NUR 2459 Mental & Behavioral Health Nursing

Exam 1 Review Study Guide

Exam Content Review

You need to study and UNDERSTAND …

● Role of the psychiatric Nurse:

o By Peplau- based on the stranger, resource person, teacher, leader,

surrogate, technical expert, counselor.

▪ Stranger-first interaction with the nurse and treating the

patient with respect.

▪ Resource person-

▪ Teacher- the nurse identifies learning needs and information

related to the patients healthcare.

▪ Leader- encourages both the nurse and the patient to have a

democratic relationship and be active in the plan of care.

▪ Surrogate- the patient may see the nurse as a mother figure,

sibling, or another nurse in the past where the situation may

generate feelings similar to ones felt in the past.

▪ Technical expert- understands technical devices and clinical

interventions needed for the best interest of the patient.

▪ Counselor- the nurse uses interpersonal techniques to assist

patients in adapting with changes in life experiences and to

help them understand what they are going through in the

present situation.

o The Counselor role is most expressed in psychiatric nursing. They

must have skills developed to provide helpful individual, group, or

family therapy. The staff nurse should have general knowledge of

basic counseling techniques and to have a therapeutic or helping

relationship. Relationship development is important to establish

strong interpersonal relationships. 

● Therapeutic use of self

o The ability to use one's personality consciously and in full

awareness in an attempt to establish relatedness and to structure

nursing intervention.

o The nurse must possess self-awareness and self understanding

based on the belief of the human condition.

o The nurse must understand the ability to effectively help others in

time of need is influenced strongly by the internal values one has.

● Phases of the therapeutic nurse patient relationship:

o Pre Orientation: involves preparation for the first encounter with

the patient.

▪ The nurse obtains information from the chart, significant

others, or other team members.

▪ They also may examine one's feelings, fears, and anxieties

about working with a specific patient and how they may

affect the ability to care for the patient.

o Orientation: involves the nurse and the patient becoming

acquainted. Introductions.

▪ Creating an environment with trust and rapport

▪ Establishing a contract that identifies details and

expectations of the nurse and patient.

▪ Identifies patient strengths and limitations.

▪ Gather assessment data to build a strong patient database.

▪ Setting goals and formulating nursing diagnoses that are

agreeable by the nurse and patient.

▪ Develop a plan of action and explore feelings of both the

nurse and patient.

o Working: the therapeutic work of the relationship is accomplished,

and interventions take place.

▪ Maintaining trust and rapport established.

▪ Promoting patient insight and perception of reality.

▪ Problem solving.

▪ Overcoming resistance behaviors on the part of the patient

as the level of anxiety increases based on painful issues.

▪ Continuous evaluation towards reaching goals.

▪ Transference: when the patient unconsciously displaces to

the nurse feelings formed to a person from his or her past

from feelings or personality that remind the patient of

another person, but also be dependency on the nurse based

on unreal patient expectations. Have to not cut relationships

but work to sort it out. 

▪ Countertransference: the nurse's behavioral and emotional

responses in which the nurse transfers feelings about past

experiences to the patient that can interfere with the

relationship. The nurse must be assisted in identifying

feelings based on the situation.

o Termination: occurs when the goals are reached, the client is

discharged, or the shift ends.

▪ Can be difficult for all parties involved and therapeutic

conclusions must be developed.

▪ must have a plan for continuing care or assistance going

forward.

▪ Feelings may be explored and sadness and loss may occur.

must have acceptance.

▪ May also have to evaluate actions and set new goals.

● Barriers/ Boundaries to the therapeutic nurse patient relationship

o Material: can be seen, like a fence that borders land.

o Social: these are established within a culture and define how

individuals are expected to behave in social situations.

o Personal: these are boundaries that individuals define for

themselves.

▪ Physical/Distance: how close individuals will allow others to

enter their physical space.

▪ Emotional: how much individuals choose to disclose their

most private and intimate sleeves to others.

o Professional: limit and outline expectations for appropriate

professional relationships with patients. space between nurses

power and patient vulnerability. Imbalance of power does exist

because the nurse can see patient records. They must avoid

conflict where a personal gain may be achieved within the

relationship.

o Self Disclosure: appropriate when the information could

therapeutically benefit the patient. Not undertaken to meet the

nurses needs.

o Gift Giving: Nurses should not accept gifts but also use

professional judgement based on the type of gift and patient care

and thought behind it. Refusal should be based on patient

sensitivity.

o Touch: Touching is required to do the therapeutic procedures and

care, but caring touch in times where they have no need to do so is

inappropriate. Touch should be appropriate, therapeutic, and

welcomed. Many need to avoid it based on the situation and

culture. 

o Friendship/ Romantic Association: all relationships should be

professional. If unable to do this, one should withdraw from the

relationship. Romantic relationships should not occur.

● Complicates if boundaries are breached

o SIgns this occurs: favoriting patients, keeping secrets, changing

dress for working, swapping assignments, giving special attention

to one client over another, spending free time with patients,

thinking about patients when away from work, shoring personal

concerns with patient, receive gifts or have contact with the patient

after discharge

o Complications: threatens the integrity of the nurse patient

relationship, cna cause boundary violations. Potential for the nurse

to be fired or to lose their license.