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
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Is a form of psychosocial treatment
Goals are sharing, gaining personal insight, & improving interpersonal coping
Group therapy
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Differs in that the focus is not only psychotherapy but rather on interaction & relationships among group members w/regard to a selected issue
Therapeutic groups
Therapeutic Factors
- Instillation of hope
- Universality
- Imparting of information
- Altruism
- Corrective recapitulation of the primary family group
- Development of socializing techniques
- Imitative behavior
- Interpersonal learning
- Group cohesiveness
- Catharsis
- Existential factors
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The client is reminded that if others’ problems can be solved, maybe theirs can be too
Instillation of hope
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The individual is reminded they aren’t alone
Universality
Imparting of information
> Can be through formal instruction or advice from members
Altruism
> Support, mutual sharing, and concern for members
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
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
Imitative behavior
> Members can imitate desirable behaviors of a role model
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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Provides a sense of belonging. Both individual members & the total group are of value to each other
Group cohesiveness
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Occurs when members are able to express both positive & negative feelings, allowing the client the ability to “let it get all out”
Catharsis
Existential factors
> Group is able to help individual members take direction of their own lives & accept responsibility for the quality of their existence
Phases of Group Development
Initial or Orientation phase > Middle or Working phase > Final or Termination phase
Leadership styles
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Supports group interaction & decision making to solve problems; members are satisfied & this is derived from personal input & participation
Democratic
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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
Autocratic
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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
Laissez-faire
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Refers to environment or surroundings
Milieu
What are 3 goals of milieu therapy?
Adaptive coping
Interaction
Relationship skills
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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
Milieu therapy
Role of the nurse in the therapeutic community
Trust > Orient (2) > Physiological needs > Medication administration > Education > Setting Limits > Trust
- 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
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
- 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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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
Recovery
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
- 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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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
Tidal Model
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
- Has 10 tidal commandments empowering people to making their own change
! Change takes time & is an ongoing process
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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
Wellness Recovery Action Plan (WRAP)
- Wellness toolbox - is strategies & skills that were used in the past or techniques to try to assist in relieving disturbing sx’s
- Maintenance list - is a list of things to do everyday to maintain wellness & a list of things that need to be done
- Triggers
- Early warning signs
- 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
- Crisis planning - identifies sx’s indicating that the individual can no longer take care of themselves & make independent decisions or keep themselves safe
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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
Psychological Recovery Model
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Individual comes to the realization that the possibility for recovery exists
Awareness
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Individual has the resolve to begin working on recovery
Preparation
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Identified by dark despair & confusion; feels like life is on hold
Moratorium
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Is the outcome of the psychological model; is a dynamic stage & is a continuing life process
Growth
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Is where the hard work of recovery begins
Rebuilding
Nurse’s Role in Recovery
- Advocate
- Coordinates care
- Provides feedback
- Offers hope
Interventions w/Families: Role of the Nurse
- Assess family interaction
- Recognize problems
Developmental stages of family
- Single young adult
- Joined through marriage/union
- With young children
- With adolescents
- Launching children/moving towards midlife
- Later in life
Family functioning
! Functional or dysfunctional
* On a continuum
* Dynamic & fluctuate
* 6 elements of assessment
- Communication
- Self-concept reinforcement
- Family members’ expectation(s)
- Handling differences
- Family interactional patterns
- Family climate
Communication - Functional
✓ Clear, direct, open, honest, with congruence between verbal & nonverbal
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”)
Self-Concept Reinforcement - Functional
✓ Supportive
✓ Loving, praising, approving
✓ Behaviors that instill confidence
Dysfunctional
! Expressing denigrating remarks
! Withholding supportive messages
! Taking over
Family members’ expectation - Functional
✓ Realistic
✓ Flexible
✓ Individualized
Dysfunctional
! Ignoring individuality
! Demanding proof of love
Handling differences - Functional
✓ Tolerant
✓ Dynamic
✓ Negotiating
Dysfunctional
! Attacking
! Avoiding
! Surrendering
Family interactional patterns - Functional
✓ Workable
✓ Constructive
✓ Flexible
✓ Promoting the needs of all members
Family interactional patterns - Dysfunctional
! Contradictory, self-defeating, & destructive
! Cause emotional discomfort
! Perpetuate or intensify problems
! Are in conflict w/each other
Family Climate - Functional
✓ Trust, openness
✓ Appropriate humor & laughter
✓ Expressions of caring
✓ Mutual respect
✓ Valuing, feeling of well-being
Family Climate - Dysfunctional
! Tension, frustration
! Guilt, anger, resentment
! Depression
! Despair
Theoretical approach to family therapy [Bowen]
- Differentiation of self
- Triangles
- Nuclear family emotional process
- Family projection process
- Multigenerational transmission process
- Sibling position
- Emotional cutoff
- Societal emotional process
Differentiation of self
> Is the ability to define oneself as a separate being
Triangles
> A 3-person emotional configuration that is considered the basic building block of the family system
Nuclear family emotional process
> Describes the patterns of emotional function in a single generation
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
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
Sibling position
> View suggests that birth order in a family influences the development of predictable personality characteristics
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
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
Therapeutic modalities w/families
Is this strategic or structural?
- Communication = foundation of functioning
- Open systems w/clear, precise messages
Strategic
Strategic or structural?
- Systems
- Transactional patterns
- Subsystems
- Boundaries
Structural
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Is the cognitive or thinking component of the self
Self-concept
Self-Concept
- Body image
- Personal identity
- Self-esteem
Manifestations of low self-esteem
- Appetite changes, sleep issues, withdrawal, anger, feelings of worthlessness, inadequacy & issues w/boundaries
Nursing Diagnoses
> Chronic low self-esteem
Situational low self-esteem
> Risk for chronic low self-esteem
Risk for situational low self-esteem
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
- Alternative medical systems
- Mind-body interventions
- Biologically-based therapies
- Manipulative and body-based methods
- Energy therapies
Types of Complementary Therapies
- Herbal, chiropractic medicine
- Pet therapy
- Acupressure & acupuncture
- Therapeutic touch & massage
- Diet & nutrition
- Yoga
Psychosocial Therapies
> Tools of the provider who works in psychiatry
- Individual psychotherapies, interpersonal psychotherapy
- Assertiveness training, reality therapy
- Cognitive therapy, catharsis, relaxation therapy
- Psychoanalysis & psychoanalytic psychotherapy
Relaxation Therapy
- Stress epidemic / achieving relaxation
> Stress as a contributor to physical manifestations (! achieve relaxation to counter these sx’s)
- Deep breathing exercises, progressive relaxation, meditation, mental imagery, biofeedback, & physical exercise
Role of the Nurse in Relaxation Therapy
- Assess responses (adaptive vs maladaptive)
- Identify appropriate nursing diagnosis
- Encourage utilization of techniques
- Identify outcome criteria & evaluate effectiveness
