185 unit 3 Flashcards
Describe four aims of the nurse in the role of a counselor
Promoting health
preventing illness
restoring health
facilitating coping with disability and death
promoting health
health teaching varied and range from teaching passive exercises to a patient with left-sided paralysis to designing a safe exercise program for a young athlete.
Developmental and maturational issues, normal childbearing, hygiene, nutrition, exercise, mental health, spiritual health.
preventing illness
counsel women of childbearing age about health practices that promote optimal fetal development, teach parents how to make their home safe for a toddler, or counsel people at high risk for heart disease, cancer, or communicable diseases. First aid, safety, immunizations, screening, identification and management of risk factors.
restoring health
preoperative and postoperative teaching; sexual counseling for a patient recovering from a myocardial infarction, and lifestyle counseling for a patient with an ostomy. Orientation to a treatment center and staff, patients and nurses expectations of one another, the illness and physical condition anatomy and physiology, etiology of the problem, the significance of symptoms, prognosis The medical and nursing regimens and how the patient can participate in care. Self-care practices the patient and family need to manage the patients condition independently.
facilitating coping with disability and death
How the patients physical and mental condition affects other areas of functioning; lifestyle counseling. Measures that maximize independence and enhance self-concept. Stress management. Environmental alterations. community resources. Appropriate referrals. Grief and bereavement counseling.
define counseling as it relates to the role of the nurse
the interpersonal process of helping patients make decisions that promote their overall well-being. Counseling may be formal or informal. The interpersonal skills of warmth, friendliness, openness, and empathy are necessary for successful counseling. involve listening carefully to the patients or family questions, concern, demands, and complaints and then responding in an effective manner.
identify problems that may indicate a need for counseling
DECISIONAL CONFLICT - ability to authorize withdawal of life-sustaining treatment despite believing this to be in the patient best interest.
Hopelessness - progression of debilitating symptoms and belief that even god has abandoned me
impaired social interaction - communication barriers
situational low self-esteem - recent lay-off and divorce
describe the arousal mechanism
RAS
state of arousal
situational
situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life.
developmental
a developmental crisis can occur when a person is going through a developmental stage or passage.
motivational
an evidence-based counseling approach that involves discussing feeling and incentives with the patient.
short-term
focuses on the immediate problem or concern of the patient or family. it can be a relatively minor concern or a major crisis, but in any case, it needs immediate attention. Short-term counseling might be used during a situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life.
long-term
extends over a prolonged period. a patient experiencing a developmental crisis, for example, might need long-term counseling. a developmental crisis can occur when a person is going through a developmental stage or passage.
identify situations that may call for a referral
needs specialized counseling from a nurse with advanced training or from other health care professionals.
self esteem
the need to feel good about oneself and to believe that others hold on in high regard
self actualization
is the need to reach one’s potential through full development of one unique capability
self concept
which is the mental image or picture of self, has the power to either encourage or thwart personal growth.
discuss the dimensions of self-concept
SELF-KNOWLEDGE- abilities, nature, limitations
SELF-EXPECTATION-realistic or unrealistic
SELF EVALUATION- view of oneself in relation to events, situations
describe the factors affecting self-concept
developmental considerations culture internal and external resources history of success and failure crisis or life stressors aging, illness or trauma
developmental considerations
as a person matures, the criteria that mark the experiences necessary for a positive self-concept change.
culture
if culture is stable little tension will be experienced between what culture expects of the child and what the child expect of self. parents might expect children to behave according to their own cultural norms, peers and society, as well as the adolescent desire to belong may create the desire to abandon old cultural belief, attitudes, and practices among many of these children. conflict between parents and children as well as cultural confusion occur.
internal and external resources
the degree to which a person integrates healthy, useful internal resources or personal strengths is associated with how well a person has been able to establish a postive self-concept. one person might use humor as both an effective coping mechanism and a successful interpersonal tool. self con-cept is also associated with the ability to identify and use external resources such as a network of support people, adequate finances, and organizational supports. People who feel more positively about themselves tend to feel connected to others and to society; they can identify and use more external resources.
history of success and failure
people with a history of repeated failure might perceive themselves as failures and actually perpetuate this image by unconsciously encouraging others to treat them this way they come to fear success and find it easier to fail even though they do not like it. a series of successful experiences especially when occuring in the context of an accepting, nurturing, caring relationship might condition a person to strive for the next success, and a positive self-concept might be forged that expects success and makes it happen.
crisis or life stressors
might call forth a personal response and mobilize a person talents, resulting in good feeling about oneself, or it might result in emotional paralysis with diminished self-concept. factors that determine a person’s response to crisis: the person’s perception of the event, the person’s situational supports, the coping mechanisms the person possess.
identify ways to assess a person self-concept
personal identify - describe a person a conscious sense of who they are “ how would you describe yourself “.
personal strengths - asking pointed questions about personal strength can help a patient identify positive factor.s
body image - response to deformity or limitation - the person’s subjective view of one physical appearance.
independent - dependence patterns
self-esteem - socialization and communication
role performance
identify ways to assess a person self-concept
personal identify - describe a person a conscious sense of who they are “ how would you describe yourself “.
personal strengths - asking pointed questions about personal strength can help a patient identify positive factor.s
body image - response to deformity or limitation - the person’s subjective view of one physical appearance. Adaptive response - The patient exhibits signs of grief and mourning. Maladaptive responses - patient continues to deny and avoid dealing with the deformity or limitation, engage in self-destructive behavior.
independent - dependence patterns - ADAPTIVE RESPONSES - patient assumes responsibility for care ( makes the decision), develops new self-care behaviors, uses available resources, interacts in a mutually supportive way with family.
MALADAPTIVE RESPONSES - The patient assigns responsibility for his or her care to others, becomes increasingly dependent, or stubbornly refuses necessary help.
self-esteem - “ Tell me what you like about yourself “ - the greater the discrepancy, the lower the self-esteem the smaller the discrepancy the higher the self-esteem.
socialization and communication - ADAPTIVE - maintains usual social patterns, communicates needs and accepts an offer of help, serves as a support for others.
MALADAPTIVE - isolates oneself, exhibits superficial self-confidence, is unable to express needs(become hostile, ashamed, frustrated, depressed)
role performance - illness or developmental processes such as aging make it necessary to alter or relinquish previous role. people experience such alteration as major losses thus all people who roles are altered or compromise are at risk for disturb self-concept.
identify and use personal strengths
encourage pt to identify their strength.
replace self-negation with positive thinking.
notice and reinforce patient strengths.
encourage pt to will for themselves the strengths they desire and to try them on.
help patients cope with the necessary dependency resulting from aging or illness.
maintain a sense of self
help pt maintain a sense of self and worth - use looks, speech, and judicious touch to communicate worth.
acknowledge the pt status, roles, individuality.
speak to the pt respectfully and in a nonpatronizing manner.
converse with the pt about the pt life experience.
address the pt by preferred name whenever entering the pt room.
offer the pt a simple explanation before initiating any procedure.
move the pt body respectfully if the pt is unable to do this.
respect the pt privacy and sensibilities.
acknowledge and allow expression of negative feelings.
help the pt to recognize strengths and explore alternatives.
