Professional Documents
Culture Documents
Therapeutic communication
Dynamic process of exchanging
information
Composed of verbal and non-verbal
techniques that the nurse uses to
focus on the client’s needs
Therapeutic Relationships
Therapeutic communication :
ELEMENTS
Sender- the source of message
Message- the information
transmitted
Receiver- recipient of message
Feedback- receiver’s response to
the message
Therapeutic Relationships
VERBAL COMMUNICATION
Use of therapeutic communication
techniques
Effective communication should be
therapeutic, appropriate, simple,
adaptive, concise and credible
Therapeutic Communication
Asking ‘Why’
Non-therapeutic communication
Making judgment You are wrong
PERSONAL= 1 ½ to 4 ft
SOCIAL= 4 to 12 ft
PUBLIC= 12 to 15 ft
Psychiatric Nursing Process
Nursing ASSESSMENT
Nursing History
Physical Examination including the
Neurological examination
Laboratory Examination
Psychiatric Nursing Process
Nursing ASSESSMENT
Refers to the scientific process of
identifying a patient’s psychosocial
problems, strengths an concerns
Interview is done to acquires broad
information about a client
Psychiatric Nursing Process
MENTAL STATUS ASSESSMENT
Level of consciousness
General appearance
Behavior
Speech
Mood and affect
Judgment
Memory
insight
Psychiatric Nursing Process
Physical Examination
Observation for key signs
Diagnostic Tests
CT, MRI, PET, EEG
Laboratory tests= CBC, Electrolytes,
Drug levels
Psychiatric Nursing Process
Other diagnostic tests
Beck depression inventory
Minnesota multiphasic personality
inventory
Draw-a person test
Sentence completion test
Thematic aperception test
Psychiatric Nursing Process
Nursing Diagnoses
Anxiety
Ineffective coping- individual, family
Fatigue
Fear
Sleep pattern disturbance
Altered thought process
Etcetera
Psychiatric Nursing Process
Nursing Objectives
Short term goals are set for
immediate problems, feasible and
within client's capabilities
Long term goals are related to
discharge planning and prevention
of recurrence of symptoms
Psychiatric Nursing Process
Nursing Interventions
Use of therapeutic communication
Therapeutic Groups
Psychotherapy: Family, Milieu,
Behavioral modification, Crisis
intervention, Psychopharmacology
Electroconvulsive therapy
Psychiatric Nursing Process
Nursing Evaluation
Determine if goals are met by
collecting data and comparing them
to baseline
Clients’ behavior should demonstrate
optimal orientation to reality and
interaction with others appropriately
Treatment Modalities
Therapeutic Environment- Milieu
Therapeutic Groups
Crisis intervention
Family therapy
Behavioral modification
Cognitive therapy
Psychotherapy
Therapeutic environment
Characteristics of a Therapeutic
environment
The clients’ physical needs are
met
The client is respected
Decision making authority is
clearly defined
Client is protected from injury
(self and others)
Therapeutic environment
Characteristics of a Therapeutic
environment
5. Clients are allowed freedom of
choice commensurate to his
ability to decide
6. Nursing Personnel remain
constant and assignments are
stable
7. Emphasis is placed on social
interaction between clients and
Therapeutic Modalities
Milieu therapy
Total environment has an effect on
the person’s behavior- physical,
emotional, relationships
Purposes of therapy
Improve client’s behavior
Involve client in decision making
Increase autonomy and
communication
Set structure of unit and
behavioral limits
Therapeutic Modalities
Milieu therapy
The surrounding is made positive
to effect behavioral changes in
the prescribed directions
Goals of milieu therapy: to help
patient develop sense of self-
esteem, personal growth,
improve ability to relate to others
and return to the community
better prepared
Therapeutic modalities
Milieu therapy
The nurse involves the client in
decision making
The nurse promotes the
involvement of staff in care
Social skills are developed and
sense of community is fostered
Therapeutic Groups
A treatment approach in which the
entire milieu is used as treatment
This includes the physical
environment and the others clients
Therapeutic Groups
Group Therapy
Involves meaningful interaction
between members of a group as they
relate their personal experiences to
each other
The main objective is for each group
member to examine his own behavior
and relationship. The group can
influence to change his behavior and
relationships
Therapeutic Groups
Purposes
To increase self-awareness
To improve interpersonal
relationships
To make changes in behavior
To enhancing group teaching and
learning
Therapeutic Groups
CRISIS
A disturbance caused by a
precipitating event such as perceived
loss, a threat of loss or a challenge that
is perceived as a threat to self.
Therapeutic modalities
CRISIS
Can be classified as to maturational
crisis, situational crisis or adventitious
crisis
Maturational= role changes
Situational= loss of job, death
Adventitious= fires, earthquakes and
floods
In a crisis, the person’s usual methods of
coping are INEFFECTIVE
Therapeutic Modalities
Characteristics of Crisis:
It is sudden
It is short term may last for 4-6 weeks
Individualized
The person becomes dependent and
overwhelmed
Therapeutic Modalities
CRISIS INTERVENTION
A technique of helping the person go
through the crisis
To mobilize his resources
To help him deal with the here and now
A five step problem solving technique
designed to promote a more adaptive
outcome including improved abilities to
cope with future crises
Therapeutic modalities
Goal of Crisis intervention: help the patient go back to
his state of optimum level of functioning
IDENTIFY the problem- A solution is not possible
unless the problem be identified.
LIST alternatives- all possible solutions to the
problem need to be listed.
CHOOSE from among the alternatives- each
options is carefully considered, and the
alternative chosen is usually highly
individualized, based on priorities and values of
the person
IMPLEMENT the plan- the alternative is put into
action. The nurse may need to support and
encourage patient to take action
EVALUATE the outcome- the effectiveness of the
plan is evaluated.
Therapeutic modalities
Family therapy
An approach in which the
therapist focuses on the behavior
of the entire family as a system
instead of focusing on the
pathology of one member
Therapeutic modalities
Family therapy
Focuses on the client as a ‘family”
Involvement of family members
Purposes of family therapy
Improve relationships among family
members
Promote family functions
Resolve family problems
Help family find ways to cope with
problems
Therapeutic modalities
Family therapy
Problems are identified by each
family members and each
discusses his/her involvement in
the problem
Members discuss how problems
affect them and they explore how
to solve them
Therapeutic Modalities
Family therapy
The nurse functions to assess the
family interactions, makes
observations and encourages
expression of feelings
Helping the family resolve the
problem is the goal
Therapeutic Modalities
Behavioral Modification
Therapy to change the unacceptable
behavior to acceptable
The nurse determines the
unacceptable behaviors and she
identifies adaptive behaviors
Punishment is given to
unacceptable behavior
Reward is given to acceptable
behavior
Therapeutic Modalities
Behavioral Modification
Other Behavioral therapies
1. Self-control therapy
2. Aversion therapy
3. Desensitization
4. Modeling
5. Operant conditioning
Therapeutic Modalities
Cognitive therapy
An active, directive, time-limited
approach
Therapeutic techniques are used
to identify reality testing
The nurse helps the patient think
and act more realistically and
adaptively about his problems
Therapeutic Modalities
Play therapy
Therapy with children in which they
are helped to express themselves or
their behavior through play
Therapeutic Modality:
Psychotherapy
A method of treating mental illness
in which verbal and expressive
techniques are used to help the
person resolve inner conflict and
modify behaviors
Therapeutic Modality:
Psychotherapy
Psychoanalysis
Client centered therapy
Rational emotive therapy
Gestalt therapy
Reality therapy
Transactional analysis
Therapeutic Modality:
Psychotherapy
Psychoanalysis
THE therapist obtains information
about the past and present
experiences that have repressed in
the person’s subconscious mind
By learning the source of the
problem, the problems can be
brought to the conscious where the
therapist helps the individual dealt
with them
Therapeutic Modality:
Psychotherapy
2. Client Centered therapy
The therapist work with one client
Accepting, non-judgmental
environment aimed at reducing the
anxiety and reducing negative
defenses
The patient is encouraged to
express his feelings and increase
self-awareness
When the person is aware of what
he feels, he can work on improving
Therapeutic Modality:
Psychotherapy
3. Rational-Emotive therapy
This is based in the assumption that
a person’s behavior is due to his
own thinking
Problems arise as the person
believes about eh events
The therapy aims to change the
person’s belief system
Therapeutic Modality:
Psychotherapy
4. Gestalt Therapy
The mind receives experiences as a
whole
When the experience is complete,
the problem will arise
The goal of the therapy is to help
patients complete the experience
through awareness
Therapeutic Modality:
Psychotherapy
5. Transactional Analysis
A group therapy method
Helps people “analyze” their
transaction or interaction with
others and guides them to the
conclusion: I’m OK you are OK
Responses to Illness
Stress
Anxiety
Crisis
Anger and hostility