Test 2

Acute stress

an intense biopsychosocial reaction to a threatening event, is time limited (usually less than a month) but can occur repeatedly associated with the "fight-or-flight" response

Allostasis

The dynamic regulatory process that maintains homeostasis through a process of adaptation involving functions of the autonomic nervous system, the hypothalamic-pituitary-adrenal (HPA) axis, and the cardiovascular, metabolic, and immune systems respond to internal and external stimuli

Chronic Stress

an ongoing physiologic reaction to events resulting in "wear and tear" on the body and negatively impacts health and well-being. The adaptive physiologic changes that occur during acute stress become maladaptive when prolonged and contribute to the risk for illness

Mental Health Nursing Assessment

careful health history, current stressful event, and coping resources Physical assessment -Review of systems -Physical functioning-sleep, appetite, body weight -Pharmacological assessment-alocohol, tobacco, meds Psychosocial assessment -psychological assessment focuses on the person's emotions and their severity, as well as their coping strategies. The assessment elicits the person's appraisal of risks and benefits, the personal meaning of the situation, and the person's commitment to a particular outcome. The nurse can then understand how vulnerable the person is to stress

Social Networks

consists of linkages among a defined set of people with whom an individual has personal contacts. A social identity develops within this network Distinguishing a social network from social networking and social media is vital. Because social media has grown in popularity throughout the past two decades, there is controversial evidence about the relationship between social media usage and mental health outcomes One of the important functions of the social network is to provide social support in the form of positive interpersonal interactions as part of a dynamic process that is in constant flux and varies with life events and health status

Coping

deliberate, planned, and psychological effort to manage stressful demands. The coping process may inhibit or override the innate urge to act

Nonemotions

describe emotional reactions that are too ambiguous to fit into any of the preceding categories: confidence, awe, confusion, and excitement

Transactional stress model

describes the psychological experience of stress. This model views stress as an interactive process arising from real or perceived internal or external environmental demands that are appraised as threatening or benign The external environment includes physical aspects such as air quality, cleanliness of food and water, temperature, and noise and social aspects such as living arrangements and personal contacts

Holmes-Rahe Life Events Scale

evaluates the frequency and significance of life-changing events

Allostatic load and gender

high AL is more often associated with depression in Black men and White women than their corresponding counterpart

Is the situation below an example of problem or emotion focused coping? When noise from the television interrupts a student's studying and causes the student to be stressed, the student turns off the television and eliminates the noise.

problem

Stress

process arising from real or perceived internal or external environmental demands that are appraised as threatening or benign

Oscillation

process of confronting (loss-oriented coping) and avoiding (restoration-oriented coping) the stresses associated with bereavement

reapprasial

same as appraisal except that it happens after coping strategies are implemented, provides feedback about the outcomes and allows for continual adjustment and actions to new information

Borderline emotions

somewhat ambiguous: hope, compassion, empathy, sympathy, and contentment.

Appraisal

the individual perception that an event or situation is a threat. One situation may be perceived as threatening to one person but not to another process where potentially stressful events are evaluated for meaning and significance to individual well-being -two levels-primary and secondary

problem-focused coping

the person addresses the source of stress and solves the problem (eliminating it or changing its effects)

emotion focused coping

the person reduces the stress by reinterpreting the situation to change its meaning

Bereavement

the process of healing and learning how to cope with the loss. It begins immediately after the loss, and can last months or years. Individual differences, age, religious and cultural practices, and social support influence grief and bereavement

Debriefing

the reconstruction of the traumatic events by the victim

Allostatic load

wear and tear on a person's body and brain resulting from chronic stress

Anger

"a strong, uncomfortable emotional response to a provocation that is unwanted and incongruent with one's values, beliefs, or rights" -excessive outwardly directed anger is linked to coronary heart disease, metabolic syndrome, MI -Suppressed anger is related to arthritis, cancer, chronic pain, HTN

Type D personalities

(distressed) personalities experience a tendency toward negative emotions and pessimism. These individuals are more likely to be socially inhibited and are unlikely to show their emotions to others. Despite some overlap, the characteristics of type D personalities are different than depression and anxiety -mixed research support for an association between a type D personality and mental health disorders and poor physical health status -Emerging data suggest that type D personality is related to outcome severity of acute coronary syndrome and diabetes

Cultural myths about anger

-Anger is a knee-jerk reaction to external events. -Anger can be uncontrollable, resulting in crimes of passion such as "involuntary manslaughter." -Anger behavior in adulthood is determined by temperament and childhood experiences. -Men are angrier than women. -People must behave aggressively to get what they want.

Anger management criteria

-Candidates for psychoeducational anger management classes must have some insight that their behavior is problematic and some desire to enlarge their behavioral repertoire -Exclusion criteria are paranoia, organic disorders, and severe personality disorders

De-escalation

-De-escalating potential aggression is always preferable to challenging or provoking a patient. De-escalating (commonly known as "talking the person down") is a skill that every nurse can develop. Trying to clarify what has upset the patient is important although not all patients are capable of articulating what provoked them, as in cases where violent acting out has been triggered by delusions or hallucinations -The nurse who works with potentially aggressive patients should do so with respect and concern. The goal is to work with patients to find solutions, approaching these patients calmly and empathizing with the patient's perspective. Offering a simple apology to an agitated patient can circumvent a power struggle

Which personality Type is associated more with depression and difficult marital adjustment?

Type C

Which personality type is associated with cancer?

Type C

Which personality type is associated with mental health disorders and poor physical status?

Type D

Stress response males v. females

Whereas males are more likely to respond to stress with a fight-or-flight response, females have less aggressive responses; they "tend and befriend"

Psychological theories of aggression and violence: Social learning theory

-In Bandura social learning theory, Bandura focuses on the role of learning and rewards in the expression of aggression and violence -Children's observations of aggressive behaviors among family members and violence in their communities foster a context for learning that aggressive behavior is an acceptable way of getting what they want. -According to this view, people develop aggressive and violent behaviors by participating in an environment that rewards aggression, such as violent video games

The history of anger expression

-In Western culture, control of anger was the dominant stance from Greco-Roman times to the 20th century. Anger was viewed as sinful, dangerous, and destructive—an irrational emotion to be contained, controlled, and denied. This pejorative view contributed to the development of a powerful taboo against feeling and expressing anger. People who have accepted this persistent taboo may have difficulty even knowing when they are angry -In contrast to the denial or containment of angry emotion, some mental health care providers began to advocate the use of catharsis during the early 20th century, based on the animal research of ethologists and on Freud's conceptualization of "strangulated affect"; rather than holding in their anger, people were urged to "vent it," lest there be a dangerous "slush fund" of unexpressed anger building up in the body.

Biological theories for aggression and violence

-Patients with a history of damage to the cerebral cortex are more likely to exhibit increased impulsivity, decreased inhibition, and decreased judgment than are those who have not experienced such damage. -The interaction of neurocognitive impairment and social history of abuse or family violence increases the risk for violent behavior, particularly for boys -There is increasing evidence that activity of monoamine oxidase A is related to the development of impulsivity and aggression. Inhibition of this enzyme, which affects the activity of norepinephrine, serotonin, and dopamine, may play a significant role in the violence enacted by abused children, especially boys. -Low serotonin levels are also associated with irritability, increased pain sensitivity, impulsiveness, and aggression -Activation of the amygdala is correlated with higher anger scores in men but not in women. When provoked, men also have more activation in the orbitofrontal cortex, rectal gyrus, and anterior cingulate cortex than women. Activation of these areas is associated with aggression

Mental Health nursing assessment for grief

-Physical health-sleep difficulty, lack of appetite, weight loss -Cognition-assess for negative/maladaptive thoughts -Emotional and Behavioral responses-current mood and behavior, grooming, appearance, facial expression -Social Functioning and support

Phases of Disaster

-Prewarning of the disaster- preparing the community for possible evacuation of the environment, mobilization of resources, and review of community disaster plans. -The disaster event occurs- rescuers provide resources, assistance, and support as needed to preserve the biopsychosocial functioning and survival of the victims. -Recuperative effort-the focus is on implementing strategies for healing sick and injured people, preventing complications of health problems, repairing damages, and reconstructing the community

Cognitive-Behavioral Therapy for Anger

-The first step is establishing a therapeutic alliance because some angry individuals are not in a stage of readiness to change their behavior -involves avoidance of provoking stimuli, self-monitoring regarding cues of anger arousal, stimulus control, response disruption, and guided practice of more effective anger behaviors. -Relaxation or mindfulness training is often introduced early in the treatment because it strengthens the therapeutic alliance and convinces clients that they can indeed learn to calm themselves when angry

General Adaptation Syndrome

-The relationship between chronic stress and illness was identified many years ago with the introduction of the general adaptation syndrome -Hans Selye-study of stress -stress by positive emotions-eustress -stress by negative feelings-distress -corticosteroid increases during stress and causes illness

Primary appraisal

-a person evaluates the events occurring in their life as a threat, harm, or challenge -the person determines whether (1) the event is relevant, (2) the event is consistent with their values and beliefs, and (3) a personal commitment is present. Ex-In Box 19.2, Susan's commitment to the goal of doing well on the test was consistent with her valuing the content, which in turn motivated her to study regularly and prepare carefully for the examination. She believed that the test would be difficult. Joanne had a commitment to pass the test but did not value the content. Unlike Susan, Joanne believed that the test would be relatively easy because she expected the questions to be the same as those on the previous examination

Psychological theories of aggression and violence: Behavioral theories

-anger was viewed as a learned response to a stimulus rather than an instinctual drive -In the 1930s, the frustration-aggression hypothesis was advanced in which a person may experience anger and act violently in response to interference with or blocking of a goal. -Laboratory experiments and the reality of everyday experience have proved the limitations of this theory

Type A personalities

-competitive, aggressive, ambitious, impatient, alert, tense, and restless. -think, speak, and act at an accelerated pace and reflect an aggressive, hostile, and time-urgent style of living that is often associated with increased psychophysiological arousal

Type C personalities

-difficulty expressing emotion and are introverted, respectful, conforming, compliant, and eager to please and avoid conflict. They respond to stress with depression and hopelessness. This personality type was initially associated with the development of cancer, specifically breast cancer in women, presumably due to the changes that occur within endocrine and immune function -more likely that this personality type will experience more depression and difficult marital adjustment

Violence

-extreme aggression and involves the use of strong force or weapons to inflict bodily harm to another person and in some cases to kill -Violence connotes greater intensity and destruction than aggression. -All violence is aggressive, but not all aggression is violent.

Psychological theories of aggression and violence: General aggression model

-framework that accounts for the interaction of cognition, affect, and arousal during an aggressive episode -In this model, an episode consists of person and situation factors in an ongoing social interaction. The episode is mediated through a person's thoughts, feelings, and intensity of arousal. Within this context, the individual appraises the episode and then decides about a follow-up action. The outcome is either thoughtful or impulsive action. The person factors include characteristics such as gender, personality traits, beliefs and attitudes, values, goals, and behavior patterns. Situational factors include the actual provocation (insults, slights, verbal and physical aggression, interference with achieving goals) and cues that trigger memories of similar situations. Cognition includes hostile thoughts and scripts (previous behavior patterns and responses to similar episodes). Mood, emotion, and expressive motor responses (automatic reactions to specific emotions) represent the affect component. Arousal can be physiologic, psychological, or both

Aggression

-involves overt behavior intended to hurt, belittle, take revenge, or achieve domination and control -verbal or physical

Complicated Bereavement

-occurs in about 10% to 20% of bereaved persons -person is frozen or stuck in a state of chronic mourning which lasts for more than a month to 6 months after a loss-person may have trouble accepting the death, an inability to trust others since the death, excessive bitterness related to the death, and feeling that life is meaningless without the deceased person -Individuals who are more vulnerable for developing complicated bereavement are those who have experienced a sudden, unexpected loss, stigmatic loss, or death of a loved one after a long-term chronic illness

Dual Process Model

-offers a nonlinear explanation of how grieving persons and families come to terms with their loss over time -the person adjusts to the loss by oscillating between loss-oriented coping (preoccupation with the deceased) and restoration-oriented coping (preoccupation with stressful events as a result of the death including financial issues, new identity as a widow\[er\])

Uncomplicated Bereavement

-painful and disruptive, however, there is always movement -most people experience this type

Mental health nursing interventions

-self care -meds -counseling -social support

Secondary Appraisal

-the person determines if they possess the necessary coping mechanisms to overcome the event. -In the example, Susan was nervous but took the test. Joanne's secondary appraisal of the test-taking situation began with the realization that she might not pass the test because the questions were different. She acted impulsively by blaming the teacher for giving a different examination and storming out of the room. She clearly did not cope effectively with a difficult situation.

ABCs of psychological first aid

A (arousal)-intervention goal is to decrease excitement by providing safety, comfort, and consolation B (behavior)-When abnormal or irrational behavior is present, survivors should be assisted to function more effectively in the disaster C (cognition)-when cognitive disorientation occurs, reality testing and clear information should be provided

catharsis

A Freudian concept meaning release of feelings, as in the venting of anger

Diathesis

A genetic predisposition that increases susceptibility to developing a disorder

anger management

A psychoeducational intervention for persons whose anger behavior is dysfunctional in some way (i.e., interfering with success in work or relationships) but not violent

emotion-focused coping

A type of coping in which a person reduces stress by reinterpreting the situation to change its meaning

outwardly directed anger

Anger expression particularly the hostile, attacking forms

inwardly directed anger

Anger that is stifled despite strong arousal

Reappraisal

Appraisal after coping that provides feedback about the outcomes and allows for continual adjustment to new information

Review of Appraisal What is appraisal? What is primary appraisal? Describe 3 common questions associated with primary appraisal What is secondary appraisal?

Appraisal-the individual perception that an event or situation is a threat Primary appraisal-evaluate event as harm, challenge, or threat. Is it relevant? Is it consistent with values and beliefs? Am I committed to it? Secondary appraisal-Do I have the coping mechanisms to get through this?

Which answer corresponds to letter A (arousal) in the ABCs of psychological first aid? A. Survivors should be assisted to function more effectively in the disaster B. Goal is to decrease excitement by providing safety, comfort, and consolation C. Reality testing and clear information should be provided

B is correct. Goal is to decrease excitement by providing safety, comfort, and consolation A is Behavior C is Cognition

When is the best time to teach the patient techniques for managing anger and aggression? A. When the patient is experiencing a provoking event B. When the patient is not experiencing a provoking event

B. The best time to teach the patient techniques for managing anger and aggression is when the patient is not experiencing the provoking event. Cognitive therapy approaches are useful and can be prioritized according to responses.

Is the situation below an example of problem or emotion focused coping? A husband is adamantly opposed to visiting his wife's relatives because they keep dogs in their house. Even though the dogs are well cared for, their presence in the relative's home violates his need for an orderly, clean house and causes the husband sufficient stress that he copes with by refusing to visit. This becomes a source of marital conflict. One holiday, the husband is given a puppy and immediately becomes attached to the dog, who soon becomes a valued family member. The husband then begins to view his wife's relatives differently and willingly visits their house more often.

Emotion

Is the situation below an example of problem or emotion focused coping? A mother is afraid that her teenage daughter has been in an accident because she did not come home after a party. Then, the woman remembers that she gave her daughter permission to stay at a friend's house. She immediately feels better

Emotion

maladaptive anger

Excessive outwardly directed anger or suppressed anger; linked to psychiatric conditions, such as depression, as well as medical conditions

True or false: Age, gender, and race of patients are good predictors of aggression and violence

False

True or false: Patients who have psychiatric problems are more violent than other patients

False

Allostatic load and race

Health disparities found in lower socioeconomic groups, racial and ethnic minorities, and older adults may be partly explained by the chronic stress they tend to experience. These groups have been found to have elevated AL. AL has been found to differ by race, where Black Americans display greater levels than White Americans

Biologic responses to stress

Homeostasis Allostasis Acute stress Chronic Stress Allostatic load General Adaptation syndrome Diathesis model

case finding

Identifying people who are at risk for suicide to initiate proper treatment. Identification of depression and risk factors associated with suicide.

What happens to the immune system during chronic stress?

In chronic stress, the immune system is suppressed. Cortisol is primarily immunosuppressive and contributes to reduction in lymphocyte numbers and function (primarily T-lymphocyte and monocyte subsets) and natural killer activities Elevation of white blood cell counts and lower counts of T, B, and natural killer cells are found in those who face academic examinations, job strain, caregiving for a family member experiencing dementia, marital conflict, and daily stress

What happens to the immune system during acute stress?

Increased immune system responses causing reduced risk of infections

social network

Linkages among a defined set of people, among whom there are personal contacts

Emotion types

Negative emotions occur when there is a threat to, delay in, or thwarting of a goal or a conflict between goals: anger, fright, anxiety, guilt, shame, sadness, envy, jealousy, and disgust. Positive emotions occur when there is movement toward or attainment of a goal: happiness, pride, relief, and love. Borderline emotions are somewhat ambiguous: hope, compassion, empathy, sympathy, and contentment. Nonemotions describe emotional reactions that are too ambiguous to fit into any of the preceding categories: confidence, awe, confusion, and excitement

Is anger management effective in modifying violent behavior?

No Anger management is an effective intervention that nurses can deliver to persons whose anger behavior is maladaptive in some way (i.e., interfering with success in work or relationships) but not violent

Social Functioning

Performance of daily activities within the context of interpersonal relations and family and community roles.

stress response

Physiologic, behavioral, and cognitive reaction to an appraised threatening person-environment event

social support

Positive and harmonious interpersonal interactions that occur within social relationships.

Is the situation below an example of problem or emotion focused coping? An abused spouse is finally able to leave her husband because she realizes that the abuse will not stop even though he promises never to hit her again

Problem

Which personality type is competitive and have a time-urgent lifestyle?

Type A

Psychological theories of aggression and violence: Psychoanalytic theory

Psychoanalytic -emotions as instinctual drives -view suppression of these drives as unhealthy and possible contributors to the development of psychosomatic or psychological disorders -catharsis sometimes recommended -focus on issues such as improved control over outbursts, heightened empathy for others, and repair of deficits in the personality structure

Emotions

Psychophysiologic reaction that defines a person's mood and can be categorized as negative (anger, fright, anxiety guilt, shame, sadness, envy, jealousy, and disgust), positive (happiness, pride, relief, and love), borderline (hope, compassion, empathy, sympathy, and contentment), or nonemotions (confidence, awe, confusion, excitement)

Homeostasis

The body's tendency to resist physiologic change and hold bodily functions relatively consistent, well-coordinated, and usually stable. Introduced as a concept by Walter Cannon in the 1930s

Which personality type is more caring and relaxed?

Type B

Dealing with the violent patient

The violent individual may feel trapped, frightened, or desperate, perhaps at the end of their rope. The nurse must remember that many violent individuals have experienced childhood abandonment, physical brutality, or sexual abuse. Confinement that replicates earlier experiences of degrading treatment may provoke aggressive response, but humane care may kindle hope of recovery and rehabilitation

Restraints Medicare guidelines

These guidelines specify that a registered nurse must verify the need for restraint or seclusion and then contact the physician or other licensed practitioner; within 1 hour, that practitioner must examine the patient

Intermittent explosive disorder

This diagnosis is used when recurring aggressive outbursts cannot be attributed to any other condition. People with IED display aggressive behavior that is disproportionate to the precipitating event, usually a minor provocation by a family member or other close associate -usually occurs in teen years -Because the disorder involves inadequate production or functioning of serotonin, IED is commonly treated with selective serotonin reuptake inhibitors. However, behavior therapy should also be included. Very few people with IED ever choose to be treated for their anger

Spielberger State-Trait Anger Expression Inventory

This instrument measures the general temperamental proneness to be aroused to anger (trait anger) as well as current feelings (state anger) and several styles of anger expression, including anger-in, anger-out, and control through calming techniques

Psychosocial perspectives of stress

Transactional Stress model Appraisal Personality types Social network Social Support Cultural Factors and Ethnic Identity Employment factors Gender influences Life events

People and disasters

Women exhibit higher levels of distress than men after a disaster, especially pregnant women and older women Children are especially vulnerable to disasters and respond according to their ages and family experiences.

diathesis-stress model

a genetic predisposition that increases susceptibility of developing a disorder. This model describes how stress can trigger the development or exacerbation of an illness ex. childhood trauma causing illness

instrumental aggression

a goal-directed aggressive behavior that is premeditated and unrelated to immediate feelings of frustration or threat; it is a means to secure a goal or reward

Adaptation

a person's capacity to survive and flourish. Adaptation affects three important areas: health, psychological well-being, and social functioning.

Disaster

a sudden overwhelming catastrophic event that causes great damage and destruction that may involve mass casualties and human suffering requiring assistance from all available resources

traumatic grief

more difficult and prolonged grief. In traumatic grieving, external factors influence the reactions and potential long-term outcomes The external circumstances of death associated with traumatic grief include (1) suddenness and lack of anticipation; (2) violence, mutilation, and destruction; (3) degree of preventability or randomness of the death; (4) multiple deaths (bereavement overload); and (5) mourner's personal encounter with death involving a significant threat to personal survival or a massive and shocking confrontation with the death (or mutilation) of others

Type B personalities

more relaxed, easygoing, and easily satisfied. Type B personalities are less likely than Type A personalities to engage in risky health behaviors such as alcohol consumption and smoking. Type B personalities are also more likely to practice preventative care measures and wellness activities -accepting and relaxed. They are unlikely to experience a lack of time for commitments and are able to commit time for relaxation

Positive emotions

movement toward or attainment of a goal: happiness, pride, relief, and love.

Grief

natural, intense, physical, emotional, social, cognitive, or social reaction to the death of a loved one. Spontaneous expressions to loss can include sobbing, crying, anger, and expressions of guilt

Negative emotions

occur when there is a threat to, delay in, or thwarting of a goal or a conflict between goals: anger, fright, anxiety, guilt, shame, sadness, envy, jealousy, and disgust.

Acute grief

occurs immediately after the death of a loved one and normally evolves to a permanent state of integrated grief after a process of adaptation

impulsive aggression

occurs in situations of anger and anxiety when the individual lashes out

predeath grief

occurs prior to a death such as when a loved one has a terminal illness. The grief symptoms can be severe and are most likely to occur in caregivers of patients at the end of life, particularly dementia patients