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