Self-Awareness

Theoretical Frameworks Influencing the Development of

Psychiatric Nursing
 Theorist Theory Brief description (to be

filled out by students)

1 Sigmund Psychoanalytic

Freud theory/

Psychosexual

theory
2 Harry Stack Interpersonal

Sullivan theory
3 B.F. Skinner Behavior theory
4 Eric Erikson Psychosocial/devel

opmental theory
5 Florence Environmental

Nightingale theory
6 Hildegard Interpersonal

Peplau theory
7 Virginia Needs theory

Henderson
8 Faye Abdellah Patient-centered

theory
9 Dorothea Self-care deficit

Orem theory
Theories in Focus

1. Sigmund Freud
 DEFENSE MECHANISM EXAMPLE

COMPENSATION A physically handicapped boy is unable

to participate in football, so he
Covering up a real or
compensates by becoming a great
perceived weakness by
scholar.
emphasizing a trait one
considers more desirable

DENIAL A woman drinks alcohol every day and

cannot stop, failing to acknowledge that
Refusing to acknowledge the
she has a problem.
existence of a real situation or
the feelings associated with it

DISPLACEMENT A client is angry with his physician, does

not express it, but becomes verbally
The transfer of feelings from
abusive with the nurse.
one target to another that is
considered less threatening or
that is neutral
 DEFENSE MECHANISM EXAMPLE

IDENTIFICATION A teenager who required lengthy

rehabilitation after an accident decides to
An attempt to increase self-
become a physical therapist as a result of
worth by acquiring certain
his experiences.
attributes and characteristics of
an individual one admires

INTELLECTUALIZATION Sarah’s husband is being transferred

with his job to a city far away from her
An attempt to avoid
parents. She hides anxiety by explaining
expressing actual emotions
to her parents the advantages associated
associated with a stressful
with the move.
situation by using the
intellectual processes of logic,
reasoning, and analysis

INTROJECTION Children integrate their parents’ value

system into the process of conscience
Integrating the beliefs and
formation. A child say to a friend, “Don’t
values of another individual
cheat. It’s wrong.”
into one’s own ego structure

ISOLATION A young woman describes being

attacked and raped without showing any
Separating a thought or
emotion.
memory from the feeling,
tone, or emotion associated
with it
 DEFENSE MECHANISM EXAMPLE

PROJECTION Sue feels a strong sexual attraction to

her track coach and tells her friend, “He’s
Attributing feelings or
coming on to me!”
impulses unacceptable to
one’s self to another person

RATIONALIZATION John tells the rehab nurse, “I drink

because it’s the only way I can deal with
Attempting to make excuses
my bad marriage and my worse job.”
or formulate logical reasons to
justify unacceptable feelings or
behaviors

REACTION FORMATION Jane hates nursing. She attended

nursing school to pleas her parents.
Preventing unacceptable or
During career day, she speaks to
undesirable thoughts or behaviors
prospective students about the
from being expressed by exaggerating
excellence of nursing as a career.
opposite thoughts or types of
behavior

REGRESSION When 2-year-old Jay is hospitalized for

tonsillitis he will drink only from a bottle,
Retreating in response to
even though his mother states he has
stress to an earlier level of
been drinking from a cup for 6 months.
development and the comfort
measures associated with that
 DEFENSE MECHANISM EXAMPLE

level of functioning

REPRESSION An accident victim can remember

nothing about his accident.
Involuntarily by blocking
unpleasant feelings and
experiences from one’s
awareness

SUBLIMATION A mother whose son was killed by a

drunk driver channels her anger and
Rechanneling of drives or
energy into being the president of the
impulses that are personally or
local chapter of Mother Against of Drunk
socially unacceptable into
driving
activities that are constructive

SUPPRESSION Scarlett says, “I don’t want to think

about that now. I’ll think about that
The voluntary blocking of
tomorrow.
unpleasant feelings and
experiences from one’s
awareness

UNDOING Joe is nervous about his new job and

yells at his wife. On his way home he
Symbolically negation or
stops and buys her some flowers.
canceling out an experience
that one finds intolerable
2. Carl Jung
Background of the theorist::

MBTI Personality Test:

https://www.16personalities.com/free-personality-test

3. Developmental Stages :
https://drive.google.com/file/d/1cJEgFumCWk30FsYZgCP_h3jF
LN1M7Jr0/view?usp=sharing

Background of the theorist (Sigmund Freud)

Background of the theoris (Erik Erikson)

Background of the theorist (Jean Piaget)

Background of the theorist (Lawrence Kohlberg):

4. Harry Stack Sullivan
Background of the theorist:

HARRY STACK SULLIVAN’S

INTERPERSONAL PSYCHODYNAMIC
THEORY

INTERPERSONAL THEORETICAL MODEL

Assumptions and Key Concepts

 Anxiety: the “main disruptive force” in interpersonal relations

 Basic Anxiety: fear of rejection by significant persons

 Interpersonal Security: feelings associated with relief of anxiety,

the point when all needs are met or a sense of total well-being
 Parataxic Distortion: a person’s fantasy perception of another
person’s attributes without consideration important personality
differences
 Selective Inattention: how people cope with the anxiety caused
by the undesired traits

Sullivan focused on anxiety as being a consequence of faulty social

interactions.  He believed people developed a personification of self and
others through the integration of “good me, bad me, and not me”
perception (the self-system):

Self System: The collection of experiences or security measures to

protect against anxiety

 Good Me: represents what people like about themselves and is

willing to share with others
 Bad Me: what people don’t like about themselves and not willing
to share. Develops in response to negative feedback with feelings of
discomfort, displeasure, and distress. The “Bad Me” creates anxiety.
 Not Me: the aspects of self that are so anxiety-provoking that the
person does not consider them apart of the person. It contains
feelings of horror, dread, dread. This part of the self is primarily
unconscious (dissociative coping).

Sullivan believed that all psychological disorders have an interpersonal

origin and can be understood only with reference to the patient’s social
environment. To understand a person’s drives for behavior, 2 needs are
involved; satisfaction (sleep, sex, hunger) & security (conforming to social
norms of the person’s reference group). If the 2 drives of “self-system”
are interfered with, mental illness occurs.

STAGES OF INTERPERSONAL DEVELOPMENT 

STAGE TIME-
DEVELOPMENTAL TASK
(EPOCHS) PERIOD

Infancy 0-18mths Oral gratification; anxiety first

occurs

Childhood 18mths-6y Delayed gratification

Juvenile 6-9y Forming peer-relationships

Preadolescence 9-12y Same-sex relationships

Early 12-14y Opposite-sex relationships

Adolescence

Late 14-21y Self-identity is developed

Adolescence

5. Hildegard Peplau
Background of the theorist:
Therapeutic nurse-client relationship

A professional and planned relationship between client and nurse that

focuses on the client’s needs, feelings, problems, and ideas. It involves
interaction between two or more individuals with a common goal. The
attainment of this goal, or any goal, is achieved through a series of steps
following a sequential pattern.

Four Phases of the therapeutic nurse-patient relationship:

1. Orientation Phase

The orientation phase is directed by the nurse and involves engaging the
client in treatment, providing explanations and information, and
answering questions.

Problem defining phase

Starts when the client meets nurse as a stranger
Defining problem and deciding the type of service needed
Client seeks assistance, conveys needs, asks questions, shares
preconceptions and expectations of past experiences
Nurse responds, explains roles to the client, helps to identify
problems and to use available resources and services
 Factors influencing orientation phase.

2. Identification Phase

The identification phase begins when the client works interdependently

with the nurse, expresses feelings, and begins to feel stronger.

Selection of appropriate professional assistance

Patient begins to have a feeling of belonging and a capability of
dealing with the problem which decreases the feeling of
helplessness and hopelessness

3. Exploitation Phase

In the exploitation phase, the client makes full use of the services
offered.
 In the exploitation phase, the client makes full use of the services
offered.
Use of professional assistance for problem-solving alternatives
Advantages of services are used is based on the needs and interests
of the patients
The individual feels like an integral part of the helping environment
They may make minor requests or attention-getting techniques
The principles of interview techniques must be used in order to
explore, understand and adequately deal with the underlying
problem
Patient may fluctuate on independence
Nurse must be aware of the various phases of communication
Nurse aids the patient in exploiting all avenues of help and progress
is made towards the final step

4. Resolution Phase

In the resolution phase, the client no longer needs professional services

and gives up dependent behavior. The relationship ends.

In the resolution phase, the client no longer needs professional

services and gives up dependent behavior. The relationship ends.
Termination of professional relationship
The patients needs have already been met by the collaborative
effect of patient and nurse
Now they need to terminate their therapeutic relationship and
dissolve the links between them.
 Sometimes may be difficult for both as psychological dependence
persists
Patient drifts away and breaks the bond with the nurse and
healthier emotional balance is demonstrated and both becomes
mature individuals

SELF-AWARENESS AND THERAPEUTIC USE OF SELF

SELF-AWARENESS

What is Self-awareness?
How important is self-awareness in the therapeutic nurse-patient relationship?

Therapeutic Communication Characteristics:

A. Responsive Dimensions - Genuineness, respect, emphatic understanding, and

concreteness.
B. Action Dimensions - confrontation, immediacy, therapist self-disclosure, catharsis
and role playing.

A.l Genuineness:  

       It implies that the nurse is an open, honest, sincere person who is actively
involved in the relationship. Genuineness is the opposite of self-alienation, which
occurs when many of one’s real, spontaneous reactions to life are repressed or
suppressed. Genuineness means that the nurse’s response is sincere rather than
phony, that the nurse is not thinking and feeling one thing and saying something
different. It is an essential quality, because the nurse cannot expect openness, self-
acceptance, and personal freedom in the patient, if he or she lacks these qualities in
the relationship.

A.2 Respect:

     ‘Non possessive warmth’ or ‘unconditional positive regard’ is known as respect.’

Positive regard is unconditional in that it does not depend on the
patients’ behavior Caring, liking and valuing are other terms for respect. The patient is
regarded as a person ‘worth; he is accepted. The nurse’s attitude is non-judgmental;
it is without criticism, clue, depreciation, or reservation. Imperfections are accepted
along with mistakes and weaknesses as a part of the his condition.

Respect to Patient is communicated in Many Ways:

• By sitting silently with a patient who is crying

• Laughing with a patient over a particular event
• Maintaining confidentiality
• By apologizing for the hurt unintentionally made
• Being genuine with the patient
• Listening

A.3 Emphatic Understanding

Empathy is an ability to enter into the life of another person, to accurately perceive
current feelings and their meanings. It is an essential element of the interpersonal
process.  Communicated, it forms the basis for a helping relationship between the
nurse and the patient.-
Empathy understands the patient’s world as if it were your own, but without losing
‘As if’ quality. . '
• Accurate empathy involves more than knowing what the patient means. It also
involves, nurse’s sensitivity to the patient’s current feelings and the verbal ability to
communicate understanding in a language attuned to the patient.
• Accurate empathy also means that the nurse frequently confirms with the patient
the accuracy of one’s perceptions and being guided by the patient’s responses.

Mansfield identified specific verbal and non-verbal behaviors that conveyed high
levels empathy to the patient:
i) Having the nurse introduce himself or herself to the patient.
ii) Head and body positions turned towards the patient and occasionally leaning
forward.
iii) Verbal responses to the patients’ previous comments, responses that focus on his
strength and resources.
iv) Consistent eye contact and response to the patients’ non-verbal cues such has
signs, tone voice, restlessness, and facial expressions.
v) Conveyance of interest, concern and warmth by the nurse’s own facial expressions.
vi) A tone of voice consistent with facial expression and verbal response.
vii) Mirror imaging of body position and gestures between the nurse and patient.

A4. Concreteness
Concreteness involves using specific terminology rather than abstractions when
discussing the patient’s feelings, experience and behavior. It avoids vagueness and
ambiguity and is the opposite of generalizing, categorizing, classifying and labeling the
patient’s experiences. It has three functions:

i) To keep the nurse’s responses close to the patient’s feeling and experiences
ii) To foster accuracy of understanding by the nurse, and
iii) To encourage the patient to attend to specific problem areas.

By focusing the patient in specific and concrete terms to his vague responses, the
nurse helps the patient identify significant aspects of his problem.
The level of concreteness varies in different phases of nurse patient relationship. To
increase empathy high level of concreteness in the orientation phase, to facilitate a
thorough self exploration, low level of empathy in the working phase, and at the
terminal phase again high levels of concreteness are desired.

B. Action Dimension
B.l. Confrontation
B.2. Immediacy
B.3. Self disclosure
B.4. Emotional Catharsis
B.5.Role Playing.

The action dimensions must have a context of warmth and understanding. With the
action dimensions, the nurse moves the therapeutic relationship upward and outward
by identifying obstacles to the patient’s progress and the need for both internal
understanding and external action.

B.l Confrontation:
Confrontation usually implies venting anger and aggressive behavior. This has the
effect of belittling, blaming, and embarrassing the receiver- all of which are harmful
and destructive in both social and therapeutic relationships. But confrontation in
action dimension is an assertive rather than aggressive action. Confrontation is an
expression by nurse of perceived discrepancies in the patient’s behavior. Carkhoff
identifies three categories of confrontation:

i) Discrepancy between the patient’s expressions of what he is (self-concept) and

what he wants to be (self-ideal).
ii) Discrepancies between the patient’s verbal expressions about himself and his
behavior.
iii) Discrepancies between the patients’ expressed experience of himself and the
nurse’s experience of him Confrontation is an attempt by the nurse to make the
patient aware of incongruence in feelings, attitudes, beliefs, and behaviors. It also
points out the discrepancies involving his I sources and the strengths that are
unrecognized and unused. The nurse who uses confrontation I modeling an active
role to the patient; the nurse is using insight and understanding to ambiguity and
inconsistency and thus seek deeper understanding.
B.2. Immediacy:

Immediacy involves focusing on the current interaction of the nurse and the patient in
1 relationship. Immediacy may be viewed as empathy, genuineness or confrontation
that involves particular content-the relationship between the nurse and the patient.
Immediacy connotes sensitivity by the nurse to the patient’s feelings and willingness
to with these feelings rather than ignore them. Patient is actively involved in
describing what! Feels is helping or hindering the relationship. It is not possible or
appropriate for the nurse ' focus continually on the immediacy o f the relationship. It
is most appropriate to do so when I relationship seems to be stalled or is not
progressing.

B.3. Nurse Self-Disclosure:

Self-disclosure has three characteristics. They are:

i) Subjectively true.
ii) Personal statements about the self and
iii) Intentionally revealed to another person.

                In self-disclosure, the nurse reveals information about himself or herself

such as ideas, values, feelings and attitudes. The nurse may share that he/she has had
experiences or feelings similar to those of the patient and may emphasize both the
similarities and differences. This kind of self-disclosure is an index of the closeness of
the relationship and involves a particular kind of respect for the patient. It is an
expression of genuineness and honesty by the nurse and is an aspect of empathy.
Nurse’s self-disclosure increases the likelihood of patient self-disclosure. Patient self-
disclosure is necessary for a successful therapeutic outcome. The number of
disclosures and the, appropriateness or the relevance of the nurse’s self disclosure
are based on the clinical experience, and that determines the optimum therapeutic
level. Usefulness o f self disclosures are cooperation, learning to deal with life
problems more effectively, catharsis of the suppressed feelings and support to
accomplish his life goals.

The nurse should take into account the type and goal of treatment, the context of
the nurse patient relationship, the patient’s ego strength, the patient’s feelings about
the nurse and the nurse’s feelings about the patient. These guidelines govern the
“dosage and timing” of self-disclosures and help the nurses assess the
appropriateness, effectiveness and anticipated response of the patient to the self-
disclosure.

B.4. Emotional Catharsis:

Emotional catharsis occurs when the patient is encouraged to talk about things that
bother him most. Catharsis brings fears, feelings and experiences out into the open so
that they can be examined and discussed with the nurse. The expression of feelings
can be very therapeutic in itself, even if behavioral change does not ensue. The
patient’s catharsis depends on the confidence and trust he has in the nurse.
The nurse must be able to recognize cues from the patient that he is ready to discuss
his problems. It is important that the nurse proceeds with the patient at the rate he
chooses and support him as he discusses difficult areas. If the patient is having
difficulty expressing feelings, the nurse may help by suggesting how he or she might
feel in the patient’s place or how others Might feel in that situation. The nurse might
validate with the patient the feeling he seems to be describing in a general way. For
this, the dimensions of empathy and immediacy are required for the nurse to notice
and express emotions.

B.5. Role Playing:

Role-playing involves acting out a particular situation. It increases the patient’s insight
into human relations and can deepen his ability to see the situation from another
person’s point of view. The intent of role playing is to represent closely real life
behaviors that involve the individual holistically, to focus attention on a problem and
to permit the individual to see himself in action in a neutral situation. It provides a
bridge between thought and action in a “safe” environment in which the patient can
feel free to experiment with new behavior. It is a method of learning that makes
actual behavior the focus of study; it is action oriented and provides immediately
available information.

Role Playing Consists of the Following Steps:

a.       Defining the problem.

b.      Creating a readiness for role-playing.
c.       Establishing the situation.
d.      Casting the characters.
e.       Briefing and warming up.
f.       Considering the training design.
g.      Acting.
h.      Stopping.
i.        Involving the audience.
j.        Analyzing and discussing.
k.      Evaluation.

When role-playing is -used for attitude change; it relies heavily on role reversal. The
patient may be asked to play the role of a certain person in a specific situation or to
play the role of someone with opposing beliefs. This helps the patient to re evaluate
the other person’s intentions and become more understanding of the other person’s
positions. After role reversal, patients may be more receptive in modifying their own
attitudes.
Role playing helps in promoting self awareness, ‘experience a situation rather than
just ‘talk about it,’ elicits feelings, provides opportunity to develop insight and for the
expression of affect. It also allows the patient to experiment with new behavior in a
safe environment.
TABLE1 : Therapeutic Communication Technique
Therapeutic
Communication
Technique
Accepting—indicating
reception
Broad opening –allowing
the client to take the
initiative in introducing
the topic
Consensual validation –
searching for mutual
understanding, for accord
in the meaning of the
words
Encouraging comparison
– …?”
Asking that similarities and
differences be noted
Encouraging description
Examples Rationale
“Yes” An accepting response indicates the
“I follow what you nurse has heard and followed the train
said.” Nodding of thought. It does not indicate
agreement but is nonjudgmental. Facial
expression, tone of voice, and so forth
also must convey acceptance or the
words lose their meaning.
“ Is there something   Broad openings make explicit that
you’d like to talk the client has the lead in the
about?” interaction. For the client who is
“Where would you like hesitant about talking, broad openings
to being?” may stimulate him or her to take the
initiative.
“Tell me whether my For verbal communication to be
understanding of it meaningful, it is essential that the
agrees with yours.” words being used have the same
“Are you using this word meaning for both (all) participants.
to convey that …?” Sometimes, word, phrases, or slang
terms have different meanings and can
be easily misunderstood.
“Was it something like Comparing ideas, experiences, or
relationships brings out many recurring
“Have you have similar themes. The client benefits from
experiences?” making these comparisons because he
or she might recall past coping
strategies that were effective or
remember that he or she has survived
a similar situation.
“Tell me when you feel To understand the client, the nurse
TABLE1 : Therapeutic Communication Technique
Therapeutic
Communication
Technique
of perception – asking
the client to verbalize
what he or she perceives
Encouraging expression
– asking the client to
appraise the quality of his
or her experiences
Exploring – delving
further into a subject or
an idea
Focusing – Concentrating
on a single point
Formulating a plan of
action – asking the client
Examples Rationale
anxious” must see things from his or her
“What is happening?” perspective. Encouraging the client to
“What does the voice describe ideas fully may relieve the
seem to be saying” tension the client is feeling, and he or
she might be less likely to take action
on ideas that are harmful or frightening.
“What are you feeling in The nurse asks the client to
regard to …?” consider people and events in light of
“Does this contribute to his or her own values. Doing so
your distress?” encourages the client to make his or
her own appraisal rather than to
accept the opinion of others.
“Tell me more about When client deal with topics
that.” superficially, exploring can help them
“Would you describe it examine the issue more fully. Any
more fully?” problem or concern can be better
“What kind of work?” understood if explored in depth. If the
client expresses an unwillingness to
explore a subject, however, the nurse
must respect his or her wishes.
“This point seems worth The nurse encourages the client to
looking at more concentrate his or her energies on a
closely.” single point, which may prevent a
“Of all the concerns multitude of factors or problems from
you’ve mentioned, overwhelming the client. It is also a
which is most useful technique when a client jumps
troublesome?” from one topic to another.
“What could you do to It may be helpful for the client to
let your anger out plan in advance what he or she might
TABLE1 : Therapeutic Communication Technique
Therapeutic
Communication Examples Rationale
Technique
to consider kinds of harmlessly?” do in future similar situations. Making
behavior likely to be “Next time this comes definite plans increases the likelihood
appropriate in future up, what might you do that the client will cope more
situations to handle it?” effectively in a similar situation.
General leads – giving “Go on.” General leads indicate that the
encouragement to “And then?” nurse is listening and following what
continue “Tell me about it” the client is saying without taking away
the initiative for the interaction. They
also encourage the client to continue if
he or she is hesitant or uncomfortable
about the topic.
Giving Information – “My name is …?” Informing the client of facts
Making available the facts “visiting hours are …” increases his or her knowledge about a
that the client need “My purpose in being topic or lets the client know what to
here is …” expect. The nurse is functioning as a
resource person. Giving information
also builds trust with the client.
Giving recognition – “Good morning, Mr. S…” Greeting the client by name,
Acknowledging, indicating “You’ve finished your indicating awareness of change, or
awareness list of things to do.” noting efforts the client has made all
“I notice that you’ve show that nurse recognizes the client
combed your hair.” as a person, as an individual. Such
recognition does not carry the notion
of value, that is,, of being “good” or
“bed.”
Making observations— “You appear tense.” Sometimes clients cannot verbalize
verbalizing what the nurse “Are you uncomfortable or make themselves understood. Or
perceives when…?” the client may not be ready to talk.
“I notice that you’re
biting your lip.”
Offering self – making “I’ll sit with you The nurse can offer his or her
oneself available awhile.” presence, interest, and desire to
TABLE1 : Therapeutic Communication Technique
Therapeutic
Communication
Technique
Placing event in time or
sequence – clarifying the
relationship of events in
time
Presenting reality –
offering for consideration
that which is real
Reflecting – directing
client actions, thoughts,
and feelings back to client
Examples Rationale
“I’ll stay here with you” understand. It is important that this
“I’m interested in what offer is unconditional; that is, the client
you think.” does not have to respond verbally to
get the nurse’s attention.
“What seemed to lead Putting events in proper sequence
up to …?” helps both the nurse and the client to
“Was this before or after see them in perspective. The client
…?” may gain insight into cause-and-effect
“when did this behavior and consequences, or the
happen?” client may be able to see that perhaps
some things are not related. The nurse
may gain information about recurrent
patterns or themes in the client’s
behavior or relationships.
“I see no one else in When it obvious that the client is
the room.” misinterpreting reality, the nurse can
“That sound was a car indicate what is real. The nurse does
backfiring.” this by calmly and quietly expressing
“your mother is not his or her perceptions or the facts; not
here; I am a nurse” by way of arguing with the client or
belittling his or her experience. The
intent is to indicate an alternative line
of thought for the client to consider,
not to “convince” the client that he or
she is wrong.
Client: “Do you think I Reflection encourages the client to
should tell the recognize and accept his or her own
doctor…?” feelings. The nurse indicates that the
Nurse: “Do you think client’s point of view has value and
TABLE1 : Therapeutic Communication Technique
Therapeutic
Communication Examples Rationale
Technique
you should?” that the client has the right to have
Client: “My brother opinions/ make decisions, and think
spend all my money independently.
and then has nerve to
ask for more.”
Nurse: “This causes you
to feel angry?”
Restating – repeating the Client: “I can’t sleep. I The nurse repeats what the client
main idea expressed stay awake all night.” has said in approximately or nearly the
Nurse: “You have same words the client has used. This
difficulty sleeping” restatement lets the client know that
Client: “I’m really mad, he or she communicated the idea
I’m really upset.” effectively. This encourages the client
Nurse: “You’re really to continue. Or if the client has been
mad and upset.” misunderstood, he or she can clarify
his or her thoughts.
Seeking information – “I’m not sure that I The nurse should seek clarification
seeking to make clear that follow.” throughout interactions with clients.
which is not meaningful “Have I heard you Doing so can help the nurse to avoid
or that which is vague correctly?” making assumptions that understanding
has occurred when it has not. It helps
the client to articulate thoughts,
feelings, and ideas more clearly.
Silence – absence of Nurse says nothing but Silence often encourages the client
verbal communication, continues to maintain to verbalize, provided that it is
which provides time for eye contact and interested and expectant. Silence gives
the client to put thoughts conveys interest. the client time to organize thoughts,
or feelings into words, to direct the topic of interaction, or focus
regain composure, or to on issue that are most important. Much
continue talking nonverbal behavior take place during
silence, and the nurse needs to be
aware of the client and his or her own
TABLE1 : Therapeutic Communication Technique
Therapeutic
Communication
Technique
Suggesting collaboration
– offering to share, to
strive, and to work with
the client for his or her
benefit
Summarizing – organizing
and summing up that
which has gone before
Translating into feelings
— seeking to verbalize
client’s feelings that he or
she expresses only
indirectly.
Verbalizing the implied
— voicing what the client
has hinted at or suggested
Examples Rationale
nonverbal behavior.
“Perhaps you and I can The nurse seek to offer a
discuss and discover the relationship in which the client can
triggers for your identify problems in living with others,
anxiety.” grow emotionally, and improve the
“Let’s go to your room, ability to form satisfactory
and I’ll help you find relationships. The nurse offer to do
what you’re looking things with, rather than for, the client.
for.”
“Have I got this Summarization seeks to bring out
straight?” the important point of the discussion
“You’ve said that…” and seeks to increase the awareness
“During the past hour, and understanding of both participants.
you and I have It omits the irrelevant and organizes
discussed…” the pertinent aspects of the
interaction. It allows both client and
nurse to depart with the same ideas
and provides a sense of closure at the
completion of each discussion.
Client: “I’m dead.” Often heat the client says, when
Nurse: “Are you taken literally, seems meaningless or
suggesting that you feel far removed from reality. To under sat
lifeless?” and, the nurse must concentrate on
Client: “I’m way out in what the client might be feeling to
the ocean.” express himself or herself this way.
Nurse: “You seem to
feel lonely or deserted.”
Client: “I can’t talk to Putting into words what the client
you or anyone. It’s a has implied or said indirectly tends to
waste of time.” make the discussion less obscure. The
Nurse: “Do you feel nurse should be as direct as possible
that no one without being unfeelingly blunt or
 TABLE2 : Non-therapeutic Communication Techniques
Non therapeutic
Communication Examples Rationale
Techniques
TABLE1Advising—
: Therapeutic Communication
telling the Technique
“I think you should…” Giving advice implies that only the
Therapeutic
client what to do “Why don’t you…” nurse knows what is best for the client.
Communication
Agreeing — indicating accord Examples
“That’s right.” Rationale
Approval indicates the client is “right”
Technique
with the client “I agree.” rather than “wrong.” This gives the client
understands?” obtuse. the
Theimpression
client may have
that difficulty
he or she I’d “right”
because directly.
communicating of agreement
The with
nursethe nurse.
Opinions
should stake careand
to conclusions
express onlyshould
may be
exclusively the client’s. What the nurse
be jumping to conclusions or
agrees with the client, there is no
interpreting the client’s
opportunity for the client to change his or
communication.
her mind without being “wrong.”
Voicing doubt — “Isn’t that unusual?” Another means of responding to
Belittling feelings expressed Client: “I have nothing to When the nurse tries to equate the
expressing uncertainty
— misjudging “Really?”
the degree of distortions
live for…I wish I was dead.” of reality
intense is to expressfeelings the
and overwhelming
about the
thereality
client’sofdiscomfort
the “That’s Nurse:
hard to doubt. Such
“Everybody gets clientexpression permits
has expressed the
to “everybody” or to
client’s perceptions believe.”
down in the dumps,”client
or tothe
become
nurse’saware that others
own feelings, do implies
the nurse
not necessarily
“I’ve felt that way myself.” that the perceive
discomfortevents in the mild, self
is temporary,
limiting,
same way or drawor not
thevery
sameimportant. The client
is focused
conclusions. on hisnot
This does or her ownthe
mean worries and
feelings; hearing the problems or feelings
client will alter his or her point of view,
of others is not helpful.
but at least the nurse will encourage
Challenging — demanding “But how can you be Often, the nurse believes that if he or
the client to reconsider or reevaluate
proof from the client president of the United she can challenge the client to prove
what has happened. The nurse neither
States?” unrealistic ideas, the client will realize
agreed nor
“If you’re dead, why is
disagreed; however, he or
there is no “proof” and then will
your heart beating?” she has recognize
not let the misperceptions
reality. and
Actually, challenging
distortions passthe
causes without comment.
client to defend the delusions
or misperception more strongly than
before.
Defending — attempting to “This hospital has a fine Defending what the client has criticized
protect someone or reputation.” implies that he or she has no right to
something from verbal attack “I’m sure your doctor has express impressions, opinions, or feelings.
your best interests in Telling the client that his or her criticism is
mind.” unjust or unfounded does not change the
client’s feeling but only serves to block
further communication.
Disagreeing — opposing the “That’s wrong.” Disagreeing implies the client is
client’s ideas “I definitely disagree “wrong.” Consequently, the client feels
with…” defensive about his or her point of view or
“I don’t believe that.” ideas.
Disapproving — denouncing “That’s bad.” Disapproval implies that the nurse has
the client’s behavior or ideas “I’d rather you wouldn’t…” the right to pass judgment on the client’s
thoughts or actions. It further implies that
the client is expected to please the nurse.
Giving approval — “That’s good.” Saying what the client thinks or feels is
 CLIENT ASSESSMENT

Cognitive Distortions:

Background of the authors:

1. Aaron Beck:

2. David Burns

COMMON COGNITIVE DISORTIONS

 Which
one (s)
Brief Description are
Cognitive
(to be filled-out Example sometim
distortions
by students) es TRUE
for you?
Put a R
All-or-Nothing
1 Thinking/Polariz
ed Thinking

Overgeneralizati
2
on

3 Mental Filter

Disqualifying the
4
Positive

Jumping to
5 conclusions-
Mind Reading
Jumping to
6 conclusions-
Fortune Telling
Magnification
7 (Catastrophizing
) or
 Which
one (s)
Brief Description are
Cognitive
(to be filled-out Example sometim
distortions
by students) es TRUE
for you?
Put a R
Minimization

Emotional
8
Reasoning

Should
9
Statements

1 Labeling and
0 Mislabeling

1
Personalization
1

1
Control Fallacies
2

1 Fallacy of
3 Fairness
 Which
one (s)
Brief Description are
Cognitive
(to be filled-out Example sometim
distortions
by students) es TRUE
for you?
Put a R

1 Fallacy of
4 change

1 Always being
5 right

1 Heaven’s
6 Reward Fallacy

PSYCHIATRIC DISORDERS

A. Diagnostic and Statistical B. International Classification of

Manual of Mental Diseases,10th Edition
Disorders (DSM–5)
Q: What is the difference between difference between DSM-5 and
ICD-10?

Q: How was DSM created ?

Q: How different is DSM 1, 2, 3, 4 from DSM-5?

FIVE STAGES OF GRIEF: ELIZABETH KÜBLER-ROSS (D-A-B-D-A)

A. ANXIETY DISORDERS

Q. What is the difference between anxiety and fear?

a) LEVELS OF ANXIETY

i. Normal

ii. Mild

iii. Moderate

iv. Severe

v. Panic
 b) Panic disorder

i. Q: Signs and symptoms

c) Phobias

i. Agoraphobia : Fear of being along in public places

ii. Social phobia: Social anxiety disorder, compelling desire to avoid situations in
which others may criticize a person.

iii. Specific phobia:

Phobia Fear Phobia Fear Phobia Fear

Acrophob heights Hematophobi blood Sitophobia flood
ia a
Agorapho Being along in Hydrophobia Water Thanatophob death
bia public places ia
Algophob pain Larrophobia doctors Topophobia Particular
ia place
Andropho men Necrophobia Dead bodies Zoophobia animals
bia
Astropho Stroms, lightning, Nyctophobia Night
bia thunder
Autophob Being alone Ochlophobia crowds
ia
Aviophobi flying Ophidiophobi snakes
a a
Claustrop Enclosed places Pathophobia disease
hobia
Entomop insects Pyrophobia fire
hobia

d) Generalized Anxiety Disorder

e) Obsessive-Compulsive Disorder

i. Definition and example:

ii. Obsession

iii. Compulsion

iv. How different is OCD from OCPD?

v. Screening tools and assessment Scales

f) Medications
Classification IMPORANT NOTES
BENZODIAZEPINES
Alprazolam, clonazepam, Lorazepam NO alchohol or sleep-inducing otc drugs, no
driving if dizziness occurs, has potential for
drug dependence and withdrawal syndrome
can occur when discontinued abruptly.
SSRI, SNRI, ATYPICAL AGENTS
Buspirone, Citalopram, Duloxetine, Contraindicated with MAOIs; careful about
Escitalopram, Fluoxetine, Fluvoxamine, renal, hepatic, cardiac disease, GI
Paroxetine, Sertraline, Venlafaxine disturbances. Monitor intake with diabetes,
glaucoma, risk for suicide, mania, seizures,
weight loss, hypertension etc.
Note for serotonin syndrome.
BETA-BLOCKERS
Atenolol, Propanolol Give with meals to facilitate absorption

Q: Nursing care and therapies:

B. Somatoform and Dissociative Disorders

a) Somatoform disorders

Disorder Description
1. Body dysmorphic Pervasive subjective feeling of ugliness and are preoccupied
disorder (Imagined ugliness) with an imagined defect in physical appearance or vastly
exaggerated concern about a minimal defect. The person
believes or fears he or she is unattractive or even repulsive.
2. Somatization disorder Chronic, severe anxiety disorder in which a client expresses
emotional turmoil or conflict through significant physical
complaints (including pain and GI, sexual, and neurologic
symptoms), usually with a loss or alteration of physical
functioning.
3. Conversion disorder A somatoform disorder that involves motor or sensory problems
Note: La belle suggestiong neurologic condition. Anxiety- provoking impulses
indifference, are converted unsconsciously into functional symptoms.
pseudoneurologic
manifestation.
4. Pain disorder An individual experiences significant pain without physical basis
for pain or with pain that greatly exceeds what is expected
based on the extent of the injury.
5. Hypochondriasis A client presents with unrealistiic or exaggerated physical
complaints. Referred to as “professional patients”

b) Dissociative disorders: state in which a person becomes separated from the reality.

Dissociative disorder Description

1. Dissociative amnesia Inability to recall an extensive amount of important personal
(psychogenic amnesia) information because of physical or psychological trauma.
2. Dissociative Fugue The person suddenly and unexpectedly leaves home or
(psychogenic fugue) work and is unable to recall the past.
3. Dissociative Identity Disorder A person is dominated by at least one of two or more
(multiple personality disorder) definitive personalities that alternatively take over the
person’s behavior.
4. Depersonalization Disorder Uncomfortable, distorted perception of self, body and one’s
life that is associated with a sense of unreality.

c) Medications

Classification IMPORANT NOTES

TCAs
Amitriptyline, Protriptyline Monitor for lethargy, sedation, arrythmias,
hypotension, constipation. Contraidincated
with MAOIs. Use cautiously with elderly
clients.
SSRI, SNRI, ATYPICAL AGENTS
Buspirone, Citalopram, Duloxetine, Contraindicated with MAOIs; careful about
Escitalopram, Fluoxetine, Fluvoxamine, renal, hepatic, cardiac disease, GI
Paroxetine, Sertraline, Venlafaxine disturbances. Monitor intake with diabetes,
glaucoma, risk for suicide, mania, seizures,
weight loss, hypertension etc.
Note for serotonin syndrome.

Q: Nursing Care and Therapies

MOOD DISORDERS

A. Mood Disorders

a) Major Depressive Disorder

 b) Dysthmic Disorder

B. Bipolar disorders

a) Bipolar 1

b) Bipolar II

c) Cyclothymic disorder

Screening Tools and Assessment Scales

 d) Medications

Classification IMPORANT NOTES

ANTIDEPRESSANTS

ANTICONVULSANTS

LITHIUM SALTS

ATYPICAL ANTIPSYCHOTICS

‘Nursing Care and Therapies