Intro to Psych Nursing Flashcards
Self-Stigma
Patient is aware of public’s negative view of mental illness, and agree with the public’s perception
Label Avoidance
Avoiding treatment or care in order not to be labeled as being mentally ill, is another type of stigma, and one of the reasons, that so few people with mental health problems actually receive help
Recovery
Journey of healing and transformation enabling the person with mental health problem to lead a meaningful life in community of choice while striving to achieve full potential
- Single most important goal
Acute Stress as it relates to Mental Illness
Acute stress can lead to physiologic overload, which in turn can have a negative impact on a person’s health
Chronic Stress as it relates to Mental Illness
Chronic stress is clearly associated with negative health incomes.
Person-Environment Relationship
Has to do with the interpersonal and psychosocial aspects of stress
It is the interaction between an individual and the environment that change throughout a stress experience. It is based on the values and beliefs people they carry with them in life, as well as personality factors and factors related to the individual’s social and physical environment.
Appraisal
A given event or situation may be extremely stressful to one person but not to another. The more important or meaningful the outcome, the more vulnerable the person is to stress. Appraisal is the process where all aspects are considered—the demands, constraints, and resources are balanced with personal goals and beliefs.
What two factors determine if a person experiences stress response?
- Person-Environment relationship
2. Appraisal
Person-Environment Relationship Personality Types
Types A, B, C, and D
Type A Personality
- Competitive
- Aggressive
- Ambitious
- Impatient
- Alert
- Tense
- Restless
Type B Personality
- Relaxed
- Easygoing
- Easily satisfied
Type C Personality
- Introverted
- Respectful
- Conforming
- Compliant
- Eager to please
Type D Personality
- Increased negative emotions
- Pessimism
- Non-sharing of emotions
Emotional Stress Responses
- Negative emotions
- Positive emotions
- Borderline emotions
- Nonemotions
Negative Emotions
An emotional stress response
- Occur when there is a threat to, delay in, or thwarting of a goal or a conflict between goals: anger, fright, anxiety, guilt, shame, sadness, envy, jealousy, and disgust
Positive Emotions
An emotional stress response
- Occur when there is movement toward or attainment of a goal: happiness, pride, relief, and love
Borderline Emotions
An emotional stress response
- Are somewhat ambiguous: hope, compassion, empathy, sympathy, and contentment
Nonemotions
An emotional stress response
- Connote emotional reactions but are too ambiguous to fit into any of the preceding categories: confidence, awe, confusion, and excitement
Coping
- Deliberate, planned, and psychological activity to manage stressful demands
- Positive coping leads to adaptation
- Teach patients how to adapt to stress
Adaptation
Person’s ability to survive and flourish.
The three important areas that adaptation effects
- Health
- Psychological well-being
- Social functioning
Human Response to Stress: Overall Goals
- Resolve stressful person-environment situations
- Reduce the stress response
- Develop positive coping skills
Human Response to Stress: Goals for those at risk for stress
- Recognize the potential for stressful situations
2. Strengthen positive coping skills
Assessment of the Biologic Domain of Mental Health
- Gender differences
- Review of systems
- Physical functioning
- Pharmacological assessment
Biologic Domain Assessment: Gender Differences
It is now known that people experience stress differently depending on their gender. Whereas males are more likely to respond to stress with a fight or flight response, females have less aggressive responses; they “tend and befriend.”
Biologic Domain Assessment: Review of Systems
A systems review can elicit the person’s own unique physiologic response to stress and can also provide important data on the effect of chronic illnesses
Biologic Domain Assessment: Physical Functioning
Typically, sleep is disturbed, appetite either increases or decreases, body weight fluctuates, and sexual activity changes. Physical appearance may be uncharacteristically disheveled—a projection of the person’s feelings. Body language expresses muscle tension, which conveys a state of anxiety not usually present. Because exercise is an important strategy in stress reduction, the nurse should assess the amount of physical activity, tolerance for exercise, and usual exercise patterns
Biologic Domain Assessment: Pharmacologic Assessment
In assessing a person’s coping strategies, the nurse needs to ask about the use of alcohol, tobacco, marijuana, and any other addictive substances. If a psychiatric disorder is present, the nurse should assess medication compliance, especially if the psychiatric symptoms are reappearing
Nursing Interventions for the Biologic Domain of Mental Health
- Activities of daily living
- Nutrition
- Exercise
- Relaxation techniques
- Referral for hypnosis or biofeedback
Assessment of the Psychological Domain of Mental Health
- Emotions and their severity
- How the person reacts to emotions
- Coping Strategies
Two types of Coping Strategies
- Problem focused
2. Emotion focused
Problem Focused Coping Strategy
In problem-focused coping, the person attacks the source of stress and solves the problem (eliminating it or changing its effects), which changes the person–environment relationship.
Problem or Emotion Focused Coping?
When noise from the television interrupts a student’s studying and causes the student to be stressed, the student turns off the television and eliminates the noise.
Problem Focused
Problem or Emotion Focused Coping?
An abused spouse is finally able to leave her husband because she realizes that the abuse will not stop even though he promises never to hit her again
Problem Focused
Problem or Emotion Focused Coping?
A husband is adamantly opposed to visiting his wife’s relatives because they keep dogs in their house. Even though the dogs are well cared for, their presence in the relative’s home violates his need for an orderly, clean house and causes the husband sufficient stress that he copes with by refusing to visit. This becomes a source of marital conflict. One holiday, the husband is given a puppy and immediately becomes attached to the dog, who soon becomes a valued family member. The husband then begins to view his wife’s relatives differently and willingly visits their house more often
Emotion Focused
Problem or Emotion Focused Coping?
A mother is afraid that her teenage daughter has been in an accident because she did not come home after a party. Then the woman remembers that she gave her daughter permission to stay at a friend’s house. She immediately feels better
Emotion Focused
Nursing Interventions for the Psychological Domain of Mental Health
- Assist patients to develop appropriate problem-solving strategies
- Have the patient discuss the person-environment situation and develop alternative coping strategies
Assessment of the Social Domain of Mental Health
- Recent life changes
- Social network
- Size and extent of the network
- Functions that the network serves
- Degree of reciprocity between the patient and other network members
- Degree of interconnectedness
Nursing Interventions of the Social Domain of Mental Health
- Facilitation of family functioning
- Assistance in expanding social network
- Support of family unit functioning
- Parent education
- Family therapy
Compensation
Allows a person to overcome weakness and achieve success
Denial
Refusing to acknowledge some painful aspect of external reality or subjective experience that would be apparent to others
Displacement
Transferring a feeling about, or a response to, one object onto another (usually less threatening), substitute object
Identification
Helps a person avoid self-devaluation; attempt to increase self-worth by acquiring certain attributes of an individual one admires
Intellectualization
Helps protect a person from pain and traumatic events; attempt to avoid expressing actual emotions associated with a stressful situation by using logic, reasoning, and analysis
Introjection
Internalization of the beliefs and values of another individual such that they symbolically become a part of the self to the extent that the feeling of separateness or distinctness is lost
Isolation
Separation of ideas from the feelings originally associated with them
Minimization
Allows a person to decrease responsibility for own behavior; not acknowledging the significance of one’s own behavior
Projection
Allows a person to deny the existence of shortcomings and mistakes; protects self image
Rationalization
Helps a person cope with the inability to meet goals or certain standards; attempting to make excuses to formulate logical reasons to justify unacceptable feelings or behaviors
Reaction Formation
Aids in reinforcing repression by allowing feelings to be acted out in a more acceptable way; substituting behavior that is diametrically opposed to one’s own unacceptable thoughts or feelings
Regression
Allows a person to return to a point in development when nurturing and dependency were needed and accepted with comfort
Repression
Protects a person from a traumatic experience until he/she has the resources to cope; an unconscious mechanism by which threatening thoughts, feelings, and desires are kept from becoming conscious
Sublimation
Protects a person from behaving in an irrational, impulsive way; Channeling potentially maladaptive feelings or impulses into socially acceptable behavior
Supression
Intentionally avoiding thinking about disturbing problems, wishes, feelings, or experiences
Substitution
Helps a person achieve goals and minimizes frustration and disappointment
Undoing
Allows a person to appease guilty feelings and atone for mistakes
A high school student too small to play football becomes the star long distance runner for the track team
Compensation
A man whose brother is in ICU spends his time speaking to the nursing staff about his condition and treatment plan instead of visiting with his brother
Intellectualization
A father spanks his child and the next evening brings home a present for him
Undoing
A person with excessive, primitive sexual drives invests psychic energy into a well-defined religious value system
Sublimation
An adult throws a temper tantrum when he does not get his way
Regression
A woman drinks alcohol every day and cannot stop, failing to acknowledge she has a problem
Denial
A physically challenged young man who is unable to participate in sports compensates by becoming a great scholar
Compensation
A person says “don’t believe everything my wife tells you. I wasn’t so drunk that I couldn’t drive”
Minimization
An executive resents his boss for calling in a consulting firm to make recommendations for change in his department but verbalizes complete support of the idea and is exceedingly polite and cooperative
Reaction Formation
A woman wants to marry a man exactly like her dead father and settles for someone who looks a bit like him
Substitution
A man is rejected by his girlfriend, but explains to his friends that her leaving was best because she was beneath him socially and would not be liked by his family
Rationalization
A husband and wife are fighting, and the husband becomes so angry he hits a door instead of his wife
Displacement
A psychiatric client claims to be the Son of God, drapes himself in a sheet and blanket, performs miracles on the other clients and refuses to respond unless addressed as Jesus
Introjection
Scarlett O’Hara says “I don’t want to think about that now. I’ll think about that tomorrow.”
Suppression
A mother spanks her child too hard and says it was all right because he couldn’t feel it through his diapers anyway
Rationalization
A woman loses touch with the feelings associated with a rape while remaining aware of the details
Isolation
A student nurse imitates the nurturing behavior she observes one of her instructors using with clients
Identification
A teenager’s best friend moves away, but the adolescent says he does not feel sad
Denial
A woman does not remember the experience of being raped in the basement, but does feel anxious when going into that house
Repression
A teenage with strong competitive and aggressive drives becomes the star football player on his high school team
Sublimation
A teacher writes an easy examination, and then constructs a grading curve that makes it difficult to earn a high grade
Undoing
A mother is told that her child must repeat a grade in school and she blames this on the teacher’s poor instructions
Projection
A person says “I didn’t try to kill myself; I just took some pills because my head hurt”
Minimization
A 7 year old tells his little sister “don’t talk to strangers.” He was told this by his teachers and parents
Introjection
A teenage who required lengthy rehabilitation after an accident decides to become a physical therapist
Identification
A teenager, seeing his best friend killed in a car accident, becomes amnesic about the circumstances surrounding the accident
Repression
A student is anxiously awaiting test results but goes to a movie to stop thinking about it
Suppression
A wife finds out about her husband’s extramarital affairs and tells her friends that she thinks his affairs are perfectly appropriate
Reaction Formation
A child is mad at her mother for leaving her for the day, but says she is really mad at the sitter for serving her food she does not like
Displacement
A college professor’s fiancee breaks the engagement. He shows no remorse, but instead tries to analyze the situation and figure out why she broke off the engagement
Intellectualization
A critically ill patient allows the nurse to bathe and feed him
Regression
A husband forgets to pay a bill and blames his wife for not giving it to him earlier
Projection
Self-Determinism
- The right to choose one’s own health-related behaviors
- Could possibly be different from those recommended by health professionals
- A basic and fundamental psychological need
- *A self-determined individual is internally motivated to make choices based on personal goals, not to please others or to be rewarded. That is, a person engages in activities that are interesting, challenging, pleasing, exciting, or fun, requiring no rewards other than the positive feelings that accompany them because of inner goals, needs, drives or preferences
Two key values of self-determinism
- Personal autonomy
2. Avoidance of dependence on others
The Patient Self-Determination Act
Requires that agencies receiving Medicare or Medicaid reimbursement to inform patients at the time of reimbursement to inform patients at eh time of admission of their right to be a central part of any and all health care decisions made about them or for them
Psychiatric Advance Directives
Allow patients, while competent, to document their choices of treatment and care
Competency
It is generally agreed thatcompetence, or the degree to which the patient can understand and appreciate the information given during the consent process, refers to a patient’s cognitive ability to process information at a specific time. A patient may be competent to make a treatment decision at one time and not be competent at another time. Competence is also decision specific, so that a patient may be competent to decide on a simple treatment with a relatively clear consequence but may not be competent to decide about a treatment with a complex set of outcomes. A competent patient can refuse any aspect of the treatment plan
** Competence is necessary to give consent
How to determine competency
During the assessment, can they…
- Communicate choices
- Understand relevant information
- Appreciate situation and consequences
- Use a logical thought process to compare risks and benefits of treatment options
Least Restrictive Environment
- A person cannot be restricted to an institution when he or she can be successfully treated in the community
- Medication cannot be given unnecessarily
- Use of restraints or locked room only if all other “less restrictive” interventions have been tried first
First line of restraints/seclusion
Verbal = its almost like a warning
Second line of restraints/seclusion
Chemical intervention = medications
Third line of restraints/seclusion
Physical/mechanical interventions = last resort
When can you restrain or seclude a patient?
- Their behavior is harmful to themselves or 3rd party
- Least restrictive measures are insufficient to protect patient/others from harm
- Decrease in sensory overstimulation (seclusion only) is needed
- When the patient anticipates that a controlled environment would be helpful and requests it
When can you NOT seclude a patient?
- Extremely unstable medical/psychiatric conditions without direct observation
- Delirium or dementia without direct observation
- Severe drug reactions or overdoses
- Desire for punishment or convenience of staff
Types of Committment
- Voluntary
2. Involuntary
Voluntary Committment
- Person retains full civil rights
- Free to leave at any time, even against medical advice
Involuntary Committment
- Court ordered
- Without the patient’s consent
The three common elements of involuntary committment
The patient must be…
- Mentally disordered
- Dangerous to self or others
- Unable to provide for basic needs
Mandates to Inform
- A legal obligation to breach confidentiality
- Judgement that the patient has harmed someone or is about to injure someone
Assault
Threat of unlawful force to inflict bodily injury upon another. An assault must be imminent and cause reasonable apprehension in the individual
Battery
The intentional and unpermitted contact with another
Medical Battery
Intentional and unauthorized harmful or offensive contact, occurs when a patient is treated without informed consent. For example, a clinician who fails to obtain consent before performing a procedure is subject to being accused of medical battery. Also, failure to respect a patient’s advance directives is considered medical battery
False Imprisonment
The detention or imprisonment contrary to provision of the law. Facilities that do not discharge voluntarily committed patients upon request can be subject to this type of litigation.
Negligence
Breach of duty of reasonable care for a patient for whom a nurse is responsible that results in personal injuries. A clinician who does get consent but does not disclose the nature of the procedure and the risks involved is subject to a negligence claim
Autonomy
- Respecting the the rights of others to make their own decisions
- Each person has the right to self-determination
Beneficence
- Relates to the quality of doing good and can be described as charity
- Example: spending extra time to help calm an extremely anxious patient
Justice
- The duty to treat all fairly
- Example: the ICU nurse devotes an equal amount of time to a patient who has AIDS as to the VIP who is there for a CABG
Nonmaleficence
- Requirement that health care providers do no harm to their patients, either intentional or unintentional
- Maintain loyalty and commitment to the patient
- Examples: Maintain expert nursing skill throughout nursing education; A nurse stays after her shift to comfort a bipolar patient that learned his mother has died
Paternalism
- The belief that knowledge and education authorize professionals to make decisions for the good of the patient
- This principle can be in direct conflict with the mental health recovery belief of self-determinism
- Example: mandatory use of seat belts
Veracity
- The duty to communicate truthfully
- Limitations may be placed on this principle when knowing the truth would produce harm or interfere with the recovery process
- Lying is never justified
- Examples: The nurse describes the purpose and side effects of psychotropic medications in a truthful and non-misleading way
Fidelity
- Faithfulness to obligations and duties
- Keeping promises
- Important in establishing trusting relationships
