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NUR 201 Week 6 > Care & Management of Adult Client with Problems r/t Mental Health/Illness > Flashcards

Care & Management of Adult Client with Problems r/t Mental Health/Illness Flashcards

- Therapeutic Groups - Milieu Therapy & Recovery Model - Interventions with Families - Promoting self-esteem, complimentary, psychosocial & relaxation therapies

1
Q

?

Is a form of psychosocial treatment

Goals are sharing, gaining personal insight, & improving interpersonal coping

A

Group therapy

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2
Q

?

Differs in that the focus is not only psychotherapy but rather on interaction & relationships among group members w/regard to a selected issue

A

Therapeutic groups

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3
Q

Therapeutic Factors

  • Instillation of hope
  • Universality
  • Imparting of information
  • Altruism
  • Corrective recapitulation of the primary family group
  • Development of socializing techniques
A
  • Imitative behavior
  • Interpersonal learning
  • Group cohesiveness
  • Catharsis
  • Existential factors
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4
Q

?

The client is reminded that if others’ problems can be solved, maybe theirs can be too

A

Instillation of hope

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5
Q

?

The individual is reminded they aren’t alone

A

Universality

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6
Q

Imparting of information
> Can be through formal instruction or advice from members

A

Altruism
> Support, mutual sharing, and concern for members

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7
Q

Corrective recapitulation of the primary family group
> Making a relationship w/someone to replace missing family relationships
> Attempts at resolution are promoted through feedback & exploration

A

Development of socializing techniques
> Through interaction w/ & feedback from other members within the group, individuals are able to correct maladaptive social behavior & learn & develop new social skills

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8
Q

Imitative behavior
> Members can imitate desirable behaviors of a role model

A

Interpersonal learning
> The group offers many & varied opportunities for interacting w/other people; insight is gained on how one perceives & is being perceived by others

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9
Q

?

Provides a sense of belonging. Both individual members & the total group are of value to each other

A

Group cohesiveness

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10
Q

?

Occurs when members are able to express both positive & negative feelings, allowing the client the ability to “let it get all out”

A

Catharsis

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11
Q

Existential factors
> Group is able to help individual members take direction of their own lives & accept responsibility for the quality of their existence

A

Phases of Group Development

Initial or Orientation phase > Middle or Working phase > Final or Termination phase

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12
Q

Leadership styles

?

Supports group interaction & decision making to solve problems; members are satisfied & this is derived from personal input & participation

A

Democratic

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13
Q

?

The leader completely controls the direction & structure of the group w/o allowing for group interaction or decision making to solve problems

> Can lead to low motivation & commitment on part of the members

A

Autocratic

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14
Q

?

Leadership that will progress w/o any attempt by the leader to control direction; low motivation & commitment by the members b/c of feelings of frustration from the lack of direction or guidance

A

Laissez-faire

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15
Q

?

Refers to environment or surroundings

A

Milieu

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16
Q

What are 3 goals of milieu therapy?

A

Adaptive coping
Interaction
Relationship skills

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17
Q

?

Is defined as structuring of the environment in order to effect behavioral changes and improve the psychological health & functioning of the individual; also called the therapeutic community

A

Milieu therapy

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18
Q

Role of the nurse in the therapeutic community

Trust > Orient (2) > Physiological needs > Medication administration > Education > Setting Limits > Trust

A
  • Just like w/therapeutic communication, the role of the nurse in the therapeutic community is to promote trust, reduce anxiety, allow for acceptance, & show unconditional positive regard
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19
Q

Orienting (2)

  • First is to orient the client to the environment, to his or her rights & responsibilities within the unit, to the structured activities designed for personal growth, & to any limits or restrictions necessary to maintain safety
A
  • Second meaning is reality orientation, & this is for clients who have disorganized thinking or who are disorganized or confused
    > Give them guidelines in terms of date & time to orient them
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20
Q

?

Is defined as the process of movement towards improvement in health & the quality of life; a model that originated from the substance abuse treatment field

A

Recovery

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21
Q

Guiding Principles

  • Respect & hope
    > Hope is viewed as a belief that people can overcome challenges
  • Person driven
    > Recovery is self-directed & individuals define their own life goals
  • Holistic, culturally based
    > Mind, body, spirit, & whole community
A
  • Peers, family relationships, social networks
  • Addresses trauma
    > Experience of trauma is often a precursor to mental health or substance abuse & needs to be addressed
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22
Q

?

Is a mental health nursing recovery model that may be used as the basis for interdisciplinary mental health care

  • Authors use power of a metaphor to engage w/the person in distress
    > Metaphor of water to describe how individuals can be emotionally, physically, and spiritually shipwrecked
A

Tidal Model

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23
Q

Tidal Model

  • Uses a person-centered approach to help people deal w/their problems of human living; focus is on the individual’s personal story w/the problems first appeared & where any growth, benefit, or recovery will be found
A
  • Has 10 tidal commandments empowering people to making their own change
    ! Change takes time & is an ongoing process
24
Q

?

Is a structured system of monitoring uncomfortable & distressing sx’s & through planned responses, reducing & modifying or eliminating those sx’s

> Also includes plans for responses from others when a person’s sx’s have made it impossible for them to continue to make their own decisions

6 steps

A

Wellness Recovery Action Plan (WRAP)

25
Q
  1. Wellness toolbox - is strategies & skills that were used in the past or techniques to try to assist in relieving disturbing sx’s
  2. Maintenance list - is a list of things to do everyday to maintain wellness & a list of things that need to be done
A
  1. Triggers
  2. Early warning signs
26
Q
  1. Things that are breaking down - would be sx’s that are producing great discomfort & a plan that will help when the sx’s have worsened
A
  1. Crisis planning - identifies sx’s indicating that the individual can no longer take care of themselves & make independent decisions or keep themselves safe
27
Q

?

A recovery model that does not emphasize the absence of sx’s but focuses on the person’s self-determination in the course of the recovery process

5 stages

A

Psychological Recovery Model

28
Q

? stage

Individual comes to the realization that the possibility for recovery exists

A

Awareness

29
Q

? stage

Individual has the resolve to begin working on recovery

A

Preparation

30
Q

? stage

Identified by dark despair & confusion; feels like life is on hold

A

Moratorium

31
Q

? stage

Is the outcome of the psychological model; is a dynamic stage & is a continuing life process

A

Growth

32
Q

?

Is where the hard work of recovery begins

A

Rebuilding

33
Q

Nurse’s Role in Recovery

  • Advocate
  • Coordinates care
  • Provides feedback
  • Offers hope
A
34
Q

Interventions w/Families: Role of the Nurse

  • Assess family interaction
  • Recognize problems
A

Developmental stages of family

  • Single young adult
  • Joined through marriage/union
  • With young children
  • With adolescents
  • Launching children/moving towards midlife
  • Later in life
35
Q

Family functioning

! Functional or dysfunctional
* On a continuum
* Dynamic & fluctuate
* 6 elements of assessment

A
  1. Communication
  2. Self-concept reinforcement
  3. Family members’ expectation(s)
  4. Handling differences
  5. Family interactional patterns
  6. Family climate
36
Q

Communication - Functional

✓ Clear, direct, open, honest, with congruence between verbal & nonverbal

A

Communication - Dysfunctional

! Making assumptions
! Belittling feelings
! Failing to listen
! Communicating indirectly
! Presenting double-bind messages (i.e., “damned if I do, damned if I don’t”)

37
Q

Self-Concept Reinforcement - Functional

✓ Supportive
✓ Loving, praising, approving
✓ Behaviors that instill confidence

A

Dysfunctional

! Expressing denigrating remarks
! Withholding supportive messages
! Taking over

38
Q

Family members’ expectation - Functional

✓ Realistic
✓ Flexible
✓ Individualized

A

Dysfunctional

! Ignoring individuality
! Demanding proof of love

39
Q

Handling differences - Functional

✓ Tolerant
✓ Dynamic
✓ Negotiating

A

Dysfunctional

! Attacking
! Avoiding
! Surrendering

40
Q

Family interactional patterns - Functional

✓ Workable
✓ Constructive
✓ Flexible
✓ Promoting the needs of all members

A

Family interactional patterns - Dysfunctional

! Contradictory, self-defeating, & destructive
! Cause emotional discomfort
! Perpetuate or intensify problems
! Are in conflict w/each other

41
Q

Family Climate - Functional

✓ Trust, openness
✓ Appropriate humor & laughter
✓ Expressions of caring
✓ Mutual respect
✓ Valuing, feeling of well-being

A

Family Climate - Dysfunctional

! Tension, frustration
! Guilt, anger, resentment
! Depression
! Despair

42
Q

Theoretical approach to family therapy [Bowen]

  1. Differentiation of self
  2. Triangles
  3. Nuclear family emotional process
  4. Family projection process
A
  1. Multigenerational transmission process
  2. Sibling position
  3. Emotional cutoff
  4. Societal emotional process
43
Q

Differentiation of self

> Is the ability to define oneself as a separate being

A

Triangles

> A 3-person emotional configuration that is considered the basic building block of the family system

44
Q

Nuclear family emotional process

> Describes the patterns of emotional function in a single generation

A

Family projection process

> Spouses who are to work through undifferentiation or fusion that occurs w/permanent commitment may project the resulting anxiety onto children when they become parents; manifested as a father, mother, child triangle

45
Q

Multigenerational transmission process

> The manner in which interactional patterns are transferred from one generation to another
Attitudes, values, beliefs, behaviors, and patterns of interaction are passed along from parents to children over many lifetimes

A

Sibling position

> View suggests that birth order in a family influences the development of predictable personality characteristics

46
Q

Emotional cutoff

> Describes differentiation of self from the perception of the child

> All individuals have some degree of unresolved emotional attachment to their parents in the lower level of differentiation; the greater the degree of unresolved emotional attachment

A

Societal emotional process

> Compares society’s response to stress to the same type of response seen in individuals and families in response to emotional crisis

47
Q

Therapeutic modalities w/families

Is this strategic or structural?

  • Communication = foundation of functioning
  • Open systems w/clear, precise messages
A

Strategic

48
Q

Strategic or structural?

  • Systems
  • Transactional patterns
  • Subsystems
  • Boundaries
A

Structural

49
Q

?

Is the cognitive or thinking component of the self

A

Self-concept

50
Q

Self-Concept

  • Body image
  • Personal identity
  • Self-esteem
A

Manifestations of low self-esteem

  • Appetite changes, sleep issues, withdrawal, anger, feelings of worthlessness, inadequacy & issues w/boundaries
51
Q

Nursing Diagnoses

> Chronic low self-esteem
Situational low self-esteem

A

> Risk for chronic low self-esteem
Risk for situational low self-esteem

52
Q

Complementary Therapy

  • Has 5 domains and is used in conjunction w/conventional therapies/medical practice

> Views client in a holistic manner; being recognized by insurances & considered for reimbursement

A
  • Alternative medical systems
  • Mind-body interventions
  • Biologically-based therapies
  • Manipulative and body-based methods
  • Energy therapies
53
Q

Types of Complementary Therapies

  • Herbal, chiropractic medicine
  • Pet therapy
  • Acupressure & acupuncture
A
  • Therapeutic touch & massage
  • Diet & nutrition
  • Yoga
54
Q

Psychosocial Therapies

> Tools of the provider who works in psychiatry

A
  • Individual psychotherapies, interpersonal psychotherapy
  • Assertiveness training, reality therapy
  • Cognitive therapy, catharsis, relaxation therapy
  • Psychoanalysis & psychoanalytic psychotherapy
55
Q

Relaxation Therapy

  • Stress epidemic / achieving relaxation

> Stress as a contributor to physical manifestations (! achieve relaxation to counter these sx’s)

A
  • Deep breathing exercises, progressive relaxation, meditation, mental imagery, biofeedback, & physical exercise
56
Q

Role of the Nurse in Relaxation Therapy

  • Assess responses (adaptive vs maladaptive)
  • Identify appropriate nursing diagnosis
A
  • Encourage utilization of techniques
  • Identify outcome criteria & evaluate effectiveness

NUR 201 Week 6 (5 decks)

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