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PSYCHIATRIC NURSING

NURSE-CLIENT RELAIONSHIP
➔ 2 way
➔ a series of interaction between the nurse and
the client (consistent and continuous process)
➔ facilitate a helping relationship
GOAL: positive behavioral change
ELEMENTS OF THERAPEUTIC RELATIONSHIP
T-trust
R-rapport
U-unconditional positive regard (accept the client
regardless of age, religion, and etc
...
When does the therapeutic relationship begin?
Ans: begins as early as your orientation (the first
time the nurse and patient meet each other)
2
...
When is trust established?
Ans: when the patient starts “SHARING”
THERAPEUTIC BEHAVIOR
➔ Genuineness: must be sincere, honest (reality
based)
➔ Concreteness: ability to identify client’s
feelings (must know when ang patient naiirita,
offended, when siya pwedeng kausapin, kalian
siya masaya, galit or sad boi) (pag sinabi
niyang okay lang siya dele yan okay, pag sinabi
hndi siya gutom, gutom yan, pag sinabi niyang
pumunta ka, wag kang pumunta)))
➔ Respect: consideration that each client is
unique (every patient has different emotion,
perception, belief and etc
...

Types of CRISIS
➔ Situational – caused by unexpected event
(Loss of a job / starting a new job, Death of a
loved one)
➔ Adventitious / Social – caused by natural
catastrophe (earthquake, fire, tornado)
➔ Maturational / Developmental – caused by
expected events (menarche, marriage,
pregnancy, retirement)
THERAPEUTIC COMMUNICATION
Therapeutic Communication (Theracomm)
➔ "Dynamic"-(nagbabago) process of
exchanging information
➔ Verbal and non verbal techniques
Elements

PSYCHIATRIC NURSING

➔ Sender/Encoder: source of the message
➔ Message: information being transmitted
➔ Receiver/Decoder: recipient of the message
➔ Feedback: receiver's response
NON-VERBAL COMMUNICATION
➔ Proxemics: physical space between the
sender and receiver (3-6 ft/one arm and half)
➔ Kinetics: body movements (gestures, facial
expressions, mannerisms)
➔ Touch: intimate physical contact->conveys
empathy (invasive->consent)
➔ Silence: conveys listening, interest, form of
agreeing, encourages patient to talk
➔ Paralanguage: “voice quality” (tone,
inflection); it is how the message is delivered
NON-VERBAL COMMUNICATION
➔ should be therapeutic, appropriate, simple and
concise, adaptive, credible
➔ Offering self: let me sit with you for 5 minutes
(time frame is given but it should be SMART;
5mins is smart)
S-specific
M-measurable
A-attainable
R-realistic
T-time bounded
➔ Active listening: “yes, no, ah huh, really ba?,
awtsu”
➔ Exploring: You said Hannah was the best,
can you describe her?
➔ Broad openings: Where would you like to
begin?
➔ Making observation: I noticed you have
combed your today
➔ Summarizing: In the past 15 minutes we have
talked about
...

➔ Encourage description of perception: “what
are the voices telling you…
➔ Presenting reality: I know that the voices
seems real to you, but there are no voices
here…
➔ Reflecting
➔ Restating: rephrasing

FREUD’S STRUCTURAL
THEORY OF PERSONALITY
ID- pleasure seeker
EGO- reality
SUPEREGO- moral conscience, guilt
EGO DEFENSE MECHANISM
Repression

unconsciously forgetting (di
sadya

Suppression

consciously forgetting (sadya)

Reaction
formation

Opposite of what one thinks or
feels

Rationalization

reasoning out/making excuses

Projection

blaming others

Introjection

blaming self/exact repli

Identification

idolization/certain features

ocompensation

weak on one aspect->strong
on another aspect

Denial

unacceptance of the truth

Displacement

channelling of anxiety

Regression

going back to the previous dev
stage

Undoing

hugas kamay

Conversion

Anxiety->physical symptoms

Intellectualizati
on

reasoning
(detailed/references)/without
emotions

Substitution

unavailable->available

Sublimation

unacceptable-> acceptable

DISTURBANCES IN COMMUNICATION
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Mutism: mute
Negativism: always says “NO”
Circumstantiality: beating around the bush;
ANSWERS THE QUESTION
Tangentiality: beating around the bush;
DOES NOT ANSWER THE QUESTION
Stilted language: flowery words (common in
male)
Flight of ideas: slightly related W/ MEANING
Loose association: W/O MEANING, not
related at all
Perseveration: going back to the same topic

PSYCHIATRIC NURSING


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over and over again
Echolalia: repeating the words of others
Palilalia: repeating own words
Verbigeration: repeating phrases
Coprolalia: involuntary swearing or the
involuntary utterance of obscene words
Neologism: invent/coining of new words
Blocking: mental block
Word salad: mixture of unrelated words
Clang association: rhyming of words

STRESS
➔ STAGE 1: alarm reaction; you have determine
that there is stress
➔ STAGE 2: stage of resistance; utilize all of
resources to solve the problem (ex
...
I am the Queen of
England; I am the President of United
States of America)
o Persecutory: “to be harmed by others”
(ex
...
sabi ni Nadine lustre gusto
niya ako<333)
Magical thinking
Paranoia: extreme suspiciousness
Religiosity: obsession to religious ideas
Phobia: irrational fear
Obsession: persistent thought
Compulsion: persistent actions
Preoccupation: idea with intense desire
Thought broadcasting: others know what I
am thinking
Delusions/ideas of reference: feeling main
character (common in paranoia)
Affect: Emotions/expressions
1
...
Blunted: Little response (correct response
but little response/energy)
3
...
Labile mood: unpredictable mood changes
5
...
Ambivalence: opposing feelings
7
...
Euphoria: experiencing extreme pleasure
(high; laging masaya, lagging alrayt)

ANXIETY
➔ Anxiety (unknown) vs Fear (known)
Levels of Anxiety
➔ Mild- logical thinking, increase concentration,
increase alertness
Solution: problem solving approach
-good anxiety
-highest level of thinking
➔ Moderate- decrease attention span, selective
inattentiveness (hati ang atensyon)
-relaxation techniques; DBE, encourage
verbalization of feelings
-MEDICATION is given already
-BENZODIAZEPINES/ANXIOLYTICS:
“pam/lam”
➔ Severe- extreme muscle tension, loud and
rapid speech, diff of focusing even with
assistance distorted perception
NI: remain with the client> effective in
decreasing anxiety
➔ Panic- suicidal attempts, fixed eyes,
hysterical/mute, incoherence (hindi alam ang
ginagawa)
NI: decrease stimulation, stay with the client,
assist relaxation techniques, PAPER BAG: for
hyperventilation
ANXIETY RELATED DISORDER

➔Generalized Anxiety Disorder
(GAD)
-worry worm: pacing (hindi mapakali)
-no apparent reason
- For 6 months
-no phobias, no panic attacks, no OC
manifestations
S/SX:

PSYCHIATRIC NURSING

-palpitations: sympathetic nervous response
-chest pain due to palpitation
-headache
-insomnia
Management:
-assist in problem solving (just guide/assist not
solve the problem)
-teach coping behaviors (assess previous
coping)
-DOC: Benzodiazepines/Anxiolytics: “pam/lam”

➔Panic Disorder
-recurrent (pabalik balik)
-unpredictable when to occure (pwede habang
kumakain, tumatae, naglalaba, nag eemel)
-panic attacks; may trembling, racing heart
(tachycardia), chest pain, DOB, choking
sensation, numbness
Management:
-assist in problem solving
-teach coping behaviors
*if with addiction to benzodiazepines: use Antihistamine*
DOC: Benzodiazepines
-primary effect: anti-allergic reactions
-secondary: depressant/sedative
Other Medications:
 Beta-blockers: “olol”
-blocks adrenergic receptor
 Anti- Depressants
-MAOI, SSRI (to balance neurotransmitter)

➔Acute Stress Disorder
-s/sx of anxiety but for 1mnth only (after 2dys4wks)
Manegement:
-progressive review of the trauma (to have
acceptance)
DOC: Benzodiazepines

➔PTSD (post-traumatic stress disorder)
-s/sx are more than 4wks (1mnth) after the
acute stress disorder
-Recurrent flashbacks occurs
Flashback: intrusive thoughts
Ex
...
Mechanism: displacement (channeling of
anxiety; nagwawala)
S/SX:
-starts w/ general numbing then lead to somatic
symptoms (bodily symptoms)
-irritated
-aggressiveness
-depression (feeling of hopelessness,
worthless)
-anger (can’t forgive self)
-social withdrawal (self-isolation)
*group therapy with patients who had same
experience*
Management:
-assisst in gaining control over angry impulses
DOC: SSRI, Benzodiazepines (acute attacks)- anti histamines, beta-blockers

➔Phobic Disorder
-persistent, irrational fear
-fear is unreasonable proportional to the actual
danger
3 MAIN TYPES
1
...
Social Phobia
3

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