Care & Management of Adult Client with Problems related to Mental Health/Illness Flashcards
- Problems related to anger & aggression - Assertiveness training - Management of anger & aggression - Cognitive & behavioral therapies
1
Q
Behaviors
- Nonassertive behavior
- Aggressive
- Assertive
- Passive-Aggressive
A
2
Q
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Is the ability of the individual to stand up for their own rights while protecting the rights of others
A
Assertive
3
Q
?
Saying what’s on your mind, often at the expense of others. Is a type of behavior that hinders interpersonal relationships
A
Aggressive
4
Q
?
Responding to others by appearing passive and accepting of others’ demands while behaving in a way that suggests anger and resentment in true feelings; is often a manifestation of low self-confidence
A
Passive-Aggressive
5
Q
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Or passive; an individual seeks to please others at the cost of their own human rights (i.e., to be treated with respect; to express feelings; to say no; to make mistakes; to be listened to; to change your mind; to ask for what you want; to sometimes put yourself first; to set your own priorities; and to refuse to justify your own feelings and behaviors)
A
Nonassertive
6
Q
Role of the Nurse in Assertiveness Training
- Self-awareness
- Coping, defensive coping, ineffective decisional conflict
- Denial; personal identity, disturbed
- Powerlessness; rape-trauma syndrome; self-esteem
- Low social interaction, impaired social isolation
A
- Using “I” statements and thought stopping
- The goal for nurses working with individuals needing assertiveness training is to help them develop more satisfying interpersonal relationships
> Evaluation requires that nurse and client assess whether these techniques are achieving the desired outcome like the ability to verbalize opinions, decline a request without feeling guilty, and improve personal relationships
7
Q
Anger ⥰ Aggression
A
Anger is a normal, healthy emotion that serves as a warning signal
- When it’s denied or buried, it can precipitate a number of physical problems. When turned inward, it can result in depression and low self-esteem.
- It arouses the SNS and is manifested by a frowning facial expression, clenched fist, low-pitched verbalization force through clenched teeth, yelling, shouting, intense eye contact or avoidance of eye contact
8
Q
- Anger takes on a negative connotation as it’s linked to aggression
A
- Aggression is manifested by pacing, yelling, swearing, threats of harm to self or others, destruction of property, and acts of physical harm toward another person
9
Q
Assessing Risk Factors
- Past history of violence
- Client diagnosis
- Current behavior
A
Past history of violence
- A major risk factor
- Diagnosis of schizophrenia, major depression, bipolar disorder, and substance use disorders also have a strong correlation with violent behavior
- Other conditions include antisocial, borderline, and intermittent explosive personality disorder
10
Q
- Escalating behaviors include rigid posture; a clenched fist and jaw; grim, defiant affect; talking in a rapid, raised voice; arguing and demanding; using profanity and threatening; agitation, pacing, pounding, and slamming behaviors
> Prodromal syndrome
A
- Prevention is key to the management of violent or aggressive behaviors. Also, male gender is considered a risk factor
11
Q
De-escalation Techniques
- Calm voice
- Open hands and non-threatening posture
- Express concern
- Reduce stimulation
- Relaxation techniques
- Identify consequences
- Verbal redirection and limit setting
- Offer PRN medication
A
- Identify consequences of disruptive behavior
- Restraints are used as a last resort
12
Q
Principles of Behavior Therapy
Classical Conditioning (Pavlov)
- Reflexive OR Learned response
A
Operant Conditioning
- Consequences of the behavioral response
- Positive or negative reinforcement
13
Q
Behavior Therapy
- Shaping (i.e., behavior, reinforcements are given for increasingly closer approximations to the desired response) [eliciting speech from an autistic child]
- Modeling (initiating positive behavior; imitation)
- Premack Principle (R1 occurs only after R2 has been performed) [Jenny can talk on her cell phone w/friends if she completes her homework that she’s been neglecting]
- Extinction [not giving in to a temper tantrum]
- Contingency Contracting [a contract drawn up between parties that’s specific about reinforcements and punishments]
- Token Economy (reinforcements are given for desired behavior and are presented in the form of tokens)
A
- Time-Out (considered a punishment; the client is removed from the environment)
- Reciprocal Inhibition [counterconditioning; i.e., introducing relaxation exercises to a phobic individual]
- Overt sensitization [produces unpleasant consequences for undesirable behavior (Antabuse)]
- Covert sensitization [the individual doesn’t perform the undesired behaviors but imagines them]
- Systematic desensitization (a technique used for overcoming phobias where there is a hierarchy of anxiety-producing events which the individual progresses)
14
Q
Role of the Nurse in Behavior Therapy
- Modeling appropriate behavior
- Use of token system
- Relaxation with exposure
! Use of the nursing process to assist patients
A
Cognitive Therapy
- Automatic thoughts
- Schemas
15
Q
Automatic thoughts
- Arbitrary inference [Mrs. B. doesn’t receive acknowledgement of her wedding gift and states she thinks the couple thinks she has poor taste w/o thinking of other reasons for the delay from them]
- Overgeneralizations [Frank’s article to a nursing journal is rejected and he thinks that no journal will ever be interested in anything he writes]
- Dichotomous thinking [Frank’s article is returned w/suggestions for revision and he thinks that he’s a bad writer instead of realizing that revision is a part of the process]
- Selective abstraction [Jackie doesn’t think about all the positive things she’s accomplished in high school and instead focuses on not getting into the Ivy league school]
A
- Magnification [Nancy wasn’t invited to a co-workers party and thinks she’s not liked versus understanding that it could have been for a small group only]
- Minimization [Mrs. M. feels unloved by the granddaughter who cannot visit her but makes the effort to call twice]
- Catastrophic thinking [Janet’s boss returns a letter to her noting revisions to be made and she feels like she is going to be fired; she doesn’t realize that her boss may be trying to get her acquainted to aspects of the job]
- Personalization [Jack gives a 2 hr car demo to Mrs. W. but in the end Mrs. W. says she won’t be buying a car from him; Jack thinks he’s a bad salesman but doesn’t consider that they might not have money to buy the car right now]
