NUR 2488 Mental Health Nursing Final Exam
Introduction in Psychiatric Nursing
Understand milieu therapy- can you describe it in a clinical setting?
Team working together, stress free working environment
Describe the difference between mental health and mental illness
Mental health: a person’s condition about their psychological and emotional well-being:
Mental illness: a disorder or disease affecting a person’s psychological and emotional well-
being.
Maslow’s Hierarchy of needs (pg 31)
,Erikson
Infancy Birth-1.5yrs Trust vs. Mistrust Develops trust
Self-control;
Autonomy vs.
Early Childhood 1.5-3yrs independence;
Shame/Doubt
confidence
Developing sense of
Play Late Child 3-6yrs Initiative vs. Guilt
purpose
“An 11-year-old
Industry vs.
School Age 6-12yrs Competing girl trying out
Inferiority for cheer”
Identity vs. Role
Adolescent 12-20yrs Secure sense of self
Confusion
Ability to love and be
Young Adult 20-30yrs Intimacy vs. Isolation
loved
Generativity vs. Nurturing subsequent
Adulthood 30-65yrs
Stagnation generations
Old Adult 65-death Integrity vs. Despair Acceptance of life
Freud-(Apply concept of Id, Ego and Superego) (page 19)
The id is the primitive, pleasure-seeking part (according to Freud, predominantly sexual pleasure) of our
personalities that lurks in the unconscious mind. (Unconscious)
Pleasure-pain principle
Id, the instinctive and primitive mind, is dominant
The ego is our sense of self and acts as an intermediary between the id and the world by using ego
defense mechanisms, such as repression, denial, and rationalization (conscious)
The superego is assigned to those processes that Freud referred to as our conscience (our sense of what is
right or wrong) and is greatly influenced by our parents’ or caregivers’ moral and ethical stances. The
assumption is made that in healthy individuals, the ego is able to realistically evaluate situations, limit the
id’s primitive impulses, and keep the superego from becoming too rigid and obsessive. (Unconscious)
Therapeutic Communication
Be able to given examples of verbal and non-verbal communication
,ABLE 8-2
Techniques that Enhance Communication
Technique Discussion Examples
Using silence Gives the person time to collect thoughts or think through a point. Encourage a person to talk by
waiting for the answers.
Accepting Indicates that the person has been understood. The statement does not “Yes.”
necessarily indicate agreement but is nonjudgmental. However, “Uh-huh.”
nurses should not imply that they understand when they do not “I follow what you say.”
understand.
Giving recognition Indicates awareness of change and personal efforts. Does not imply “Good morning, Mr. James.”
good or bad, or right or wrong. “You’ve combed your hair
today.” “I notice that you shaved
today.”
Offering self Offers presence, interest, and a desire to understand. Is not offered to “I would like to spend time
get the person to talk or behave in a specific way. with you.”
“I’ll stay here and sit with you
a while.”
Offering general Allows the other person to take direction in the discussion. Indicates “Go on.”
leads that the nurse is interested in what comes next. “And then?”
“Tell me about it.”
Giving broad Clarifies that the lead is to be taken by the patient. However, the “Where would you like to begin?”
openings nurse discourages pleasantries and small talk. “What are you thinking about?”
“What would you like to
discuss?”
Placing the events in Puts events and actions in better perspective. Notes cause-and-effect “What happened before?”
time or sequence relationships and identifies patterns of interpersonal difficulties. “When did this happen?”
Making observations Calls attention to the person’s behavior (e.g., trembling, nail biting, “You appear tense.”
restless mannerisms). Encourages the person to notice the “I notice you’re biting your lips.”
behavior to describe thoughts and feelings for mutual “You appear nervous whenever
understanding. Helpful with mute and withdrawn people. John enters the room.”
Encouraging Increases the nurse’s understanding of the patient’s perceptions. “What do these voices seem to be
description of Talking about feelings and difficulties can lessen the need to act saying?”
perception them out inappropriately. “What is happening now?”
“Tell me when you feel anxious.”
Encouraging Reveals recurring themes in experiences or interpersonal “Has this ever happened
comparison relationships. Helps the person clarify similarities and before?” “Is this how you felt
differences. when…?” “Was it something
like…?”
Restating Repeats the main idea expressed. Gives the patient an idea of what Patient: “I can’t sleep. I stay
has been communicated. If the message has been awake all night.”
misunderstood, the patient can clarify it. Nurse: “You have
difficulty sleeping?”
Patient: “I don’t know … he
always has some excuse for
not coming over or keeping
our appointments.”
Nurse: “You think he no
longer wants to see you?”
Reflecting Directs questions, feelings, and ideas back to the patient. Encourages Patient: “What should I do
the patient to accept his or her own ideas and feelings. about my husband’s
Acknowledges the patient’s right to have opinions and make affair?”
decisions and encourages the patient to think of self as a capable Nurse: “What do you think you
should do?”
, Technique Discussion Examples
Using silence Gives the person time to collect thoughts or think through a point. Encourage a person to talk by
waiting for the answers.
person. Patient: “My brother spends all of
my money and then has the
nerve to ask for more.”
Nurse: “You feel angry when
this happens?”
Focusing Concentrates attention on a single point. It is especially useful when “This point you are making
the patient jumps from topic to topic. If a person is experiencing about leaving school seems
a severe or panic level of anxiety, the nurse should not persist worth looking at more
until the anxiety lessens. closely.”
“You’ve mentioned many things.
Let’s go back to your
thinking of ‘ending it all’.”
Exploring Examines certain ideas, experiences, or relationships more fully. If “Tell me more about that.”
the patient chooses not to elaborate by answering no, the nurse “Would you describe it more
does not probe or pry. In such a case, the nurse respects the fully?” “Could you talk about how
patient’s wishes. it was
that you learned your mom
was dying of cancer?”
Giving information Makes available facts the person needs. Supplies knowledge from “My purpose for being here
which decisions can be made or conclusions drawn. For is…” “This medication is for…”
example, the patient needs to know the role of the nurse; the “The test will determine…”
purpose of the nurse-patient relationship; and the time, place,
and duration of the meetings.
Seeking clarification Helps patients clarify their own thoughts and maximize mutual “I am not sure I follow you.”
understanding between nurse and patient. “What would you say is the main
point of what you just
said?” “Give an example of a
time you
thought everyone hated you.”
Presenting reality Indicates what is real. The nurse does not argue or try to convince the “That was Dr. Todd, not a
patient, just describes personal perceptions or facts in the terrorist stalking and trying
situation. to harm you.”
“That was the sound of a
car backfiring.”
“Your mother is not here; I am
a nurse.”
Voicing doubt Undermines the patient’s beliefs by not reinforcing the exaggerated “Isn’t that unusual?”
or false perceptions. “Really?”
“That’s hard to believe.”
Table Continued
Technique Discussion Examples
Seeking consensual Clarifies that both the nurse and the patient share mutual “Tell me whether my
validation understanding of communications. Helps the patient become understanding agrees with
clearer about what he or she is thinking. yours.”
Verbalizing the Puts into concrete terms what the patient implies, making the Patient: “I can’t talk to you or
implied patient’s communication more explicit. anyone else. It’s a waste
of time.”
Nurse: “Do you feel that no one
understands?”
Encouraging Aids the patient in considering people and events from the “How do you feel about…?”
evaluation perspective of the patient’s own set of values. “What did it mean to you when he
Introduction in Psychiatric Nursing
Understand milieu therapy- can you describe it in a clinical setting?
Team working together, stress free working environment
Describe the difference between mental health and mental illness
Mental health: a person’s condition about their psychological and emotional well-being:
Mental illness: a disorder or disease affecting a person’s psychological and emotional well-
being.
Maslow’s Hierarchy of needs (pg 31)
,Erikson
Infancy Birth-1.5yrs Trust vs. Mistrust Develops trust
Self-control;
Autonomy vs.
Early Childhood 1.5-3yrs independence;
Shame/Doubt
confidence
Developing sense of
Play Late Child 3-6yrs Initiative vs. Guilt
purpose
“An 11-year-old
Industry vs.
School Age 6-12yrs Competing girl trying out
Inferiority for cheer”
Identity vs. Role
Adolescent 12-20yrs Secure sense of self
Confusion
Ability to love and be
Young Adult 20-30yrs Intimacy vs. Isolation
loved
Generativity vs. Nurturing subsequent
Adulthood 30-65yrs
Stagnation generations
Old Adult 65-death Integrity vs. Despair Acceptance of life
Freud-(Apply concept of Id, Ego and Superego) (page 19)
The id is the primitive, pleasure-seeking part (according to Freud, predominantly sexual pleasure) of our
personalities that lurks in the unconscious mind. (Unconscious)
Pleasure-pain principle
Id, the instinctive and primitive mind, is dominant
The ego is our sense of self and acts as an intermediary between the id and the world by using ego
defense mechanisms, such as repression, denial, and rationalization (conscious)
The superego is assigned to those processes that Freud referred to as our conscience (our sense of what is
right or wrong) and is greatly influenced by our parents’ or caregivers’ moral and ethical stances. The
assumption is made that in healthy individuals, the ego is able to realistically evaluate situations, limit the
id’s primitive impulses, and keep the superego from becoming too rigid and obsessive. (Unconscious)
Therapeutic Communication
Be able to given examples of verbal and non-verbal communication
,ABLE 8-2
Techniques that Enhance Communication
Technique Discussion Examples
Using silence Gives the person time to collect thoughts or think through a point. Encourage a person to talk by
waiting for the answers.
Accepting Indicates that the person has been understood. The statement does not “Yes.”
necessarily indicate agreement but is nonjudgmental. However, “Uh-huh.”
nurses should not imply that they understand when they do not “I follow what you say.”
understand.
Giving recognition Indicates awareness of change and personal efforts. Does not imply “Good morning, Mr. James.”
good or bad, or right or wrong. “You’ve combed your hair
today.” “I notice that you shaved
today.”
Offering self Offers presence, interest, and a desire to understand. Is not offered to “I would like to spend time
get the person to talk or behave in a specific way. with you.”
“I’ll stay here and sit with you
a while.”
Offering general Allows the other person to take direction in the discussion. Indicates “Go on.”
leads that the nurse is interested in what comes next. “And then?”
“Tell me about it.”
Giving broad Clarifies that the lead is to be taken by the patient. However, the “Where would you like to begin?”
openings nurse discourages pleasantries and small talk. “What are you thinking about?”
“What would you like to
discuss?”
Placing the events in Puts events and actions in better perspective. Notes cause-and-effect “What happened before?”
time or sequence relationships and identifies patterns of interpersonal difficulties. “When did this happen?”
Making observations Calls attention to the person’s behavior (e.g., trembling, nail biting, “You appear tense.”
restless mannerisms). Encourages the person to notice the “I notice you’re biting your lips.”
behavior to describe thoughts and feelings for mutual “You appear nervous whenever
understanding. Helpful with mute and withdrawn people. John enters the room.”
Encouraging Increases the nurse’s understanding of the patient’s perceptions. “What do these voices seem to be
description of Talking about feelings and difficulties can lessen the need to act saying?”
perception them out inappropriately. “What is happening now?”
“Tell me when you feel anxious.”
Encouraging Reveals recurring themes in experiences or interpersonal “Has this ever happened
comparison relationships. Helps the person clarify similarities and before?” “Is this how you felt
differences. when…?” “Was it something
like…?”
Restating Repeats the main idea expressed. Gives the patient an idea of what Patient: “I can’t sleep. I stay
has been communicated. If the message has been awake all night.”
misunderstood, the patient can clarify it. Nurse: “You have
difficulty sleeping?”
Patient: “I don’t know … he
always has some excuse for
not coming over or keeping
our appointments.”
Nurse: “You think he no
longer wants to see you?”
Reflecting Directs questions, feelings, and ideas back to the patient. Encourages Patient: “What should I do
the patient to accept his or her own ideas and feelings. about my husband’s
Acknowledges the patient’s right to have opinions and make affair?”
decisions and encourages the patient to think of self as a capable Nurse: “What do you think you
should do?”
, Technique Discussion Examples
Using silence Gives the person time to collect thoughts or think through a point. Encourage a person to talk by
waiting for the answers.
person. Patient: “My brother spends all of
my money and then has the
nerve to ask for more.”
Nurse: “You feel angry when
this happens?”
Focusing Concentrates attention on a single point. It is especially useful when “This point you are making
the patient jumps from topic to topic. If a person is experiencing about leaving school seems
a severe or panic level of anxiety, the nurse should not persist worth looking at more
until the anxiety lessens. closely.”
“You’ve mentioned many things.
Let’s go back to your
thinking of ‘ending it all’.”
Exploring Examines certain ideas, experiences, or relationships more fully. If “Tell me more about that.”
the patient chooses not to elaborate by answering no, the nurse “Would you describe it more
does not probe or pry. In such a case, the nurse respects the fully?” “Could you talk about how
patient’s wishes. it was
that you learned your mom
was dying of cancer?”
Giving information Makes available facts the person needs. Supplies knowledge from “My purpose for being here
which decisions can be made or conclusions drawn. For is…” “This medication is for…”
example, the patient needs to know the role of the nurse; the “The test will determine…”
purpose of the nurse-patient relationship; and the time, place,
and duration of the meetings.
Seeking clarification Helps patients clarify their own thoughts and maximize mutual “I am not sure I follow you.”
understanding between nurse and patient. “What would you say is the main
point of what you just
said?” “Give an example of a
time you
thought everyone hated you.”
Presenting reality Indicates what is real. The nurse does not argue or try to convince the “That was Dr. Todd, not a
patient, just describes personal perceptions or facts in the terrorist stalking and trying
situation. to harm you.”
“That was the sound of a
car backfiring.”
“Your mother is not here; I am
a nurse.”
Voicing doubt Undermines the patient’s beliefs by not reinforcing the exaggerated “Isn’t that unusual?”
or false perceptions. “Really?”
“That’s hard to believe.”
Table Continued
Technique Discussion Examples
Seeking consensual Clarifies that both the nurse and the patient share mutual “Tell me whether my
validation understanding of communications. Helps the patient become understanding agrees with
clearer about what he or she is thinking. yours.”
Verbalizing the Puts into concrete terms what the patient implies, making the Patient: “I can’t talk to you or
implied patient’s communication more explicit. anyone else. It’s a waste
of time.”
Nurse: “Do you feel that no one
understands?”
Encouraging Aids the patient in considering people and events from the “How do you feel about…?”
evaluation perspective of the patient’s own set of values. “What did it mean to you when he
