Mental Health Exam 1
Situational crisis
unanticipated or sudden events that threaten the individuals integrity, such as the death or a loved one, loss of a job, and physical or emotional illness in the individual or family member.
People with mental illness who are in the criminal justice system face several barriers to successful community reintegration:
Poverty Homelessness Substance abuse Violence Victimization, rape, and trauma Self-harm
Acting the opposite of what one thinks or feels Ex: Person who despises the boss tells everyone what a great boss she is.
Reaction Formation
Existential Theories: Gestalt therapy
Therapist: Frederick S. Peris A therapy focusing on the identification of feelings in the here and now, which leads to self-acceptance
Existential Theories: Logotherapy
Therapist: Viktor E. Frankl A therapy designed to help individuals assume personal responsibility (the search for meaning in like is a central theme)
Diversity is not limited to culture; the structure of ___________ has changed as well.
families
The first training of uses to work with persons with mental illness was...
in McLean Hospital in Belmont, Massachusetts
Occurs when the therapist displaces onto the client attitudes or feeling from his or her past.
Countertransference
Maslow's Hierarchy of Needs
(level 1) Physiological Needs (level 2) Safety and Security (level 3) Relationships, Love and Affection (level 4) Self Esteem (level 5) Self Actualization
Carpers Patterns: Personal knowing
(obtained from life experience) ex: Clients face shows the panic.
Carpers Patterns: Aesthetic knowing
(obtained from the art of nursing) ex: Although the clients shows outward signals now, the nurse sensed previously the clients jumpiness and subtle differences in the clients demeanor and behavior.
Carpers Patterns: Ethical knowing
(obtained from the moral knowledge of nursing) ex: Although the nurses shift has ended, he or she remains with the client.
Carpers Patterns: Empirical knowing
(obtained from the science of nursing) ex: Client with panic disorder begins to have an attack. Panic attack will raise pulse rate.
Areas of Practice: Psychobiologic interventions
1. Administering medications 2. Teach 3. Observe
Panic anxiety
...can involve loss of rational thought, delusions, hallucinations, and complete physical immobility and muteness. The person may bolt and run aimlessly, often exposing himself or herself to injury Perceptual field reduced to focus on self Cannot process environmental stimuli Distorted perceptions Loss of rational thought Personality disorganization Doesn't recognize danger Possibly suicidal Delusions or hallucinations possible Cant communicate verbally Either cannot sit (may bolt and run) or is totally mute and immobile
Phillip Pinel in France and William Tuke in England...
...formulated the concept of ASYLUM as a safe refuge or haven offering protection at institutions where people had been whipped, beaten, and starved just because they were mentally ill.
Moderate anxiety
...involves a decreased perceptual field; the person can learn new behavior or solve problems only with assistance. Another person can redirect the person to the task. Selectively attentive Perceptual field limited to the immediate task Can be redirected Cannot connect thoughts or events independently Muscle tension Diaphoresis Pounding pulse Headache Dry mouth Higher pitched voice Increased rate or speech GI upset Frequent urination Increased automatisms
Severe anxiety
...involves feelings of dread or terror. The person cannot be redirected to as task; he or she focuses only on scattered details and has physiological symptoms of tachycardia, diaphoresis, and chest pain. A person with severe anxiety may go to an emergency department, believing he or she is having a heart attack. Perceptual field reduced to one detail or scattered details Cannot complete tasks Cannot solve problems or learn effectively Behavior geared toward anxiety relief and is usually ineffective Feels awe, dread, or horror Doesn't respond to redirection Severe headache N/V/D Trembling Rigid stance Vertigo Pale Tachycardia Chest pain Crying Ritualistic (purposeless, repetitive) behavior
Mild anxiety
...is a positive state of heightened awareness and sharpened senses, allowing the person to learn new behaviors and solve problems. The person can take in all available stimuli. Sharpened senses Increased motivation Alert Enlarged perceptual field Can solve problems Learning is effective Restless Butterflies Sleepless Irritable Hypersensitive to noise
Many of the problems of the homeless mentally ill...
...stem from the lack of the adequate community resources.
Operant conditioning behavior techniques:
1. All behavior is learned. 2. Consequences result from behavior--broadly speaking, reward and punishment. 3. Behavior that is rewarded with reinforcers tends to recur. 4. Positive reinforcers that follow a behavior increase the likelihood that the behavior will recur. 5. Negative reinforcers that are removed after a behavior increase the likelihood that the behavior will recur. 6. Continuous reinforcement (a reward every time the behavior occurs) is the fastest way to increase the behavior, but the behavior will not las long after the reward ceases. 7. Random intermittent reinforcement (an occasional reward for the desired behavior) is slower to produce an increase in behavior, but the behavior continues after the reward ceases.
For a malpractice suit to be successful, that is, for the nurse, physician, or hospital or agency be liable, the client or family needs to prove the following four elements:
1. Duty--a legally recognized relationship existed. The nurse had a duty to the client, meaning that the nurse was acting in the capacity of a nurse. 2. Breach of duty--the nurse failed to conform to standards of care, thereby breaching or failing the existing duty. The nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances. 3. Injury or damage--the client suffered some type of loss, damage, or injury. 4. Causation--the breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner.
Areas of Practice: Self-care activities
1. Encourage independence 2. Increase self-esteem 3. Improve function and health
Other areas of practice
1. Health teaching 2. Case management 3. Health promotion and maintenance
Areas of Practice: Counseling
1. Interventions and communication techniques 2. Problem solving 3. Crisis interventions 4. Stress management 5. Behavior modification
Areas of Practice: Milieu therapy
1. Maintain therapeutic environment 2. Teach skills 3. Encourage communication between clients and others 4. Promote growth through role modeling
Proving liability for an intentional tort involved three elements:
1. The act was willful and voluntary on the part of the defendant (the nurse). 2. The nurse intended to bring about consequences or injury to the person (client). 3. The act was a substantial fact in causing injury or consequences.
Student concerns:
1. What if I say the wrong thing? 2. What will I be doing? 3. What if no one will talk to me? 4. Am I prying when I ask personal questions? 5. How will I handle bizarre or inappropriate behavior? 6. What happens if a client asks me for a date or displays sexually aggressive or inappropriate behavior? 7. Is my physical safety in jeopardy? 8. What if I encounter someone I know being treated on the unit? 9. What if I recognize that I share similar problems or backgrounds with clients?
Freud Developmental Stage: Genital
11-13 years Begins with puberty and the biologic capacity for orgasm; involves the capacity for the true intimacy
Freud Developmental Stages: Anal
18 to 36 months Anus and surrounding areas are a major source of interest Voluntary sphincter control (toilet training) is acquired
Adult Growth and Development Tasks: Young Adult
25-45 years of age Accepts self Stabilizes self image Establish independence from parental home and financial independence Establish a career or vocation Form an intimate bond with another person Build a congenital social and friendship group Become an involved citizen Establish and maintain a home
Freud Developmental Stages: Phallic/Oedipal
3-5 years Genital is the focus of interest, stimulation, and excitement Penis is the organ of interest for both sexes Masturbation is common Penis envy (wish to possess penis) is seen in girls; oedipal complex (wish to marry opposite-sex parent and be rid of same-sex parent) is seen inboxes and girls
_____% of the homeless population have a severe mental illness of chronic substance disorder.
42%, approximately 257,300 homeless people. 30% of this group has psychiatric illness and two thirds have a primary substance abuse disorder or other chronic health condition.
Adult Growth and Development Tasks: Middle Adult
45-65 years of age Establish love through more than sexual contacts Develop sense of unity with mate Maintain healthy life patterns Help growing and grown children to be responsible adults Relinquish central role in loves of grown children Create a comfortable home Be proud of accomplishments of self and mate/spouse Reverse roles wit aging parents Achieve mature civic and social responsibilities Adjust to physical changes of middle age Use leisure time creatively Cherish old friends and make new ones
Freud Developmental Stages: Latency
5-11 or 13 years Resolution of oedipal complex Sexual drive channeled into socially appropriate activities such as school work and sports Formation of the superego Final stage of psychosexual development
Adult Growth and Development Tasks: Older Adult
65 years of age and older Prepare for retirement Recognize the aging process and its limitations Adjust to health changes Decide where to live out remaining years Continue warm relationship with mate/spouse Adjust living standards to retirement income Maintain maximum level of health Care for self physically and emotionally Maintain contact with children and relatives Maintain interest in people outside of family Find meaning in life after retirement Adjust to the death of mate/spouse or other loved one
Deinstitutionalization
A deliberate shift from institutional care in state hospitals to community facilities.
In 1950...
A great leap in the treatment of mental illness with the development of psychotropic drugs, or drugs used to treat mental illness. Chlorpromazine (Thorazine), an antipsychotic drug, and Lithium, an antigenic agent, were the first drugs to be developed.
The essence of membership in the clubhouse (clubhouse model) is based on the four guaranteed rights of members:
A place to come to Meaningful work Meaningful relationships A place to return to (lifetime membership) The clubhouse model recognizes the physician-client relationship as a key to successful treatment and rehabilitation while acknowledging that brief encounters that focus on symptom management are not sufficient to promote rehabilitation efforts.
Freuds Dream Analysis
A primary technique used in psychoanalysis, involves discussing a clients dreams to discover their true meaning and significance.
Special considerations:
A suicidal patient may not be permitted to keep a belt, shoelaces, or scissors because he or she may use these items for self-harm. A client who becomes aggressive after having a particular visitor may have that person restricted from visiting for a period of time. A client making threatening phone calls to other outside the hospital may be permitted only supervised phone calls until his or her condition improves.
Therapeutic Communication Techniques pg. 102
Accepting--indicating response (nodding) Broad openings--allowing the client to take the initiative in introducing the topic (Where would you like to begin) Consensual validation--searching for mutual understanding, for accord in the meaning of the words (Tell me whether my understanding of it agrees with yours.) Encouraging comparison--asking similarities and difference be noted (Have you had similar experiences) Encouraging description of perceptions--asking the client to verbalize what he or she perceives (Tell me when you feel anxious) Encouraging expression--asking the client to appraise the quality of his or her experiences (Does this contribute to your distress) Exploring--delving further into a subject or an idea (Tell me more about that) Focusing--concentrating on a single point (Of all the concerns you've mentioned, which is most troublesome?) Formulating a plan of action--asking the client to consider kinds of behavior likely to be appropriate in future situations (Next time this comes up, what might you do to handle it?) General leads--giving encouragement to continue (Go on.) Giving information--making available the facts that the client needs (My name is...) Giving recognition--acknowledging (I notice that you've combed your hair.) Making observations--verbalizing what the nurse perceives (You appear tense.) Offering self--making oneself available (I'll sit with you awhile.) Placing event in time or sequence--clarifying the relationship of events in time (Was this before or after...?) Presenting reality--offering for consideration that which is real (I see no one else is in the room.) Reflecting--directing client actions, thoughts, and feelings back to client (Do you think you should?) Restating--repeating the main idea expressed (You have difficulty sleeping.) Seeking information--seeking to make clear (Im not sure that I follow.) Silence--absence of verbal communication Suggesting collaboration--offering to share or work with the client (Perhaps you and I can discuss and discover the triggers for your anxiety.) Summarizing--organizing and summing up that which has gone before (Have I got this straight?) Translating into feelings--seeking to verbalize feelings ("Im dead." Are you suggesting that you feel lifeless?) Verbalizing the implied--voicing what the client has hinted at (Do you feel that no one understands?) Voicing doubt--expressing uncertainty about the reality of the clients perceptions (Isn't that unusual? Really?)
(ACCESS)
Access to community care and effective services and support
Nontherapeutic Communication Techniques
Advising (I think you should...) Agreeing (Thats right.) Belittling feelings expressed (Everybody gets down in the dumps.) Challenging (If you're dead, why is your heart beating?) Defending (This hospital has a fine reputation.) Disagreeing (Thats wrong.) Disapproving (Thats bad.) Giving approval (Thats good.) Giving literal responses (Try not to watch TV or what channel?) Indicating the existence of an external source (What makes you say that?) Interpreting (What you really mean is..) Introducing an unrelated topic (Did you have visitors last evening?) Making stereotyped comments (Its for your own good.) Probing (Now that you tell me about this, I have to find out.) Reassuring (I wouldn't worry about it.) Rejecting (Lets not discuss.) Requesting an explanation (Why do you think that way?) Testing (Do you know what kind of hospital that is?) Using denial (Of course you're something--everybody is something.)
_____________ is the outward expression of the clients emotions.
Affect
_________________________ identified 11 "irrational beliefs" that people use to make themselves unhappy. He also believes that people have "automatic thoughts" that cause them unhappiness in certain situations. He used the ABC technique to help people identify these automatic thoughts: A is the activating stimulus or event, C is the excessive inappropriate response, and B is the black in the persons mind that he or she must fill in by identifying the automatic thought.
Albert Ellis
NCCIH studies a wide variety of complementary and alternative therapies:
Alternative medical systems Mind-body interventions Biologically Manipulative and body-based therapies Energy therapies
Points to consider when working with individual responses to illness:
Approach the client with a genuine caring attitude Ask the client at the beginning of the interviews how he or she prefers to be addressed and ways the nurse can promote spiritual, religious, and health practices Recognize any negative feelings or stereotypes and discuss them with a colleague to dispel myths and misconceptions Remember that a wide variety of factors influence the clients complex response to illness
_________________ involved any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority.
Assault
An ACT program has a problem-solving orientation:
Assertive community treatment programs provide most services directly rather than relying on referrals to other programs or agencies, and they implement the serviced in the clients homes or communities, not in offices.
_________________ are general feelings or a frame of reference around which a person organizes knowledge about the world.
Attitudes
________________ refers o the persons right to self-determination and independence.
Autonomy
______________ includes harmful of unwarranted contact with a client; actual harm or injury may or may not have occurred.
Battery
Parataxic Mode
Begins in early childhood as the child begins to connect experiences in sequence.
Syntaxic Mode
Begins to appear in school-ages children and becomes more predominant in preadolescence, the person begins to perceive himself or herself and the world within the context of the environment and can analyze experiences in a variety of settings.
_________________ is a school of psychology that focuses on observable behaviors and what one can do externally to bring about behavior changes.
Behaviorism
____________ are ideas that one holds to be true.
Beliefs
__________________ refers to one duty to benefit or to promote the good of others.
Beneficence
Freud Development Stages: Oral
Birth to 18 months Major site of tension and gratification is the mouth, lips, and tongue; includes biting and sucking activities Id is present at birth Ego develops gradually from rudimentary structure present at birth
Assessing Affect:
Blunted affect--showing little or slow-to-respond facial expression Broad affect--displaying a full range of emotional expressions Flat affect--showing no facial expression Inappropriate affect--displaying a facial expression that is incongruent with mood or situation; often silly or giddy regardless of circumstances Restricted affect--displaying one type of expression usually serious of somber
Dual problem/diagnosis
Both severe mental illness and substance abuse. Use of alcohol and drugs exacerbates symptoms of mental illness.
Eriksons Stages: Generativity vs. Stagnation (middle adult)
Care Being creative and productive; establishing the next generation
Case management...
Case management, or management of care on a case-by-case basis, represented an effort to provide necessary services while containing costs.
Prototaxic Mode
Characteristics of infants and childhood, involves brief, unconnected experience that have no relationship to one another.
Thought process and content terms:
Circumstantial thinking--client eventually answers a question but only after giving excessive unnecessary details; Delusion--a fixed false belief not based in reality Flight of ideas-- excessive amount and rate or speech composed of fragmented or unrelated ideas Ideas of reference--cleints inaccurate interpretation that general events are personally directed to him or her such as hearing a speech on the news and believing the message had personal meaning Loose association--disorganized thinking that jumps from one idea to another with little to no evident relation between thoughts Tangential thinking--wandering off the topic and never providing the information requested Thought blocking--stopping abruptly in the middle of a sentence or train of thought; sometimes unable to continue the idea Thought broadcasting--a delusional belief that others can hear and know what the client is thinking Thought insertion--a delusional belief that others are putting ideas or thoughts into the clients head--that is, the ideas are not those of the client Thought withdrawal--a delusional belief that others are taking the clients thoughts away and the client is powerless to stop it Word salad--flow of unconnected words that convey no meaning to the listener
_______________________________ therapy focuses on the role of the client, rather than the therapist, as the key to the healing process.
Client-centered
Factors in Cultural Assessment
Communication Physical distance or space Social organizations Time orientation Environmental control Biologic variations
___________________-based programs have positive aspects that make them preferable for treating many people with mental illnesses.
Community
________________ programs were developed to meet the needs of persons with mental illness outside the walls of an institution. The availability and quality of services vary among different areas of the country.
Community support service
Overachievement in one area to offset real or perceived deficiencies in another area. Ex:Napoleon complex. Nurse with low self-esteem working double shifts so her supervisor will like her.
Compensation
Eriksons Stages: Industry vs. Inferiority (school age)
Competence Emerging confidence in own abilities; taking pleasure in accomplishments
Five states don't have assisted outpatient treatment:
Connecticut, Maryland, Massachusetts, New Mexico, and Tennessee.
Conscious refers to...
Conscious refers to the perceptions, thoughts, and emotions that exist in the persons awareness, such as being aware of happy feelings or thinking about a loved one.
Freud believed that the human personality functions at three levels of awareness:
Conscious, preconscious, and unconscious
Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature.
Conversion
_____________ is all the socially learned behaviors, values, beliefs, and customer transmitted down to each generation.
Culture
In ___________________ programs, clients return home at night; evening programs are just the reverse. Most programs include groups for building communication and social skills, solving problems, monitoring medications, and learning coping strategies and skills for daily living.
Day treatment
Revolving door effect
Deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to those beds correspondingly increased by 90%. The result frequently is decompensation and re-hospitalization.
Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue. Ex: Diabetic person eating chocolate candy saying one piece won't hurt.
Denial
____________________ is a theory that says decisions should be based on whether or not an act is morally right with no regard for the result or consequences.
Deontology
DSM-5
Diagnostic and Statistical Manual of Mental Disorders, 5th edition Three purposes: 1. Standardized nomenclature and language 2. Defining characteristics or symptoms that differentiate specific diagnoses 3. Assist in identifying the underlying disease The classification system allows the practitioner to identify all the factors that relate to a person's condition: 1. All major psychiatric disorders 2. Medical conditions 3. Psychosocial and environmental problems
___________ interventions are designed to assess the persons health status and promote problem-solving, such as offering the person nee information, knowledge, or meaning.
Directive
Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings. Ex: Person who is mad at the boss yells at his or her spouse.
Displacement
Dealing with emotional conflict by a temporary alteration in consciousness of identity Ex:Adult remembers nothing of childhood sexual abuse.
Dissociation
Methods od attempting to protect the self and cope with basic drives or emotionally painful thought, feelings, or events.
Ego defense mechanisms
Freud: Ego
Ego is the balancing or mediating force between the id and the superego. The ego represents mature and adaptive behavior that allows a person to function successfully in the world.
In which the therapist senses the feelings and personal meaning from the client and communicates this understanding to the client..
Empathetic understanding
______________ is the ability of the nurse to perceive the meanings and feelings of the client. It is considered one of the essential skills a nurse must develop to provide high-quality, compassionate care.
Empathy
____________ is a branch of philosophy that deals with values of human conduct related to the rightness and wrongness of actions and to the goodness and badness of the motived and ends of such actions.
Ethics
Developing Self-efficacy: Four ways to do so
Experience of success or mastery in overcoming obstacles Social modeling (observing successful people instills the idea that one can also succeed) Social persuasions (persuading people to believe in themselves) Reducing dress, building physical strength, and learning how to interpret physical sensations positively
_____________________________ is defined as the unjustifiable detention of a client such as the inappropriate use of restraint or seclusion.
False imprisionment
_____________ refers to the obligation to honor commitments and contracts.
Fidelity
Eriksons Stages: Identity vs. Role Confusion (adolescence)
Fidelity Formulating a sense of self and belonging
______ refers to feeling that one meshes or fits in with the system or environment.
Fit
Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage
Fixation
Interdisciplinary team: Occupational Therapist
Focuses on the functional abilities of the client and ways to improve client functioning, such as working with arts and crafts and focusing on psychomotor skills.
Japanese Americans
Formal greeting such as smile or small bow for older generations and handshake for younger generations There may be little touching and eye contact may be minimal Mental illness may bring shame and social stigma to the family, so clients may be reluctant to seek help Evil spirits are sometimes thought to cause loss of mental self control as a punishment for bad behaviors or failure to love a good life Western psychological therapies based on self-disclosure, sharing feelings, and discussing ones family experiences are very difficult for many Japanese
The therapists tries to uncover the clients true thought and feelings by saying a word and asking the client to respond quickly with the first thing that comes to mind.
Free association
A ____________________ is a term we commonly use to describe slips of the tongue.
Freudian slip
Knapp identifies five types of touches:
Functional--professional: used in examinations Social--polite: used in greetings, hand guides to direct people Friendship--warmth: hugs, arms over the shoulder, backslapping Love--intimacy: tight hugs and kisses Sexual--arousal: used by lovers
The therapeutic results of a group therapy include the following:
Gathering new information, or learning Gaining inspiration or hope Interacting with others Feeling acceptance and belonging Becoming aware that one is not alone and that others share the same problem Gaining insight into ones problems and behaviors and how they affect others Giving of oneself for the benefit of others (altruism)
Realness or congruence between what the therapist feels and what he or she says to the clients..
Genuineness
____________________ emphasizes identifying the persons feelings and thoughts in the here and now. He believed that self-awareness lead to self-acceptance and responsibility for ones own thoughts and feelings.
Gestalt therapy
Arab Americans
Greetings may include a smile, direct eye contact, and a social comment about family or the client Using a loud voice might indicate the importance of the topic, as does repeating the message Families make collective decisions with the men of the family (family spokesperson) The culture may believe mental illness results from sudden fear, attempts to manipulate family, wrath of God, or Gods will, all of which focus on the individual Such client may seek mental health care only as a last resort after they have exhausted all family and community resources Prayer is important with strict prayer times 5x a day, wash before every prayer, and in silence
Residential Settings
Group homes Supervised apartments Board and care homes Assisted living Adult foster care Respite/crisis housing
________________ is the ability to resist illness when under stress.
Hardiness
Interdisciplinary team: Psychologist
Has a doctorate in clinical psychology and is prepared to practice therapy, conduct research, and interpret psychological tests. Psychologists may also participate in the design of therapy programs for groups of individuals.
B. F. Skinner: Operant Conditioning
He developed the theory of operant conditioning,w which says people learn their behavior from their history or past experiences that were repeatedly reinforced.
Teacher
Helping the client to learn formally or informally.
Interdisciplinary team: Recreation Therapist
Helps the client to achieve a balance of work and play in his or her life and provides actives that promote constructive use of leisure or unstructured time.
_____________ developed the concept of the therapeutic nurse-patient relationship, which includes four phases: orientation, identification, exploitation, and resolution.
Hildegard Peplau
Two early nursing theorists that shaped psychiatric nursing practice...
Hildegard Peplau and June Mellow
Ivan Pavlov: Classical Conditioning
His experiment with dogs involved his observation that dogs naturally began to salivate (response) when they saw or smelled food (stimulus).
Eriksons Stages: Trust vs. Mistrust (infant)
Hope Viewing the world as safe and reliables; relationships as nurturing, stable, and dependable
Lifes virtues...
Hope, purpose, fidelity, love, caring, and wisdom.
Interdisciplinary team: Vocational Rehabilitation Specialist
Includes determine clients interests and abilities and matching them with vocational choices. Clients also assist in job seeking and job retention skills as well as in pursuit of further education, if that is needed and desired.
Freud: Id
Id is the part of one's nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses.
Modeling actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or occupational goal. Ex: Nursing student becoming a critical care nurse because this is the specialty of an instructor she admires.
Identification
Imbalances of the four humors...
Imbalances of the four humors were believed to cause mental disorders; so treatment was aimed at restoring balance through bloodletting, starving, and purging.
In early Christian times...
In early Christian times, primitive beliefs and superstitions were strong. All diseases were again blamed on demons, and the mentally ill were viewed as possessed.
________________________ psychotherapy is a method of bringing about change in a person by exploring his or her feelings, attitudes, thinking, and behavior. It involves a one-to-one relationship between the therapist and the client. The therapist-client relationship is key to success of this type of therapy. The client must select a therapist whose theoretical beliefs and style of therapy are congruent with the clients needs and expectations of therapy.
Individual
__________ is the ability to understand the true nature of ones situation and accept some personal responsibility for that situation.
Insight
Dorothea Dix
Instrumental in opening 32 state hospitals that offered asylum to the suffering. She advocated adequate shelter, nutritious food, and warm clothing.
Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions. Ex: Person shows no emotional expression when discussing serious car accident.
Intellectualization
__________________________ tests are designed to evaluate the clients cognitive abilities and intellectual functioning.
Intelligence
Functioning as an effective team member requires the development and practice of several core skill areas:
Interpersonal skils (tolerance, patience, and undestanding) Humanity (warmth, acceptance, empathy, genuineness, and nonjudgemental attitude) Knowledge base about mental disorders, symptoms, and behavior Communication skills Personal qualities (consistency, assertiveness, and problem solving abilities) Teamwork skills (collaborating, sharing, and integrating) Risk assessment and risk management skills
Accepting another persons attitudes, beliefs, and values as ones own. Ex: Person who dislikes guns becomes an avid hunter, just like his best friend.
Introjection
When making a decision about warning a third party, the clinician must base his or her decision of the following:
Is the client dangerous to others? Is the danger the result of serious mental illness? Is the danger serious? Are the means to carry out the threat available? Is the danger targeted at identifiable victims? Is the victim accessible?
Mental Health Parity Act which eliminated...
It eliminated annual and lifetime dollar amounts for mental health care for companies with more than 50 employees. Mental health parity is only required if mental health is covered.
African Americans
It is best to ask what each client prefers to be called Families often feel comfortable demonstrating public affections such as hugging and touching one another Greeting strangers usually includes a handshake and direct eye contact indicates interest and respect Silence may indicate a lack of trust of the caregiver or the situation May use folk remedies in conjunction with western medicine Church is an important and values support system
___________ explored how intelligence and cognitive functioning developed in children.
Jean Piaget
The first school of nursing to include a course in psychiatric nursing in its curriculum..
Johns Hopkins
______________ refers to the ability to interpret ones environment and situation correctly and to adapt one behavior and decisions accordingly.
Judgment
___________ refers to fairness; that is, treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion, ethnicity, or cultural beliefs.
Justice
Boarded
Kept in the ED while waiting to see if the crisis de-escaltates or till an inpatient bed can be located or becomes available
Aristotle attempted to...
Later, Aristotle attempted to relate mental disorders to physical disorders and developed his theory that the amounts of blood, water, and yellow and black bill in the body controlled the emotions.
Eriksons Stages: Intimacy vs. Isolation (young adult)
Love Forming adult, loving relationships and meaningful attachments to others
Sullivans Life Stages: Adolescence---puberty to adulthood
Lust is added to interpersonal equations Need for special sharing relationship shifts to the opposite sex New opportunities for social experimentation lead to the consolidation of self-esteem or self-ridicule If the self-system is intact, areas of concern expand to include values, ideas, career decisions, and social concerns
Crisis occurs in response to a variety of life situations and events and fall into three categories:
Maturational crisis Situational crisis Adventitious crisis
Native Americans (American Indians)
May go by tribal name Light-touch handshake is a respectful greeting Minimal direct eye contact Communication may be slow and punctuated by many long pauses It is important not to rush or interrupt with questions Orientation to time may be flexible and might not coincide with rigidly scheduled appointments
The Health Care Finance Administration administers two insurance programs:
Medicare and Medicaid
____________ described her approach of focusing on clients' psychosocial needs and strengths.
Mellow
What is the leading cause of disability in the US and Canada for persons 15 to 44 years of age?
Mental disorders
Mental illness
Mental illness includes disorders that affect mood, behavior, and thinking, such as depression, schizophrenia, anxiety disorders, and addictive disorders. Mental disorders often cause significant distress, impaired functioning, or both. Individuals experience dissatisfaction wit self, relationships, and ineffective coping.
___________ refers to the clients pervasive and enduring emotional state.
Mood
Mental illness in the 21st century...
More than 18.6% of Americans aged 18 years and older have some form of mental illness. 8.4 million had co-occuring mental illness and substance use disorder, or dual diagnosis. Furthermore, mental illness or serious emotional disturbances impair daily activities for the estimated 15 million adults and 4 million children and adolescents.
Mexican Americans
Most consider a handshake to be polite but do not appreciate touch my strangers, although touching and embracing warmly are common among family members Avoid eye contact with authoritah figures Prefer small polite interactions to help establish rapport before answering health-related questions Silence is often a sign of disagreement Orientation to time is flexible May seek care for severe symptoms while still using folk medicine to deal with spiritual or psychic influences
Sullivans Life Stages: Preadolescence---8 to 12 years
Move to genuine intimacy with friend of the same sex Move away from family as a source of satisfaction in relationships Major shift to syntaxic mode occurs Capacity for attachment, love, and collaboration emerges or fails to develop
The nurse is assuming a ______________ role in this typer of therapeutic communication, using broad openings and open-ended questions to collect information and to help the client identify and discuss the topic of concern.
Non-directive
___________________ is a requirement to do no harm to this either intentionally or unintentionally.
Nonmaleficence
Nursing Liability
Nurses are expected to meet standards of care, meaning the care they provide to clients meets set expectations and is what any nurse in similar situations would do. Standards of care are developed from professional standards, state nursing practice acts, federal agency regulations, agency policies and procedures, job descriptions, and civil and criminal laws.
Cultural considerations...
Nurses must be prepared to care for this culturally diverse population; preparation includes being aware of cultural differences that influence mental health and the treatment of mental illnesses.
The first psychiatric nursing textbook...
Nursing Mental Diseases by Harriet Bailey
Leader
Offering direction to the client or group.
Stranger
Offering the client the same acceptance and courtesy that the nurse would to any stranger.
Chinese
Often shy in unfamiliar environments Avoid direct eye contact with authority figures to show respect Loudness is not a sign of agitation or anger Extended families with eldest male making the decisions (spokesperson) Mental illness is often thought to result from a lock of harmony of emotions or from evil spirits Strong believers in folk medicine
Duty to Warn Third Parties
One exception to the clients right to confidentiality is the duty to warn, based on the California Supreme Court decision in Tarasoff vs. Regents of the University of California.
Phases of the Nurse-Client Relationship
Orientation: Client seeks assistance, asks questions, shares expectations. Nurse responds to client, explains roles, reduces anxiety and tension, gathers data. Working (Identification and Exploitation): Client participates in identifying problems, explores feelings, responds to help, attempts to attain new goals, makes full use of services. Nurse shows acceptance, helps express needs and feelings, provides information, continues assessment, helps plan for total needs, facilitates forward movement of personalities. Termination: Client abandons old needs, applies new skills, shows positive changes. Nurse promotes family interactions, sustains relationship, teaches preventative measures, terminates nurse-client relationship.
Sullivans Life Stages: Childhood---language to 5 years
Parents are viewed as a source of praise and acceptance Shift to parataxic mode: Experiences are connected in sequence to each other Primary sone is anal Gratification leads to positive self-esteem Moderate anxiety leads to uncertainty and insecurity; severe anxiety results in self-defeating patterns of behavior
_________________________________ (PHP's) are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions.
Partial Hospitalization Programs
People of ancient times...
People of ancient times believed that any sickness indicated displeasure of the gods and, in fact, was a punishment for sins and wrongdoings. Those with mental disorders were viewed as being either divine or demonic.
Conservatorship and Guardianship
People who are gravely disabled; are found to be incompetent; cannot provide food, clothing and shelter for themselves even when resources exist; and cannot act in their own best interests may require appointment of conservator or legal guardian. The clients with a guardian loses the right to enter into legal contracts or agreements that require a signature.
__________ described the therapeutic nurse-client relationship with its phases and tasks and wrote extensively about anxiety.
Peplau
_______________________, or ways one person expects another to behave or speak.
Perceptions
_____________________ tests reflect the clients personality in areas such as self-concept, impulse control, reality testing, and major defenses.
Personality
Members of the interdisciplinary team include:
Pharmacist Psychiatrist Psychologist Psychiatric nurse Psychiatric social worker Occupational therapist Recreation therapist Vocational rehabilitation specialist
Preconscious refers to...
Preconscious thought and emotions are not currently in the persons awareness, but he or she can recall them with some effort---for example, an adult remembering what he or she did, thought, or felt as a child.
Sullivans Life Stages: Infancy---birth to onset of language
Primary need exists for bodily contact and tenderness Prototaxic mode dominates (no relation between experiences) Primary sones are oral and anal If needs are met, infant has sense of well-being; unmet needs leads to dread and anxiety
Unconscious blaming of unacceptable inclinations or thoughts on an external object
Projection
(PATH)
Projects for assistance in transition from homeless
Counselor
Promoting experiences leading to health for the client such as expression of feelings.
Resource Person
Providing specific answers to questions within a larger context.
The focus on discovering the causes of the clients unconscious and repressed thoughts, feelings, and conflicts believed to cause anxiety and on helping the client to gain insight into and resolve these conflicts and anxieties. They analytic therapist uses the techniques of free association, dream analysis, and interpretation of behavior. It is still practiced today, but on a very limited basis. It is lengthy and costly.
Psychoanalysis
Sigmund Freud: The Father of Psychoanalysis
Psychoanalytic theory supports the notion that all human behavior is caused and can be explained. Freud believed that repressed (driven from conscious awareness) sexual impulses and desires motivate much human behavior.
Eriksons Stages: Initiative vs. Guilt (preschool)
Purpose Beginning development of a conscience; learning to manage conflict and anxiety
Johari Window
Quadrant 1: Oen/public--self qualities one knows about oneself and others also know. Quadrant 2: Blind/unaware--self qualities know only by others. Quadrant 3: Hidden/private--self qualities known only to ones self. Quadrant 4: Unknown--an empty quadrant to symbolize qualities as yet undiscovered by oneself or others.
Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect Ex: Student blames failure on teacher being mean.
Rationalization
Active listening and observation help the nurse to:
Recognize the issue that is most important to the client at this time Know what further questions to ask the client Use additional therapeutic communication techniques to guide the client to describe his or her perceptions fully Understand the client perceptions of the issue instead of jumping to conclusions Interpret and respond to the message objectively
_________________ goes beyond symptom control and medication management to include personal growth, reintegration into the community, empowerment, increased independence, and improving quality of life as the beginning of the recovery process.
Recovery
Goals of psychiatric rehabilitation
Recovery from mental illness Personal growth Quality of life Community reintegration Empowerment Increased independence Decreased hospital admissions Improved social functioning Improved vocational functioning Continuos treatment Increased involvement in treatment decisions Improved physical health Recovered sense of self
Moving back to a previous developmental stage to feel safe or have needs met Ex: Man pouts like a 4 year old if he is not the center of his girlfriends attention.
Regression
Excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness. Ex: Woman has no memory of the mugging she suffered yesterday.
Repression
______________ is defined as having healthy responses to stressful circumstances or risky behaviors.
Resilience
Overt or covert antagonism towards remembering or processing anxiety-producing information Ex: Person tends court-ordered treatment for alcoholism but refuses to participate.
Resistance
______________ involves using problem-solving abilities and believing that one can cope with adverse or novel situations.
Resourcefulness
______________ is the direct application of physical form to a person, without his or her permission, to restrict his or her freedom of movement. The physical force may be human or mechanical or both. Human ___________ occurs when staff members physically control the client and more him or her to a seclusion room.
Restraint
_____________ is the involuntary confinement of a person in a specially constructed, locked room equipped with a security window or camera for direct visualization monitoring.
Seclusion
______________________ is the process of developing an understanding of ones own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths, and limitations and how these qualities affect others.
Self-awareness
Self awareness issues...
Self-awareness is the process by which the nurse gains recognition of his or her own feelings, beliefs, and attitudes. At times, a nurse's values and beliefs will conflict with those of the client or with the clients behavior. The nurse must learn to accept these difference among people and view each client as a worthwhile person. Nurses that accomplish self-awareness through reflection, spending time consciously focusing on how one feels and what one values or believes.
______________ is the way one views oneself in terms of personal worth and dignity.
Self-concept
____________________ is a belief that personal abilities and efforts affect events in our lives.
Self-efficacy
Surrogate
Serving as a substitute for another such as a parent or sibling.
Sullivans Life Stages: Juvenile---5 to 8 years
Shift to the syntaxic mode begins (thinking about self and others based on analysis of experiences in a variety of situations) Opportunities for approval and acceptance of others Learn to negotiate own needs Severe anxiety may result in a need to control or in restrictive, prejudicial attitudes
Interdisciplinary team: Psychiatric Social Worker
Social workers may practice therapy and often have the primary responsibility for working with families, community support, and referral.
________________ is a clients belief about life, health, illness, death, and ones relationship to the universe.
Spirituality
Peplaus nursing roles...
Stranger Resource person Teacher Leader Surrogate Counselor
Freud believed that much of what we do and say is motivated by our ____________ thoughts or feelings (those in the preconscious or unconscious level of awareness).
Subconscious
Substituting a socially acceptable activity for an impulse that is unacceptable Ex: Person who has quit smoking sucks on hard candy when the urge to smoke arises.
Sublimation
Replacing the desired gratification with one that is more readily available Ex: Woman who would like to have her own children opens a day care center.
Substitution
Freud: Superego
Superego is that part of a persons nature that reflects moral and ethical concepts, values, and parental and social expectations.
In addition to deinstitutionalization, federal legislation was passed to provide an income from disabled persons....
Supplemental Security Income (SSI) and Social Security Disability Income (SSDI)
__________ interventions aim at dealing with the persons needs for empathetic understanding, such as encouraging the person to identify and discuss feeling.
Supportive
Conscious exclusion of unacceptable thought and feeling from conscious awareness Ex: Student decides not to think about a parents illness to study for a test.
Suppression
Insanity Defense
The argument that a person accused of a crime is not guilty because that person cannot control his or her actions and cannot understand the wrongfulness of the act is now as the M'Naghten Rule.
___________________ can be used to help clients overcome irrational fears and anxiety associated with phobias.
Systematic desensitization
Piagets Stages: Concrete Operations---6 to 12 years
The child begins to apply logic to thinking, understands spirituality and reversibility, and is increasingly social and able to apply rules; however, thinking is still concrete.
Piagets Stages: Sensorimotor---birth to 2 years
The child develops a sense of self as separate from the environment and the concept of object permanence, that is, tangible objects do not cease to exist just because that are out of sight. He or she begins to form mental images.
Piagets Stages: Preoperational---2 to 6 years
The child develops the ability to express self with language, understand the meaning of symbolic gestures, and begins to classify objects.
Piagets Stages: Formal Operations---12 to 15 years and beyond
The child learns to think and reason in abstract terms, further develops logical thinking and reasoning, and achieves cognitive maturity.
Interdisciplinary team: Pharmacist
The registered pharmacist is a member of the team when medications, management of side effects, and/or interactions with non psychiatric medications are complex. Clients with refractory symptoms may also benefit from the pharmacists knowledge of chemical structures and actions of medications.
Interdisciplinary team: Psychiatric Nurse
The nurse gains experience in working with clients with psychiatric disorders after graduation. The nurse has a solid foundation in health promotion, illness prevention, and rehabilitation in all areas, allowing him or her to view the client holistically. The nurse is also an essential team member in evaluating the effectiveness of medical treatment, particularly medications.
Documentation with restraints:
The nurse monitors and documents the clients skin condition, blood circulation in hands and feet, emotional well-being, and readiness to discontinue seclusion or restraint. The nurse or designated car provider also implements and documents offers of food, fluids, and opportunities to use the bathroom per facility policies and procedures. If a client remains in restraints for 1 to 2 hours, two staff members can free one limb at a time for movement and exercises.
Healthy People 2020
The objectives were revised to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. The objectives also strive to decrease rates of suicide and homelessness, to increase employment among those with serious mental illness, and to provide more services both for juveniles and for adults who are incarcerated and have mental health problems.
Confidentiality
The protection and privacy of personal health information is regulated by the federal government through the Health Insurance Portability and Accountability Act or 1996.
Interdisciplinary team: Psychiatrist
The psychiatrist is a physician certified in psychiatry. The primary function of the psychiatrist is diagnosis of mental disorders and prescription of medical treatment.
Prisoners
The rate or mental illness in the jailed population has been increasing faster than that of the general population. It is estimated that the rate of mental illness is 5x higher. Factors cited as reasons that mentally ill people are placed in the criminal justice system includes deinstitutionalization, more rigid criteria for civil commitment, lack of adequate community support, economizing on treatment for mental illness, and the attitudes of police and society.
Mental health
The world health organization defines mental health as a state of complete physical, mental, and social wellness, not merely the absence of disease or infirmity. In most cases, mental health is a state of emotional, physiological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability.
_______________________________________ is an interpersonal interaction between the nurse and the client during which the nurse focuses on the clients specific needs to promote an effective exchange of information.
Therapeutic communication
Existential Theories: Rational emotive therapy
Therapist: Albert Ellis A cognitive therapy using confrontation of "irrational beliefs" that prevent the individual from accepting responsibility for self and behavior
Existential Theories: Reality therapy
Therapist: William Glosser Therapeutic focus is need for identity through responsible behavior; individuals are challenged to examine ways in which their behaviors thwarts their attempts to achieve life goals
Mental Status Exams
These exams usually include items such as orientation to person, place, time, date, season, and day of the week; ability to interpret proverbs; ability to perform math calculations; memorization and short-term recall; naming common objects in the environment; ability to follow multistep commands; and ability to write or cope a simple drawing.
Commitment laws changed in early 1970s...
They changed making it more difficult to commit people for mental health treatment against their will.
Peplaus phases: Identification
This phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger.
Peplaus phases: Orientation
This phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions.
Peplaus phases: Exploitation
This phase the client makes full use of the services offered.
Peplaus phases: Resolution
This phase the client no longer needs professional services and gives up dependent behavior. The relationship ends.
Highlights of Patients Bill of Rights:
To be informed about benefits, qualifications of all providers, available treatment options, and appeals and grievance procedures. Least restrictive enviroment to meet needs. Confidentiality. Choice of providers. Treatment determined by professionals, not third-party payers. Parity. Nondiscrimination. All benefits within scope of benefit plan. Treatment that affords greatest protection and benefit. Fair and valid treatment review processes. Treating professionals and payers held accountable for any injury caused by gross incompetence, negligence, or clinically unjustified decisions.
A _____ is a wrongful act that results in injury, loss, or damage. ______ may either be intentional or unintentional.
Tort
Occurs when the client displaced onto the therapist attitudes and feelings that the client originally experienced in other relationships.
Transference
T/F: A group is a number of persons who gather in a face-to-face setting to accomplish tasks that require cooperation, collaboration, or working together. Pregroup stage Beginning stage Working stage Termination
True
T/F: A person can be detained in a psychiatric facility for 48 to 72 hours on an emergency basis until a hearing can be conducted to determine whether or not he or she should be committed to a facility for treatment for a specified period.
True
T/F: All existential therapies have the goal of helping the person discover an authentic sense of self.
True
T/F: Clients receiving mental health care retain all civil rights afforded to all people except the right to leave the hospital in the case of involuntary commitment.
True
T/F: Compared with homeless people without mental illness, mentally ill homeless people are homeless longer, spend more time in shelters, have fewer contacts with family, spend more time in jail, and face greater barriers to employment.
True
T/F: Court-ordered outpatient treatment is more common among persons with severe and persistent mental illness who have had frequent and multiple contacts with mental health, social welfare, and criminal justice agencies.
True
T/F: Crisis is described as self-limiting; that is, the crisis does not last indefinitely but usually exists for 4 to 6 weeks. The crisis is resolved in one of three ways. In the first two, the person either returns to his or her pre crisis level of functioning or beings to function at a higher level; both are positive outcomes. The third resolution id that the persons functioning stabilizes at a level lower than pre crisis functioning, which is a negative outcome for the individual.
True
T/F: Ethnic groups differ in the metabolism and efficacy of psychoactive compounds. Some ethnic groups metabolize drugs more slowly which increases the frequency and severity of side effects. Client who metabolize drugs more slowly generally need lower doses of a drug to produce the desire effects.
True
T/F: Existential theorists believe that behavioral deviations result when a person is out of touch with himself or herself or the environment.
True
T/F: Family therapy is a form of group therapy in which the client and his or her family members participate.
True
T/F: Growth-producing roles include the information seeker, information giver, energizer, coordinator, harmonizer, encourager, and elaborator. Growth-inhibiting roles include the monopolizer, aggressor, dominator, critic, recognition seeker, and passive follower.
True
T/F: Historically, clients with mental illness had few rights and were subjected to institutionalization, warehousing, and inhumane treatment. In the 1970s, recognition of patients rights and changes in the law governing commitment improved the rights of clients.
True
T/F: In a self help group, members share a common experience, but the group is not a formal or structured therapy group.
True
T/F: Inpatient treatment is often the last, rather than the first, mode of treatment for mental illness.
True
T/F: Legally mandated or assisted outpatient treatment is the requirement that clients continue to participate in treatment on an involuntary basis after their release from the hospital into the community. This may involve taking prescribed medication, keeping appointments with health-care providers for follow-ups, and attending specific treatment programs or groups.
True
T/F: Managed care began in the early 1970s in the form of health maintenance organizations, which were successful in some areas with healthier populations of people.
True
T/F: Mental health care is managed through privately owned behavioral health-care firms. Persons without private insurance must rely on their counties of residence to provide funding through tax dollars. These persons are often homeless or in jail.
True
T/F: Mental health care is separated from physical health care in terms of insurance coverage.
True
T/F: Psychiatric rehabilitatio involved providing services to people with severe and persistent mental illness to help them to live in the community. These programs are often called community support serviced or community support programs. It focuses on the clients strength. These programs assist clients with activities of daily lining such as transportation, shopping, food preparation, money management, and hygiene.
True
T/F: Psychosocial intervention are nursing activities that enhance the clients social and psychological functioning and improve social skills, interpersonal relationships, and communication.
True
T/F: Self disclosure examples are most helpful.
True
T/F: Short-term use of restraint or seclusion is permitted only when the client is imminently aggressive and dangerous to himself or herself or to others, and all other means of calming the client have been unsuccessful. For adult clients, use of restraint and seclusion requires a face-to-face evaluation by the licensed independent practitioner within 1 hour of restraint or seclusion and every 8 hours thereafter, a physicians order every 4 hours, documented assessment by the nurse every 1 to 2 hours, and close supervision of the client.
True
T/F: Support groups are organized to help members who share a common problem to cope with it.
True
T/F: The client finds it easier to manipulate the nurses feelings. This discourages the client from exploring his or her problems, thoughts, and feelings; discourages client growth; and often leads to client dependency.
True
T/F: The community based system did not accurately anticipate the extent of the needs of people with severe and persistent mental illness.
True
T/F: The goal of a psychotherapy group is for members to learn about their behaviors and to make positive changes in their behaviors by interacting and communicating with others as a member of a group.
True
T/F: The goal of an education group is to provide information to members on a specific issue--for instance, stress management, medication management, or assertiveness training.
True
T/F: The prevalence of disorders such as PTSD and major depression among active duty military service members is greater than their civilian counterparts. There is also an increased rate of suicide, homicide, injury, and physical illness. Also common are sleep disorders, substance abuse, cardiovascular disease, smoking, homelessness, and marital and family dysfunction.
True
T/F: The role of psychiatric nurses expanded as somatic therapies for the treatment of mental disorders were developed.
True
T/F: Today, inpatient units must provide rapid assessment, sterilization of symptoms, and discharge planning, and they must accomplish goals quickly. A client-centered multidisciplinary approach to a brief stay is essential.
True
T/F: William Glasser devised an approach called reality therapy that focuses on the persons behavior and how that behavior keeps him or her from achieving life goals.
True
T/F: With community mental health treatment, the client can often continue to work and can stay connected to family, friends, and other support systems while participating in therapy. Outpatient therapy also takes into account that a persons personality or behavior patterns, such as coping skills, style of communication, and level of self-esteem, gradually develop over the course of a lifetime and cannot be changed in a relatively short inpatient course of treatment.
True
T/F: Proxemics is the study of distance zones between people during communication.
True Intimate zone--0-18 inches between people (whispering, parents with young children) Personal zone--10-36 inches between people (family and friends) Social zone--4-12 feet between people (social, work, and business settings) Public zone--12-25 feet between people (speaker and audience, small groups)
___________ develops when the client believes that the nurse will be consistent in his or her words and actions and can be relied on to do what he or she says.
Trust
A nonjudgemental caring for the client that is not dependent on the clients behavior..
Unconditional positive regard
Unconscious refers to...
Unconscious is the realm of thoughts and feelings that motivates a person even though he or she is totally unaware of them.
Exhibiting acceptable behavior to make up for or negate unacceptable behavior Ex: Person who cheats on a spouse brings the spouse a bouquet of roses.
Undoing
_____________________ is a theory that bases decisions on :the greatest good for the greatest number."
Utilitarianism
________ refers to feeling needed and accepted.
Value
______________ are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living.
Value
_______________ is the duty to be honest or truthful.
Veracity
____________________ concluded that survivors were able to find meaning in their lives even under miserable conditions. Hence, the search for meaning (logos) is the central theme in logo-therapy.
Viktor Frankl
Eriksons Stages: Autonomy vs. Shame and doubt (toddler)
Will Achieving a sense of control and free will
Eriksons Stages: Ego Integrity vs. Despair (maturity)
Wisdom Accepting responsibility for ones self and life
The nurse who does not become upset or responds negatively to a clients outbursts, anger, or acting out conveys ______________ to the client. Avoiding judgements of the person, no matter what the behavior, is acceptance.
acceptance
The economic burden of mental illness in the US, including both healthcare costs and lost productivity, exceeds the economic burden caused by...
all kinds of cancer.
Many existential therapists use ___________________ therapy, which focuses on immediate processing--how a person perceives or interprets his or her experience and determines how he or she feels and behaves.
cognitive
A ____________ is a turning point in an individuals like that produces an overwhelming emotional response. 1. the person is exposed to a stressor, experience anxiety, and tries to come in a customary fashion. 2. Anxiety increased when customary coping skills are ineffective. 3. the person make all possible efforts to deal with the stressor, including attempts at new methods of coping. 4. when coping attempts fail, the person experiences disequilibrium and significant distress.
crisis
An ___________________________________ is a situation in which ethical principles conflict or when there is no one clear course of action in a given situation.
ethical dilemma
The _______________________ household is a group-living situation in which the residents make the transition from a traditional group home to a residence where they fulfill their own responsibilities and function without on-site supervision from paid staff.
evolving consumer
Secondary prevention:
ex: early identification of potential mental health problems
Tertiary prevention:
ex: monitoring and coordinating rehabilitation services for the mentally ill
Primary prevention:
ex: stress management education
When the nurse is comfortable with himself or herself aware of his or her strengths and limitations, and clearly focused, the client perceives a genuine person showing.....
genuine interest
People with severe and persistent mental illnesses were either _________ or ________ by community mental health centers.
ignored or underserved
A healthy _____________ relationship involves two people who are emotionally committed to each other.
intimate
Two essential components of transitional care are...
peer support and bridging staff.
The nurse who appreciated the client as a unique worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle. This unconditional nonjudgemental attitude is known as.....
positive regard
A ________________________ is the feeling of connectedness with or involvement in a social system or enviroment of which a person feels an internal part.
sense of belonging
A _____________ relationship is primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of a task.
social
Maturational crisis
sometimes called developmental crisis, are predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career.
Adventitious crisis
sometimes called social crisis, include natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks; riots; and violent crimes such as rape or murder.
Linda Richards is called...
the first American psychiatric nurse.
The _____________ relationship differs from the social or intimate relationship in many ways because it focuses on the needs, experiences, feelings, and ideas of the client only.
therapeutic
By developing self-awareness and beginning to understand his or her attitudes, the nurse can begin to use aspects of his or her personality, experiences, values, feelings, intelligence, needs, coping skills, and perceptions to establish relationships with clients. This is called ___________________________________.
therapeutic use of self
Congruence occurs when....
words and actions match
