NURSE PATIENT INTERACTION
Hildegard Peplau
Phase
Pre-Interaction Phase
 ⊗ begins when the
nurse is
assigned/chooses a
patient
 ⊗ patient is excluded
as an active participant
Orientation phase
⊗ when the nurse- patient
interacts for the first time
Anxiety Tasks
⊗ Major task: develop self-
awareness
⊗ includes all of what the nurse
thinks and does
Nurse before interacting with the
patient
⊗ data gathering, planning for
first interaction
Patient  ⊗ Major task: establish
trust and rapport
 ⊗ conduct initial
interview
 ⊗ establish contract with
the patient
 ⊗ learn about the
patient and his initial
concerns and needs
 ⊗ encourage the patient
to feel comfortable with
the meeting
 ⊗ manage present
emotions of the patient
 ⊗ provide support and
empathy of the patient’s
feelings
  ⊗ assure confidentiality

⊗ Major task: identification and

Working / Therapeutic resolution of the patient's
Phase problems
 ⊗ it is highly ⊗ planning and implementation
individualized (focus Teach
only on the patient)
Learn Change
 ⊗ more structured
Problems:
than the None ⊗ Transference

orientation phase 􏰀 the development of an emotional

attitude towards the nurse
 ⊗ the longest and
most productive 􏰀 positive or negative
phase ⊗ Counter transference –
experienced by the
 ⊗ limit setting must
nurse / therapist
be employed

⊗ Reinforce and reward change

and strength of patient

⊗ Encourage expression of
feelings about termination of the
Termination Phase Patient
relationship

⊗ Summarize the progress

⊗ Terminate the relationship
without giving promises
DISSOCIATIVE DISORDERS

Conditions that involve disruptions or breakdowns of memory,

awareness, identity and/or perception

Dissociative Amnesia

 ⊗ Inability to recall extensive amount of important information

 ⊗ Caused by trauma

⊗ Characterized by:

􏰀 Disorientation
􏰀 Purposeless wandering
􏰀 Impairment inability to perform ADL

 ⊗ Rapid recovery generally occur

Depersonalization Disorder

⊗ Periods of detachment from self or surrounding which may be

experienced as "unreal" while retaining awareness that this is only
a feeling and not a reality

Dissociative Identity Disorder

⊗ Occurrence of two or more personalities within the same

individual, each of which is controlling the person's life.

Nursing Interventions:

 ⊗ Professional attention
 ⊗ Education of family
  ⊗ Resolution of primary cause (traumatic events e.g. sexual or
physical abuse)
 ⊗ Supportive therapies (psychotherapy: talk therapy)
 ⊗ Offer support and empathy
 ⊗ Nonjudgmental attitude
 ⊗ Administer medications, as ordered (antidepressant: Elavil
improve mood, relieve anxiety or tension.)
 ⊗ Listen attentively

PERSONALITY DISORDERS

way of thinking, feeling and behaving that deviates from the

expectations, and lasts over time and leads to distress or impairment.

Types of Personality Disorders:

Eccentric Personality Disorder (Type A) STRANGE BEHAVIOR

⊗ Paranoid (Suspicious and distrustful)

􏰀 Persons who display pervasive and long stand suspiciousness

􏰀 More common in men

⊗ Schizoid (Socially distant and detached)

􏰀 Chooses solitary activities (mag isa)

⊗ Schizotypal (Odd and eccentric)

􏰀 “mild schizophrenia”
􏰀 Being a loner and lacking close friends
􏰀 Flat emotions or limited emotional responses.
􏰀 Incorrect interpretation of events, such as a feeling that something that
is actually harmless or inoffensive has a direct personal meaning.

Dramatic-Erratic Personality Disorder (Type B)

UNPREDICTABLE/CHANGING BEHAVIOR

⊗ Antisocial (aggressive and manipulative)

􏰀 Repeatedly violating the rights of others through intimidation and
dishonesty.
􏰀 Lack of remorse about harming others.
􏰀 Low self-esteem

⊗ Borderline (destructive and unstable)

􏰀 Impulsive and risky behavior
􏰀 Fear of abandonment
􏰀 Unstable relationships
􏰀 Self-mutilating behavior
􏰀 More common in women

⊗ Histrionic (emotional and dramatic)

􏰀 Excessive emotionally and attention-seeking behaviors that are
dramatic and egocentric
􏰀 Exaggerated expression of emotion
􏰀 Over reaction to minor events
⊗ Narcissistic (boastful / superiority complex)
􏰀 Grandiosity and need for constant admiration
􏰀 Exploitation of others for fulfillment of own desire

Anxious or Fearful Personality Disorder (Type C)

⊗ Avoidant (inferiority complex)
􏰀 Low self-esteem
􏰀 Social withdrawal inspite of a desire for affection and acceptance

⊗ Dependent (submissive)
􏰀 Submissive clinging behavior related to excessive need to be cared
for by others
􏰀 Lack of self-confidence
􏰀 Perceive self as helpless and stupid

⊗ Obsessive-Compulsive (perfectionist)
􏰀 Preoccupied with orderliness, perfectionism, inflexibility, need to be
in control
􏰀 Judgmental of self and others

⊗ Passive-Aggressive
􏰀 Does not cooperate
􏰀 They express negative feelings and emotions passively rather than
directly.
􏰀 They show opposition to the demands of others, especially the
demands of people in positions of authority.

Nursing Diagnosis:
Ineffective individual coping- (the inability to make decisions due to the
failure of assessing a stressful life event. The person may verbalize
being unable to ask for help, find proper resources, and/or utilize
problem-solving skills to manage the situation at hand)

Self-esteem disturbance- (when someone lacks confidence about who

they are and what they can do. They often feel incompetent, unloved, or
inadequate. People who struggle with low self-esteem are consistently
afraid about making mistakes or letting other people down.)

Nursing Care:
- Avoid client attempts to manipulate
- Set limits and boundaries
 - Consistency is essential
- Clear communication
- Deal with frustration
- Specific treatment of symptoms

MOOD DISORDERS

Common Types of Mood Disorders:

Major Depressive Disorder

⊗ Lasts at least 2 weeks which impairs ADL
⊗ Characterized by depressed mood / loss of pleasure in most activities

Clinical Symptoms of Major Depressive Episode

⊗ Affect is flat
⊗ Loss of memory
⊗ Obvious sleep disturbances
⊗ Sad feelings / Social withdrawal
⊗ Reduced appetite

Mania – abnormally and persistently elevated mood lasting for 1 week

Clinical Symptoms of Manic Episode;

⊗ Agitation
⊗ Flight of ideas
⊗ Increased activity
⊗ Grandiosity
⊗ High emotions
⊗ Talkative or pressured to keep talking

Bipolar Disorder

 ⊗ A person’s mood cycles between mania and depression for 1

week
  ⊗ Bipolar I Disorder
􏰀 one or more of symptoms of manic episode
􏰀 accompanied by major depressive episode

⊗ Bipolar II Disorder 􏰀one or more symptoms of major
depressive episode with hypomania

Mania Depression
Appearance Elated Sad
DM Projection Introjection
Attitude therapies Matter of fact Kind firmness
Activity Non-stimulating Monotonous
Never give anything that
requires attention

Priority Ndx Risk for injury: Directed Risk for injury: self-
at others directed

Nursing Mngt Individual therapies Group therapy

Lithium Antidepressants ECT
Diet

Suicide

⊗ thought or act of taking one’s own life

⊗ a way to end feelings of hopelessness and helplessness
Risk Factors
⊗ Sex (more female attempts suicide but more male commits suicide)
⊗ Use of drugs / alcohol
⊗ Identification with a dead family member
⊗ Chronic Illness (e.g. Cancer)
⊗ Irrational thinking
⊗ Depression/Dependent personality
⊗ Age (18-25 and 40)
⊗ Lethality of previous attempt/Losses

Nursing Diagnosis: Risk for injury-Self-directed

Nursing care:

 ⊗ Safe environment
 ⊗ Always take overt or covert threats or attempts seriously
 ⊗ Ventilation of feelings
 ⊗ Encourage activities
 ⊗ Monitor closely (one-on-one, 24/7)
 ⊗ Empathy (show acceptance & appreciation)

ANXIETY DISORDERS

Panic Disorder
⊗ A sudden surge of overwhelming anxiety and fear
⊗ May include terror, sense of unreality or fear of loosing control ⊗
Attack: 1 minute to 1 hour

Phobic Disorder
⊗ Phobia is an irrational, unrealistic or exaggerated fear of a specific
object, activity, or situation that in reality presents little or no danger.

Examples:
⊗ Acrophobia – heights
⊗ Agoraphobia - open places and of being alone in public places ⊗
Algophobia – pain
⊗ Arachnophobia - spiders (arachnoids)
⊗ Claustrophobia - enclosed place
⊗ Monophobia - being alone
⊗ Pathophobia – disease
⊗ Social phobia - criticism, humiliation or embarrassment.
⊗ Thanatophobia - crowds

Generalized Anxiety Disorder (GAD)

 ⊗ Involves anxiety and worry that is excessive and unrelenting.

 ⊗ May alter ADL
 ⊗ Clients may experience: fatigue, irritability, restlessness,
muscle tension, sleep disturbance

Obsessive Compulsive Disorder

⊗ An anxiety disorder characterized by uncontrollable, unwanted

thoughts and repetitive, ritualized behaviors.

Post-Traumatic Stress Disorder (PTSD)

 ⊗ A delayed reaction of the person who has been involved or

exposed to traumatic events.
 ⊗ Symptoms:
􏰀 intense psychological distress
 􏰀 feeling of detachment or estrangement from others
􏰀 insomnia
􏰀 decreased concentration

Nursing Interventions

 ⊗ Modify environment – safe

 ⊗ Approach: kind-firmness
 ⊗ Nonjudgmental and calm attitude
 ⊗ Allow agreeable time for rituals
 ⊗ Give medications as ordered
 ⊗ Execute therapeutic modalities - biofeedback, change of the
scenery, therapeutic touch, hypnosis, massage or relaxation
exercises
 ⊗ Desensitization

EATING DISORDERS

⊗ More common among females.

Causes:

⊗ Psychological factors
􏰀 Parental factors(domineering parents)  controlling
􏰀 Individual factors(conflict about growing up)
􏰀 Socio cultural factors

Anorexia Nervosa

o ⊗ Main sign: Morbid fear of gaining weight

o ⊗ Other signs:
o 􏰀 Sensitivity to cold temperatures
o 􏰀 Amenorrhea
o 􏰀 Deliberate self-starvation with weight loss
 Bulimia Nervosa

􏰀 Denial of hunger
􏰀 Obvious thinness but feels fat
􏰀 Lanugo all over the body (people who are malnourished may grow
this hair on their face and body)

⊗ Extreme measures to lose weight

􏰀 uses diet pills, diuretics or laxatives
􏰀 purges after eating (expel food, vomits)
􏰀 extreme exercise

o ⊗ Signs of purging
􏰀 swelling of the cheeks or jaw area
􏰀cuts and calluses on the back of the hands and knuckles
(Russel’s sign)
􏰀 teeth that look clear

⊗ Peculiar signs
􏰀 depression
􏰀 loss of interest in activities

Findings: (for both)

⊗ Weight loss of 15% or more of original body weight

⊗ Amenorrhea
⊗ Social withdrawal and poor family and individual coping
⊗ History of high activity and achievement in academics,

Nursing Diagnosis:

⊗ Body image disturbance

⊗ Ineffective individual coping

Nursing Interventions:
⊗ Reinforce treatment plans and dietary prescriptions
⊗ Establish a trusting relationship
 ⊗ Monitor weight and vital signs
⊗ Encourage client to express feelings
⊗ Decrease emphasis on foods, eating, weight
⊗ Involve in decision-making
⊗ Employ limit setting
⊗ Stay with the client after meal and for 1st four hours

(ADHD) ATTENTION DEFICIT HYPERACTIVITY DISORDER

 ⊗ Common in boys
 ⊗ Usually diagnosed before age 7

⊗ Problems:
􏰀 Inattention
􏰀 Hyperactivity
􏰀 Impulsivity

Causes:

 ⊗ Abuse of the child

 ⊗ Drug exposure
 ⊗ Developmental problems
􏰀 Neurologic impairment
􏰀 Pre-natal trauma
􏰀 Early malnutrition

Signs and Symptoms

⊗ Obstinacy (stubborn)
⊗ Negativism (doing the opposite)
⊗ Egocentrism (inability to see a situation from another person's point
of view)
⊗ Fighting syndrome
⊗ Aggressiveness
⊗ Tolerance is low
⊗ Difficulty concentrating
⊗ Excessive talking
⊗ Fidgeting
⊗ Interrupt/intrudes on others

Nursing Diagnosis:
- Potential for injury

Nursing interventions:

 ⊗ Provide nutrition and safety

 ⊗ Provide an environment that:
􏰀 is calm
􏰀 is structured
􏰀 enables appropriate reaction to the environmental stimuli
 ⊗ Plan a firm and consistent care in which limits and standards
are set.
 ⊗ Parent education

 ⊗ Pharmacology:
- Methylphenidate (Ritalin) (It helps with hyperactivity and
impulsive behaviour, and allows them to concentrate better.

AUTISM

 Characterized by:
􏰀 impairment in communication skills
􏰀 presence of stereotyped behavior, interests and activities.
 􏰀 impairment on social interactions
 ⊗ Treatable but not curable
 ⊗ More common among boys
  ⊗ Usually diagnosed at age 2

Main problem: Interpersonal functioning

 ⊗ Most acceptable cause: Biological factors - brain anoxia, intake

of drugs

Signs and Symptoms

 ⊗ Not cuddly
 ⊗ Echolalia (repeat other words or sentences)
 ⊗ Crying tantrums
 ⊗ Head towards anything
 ⊗ Inanimate object attachment
 ⊗ Loves to spin objects / self
 ⊗ Difficulty interacting with others
 ⊗ Wants blocks
⊗ Acts as deaf
⊗ Resists normal teaching method / routine changes
⊗ No fear of danger
⊗ Insensitive to pain
⊗ No eye contact
⊗ Giggling or silly laughing

Nursing Interventions

 ⊗ Environment:
􏰀 safe
􏰀 consistent

 ⊗ Encourage the client to participate for self-care

 ⊗ Promote communication
􏰀 Speak calmly when giving instructions
􏰀 Use simple words or phrases
􏰀 Repeat instructions as necessary.
  ⊗ Haloperidol - symptomatic relief for hyperactivity,
stereotypical and self- destructive behavior

MENTAL RETARDATION

 Not a mental illness.

 Onset: 18
 IQ below 70

 Manifested by sub-average intellectual functioning in:
􏰀 Communication 􏰀Social skills
 􏰀 Self-care 􏰀 Health and safety
􏰀 Home living

Causes

 HIV/ AIDS / rubella infection

 Alcoholic mother
  Thyroid deficiency
 Excessive lead poisoning
 Damage to the brain
 Neurological / neurodevelopmental impairment
 Exact gestational age is not reached (premature)
 ⊗ Opiate intoxication
⊗ Nutritional deficiency (lack in Folic Acid)
 ⊗ Anoxia
⊗ Toxemia (pregnancy-induced hypertension)
 ⊗ Environmental factors
⊗ Severe RH incompatibility

LEVELS IQ IMPLICATION
Mild/moron 51-70 Difficulty adapting to
school

Educable – needs
assistance

Moderate/Imbecile 36-50 Poor awareness of

needs of others

Trainable – needs
moderate supervision

Severe/Idiot 20-35 Unable to learn

academic skills

Poor motor
development and
minimal speech
 Needs complete and
close supervision

-Has minimal capacity

for sensorimotor
function
Profound Below 20
-Needs custodial care
with a totally
structured
environment

Principles of Nursing Care

 ⊗ Protective care
 ⊗ Education of the family
􏰀Their involvement is an important factor in the plan of care to
promote progress and to minimize the stress.

 ⊗ Repetition
 ⊗ Role modeling
 ⊗ Restructuring
 ⊗ Focus of Education

􏰀 Reading
􏰀 Arithmetic
􏰀 Writing
CRISIS INTERVENTION

 an individual's habitual coping ability becomes ineffective to meet

the demands of a situation.
 A serious interruption and disturbance of one's equilibrium or
homeostasis
 Leads to potentially dangerous, self-destructive or socially
unacceptable behavior.
 Major Goal: Restore the maximum level of functioning (pre-crisis
state)

Characteristics

 Highly-individualized
 Self-limiting: 4-6 weeks
 Person affected becomes passive and submissive
 Affects a person’s support system
 Type
 Description
 Example

Type Description Example

Puberty, adolescence,
expected, predictable
Maturational / young adulthood,
and internally
Developmental marriage, or the aging
motivated
process.
Unexpected, Economic difficulty,
Situational /
unpredictable and illness, accident, rape,
Accidental
externally motivated divorce or death
Social /
Due to acts of nature Natural calamities
Adventitious

Domestic Violence Requiring Crisis Intervention:

 RAPE -Nonconsensual sexual penetration of an individual, in
which the victim is not capable of consent.

Kinds of Rape

 Power – to prove masculinity

 Anger – means of retaliation
 Sadistic – to express erotic feelings

 Silent Rape Syndrome

 A maladaptive reaction to rape
 The victim:
fails to disclose information about the rape
results to increase anxiety and may develop a sudden phobic
reaction.

Rape Trauma Syndrome (RTS)

• Refers to a group of signs and symptoms experienced by a victim

in reaction to rape

Phases:

 Acute / Impact – shock, numbness, disbelief

 Repression / Denial – refusal to discuss the event
 Heightened Anxiety – fear, tension, nightmares
 Stage of Resolution

 BATTERED WIFE SYNDROME (BWS)

 A form of cyclic domestic violence
 Men: low self-esteem
 Women: Dependent personality disorder
  Characteristics of Abusive Husbands:
 They usually come from violent families
 They are immature, dependent and non-assertive
 They have strong feelings of inadequacy

CHILD ABUSE

An act of omission of responsibility or commission in which intentional

harm is inflicted on a child.

Components of Omission:

 Child abandonment – leaving the child physically

 Child neglect - lack of provision of those things which are
necessary for the child's growth and development
 Types of Commission:

Physical Abuse - is an intentional physical harm inflicted on a

child by a parent or other person.
Emotional abuse - insult and undermining one's confidence
Sexual abuse - in the form of sexual contact

Characteristics of Abusive Parents:

 They come from violent families

 They were also abused by their parents
 They have inadequate parenting skills
 They are socially isolated because they don't trust anyone
 They are emotionally immature
 They have negative attitude towards the management of the
abused

Warning signs of Child Abuse / Neglect:

 Child’s excessive knowledge on sex and abusive words

  Hair growth in various lengths
 Inconsistent stories from the child and parent/s
 Low self-esteem
 Depression

 Apathy
 Bruised or swollen genitalia; tears or bruising of rectum
or vagina
 Unusual injuries for the child’s age and development
 Serious injuries (fractures, burns, lacerations)
 Evidence of old injuries not reported

 Nurse should display:

o Sensitivity
o Attitude (Nonjudgmental) o Confidentiality
o Respect
o Empathy
o Dignity

 Evidences are important:
o stained clothing
o fingernail scrapings
o mouth or anal smears containing semen
 Intervention focuses on family as a unit
 If the victim is a child: Play and art therapy

SOMATOFORM DISORDERS (BRIQUET’S SYNDROME)

⊗ Characterized by physical symptoms that mimic disease or

injury for which there is no identifiable physical cause

Example: a person who has just lost a loved one may somaticize their
grief through severe fatigue.
 ⊗ Clients:
􏰀express emotional conflict through physical symptoms
􏰀 usually seek repeated medical attention

⊗ Associated with anxiety and depression

- they complain of varied physical symptoms that have no
identifiable physical origin

Conversion Disorder

o ⊗ A condition in which an anxiety-provoking impulse is

converted unconsciously into functional symptoms.
o ⊗ Classic feature: Labelle indifference (lack of concern or
distress)

o ⊗ Examples: Paralysis, blindness, loss of touch or pain

sensation, dyspnea, seizures or convulsions

Hypochondriasis

o ⊗ Unrealistic or exaggerated physical complaints.

Example: they may be convinced that something as simple as a

sneeze is the sign they have a horrible disease.

Body Dysmorphic Disorder

⊗ Preoccupation with an imagined defect in his or her

appearance.

⊗ Slight physical abnormality = excessive concern / anxiety

Example: frequently checking the mirror, grooming or skin picking.

Attempting to hide perceived flaws with styling, makeup or clothes
SUBSTANCE ABUSE/ SUBSTANCE RELATED DISORDERS

Alcoholism

 ⊗ A chronic disease or a disorder characterized by excessive

alcohol intake and interference in the individual’s health,
interpersonal relationship and economic functioning.

 Signs of use:
⊗ .1-.2% - low coordination
⊗ .2-.3% - presence of ataxia(uncoordinated movements),
tremors, irritability, stupor
 ⊗ .3 and above - unconsciousness

Progression:

 ⊗ Pre-alcoholic
􏰀 starts with social drinking
􏰀 tolerance begins to develop


 ⊗ Prodromal
􏰀 alcohol becomes a need
􏰀 blackouts occur
􏰀 denial starts

 ⊗ Crucial - cardinal symptoms of alcoholism develops
 ⊗ Chronic - the person becomes intoxicated all day

Outcome:
⊗ Brain damage
⊗ Alcoholic hallucinosis
⊗ Death

Behavioral problems:
⊗ Denial
⊗ Dependency
⊗ Demanding

Alcohol Withdrawal
⊗ Occurs when an individual abruptly stops drinking ⊗ Symptoms
develop within few hours

⊗ Symptoms include:

􏰀 Careless behavior
􏰀 Autonomic hyperactivity
􏰀 Unusual perceptions(illusions, hallucinations)
􏰀 Tachycardia(impending delirium tremens)
􏰀 Increased temperature

Alcohol Withdrawal Delirium

 ⊗ AKA delirium tremens

 ⊗ Experienced within 48 to 72 hours after the last intake

 ⊗ Symptoms include:
􏰀 Diaphoresis
􏰀 Elevated VS
􏰀 Agitation
􏰀 Tremors(seizures)
􏰀 Hyper excitability to depression
 Nursing Diagnosis: Ineffective individual coping

Principles of Nursing Care:

o ⊗ Monitor vital signs

 o ⊗ Well-lighted room
o ⊗ Diet as tolerated
o 􏰀 Vitamins

DRUG-RELATED DISORDERS

Cocaine-Related Disorders (Stimulants)

 ⊗ Cocaine is a white powdered stimulant substance

 ⊗ Usually sniffed, snorted, smoked in a pipe or injected into a
vein or subcutaneous tissue.

 ⊗ Poor man’s cocaine:
􏰀 Shabu(sha-boo)
 ⊗ Signs of use:
􏰀 Obvious dilation of the pupils
􏰀 Cardiac problems
􏰀 Agitation
􏰀 Insomnia
􏰀 No appetite
􏰀 Excessive sweating
􏰀 Severe to panic anxiety

Cannabis-Related Disorders (Cannabinoids)

Marijuana

 ⊗ Not physically addicting but may lead to psychological

dependence
 ⊗ Plant : cannabis sativa
 ⊗ Active component is Tetrahydocannabinol
 ⊗ Routes of use:
 􏰀 Orally(capsules, tablets,on sugar cubes)
􏰀 With food
􏰀 Smoked in a pipe or rolled as cigarette.
  ⊗ Acts within 15 minutes
 ⊗ Effects lasts approximately 2 to 4 hours

 ⊗ Physiologic symptoms include

􏰀 Increased appetite
􏰀 Nausea and vomiting
􏰀 Drowsiness
􏰀 Inability to think clearly
􏰀 Excitement
􏰀 Non-steady gait

⊗ Classic sign: bloodshot eyes

⊗ In large doses, it may cause:

􏰀 Hallucination
􏰀 Suicidal ideations
􏰀 Delusions of invulnerability

Long-term Goals:
⊗ Community resources
⊗ Other coping means aside from denial
⊗ Personal responsibility (behavioral contract)
⊗ Isolation
⊗ Nutrition
⊗ Group therapy

JUST ADDITIONAL LANGS;

THERAPEUTIC COMMUNICATION

-Open self
-Blind self
-Unknown to self boh of you wala nakakaalam
-Hidden self ikaw may secret
T- tell me more (catharsis) verbalize feelings
H- holistic opening- open ended (what, when, where, how)
E- empathy
R- restate/reflect
A-active listening (SOLER- sit near patient, open disposition ex: don’t
cross legs, listen, eye contact, relax. FERMS- focus, eye contact,
respond, minimize distractions, silence)
P- presence no talking, wait for pt to open up (answer if pt is suffering
from: crisis, major depression, suicide)
E-explore
U-use of silence
T-touch needs consent ( do not touch the paranoid)
I-information (give facts)
C-clarify
S- summarize

Spaces:

Intimate- 0-18inch
Personal- 18 inch to 4 ft (therapeutic space)
Social- 4-12 inch ( pag paranoid ito dapat)
Public- more than 12

Non Therapeutic Communication

Belittle- takes for granted what client feel (you cannot be a nurse) (lost
of trust) ex: pang apat mo na yan wag kana mag take ng boards
Advise- telling client what to do (if I were you, would you do this
instead)
Disapproved/Disagree- passing judgement ( I don’t agree on ur
statement)
Neglect- not attending needs of client (do it on your own) FFMB-
failure to monitor etc, falls, medication error, burns
Underestimate- degrades the client (total lost of trust) ex: wag kana
mag nursing, vulcanizing kana lang di kaya ng utak
Reassure- false reassurance (don’t worry)
Stereotype- generalizing situation (all your family are dumb
enough)
Ending inappropriately- always in a hurry, interrupts frequently