Normalcy Flashcards
Normalcy: DEFINITION
The promotion of human functioning and development
within social groups in accord with human potential,
known human limitations, and the human desire to be
normal.
person’s normalcy will affect how they react to illness
The Nurse’s Effect on the Client’s Self-Concept/ Sense of normalcy?
Nurses need to remain aware of their own feelings, ideas, values, expectations, and judgements.
Use a positive and matter-of-fact approach.
Build a trusting relationship.
Be aware of facial and body expressions.
TWO (2) ESSENTIAL PRINCIPLES IN ESTABLISHING A
TRUSTING RELATIONSHIP?
1. Apply therapeutic communication techniques: Maintain appropriate eye contact* Maintain neutral facial expression Listen actively & attentively Use therapeutic communication responses
- Consider concepts you learned in the Values Lab:
Maintain confidentiality
Awareness of your own values, biases and discomforts
Consider whether the patients behavior is related to culture
Assessment Guidelines?
Minimize interruptions
Create a quiet private environment
Use attending behaviors (What are these??)
Listen and attend the patients concerns
Remain non-judgemental (verbal and non-verbal)
Ask open ended relevant questions
Be culturally sensitive
Maintain confidentiality
Obtain permission to document data as well as in seeking further information from others
Observations during Assessment?
General appearance:
Facial expression
Hygiene
Grooming/dress
Nonverbal/Verbal behavior:
Body posture
Eye contact
Language, Tone, Volume
Self-Concept?
cognitive component of the self system
collection of notions, beliefs and feelings about ourselves
“How I see myself”
Is the mental image that one has of oneself
Is a composite of ideas, feelings, and attitudes that a person has about his or her own identity, worth, strengths, and limitations
Comprises social, emotional, physical, academic domains
Affects how a person adapts to challenges, difficult situations, and relationships
BCFs that impact Self Concept?
Age and Developmental Stage
Sociocultural orientation: Education, Religious/Cultural factors
Patterns of Living: Internal and external resources Life experiences Methods of coping (with Stressors?) Successful or maladaptive responses
Health Care System Factors: Current medical Diagnosis
Nursing Knowledge Base: Development of Self-Concept?
Development of self-concept is a lifelong process.
Erikson’s theory of psychosocial development (1963)
This theory is helpful in understanding key tasks.
Each stage builds on tasks of the previous stage.
Successful mastery leads to a sense of self.
The Family’s Effect on Development of Self-Concept?
Family plays a key role.
Attachment theory (Bowlby,1982) emphasizes the quality of the attachment children have with their caregivers.
Children develop a basic sense from family.
Strong parental support and parental monitoring create positive effects.
Family and cultural influences can be positive or negative.
Behaviours suggestive of altered self concept?
Avoidance of eye contact Slumped posture Unkempt appearance Being overly apologetic Hesitant speech Being overly critical or angry Frequent or inappropriate crying Negative self evaluation Being excessively dependent Potter: box 25-7 p406
Personal Identity: Definition?
Conscious sense of individuality and uniqueness that is evolving throughout life
What distinguishes yourself from others
Identity Stressors?
- Decline in physical, mental, sensory abilities,
- Unrealistic ideal self,
- Inability to achieve goals
- Relationship concerns
- Sexuality concerns
- Change in physical appearance i.e wrinkles, graying hair
- Confusion regarding sense of self, purpose in life
Personal Identity: Assessment?
Subjective data:
Are the words or the general feeling of the responses negative or positive?
Listen to HOW the patient describes themselves.
Might have difficulty making decisions
Maintain positive self-identity by?
setting small achievable goals
developing strategies to cope with self concept
Body Image: Definition?
Involves attitudes related to the body, including physical appearance, structure or function
Potter p399
Not always consistent with actual appearance
Includes the knowledge of the body and its attachments
Body Image Stressors?
- change in appearance
- Loss of body parts,
- Disfigurement,
- Loss of body functions,
- Unrealistic body ideal
Assessing Body Image?
Inspect/observe the following:
Will the patient experience a change in body structure or function?
Does the patient look at, touch or hide the affected body part?
Does the patient avoid social situations?
Does the patient willingly engage in self-care?
Include in your assessment: Functional significance of the part involved. Importance of physical appearance. Visibility of the body part. Meaning the person attaches to the part.
Assessing Body Image questions?
What do you like most/least about your body?
What parts of your body are most important to you?
Is there anything about your appearance that you would like to change?
What do you understand about your health problem?
What limitations do you think will result?
What changes in your body do you expect following your surgery
How have significant others in your life reacted to changes in your body?
Do you feel different or inferior to others?
Promote a positive body image by:?
setting realistic short term goals
involving in self care
seeking appropriate support system
Role Performance?
Definition: How an individual fulfills the expected duties of a particular role.
Way they perceive their ability to carry out the role
Sets of socially expected behavior patterns associated with an individual’s function in various social groups
Transitional
Roles are easily compromised during illness
Role Ambiguity?
occurs when people are unclear of role responsibilities and do not know what to do or how to do it and are unable to predict the reactions of others to their behaviour
Role Strain
occurs when people feel or are made to feel inadequate or unsuited to a role.
Role Conflicts?
arise from opposing or incompatible expectations of a role or position
- Interpersonal Conflicts - Interrole Conflicts - Person-role Conflicts
Role Overload?
Stress of multiple obligations and an inability to perform well in all roles.
Results in a loss of role?
Hospitalization/Illness
Role Stressors?
- Divorce,
- Illness,
- Loss of significant other,
- Inability to meet role expectations,
- Loss or change in job,
- Ambiguous or conflicting role expectations
Altered roles performance?
When one experiences a change, conflict or denial of role responsibilities or inability to perform role responsibilities
- inability to perform new or usual roles
- lack of knowledge or difficulty in learning about role
- different perception of role
Confusion or frustration about role performance
Changes in usual patterns of responsibilities
Change in physical ability to perform role
Roles: Assessment?
Will the patient experience a change in ability to perform role responsibilities related to hospitalization/illness?
Does the patient exhibit a lack of knowledge about or inability to learn a new role?
Maintain or promote role performance by?
discussing new roles
expressing feelings about role loss
Self-Esteem?
a person’s judgement of their own self worth, how their standards compare with those of others and with their ideal self
How Self-Esteem Develops?
Significant others (ie family)
Social role expectations
Completion of expected tasks at different stages of development
Questions to Assess self-Esteem?
Are you satisfied with your life?
How do you feel about yourself?
Are you accomplishing what you want?
What goals in life are important to you?
Self-Esteem: Assessment?
Does the client exhibit any of the following:
Self-negating verbalizations
Expressions of shame or guilt
Evaluates self as unable to deal with events
Rationalizes away or rejects positive feedback and exaggerates negative feedback about self
Unable to set goals
Lack of or poor problem-solving ability
Inability to engage in self-care
Overly critical of self or others
Avoids eye contact
Stooped or poor posture
Movements are slow
Poor hygiene, un-kempt appearance
Apologizes frequently
Verbalizes feeling hopeless, helplessness, powerlessness
Social withdrawal
Avoidance of new situations
Verbalizations of or behaviours indicating lack of self-confidence
Strategies to promote positive Self-Concept and Increase Self-Esteem?
Identifying areas of strength by: Emphasize positive thinking Awareness & verbally reinforcing patient’s strengths Setting realistic & attainable goals Acknowledge goals that have been met Provide honest, positive
Increase confidence or promote self-esteem by
not focusing on past
choosing activities that you like to do
When caring for children or adolescents who have not achieved an age-appropriate developmental stage, the nurse understands that they may do which of the following?
Remain unchanged during illness or crisis.
*Regress to an earlier stage during illness or crisis.
Recognize that they have an illness or crisis.
Proceed as though nothing has changed in their lives.
The nurse is caring for an adolescent client who has undergone six months of a diet and exercise program, supervised by a nurse practitioner. This adolescent tells the nurse, “There is still a fat person inside of me.” Which element of self-concept does this type of statement illustrate is flawed?
Identity
Self-esteem
*Body image
Role performance
Having a positive self-concept is most likely to results when an individual has which of the following?
High self-esteem and a positive racial identity
*High self-esteem and a supportive family
High self-esteem and a supportive community
High self-esteem and access to higher education
Mrs. McIntosh is a 72-year-old woman whose husband of 50 years recently died. She had been his primary caregiver. Since her husband’s death three months ago, she has lost 10 kg as a result of her lack of interest in food. She tells her daughter that she feels “so heavy and tired all of the time.” Mrs. McIntosh, once vivacious and very active, now confesses that she has trouble getting out of bed in the morning and feels she doesn’t have much purpose in life because she no longer needs to care for Mr. McIntosh.
Mrs. McIntosh’s daughter brings Mrs. McIntosh to the behavioral health clinic for assistance. Walter is the nursing student assigned to her. He takes a patient history and asks her several questions about her mood and recent habits.
Mrs. McIntosh no longer has to care for Mr. McIntosh. Because of this, she is most likely experiencing which of the following?
A.* Role performance stressor
B. Body image disturbance
C. Identity attainment
D. Self-esteem freedom
Mrs. McIntosh displays signs of altered self-concept during the patient interview with Walter. What are the signs of altered self-concept? (Select all that apply.)
A. *Avoidance of eye contact B. *Lack of interest C. *Difficulty in making a decision D. Rapid speech E. *Unkempt appearance
collect: family system factors, current medical problems
is in later years; ego integrity vs despair
Ask: how would you describe yourself right now?
how are you coping?
how has this affected you?
A&D for mrs macintosh?
promote a positive self-concept in a 72 year old woman who is experiencing role performance alterations, self-identity disturbance and situational stressors secondary to the loss of her husband by:
setting small achievable goals express grief/anger of loss attend grieving groups join social group focus on new role pick up a hobby
Stress?
Response to any demand (physical or emotional) made upon the body (Seyle).
Experiences changes to the normal balanced state.
General Adaptation Syndrome A three-stage reaction to stress?
Alarm reaction: fight/flight
Resistance stage
Exhaustion stage: body is alert but starts seeing signs of wear and tear
Psychological Conceptualizations?
Primary appraisal
Identification
Secondary appraisal
Coping strategies
psychological indicators of stress: anxiety, irritability, depression
The nurse working in the university’s student health centre is assessing an athlete who has just fallen and has been injured. When assessing the patient, the nurse takes into consideration the general adaptation syndrome. What symptom will the athlete be exhibiting?
An increased appetite
*An increased heart rate
A decrease in perspiration
A decreased respiratory rate
Sources of Stress?
Internal: inside body
External: outside body
Developmental/ maturational: happens during lifespan
Situational: arises from an external event
gender can be a stressor due to different gender roles
Situational, Maturational, and Sociocultural Factors
Situational factors
Arise from job changes, illness, caregiver stress
Maturational factors
Vary with life stages
Sociocultural factors
Environmental and social stressors perceived by children, adolescents, and adults
Types of Stress?
Distress: mental/physical problems
Damaging stress: anxiety, concern, loss of sleep
Eustress: good stress
Stress that protects health: stress linked to happiness (having a baby)
A patient comes into the emergency department complaining of chest pain. When discussing possible reasons why the chest pain has occurred, the nurse learns that the patient is depressed because he has lost his job. How can this type of crisis be classified?
*Situational
Maturational
Sociocultural
Post-traumatic
Effects of Stress: Emotional ?
Anxiety Fear Anger Depression Ego Defense Mechanisms: denial, compensation, repression, projection, rationalization
Stress: Assessment
Subjective data:
What has caused you to feel stress in the past?
What do you do to feel better when you are anxious?
Objective data:
Observe non-verbal behaviors of patient
Observe for physiological responses to stress (sweating, anxiety, talking fast)
Coping?
Definition: Cognitive and behavioral effort to manage external or internal demands that are appraised as taxing or exceeding the resources of the person
Factors that impact Coping?
Past experiences
Amount, duration & intensity of the stressor
Support systems available
Personal qualities of the individual/patient
Coping Strategies: Categories
Problem-focused versus emotion-focused (how they deal with the problem vs how they are expressing their emotions)
Short-term versus long-term (emotional focus for short term)
Maladaptive versus adaptive (smoking, drinking)
Health promotion/ prevention of stress (exercise, diet, sleeping)
Primary modes of intervention
Decrease stress producing situations Increase resistance to stress Learn skills to reduce physiological and psychological responses to stress Regular exercise Support systems Time management Guided imagery/ visualization Progressive muscle relaxation Assertiveness training Journal writing
Which of the following scenarios is an example of an effective method for coping with a stressful nursing experience?
Having a glass of wine
Going to sleep for 8 hours
*Journalling the experience
Forgetting about the day
Increase effective coping by:
developing realistic goals
verbalizing stressful events
Sexuality
Vital elements to the wholeness that we feel as human beings
``Central aspect of being human throughout life and encompasses sex, gender, identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction`
Sexual and Gender Identity?
Sexual identity
The objective labelling of a person as male or female
Variations occurring in genitalia, gonads, chromosomes, or hormones
Gender identity
The degree to which a person identifies as male, female, or some combination
Usually consistent with physical sex at birth
Transsexuality
Sexual Orientation
The predominant gender preference of a person’s sexual attraction over time
Heterosexuality
Homosexuality
Bisexuality
BCFs impacting Sexuality?
Sociocultural orientation Religion Culture Family System Patterns Health Care System Factors Developmental stage
Sexual Development?
Sexuality changes with each stage of development. Infancy and childhood Puberty and adolescence Adulthood Older adulthood
In order to be effective in integrating sexual health care into everyday practice, what must nurses do?
Be sexually active in their own lives.
*Be aware of their own values and beliefs.
Be aware of the sexual practices of the community.
Be aware of the cultural practices of the clients.
Sexuality: Assessment?
Thorough health history Thorough physical exam Self-Care Practices: High risk sexual behaviours Use of condoms Understanding of safe sex practices
Which of the following statement is true about older adults?
They do not engage in sexual activity as they age.
They should expect a decreased interest in sexual activity.
They only engage in romance and demonstrations of affection.
They can, and do, remain sexually active as they age.
What should nurses focus on when gathering a client’s sexual history upon admission?
Focus only on physical factors that affect sexual functioning.
Discuss sexual concerns only if the client raises questions or concerns.
Use emotionally laden terms when discussing sexual concepts.
*Include questions related to sexual function.
Maintain, restore or improve individual sexuality by:
engaging in activities to identify own sexuality
seeking accurate information about sexual health problems
Defining Spirituality?
Pertains to an individual’s relationship with a non-material life force of a higher power Spirituality may be expressed through: Organized religion Faith Beliefs and practices
spirituality (relationship with nature) is not the same as religion (relationship with higher power)
BCFs that impact Spirituality?
Developmental state Sociocultural orientation: Culture Organized religion Patterns of Living: Methods of Coping
Spiritual Health
Caring for the whole person
Accepting beliefs and experiences
Helping with issues surrounding meaning and hope
spiritual health: caring for yourself, accepting other’s beliefs/experiences
Spirituality in Health and Illness?
Source of support Source of strength and healing Source of conflict Guide to daily living habits Spiritual needs may increase as health declines.
To holistically care for patients, nurses must understand the difference between religion and spirituality. How does religious care help patients?
*It maintains their belief systems and worship practices.
It helps them develop a relationship with a higher being or life force.
It establishes a cultural connectedness with the purpose of life.
It achieves the balance needed to maintain health and well-being.
What is the best action a nurse can take in order to assess, evaluate, and support a patient’s spirituality?
Assist the patient to use faith in order to get well.
Refer the patient to the health care facility chaplain.
Provide the patient with a variety of religious literature.
*Determine the patient’s perceptions and belief system.
Spirituality: Assessment
Spiritual beliefs & usual practices Spiritual needs while in hospital Source of strength during difficult periods Spiritual conflict Patient’s dress Patient’s diet Presence of spiritual or religious objects at the patient’s bedside Patient’s verbalizations
Spiritual Distress: Definition
Disruption of individual’s belief or value system that provides strength, hope and meaning to life
Goals for Guiding Spiritual Conversations?
Invite patients to share spiritual beliefs and values.
Learn about those beliefs and values.
Open an opportunity for compassionate care.
Empower patients to draw on their resources for healing and acceptance.
Identify practices and beliefs that are important for the plan of care.
Identify those patients who would benefit from a referral to a spiritual care provider.
Providing Spiritual Care
An altruistic, relational, intuitive, and integrative process; seeking to understand and reflect the patient’s spiritual values, beliefs, and experiences
Perceived barriers to spiritual care
Perceived time constraint
Lack of knowledge of the issues
Lack of confidence about spiritual conversations
Challenges in articulating spirituality
Uncertainty as to what spiritual care entails
Multiplicity of beliefs, ideologies, religions, philosophies
Maintain, restore or improve individual spirituality by:
engaging in activities to enhance spirituality
. You are caring for Mrs. Wylie (age 60 years old), who is admitted to hospital for surgery. During her admission interview, she tells you that she and her husband of 30 years are getting a divorce. Mrs. Wylie states:
“I have been Mrs. Wylie for so long, almost 30 years. I don’t know how I’ll react when the divorce is final and I go back to being Ms. Adams.”
Identify which of the four (4) components of self-concept that Mrs. Wylie maybe having difficulty with.
Disturbance in self-esteem
Altered role performance
*Disturbance in identity
Body Image disturbance
You are caring for a patient whom you have hypothesized has a disturbance in self-esteem.
Identify two pieces of objective data that you could collect in order to validate your hypothesis.
not making appropriate eye contact
slumped posture
You are a student who is juggling multiple responsibilities at home, school and work. Which of the following are you most likely to experience?
Role ambiguity
Role performance
*Role overload
Provide an example of how hospitalization and illness can affect a patient’s ability to perform their roles.
can’t work/take care of themselves or family
You are preparing to assist your patient who has a new colostomy with hygiene care. Your patient tells you to Go away and leave me alone. Why bother, I am useless to everyone now. Identify two self-concepts the patient
self-esteem
body image
The nurse is performing a dressing change on his/her patient. Identify two (2) pieces of objective data that would indicate the patient is experience body image disturbance.
try and hide it
facial expression
not touching body part
