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

Question 1

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Is a form of psychosocial treatment

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

Answer 1

Group therapy

Question 2

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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

Answer 2

Therapeutic groups

Question 3

Therapeutic Factors

• Instillation of hope
• Universality
• Imparting of information
• Altruism
• Corrective recapitulation of the primary family group
• Development of socializing techniques

Answer 3

• Imitative behavior
• Interpersonal learning
• Group cohesiveness
• Catharsis
• Existential factors

Question 4

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

Answer 4

Instillation of hope

Question 5

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The individual is reminded they aren’t alone

Answer 5

Universality

Question 6

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

Answer 6

Altruism
> Support, mutual sharing, and concern for members

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

Group cohesiveness

Question 10

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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”

Answer 10

Catharsis

Question 11

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

Answer 11

Phases of Group Development

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

Question 12

Leadership styles

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

Answer 12

Democratic

Question 13

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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

Answer 13

Autocratic

Question 14

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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

Answer 14

Laissez-faire

Question 15

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Refers to environment or surroundings

Answer 15

Milieu

Question 16

What are 3 goals of milieu therapy?

Answer 16

Adaptive coping
Interaction
Relationship skills

Question 17

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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

Answer 17

Milieu therapy

Question 18

Role of the nurse in the therapeutic community

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

Answer 18

• 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

Question 19

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

Answer 19

• 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

Question 20

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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

Answer 20

Recovery

Question 21

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

Answer 21

• Peers, family relationships, social networks
• Addresses trauma
  > Experience of trauma is often a precursor to mental health or substance abuse & needs to be addressed

Question 22

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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

Answer 22

Tidal Model

Question 23

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

Answer 23

• Has 10 tidal commandments empowering people to making their own change
  ! Change takes time & is an ongoing process

Question 24

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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

Answer 24

Wellness Recovery Action Plan (WRAP)

Question 25

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

Answer 25

3. Triggers 4. Early warning signs

Question 26

5. 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

Answer 26

6. Crisis planning - identifies sx's indicating that the individual can no longer take care of themselves & make independent decisions or keep themselves safe

Question 27

? 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

Answer 27

Psychological Recovery Model

Question 28

? stage Individual comes to the realization that the possibility for recovery exists

Answer 28

Awareness

Question 29

? stage Individual has the resolve to begin working on recovery

Answer 29

Preparation

Question 30

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

Answer 30

Moratorium

Question 31

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

Answer 31

Growth

Question 32

? Is where the hard work of recovery begins

Answer 32

Rebuilding

Question 33

Nurse's Role in Recovery * Advocate * Coordinates care * Provides feedback * Offers hope

Question 34

Interventions w/Families: Role of the Nurse * Assess family interaction * Recognize problems

Answer 34

Developmental stages of family * Single young adult * Joined through marriage/union * With young children * With adolescents * Launching children/moving towards midlife * Later in life

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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")

Question 37

Self-Concept Reinforcement - Functional ✓ Supportive ✓ Loving, praising, approving ✓ Behaviors that instill confidence

Answer 37

Dysfunctional ! Expressing denigrating remarks ! Withholding supportive messages ! Taking over

Question 38

Family members' expectation - Functional ✓ Realistic ✓ Flexible ✓ Individualized

Answer 38

Dysfunctional ! Ignoring individuality ! Demanding proof of love

Question 39

Handling differences - Functional ✓ Tolerant ✓ Dynamic ✓ Negotiating

Answer 39

Dysfunctional ! Attacking ! Avoiding ! Surrendering

Question 40

Family interactional patterns - Functional ✓ Workable ✓ Constructive ✓ Flexible ✓ Promoting the needs of all members

Answer 40

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

Question 41

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

Answer 41

Family Climate - Dysfunctional ! Tension, frustration ! Guilt, anger, resentment ! Depression ! Despair

Question 42

Theoretical approach to family therapy [Bowen] 1. Differentiation of self 2. Triangles 3. Nuclear family emotional process 4. Family projection process

Answer 42

5. Multigenerational transmission process 6. Sibling position 7. Emotional cutoff 8. Societal emotional process

Question 43

Differentiation of self > Is the ability to define oneself as a separate being

Answer 43

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

Question 44

Nuclear family emotional process > Describes the patterns of emotional function in a single generation

Answer 44

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

Question 45

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

Answer 45

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

Question 46

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

Answer 46

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

Question 47

Therapeutic modalities w/families Is this strategic or structural? * Communication = foundation of functioning * Open systems w/clear, precise messages

Answer 47

Strategic

Question 48

Strategic or structural? * Systems * Transactional patterns * Subsystems * Boundaries

Answer 48

Structural

Question 49

? Is the cognitive or thinking component of the self

Answer 49

Self-concept

Question 50

Self-Concept * Body image * Personal identity * Self-esteem

Answer 50

Manifestations of low self-esteem * Appetite changes, sleep issues, withdrawal, anger, feelings of worthlessness, inadequacy & issues w/boundaries

Question 51

Nursing Diagnoses > Chronic low self-esteem > Situational low self-esteem

Answer 51

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

Question 52

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

Answer 52

* Alternative medical systems * Mind-body interventions * Biologically-based therapies * Manipulative and body-based methods * Energy therapies

Question 53

Types of Complementary Therapies - Herbal, chiropractic medicine - Pet therapy - Acupressure & acupuncture

Answer 53

- Therapeutic touch & massage - Diet & nutrition - Yoga

Question 54

Psychosocial Therapies > Tools of the provider who works in psychiatry

Answer 54

* Individual psychotherapies, interpersonal psychotherapy * Assertiveness training, reality therapy * Cognitive therapy, catharsis, relaxation therapy * Psychoanalysis & psychoanalytic psychotherapy

Question 55

Relaxation Therapy * Stress epidemic / achieving relaxation > Stress as a contributor to physical manifestations (! achieve relaxation to counter these sx's)

Answer 55

* Deep breathing exercises, progressive relaxation, meditation, mental imagery, biofeedback, & physical exercise

Question 56

Role of the Nurse in Relaxation Therapy - Assess responses (adaptive vs maladaptive) - Identify appropriate nursing diagnosis

Answer 56

- Encourage utilization of techniques - Identify outcome criteria & evaluate effectiveness