PT20E Therapeutic Communications and Relationships

1. PT20E Therapeutic Communications and Relationships PowerPoint #3

2. Course Objective #1 • Define and describe the Psychotherapeutic Management Model according to the Diagnostic and Statistical Manual, (DSM) current edition.

3. Psychopathology • Definition: the systematic study of mental disorders.

4. Psychotherapeutic Management Model • Definition: Nursing care that balances the three (3) primary interventions used in care of D.D. and Psychiatric patients.

5. Psychotherapeutic Management Model • Three (3) primary interventions: • Communicated Nurse-Patient Relationship (words) • Psychopharmacology (drugs) • Milieu management (environment)

6. Therapeutic Nurse-Pt. Relationship • Communication skills

7. Psychopharmacology • Psychotropic drugs:

8. Course Objective #4 • Relate why a psychopharmacologic understanding is important for the psychiatric technician

9. Importance of Psychopharmacology • Assess response • Respond to side effects • Evaluate for desired results • Safely dispense • Teaching • Idiosyncratic reactions

10. Milieu Management • Definition: Purposeful manipulation of the environment to promote a therapeutic atmosphere.

11. Course Objective #5 • Define milieu management and its six elemental components

12. Milieu Management • Components: • Safety • Structure • Norms • Setting limits • Balance • Environmental modifications

13. Safety • Freedom from danger or harm

14. Structure • Physical environment • Regulations • Schedules

15. Norms • Expectations of behavior • Promote community

16. Beliefs • Truths held by a culture

17. Values • Deep feelings that determine what is considered good or bad.

18. Norms • Society accepted rules

19. Setting Limits • Clear & enforceable limitations on behavior

20. Setting Limits • Behaviors: • Physical aggressiveness • Self-destructive acts • Lack of compliance • Use of alcohol or drugs • Elopement

21. Setting Limits • Anticipate behavior!

22. Balance between Independence vs. Dependence • Gradual process • too fast  • Overwhelmed

23. Environmental Modifications • Changing the environment to promote mental health • Physical arrangement • safety issues • orientation features

24. Course Objective # 2 • Describe the consequences of an imbalance in nursing care

25. Consequences of an Imbalance in Nursing Care • Patient needs & setting • Utilization Influence

26. Consequences of an Imbalance in Nursing Care • All components must be present if pt’s. are to fully benefit

27. Consequences of an Imbalance in Nursing Care • Imbalance  • compromise tx

28. Course Objective #3 • Relate the difference between therapy and being therapeutic.

29. Therapeutic vs. TherapyEducation • Therapy • graduate-level psychiatric training • Therapeutic • undergraduate-level psychiatric nurses

30. TherapeuticTasks • Communication • Respect • Desire • Understanding • Active listening

31. Therapeutic • Knowledge/skills • Each encounter is part therapeutic milieu

32. Therapeutic • Real! • Problems • Solutions • Practice situations

33. Therapeutic • Consistent • Spontaneous • Informal • Recreational

34. Therapy • Cure or manage the course of mental disorder • Trained • Selective pt

35. Therapy • Sessions • Formalized • On-going • Specific time, place, & length • Specialized techniques

36. Therapeutic Nurse-Pt. Relationship • Definition: A series of goal-directed interactions that focus on the patient • T, F, B’s • potential solutions • Purposeful • Unique

37. Therapeutic Nurse-Pt. Relationship • Client challenges: • Communicating • Relating • Functioning

38. Role of the Psych. Nurse • Identify problems • Discover ways of meeting needs • Experience relationship

39. Characteristics of the TxN-PR • Planned • Patient centered • Goal directed

40. Brief Encounters • Brief encounters • Process feelings • Validation • Feedback • Quickly

41. 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

42. Stages of TxNPR • Orientation Stage • Working Stage • Termination Stage

43. Orientation stage • Establishing trust and rapport • Nurses learns • Concerns • Patient learns • Role of the nurse

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

45. Orientation stage • Initiating conversations • Non-confrontational

46. Orientation stage • Establish a contract • Expectation • responsibilities

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

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

49. Orientation stage • Management of emotions: • Fear of losing control • Feelings • Anger

50. Orientation stage • Feelings natural • Expression • Empathy • Not alone • Hope