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Stage I Building the therapeutic working relationship through: - Empathy- relating to patient - Respect - Genuineness -Concreteness * In this stage, the client explores him/herself Stage II Deeper exploration through: - Additive Empathy - Self disclosure (typically only helpful with abused & raped - Feedback - Confrontation - Immediacy- "what I need from you right now" *The client learns to listen non-defensively and attempts to understand his/her own personal patterns Stage III Implementation - Problem solving - Support - Action Plans *The client collaborates with the nurse and takes personal risks to make desired changes and take action in his/her life DSMV-IV Axis Axis I: all mental health diagnosis except for those found in Axis II Axis II: any personality disorder diagnosis and mental retardation Axis III: any general medical diagnosis, such as asthma Axis IV: pertinent psychosocial problems and problems that may affect diagnosis, treatment, and prognosis of mental disorders Axis V: global assessment of functioning (GAF) an assessment of present and past-year functioning that rates the clients level of functioning in the areas of work performance, social abilities, and psychological ability on a scale of 1 to 100 Mental Status Examination Affect Physical Appearance Behavior- mood and affect Cognitive and intellectual abilities- orientation to time and place, remote, and recent memory, level of knowledge, ability to calculate (count back in 7s), abstract thinking, judgement, and rate and volume of speech Intentional Tort False imprisonment- confining a client to a specific area, such as a seclusion room, if the reason for confinement is for the convenience of the staff Assault- Making a threat to a client's person, approaching a client in a threatening manner with a syringe in hand Battery- touching a client a harmful or offensive way- if the nurse threatening the client with a syringe grabbed the client's arm and gave an injection Dual Diagnosis Mental illness with mental retardation or abuse/addiction External Therapeutic Environments Privacy Autonomy Safety Group-Well being Restrictiveness Program Structure Social Climate Counter-transference the nurse displaces feelings onto the client related to others in the nurse's past Orientation Phase first time the nurse and patient meet Establish: trust, parameters of relationship (nurse's role and responsibilities of both), formal and informal contract (time, place, date, duration), confidentiality, mutual goals, discuss termination Patient problems are articulated and mutually agreed upon goals are established Working Phase Maintain relationship Gather further data Promote client's: problem solving skills, self esteem, use of language and communication skills Facilitate behavioral change Overcome resistant behaviors Evaluate problems and goals Promote practice and expression of alternative adaptive behaviors *The nurse and the patient together identify and explore areas that are causing problems in the patient's life *Transference and countertransference typically happen here Termination Phase Deal with intense feelings regarding the experience Summarize goals and objectives achieved Review client's plan for the future and ways to implement new coping strategies into every day life Finalize termination