 171 172 173

MODELS OF CARE IN PSYCHIATRIC NURSING

FOCUS

ORK

APPLICATION

PY
Understanding on issues of importance to the client, the purpose of interaction, and the use of verbal and nonverbal techniques of communication

the sonal

Most forms of psychotherapy us Some also use various other forms o the written word, artwork, drama, na

lient or lems of

Nonverbal techniques include silenc expressions and respects for person Levels of Psychotherapy 1. Supportive therapy Allows the client to express alternatives and make deci environment It may be needed briefly or There is no plan to introduc coping, therapist reinforces mechanism 2. Reeducative therapy Involves learning new behaving

 The client explores alt systematic way, which req supportive therapy require The clients enter into c desired changes of behavi duration of meetings (can contract or stated as an inf Reeducative therapy in psychotherapy, reality ther restructuring and behavior 3. Reconstructive therapy Involves deep psychothera It may require 2 to 5 years o focuses on all aspects of th Emotional and cognitive re takes place.

RAPY:

SIS

study of human psychological functioning and behavior

A method of investigation of the thinks

e called a

A systematized set of theories a

A method of treatment of psych illness

Free association (also in Psycho

technique used in psychoanalysis a by Sigmund Freud's The use of free association was inten notions that a patient had developed unconscious level, including: 1. Transference development or negative by the client to th Counter-transference devel nurse towards the client

2. Projection - projecting inter

instead ascribing them to oth

3. Resistance - holding a men

Psychosexual development

remembering or accepting so

1. 2.

Oral 0-2 Stage of ID Fixated at this stage may mean an stimulation, such as cigarettes, d

Anal 2-4 Stage of EGO Anal retentive personality is sting of order and tidiness. The person perfectionist. Anal expulsive personality is an o personality, and has a lack of self messy and careless.

IC

sis, but nds to be

primary focus is to reveal the unconscious content of a client's

3.

Phallic 4-5 Stage of SUPER EG Boys experience the Oedipus Com anxiety Girls experience the Electra comp

han

intrapsychic and unconscious conflicts, and their relation to development

4. 5.

Latency 6-puberty Stage of Str Genital - puberty onwards

Psychosocial task throughout the life cycle

It relies on the interpersonal relation

therapist. A belief that psychopathology d early childhood experiences

Used in individual psychotherapy, gr family therapy

explain eight stages through which a

aims to treat

human should pass from infancy to l

In each stage the person confro masters, new challenges; challenges successfully completed may be expe problems in the future.

HERAPY

1.

Trust vs. Mistrust (Infants, 0 to

ng theory

psycho-pathology through techniques designed to reinforce desired and extinguish undesired behaviours

2.
3. 4. 5. 6. 7.

Thought process Help the patient overcome difficulties by identifying and changing dysfunctional thinking, behavior, and emotional responses

8.

Autonomy vs. Shame & Doubt I do things myself or must I alway Initiative vs. Guilt (Preschool, 4 to bad?" Industry vs. Inferiority (Childhood successful or worthless?" Identity vs. Role Confusion (Adole "Who am I and where am I going? Intimacy vs. Isolation (Young Adu loved and wanted?" or "Shall I sh live alone?" Generativity vs. Stagnation (Midd "Will I produce something of real Ego Integrity vs. Despair (Seniors lived a full life?"

Includes approaches for dealing with

HERAPY

Interaction of person and environment

Desensitization the reduction stimulus by repeated exposure to th and milder form. Self-control therapy combination o approaches; a basic example is talki and control actions more effectively May be beneficial in managing ADHD Deficit Hyperactivity Disorder)

 Treatment is based on collabora therapist and on testing beliefs Therapy may consist of testing one makes and identifying how cert unquestioned thoughts are distorte unhelpful.

Involves the use of therapeutic communities

cal and in l lives

Based on the theory that depre distortions in the patient's perspect thinking, over-generalization, and se Serves as basis to promote trea compulsive disorder and Depressio

Physiologic alterations manifested in behavior

Serves as a framework for understan inappropriate interpersonal relation of maladaptive behavior Mental illness is viewed as arising fr experiences. In treating the client th participant observer According to Peplau, nursing is ther healing art, assisting an individual health care The nurse and patient work together and knowledgeable in the process.

Provide a safe environment that is ad clients needs and also provides gre of expression than has been experie client

Modification of environment in w and interactions are therapeutically of enhancing social skills and build

Milieu therapy is thought to be o

personality disorders and behaviou

Utilization of diagnostic tools, s drugs and electroconvulsive therap Mental illness is viewed as a res impairment or imbalance
174 175 176 177 178

179 180 181

LEVELS OF PREVENTION IN PSYCHIATRIC NURSING

LEVEL DEFINITION EXAMPLES

PRIMARY

SECONDARY

- Measures aimed at lowering the rate of new cases of mental disorders in a population over a certain period by counteracti ng harmful circumstanc es before they could have a chance to produce illness

- Identifying potentially stressful conditions and high risk populations - Parenting classes - Divorce therapy - Being politically active in relation to mental health issues - Health promotion - Wellness programs

TERTIARY - Measures to limit the severity of illness through case finding

- Providing brief psychothera py - Suicide prevention, hotline counseling and crisis

and prompt treatment

intervention - Counseling victims of violence

- Measures to reduce disability after a disorder through the prevention of complictatio ns and active program of rehabilitatio n
182 183 184 185 186

- Discharge Planning - Follow-up home care - Serving as client advocate - Staffing partial hospitalizati on program

- Membeship
in Alcoholics Anonymous

ROLES OF THE NURSE IN A THERAPEUTIC RELATIONSHIP

ROLES EXAMPLES
- Development of a warm

1.

Ward Manager/Creat or of a therapeutic environment

home-like, accepting atmosphere - Improving social relationships of clients with other people by helping them to develop feelings of security with others as they participate in group activities - Helping the client to remember and understand fully what is happening to him/her through: 1. Empathic listening 2. Providing reassurance 3. Helping the client to find acceptable outlets of anxiety - Helping the client learn to participate in a more socially acceptable and satisfying way - Enabling the client to learn more adaptive ways of coping with problems

2. Socializing Agent

3. Counselor

4. Teacher

5. Parent Surrogate 6. Technical

nursing role/ Care-giving 7. Therapist 8. Healthy role model

- Acting as a substitute parental figure - Providing nursing care - Applying the principle of psychotherapy when interacting with the client - Serving as a reality base for the client on three levels: 1. Distinguishing what is objectively real from what is not 2. Validating normal feelings and experiences 3. Representing social reality to the client

187 188 189 190

191 192 193 194

The Nursing Process in Psychiatric/Mental Health Nursing A

psychiatric nurse has the additional responsibility of maintaining and adhering to a specific Nursing Process as part of his or her routine obligations of providing care and assistance to patients suffering from mental disorders Contrary to other specialized career options in nursing profession, a psychiatric nurse needs to interact with the patient and others closely related to the patient, have effective communication skills with the patient and also involve the patient as well as close relatives of the patient in what would be called the problem-solving process aimed at complete cure and restoration of normalcy for the patient. The Nursing process is not a onetime affair but a continuous

195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217

218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247

process in which not just the psychiatric nurse but the patient as well will have to play an important role. More specifically, the interaction between the nurse and the patient that includes therapeutic communication and the details provided by the patient in connection with the ailment will be an important aspect. The psychiatric nurse should design and record the nursing process in a methodical way that includes the following steps in the same order: 1. A s s e s s m e n t o f t h

248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278

e p a t i e n t 2. P u t t i n g i n p l a c e t e n t a

279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309

t i v e n u r s i n g d i a g n o s i s 3. I d e n t i f y i

310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340

n g e x p e c t e d o u t c o m e s 4. I d e n t i f y i n

341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371

g t h e g o a l o r o b j e c t i v e o f n u r s

372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398

i n g

5 .P
l a n n i n g a n d s c h e d u l i n g

398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421

n u r s i n g i n t e r v e n t i o n s ,

422 423 424

i n c

426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452

l u d i n g o p t i o n s f o r s o l v i n g

453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478

p r o b l e m s i f a n y

6 .E
v a l u a t i o n

478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503

o f t h e e n t i r e p r o c e s s , a n

504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530

d m a k i n g c h a n g e s w h e r e v e r r

531 532 533 534 535 536 537 538 539 540 541 542

e q u i r e d

THE STANDARDS OF CARE FOR PSYCHIATRIC NURSING ARE WRITTEN AROUND THE SIX STEPS OF THE NURSING PROCESS.

Standard I. Assessment
The Assessment of the patient forms an important part of the nursing process wherein the psychiatric nurse has an effective therapeutic communication with the patient and other family members closely associated with the patient ABC Appearance, Behavior, & Communication without the support and participation of the patient/family members, it is impossible for the psychiatric nurse to provide care and assistance.

Standard II. Diagnosis

 The psychiatric / mental health nurse analyzes the assessment data in determining diagnoses Priority is the life/death situation such as when the patient is in imminent danger (Depression=Suicidal patients) or starve to death (Anorexia Nervosa and Bulimia Nervosa) PRIORITY? SAFETY! The nursing Diagnosis describes the client s condition For example: Disturbed sensory perception, evidenced by hearing voices

Standard III. Outcome Identification

The psychiatric / mental health nurse identifies expected outcomes that are measurable and realistic and individualized to the client. The client will demonstrate trust in one staff member In 5 days.

The client will express understanding that the voices are not real (not heard by others ) in 10 days.

Standard IV. Planning

The psychiatric / mental health nurse develops a plan of care that is negotiated among the client, nurse,

family, and healthcare team and prescribes evidencebased interventions to attain expected outcomes.

SAFETY Promotion 1ST Priority Formulate a plan that will help enhance the clients self esteem/confidence

Standard V. Implementation
The psychiatric/mental health nurse implements the interventions identified in the plan of care. Specific interventions:
o

Standard Va. Counseling: to assist clients in improving coping skills and preventing mental illness and disability Standard Vb. Milieu therapy: to provide and maintain a therapeutic environment for client Standard Vc. Self-care activities: to foster independence and mental and physical well-being Standard Vd. Psychobiological interventions: to restore the client s health and prevent further disability Standard Ve. Health teaching: to assist clients in achieving satisfying, productive,and healthy patterns of living Standard Vf. Case management: to coordinate comprehensive health services and ensure continuity of care Standard Vg. Health promotion and health

maintenance: implements strategies with clients to promote and maintain mental health and prevent mental illness Advanced practice interventions also include:
o

Standard Vh. Psychotherapy: provides therapy for individuals, groups, families, and children to foster mental health and prevent disability Standard Vi. Prescriptive authority and treatment: provides pharmacological intervention, in accordance with state and federal laws and regulations, to treat symptoms of psychiatric illness and improve functional health status Standard Vj. Consultation: provides

consultation to enhance the abilities of other clinicians to provide services for clients and effect change in the system ELEMENTS OF THE YOUR NURSING INTERVENTIONS:

1. Containment
- Remove things that can be dangerous - Suicidal/homicidal-never leave them alone - Need constant observation

2. Structure
anxiety of policies Name tag/bracelet to each Orientation, explanation Predictability Can help decrease

patient

3.
-

Support
Establish a trusting relationship Trust develops over time the nurse behavior should demonstrate a non-judgmental, accepting behavior

4.
-

Involvement
Learn about ones self Must realize the impact of your behavior to others/patient

Standard VI. Evaluation

The psychiatric/mental health nurse evaluates the client s progress in attaining expected outcomes
543

544

545

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NURSE - CLIENT RELATIONSHIP

PRINCIPLES: o Series of interactions between the nurse and the client wherein the nurse

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assists the client to attain positive behavioral change. o Respect the client and value the client as an individual o Maintain appropriate limits o The establishment of a therapeutic relationship begins with introduction of the nurse to the client.

A trusting relationship is a

prerequisite to the implementation of therapies o The use of self is often the only tool available to the nurse. o To be therapeutic the nurse encourages the client to express feelings and must actively listen to the client. o Trust has been established when there is a willingness on the part of the client to discuss any problems or needs

Remember that empathy is

therapeutic and sympathy is non therapeutic Empathy is the objective understanding of how a person sees or feels regarding a specific situation. It is the ability of the nurse to project

582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606

himself/herself into the clients emotions to share the emotions in an objective way. Sympathy is the subjective expression of ones concern or compassion for another person. It is also the subjective sharing of emotion over real or imagined loss. o The basic elements of a therapeutic nurse-client relationship include TRUST

T Trust R Respect & Rapport U Understanding &

Unconditional positive regard

S Setting limits T Therapeutic

communication

TYPES OF RELATIONSHIPS
SOCIAL INTIMATE THERAPEUTIC

 Friendship Companion Use small talk Superficial

Emotional commitmen t May be sexual/emot ional intimacy

Focus on the clients needs, feelings, ideas Goal oriented

607 608 609 610 611

PHASES OF THE NURSE CLIENT RELATIONSHIP

PHASE DESCRIPTION MAJOR TASK OF THE NURSE
Develop Selfawarene ss Examine own feelings, fears, anxietie s

PRE INTERACTION PHASE

Begins when the nurse is assigned to a client. Client is excluded as an active participant Nurse feels a certain

degree of anxiety Includes all the things the nurse thinks and does before interacting with the client
612 613

ORIENTATION PHASE

Begins when the nurse and client interact for the first time Establish boundaries and trust with the client The nurse begin to know about the client Assess patients feelings such as

Develop a mutually acceptable contract Establishing confidentiali ty

Provide
information about the termination of nurseclient relationship

anxiety The client tests the nurse's sincerity must outline the responsibiliti es of the nurse and patient and must agree on it in a formal (written) or informal (verbal) contract Contract an outline of the responsibiliti es of nurseclient relationship w/c includes: 1. time, date, place and duration of meeting 2. when

session s will terminat e 3. who will be involve d in treatme nt plan(fa mily member s& health team member s

WORKING PHASE

The longest and most productive phase of nurse client relationship > Implementati on of care plan Promote an attitude of acceptance

Identify and resolve the clients problem Promote insights and the use of constructive coping mechanism

Work with
client in increasing

 Assist the client to express feelings

Identify
client problems Continue to assess and evaluate problems Development of problem solving skills and coping strategy Limit-setting is employed Prepare the client about the termination of relationship

his/her ability towards independen ce

TERMINATION PHASE

Identify and deal with termination and separation issues

Assist the client to review what he has learned and transfer his learning to

 Encourage client to discuss feelings about termination Involves feelings of anxiety, fear and loss Do not promise the client that the relationship will continue Evaluate progress and achievement of goals
614 615 616 617 618 619 620 621 622 623

how he deals with stress and relationship with others Assist the client to deal with loss and learn to say goodbye

o For most nurses, developing selfawareness is the most difficult part of the nurse-client relationship. o Information about the termination of the nurse-client relationship should be provided in the Orientation phase o Achieving goals and sharing facts and feelings occur in the working phase

624 625 626 627 628 629 630 631 632 633 634

o Moving towards independence occurs in the termination phase. o