Exam 1 Study Guide Flashcards
SMART Goal creation abbreviations
S: Specific
M: Measurable
A: Achievable
R: Realistic
T: Time
S in Smart goals
Specific: The goal of the plan is specific and well-defined. How many, exactly what for?
M is Smart goals
Measurable: The specific goal set is measurable.
A in Smart goal
Achievable: The nurse identifies and analyzes the resources the client currently has access to. The planned behavior change should align with what is accessible and achievable for the client.
R in Smart goals
Realistic: After the client’s resources have been identified, the nurse and the client should work together to determine what is realistic to achieve within the resource constraints.
T in Smart goals
Time: The nurse and client agree upon a time in which the behavior change will be measured. Having the plan bound by time elicits a sense of accountability and gives the client a sense of anticipation toward accomplishment.
OARS technique abbreviation
O: Open- ended statements
A: Affirmations
R: Reflecting
S: Summary
O in OARS technique
Open- ended statements allow the client to elaborate on what is important to them in their own words
A in OARS technique
Affirmations are used best while speaking about specific, observed client strengths, as it builds engagement and trust.
R in OARS technique
Reflecting provides an opportunity to clarity thoughts or feelings.
• A simple reflection uses some element of what the client said.
• A complex reflection is similar to taking an educated guess on how the dient is feeling.
S in OARS technique
Summary - providing a clarifying consolidation of what the patient has said, and addressing the impact of the information
SOLER abbreviations
S: Sit squarely to the client
0: Open posture
L: Lean forward
E: Eye contact
R: Relax
What is DSM-5-TR ?
THIS IS WRITTEN TO HELP “DIAGNOSE” - Therefore written FOR those who diagnose- but all can USE it!
What is the propose of DSM-5-TR?
The purpose of the DSM-5-TR is to assist providers in using common diagnostic language to describe clients with mental health disorders.
THE EFFECTS OF STIGMA AND BIAS ON HEALTH CARE
STIGMA —> Public, Self, Institutional
BIAS —> Implicit, Explicit
BIAS —> Stereotyping, Prejudice, Discrimination
Public Stigma
When there is a negative attitude or discredit against an individual or identifiable group in which the individual or group is labeled as being different.
Self Stigma
When an individual adopts a negative view or internalized shame regarding their condition.
Institutional Stigma
When governmental policies or organizations limit opportunities for those with mental illness; this can be both intentional and unintentional.
2 Types of primary Bias
Implicit bias and explicit bias
Implicit Bias
when the bias occurs outside of one’s conscious awareness. (Not aware you’re being bias)
Explicit Bias
Is intentionally displaying behaviors of discrimination toward someone (aware)
Duty to warn
Health care providers have a “duty to warn” when there is a threat from a client to another individual to cause harm to them.
Duty to report
Nurses are also required by law to protect vulnerable individuals such as children, the elderly, and the disabled by reporting mistreatment or abuse of these individuals to local and state authorities. Termed mandatory reporting laws, it requires nurses, as well as other healthcare professionals, to report mistreatment including neglect and abuse of a physical, sexual, emotional, or financial nature.
What are some modifiable risk factors?
Lack of social support
Housing inaccessibility
Adverse childhood experiences and trauma
Unemployment or underemployment
Food insecurity
Lack of access to or poor quality of physical/mental health care
Educational inequities
Income inequities
Unhealthy or unsafe surroundings/neighborhood
Stress/diathesis model
Diathesis (“vulnerability Factor”) + Stress ( “triggering event”) = Development of mental illness or the aggravation of a mental health disorder.
Diathesis/Stress Model examples
Genetic link - such as a parent with a mental illness - Diathesis
Growing up in a household with a parent with a mental illness - Diathesis
Growing up in poverty - Diathesis
A specific current financial crisis (loss of a job for example) - Stress
Experiencing childhood trauma when growing up - Diathesis
Currently being in an abusive relationship - Stress
Having a long term medical or mental illness - Diathesis
Being diagnosed with a new significant medical or mental illness - Stress
Personality/Temperament Factors & lack of Resilience - Diathesis
Major Life Upset (Divorce, Death of a Loved One, Maturational Crisis”) - Stress
Can you change genetic factors?
No
Can you change social factors?
Are things you may not be able to change and are based on those around you
• Physical abuse and job stress are social factors.
• Other factors related to social conditions can include education, job opportunities, social support systems, housing conditions, and family dynamics.
What are Environmental factors ?
are related to basic necessities and how they impact an individual.
• Water, social inequality, and natural disasters are factors related to the environment.
• Other environmental factors can include war, pollutants in the air, food, and climate.
SURETY abbreviation
Sit at an angle: When a client is feeling vulnerable, sitting directly across from them can feel confrontational
Uncross legs and arms: Crossing legs or arms can be perceived as a nonverbal cue of defensiveness or disinterest.
Relax: A client may choose to disclose information to you that is surprising or disturbing it is important to be relaxed as to not appear tense or display negative emotions.
Eye contact: Generally conveys respect and engagement. Culture does need to be considered.
Touch: Is a powerful cue that displays care and understanding. Usually on hand, lower arm or shoulder. Culture and history of abuse must be considered.
Your intuition: Unconscious processing of subtle cues in the environment to aid in clinical judgment
Stage 1 - FREUD STAGES OF PSYCHOSEXUAL DEVELOPMENT
Stage 1: Oral
O to 1 year old
Fixation on oral gratification. This is the center of pleasure for a newborn and provides gratification.
Stage 2 - FREUD STAGES OF PSYCHOSEXUAL DEVELOPMENT
Stage 2: Anal
1 to 3 years old
Toilet training occurs during this time frame. Performance of the child is shifted from oral to anal.
Stage 3 - FREUD STAGES OF PSYCHOSEXUAL DEVELOPMENT
Stage 3: Phallic
3 to 6 years old
This is when a child experiences pleasure related to genitalia. This is a very primitive development with a fixation toward their caregiver.
Stage 4 - FREUD STAGES OF PSYCHOSEXUAL DEVELOPMENT
Stage 4: Latency
6 to 12 years old
A child may begin to act on impulses related to relationships; the libido is considered repressed in this stage.
Stage 5 - FREUD STAGES OF PSYCHOSEXUAL DEVELOPMENT
Stage 5: Genital
13 to 18 years old
The ego has become fully developed, and the child seeks independence. Lasting relationships are created and sexual desires are normal.
Hildegard Peplau - Theory of Interpersonal Relationships
Defines the nurse-client relationship as occurring in four distinct, overlapping phases
• Pre-Interaction, Orientation, Working, Termination
Interpersonal relationships and the therapeutic use of self are key in the nurse-client relationship for mental health nursing practice
John Watson - Behavioral Therapy
• Focus is on the observed behaviors of an individual, not the individuals unconscious mental state, as this cannot be observed
* Environment is a strong factor in shaping a child’s behavior.
If a child is not shown affection, love, or physical comfort, for example, the child will not display these features to others when growing up
Pavlov’s Classical Conditioning
Also known as associative learning, focuses on unconscious memory.
• Bell experiment with dogs (salivation)
• Positive use of adaptative coping mechanisms
What is Transtheoretical model of change
An integrative, biopsychosocial model to conceptualize the process of intentional behavior change. Part of motivational interviewing.
Transtheoretical model of change : Precontemplative Stage
Client lacks insight into their issue or demonstrates the defense mechanism of denial - aim to raise awareness of the positive and negative impact the clients current behaviors have on their life.
Transtheoretical model of change: Contemplative Stage
Client is ambivalent - aim to explore the positives and negatives of current and proposed behavior changes.
Transtheoretical model of change: Preparation Stage
Client demonstrating adjustments or minor changes to their current habits aim to identify the client’s current coping skills and possible support systems.
Transtheoretical model of change: Action Stage
Client experiencing changed behaviors - aim to help the client identify positive outcomes of making the behavior change and develop contingencies if planned coping or support systems fail.
Transtheoretical model of change: Maintenance Stage
Client feeling like the change is second nature and actively working to prevent relapse - aim to help the client identify triggers for relapses like people, places, or objects that are associated with the old behavior.
What is ACES?
Traumatic or negative events such as physical or emotional abuse and neglect, sexual abuse, and a dystunctional homelite that increase the risk for depression, anxiety, behavior, and substance use disorders.
Risk factors associated with ACES
ACES increase the risk for depression, anxiety, behavior, substance use disorders, and suicide.
They also limit the individuals success in school, the workplace, and in social relationships throughout their lifetime.
What is insight?
How you think about something
What is judgement?
The things you do because of how you think about something
What are the three intervention levels
Primary preventions
Secondary preventions
Tertiary preventions
What are the three intervention levels
Primary preventions
Secondary preventions
Tertiary preventions
Intervention Level 1: Primary Prevention
are focused on preventing mental health issues from emerging.
Teaching children about emotions
Providing information about mental well-being and self-care through pamphlets or via the internet
Being involved in political, policy, or programs that promote well-being, reduce stigma around mental health, or promote talking about mental health and illness
Intervention Level 2: Secondary Prevention
often called targeted solutions, as they focus on persons who may have characteristics or manifestations of the mental illness or are exposed to risk factors for developing a mental illness or are experiencing the disorder.
Screening for alcohol or substance use
Identifying individuals at high risk for developing a mental illness and providing supportive therapeutic care such as individuals exposed to trauma and persons with a debilitating chronic disease who is at greater risk for developing depression.
Mental health care for clients who are acutely experiencing a mental health crisis.
Intervention Level 3: Tertiary Prevention
provide resources and care for those experiencing mental health concerns to enhance their quality of life and reduce relapse.
Ensuring clients have a plan if clinical manifestations of the disorder return
Support groups or therapy groups for persons experiencing trauma, grief, or depression
Community programs for persons who have mental illnesses who lack housing or need assistance with medication management
Therapeutic Relationship and therapeutic communications
A nurse maintains a therapeutic relationship with a client by being an empathetic active listener, fostering a supportive environment, providing client-centered care, and seeing the client as a whole person.
Therapeutic Relationship
A nurse maintains a therapeutic relationship with a client by being an empathetic active listener, fostering a supportive environment, providing client-centered care, and seeing the client as a whole person.
A client is less likely to disclose information to the nurse it a client feels that they are in a rush or are judgmental or nonaccepting of them. It is vital that nurses approach a client in a nonreactive and nonjudgmental manner to maintain a therapeutic relationship
The Clinical Judgement Action Model (CJAM) Steps:
- Recognize cues
- Analyze cues
- Prioritize hypothesis
- Generate solutions
- Take action
- Evaluate outcomes
Humanistic Theory
Individual is studied or viewed as a whole
People are innately good
Individuals perceive the world based on their own experiences, which are then reflected in their personality and behaviors to meet self-actualization.
Human beings make choices and have a consciousness that allows them
to be aware of others and their responsibilities
Centered around the concept of human interest and value
DSM-5-TR Cultural Formation Interview (CFI) domains and questions: Domain 1
Domain 1: Cultural definition of the mental health concern
• Some people describe their concerns to their family, friends, or community in different ways. How would you describe your concem?
• What is most concerning to you?
DSM-5-TR Cultural Formation Interview (CFI) domains and questions:
Domain 2
Domain 2: Cultural perception of cause, context, and support
• Why do you think you are experiencing this? What do you think is the cause?
DSM-5-TR Cultural Formation Interview (CFI) domains and questions:
Domain 3
Domain 3: Cultural factors affecting self-coping and what worked in the past
• Is there any specific support for your concern that makes you feel better? (Include further inquiry to family, friends, or community members.)
• Sometimes aspects of a person’s background (the family or group the client identifies with can make the concern feel worse or better.
DSM-5-TR Cultural Formation Interview (CFI) domains and questions:
Domain 4
Domain 4: Cultural factors which affect currently seeking help
• Often people seek help or support from others such as doctors or healers. What kinds of help or treatments have you found useful?
• Is anything preventing you from getting the assistance you need?
• What kind of help or assistance would you find the most useful?
Bias Free Language
• Diversity: In a nursing context, this term refers to the qualities of a client that differs from that of the nurse.
• Equity: In a nursing context, this term refers to ensuring that the client has equal opportunity to initiate and continue fair treatment.
• Inclusion: In a nursing context, this term refers to placing value and respecting each person’s input in navigating care decisions.
> Describe at the Appropriate Level of Specificity
• Focus on relevant characteristics
• Acknowledge relevant differences that do exist (CF) o Be appropriately specific
Be Sensitive to Labels
• Acknowledge people’s humanity “how do you address yourself”
• Avoid false hierarchies - “normal”
Cultural competence
The skills, knowledge and attitudes necessary to function effectively in cross-cultural situations
