CULTURAL AND SPIRITUAL CONCEPTS COMMMUNICATION Filipinos usually make friends easily. They are warm and hospitable.

They smile a lot, which makes it easier for strangers or foreigners to feel at ease with them. They can easily strike up a conversation with the person seated next to them, for example. Filipinos can communicate with peoples of other nations with ease because the majority of the population can fluently converse in English. When meeting a Filipino for the first time, and you want to make a good impression, maintain a low profile, be friendly without being "artificial" and show a genuine interest in the culture. Do not flaunt your wealth (jewellery and other expensive looking personal belongings and cash). Avoid wearing immodest or revealing clothing, especially in Muslim-dominated areas where there is a clear standard for appropriate attire. Filipinos have a knack for humour. They can always find something to laugh about. They even love to craft funny anecdotes about socio-economic-political situations and adversaries in life. But it is not appropriate for a foreigner to comment on the political situation or discuss about religion. With regard to socio-cultural conflicts and issues, just listen during discussions and do not take sides. Good discussion topics include: family (Filipinos love to talk about their families), where you are from (bring pictures of Canada with you, post cards may do) and the reason why you are in the Philippines (explain explicitly and clearly your organizations aims). Most Filipinos do not mind being asked their age, so it would not be unusual for them to ask yours. When speaking to adults/older people and people of status, use the polite forms of speech (po/ho) so that you will be regarded well. (Example: "Good morning po/ho!") Filipinos differ and ethnic background, social class, gender and age are important in determining peoples level of comfort with touching, tone of voice and gestures. Generally, Filipinos try to avoid hurting other peoples feelings, so they struggle with the word "no" when asked for a favour or request to do work (they may say "maybe", "Ill see...", "Ill try... etc.). As much as possible, they express their opinions and ideas with diplomacy and humility so as not to appear arrogant. They have difficulty contending with frankness or directness. It is common to shake hands with both men and women, when introduced or greeting a person. But touching, especially men touching women, is not taken well by Filipinos. Carefully observe the degree of comfort and sense of space in Muslim-dominated areas. Eye contact is important, especially professionally. It is a good sign of self-confidence. But if a person refuses to or is reluctant to make eye contact, it is considered a sign of shyness. Filipinos use a lot of non-verbal communication. Some examples are raising eyebrows or lifting the head upwards slightly to indicate "yes" or to greet friends. It is considered impolite to pass between people conversing or facing one another. If you must do so, the Filipino polite way is to extend an arm or two arms with the hands clasped and pointing downwards. Some gestures that are considered rude are middle finger erect, waving a pointed index finger and pointing at someone.

SPACE Most Filipinos are generally open about their emotions (as long as in their judgment, they are appropriate and positive). But they do not normally express anger in public so as not to appear rude. Public display of affection such as holding hands and putting arms around the shoulders of ones significant other are acceptable. SOCIAL ORGANIZATION A superior (local or non-local/expat) is usually respected for his or her educational attainment (including the reputation of the university where the degree was earned), expertise in the field, work experience, ability to work well with and inspire others, and good communication skills. If a superior is arrogant (not open to ideas, and makes employees feel unintelligent and incapable to do work), it is quite likely that members of his or her staff have low morale and talk among themselves. The disgruntled staff can report problems with a superior to higher management through the employees union if a company or an organization has one. Generally, discussions about important organizational issues are made collectively so that everybody is responsible for the outcome of decisions made. It is acceptable though to go to an immediate superior for answers to questions or concerns and feedback. TIME Time is a resource that is very important but often overlooked. Other than its social and economic value, time is something that can unite us as Filipinos. Time is a precious resource; once it is gone you cant bring it back. In modern societies, time literally is money, so if youre wasting time, youre wasting money. Filipino Time can be described simply with four words: no concept of time.Despite Filipinos generally knowing how to agree on appointments and commitments at specific times, many of them have a habit of being tardy more than what is socially deemed acceptable. A society where each individual thinks he/she is more important than everybody else is not one where its constituents will learn to respect the time of others. Certainly, a society with inhabitants that put their own interest before others will find it hard to grasp the idea of sticking to schedules. ENVIRONMENT The Philippines is a beautiful country rich in resources and inhabited by a vast variety of plants and animals. In 2000, it was also inhabited by 76.5 million people, and by 2029, government estimates suggest that this number will have doubled (National Statistics Office). Naturally, these people have a huge impact on the Philippine environment. More educated people tended to know a lot more about the environment than less educated people. What they actually studied did not seem to matter, and several of their answers indicated that some of what they knew they had learnt later in life, after their formal education was over. This suggests that eagerness to learn was probably the cause of their higher awareness, rather than the amount of time they actually spent studying the environment. Younger people seemed to have better environmental understanding than older people with the same educational level. Several factors may account for this, but the researcher believes this may suggest

public awareness is on the rise, with younger people learning more about the Philippine environment than their predecessors. SOCIOLOGICAL VARIATIONS Gender: The Philippines has a matriarchal society. Women occupy a high place in society, politics and the professions. They enjoy equal social and political rights with men. The present-day Filipina is now more assertive (compared to their ancestors during the Spanish era). The Filipino family is generally classified as egalitarian. Authority is more or less divided between husband and wife. The husband is formally recognized as the head but the wife has the important position of treasurer of the household and manager of the domestic affairs. Since there are more working women now than ever before, todays Filipina does a balancing act between career and family. Religion: The Philippines is the only Christian nation in Asia and Filipinos have high spiritual fervour. They observe holy days (business establishments are normally closed on Maundy Thursday, Good Friday, Easter, All Saints-All Souls Days and Christmas). Sunday is considered both a religious and a family day. As much as possible, avoid working on that day because most Filipinos go to church and do things together as a family. Class: There are three social classes in the country based on income and national wealth. The members of the rich class represent about 10% of the population but own or earn about 90% of the wealth of the country. They are composed of wealthy industrialists with big corporations and owners of large haciendas or plantations. The members of the middle class represent about 20% of the population. They are composed of professionals (doctors, lawyers, etc.). The members of the lower or poor class comprise about 70% of the population but they only earn or share 10% of the wealth. They often cannot earn enough to be able to buy necessities in life, save for emergencies or for future needs. The poor could become rich by education and by hard work. Ethnicity: Filipinos have a strong sense of regionalism. Strong ties bind those who come from the same province or those who speak the same dialect. They support each other because they consider themselves as "brothers or sisters". Sometimes, it is whom you know that counts when facilitating papers or when trying to get quick and positive results. CULTURE BOUND SYNDROME amok or mata elap: (Malaysia) a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at people and objects. The episode tends to be precipitated by a perceived insult or slight and seems to be prevalent only among males. The episode is often accompanied by persecutory ideas, automatism, amnesia for the period of the episode, exhaustion, and a return to premorbid state following the episode. Some instances of amok may occur during a brief psychotic episode or constitute the onset or exacerbation of a chronic psychotic process. Similar to cafard or cathard (Polynesia), mal de pelea (Puerto Rico), iich'aa (Navaho), and syndromes found in Laos, Papua New Guinea, and the Philippines. Similar also to the nascent American folkcategory of going postal.

 anorexia mirabilis or holy anorexia: (medieval Europe): severe restriction of food intake, associated with experience of religious devotion. Often not considered pathological within the culture. The terms are used by historians, and are not emic. anorexia nervosa (North America, Western Europe): severe restriction of food intake, associated with morbid fear of obesity. Other methods may also be used to lose weight, including excessive exercise. May overlap with symptoms of bulimia nervosa. boufe deliriante: (West Africa and Haiti) sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It may sometimes be accompanied by visual and auditory hallucinations or paranoid ideation. brain fag or brain fog: (West Africa) a condition experience by primarily male high school or university students. Symptoms include difficulties in concentrating, remembering, and thinking. Students often state that their brains are "fatigued". Additional symptoms center around the head and neck and include pain, pressure, tightness, blurring of vision, heat, or burning. "Brain tiredness" or fatigue from "too much thinking" is an idiom of distress in many cultures. bulimia nervosa (North America, Western Europe): binge eating followed by purging through selfinduced vomiting, laxatives, or diuretics; and morbid fear of obesity. May overlap with symptoms of anorexia nervosa. dhat: (India) semen-loss syndrome, characterized by severe anxiety and hypochondriacal concerns with the discharge of semen, whitish discoloration of the urine, and feelings of weakness and exhaustion. falling out or blacking out: (Southern U.S. and Caribbean) episodes characterized by sudden collapse, either without warning or preceded by feelings of dizziness or "swimming" in the head. The individual's eyes are usually open, but the person claims inability to see. The person usually hears and understands what is occurring around him or her, but feels powerless to move. ghost sickness: (American Indian groups) preoccupation with death and the deceased, sometimes associated with witchcraft. Symptoms may include bad dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, amd a sense of suffocation. grisi siknis: (Miskito Indians, Nicaragua) symptoms include headache, anxiety, anger, aimless running. Some similarities to pibloktoq. Hi-Wa itck: (Mohave American Indians) insomnia, depression, loss of appetite, and sometimes suicide associated with unwanted separation from a loved one. hsieh-ping: (Taiwan) a brief trance state during which one is possessed by an ancestral ghost, who often attempts to communicate to other family members. Symptoms include tremor, disorientation and delirium, and visual or auditory hallucinations. hwa-byung or wool-hwa-bung: (Korea) "anger syndrome". Symptoms are attributed to suppression of anger and include insomnia, fatigue, panic, fear of impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations, generalized aches and pains, and a feeling of a mass in the epigastrium. involutional paraphrenia: (Spain, Germany) paranoid disorder occurring in midlife. koro: (Malaysia) an episode of sudden and intense anxiety that the penis (or in the rare female cases, the vulva and nipples) will recede into the body and possibly cause death. The syndrome occasionally occurs in local epidemics. latah: (Malaysia and Indonesia) hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, and dissociative or trancelike behavior. The Malaysian syndrome is more frequent in middle-aged women. Similar syndromes include: amurakh, irkunii, ikota, olan, myriachit,

and menkeiti(Siberian groups); bah-tschi, bah-tsi, and baah-ji (Thailand); imu (Ainu & Sakhalin, Japan); and mali-mali and silok (Philippines). locura: (Latin America) a severe form of chronic psychosis, attributed to an inherited vulnerability, the effect of multiple life difficulties, or a combination of the two. Symptoms include incoherence, agitation, auditory and visual hallucinations, inability to follow rules of social interaction, unpredictability, and possible violence. pibloktoq or Arctic hysteria: (Greenland Eskimos) an abrupt dissociative episode accompanied by extreme excitement of up to 30 minutes' duration and frequently followed by convulsive seizures and coma lasting up to 12 hours. The individual may be withdrawn or mildly irritable for a period of hours or days before the attack and will typically report complete amnesia for the attack. During the attack, the individual may tear off his or her clothing, break furniture, shout obscenities, eat feces, flee from protective shelters, or perform other irrational or dangerous acts. Qi-gong Psychosis: (China) an acute, time-limited episode characterized by dissociative, paranoid, or other psychotic or nonpsychotic symptoms that occur after participating in the Chinese folk healthenhancing practice of qi-gong. Especially vulnerable are individuals who become overly involved in the practice. sangue dormido: (Portuguese Cape Verdeans) Literally "sleeping blood". Symptoms include pain, numbness, tremor, paralysis, convulsions, stroke, blindness, heart attack, infection, and miscarriage. shenjian shuairuo: (Chinese) equivalent to now-defunct diagnosis of "neurasthenia". Symptoms include physical and mental fatigue, dizziness, headaches and other pains, difficulty concentrating, sleep disturbance, and memory loss. Other symptoms include gastrointestinal problems, sexual dysfunction, irritability, excitability, and various signs suggesting disturbances of the autonomic nervous system. Shenkui (Chinese): marked anxiety or panic symptoms with accompanying somatic complaints for which no physical cause can be demonstrated. Symptoms include dizziness, backache, fatiguability, general weakness, insomnia, frequent dreams, and complaints of sexual dysfunction (such as premature ejaculation and impotence). Symptoms are attributed to excessive semen loss from frequent intercourse, masturbation, nocturnal emission, or passing of "white turbid urine" believed to contain semen. Excessive semen loss is feared because it represents the loss of one's vital essence and can thereby be life threatening. shin-byung: (Korea) syndrome characterized by anxiety and somatic complaints (general weakness, dizziness, fear, loss of appetite, insomnia, and gastrointestinal problems), followed by dissociation and possession by ancestral spirits. shinkeishitsu: (Japan) syndrome marked by obsessions, perfectionism, ambivalence, social withdrawal, neurasthenia, and hypochondriasis. spell: (southern U.S.) a trance state in which individuals "communicate" with deceased relatives or with spirits. At times this is associated with brief periods of personality change. Spells are not considered medical events in the folk tradition, but may be misconstrued as psychotic episodes in a clinical setting. tabanka: (Trinidad) depression associated with a high rate of suicide; seen in men abandoned by their wives. taijin kyofusho: (Japan) a syndrome of intense fear that one's body, body parts, or bodily functions are displeasing, embarrassing, or offensive to other people in appearance, odor, facial expressions, or movements. windigo or witiko: (Algonkian Indians, NE US and Eastern Canada). Famous syndrome of obsessive cannibalism, now somewhat discredited. Wendigo was supposedly brought about by consuming

human flesh in famine situations. Afterwards, the cannibal was supposed to be haunted by cravings for human flesh and thoughts of killing and eating humans. zar: (Ethiopia, Somalia, Egypt, Sudan, Iran, and elsewhere in North Africa and the Middle East) experience of spirit possession. Symptoms may include dissociative episodes with laughing, shouting, hitting the head against a wall, singing, or weeping. Individuals may show apathy and withdrawal, refusing to eat or carry out daily tasks, or may develop a long-term relationship with the possessing spirit. Such behavior is not necessarily considered pathological locally. RELATIONSHIP DEVELOPMENT (ROLES OF NURSE) Direct Care Provider Considers the needs and strengths of the whole person, the family and the community to assess mental health needs, formulate diagnoses, and plan, implement and evaluate nursing care; Collaborates with people and interprofesssional partners to provide people with information to make informed decisions about their health; Uses population-focused interventions that provide health prevention and early intervention initiatives; Identifies and responds to people/group(s) most vulnerable to mental health problems; Motivates and enables individuals and communities to take responsibility for their health and to make healthier choices; Provides ongoing information and education to clients, other providers, other organizations, and the public about current and emerging mental health issues; Promotes community acceptance of people with mental health problems; Fosters and supports creativity and innovation in nursing practice; Provides culturally-sensitive care; Provides outreach and links people to services; and, Provides liaison function with the hospital and the emergency department to support people when they return home. Counsellor Help people focus on a goal(s) or outcome(s); Help people develop strategies that support self-care and enable individuals and their families to take responsibility for and participate in decisions about their health; Provide a range of services including: education, research and knowledge sharing; evidence informed practices; system navigation; and communication; provide an opportunity for people to work towards living in a more satisfying and resourceful way; Use a range of counselling skills based on counselling models such as interpersonal psychotherapy, cognitive-behavioural therapy and solution-focused therapy to improve an individuals functioning and quality of life; and, Help people to be supported, to gain insight, and to bring about change in thoughts, feelings and behaviour Addictions counsellor Provide intake coordination, assessment, treatment (including counselling, group therapies) and follow-up care for children, youth, adults, seniors and their families with addictions, mental illness and mental health problems using common assessment tools;provide health promotion, prevention and early detection of problematic substance use;

Use core competencies and knowledge in addictions and a full range of withdrawal management services including detoxification services using best practice treatment protocols, outreach, prescribing, counselling, and harm reduction, Provide addiction counselling using motivational interviewing techniques to help clients effect change to live out their lives that fulfil their underlying hopes, beliefs and values

Crisis Worker Provides a comprehensive holistic biopsychosocial assessment including assessment of risk to life, mental status assessment (in cases of psychiatric history or current psychiatric disorder), physical assessment and identification of the clients strengths, coping mechanisms and current support systems (Hoff, 2001); Provides mobile outreach response in psychiatric and mental health crisis to provide rapid assessment and intensive home treatment services, reducing the likelihood of hospitalization; Teaches and educates colleagues, families, family practitioners, police, community leaders and the general public, regarding crisis prevention and intervention (RNAO, 2006b); and, Provides crisis intervention, referrals and linkages, and short-term follow up (RNAO, 2006b). Advocate Protects the rights of clients; Acts on behalf of clients who are in need of particular skills on which their lives depend; Ensures that an optimal level of mental health and addictions care is available and accessible to all people; Helps people understand the impact of social determinants on health; Supports people, families and communities in the utilization of political strategies to address inequities in the system; Influences healthy public policy by taking political action; Influences key policy decisions by seeking leadership roles; Networks with law enforcers to facilitate medical services for individuals who are at imminent risk of danger; Takes responsibility to resolve the conflict that might exist between the needs of the organization and those of the clientele; and, Educates the public and other health care professionals to eliminate stigma and to dispel myths of mental illness Case Manager Supporting people to function at optimal levels of health and to become self-sufficient; Co-ordinating, negotiating and managing the care of complex patients; Facilitating collaborative practice; Teaching people and their families; Providing therapeutic interventions to the client and family; providing supportive counselling, problem solving, medication monitoring and relapse prevention; Teaching psychosocial rehabilitation; Linking clients to other services in the community; and, Participating on assertive community treatment teams. Educator Provides education on a variety of mental health issues in a range of formats for individual, families, and populations;

Uses principles of child and adult learning appropriate to the target group; Acts as a preceptor and mentor to students and novice practitioners in community mental health settings; and, Provides continuing education with nurses and other health care providers on mental health and addictions.

Consultant Shares specialized knowledge and expertise which comprise best practices and facilitates their application in practice settings; Provides consultation and education to clients, nurses, other health care professionals, health care organizations and policy makers; Maintains a clearinghouse for best practices; and, Develops, implements and evaluates best practices and model programs of care. Researcher/Evaluator Identifies and uses evidence-based research in decision-making and shares this research with clients to support them to make well informed choices; Participates in research projects at all levels to yield qualitative and or quantitative evidence pertaining to nursing practice, administration, education and research; and, Develops a program of research into outcomes associated with improved integration of mental health and primary health Community Developer Designing and implementing mental health prevention and early intervention initiatives that build social networks, promote and support community capacity building; Using many strategies to help strengthen individuals, families and communities; and, Facilitating self-help and mutual aid to strengthen the capacity of people to be self-reliant. Member of a Profession Protect the rights of the individual and the family in matters relating to confidentiality and privacy; Advocate for public awareness and understanding of mental health and illness; Maintain standards of nursing practice and professional behaviour related to nurses ethical, moral and legal obligations in the community; Seek opportunities for continuing education and participate in educational opportunities that promote an integrated and multidisciplinary approach to nursing practice; advocate for certification for advanced practice nursing roles in the community; Use the results of research to promote quality nursing care, eg. impact of community treatment orders on care; Mentor students, colleagues and promote nursing as a career; and, Clarify and advance nurses scope of practice.

THERAPEUTIC COMMUNICATION Johari window four regions what is known by the person about him/herself and is also known by others - open area, open self, free area, free self, or 'the arena' what is unknown by the person about him/herself but which others know - blind area, blind self, or 'blindspot' what the person knows about him/herself that others do not know hidden area, hidden self, avoided area, avoided self or 'facade' what is unknown by the person about him/herself and is also unknown by others - unknown area or unknown self

Johari quadrant 1 - 'open self/area' or 'free area' or 'public area', or 'arena' Johari region 1 is also known as the 'area of free activity'. This is the information about the person behaviour, attitude, feelings, emotion, knowledge, experience, skills, views, etc - known by the person ('the self') and known by the group ('others'). The aim in any group should always be to develop the 'open area' for every person, because when we work in this area with others we are at our most effective and productive, and the group is at its most productive too. The open free area, or 'the arena', can be seen as the space where good communications and cooperation occur, free from distractions, mistrust, confusion, conflict and misunderstanding. Established team members logically tend to have larger open areas than new team members. New team members start with relatively small open areas because relatively little knowledge about the new team member is shared. The size of the open area can be expanded horizontally into the blind space, by seeking and actively listening to feedback from other group members. This process is known as 'feedback solicitation'. Also, other group members can help a team member expand their open area by offering feedback, sensitively of course. The size of the open area can also be expanded vertically downwards into the hidden or avoided space by the person's disclosure of information, feelings, etc about him/herself to the group and group members. Also, group members can help a person expand their open area into the hidden area by asking the person about him/herself. Managers and team leaders can play an important role in facilitating feedback and disclosure among group members, and in directly giving feedback to individuals about their own blind areas. Leaders also have a big responsibility to promote a culture and expectation for open, honest, positive, helpful, constructive, sensitive communications, and the sharing of knowledge throughout their organization. Top performing groups, departments, companies and organizations always tend to have a culture of open positive communication, so encouraging the positive development of the 'open area' or 'open self' for everyone is a simple yet fundamental aspect of effective leadership. Johari quadrant 2 - 'blind self' or 'blind area' or 'blindspot' Johari region 2 is what is known about a person by others in the group, but is unknown by the person him/herself. By seeking or soliciting feedback from others, the aim should be to reduce this area and thereby to increase the open area, to increase self-awareness. This blind area is not an effective or productive space for individuals or groups. This blind area could also be referred to as ignorance about oneself, or issues in which one is deluded. A blind area could also include issues that others are

deliberately withholding from a person. We all know how difficult it is to work well when kept in the dark. No-one works well when subject to 'mushroom management'. People who are 'thick-skinned' tend to have a large 'blind area'. Group members and managers can take some responsibility for helping an individual to reduce their blind area - in turn increasing the open area - by giving sensitive feedback and encouraging disclosure. Managers should promote a climate of non-judgemental feedback, and group response to individual disclosure, which reduces fear and therefore encourages both processes to happen. The extent to which an individual seeks feedback, and the issues on which feedback is sought, must always be at the individual's own discretion. Some people are more resilient than others - care needs to be taken to avoid causing emotional upset. The process of soliciting serious and deep feedback relates to the process of 'self-actualization'.

Johari quadrant 3 - 'hidden self' or 'hidden area' or 'avoided self/area' or 'facade' Johari region 3 is what is known to us but kept hidden from, and therefore unknown, to others. This hidden or avoided self represents information, feelings, etc, anything that a person knows about him/self, but which is not revealed or is kept hidden from others. The hidden area could also include sensitivities, fears, hidden agendas, manipulative intentions, and secrets - anything that a person knows but does not reveal, for whatever reason. It's natural for very personal and private information and feelings to remain hidden, indeed, certain information, feelings and experiences have no bearing on work, and so can and should remain hidden. However, typically, a lot of hidden information is not very personal, it is work- or performance-related, and so is better positioned in the open area. Relevant hidden information and feelings, etc, should be moved into the open area through the process of 'disclosure'. The aim should be to disclose and expose relevant information and feelings - hence the Johari Window terminology 'self-disclosure' and 'exposure process', thereby increasing the open area. By telling others how we feel and other information about ourselves we reduce the hidden area, and increase the open area, which enables better understanding, cooperation, trust, team-working effectiveness and productivity. Reducing hidden areas also reduces the potential for confusion, misunderstanding, poor communication, etc, which all distract from and undermine team effectiveness. Organizational culture and working atmosphere have a major influence on group members' preparedness to disclose their hidden selves. Most people fear judgement or vulnerability and therefore hold back hidden information and feelings, etc, that if moved into the open area, ie known by the group as well, would enhance mutual understanding, and thereby improve group awareness, enabling better individual performance and group effectiveness. The extent to which an individual discloses personal feelings and information, and the issues which are disclosed, and to whom, must always be at the individual's own discretion. Some people are more keen and able than others to disclose. People should disclose at a pace and depth that they find personally comfortable. As with feedback, some people are more resilient than others - care needs to be taken to avoid causing emotional upset. Johari quadrant 4 - 'unknown self' or 'area of unknown activity' or 'unknown area' Johari region 4 contains information, feelings, latent abilities, aptitudes, experiences etc, that are unknown to the person him/herself and unknown to others in the group. These unknown issues take a variety of forms: they can be feelings, behaviours, attitudes, capabilities, aptitudes, which can be quite close to the surface, and which can be positive and useful, or they can be deeper aspects of a person's

personality, influencing his/her behaviour to various degrees. Large unknown areas would typically be expected in younger people, and people who lack experience or self-belief. The processes by which this information and knowledge can be uncovered are various, and can be prompted through self-discovery or observation by others, or in certain situations through collective or mutual discovery, of the sort of discovery experienced on outward bound courses or other deep or intensive group work. Counselling can also uncover unknown issues, but this would then be known to the person and by one other, rather than by a group. Whether unknown 'discovered' knowledge moves into the hidden, blind or open area depends on who discovers it and what they do with the knowledge, notably whether it is then given as feedback, or disclosed. As with the processes of soliciting feedback and disclosure, striving to discover information and feelings in the unknown is related to the process of 'self-actualization'. Again as with disclosure and soliciting feedback, the process of self-discovery is a sensitive one. The extent and depth to which an individual is able to seek out discover their unknown feelings must always be at the individual's own discretion. Some people are more keen and able than others to do this. Uncovering 'hidden talents' - that is unknown aptitudes and skills, not to be confused with developing the Johari 'hidden area' - is another aspect of developing the unknown area, and is not so sensitive as unknown feelings. Providing people with the opportunity to try new things, with no great pressure to succeed, is often a useful way to discover unknown abilities, and thereby reduce the unknown area. Managers and leaders can help by creating an environment that encourages self-discovery, and to promote the processes of self-discovery, constructive observation and feedback among team members. It is a widely accepted industrial fact that the majority of staff in any organization are at any time working well within their potential. Creating a culture, climate and expectation for self-discovery helps people to fulfil more of their potential and thereby to achieve more, and to contribute more to organizational performance. A note of caution about Johari region 4: The unknown area could also include repressed or subconscious feelings rooted in formative events and traumatic past experiences, which can stay unknown for a lifetime. In a work or organizational context the Johari Window should not be used to address issues of a clinical nature. Therapeutic Communication Using silence - allows client to take control of the discussion, if he or she so desires Accepting - conveys positive regard Giving recognition - acknowledging, indicating awareness Offering self - making oneself available Giving broad openings - allows client to select the topic Offering general leads - encourages client to continue Placing the event in time or sequence - clarifies the relationship of events in time Making observations - verbalizing what is observed or perceived Encouraging description of perceptions - asking client to verbalize what is being perceived Encouraging comparison - asking client to compare similarities and differences in ideas, experiences, or interpersonal relationships Restating - lets client know whether an expressed statement has or has not been understood

Reflecting - directs questions or feelings back to client so that they may be recognized and accepted Focusing - taking notice of a single idea or even a single word Exploring - delving further into a subject, idea, experience, or relationship Seeking clarification and validation - striving to explain what is vague and searching for mutual understanding Presenting reality - clarifying misconceptions that client may be expressing Voicing doubt - expressing uncertainty as to the reality of clients perception Verbalizing the implied - putting into words what client has only implied Attempting to translate words into feelings - putting into words the feelings the client has expressed only indirectly Formulating plan of action - striving to prevent anger or anxiety escalating to unmanageable level when stressor recurs

PHASES OF THERAPEUTIC NURSE-CLIENT RELATIONSHIP 1. PRE ORIENTATION - Self-assessment examine own feelings, fears and anxieties 2. ORIENTATION - Establish trust, share information with client; discrete self-disclosure, convey support, facilitate healing education 3. WORKING - Guide client to examine feelings/responses, develop new coping skills 4. TERMINATION - Examine goals achieved, explore feelings regarding termination, establish plan for continuing assistance Boundaries: 1. Nurses use professional judgment to determine the appropriate boundaries of a therapeutic relationship with each client. The nurse not the client is always responsible for establishing and maintaining boundaries. 2. Nurses are responsible for beginning, maintaining and ending a relationship with a client in a way that ensures the clients needs are first. 3. Nurses do not enter into a friendship or a romantic relationship with clients. 4. Nurses do not enter into sexual relations with clients. 5. Nurses are careful about socializing with clients and former clients, especially when the client or former client is vulnerable or may require on-going care. 6. Nurses maintain the same boundaries with the clients family and friends as with the client. 7. Nurses help colleagues to maintain professional boundaries and report evidence of boundary violations to the appropriate person. 8. At times, a nurse must care for clients who are family or friends. When possible, overall responsibility for care is transferred to another health care provider. 9. At times, a nurse may want to provide some care for family or friends. This situation requires caution, discussion of boundaries and the dual role with everyone affected and careful consideration of alternatives. 10. Nurses in a dual role make it clear to clients when they are acting in a professional capacity and when they are acting in a personal capacity. 11. Nurses have access to privileged and confidential information, but never use this information to the disadvantage of clients or to their own personal advantage.

12. Nurses disclose a limited amount of information about themselves only after they determine it may help to meet the therapeutic needs of the client. 13. Nurses may touch or hug a client with a supportive and therapeutic intent and with the implicit or explicit consent of the client. 14. Nurses do not communicate with or about clients in ways that may be perceived as demeaning, seductive, insulting, disrespectful, or humiliating. This is unacceptable behaviour. 15. Nurses do not engage in any activity that results in inappropriate financial or personal benefit to themselves or loss to the client. Inappropriate behaviour includes neglect and/or verbal, physical, sexual, emotional and financial abuse. 16. Nurses do not act as representatives for clients under powers of attorney or representation agreements. 17. Generally, nurses do not exchange gifts with clients. Where it has therapeutic intent, a group of nurses may give or receive a token gift. Nurses return or redirect any significant gift. Nurses do not accept a bequest from a client.