Mental Health - Exam 1

Rights of patients

Clients receiving mental health care *retain all civil rights - except the right to leave the hospital in the case of involuntary commitment* 1. Can refuse treatment 2. Send and receive sealed mail 3. Have or refuse visitors Restrictions can be made for verifiable, documented reasons -Ex. suicidal patient may not be allowed to keep a belt, shoelaces, or scissors

Transitional care (2 components)

Patients are discharged to the community after long hospitalizations and receive intensive services to facilitate a smooth transition 2 components: 1. Peer support -Provided by consumers now living in the community 2. Bridging staff -Overlap between hospital and community care. -*Hospital staff do not terminate therapeutic relationship with client until a therapeutic relationship with the community care provider exists*

Mandatory outpatient treatment

Requirement that clients continue to participate in treatment on an involuntary basis after their release from the hospital into the community Ex. take prescribed meds, keep appts with HCPs for follow-up, attend specific Tx groups

DSM-5 3 purposes

Taxonomy published by American Psychiatric Association 1. Standardize nomenclature, language 2. Identify defining characteristics or symptoms 3. Assist in identifying underlying causes

Active military & veterans (11)

The prevalence of PTSD and major depression is greater than their civilian counterparts. Increased rates of: 1. Suicide 2. Homicide 3. Injury 4. Physical illness 5. Sleep disorders 6. Substance abuse 7. Marital and family dysfunction 8. Reluctance to seek treatment 9. Treatment may not be readily available 10. Stigmatizing 11. Sexual traumas widespread for both males and females

Groups & Group therapy

Therapist or leader and group of clients sharing common purpose Members contribute to group with expectations of benefiting from it.

Self-actualization

a person who has achieved all the needs of the hierarchy & has developed his or her fullest potential in life

Voluntary hospitalization

right to request discharge at any time -Released unless danger to self or others; if such danger present, then commitment proceedings instituted -Patients no longer dangerous discharged from hospital

Systemic desensitization

*can be used to help clients overcome irrational fears & anxiety associated with phobias.* The client is asked to make a list of situations involving the phobic object, from the least to the most anxiety provoking. Work on relaxation techniques to manage anxiety

Treatment modalities: community mental health treatment

*primary mode of treatment* 1. Clients continue to work and are able to stay connected with family, friends, and other support systems. 2. Personality or behavior patterns gradually develop; unable to be changed in a relatively short inpatient course of treatment 3. Peer counseling, advocacy, and mentoring are showing positive results.

One result of deinstitutionalizing is the:

*revolving door of repetitive hospital admission without adequate community follow-up* -mentally ill are often "boarded" in EDs while awaiting inpatient beds -Shorter hospital stays, decompensation, rehospitalization, dual diagnoses -Homelessness (42% estimated to have serious mental illness associated with substance abuse) -33% have associated physical illness comorbidities. -Lack of adequate community resources

Period of enlightenment (1790s)

-Creation of asylums; moral treatment -Dorothea Dix -Sigmund Freud: scientific study, treatment of mental illness

Inpatient hospital treatment

-Rapid assessment, stabilization of symptoms, discharge planning -Client-centered multidisciplinary approach to brief stay -Short inpatient stays -Long-stay clients: (severe, persistent mental illness requiring acute care services) -Case management: 1. Management of care on a case-by-case basis Usually social workers 2. Accessing needed medical and psychiatric services and performing ADLs -Discharge planning: 1. Based on the individual client's needs (transportation and housing, med management)

Existential theories overall belief & goal

-deviations occur when person is out of touch with self or environment Goal: to return person to authentic sense of self

General criteria for diagnosis of mental illness (5)

1. Dissatisfaction with characteristics, abilities, accomplishments 2. Ineffective or unsatisfying relationships 3. Dissatisfaction with one's place in the world 4. Ineffective coping with life events 5. Lack of personal growth

6 Barriers to successful community reintegration

1. Poverty 2. Homelessness 3. Substance use 4. Violence 5. Victimization, rape, trauma 6. Self-harm

Homeless mentally ill (5)

1. Spend more time in jail 2. Are homeless longer 3. Spend more time in shelters 4. Have less family contact 5. Face greater barriers to employment

Interpersonal theories: Sullivan's 3 developmental cognitive modes

1. protaxic mode- characteristic of infancy & childhood, involves *brief, unconnected experiences* that have no relationship to one another 2. parataxic mode- begins in early childhood as the child *begins to connect experiences in sequence.* 3. syntaxic mode- begins to appear in school-aged children & becomes more predominant in preadolescence, the person *begins to perceive himself or herself & the world* within the context of the environment & can analyze experiences in a variety of settings

Peplau's 6 roles of the nurse in the therapeutic relationship

1. stranger- offering client same acceptance & courtesy the nurse would to any stranger 2. resource person- providing specific answers to questions within a larger context 3. teacher- helping client learn formally & informally 4. leader- offering direction 5. surrogate- serving as a substitute for another such as a parent or sibling 6. counselor- promoting experiences leading to health for the client such as expression of feelings

A 44-year-old client is unable to function since her husband asked for a divorce 2 weeks ago. She is brought to the crisis intervention center by a friend. What type of crisis reflects this situation? A. social B. situational C. Maturational D. Developmental

B. situational

Community-based programs are preferable for treating many people with mental illness. True or false?

True Although there are flaws in the system, community-based programs have positive aspects that make them preferable for treating many people with mental illness.

Incidents of child molestation often are reveled years later when the victim is an adult. Which defense mechanism reflects this situation? a. Isolation b. Repression c. Regression d. Introjection

b. Repression

Historically, mental illness was viewed as

demonic possession, sin, or weakness, and people were punished accordingly

Behavior modification

method of attempting to strengthen a desired behavior or response by reinforcement, either positive or negative

6 Residential treatment settings

persons with mental illness may live in community residential treatment settings that vary according to structure, level of supervision, & services provided. 1. group homes: 6 to 10 residents under supervision of 1 or 2 staff persons 2. supervised apartments: staff members available for crisis intervention, transportation, assistance with daily tasks 3. board & care homes 4. assisted living 5. adult foster care 6. respite/crisis housing: for clients in need of short-term temporary shelter -Usually occurs when people feel overwhelmed or cannot cope with problems or emotions

Criminalization of mental illness

practice of arresting and prosecuting mentally ill offenders, even for misdemeanors, at a rate 4 times that of the general population in an effort to contain them in some type of institution where they might receive needed treatment.

Assertive community treatment (ACT) programs

provide many of the services that are necessary to stop the revolving door of repeated hospital admissions punctuated by unsuccessful attempts at community living

Hospital (inpatient) treatment 4 indications

*often last mode of treatment* 1. severe depression/suicidal; 2. severe psychosis; 3. alcohol or drug withdrawal 4. behaviors requiring close supervision in a safe, supportive environment

Pavlov: classical conditioning

-experiments with dogs -behavior can be changed through conditioning

ACCESS demonstration project (1994)

-initiated to assess whether more integrated systems of service delivery enhance the quality of life of homeless people with serious mental disabilities through the use of services & outreach. -provided outreach & intensive case mgmt to 100 homeless people with mental illnesses every year. -positive outcomes included: increased social support, less psychotic symptoms, & fewer days in hospital, & participants were intoxicated fewer days when they had a positive relationship with their case manager

B.F. Skinner: operant conditioning (6)

1. All behavior learned 2. Behavior with consequences (reward or punishment) 3. Recurrence of rewarded behavior 4. Positive reinforcement: increased frequency of behavior 5. Removal of negative reinforcers: increased frequency of behavior 6. Continuous reinforcement: fastest way to increase behavior; random intermittent reinforcement increases behavior more slowly but with a longer-lasting effect

5 Complementary & alternative therapies

1. Alternative medical systems (homeopathy, traditional Chinese medicine) 2. Mind-body interventions (meditation, art, music therapy) 3. Biologically based therapies (herbs, foods, vitamins) 4. Manipulative and body-based therapies (therapeutic massage, chiropractic manipulation) 5. Energy therapies (therapeutic touch, qi gong, pulsed fields, magnetic fields)

Freud conceptualized personality structure as having what 3 components?

1. Id- *innate desires* such as pleasure-seeking behavior, aggression, & sexual impulses *(ex: irrational, "this is what I want now")* 2. superego- *reflects moral & ethical concepts*, values, & parental & social expectations *(ex: mature, "I don't need that")* 3. ego- *balancing or mediating force between the id & superego.* Mature & adaptive behavior *(ex: mediator. "I will get that when I have the means. I do not need it right now.")*

3 factors influencing mental health can be categorized as:

1. individual (personal)- biologic makeup, autonomy & independence, self-esteem, emotional resilience, sense of belonging, reality orientation, coping or stress management 2. Interpersonal (relationship)- effective communication, ability to help others, intimacy, balance of separateness & connectedness 3. Social/cultural (environmental)- sense of community, access to adequate resources, intolerance of violence, support of diversity, positive yet realistic view of one's world

Least restrictive environment

1. Client's have the right to treatment in the least restrictive environment appropriate to meet needs -ex . client doesn't have to be hospitalized if they can be treated in an outpatient or group home setting 2. Free of restraint or seclusion unless necessary (Joint Commission- every 2 years) -Short term use of R & S is permitted only when the client is imminently aggressive and dangerous, and all other means of calming the client have been unsuccessful -*Only for the shortest time necessary* 3. Frequent contact by the nurse promotes ongoing assessment of the client's well-being and self-control -Face-to-face eval in 1 hour, every 8 hours (4 hrs for children) -Phys order every 4 hours (2 hrs for children) -Close supervision 4. Debriefing session is required within 24 hours

5 Factors for placement in criminal justice system

1. Deinstitutionalization 2. More rigid criteria for civil commitment 3. Lack of adequate community support 4. Economization of treatment for mental illness 5. Attitudes of police, society

Psychiatric rehabilitation & recovery programs (5)

1. Emphasis on recovery, going beyond symptom control and medication management 2. includes personal growth 3. Reintegration into community 4. Empowerment, increased independence 5. Improved quality of life

Involuntary hospitalization (3)

1. If clients pose a threat to themselves or others, they can be hospitalized against their wishes 2. They are committed to a facility for psych care until they no longer pose danger to themselves or anyone else 3. A person can be detained for 48 to 72 hours on an emergency basis until a hearing can be conducted -laws determined by each state

Community-based care (5)

1. Lack of appropriate number of community mental health centers to provide services 2. Development of community support programs 3. Availability, quality of services highly variable 4. Inaccurate anticipation of extent of people's needs 5. Despite flaws, positive aspects make them *preferable for treatment*

Conservatorship and guardianship

1. Legal guardianship is separate from civil commitment for hospitalization -Gravely disabled -Cannot provide for self -Incompetent -Cannot act in one's best interests 2. client loses rights -nurse must obtain consent from guardian

Mental illness & the 21st century (6)

1. More than 18.6% of Americans aged 18 years and older have diagnosable mental disorder. 20.7 million have a substance use disorder, and 8.4 million of this population have a dual diagnosis. 2. 15 million adults and 4 million children and adolescents with impaired daily activities 3. *Economic burden exceeds that of all types of cancer* 4. *Leading cause of disability in the U.S & Canada for those 15 to 44 years of age* 5. *Increasing number of both adults and children/adolescents are being treated for mental illness*; yet only 1 in 4 adults and 1 in 5 children are treated. 6. Treatment still lagging in homeless and those with substance abuse problems

Groups & group therapy results

1. New information or learning, inspiration or hope 2. Interaction with others 3. Feelings of acceptance, belonging 4. Awareness of not being alone; others share same problems 5. Insight into problems, behaviors, and effects on others 6. Altruism

Rehab 3 Self-awareness issues

1. No one theory or treatment approach is effective for all patients. 2. Using a variety of psychosocial approaches increases nurse's effectiveness. 3. Patient's feelings, perceptions most influential in determining his or her response

Assertive community treatment (ACT) (4)

1. One of the most effective approaches 2. Problem-solving orientation: no problem is too small 3. Direct provision of service 4. Services provided as long as needed

Interdisciplinary team (8)

1. Pharmacist- involved when meds, management of side effects, & interactions with meds are complex 2. Psychiatrist- diagnosis of mental disorders & prescription of medical treatments 3. Psychologist- practice therapy, conduct research, & interpret tests. may also participate in design of therapy programs for groups of individuals 4. Psychiatric nurse- foundation in health promotion, illness prevention, & rehab. also evaluates the effectiveness of medical treatment 5. Psychiatric social worker- may practice therapy & work with families, community support, & referral. 6. Occupational therapist- focuses on functional abilities of client & ways to improve functioning 7. Recreation therapist- helps client achieve balance of work & play & provides activities that promote constructive use of leisure time 8. Vocational rehabilitation specialist- determining clients interests & abilities & matching them with vocational choices. clients are assisted in job-seeking & job-retention skills as well as further education

Cultural considerations: major psychosocial theorists were (4)

1. White 2. Born in Europe or United States 3. Seldom treated outside their cultural populations 4. Assumptions of normal or typical may not apply equally well to different racial, ethnic, or cultural backgrounds.

9 Higher-level goals of later stages of recovery

1. accepting illness 2. gaining control over symptoms 3. self-love 4. optimism 5. doing things for pleasure 6. contributing through meaningful activity 7. having a diversity of friendships 8. being needed and valued by others 9. coming to terms with family relationships

DSM-5 allows the practitioner to identify all the factors that relate to a person's condition: (3)

1. all major psychiatric disorders 2. medical conditions that are potentially relevant to understanding or managing the person's mental disorder 3. psychosocial & environmental problems that may affect the diagnosis, treatment, & prognosis of mental disorders

4 Stages of group development

1. Pregroup stage: members of group selected, purpose of group identified, group structure is addressed 2. Beginning or initial stage: when the group begins to meet. Members determine their level of comfort in the group by discussing rules and expectations 3. Working stage: members focus their attention on the task the group is trying to accomplish 4. Termination: final stage, before the group disbands its work is reviewed. There is a focus on the group's accomplishments

Psychosocial Nursing in Public Health and Home Care: primary, secondary & tertiary prevention

1. Primary prevention: stress management education 2. Secondary prevention: early identification of mental health problems 3. Tertiary prevention: monitoring, coordinating psychiatric rehabilitation services

Patient's bill of rights (11)

1. be informed about benefits, qualifications of all providers, available tx options, appeals & grievance procedures 2. least restrictive environment to meet need 3. confidentiality 4. choice of providers 5. tx determined by professionals, not 3rd party payers 6. parity 7. nondiscrimination 8. all benefits within scope of benefit plan 9. tx that affords greatest protection & benefit 10. fair and valid tx processes 11. treating professionals and payers held accountable for any injury caused by gross incompetence, negligence, or clinically unjustified decisions

PHP 8 broad categories of goals

1. Stabilizing psychiatric symptoms 2. Monitoring drug effectiveness 3. Stabilizing living environment 4. Improving activities of daily living 5. Learning to structure time 6. Developing social skills 7. Obtaining meaningful work, paid employment, or a volunteer position 8. providing follow up of any health concerns

Freud believed that the human personality functions at what 3 levels of awareness?

1. conscious- perceptions, thoughts, & emotions that *exist in the person's awareness* 2. preconscious- thoughts & emotions *not currently in person's awareness, but he or she will recall them* with some effort 3. unconscious- realm of thoughts & feelings that motivates a person even though *he or she is unaware of them*

Interpersonal theories: Sullivan's 5 life stages

1. infancy- birth to onset of language. prototaxic mode dominates (no relation between experiences) 2. childhood- language to 5 yrs. parents are source of praise & acceptance. shift to parataxic: experiences connected 3. juvenile- 5 to 8 yrs. shift to syntaxic (thinking about self) 4. preadolescence- 8 to 12. move to intimacy. major shift to syntaxic occurs 5. adolescence- puberty to adulthood. lust added; lead to consolidation of self-esteem or self-ridicule

3 categories of crises

1. maturational (developmental)- predictable events in the normal course of life, such as leaving home, getting married, having a baby, & beginning a career 2. situational- unanticipated or sudden events that threaten the individuals integrity, such as death of a loved one, loss of a job, & physical or emotional illness in the individual or family member 3. adventitious (social)- natural disasters like floods, earthquakes, or hurricanes; war, terrorist attacks; riots; and violent crimes such as rape or murder

11 Components of ACT program

1. multidisciplinary team 2. identifying fixed point of responsibility 3. elimination of debilitating symptoms 4. improve function in adult social & employment roles/activities 5. decrease family burden of care 6. implement ongoing individualized treatment 7. promote mental health through multiple resources 8. emphasize independence 9. use team meetings to strategize care 10. provide 24/7 care including respite & crisis intervention 11. measure outcomes in a vast number of aspects (independence, satisfaction, functioning, costs, etc)

5 types of groups

1. open: ongoing & run indefinitely, allowing members to join or leave the group as they need to 2. closed: structured to keep the same members in the group for a specific number of sessions 3. education group: goal is to provide info to members on a specific issue 4. support groups: organized to help members who share a common problem to cope with it 5. self help groups: members share a common experience, but the group is not a formal or structured therapy group

Peplau's therapeutic nurse-patient relationship 4 phases

1. orientation phase- directed by the nurse & involves engaging the client in treatment, providing explanations & information, & answering questions 2. identification phase- begins when the client works interdependently with the nurse, expresses feelings, & begins to feel stronger 3. exploitation phase- the client makes full use of the services offered 4. resolution phase- the client no longer needs professional services & gives up dependent behavior. The relationship ends

Positive vs negative reinforcement

1. positive: giving the client attention & positive feedback 2. negative: involves removing a stimulus immediately after a behavior occurs so that the behavior is more likely to occur again

Erikson's 8 stages of psychosocial development

1. trust vs mistrust (infant): hope. viewing world as safe & reliable; relationships nurturing 2. autonomy vs shame & doubt (toddler): will. achieving sense of control 3. initiative vs guilt (preschool): purpose. development of conscience; learning to manage conflict & anxiety 4. industry vs inferiority (school age): competence. confidence in abilities; pleasure in accomplishments 5. identity vs role confusion (adolescence): fidelity. sense of self & belonging 6. intimacy vs isolation (young adult): love. forming relationships & attachment 7. generativity vs stagnation (middle adult): care. creative & productive; establish next generation 8. ego integrity vs despair (maturity): wisdom. accepting responsibility

The shift from institutional care to care in the community began in the

1960's, allowing many people to leave institutions for the first time in years Community mental health movement -Deinstitutionalization -Legislation for disability income -Changes in commitment laws

Which statement best describes the practice of psychiatric nursing? 1. Helps people with present or potential mental health 2. Ensures clients' legal and ethical rights by being a client advocate 3. Focuses interpersonal skills on people with physical or emotional problems 4. Acts in a therapeutic way with people who are diagnosed with having a mental disorder.

3. Focuses interpersonal skills on people with physical or emotional problems

The rate of mental illness among the incarcerated is ____ times higher than the general population.

5

Which statement best reflects the current state of mental health and mental illness? A. Mental health-care costs exceed the costs for cancer care. B. Most adults and children receive adequate mental health care. C. Community resources for the homeless with mental illness are adequate. D. Deinstitutionalization has reduced the revolving-door effect.

A. Mental health-care costs exceed the costs for cancer care. Rationale: The economic burden of mental illness exceeds that for all types of cancer care. Only 1 in 4 adults and 1 in 5 children receive the necessary mental health care. Community resources for homeless clients with mental illness are inadequate. Deinstitutionalization has led to the "revolving-door" effect.

Psychoanalytic theory was developed by who?

Sigmund Freud

What is a primary technique used in psychoanalysis?

Dream analysis -Freud believed a person's dreams reflect his or her *subconscious* -involves discussing a client's dreams to discover their true meaning & significance

Crisis intervention duration, outcome, & 2 techniques

Duration: usually 4 to 6 weeks Outcome: resolution to functioning at precrisis level, higher level, or lower level Techniques: 1. Directive interventions: assess health status, promote problem solving 2. Supportive interventions: deal with person's needs for empathetic understanding

Group roles

Growth producing: information seeker, opinion seeker, information giver, energizer, coordinator, harmonizer, encourager, elaborator Growth inhibiting: monopolizer, aggressor, dominator, critic, recognition seeker, passive follower

Deinstitutionalization

Decrease in admission to hospitals and the development of community-based services as an alternative

The definition of mental health is standardized and universally accepted. True or false?

False There is no single universal definition of mental health, which has many components and is influenced by myriad factors.

Board and care homes are an example of a partial hospitalization program. True or false?

False. A board and care home is an example of a residential treatment setting. *A day treatment program is an example of a partial hospitalization program.*

Mental health patients who are hospitalized voluntarily give up their right to leave the hospital. True or false?

False. Rationale: Mental health patients who are hospitalized voluntarily retain all the civil rights afforded to any person, including the right to leave the hospital. However, patients hospitalized involuntarily give up this right.

Group leadership

Formal leader usually for therapy groups and education groups; informal leader usually for support groups and self-help groups Focus on group process, group content to be effective

Self-help groups tend to have an informal or no definitive leader. True or false?

True Rationale: *Support groups and self-help groups tend to have an informal leader or no leader at all.* Therapy and education groups typically have a formal leader.

Mental health & mental illness

Mental health: -Difficult to define; no single, universal definition -Dynamic, ever-changing state Mental illness: -Includes disorders that affect: 1. Mood 2. Behavior 3. Thinking These often indicate signs of distress and/or impaired functioning

Providing a safe environment for patients with impaired cognition, planning unit activities to stimulate thinking, and including patients and staff in unit meetings are all part of: a. Milieu therapy b. Cognitive -behavior therapy c. Behavior therapy d. Interpersonal therapy

a. Milieu therapy

Psychoanalytic theory supports the notion that:

all human behavior is *caused & can be explained* focuses on *discovering the causes of the client's unconscious & repressed thoughts, feelings, & conflicts* believed to cause the client anxiety & on helping the client to gain insight into & resolve these conflicts & anxieties

Psychiatric nursing practice: basic (7) & advanced-level functions (4)

basic: 1. Counseling 2. Milieu therapy 3. Self-care activities 4. Psychobiologic interventions 5. Health teaching 6. Case management 7. Health promotion, maintenance advanced: 1. Psychotherapy 2. Prescriptive authority for drugs 3. Consultation, liaison 4. Evaluation

In response to a question posed during group meeting, the nurse explains that the superego is that part of the self that says: a. "I like what I want." b. " I want what I want." c. "I should not want that." d. "I can wait for what I want."

c. "I should not want that."

The premise that an individual's behavior and affect are largely determined by his or her attitudes and assumptions about the world underlines: a. Modeling b. Milieu therapy c. Cognitive behavioral therapy d. Interpersonal psychotherapy

c. Cognitive behavioral therapy

Carl Rogers was a humanistic psychologist who developed a new method of _______

client-centered therapy the *therapist plays a supportive role, demonstrating unconditional positive regard (nonjudgmental caring)*, genuineness, & empathetic understanding to the client

Clubhouse model

community based rehab in NYC. The essence of membership in the clubhouse is based on the 4 guaranteed rights of members: 1. a place to come to 2. meaningful work 3. meaningful relationships 4. a place to return to (lifetime memberships) *focus on health, not illness*

Crisis intervention: 4 stages of crisis

crisis- turning point in an individuals life that produces an overwhelming emotional response 4 stages: 1. Exposure to stressor, experiences anxiety & tries to cope 2. Increased anxiety when usual coping ineffective 3. Increased efforts to cope, including new methods 4. When coping attempts fail, disequilibrium & significant distress

Individual psychotherapy

method of *bringing about change in a person* by exploring his or her feelings, attitudes, thinking, & behavior One-to-one relationship between the therapist and the patient: -Progression through stages -Relationship as key to success Therapist's theoretical beliefs strongly influence style of therapy

Partial hospitalization programs (PHPs)

day treatment programs: clients return home at night; evening programs are just the reverse Services vary but usually include: 1. Groups for building communication, social skills 2. Solving problems 3. Monitoring medications 4. Learning coping Each client has an individualized treatment plan and goals

A significant advancement in treating persons with mental illness was the

development of psychotropic drugs in the early 1950's

Token economy

ex. there is a chart for desired behaviors, and if they are performed then client receives a token. Tokens can be redeemed for prizes

Humanism

focuses on a person's positive qualities, his or her capacity to change (human potential), & the promotion of self esteem

Another method used to gain access to subconscious thoughts & feelings is:

free association, in which the therapist tries to uncover the client's true thoughts & feelings by *saying a word & asking the client to respond quickly with the first thing that comes to mind*

Projects for Assistance in Transition from Homelessness (PATH) program

funds community-based outreach, mental health, substance abuse, case mgmt, & other support services. some limited housing services are available, but *PATH works primarily with existing housing services in the given community*

Evolving consumer household

group-living situation in which the residents make the transition from a traditional group home to *a residence where they fulfill their own responsibilities & function without on-site supervision from paid staff.* -Because it is a permanent living situation, this eliminates the issue of lack of independence due to constant relocation

Abraham Maslow developed a _______ stating that people are motivated by progressive levels of needs

hierarchy of needs each level must be satisfied before the person can progress to the next level. The levels begin with physiological needs (food, water) & then proceed to safety & security needs, belonging needs, esteem needs, & finally self actualization needs

Ego 7 defense mechanisms

methods of attempting to protect the self & cope with basic drives or emotionally painful thoughts, feelings, or events. 1. denial: failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue ex: diabetic eating chocolate candy 2. identification: modeling actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or occupational goal ex: student becoming an ICU nurse bc its the specialty of an instructor they admire 3. projection: unconscious blaming of unacceptable inclinations or thoughts on an external object. -Ex. Man with many prejudices identifies others as bigots 4. Rationalization: excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect. -Ex: student blames failure on teacher being mean 5. Dissociation: dealing with emotional conflict by a temporary alteration in consciousness or identity. -Ex: adult remembers nothing of childhood sexual abuse 6. regression: moving back to previous developmental stage to feel safe ex: 5 yo asks for bottle when new baby brother is being fed 7. repression: excluding emotionally painful or anxiety provoking thoughts from conscious awareness ex: woman has no memory before age 7, when she was removed from abusive parents

Psychosocial interventions

nursing activities that enhance the client's social & psychological functioning & improve social skills, interpersonal relationships, & communication -skills used in mental health, other practice areas

Behaviorism focuses on the clients ______

observable performance & behaviors & external influences that can bring about *behavior changes rather than focusing on feelings & thoughts*

Milieu therapy (3)

originally developed by Sullivan, involved clients' interactions with one another, including: 1. Practicing interpersonal relationship skills 2. Giving one another feedback about behavior 3. Working cooperatively as a group to solve problems

Psychiatric rehabilitation

services to people with severe & persistent mental illness to *help them to live in the community* -focus on patient's strengths -Activities involving medication management, transportation, shopping, food preparation, hygiene, finances, social support, vocational referral

Freud believed that human behavior is motivated by repressed _____ & ______ & that childhood development is based on ____ as the driving force.

sexual impulses & desires sexual energy (libido)

Erik Erikson's theories focused on both ____ & _____ developments across the life span

social & psychosocial he proposed 8 stages of psychosocial development; each stage includes a developmental task & a virtue to be achieved

Cognitive therapy

used by existential therapists focuses on immediate thought processing- *how a person perceives or interprets his or her experience & determines how he or she behaves*