NURS 311- Quiz 2: Chapter 8-10, 12-15 & 25
Use of silence
Used when patient needs to express ideas but may not know quite how to do it; with silence, the patient can focus on putting thoughts together
Use of validation
Used when patient needs to express ideas but may not know quite how to do it; with silence, the patient can focus on putting thoughts together
homeostasis
A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level
Motivational interviewing (MI)
a clinical method intended to engage a patient's own decision-making ability -most often used with those who have substance use disorder or other types of addiction
anger is
a normal healthy response to violation of one's integrity
Verbal and nonverbal communications are both important, but body language, facial expressions, and gestures communicate more than verbal messages
figures 8.2 and 8.3
adaptation/maladaptation
final stage that reflects the coping efforts
Strength-based communication
focuses on the patient's strengths rather than potential deficits
what is GAS
general adaptation syndrome
Risk factor assessment
includes ascertaining whether the patient has any suicidal, assaultive, or homicidal ideation
Group Verbal communication
includes the communication pathways and group themes
type D
increased negative emotions, pessimism, non-sharing of emotions
type c
introverted, respectful, conforming, complaint, and eager to please
Groupthink
the tendency of group members to avoid conflict and adopt a normative pattern of thinking that is often consistent with the ideas of the group leader -more likely to occur if the leader is respected or persuasive -can also occur if a closed leadership style is used and external threat is present
maladaptation
unsuccessful coping or the use of ineffective strategies
Self-awareness
"Know thyself": -Physical problems experienced -Significant traumatic life events -Prejudiced or embarrassing beliefs and attitudes about others background sociocultural factors -Effect of above experiences when caring for others
emotional response: negative
- anger - fright - anxiety - guilt - shame - sadness - envy - jealousy - disgust
emotional response: nonemotions
- confidence - awe - confusion - excitement
what are some nursing interventions/care for someone experiencing stress?
- group or social support - creative imagery - thought stopping - breathing exercises - regular exercise - proper nutrition - relaxation response - quiet environment - passive attitude - comfort position - self-hypnosis - biofeedback - yoga, meditation, music
emotional response: positive
- happiness - pride - relief - love
emotional response: borderline
- hope - compassion - empathy - sympathy - contentment
what are some cultural myths about anger?
- knee-jerk reaction - can be uncontrollable - adult behavior determined by temperament and childhood - men are angrier than women - must act aggressively to get what want
How should you treat a patient?
-As a "person" not an "object" -Respect their cultural/religious beliefs -Respect their rights, autonomy/self-determinism -Always use least restrictive environment - seclusion or restraints should be last resort
Nurses must maintain professional boundaries when caring for patients
-Avoid establishing friendships with patients -In a friendship, both persons share personal information -In a professional relationship, the nurse focuses only on the patient
The process of group development occurs in phases: beginning, middle, and termination
-Beginning: "honey moon"- rapport, getting to know each another, techniques for leading groups, testing by members -Working stage: the group addresses its purpose, sharing of ideas, group personality, development of norms -Termination stage: grieve for loss of group's closeness, reestablishment of self as individual, summary and future plans
Use empathetic, trusting, respectful, non-judgmental approach
-Do not criticize, challenge or dismiss -Can use confrontation cautiously
Maintain professional boundaries
-It is ALL about the patient, NOT you
The psychological assessment
-Mental health problems -Mental status examination -Behavioral responses -Risk factor assessment
Therapeutic Communication
-Patient is the primary focus -Use a professional attitude -Limit self-disclosure; it's not about you -Refrain from giving advice, reassurance, approval/disapproval -No social relationships -Maintain confidentiality -May be helpful to know various defense mechanism
Types of groups
-Psychoeducational groups -task groups -Decision-making groups -support groups -Psychotherapy groups -Self-help groups -Age-related groups
Prioritization
-Safety first then A-B-C (Airway-Breathing-Circulation) but keep "Maslow's Hierarchy of Basic Human Needs" in mind at all times
Principles of Therapeutic Communication
-The client as primary focus -A professional attitude -Self-disclosure only for therapeutic purpose -No advice or social relationships with clients -Client confidentiality -Assessment of client's intellectual competence -Interventions based on theory -Nonjudgmental attitude -Guiding client to reinterpret experiences rationally -Clarification to track the client's verbal interaction
Nursing interventions that are implemented for each domain
-biologic (self-care, activity and exercise, sleep, nutrition, thermoregulation, and pain and medication management) -psychological (counseling, conflict resolution, bibliotherapy, reminiscence, behavior therapy, psychoeducation, health teaching, and spiritual interventions) -social (behavior therapy and modification, milieu therapy, and various home and community interventions)
The nurse-patient relationship
-built on therapeutic communication, including verbal and nonverbal interactions, between the nurse and the patient -certain physical, emotional, and social boundaries and limitations need to be observed
The assessment of the physical domain
-current and past health status -physical examination with review of body systems -review of physical functions -pharmacologic -strength -Wellness assessment
The social Assessment
-functional status -social systems -spirituality -occupational, economic, and legal status -quality of life -social strengths -wellness attributes
Closed groups
-members admitted only once -no replacement members -group more cohesive -group more likely to dissolve when members drop out
Open groups
-new members joining at any time -members leave at any time -new members are at a disadvantage -advantage of this type: the group can continue
The non therapeutic relationship consists of three major and overlapping phases:
-the orientation phase -the grappling and struggling phase -the phase of mutual withdrawal
The therapeutic nurse-patient relationship consists of three major and overlapping phases
-the orientation phase: the patient and nurse meet and establish the parameters of the relationship the working phase: the patient identifies and explores problems -the resolution phase: the patient has learned to manage problems and the relationship can be terminated (add 9.1):
Nursing Process (ADPIE)
Assessment Diagnosis Planning Implementation Evaluation
Two of the most important communication concepts are empathy and rapport
BUT first and foremost, the nurse must possess self-awareness
Nonverbal behavior varies from culture to culture
The nurse must identify and understand the meaning of communication within the patient's culture. Example: looking straight in the eye is considered disrespectful in some cultures
Group size
Either small or large groups can be effective, but dynamics change in different size groups
The mental status examination
Includes general observation of appearance, psychomotor activity, and attitude; orientations; mood; affect; emotions; speech; and thought processes
What are some groups that arecommonly nurse-led that focus on specific interventions
Medication, symptom management, anger management, and self-care groups
Leading a group involves many different functions, from obtaining and receiving information to testing and evaluating decisions
The leader should explain the rules of the group at the beginning of the group
what is the outcome for successful coping?
adaptation through enhanced health, psychological well-being, and social functioning
coping
alleviating stress using emotional, cognitive, or behavioral methods
Reflection and analysis of interactions
allows the nurse to identify significant content and themes, as well as evaluate therapeutic communication
stress
an environmental pressure or force that puts strain on a person's system
Behavioral responses
assessed as are self-concept and current and past coping patterns
A deteriorating relationship
begins with a withholding phase, continues through the phases of avoiding and ignoring, and finally, ends unsatisfactorily with a phase named "struggling with and making sense of"
chronic stress
can be associated with allostatic load and can also lead to negative health outcomes
Nurse expectations for group interventions
can be called on to lead a group in the community, at the hospital, etc
Decision-making groups
can be victims of groupthink, which can have positive or negative outcomes -The psychiatric nurse often leads decision-making groups that plan activities, develop unit rules, and select learning materials -Group members form opinions consistent with the group consensus rather than critically evaluating the situation
type A personality
competitive, aggressive, ambitious, impatient, alert, tense, restless
appraisal
consideration of demands, constraints, resources, and personal goals and beliefs
what are factors that influence social networks?
cultural factors, employment factors, and gender influences
values and goals
cultural, ethnic, family, religious values individualized more important goal or difficult = increased stress positive emotions
The nursing assessment provides
data for nursing diagnoses and planning with the patient for mutually agreeable outcomes -Anticipated patient outcomes provide direction for psychiatric-mental health nursing interventions
Coping is
deliberate, planned, psychological effort to manage stressful demands
maladaptive anger is
detrimental to one's mental and physical health
what are the three functions of social support?
emotional support, tangible support, informational support
primary appraisal
evaluation of events as a threat, harm, or challenge
secondary appraisal
explanation of outcome of events
Evaluation of patient outcomes
involves assessing cost-effectiveness of the interventions, benefits to the patient, and the patient's level of satisfaction -outcomes should be measurable, either immediately after intervention or after some time passes
acute stress can
lead to physiologic overload, and can have a negative impact on the person's health, well-being, and social functioning
What must nurses do therapeutically communicate
limit self-disclosure, actively listens to the patient, and carefully selects communication techniques -It is not about you; it all about the patient
social networks
linkages among defined set of people - develops social identity - three levels - larger network = more support available - social support - enhanced health outcome - reduced mortality
Group Nonverbal communication
more complex and involves eye contact, body posture, seating arrangement, gestures, and the mood of the group
What do nurses need to deal therapeutically with the emotions, feelings, and problems of patients?
must understand their own values and beliefs and interpersonal strengths and limitations
stress is a _____ part of life
natural
what is a negative experience in stress
negative mental and physical health consequences
what are the categories of emotional response to stress?
negative, positive, borderline, nonemotions
Many persons with mental disorders have difficulty communicating so...
nurses should understand the unique communication challenges of persons with these disorders
what factors interact with environmental demands and constraints that produce a person-environment relationship?
personality patterns, beliefs, values, and commitment to outcome
effective coping can be
problem or emotion focused
allostasis
process by which the body achieves stability through physiological change and a process of adaptation
What are defense mechanisms (coping styles)?
psychological mechanisms that help an individual respond to and cope with difficult situations, emotional conflicts, and external stressors (table 8.4)
emotional response to stress
psychophysiological reactions that define a person's mood
type B
relaxed, easygoing, easily satisfied
what are the goals in nursing management of stress?
resolve the stressful person, environment situation, reduce the stress response, and develop positive coping skills
distress
stress evoked by negative feelings or events
eustress
stress evoked by positive emotions or events
adaptation
successful coping -> individual restores balance and adjusts to the stressor in a healthy way
Assessment
the deliberate and systematic collection of information or data to determine current and past health, mental health, wellness, strengths, functional status, and present and past coping pattern -Begin with obtaining a chief complaint -Can use direct or indirect questions
what is a positive experience of stress?
the development of successful coping skills