NUR 330 Exam 1

recent life changes questionnaire (RLCQ) (page 5-6)

1. A high score on the RLCQ places the individual at greater susceptibility to physical or psychological illness. 2. Individuals differ in their reactions to life events, and these variations are related to the degree to which the change is perceived as stressful. 3. Life changes questionnaires have been criticized. -Do not consider the individual's perception of the event 4. These types of instruments also fail to consider: -Cultural variations -Individual's coping strategies -Available support systems at the time when the life change occurs

chronic or prolonged grieving

1. A prolonged grief process may be considered maladaptive when certain behaviors are exhibited. -Behaviors aimed at keeping the lost loved one alive -Behaviors that prevent the bereaved from adaptively performing activities of daily living

length of the grief process

1. Acute grief -Usually lasts about 6 to 8 weeks; longer in older adults 2. The grief process -Is very individual -May last for many years without being maladaptive. -grief process is longer in older adult because they've had more and more losses with age

distorted (exaggerated grief)

1. All of the symptoms associated with normal grieving are exaggerated. 2. The individual becomes incapable of managing activities of daily living. 3. The individual remains fixed in the anger stage of the grief process. 4. Depressed mood disorder is a type of distorted grief response. -many times the anger is turned inward on the self

secondary appraisal

1. An assessment of skills, resources, and knowledge that the person possesses to deal with the situation 2. The interaction between the primary appraisal of the event that has occurred and the secondary appraisal of available coping strategies determines the quality of the individual's adaptation response to stress.

therapeutic relationship

1. An interaction between two people (usually a caregiver and a care receiver) in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention 2. on the other hand, a social relationship is not professional 3. Therapeutic nurse-client relationships occur when each views the other as a unique human being. 4. Therapeutic relationships are goal-oriented and directed at learning and growth promotion.

leadership styles (pg. 193)

1. Autocratic -Focus is on the leader -striving to convince others in the group that his or her ideas and methods are superior. -Members are dependent -For problem-solving, decision making, and permission to perform. -Production is high. -Morale is usually low. 2. Democratic -Focuses on the members of the group -Members participate -In problem-solving of group issues & in taking action to effect change. -Production is somewhat lower. -Morale is much higher. 3. Laissez-faire -No direction from the leader -Goals are largely undefined. -Members can become frustrated and confused. -Productivity and morale are usually low. 4. may practice a combination of styles

adaptive coping strategies

1. Awareness, Relaxation, Meditation 2. Interpersonal communication -the strength of one's available support system is an existing condition that significantly influences his or her adaptation when coping with stress 3. Problem-solving/decision-making model -Assessing the facts of the situation -Formulating goals for resolution of the stressful situation -Studying the alternatives for dealing with the situation -Determining the risks and benefits of each alternative 4. Pets -Those who care for pets, especially dogs and cats, are better able to cope with the stressors of life. 5. Music -Studies have shown multiple benefits of listening to music.

impact of pre-existing conditions

1. Both sender and receiver bring certain preexisting conditions to the exchange that influence the intended message and the way in which the message is interpreted. 2. Values, attitudes, and beliefs -Can influence communication in numerous ways -learned ways of thinking -Children generally adopt the value systems and internalize the attitudes and beliefs of their parents. Children may retain this way of thinking into adulthood or develop a different set of attitudes and values as they mature. Values, attitudes, and beliefs can influence communication in numerous ways. -For example, prejudice is expressed verbally through negative stereotyping. 3. Culture or religion -Cultural mores (the customs, norms, and behaviors), norms, ideas, and customs provide the basis for ways of thinking. -Cultural values are learned and differ from society to society. -Religion also can influence communication. Symbolic gestures, such as wearing a cross around the neck or hanging a crucifix on the wall can communicate an individual's religious beliefs. 4. Social status -High-status persons often convey their high-power position with gestures of hands on hips, power dressing, greater height, and more distance when communicating with individuals considered to be of lower social status. 5. Gender -Masculine and feminine gestures influence messages conveyed in communication with others. -Roles have historically been identified as either male or female. 6. Age or developmental level Example -The influence of developmental level on communication is especially evident during adolescence. -Words such as dude, cool, awesome, and others - may relate to physiological alterations. One example is American Sign Language, the system of unique gestures used by many people who are deaf or hearing impaired. Individuals who are blind at birth never learn the subtle nonverbal gesticulations that accompany language and can totally change the meaning of the spoken word. 7. Environment in which the transaction takes place -Territoriality, density, and distance are aspects of environment that communicate messages. -Territoriality is the innate tendency to own space. -this influences communication when an interaction takes place in the territory "owned" by one or the other. -Density refers to the number of people within a given environmental space. -Distance is the means by which various cultures use space to communicate.

boundaries in the nurse-client relationship

1. Boundaries are borders or limits in a relationship. They determine the extent of acceptable limits. 2. Material boundaries are physical property that can be seen, such as fences that border land. 3. Social boundaries are established within a culture and define how individuals are expected to behave in social situations. 4. Personal boundaries are boundaries that individuals define for themselves. -They include physical distance boundaries, or just how close individuals will allow others to invade their physical space; and emotional boundaries, or how much individuals choose to disclose of their most private and intimate selves to others. 5. Professional boundaries are boundaries which limit and outline expectations for appropriate professional relationships with clients. 6. Self-disclosure on the part of the nurse may be appropriate when it is judged that the information may therapeutically benefit the client. It should never be undertaken for the purpose of meeting the nurse's needs. 7. Gift giving may be part of the therapeutic process for people who receive care. Cultural belief and values may also enter into the decision of whether to accept a gift from a client. Accepting financial gifts is never appropriate, but in some instances nurses may be permitted to suggest instead a donation to a charity of the client's choice. If acceptance of a small gift of gratitude is deemed appropriate, the nurse may choose to share it with other staff members who have been involved in the client's care. 8. Touching is required to perform the many therapeutic procedures involved in the physical care of clients. Caring touch is the touching of clients when there is no physical need. Touching or hugging can be beneficial when it is implemented with therapeutic intent and has the consent of the client. There are times when touch should be avoided or considered with extreme caution. 9. When a nurse is acquainted with a client, the relationship must move from one of a personal nature to professional. If the nurse is unable to accomplish this separation, he or she should withdraw from the nurse-client relationship. Romantic, sexual, or similar personal relationships are never appropriate between nurse and client. 10. Warning signs that professional boundaries of the nurse-client relationship may be in jeopardy -Favoring one client's care over another's -Keeping secrets with a client -Changing dress style when working with a particular client -patient says "don't tell anyone", response is "what you share with me will only be shared with treatment team" -Swapping client assignments to care for a particular client -Giving special attention or treatment to one client over others -Spending free time with a client -Frequently thinking about the client when away from work -Sharing personal information or work concerns with the client -Receiving of gifts or continued contact and communication with the client after discharge

crisis intervention

1. CRISIS is defined by a person's struggle to regain equilibrium AND to adapt/cope in a new way. 2. Is acute and time-limited (4-6 weeks) 3. Goal is to return to pre-crisis level of functioning 4. During crisis, people are often more receptive to outside intervention 5. Intervention deals with present problem and resolution of the immediate crisis ("here-and-now") 6. Nurse often takes a more active, directive role when a patient is in an acute crisis situation

interdisciplinary treatment team (IDT) in psychiatry (pg. 227)

1. Care is directed by an interdisciplinary team (IDT). -An initial assessment is made by the admitting psychiatrist, nurse, or other designated admitting agent who establishes a priority of care. 2. A comprehensive treatment plan is formulated by team. 3. Team members of all disciplines sign the plan and meet regularly to update the plan as needed. 4. Disciplines may include psychiatry, psychology, nursing, social work, occupational therapy, recreational therapy, art therapy, music therapy, dietitions, and chaplain's service.

therapeutic communication techniques (pg. 152)

1. Caregiver verbal and nonverbal techniques that focus on the care receiver's needs and advance the promotion of healing and change 2. Therapeutic communication encourages exploration of feelings and fosters understanding of behavioral motivation. 3. It is nonjudgmental, discourages defensiveness, and promotes trust. 4. in mental health sometimes sit a little to the side instead of straight on to appear less threatening

basic roles and responsibilities of psychiatric nurse

1. Coordination of care -Initial / Ongoing assessment (e.g. Mental Status Assessment) -Crisis intervention / stabilization -Treatment and recovery 2. Milieu ("environment") and administration of biological therapies -Administration and monitoring of response -a scientific structuring of the environment in order to effect behavioral changes and improve the psychological health and functioning of the individual 3. Health teaching and health maintenance -Health promotion and relapse prevention

maladaptive responses to losses

1. Delayed or inhibited grief 2. Exaggerated or distorted grief response 3. Chronic or prolonged grief

avoiding liability

1. Effective communication - The SBAR model of reporting information, which stands for situation, background, assessment and recommendations, has been identified as a useful tool for effective communication with caregivers. Establishing rapport with clients encourages open and honest communication. 2. Accurate and complete documentation in the medical record -the electronic medical record (EHR) has been identified the best way to document and share this information. The use of best sources for informatics is also identified as an important standard for quality and safety in nursing education 3. Complying with the standards of care -those established within the profession (such as ANA standards) and those identified by specific hospital policies. 4. Knowing the client - helping the client become involved in his or her care as well as understanding and responding to aspects of care in which they are dissatisfied. 5. Practice within the nurse's level of competence and scope of practice - not only adhering to professional standards (those of the ANA and State Boards of Nursing) but also keeping knowledge and nursing skills current through evidence-based literature, inservices, and continuing education.

Phase III: Final or Termination Phase

1. Group activities -A sense of loss that precipitates the grief process may be evident. 2. Leader expectations -Leader encourages members to discuss these feelings of loss and to reminisce about the accomplishments of the group. 3. Member behaviors -Feelings of abandonment may be experienced by some members. -Grief for previous losses may be triggered. -For Patient Education Groups (PEG), a one-time group may not need to go through the above experiences. -The longer a group has existed, the more difficult termination is likely to be for the members. -Termination should be mentioned from the outset of group formation and be discussed in depth for several meetings prior to the final session. -Successful termination of the group may help members develop the skills needed when losses occur in other dimensions of their lives.

Phase I of group development Initial or Orientation Phase

1. Group activities -Leader and members work together to establish rules and goals for the group. -Goals of the group are established. -Members are introduced to each other. 2. Leader expectations -Leader promotes trust and ensures that rules do not interfere with fulfillment of the goals. -The leader is expected to orient members to specific group processes, encourage members to participate without disclosing too much too soon 3. Member behaviors -Members are superficial and overly polite. Trust has not yet been established. - There is a fear of not being accepted by the group. They may try to "get on the good side" of the leader with compliments and conforming behaviors. -A power struggle may ensue as members compete for their position in the "pecking order" of the group.

Phase II: Middle or Working Phase

1. Group activities -Productive work toward completion of the task is undertaken. -In the mature group, cooperation prevails, and differences and disagreements are confronted and resolved. 2. Leader expectations -Leader becomes more of a facilitator. -The leader helps to resolve conflict and continues to foster cohesiveness among the members while ensuring that they do not deviate from the intended task or purpose for which the group was organized. 3. Member behaviors -Trust has been established between members, and cohesiveness exists. -Conflict is managed by the group with minimal assistance from the leader. -They turn more often to each other and less often to the leader for guidance. -They accept criticism from each other, using it in a constructive manner to create change. -Occasionally, subgroups will form in which two or more members conspire with each other to the exclusion of the rest of the group.

fight or flight syndrome (initial stress response) (pg. 3, 4)

1. Hans Selye's general adaptation syndrome (GAS) -Alarm reaction stage: Fight-or-flight syndrome -Stage of resistance 2. Uses physiological responses of first stage as a defense in an attempt to adapt to the stressor If adaptation occurs, the third stage is prevented or delayed. Physiological symptoms may disappear -Stage of exhaustion The body responds to prolonged exposure to a stressor. Adaptive energy is depleted. Diseases of adaptation may occur. (e.g., headaches, mental disorders, coronary artery disease, ulcers, colitis) may occur. Without intervention for reversal, exhaustion and in some cases even death ensues.

confidentiality and right to privacy

1. Health Insurance Portability and Accountability Act (HIPPA) - protects client confidentiality on the federal level. -Rights to access their medical records, have corrections made to medical records, decide with whom medical information may be shared. -may be released without consent in life-threatening situation 2. Doctrine of privileged communication - grants certain professionals privileges under which they may refuse to reveal information about, and communications with, clients. 3. Exception: A duty to warn -protection of a third party - a mental health professional has a duty not only to their client, but also to individuals who are being threatened by that client. 4. Exception: Suspected child or elder abuse -Every state requires that health care professionals report suspicion of child abuse to legal authorities, and many have similar statutes regarding elder abuse.

heterogeneous vs homogeneous groups

1. Heterogeneous grouping is when a diverse group of students is put in the same cooperative learning group. 2. Homogeneous grouping is the distribution of students, who function at similar academic, social, and emotional levels, being placed in the same cooperative learning group together.

influence of culture and history on mental illness

1. Incomprehensibility -The inability of the general population to understand the motivation behind the behavior 2. Cultural relativity -The "normality" of behavior is determined by the culture 3. cultural norms - the standards we live by

therapeutic factors in groups

1. Instillation of Hope -By observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved. 2. Universality -Individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing. 3. Imparting of Information -Group members share their knowledge with each other. Leaders of teaching groups also provide information to group members. 4. Altruism -Individuals provide assistance and support to each other, thereby helping to create a positive self-image and promote self-growth. 5. Corrective Recapitulation of Primary Family Group -Group members are able to reexperience early family conflicts that remain unresolved. 6. Development of Socializing Techniques -Through interaction with and feedback from other members of the group, individuals correct maladaptive social behaviors, and learn and develop new social skills. 7. Imitative Behavior -Group members who have mastered a particular psychosocial skill or developmental task serve as valuable role models for others. 8. Interpersonal Learning -Group offers varied opportunities for interacting with other people. 9. Group Cohesiveness -Members develop a sense of belonging that separates the individual ("I am") from the group ("we are"). 10. Catharsis -Within the group, members are able to express both positive and negative feelings. 11. Existential Factors -The group is able to assist individual members to undertake direction of their own lives and to accept responsibility for the quality of their existence.

4 kinds of distance in interpersonal interactions

1. Intimate distance is the closest distance that individuals allow between themselves and others (0-18 in.) 2. Personal distance is the distance for interactions that are personal in nature, such as close conversation with friends (18-40 in.) 3. Social distance is the distance for conversation with strangers or acquaintances (4-12 ft) 4. Public distance is the distance for speaking in public or yelling to someone some distance away. (12 ft+)

Roles of Group Members & Roles of Nurse Group Leaders (pg. 193)

1. Members play one of three roles within a group -Complete the task of the group -Maintain or enhance group processes -Fulfill personal or individual needs 2. In psychiatry, the role of nurses may be to lead various types of therapeutic groups, e.g. client education, assertiveness training, parenting, and transition to discharge groups, among others. -American Nurses Association (ANA) guidelines specify nurses who serve as group psychotherapists should have a master's degree in psychiatric nursing.

behavioral adaptation responses for each level of anxiety (pg. 19, 22, slides 14-23 wk 1 pt 1)

1. Mild anxiety -Individuals employ any of a number of coping behaviors that satisfy their needs for comfort. 2. Mild-to-moderate anxiety -Sigmund Freud identified the EGO as the reality component of the personality, governing problem solving and rational thinking. -As the level of anxiety increases, the strength of the ego is tested, and energy is mobilized to confront the threat. -Anna Freud identified a number of DEFENSE MECHANISMS employed by the ego in the face of a perceived THREAT to biological or psychological integrity -MALADAPTIVE use of defense mechanisms promotes disintegration of the ego. 3. Moderate-to-severe anxiety -Anxiety at this level that remains unresolved over an extended period of time can contribute to a number of physiological disorders. -Measurable pathophysiology can be demonstrated. 4. Severe anxiety -Extended periods of severe anxiety can result in psychoneurotic behavior patterns. -Psychiatric disturbances characterized by excessive anxiety that is expressed directly or altered through defense mechanisms. Appears as a symptom, such as an obsession, compulsion, phobia, or sexual dysfunction. -Aware they are experiencing distress -Aware their behaviors are maladaptive -Feel helpless to change their situation -Experience NO loss of contact with reality -Neurosis is no longer considered a separate category of mental disorder. However, the term is still used in the literature to further describe the symptomatology of certain disorders and to differentiate from behaviors that occur at the more serious level of certain disorders and to differentiate from behaviors that occur at the more serious level of psychosis. -Neuroses are psychiatric disturbances characterized by excessive anxiety that is expressed directly or altered through defense mechanisms, not involving hallucinations. Psychosis involves a loss of touch with reality. 5. Panic anxiety -At this extreme level, an individual is not capable of processing what is happening in the environment and may lose contact with reality. -PSYCHOSIS is defined as a significant thought disturbance in which reality testing is impaired, resulting in delusions, hallucinations, disorganized speech, or catatonic behavior. -May exhibit minimal distress -Unaware their behavior is maladaptive -Unaware of any psychological problems -Exhibiting a flight from reality into a less stressful world or one in which they are attempting to adapt -Examples of psychotic disorders include schizophrenia, schizoaffective, and delusional disorders.

role of DSM5 (diagnostic and statistical manual of disorders)

1. Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders -diagnosed by HCP, therapist, psychiatrist, licensed clinical social worker 2. Disorders are identified at their appropriate placement along the mental health/mental illness continuum 3. It is thought that psychological and behavioral factors may affect the course of almost every major category of disease, including but not limited to cardiovascular, gastrointestinal, neoplastic, neurological, and pulmonary conditions. 4. Examples of psychoneurotic responses to anxiety -Anxiety disorders Disorders in which the characteristic features are symptoms of anxiety and avoidance behavior (e.g., phobias, panic disorder, generalized anxiety disorder, and separation anxiety disorder). -Somatic symptom disorders Characteristic features are physical symptoms for which there is NO demonstrable organic pathology or medical evidence (e.g., somatic symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder). -Dissociative disorders The characteristic feature is a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. (e.g., dissociative amnesia, dissociative identity disorder, and depersonalization-derealization disorder).

normal vs maladaptive grieving

1. One crucial difference between normal and maladaptive grieving: the loss of self-esteem 2. Marked feelings of worthlessness are indicative of depression rather than uncomplicated bereavement 3. Unlike the person with Major Depressive Disorder, most recently bereaved individuals are usually not preoccupied with feelings of worthlessness, hopelessness, or unremitting gloom; rather, self-esteem is usually preserved; the bereaved person can envision a "better day;" and positive thoughts and feelings are often interspersed with negative ones.

role of nurse in milieu therapy

1. One of the first nursing interventions is establishing a foundation for trust and maintaining a therapeutic milieu -Orienting the new client to the environment -To his or her rights and responsibilities within the unit milieu -To the structured activities designed for personal growth -To any limits or restrictions necessary to maintain safety -Through use of the nursing process, nurses manage the therapeutic environment on a 24-hour basis. -Nurses have the responsibility for meeting the client's physiological and psychological needs 2. Nurse's responsibility -Medication administration -Development of a one-to-one relationship -Setting limits on unacceptable behavior -Client education -anti-ligature: not providing fixtures that provide the capability of a patient attempting to use fixture to hang himself

components of nonverbal communication

1. Physical appearance and dress - part of the total nonverbal stimuli that influence interpersonal responses and, under some conditions, they are the primary determinants of such responses. -This includes clothing, hair, tattoos, cosmetics, and jewelry. 2. Body movement and posture -The way in which an individual positions his or her body communicates messages regarding self-esteem, gender identity, status, and interpersonal warmth or coldness. 3. Touch -a powerful communication tool. It can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction. -It is a very basic and primitive form of communication, and the appropriateness of its use is culturally determined. 4. Facial expressions -primarily reveal an individual's emotional states, such as happiness, sadness, anger, surprise, and fear. -The face is a complex multimessage system. Facial expressions serve to complement and qualify other communication behaviors and at times even take the place of verbal messages. 5. Eye behavior -It is through eye contact that individuals view and are viewed by others in a revealing way. An interpersonal connectedness occurs through eye contact. -In American culture, eye contact conveys a personal interest in the other person. Eye contact indicates that the communication channel is open, and it is often the initiating factor in verbal interaction between two people. 6. Vocal cues or paralanguage -the gestural component of the spoken word. -It consists of pitch, tone, and loudness of spoken messages, the rate of speaking, expressively placed pauses, and emphasis assigned to certain words. -These vocal cues greatly influence the way individuals interpret verbal messages.

six indicators of mental health

1. Positive attitude toward self -This refers to an objective view of self, including knowledge and acceptance of strengths and limitations. The individual feels a strong sense of personal identity and security within his or her environment. 2. Growth, development (see Erikson's theoretical models of personality development), and the ability to achieve self-actualization (see Maslow's hierarchy of needs) -This indicator correlates with whether the individual successfully achieves the tasks associated with each level of development. With successful achievement in each level, the individual gains motivation for advancement to his or her highest potential. 3. Integration -The focus here is on maintaining equilibrium or balance among various life processes. Integration includes the ability to adaptively respond to the environment and the development of a philosophy of life, both of which help the individual maintain a manageable anxiety level in response to stressful situations. 4. Autonomy -This refers to the individual's ability to perform in an independent, self-directed manner. He or she makes choices and accepts responsibility for the outcomes. 5. Perception of reality -Accurate reality perception is a positive indicator of mental health. This includes perception of the environment without distortion, as well as the capacity for empathy and social sensitivity—a respect and concern for the wants and needs of others. 6. Environmental mastery -This indicator suggests that the individual has achieved a satisfactory role within the group, society, or environment, and is able to love and accept the love of others. When faced with life situations, the individual is able to strategize, make decisions, change, adjust, and adapt. Life offers satisfaction to the individual who has achieved environmental mastery.

influence of culture and history on mental health

1. Primitive beliefs regarding mental disturbances -Some cultures thought that evil spirits or supernatural or magical powers had entered the body -Still others considered that an individual with mental illness may have sinned against another individual or God -During the Middle Ages, the association of mental illness with witchcraft and the supernatural continued to prevail in Europe -*This was brought over to New England during the colonial time*

restraints and seclusion

1. Restraints generally refers to a set of leather straps used to restrain the extremities of an individual whose behavior is out of control and who poses an immediate risk to the physical safety and psychological well-being of him or herself and others. Need doctor's order unless absolute emergency, get order asap. -Restraints are never to be used as punishment or for the convenience of staff. -"talking down" (verbal intervention) and chemical restraints (tranquilizing medication) are usually tried first -seclusion is another type of physical restraint in which the client is confined alone in a room from which he/she is unable to leave 2. The Joint Commission has specific standards regarding the use of seclusion and restraint. -Seclusion or restraint is discontinued at the earliest possible time. -Unless state law is more restrictive, orders for restraint or seclusion must be renewed every 4 hours for adults ages 18 and older, every 2 hours for children and adolescents ages 9 to 17, and every hour for children younger than 9 years. -An in-person evaluation must be conducted within 1 hour of initiating restraint or seclusion. -Patients who are simultaneously restrained and secluded must be continuously monitored by trained staff, either in person or through audio or video equipment. -Staff who are involved in restraining and secluding patients are trained to monitor the physical and psychological well-being of the patient. -False imprisonment is the deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means. Healthcare workers may be charged with false imprisonment for restraining or secluding—against the wishes of the client—anyone having been admitted to the hospital voluntarily.

physical and environmental conditions that influence groups

1. Seating -Should be no barrier between the members -A circle of chairs is better than chairs set around a table. -Members should be encouraged to sit in different chairs each meeting. -This openness and change creates a feeling of discomfort that encourages anxious and unsettled behaviors that can then be explored within the group. 2. Size -Group size does make a difference in the interaction among members. -The larger the group, the less time is available to devote to individual members. -In larger groups, more aggressive individuals are most likely to be heard, whereas quieter members may be left out of the discussions altogether. -Seven or eight members provide a favorable climate for optimal group interaction and relationship development. 3. Open-ended groups are those in which members leave and others join at any time while the group is active. -The continuous movement of members in and out creates discomfort that encourages unsettled behaviors in individual members and fosters the exploration of feelings. -These are the most common types of groups held on short-term inpatient units, although they are used in outpatient and long-term care facilities as well. 4. Closed-ended groups usually have a predetermined, fixed time frame. -Often composed of individuals with common issues or problems they wish to address. -All members join at the time the group is organized and terminate membership at the end of a designated period of time.

functions of a group

1. Socialization: The teaching of social norms occurs through groups. 2. Support: Fellow members are available in time of need. 3. Task Completion: Groups can assist in endeavors that are beyond the capacity of a single individual. (depend on each other) 4. Camaraderie: Individuals receive joy and pleasure from interactions with significant others. 5. Informational: Learning takes place when group members share their knowledge with others in the group. 6. Normative: Different groups enforce established norms in various ways. 7. Empowerment: Change can be made by groups at times when individuals alone are ineffective. 8. Governance: Large organizations often have leadership that is provided by groups rather than by a single individual. -shared responsibility 9. groups may serve more than one function and usually serve different functions for different members of the group.

legal considerations

1. Statutory laws -enacted by state legislature or the U.S. Congress. 2. Common laws -derived from decisions made in previous cases and evolve from court decisions resolving various issues. These laws may differ from state to state. 3. civil law -protects the private and property rights of individuals and businesses. -Private individuals or groups may bring a legal action to court for breach of civil law. -Torts: a civil law in which an individual has been wronged -Contracts: one party claims that the other party failed to fulfill an obligation and has breached their contract 4. criminal law -provides protection from conduct deemed injurious to the public welfare. -provides punishment for those found to have engaged in this conduct

stress as a transaction

1. Stress as a transaction between the individual and the environment 2. This concept emphasizes the relationship between -internal variables (within an individual) and -external variables (within the environment). 3. Parallels the modern concept of disease etiology.

rationale for using MSA Tool

1. Surroundings and physical environment -Managing behavioral crises -Promoting safety and sense of security -Identifying potential safety risk issues 2. essential to develop appropriate plan of care 3. used for -Admission assessment -Physical health assessment -Therapeutic groups -Documentation

types of groups

1. TASK groups -These groups are formed to accomplish a specific outcome. -Focus on solving problems and making decisions 2. TEACHING groups -Convey knowledge and information to a number of individuals 3. SUPPORTIVE / THERAPEUTIC groups -Prevent future upsets by teaching the participants ways of dealing with emotional stress arising from situational or developmental crises 4. Therapeutic groups versus Group therapy -Group therapy is a form of psychosocial treatment in which a number of clients meet together with a therapist for purposes of sharing, gaining personal insight, and improving interpersonal coping strategies. -For therapeutic groups, the focus is on group relations, interactions between group members, and the consideration of a selected issue. (Focus is more on the "here-and-now"). -Leaders of both types of groups must be knowledgeable about group process as well as group content. -Leaders of group therapy have advanced degrees in psychology, social work, nursing, or medicine. 5. Self-help groups -Clients talk about their fears and relieve feelings of isolation, while receiving comfort and advice from others undergoing similar experiences. -Composed of individuals with a similar problem -May or may not have a professional leader -Run by members, and leadership often rotates from member to member -Nurse may function as a referral agent, resource person, member of an advisory board, or leader of the group. -Examples of self-help groups are Alzheimer's Disease and Related Disorders, Anorexia Nervosa and Associated Disorders, Weight Watchers, Alcoholics Anonymous.

NANDA-I nursing diagnoses (pocket guide pg. 630)

1. The North American Nursing Diagnosis Association - International 2. (NANDA-I) describes a nursing diagnosis as a clinical judgment about individual, family, or community responses to actual or potential health problems and life processes. 3. What are the parts of a nursing care plan? -assess, nursing diagnoses and outcomes, planning, implementation, evaluation 4. nursing diagnoses depending on signs and symptoms

therapeutic use of self

1. The ability to use one's personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention 2. Nurses must possess self-awareness, self-understanding, and a philosophical belief about life, death, and the overall human condition. How are you being perceived by the patient?

delayed grief

1. The absence of grief when it ordinarily would be expected 2. Potentially pathological because the person is not dealing with the reality of the loss 3. Remains fixed in the denial stage of the grief process 4. Grief may be triggered much later in response to a subsequent loss

adaptation

1. The emphasis here is on change from the existing steady state of the individual's life pattern. 2. The change can be either positive, such as outstanding personal achievement, or negative, such as being fired from a job. 3. Positive adaptation, particularly in response to adversity, has also been referred to as resilience. 4. Coping strategies are considered maladaptive when the conflict being experienced goes unresolved or intensifies.

anticipatory grieving

1. The experiencing of feelings and emotions associated with the normal grief response before the loss actually occurs - While, conventional grief tends to diminish in intensity with the passage of time, anticipatory grief can become more intense as the expected loss becomes imminent. 2. Difficulty arises when family members complete the process of anticipatory grief and detachment from the dying person occurs prematurely. 3. Anticipatory grieving may be positive for some people and less functional for others. 4. Anticipatory grieving may serve as a defense for some individuals to ease the burden of loss when it actually occurs. It may prove to be less functional for others who, because of interpersonal, psychological, or sociocultural variables, are unable in advance of the actual loss to express the intense feelings that accompany the grief response. 5. being involved in the dying process is not only healing to the person dying, but the person potentially experiencing the loss as well

negligence

1. The failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation. 2. Any conduct that falls below the legal standard established to protect others against unreasonable risk of harm, except for conduct that is intentionally, wantonly, or willfully disregards others' rights.

basic assumptions of a therapeutic milieu

1. The health in each individual is to be realized and encouraged to grow. -All individuals are considered to have strengths as well as limitations. 2. Every interaction is an opportunity for therapeutic intervention. -Within this structured setting, it is virtually impossible to avoid interpersonal interaction. The ideal situation exists for clients to improve communication and relationship development skills. Learning occurs from immediate feedback of personal perceptions. 3. Each client owns their own environment. -Clients should have the opportunity to make decisions and solve problems related to the environment (milieu) of the unit; personal needs for autonomy as well as needs that pertain to the group as a whole are fulfilled. 4. Each client owns their own behavior. -Each individual within the therapeutic community is expected to take responsibility for his or her own behavior. 5. Peer pressure is a useful and powerful tool. -Behavioral group norms are established through peer pressure. Feedback is direct and frequent, so that behaving in a manner acceptable to the other members of the community becomes essential. 6. Inappropriate behaviors are dealt with as they occur. - Individuals examine the significance of their behavior, look at how it affects other people, and discuss more appropriate ways of behaving in certain situations. 7. Restrictions and punishment are to be avoided. -Destructive behaviors can usually be controlled with group discussion. However, if an individual requires external controls, temporary isolation is preferred over lengthy restriction or other harsh consequences.

deinstitutionalization

1. The institutions became overcrowded and understaffed, and conditions deteriorated 2. residents in hospitals for years; pushed back out into community

active listening

1. To listen actively is to be attentive to what client is saying, both verbally and nonverbally. 2. Several nonverbal behaviors have been designed to facilitate attentive listening. 3. With active listening the nurse communicates acceptance and respect for the client, and trust is enhanced. 4. A climate is established within the relationship that promotes openness and honest expression. 5. SOLER

respect

1. To show respect is to believe in the dignity and worth of an individual regardless of his or her unacceptable behavior. The attitude is nonjudgmental, and the respect is unconditional in that it does not depend on the behavior of the client to meet certain standards. 2. The nurse can convey an attitude of respect by: -Calling the client by name -Spending time with the client -Allowing sufficient time to answer the client's questions -Promoting an atmosphere of privacy -Always being open and honest with the client -Listening to the client's ideas, preferences, and opinions -Striving to understand motivation behind client's behavior

trust

1. To trust another, one must feel confidence in that person's presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested 2. The nurse must convey an aura of trustworthiness, which requires that he or she possess a sense of self-confidence. Confidence in the self is derived out of knowledge gained through achievement of personal and professional goals, as well as the ability to integrate these roles and to function as a unified whole. Many psychiatric clients experience concrete thinking, which focuses their thought processes on specifics rather than generalities, and immediate issues rather than eventual outcomes. 3. Being honest (e.g., saying "I don't know the answer to your question, but I'll try to find out") and then following through. 4. Nursing interventions that promote trust in an individual who is thinking concretely -Providing a blanket when the client is cold -Providing food when the client is hungry -Keeping promises -Being honest -Simply and clearly providing reasons -Providing a written, structured schedule of activities -Attending activities with the client if reluctant to go alone -Being consistent in adhering to unit guidelines -Listening to the client's preferences, requests, and opinions and making collaborative decisions concerning his or her care -Ensuring confidentiality

tort law

1. Tort -A civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (the defendant) 2. Intentional tort -Willful or intentional acts that violate another person's rights or property -Assault: Verbal, an act that results in genuine fear that he or she will be touched without consent. -Battery: unconsented offensive touching, harm or injury do not have to occur -False imprisonment: Indefensible use of seclusion, holding a client against his or her wishes outside of an emergency situation. -Defamation of character (slander or libel): sharing false or malicious information that is detrimental to the client's reputation. When this information is in writing it is referred to as libel. When it is spoken, it is called slander. -breach of confidentiality: revealing aspects about a client's case, or even for revealing that an individual has been hospitalized, if that person can show that making this information known resulted in harm. 3. Patient safety examples: -Failure to act with suicide risks -Failure to use restraints properly -Medication errors -Violation of boundaries

group norms

1. Unspoken and often unwritten set of informal rules that govern individual behaviors in a group. 2. Group norms vary based on the group and issues important to the group. 3. Without group norms, individuals would have no understanding of how to act in social situations.

ethics

1. a branch of philosophy that deals with systematic approaches to distinguishing right from wrong behavior.

gravely disabled

1. a guardian, conservator, or committee will be appointed by the court to ensure the management of the person. 2. Gravely disabled is generally defined as a condition in which an individual, as a result of mental illness, is in danger of serious physical harm resulting from inability to provide for basic needs. -ex. diabetic, dementia

therapeutic feedback

1. a method of communication that helps the client consider a modification of behavior. 2. Feedback gives information to clients about how they are being perceived by others. 3. It should be presented in a manner that discourages defensiveness on the part of the client. 4. Characteristics of useful feedback -Descriptive rather than evaluative and focused on the behavior rather than on the client -Specific rather than general -Directed toward behavior the client has the capacity to modify -Imparts information rather than offers advice -Is well-timed

value clarification

1. a process of self-exploration through which individuals identify and rank their own personal values. 2. This is an important process for nurses so that they may better understand why certain decisions should be made and how their own values may affect nursing outcomes.

precipitating event

1. a stimulus arising from the internal or external environment and perceived by the individual in a specific manner

interpersonal communication (pg. 148)

1. a transaction between the sender and the receiver. Both persons participate simultaneously 2. In the transactional model, both participants perceive each other, listen to each other, and simultaneously engage in the process of creating meaning in a relationship

post-group debriefing of leaders

1. allows leader to formally conclude a task or project, drawing a line in the sand between one mission and another. It provides an appropriate means to putting the past behind you while allowing you to grow from the endeavor prior to moving on.

motivational interviewing

1. an evidence-based, patient-centered style of communicating that promotes behavior change by guiding the patient to explore their own motivation for change and the advantages and disadvantages of their decisions. 2. Originally developed for use with patients who were struggling with substance use disorders 3. This style of communication may decrease defensive patient responses. 4. incorporates active listening and verbal therapeutic communication techniques, but is focused on what the patient wants rather than what the nurse thinks should be the next steps in behavior change.

cognitive appraisal

1. an individual's evaluation of the personal significance of the event or occurance 2. the event "precipitates" a response on the part of the individual, and the response is influenced by the individual's perception of the event 3. The cognitive response consists of a primary appraisal and a secondary appraisal.

responses to stress

1. anxiety -A diffuse, vague apprehension that is associated with feelings of uncertainty and helplessness -Low levels of anxiety are adaptive and can provide the motivation required for survival. -Anxiety becomes problematic when the individual is unable to prevent their response from escalating to a level that interferes with the ability to meet basic needs. 2. grief

affect

1. anxious 2. inappropriate 3. wide range 4. labile/afraid/glad/sad 5. blunted/flat/constricted 6. describe: 7. *observed by interviewer*

types of loss

1. anything that is perceived as such by the individual. -A significant other (person or pet) through death, divorce, or separation for any reason -Illness or debilitating conditions. Examples include (but are not limited to) diabetes, stroke, cancer, rheumatoid arthritis, multiple sclerosis, Alzheimer's disease, hearing or vision loss, and spinal cord or head injuries -Developmental/maturational or situations, such as menopause, andropause (decreased libido in men), infertility, "empty nest," aging, impotence (inability in a man to achieve an erection), or hysterectomy changes -Decrease in self-esteem due to inability to meet self-expectations or the expectations of others. This includes a loss of potential hopes and dreams -Personal possessions that symbolize familiarity and security in a person's life

insight, judgment, and level of impulse control

1. awareness of the nature of the illness 2. ability to make good choices, solve problems 3. level of impulse control (aggression, fear, sexual feelings, etc.)

attitude

1. cooperative 2. guarded/suspicious/distant 3. hostile 4. apathetic (don't care) 5. warm/friendly

admission to acute inpatient psychiatric care

1. criteria -imminent danger of harming self -imminent danger of harming others -unable to care for basic needs; gross impairment of judgment 2. goals -crisis stabilization -initiation of treatment -referral for outpatient follow-up care

grief (page 864)

1. deep mental and emotional anguish that is a response to the subjective experience of loss of something significant. 2. there is a process, not everyone gets to the fourth stage, common threads in the process: anger, period of numbness (protective factor to help cope- don't feel any emotion-shock) 3. Mourning is differentiated from grief in that mourning is described as the psychological process of adapting to loss.

moral behavior

1. defined as conduct that results from serious critical thinking about how individuals ought to treat others. -This behavior reflects the way a person interprets basic respect for others, including autonomy, freedom, justice, honesty, and confidentiality.

group content

1. depends on type of group

mood

1. euthymic 2. anxious 3. depressed 4. irritable 5. euphoric 6. *self-report by patient*

importance of self-awareness in nurse-patient relationship (pg. 137)

1. gain self-awareness through values clarification 2. *belief* is an idea that one holds true, and it can take any of several forms -Rational beliefs are ideas for which objective evidence exists to substantiate their truth. -Irrational beliefs are ideas that an individual holds as true despite the existence of objective contradictory evidence. Delusions can be a form of irrational beliefs. -Faith (sometimes called "blind beliefs") is a belief in something or someone that does not require proof. -Stereotypes are socially shared beliefs that describe a concept in an oversimplified or undifferentiated matter. 3. *attitude* is a frame of reference around which an individual organizes knowledge about his or her world. 4. *Values* are abstract standards, positive or negative, that represent an individual's ideal code of conduct and ideal goals. 5. knowing and understanding oneself enhances the ability to form satisfactory interpersonal relationships 6. self awareness requires an individual to recognize and accept what he or she values and learn to accept the uniqueness of and difference in others

parts of a mental status assessment (MSA) (Appendix C townsend and morgan)

1. general appearance 2. behavior/activity 3. speech 4. attitude 5. mood 6. affect 7. thought processes 8. perceptual disturbances 9. sensorium and cognitive ability 10. insight, judgment, and level of impulse control

perceptual disturbances

1. hallucinations -auditory -visual -tactile (alcoholics in withdrawal feeling bugs on skin) -command type (voices telling patient what to do) -olfactory (smell odors that don't exist) -gustatory (false perception of unpleasant taste) 2. illusions -safety issue -depolarizaion, derealization

group process

1. how an organization's members work together to get things done 2. the way in which group members interact with each other; interruptions, silence, judgment, glaring

suicide assessment documentation

1. identify and distinguish ideas (thoughts), plans (intentions), and attempts (behaviors) -provide information about level of risk

voluntary admission

1. individual makes an application to the institution for services and can stay as long as treatment is deemed necessary. May sign out of the hospital at any time unless it is determined that they are harmful to themselves or others. -inpatient hospitalization -partial hospitalization or day treatment program -longer term rehabilitation programs -residential programs (supervised group homes)

rights of patients to

1. informed consent - the preservation and protection of an individual's right to decide whether to accept or reject treatment. In most cases, a nurse must ensure that the three major elements of informed consent are addressed: -Knowledge: client has received adequate information on which to base his or her decision -Competency: individual's cognition is not impaired to an extent that would interfere with decision-making or, if so, individual has a legal representative (conservator) -Free will: The individual has given consent voluntarily without pressure or coercion from others. 2. treatment -Anyone admitted to the hospital has the right to treatment - patient cannot be hospitalized and then denied appropriate treatment for his or her diagnoses. 3. refuse treatment -including medication -Patients have the right to refuse treatment unless immediate intervention is required to prevent death or serious harm to the patient or another person. -patients may be hospitalized because they are of harm to themselves or others, and treatment may be administered without the consent of the patient in order to protect themselves or others. 4. least restrictive treatment alternative -If a client can be adequately treated in an outpatient setting, they should not be hospitalized. -If hospitalized, the patient should NOT be sedated, restrained, or secluded unless less restrictive steps were unsuccessful. -right to whatever level of treatment that is effective without limiting their freedom. 5. a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and an entitlement to a benefit or service. 6. A legal right is one on which the society has agreed and formalized into law.

malpractice

1. instance of negligence or incompetence on the part of a professional. 2. the basic elements of a nursing malpractice lawsuit: -A duty to the patient existed, based on the recognized standard of care. -A breach of duty occurred. -The client was injured. -Injury was directly caused by breach of a standard of care. 3. To succeed in a malpractice claim, a plaintiff must also prove proximate cause and damages.

primary appraisal

1. irrelevant -outcome holds no significance 2. benign-positive -outcome is one that is perceived as producing pleasure for the individual 3.. Stress appraisals -include harm/loss, threat, and challenge already experienced

sensorium and cognitive ability

1. level of alertness 2. orientation (time, place, person, circumstances) 3. memory (immediate, recent/short term; remote/long term) 4. general fund of knowledge 5. calculations: serial 3s, serial 7s subtraction tasks 6. read-and-write; copy design 7. attention: spell "WORLD" backwards 8. abstraction: proverb -Used to evaluate concrete thinking vs. abstract thinking -Understand the proverb yourself -Be aware of generational issues

thought processes

1. logical/coherent 2. concrete/goal-directed 3. tangential/circumstantial/loose association 4. flight of ideas, neologisms, echolalia, perseveration 5. clang associations, blocking (stops speaking mid-sentence), word salad 6. content of thought -suicidial, homicidal -delusions -magical thinking, ideas of reference -ruminations (letting the problem replay over and over in your mind), obsessions, phobias

peplau's four levels of anxiety (pg. 18) (handout)

1. mild anxiety -seldom a problem -Prepares people for action. It sharpens the senses, increases motivation for productivity, increases the perceptual field, and results in a heightened awareness of the environment. Learning is enhanced, and the individual is able to function at his or her optimal level. 2. moderate anxiety -perceptual field begins to diminish - Extent of the perceptual field diminishes. Individual becomes less alert to events occurring within the environment. Attention span and ability to concentrate decrease and assistance with problem-solving may be required. Increased muscular tension and restlessness. 3. severe anxiety -perceptual field diminishes greatly -concentration centers on one particular detail only or on many extraneous details. Attention span is extremely limited; the individual has much difficulty completing even the simplest task. Physical symptoms may include headaches, palpitations, and insomnia. Emotional symptoms may include confusion, dread, and horror. Virtually all overt behavior is aimed at relieving the anxiety. 4. panic anxiety -the most intense state -Individual is unable to focus on even one detail within the environment. Misperceptions are common, and a loss of contact with reality may occur. Hallucinations or delusions may be present. Behavior may be characterized by wild and desperate actions or extreme withdrawal. Human functioning and communication with others are ineffective. Individuals may be convinced that they have a life-threatening illness or fear that they are "going crazy," are losing control, or are emotionally weak. Prolonged panic anxiety can lead to physical and emotional exhaustion and can be life threatening.

transference

1. occurs when the client unconsciously displaces to the nurse feelings formed toward a person from the past 2. can interfere with the therapeutic interaction when the feelings being expressed include anger and hostility. -Anger toward the nurse can be manifested by uncooperativeness and resistance to the therapy. 3. Transference can also take the form of overwhelming affection for the nurse or excessive dependency on the nurse.

general appearance

1. overall impression 2. posture 3. facial expression/eye contact 4. hygiene/grooming 5. stated age vs. appearance

documenting care

1. patient safety 2. quality improvement 3. legal evidence

values

1. personal beliefs about what is important and desirable.

phases of the nurse-patient relationship

1. pre-interaction 2. orientation (introductory) 3. working 4. termination

pre-interaction phase

1. preparation for the first meeting with the client 2. Obtain information about the client from chart, significant others, or other health team members. 3. Examine one's own feelings, fears, and anxieties about working with a particular client.

behavior/activity

1. psychomotor agitation (restlessness) 2. psychomotor retardation (very slow) 3. automatisms or stereotypic behaviors -gestures, tics, rigidity, gait, catatonia, akathisia, jaw/lip smacking

speech

1. rate/pace 2. rhythm 3. tone/inflection 4. volume 5. examples of speech terminology -normal pace -rapid vs. slowed -hyperverbal vs. mute -monotone, monosyllables -fluency (mute, hesitation/latency of response)

genuineness

1. refers to the nurse's ability to be open, honest, and real in interactions with client. -To be "real" is to be aware of what one is experiencing internally and to allow the quality of this inner experiencing to be apparent in the therapeutic relationship. -May call for a degree of self-disclosure on part of nurse -When one is genuine, there is congruence between what is felt and what is expressed. 2. genuineness is caring, which includes listening, respect

discharge procedures

1. release against medical advice (AMA)

duty to report and intervene

1. sexual misconduct 2. diversion of drugs -the transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use

ethical dilemmas (pg. 91)

1. situations that require individuals to make a choice between two equally unfavorable alternatives. 2. Taking no action is considered an action taken. 3. In this situation, there is evidence to support both moral right and wrongness related to each choice. 4. This does not mean that all ethical issues are dilemmas: A dilemma only arises when there is no a clear reason to choose one option over another, and that there are desirable and undesirable outcomes to both.

types of groups led by nurses and topics for patient education (pg. 230)

1. task, teaching, and supportive/therapeutic groups.

involuntary admission

1. temporary emergency admission -should be sought when an individual displays behavior that is clearly an imminently dangerous to themselves or others. These commitments are time-limited and a court hearing must be scheduled to decide if the patient should be discharged or if additional hospitalization is necessary. -alcoholic going through withdrawal on the streets might be held for 24 hours 2. involuntary inpatient hospitalization -unable to make decisions regarding treatment -likely to harm themselves/others -unable to fulfill basic personal needs. 3. involuntary outpatient commitment -court-ordered process used to compel a person with mental illness to submit to outpatient treatment. -Eligibility criteria for IOC include a history of repeated decompensation requiring involuntary hospitalization, likelihood of deterioration requiring inpatient commitment, presence of severe, persistent mental illness, risk of becoming homeless, violent or suicidal.

empathy

1. the ability to see beyond outward behavior and to understand the situation from the client's point of view. -Nurse can accurately perceive and understand the meaning and relevance of client's thoughts and feelings. 2. sometimes empathy can be hard due to one's own values getting in the way 3. sympathetic person cries with patient, where as empathetic person offers solution

positive regard

1. the basic acceptance and support of a person regardless of what the person says or does

termination phase

1. the end of the nurse-client relationship 2. Termination of the relationship may occur for a variety of reasons: -the mutually agreed-on goals may have been reached -the client may be discharged from the hospital -it may be the end of a clinical rotation. 3. important to end the relationship and acknowledge it -usually at end of shift -"thank you for sharing today" 4. Progress has been made toward attainment of the goals. 5. A plan of action for more adaptive coping with future stressful situations has been established. 6. Feelings about termination of the relationship are recognized and explored.

orientation phase

1. the nurse and client become acquainted with each other 2. Create an environment for trust and rapport - by providing a sense of privacy, wear an ID badge/uniform 3. Establish contract for intervention -"what brought you here today...?" -starts to let patient explain the purpose 4. Gather assessment data 5. Identify client's strengths and limitations -ask! 6. formulating nursing diagnoses 7. setting goals that are mutually agreeable 8. developing a plan of action that is realistic 9. exploring feelings of both the client and nurse. -while not expressing own feelings to patient 10. Interactions may remain on a superficial level until anxiety subsides. -Several interactions may be required to fulfill the tasks associated with this phase.

countertransference

1. the nurse's behavioral and emotional response to the client 2. may be related to unresolved feelings toward significant others from the nurse's past, or they may be generated in response to transference feelings on the part of the client. 3. It is not easy to refrain from becoming angry when the client is consistently antagonistic, to feel flattered when showered with affection and attention by the client, or even to feel quite powerful when the client exhibits excessive dependency on the nurse. 4. It may be helpful to have evaluative sessions with the nurse after his or her encounter with the patient, in which both the nurse and other staff members (who are observing the interactions) discuss and compare the exhibited behaviors in the relationship.

bereavement/overload

1. the period of sadness that is the normal process of reacting to a loss

bioethics

1. the term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health. -Beneficence: The duty to promote good, The term "advocacy" means acting on another's behalf as a supporter or defender. -Autonomy: Respecting the rights of others to make their own decisions, emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected. -Justice: Distribute resources or care equally, The concept of justice reflects a duty to treat all individuals equally and fairly regardless of race, sex, marital status, diagnosis, social standing, economic level, or religious belief. -Fidelity (Nonmaleficence): Maintaining loyalty & commitment; doing no wrong to a patient -Veracity: One's duty to always communicate truthfully, Clients have the right to know about their diagnosis, treatment, and prognosis.

elopement

1. unsupervised wandering which results in a resident leaving the nursing home facility

predisposing factors (pg. 8)

1. variety of elements influencing how an individual perceives and responds to a stressful event 2. genetic influences, past experiences, existing conditions (here and now)

social stigma (pg. 472)

1. whatever group someone puts a label on, making them "less worthy" -not acceptable to our cultural norm -may result in social isolation

working phase

1. when the therapeutic work of the relationship takes place. 2. Tasks during this phase include -maintaining the trust and rapport that was established during the orientation phase -promoting the client's insight and perception of reality -problem-solving -overcoming resistance behaviors on the part of the client -continuously evaluating progress -might involve potentially developing communication skills, role play

SOLER

S: Sit squarely facing the client -gives the message that the nurse is there to listen and is interested in what the client has to say. O: Observe an open posture -Posture is considered "open" when arms and legs remain uncrossed. This suggests that the nurse is "open" to what the client has to say. With a "closed" posture, the nurse can convey a somewhat defensive stance, possibly invoking a similar response in the client. L: Lean forward toward the client -This conveys to the client that you are involved in the interaction, interested in what is being said, and making a sincere effort to be attentive. E: Establish eye contact - Direct eye contact is another behavior that conveys the nurse's involvement and willingness to listen to what the client has to say. The absence of eye contact, or the constant shifting of eye contact, gives the message that the nurse is not really interested in what is being said. R: Relax

rapport

implies special feelings on the part of both the client and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude

mental illness

maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and that interfere with the individual's social, occupational, and/or physical functioning

Erikson's stages of development

page 551 pocket guide, chp 41 online

mental health

the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms