Rasmussen Mental Health Final Exam
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• Listening to and understanding the person in the context of the social setting of his or her
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life
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• Listening for "false notes" (i.e., inconsistencies or things the patient says that need more
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clarification)
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• Providing the patient with feedback about himself or herself of which the patient might be
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unaware
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Restating - Repeats the main idea expressed. Gives the patient an idea of what has
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II been communicated. If the message has been misunderstood, the patient can clarify it.
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Patient: "I can't sleep. I stay awake all night."
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Nurse: "You have difficulty sleeping?"
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Patient: "I don't know ... he always has some excuse for not coming over or keeping our
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appointments."
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Nurse: "You think he no longer wants to see you?"
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Reflecting - Directs questions, feelings, and ideas back to the patient. Encourages the
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patient to accept his or her own ideas and feelings. Acknowledges the patient's right to
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have opinions and make decisions and encourages the patient to think of self as a capable
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person.
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Patient: "What should I do about my husband's affair?"
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Nurse: "What do you think you should do?"
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Patient: "My brother spends all of my money and then has the nerve to ask for more."
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Nurse: "You feel angry when this happens?"
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Exploring - Examines certain ideas, experiences, or relationships more fully. If the
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patient chooses not to elaborate by answering no, the nurse does not probe or pry. In such
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a case, the nurse respects the patient's wishes.
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"Tell me more about that."
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"Would you describe it more fully?" II II II II II
"Could you talk about how it was that you learned your mom was dying of cancer?"
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, Summarizing - Combines the important points of the discussion to enhance
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understanding. Also allows the opportunity to clarify communications so that both nurse
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and patient leave the interview with the same ideas in mind.
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"Have I got this straight?" II II II II
"You said that..." II II
"During the past hour, you and I have discussed..." II II II II II II II II
II IIGiving premature advice - Assumes the nurse knows best and the patient cannot think
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II for self. Inhibits problem solving and fosters dependency.
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"Get out of this situation immediately."
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II IIMinimizing feelings - Indicates that the nurse is unable to understand or empathize with II II II II II II II II II II II II II II II
II the patient. The patient's feelings or experiences are being belittled, which can cause the
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II patient to feel small or insignificant. II II II II II
Patient: "I wish I were dead." II II II II II
Nurse: "Everyone gets down in the dumps." II II II II II II
"I know what you mean."
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"You should feel happy you're getting better."
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"Things get worse before they get better." II II II II II II
Making value judgments - Prevents problem solving. Can make the patient feel guilty,
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II angry, misunderstood, not supported, or anxious to leave.
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"How come you still smoke when your wife has lung cancer?"
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Asking "why" questions - Implies criticism; often has the effect of making the patient feel
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defensive
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"Why did you stop taking your medication?" II II II II II II
Boundaries - A well-defined therapeutic relationship allows for the establishment of
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clear patient boundaries that provide a safe space through which the patient can explore
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feelings and treatment issues.
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In reality, boundaries are at risk of blurring, and a shift in the nurse-patient partnership
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may lead to nontherapeutic dynamics. Examples of circumstances that can produce
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blurring of boundaries include the following:
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• When the relationship slips into a social context
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,• When the nurse's needs are met at the expense of the patient's needs
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II IIWarning signals that indicate a nurse may be blurring boundaries - • Overhelping: Doing
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II for patients what they are able to do themselves or going beyond the wishes or needs of
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II patients
• Controlling: Asserting authority and assuming control of patients "for their own good"
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• Narcissism: Having to find weakness, helplessness, and/or disease in patients to feel
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helpful, at the expense of recognizing and supporting patients' healthier, stronger, and
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more competent features
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Transference - The process whereby a person unconsciously and inappropriately
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displaces (transfers) onto individuals in his or her current life those patterns of behavior
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and emotional reactions that originated in relation to significant figures in childhood. The
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patient may even say, "You remind me of my ______" (mother, sister, father, brother)
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Patient: "Oh, you are so high and mighty. Did anyone ever tell you that you are a cold,
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unfeeling machine, just like others I know?"
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Nurse: "Tell me about one person who is cold and unfeeling toward you." (In this example,
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the patient is experiencing the nurse in the same way she did with significant other[s]
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during her formative years. It turns out that the patient's mother was very aloof, leaving
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her with feelings of isolation, worthlessness, and anger.)
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II IICountertransference - The tendency of the nurse to displace onto the patient feelings II II II II II II II II II II II II II II
II related to people in his or her past. II II II II II II II
Frequently, the patient's transference to the nurse evokes countertransference feelings in II II II II II II II II II II
the nurse.
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If the nurse feels either a strongly positive or a strongly negative reaction to a patient, the
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feeling most often signals countertransference in the nurse. One common sign of
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countertransference in the nurse is overidentification with the patient.
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II II Pre-orientation phase - Prep work prior to going to clinicals II II II II II II II II II II II
Getting the patients chart and being acclimated to their record PRIOR to meeting them.
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II II Orientation phase - The first time you meet your patient. Interview includes: II II II II II II II II II II II II II
-Establishing rapport II
, -Parameters of relationship II II
-Formal/informal contract II
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Confidentiality
-BEGINNING of termination begins (time-frame set) II II II II II
II II Working phase - • Maintain the relationship
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• Gather further data
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• Promote the patient's problem-solving skills, self-esteem, and use of language
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• Facilitate behavioral change
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• Overcome resistance behaviors
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• Evaluate problems and goals, and redefine them as necessary
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• Promote practice and expression of alternative adaptive behaviors
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II IITermination phase - The final, integral phase of the nurse-patient relationship. Basically,
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II the tasks of termination are as follows:
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• Summarizing the goals and objectives achieved in the relationship
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• Discussing ways for the patient to incorporate into daily life any new coping strategies
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learned during the time spent with the nurse
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• Reviewing situations that occurred during the time spent together
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• Exchanging memories, which can help validate the experience for both nurse and
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patient and facilitate closure of that relationship
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II II Autonomy - Respecting the rights of others to make their own decisions.
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Ex: Acknowledging the patient's right to refuse medication.
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Justice - The duty to distribute resources or care equally, regardless of personal
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attributes.
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Ex: When an intensive care unit (ICU) nurse devotes equal attention both to a patient who
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has attempted suicide and to another patient who suffered a brain aneurysm.
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