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Psychiatric Mental Health Nursing (NUR 333) Mental Health Hesi

Sandra Watson
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Psych hesi prep – HESI Study guide completed


University of Rhode Island


Psychiatric Mental Health Nursing (NUR 333)

Therapeutic Communication
A. Purpose of therapeutic interaction w/ pts
a. Allow them autonomy to make choices when appropriate
B. Keep statements value-free, advice-free, and re-assurance-free
C. JUST THE FACTS! NO opinions
D. What to do when there’s a psych situation and the pt describes a physical problem
a. ASSESS!!!!
b. Need to attend to physiologic needs
E. Forbidden phrases
a. “You should…”
b. “You’ll have to…”
c. “You can’t…”
d. “If it were me, I’d…”
e. “Why don’t you…”
f. “I think you…”
g. “It’s the policy on the this unit.”
h. “Don’t worry.”
i. “Everyone…”
j. “Why…?”
k. “Just a second…”
l. “I know…”
m. Avoid social interaction, clichés, and saying too much
n. Avoid changing the subjects
o. Avoid words like good, bad, right, wrong, and nice.
F. Basic communications applied to all pts
a. Establish trust
b. Demonstrate non-judgmental attitude
c. Offer self; be empathetic, not sympathetic
d. Use active listening
e. Accept and support pt’s feelings
f. Clarify and validate pt’s statements
g. Use matter-of-fact approach
G. Nurse’s nonverbal communication may be more important than the verbal communication
H. The nurse CAN’T tell a pt they won’t tell anyone what the pt discloses… nurse may NEED to tell
Coping Styles (Defense Mechanisms)
A. Denial : unconscious failure to acknowledge an event, thought, or feeling that’s too painful for
conscious awareness
a. Ex. a woman diagnosed w/ cancer tells her family all of the tests were negative
B. Displacement: transference of feelings to another person/object
a. Ex. after being scolded by supervisor @ work, man comes home and kicks dog for barking
C. Identification : attempt to be like someone or emulate personality, traits, or behaviors of another
a. Ex. a teenage boy dresses and behaves like his favorite singer
D. Intellectualization : using reason to avoid emotional conflicts

a. Ex. the wife of a substance abuser describes, in detail, the dynamics of enabling behavior yet
continues to call her husband’s workplace to report his Monday morning absences as an illness
E. Introjection : incorporation of values or qualities of an admired person or group into one’s own ego
a. Ex. young man deals w/ business client in the same fashion his dad deals w/ business clients
F. Isolation : separation of unacceptable feeling, idea, or impulse from one’s thought process
a. Ex. nurse working in an ER is able to care for seriously injured by isolating or separating her
feelings and emotions r/t the pt’s pain, injuries, or death
G. Passive-aggressive : indirectly expressing aggression towards others; a façade of overt compliance
masks covert resentment
a. Ex. employee arrives late to a meeting and disrupts others after being reminded of the meeting
earlier that day and promising to be on time
H. Projection : attributing one’s own thoughts or impulses to another person
a. Ex. student who has sexual feelings toward teacher tells her friends the teacher is “coming on
to her”
I. Rationalization : offering an acceptable, logical explanation to make unacceptable feelings and behavior
a. Ex. student who didn’t do well in a course says it was poorly taught and the course content
wasn’t important anyways
J. Reaction formation : dev’t of conscious attitudes and behaviors that are opposite of what’s really felt
a. Ex. person who dislikes animals does volunteer work for the Humane Society
K. Regression : reverting to an earlier level of dev’t when anxious or highly stressed
a. Ex. after moving to a new home, a 6 yr. old starts wetting the bed
L. Repression : INVOLUNTARY exclusion of a painful thought or memory from awareness
a. Ex. young man whose mom died when he was 12 yrs old can’t tell you how old he was or the
year she died
M. Sublimation : substitution of an unacceptable feeling by a more socially acceptable one
a. Ex. student who feels too small to play football becomes a champion marathon swimmer
N. Suppression : INTENTIONAL exclusion of feelings and ideas
a. Ex. when about to lose to Tara, Scarlet O’Hara says “I’ll think about it tomorrow”
O. Undoing : communication or behavior done to negate a previously unacceptable act
a. Ex. young



Psychiatric Mental Health Nursing (NUR 333) Mental Health Hesi

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