.. Flashcards
Refers to the ability to recognize the nature of one’s own behavior, attitude, and emotions.
Self Awareness
It can be an effective tool when interacting with clients who are exhibiting anxiety, depression, confusion, or psychosis.
Self Awareness
Outgoing person who relates more easily to people and things in the environment.
Extrovert
Likes to take charge of situations.
Extrovert
Has little difficulty in socializing.
Extrovert
Quiet individual who relates better to the inner world of ideas, thoughts, and feelings.
Introvert
Prefer to be a follower, and usually lets others initiate and direct interaction.
Introvert
Open-minded Attitude
Do not make decisions until they are aware of all facts pertaining to a certain situation.
Are often inflexible.
Judgemental Attitude
Run the risk of neglecting the perception of others.
Judgemental Attitude
Arriving at an opinion based on their own values without enough facts or enough regards for what other people may feel or think.
Judgemental Attitude
Encounter patients with mental and emotional problems.
Psychiatric Nursing
To provide effective care for any patient, you must consider both ______ and _____ aspects of health.
psychological and physiological
Pioneer in stress research
Hans Selye
Found a link between the environment and biological response
Hans Selye
Noted that emotional and physical stress because a pattern of response that unless treated, leads to infection, illness, disease and eventually death.
Hans Selye
This set of response is called?
General adaptation syndrome
What are the three stages?
- Alarm reaction
- Resistance
- Exhaustion
During this stage, any type of physical or mental trauma triggers immediate biological responses designed to counteract stress.
Alarm stage
Begins when the body starts to adapt to prolonged stress.
Resistance
With chronic stress, adoptive mechanisms eventually wear down, and the body can no longer meet the demands of stress.
Exhaustion
Some researchers attribute today’s seemingly increased incidence of mental and emotional disorders to social changes that have altered the traditional family structure and contributed to loss of the extended family.
Social Factor
APADSMMDFETR
American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, Fourth Education, Text Revision
Give at least one of the following criteria of American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, Fourth Education, Text Revision
Current distress ( a painful symptom)
Disability ( an impairment in one or more important areas of functioning)
A significantly greater risk of suffering, death pain, and disability.
An important loss of freedom.
What are the 5 axes?
Axis I – Clinical Disorders
Axis II – Personality Disorders and Mental Retardation
Axis III – General Medical Condition
Axis IV – Psychosocial and Environmental Problems
Axis V – Global Assessment of Functioning (GAF)
Personality disorders and traits as well as mental retardation.
Axis II – Personality Disorders and Mental Retardation
Example: Obsessive Compulsive Personality
Mental disorders comparable to general medical illness
Axis I – Clinical Disorders
Example: adjustment disorder with anxious mood
General medical illness or injury.
Axis III – General Medical Condition
Example: Crohn’s disease, acute bleeding episodes
Life events or problems that may affect diagnosis of mental disorder.
Axis IV – Psychosocial and Environmental Problems
Example: recent remarriage, death of father
Level of functioning reported as a number from 0-100 base on the patient’s over all psychological, social, and occupational function.
Axis V – Global Assessment of Functioning (GAF)
Example: GAF – 83
Roles of a psychiatric nurse?
- Clinical competence
- Patient- family advocacy
- Legal ethical parameter
- Social accountability
- Interdisciplinary collaboration
- Fiscal responsibility
Continuum of Care
- Inpatient
- Partial
- Residential
- Home
- Outpatient
The Versatile Nurse Roles
Staff Nurse
Primary Care provider
Administrator
Consultant
In-service educator
Clinical fractioned
Researcher
Program evaluator
Liaison between the patient and other health care team member
The nurse collects patient health data.
Standard I: Assessment
The nurse analyzes assessment data to determine applicable diagnosis.
Standard II: Diagnosis
The nurse identifies expected outcomes individualized for the patient.
Standard III: Outcome Identification
The nurse develops a care plan that’s negotiated among the patient, nurse, family and significant others, and health care team – the plan prescribes evidence – based interventions to attain expected outcomes.
Standard IV: Planning
The nurse implements the interventions identified in the care plan.
Standard V: Implementation
Uses counselling interventions to assist patients in improving or regaining their previous coping abilities, fostering mental health, and preventing mental illness and disability.
Standard V a: Counselling
The nurse provides, structures, and maintains a therapeutic environment in collaboration with the patient and other health care provider.
Standard V b: Milien therapy
The nurse structures interventions around the patient’s activities of daily living to faster self-care and mental and physical well-being.
Standard V c: Promotion of self–care abilities
Applies skills to restore the patient’s health and prevent further injury.
Standard V d: Psychobiological Intervention
Through health teaching, the nurse assists patients in achieving satisfying, productive and healthy patterns of living.
Standard V e: Health Teaching
The nurse provides case management to coordinate comprehensive health services and ensure continuity of care.
Standard V f: Case Management
The nurse uses strategies and interventions to promote and maintain mental health and prevent mental illness.
Standard V g: Health promotion and health maintenance
The nurse evaluates the patient’s progress in obtaining expected outcomes.
Standard VI: Evaluation
Who performed Advance Practice Intervention?
Advanced Practice Registered Nurse in psychiatric and Mental Health (APRN-PMH) specialist.
The ARRN-PMH uses individual, group, and family psychotherapy and other treatment to assist patients in preventing mental illness and disability, treating mental health status and functional abilities.
Standard V h: Psychotherapy
The APRN-PMH uses prescriptive authority procedure, and treatment in accordance with state and federal laws and regulations to treat symptoms of psychiatric illness and improve functional health status.
Standard V i: Prescriptive authority and treatment
The APRN-PMH provides consultation to enhance the abilities of other clinicians, provides service for patients, and affect change in the system.
Standard V j: Consultation
Freud’s addresses the relationship among inner experiences, behaviour, social roles, and functioning.
Psychoanalytical Theory
Proposes that conflicts among unconscious motivating forces affect behaviour.
Psychoanalytical Theory
Defense mechanism is called?
Repression
Freud, viewed humankind as stimulus driven
Drives
The two Primary Drives
Eros & Thanatos
Represents psychological energy or “libido”
The id
Is primarily a sexual and aggressive drive.
The id
Is the first structure to develop in the personality
The id
It operates on the pleasure principle to reduce tension.
The id
Characterized by primary process thinking-imaginary
The id
It is irrational and not based on reality
The id
Under the unconscious control.
The id
The chief executive officer of the mind.
The ego
Mediates between the id and the super ego.
The ego
Maintains reality orientation
The ego
Keeps the strong forces of the super ego from being extremely inhibitive.
The ego
Keeps the strong forces of the id from causing the person overly exhibitionistic.
The ego
Operates on reality principle.
The ego
Characterized by secondary process thinking.
The ego
Provides a means of delaying gratification of needs.
The ego
Under the conscious control.
The ego
Functions as reward or punishment
The super ego
Rewards moral behaviour
The super ego
Punishes actions that are not acceptable by creating guilt.
The super ego
Is also known as conscience
The super ego
A residue of internalized values and moral training of early childhood.
The super ego
Unconscious control
The super ego
An overly strict super ego may lead to extremes of guilt and anxiety
The super ego
Adult character traits, behaviours, and thinking process are a result of crucial events in the development years.
Psychosexual Theory of Development
Stimulation of the mouth is the primary source of satisfaction.
Oral Stage: (birth 18-months)
Sexual gratification shifts to the anus
Anal Stage: (18months-3 years of age)
Psychosexual Theory of Development
Oral Stage: (birth 18-months)
Anal Stage: (18months-3 years of age)
Phallic (3-5 years)
Latency (6-12 years)
Puberty and Adolescence (12-15 years)
Genital (15 years – adult)
Believed that a person’s social view of self is more important than libidinal urges.
Erik Erikson: Eight Stages of Ego Development
Eight Stages of Ego Development
Stage I: Orally-Sensory (birth- 1 year) Infancy
Stage II: Muscular-Anal (1-3 years) Early Childhood
Stage III: Locomotors-genital (3-5 years) Late Childhood
Stage IV: Latency (6-11 years) School age
Stage V: Adolescence (12-18 years)
Stage VI: Young Adulthood (19-35 years)
Stage VII: Adulthood (35-50 years)
Stage VIII: Maturity (50 + years) Old Age
From his study of international myths, arts and folklore, he discovered repeated images that he called “archetypes”.
Carl Jung (1967)
“a powerful archetype” which is a public personality, the aspect of a self that one’s reveals to others. The role that society expects one to play.
Persona
Contains the opposite of what we feel ourselves to be.
Shadow Archetype
Recognizes that humans are psychologically bisexual, that is “masculine” and “feminine” qualities are found in both sexes.
Shadow Archetype
Reflects the prehistoric fear of wild animals and represents the animal side of human nature.
Shadow Archetype
feminine archetype in men.
Anima
masculine archetype in women.
Animus
The Two Basic Personality Orientations
Introversion & Extroversion
The inward, cautions, shy, timid and reflective.
Introversion
The outgoing, sociable, assertive and energetic.
Extroversion
Emphasizes the importance of social forces or what one does in relation to others than internal or biological factors.
INTERPERSONAL SOCIAL THEORY
Believed that one’s social environment shape personality and interactions and that people actively guide their own growth and development.
Alfred Adler
Emphasizing the conscious as the core of personality.
Alfred Adler
Proposed that inferiority feelings are stimulates for growth.
Alfred Adler
exaggeration of feelings of inadequacy and insecurity resulting in defensive and neurotic behaviour.
Inferiority complex
3 Categories of Problems in a Person’s Life Time
- Problems involving behaviour toward others
- Problems of occupation
3.Problems of love
4 Basic Styles in Working through Problems
- Avoiding
- Expecting to get anything from others
- Dominating others
- Cooperating with others
Cultural environment greatly shapes personality and that personality development does not end at 5 of age but continues until young adulthood.
Harry Stack Sullivan (1940)
Emphasized in the development of the self-concept which be called personification.
Harry Stack Sullivan (1940)
The persona is what one talking about when one refers to “I or me”. This starts to develop from?
infancy
The persona, or self- concept begins with the idea of ?
“good me”, “bad me”, and “not me”.
Perceived when the mother is rewarding the infant.
good me
arises in response to the negative experiences with the mother.
bad me
arises out of extreme anxiety that the child rejects as part of the self.
not me
Sullivan’s Stages of Healthy Interpersonal Development from Birth to Maturity
Infancy
Childhood
Juvenile
Preadolescence
Early adolescence
Late adolescence
Experiences maternal tenderness and intuits maternal anxieties, struggles to achieve feelings of security and to avoid anxiety.
Infancy
Modifies actions to suit social demands in sex-role training, peer play and family events. Uses movement and language to avoid anxiety.
Childhood
Learns to accept subordinate to authority figures outside the family. More concepts of self-status and role.
Juvenile
Capable of participating in genuine love relationship with others.
Preadolescence
Develops consideration and concerns outside the self.
Preadolescence
Heterosexual contacts enter into personal relationship.
Early adolescence
Attempts to integrate sex with other personal relationship.
Early adolescence
Masters expression of sexual impulses. Forms satisfying and responsible associations. Uses communication skills to protect self from conflicts with others.
Late adolescence
Believed that people are dependent on each other.
Karen Horney (1937)
3 Ways People Relate with each other
- Move toward others – seeking love support and cooperation.
- Move away from others – to be independent, self-sufficient.
- Against each other’s – to be competitive, critical and domineering.
The person’s perceptions and interpretations influence subsequent biological and behavioural responses.
COGNITIVE THEORIES
Emphasizes the mental processes involved in knowing.
Aaron Beck (1991)
Beck’s six common cognitive distortions that result in maladoptive behaviours
Arbitrary interference
Selective abstraction
Overgeneralization
Magnification and Minimization
Personalization
Absolutist (dichotomous) thinking
The process of drawing a specific conclusion in the absence of evidence to support the conclusion: the evidence may be contrary to the conclusion.
Arbitrary interference
- Focusing on a detail taken out of context, ignoring more salient features of the situation, and conceptualizing the whole experience on the one detail.
Selective abstraction
The pattern of drawing a general rule or conclusion from one or more isolated incidents and applying the concepts across the board to related and unrelated situation.
Overgeneralization
Errors in evaluating the significance or magnitude of an event that is as gross as to constitute a distortion.
Magnification and Minimization
The productivity to relate external events to oneself when there is no basis for making such a connection.
Personalization
Places all experiences in one of two opposite categories, e.g. saint or sinner, flawless or defective. In describing himself, the patient selects the extreme negative categorization.
Absolutist (dichotomous) thinking
Proposed a sequence of cognitive development that emphasized the relationship between action and thought.
Jean Piaget (1958)
Stages that are characterized by distinctive features in the pattern of a person’s reasoning
First Stage – sensor motor
Second Stage – preoperational stage (2-7 years)
Third stage (5-6 years)
Characteristic of child’s thinking from birth to about 2 years of age.
First Stage – sensor motor
The young infant appears to think that the only object that exist are the objects that can be seen.
First Stage – sensor motor
Moves through three periods
Second Stage – preoperational stage (2-7 years)
The rigid and irreversible intellectual structures begin to become more flexible, and children begin the transition of the 3rd stage of through.
Third stage (5-6 years)
All behaviours are a reflection of brain function and all thought processes represents a range of functions mediated by nerve cells in the brain.
NEUROBIOLOGICAL THEORIES
Is primarily responsible for fine motor movement, sensory integration, cognition, memory, and emotional behaviour.
Dopamine (DA)
Is the precursor of adrenaline, the main ingredient in the sympathetic “fight or flight” response.
Norepinephrine (NE)
Secreted in the raphe nuclei and hypothalamus.
Serotonin
They modulate wakefulness and alertness.
Serotonin
Influence the transmission of sensory pain.
Serotonin
Controls the temperature, sleep, hunger.
Serotonin
Is an inhibitory neurotransmitter that serves as the brain’s modulator
Gamma – amino butyric acid (GABA)
main excitory neurotransmitter
Glutamate
Needs motivates the behavior of a person
HUMAN NEEDS THEORY
Are considered protective barriers used to manage instinct and affect in stressful situations.
Ego Defense Mechanism
unconscious use of a specific behaviour to make up for a real or imagined in ability or deficiency, thus maintaining self-respect or self-esteem.
Compensation
unconscious expression of a mental conflict as a physical symptom to relieve tension or anxiety.
Conversion
unconscious refusal to face thoughts feeling, wishes, needs, or reality factors that is intolerable.
Denial
unconscious shifting of feelings such as hostility or anxiety from one idea, person, or object to another.
Displacement
Separation and detachment of a strong emotionally charged conflict from ones consciousness.
Dissociation
unconscious attempt to identity with personality traits or actions of another to preserve one’s self-esteem or to reach a specific goal.
Identification
unconscious application of the philosophy, ideas, customs, and attitudes of another person to one’s self.
Introjections
8.unconscious assignment of unacceptable thoughts or characteristics of self to others.
Projection
unconscious demonstration of the opposite behaviour, attitude, or feeling of what one would normally show in a given formation.
Reaction – formation
unconscious justifications of one’s ideas, actions, or feelings to maintain self-respect, prevents feelings of guilt, or obtain social approval
Rationalization
retreat to past developmental stages to meet basic needs.
Regression
negation of a previous consciously intolerable action or experiences.
Restitution
unconscious rechanneling of intolerable or socially unacceptable impulses or behaviours into activities that are personally or socially acceptable.
Sublimation
unconscious replacement of unacceptable impulses, attitudes, needs, or emotions with those that are more acceptable.
Substitution
voluntary rejection of unacceptable thoughts and feelings from conscious awareness.
Suppression
act or communication that partially negates previous ones, a primitive defense mechanism.A
Undoing
