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NURS 419 > Quiz #1: Theories & Therapies for Nursing Practice/Therapeutic Nurse-Patient Relationship/Legal & Ethics > Flashcards

Quiz #1: Theories & Therapies for Nursing Practice/Therapeutic Nurse-Patient Relationship/Legal & Ethics Flashcards

1
Q

What are the types of admissions to psychiatric hospitals?

A
  1. Voluntary

2. Involuntary

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2
Q

Voluntary Admissions

A
  • Patient applies for admission to the facility
  • If < 18 y.o. parent/legal guardian may apply
  • Patient retains all civil rights, including right to vote, have a driver’s license, buy and sell property, manage personal affairs, hold office, practice a profession and engage in a business
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3
Q

Involuntary Admissions

A
  • Admission without patient’s consent
  • Dangerous to self or others and/or unable to provide for own basic needs
  • Can be initiated by HCP, family, police with the purpose of keeping pt and people around them safe
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4
Q

What is a Legal 2000 Hold in Nevada?

A
  • Involuntarily admitted -> usually after 48H will determine if psych or drunk (e.g.)
  • Now they are having psych NP in ER to help take off legal 2000 and discharge the patients if they don’t actually have a psych issue.
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5
Q

Legal 2000 Hold in Nevada affects the patients right to:

A
  • Communicate with people outside the hospital
  • Keep personal effects
  • Enter into contractual relationship
  • Education
  • Habeas Corpus
  • Privacy—HIPAA
  • Informed consent
  • Treatment
  • Refuse treatment– Forcing medications (can refuse)
  • Treatment in the least restrictive setting
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6
Q

Legal and Ethics: Incompetency

A
  • Every adult is assumed to be mentally competent, meaning mentally able to carry out personal affairs
  • To prove otherwise requires a court hearing
  • If ruled incompetent, a person cannot vote, marry, drive or make contracts.
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7
Q

In order for a patient to be considered incompetent, they must show:

A
  • Person has a mental disorder
  • Disorder causes a defect in judgment
  • Defect makes person incapable of handling personal affair
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8
Q

Sigmund Freud?

A 
Personality Structures
Levels of awareness
Levels of Anxiety
Defense mechanisms
Stages of Psychosexual development
Talk therapy
Dream
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9
Q

Consciousness

A

Awareness in:

  • Time (present time, what’s happening now!)
  • Perceptions
  • Thoughts
  • Fantasies
  • Memories and feelings
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10
Q

Preconsciousness

A

Easily can be retrieved through conscious efforts

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11
Q

Unconscious

A
  • Repressed memories, passion, unacceptable urges, trauma, effect the feelings; need help to retrieve it.
  • Unable to retrieve without help from professional. (Mind represses so you can’t remember because it brings the trauma or experience that comes with it)
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12
Q

Personality Structure: Freud believed there were 3

A
  1. ID
  2. Ego
  3. Super Ego
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13
Q

Personality Structure: ID

A
  • Characterized by drive, instinct and reflexes

- Cannot tolerate frustration, seeks to discharge tension and operates in pleasure.

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14
Q

Personality Structure: Ego

A

-Described as a problem solver and reality tester.
-Negotiates with the world
-Reality principle
(In psych, we want the EGO reality more prominent than ID and superego.)

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15
Q

Personality Structure: Super Ego

A
  • Moral component
  • Conscience
  • Operates in ideal
  • Seeks perfections
  • Inhibitory
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16
Q

Anxiety

A
  • Inevitable part of living

- Damage of self and d/t insecurities, threats and threats to satisfaction.

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17
Q

Defense Mechanisms of Anxiety

A
  • Ward anxiety off

- Operate on unconscious mostly, it denies, falsifies and distorts reality to decrease threat.

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18
Q

Psychosocial Stages of Development

A
  1. Oral Stage (0-1 years)
  2. Anal Stage (1-3 years)
  3. Phalic/Oedipal (3-6 years)
  4. Latency (6-12 years)
  5. Genital (12 and beyond)
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19
Q

Psychosexual Stages of Development: Oral Stage

A
  • Satisfied orally.

- Age where ID and pleasure is the biggest.

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20
Q

Psychosexual Stages of Development: Anal Stage

A
  • ID personality still present. Relief of discomfort identifies pleasure. Super ego may begin to develop (if restrictions are present).
  • Defecation. Baby is able to exercise control.
  • Best time for toilet training.
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21
Q

Psychosexual Stages of Development: Phalic/Oedipal

A
  • Identity starts to develop (male and female role develops)
  • Masturbation happens in this stage (expression of difference between male and female) pleasure is there.
  • Conflict, oedipal and electra complex may develop.
22
Q

Conflict Complex

A

Castration complex (sex organ becomes an identity of comfort)

23
Q

Oedipal Complex

A

Boy has special attraction (not sexually) to mother

24
Q

Electra complex

A

Special attraction (not sexual) to father)

25
Q

Psychosexual Stages of Development: Latency

A
  • Nothing significant/sexual
  • Continues to grow
  • Focused on interacting with the environment
26
Q

Psychosexual Stages of Development: Genital

A
  • Puberty and adolescence (time for more awareness for sexual pleasure and role of person sexual interest)
  • **Important because person develops trust during oral stage. Control in anal stage and role in phalic stage. (They use all this in order to form meaningful relationship)
27
Q

Erickson’s Psychosocial Theory includes

A
  1. Infancy (0-1.5 years) - Trust versus Mistrust
  2. Toddler/Early Childhood (1.5-3 years) - Autonomy versus Shame and Doubt
  3. Preschool (3-6 years) - Initiative versus Guilt
  4. School Age (6-12 years) - Industry versus Inferiority
  5. Adolescent (12-20) - Identity versus Role Confusion
  6. Early Adulthood (20-35 years) - Intimacy versus Isolation
  7. Middle Adulthood (35-65) Generativity versus Stagnation
  8. Late Adulthood (65-Death) Ego Integrity versus Despair
28
Q

Trust versus Mistrust

A

Trust developed by satisfying the need otherwise, mistrust develops.

29
Q

Autonomy versus Shame and Doubt

A
  • Autonomy: In this stage, caregivers often serve as a safe base from which to explore the world. When caregivers encourage independence, children will feel secure enough to take risks.
  • Shame: Children whose caregivers discourage them may develop feelings of shame. If caregivers foster excessive dependence, the child may learn to doubt their own abilities.
30
Q

Initiative versus Guilt

A

Preschoolers are increasingly focused on doing things themselves and establishing their own goals.

  • Initiative: When caregivers nurture these tendencies, children learn how to make decisions and plan for the future. They can grow into adults who are able to follow their ambitions.
  • Guilt: If children are criticized for being assertive, they may feel guilt for pursuing their desires. Controlling caregivers may teach children to follow another’s lead rather than starting their own plans.
31
Q

Industry versus Inferiority

A

As children grow in independence, they become increasingly aware of themselves as individuals. They begin to compare themselves with others.

  • Industry: Children who are accomplished compared to their peers can develop self-confidence and pride. Praise for their achievements can boost their self-esteem.
  • Inferiority: Children who do not achieve certain milestones may doubt their abilities or self-worth. When children are constantly criticized, they may develop feelings of inferiority.
32
Q

Identity versus Role Confusion

A

During this stage, adolescents’ main goal is to answer the question “Who am I?” They may try different personas to determine which roles fit them best.

  • Identity: To succeed in this stage, adolescents need to establish a coherent sense of self. They will need to determine their priorities in life (family, academic success, etc.). Then they will need to set goals for their adult selves based on those values.
  • Role confusion: Some adolescents may have a weak sense of self. They may struggle to break away from the person their parents or peers expect them to be. Without a consistent identity, they may grow confused about what they truly want for the future.
33
Q

Intimacy versus Isolation

A

According to Erikson, young adulthood is the period during which many people get married or develop significant relationships. It has been defined as anywhere from 20-24 years to 20-40 years.

  • Intimacy: Relationships can be a key source of affection and intimacy in adulthood. Many find emotional benefits from having a committed, lifelong bond.
  • Isolation: According to Erikson, people who do not develop relationships may become socially isolated. They may develop long-term feelings of loneliness.
34
Q

Generativity versus Stagnation

A

The focus of this stage is to contribute to society and the next generation. Adults in this stage are often at the height of their careers. Many people are raising children.

  • Generativity: People may offer guidance to the next generation through parenting or mentorship. They may also offer lead the way by leaving a legacy. Contributing to society’s future can give people a sense of community and purpose.
  • Stagnation: Some people may feel as if they have no impact on society. If people do not find their work meaningful, they may feel restless or isolated. Some may feel they have “peaked” and that their lives will only get worse in the future.
35
Q

Ego Integrity versus Despair

A

During this phase, older adults reflect on the life they have lived.

  • Ego Integrity: Those who feel fulfilled by their lives can face death and aging proudly.
  • Despair: People who have disappointments or regrets may fall into despair.
36
Q

Patient-centered Care

A
  • Know why patient is not there. What is the need you can reach out to your patient.
  • Establish and understanding that the nurse is safe, confidential, reliable and consistent.
  • Trust developing here.
37
Q

Therapeutic use of self (you are the tool)

A
  • Goal oriented toward promoting the patient’s growth and well-being, purposeful. **
  • Present boundaries and be professional (not there to be friends), offer support and be nonjudgmental
  • Present time restriction (say you can only be there for a certain amount of time)
38
Q

Goal Oriented Therapeutic Nurse-Patient Relationship includes

A
  • Facilitating communication of distressing thoughts and feelings
  • Assisting patients with problem solving
  • Helping patients examine self-defeating behaviors
  • Promoting self-care and independence
39
Q

Blurring Roles include

A
  • Transference

- Countertransference

40
Q

Transference

A
  • Patient unconsciously and inappropriately displaces (transfers) onto the nurse feelings and behaviors related to significant figures in patient’s past
  • You may find patient express in you bc pt says u look just like my sister and they are extra willing to give you. Bc u need an interview.
41
Q

Countertransference

A
  • Nurse unconsciously and inappropriately displaces onto the patient feelings and behaviors related to significant figures in the nurse’s past
  • Warning sign is if you over-identify with your patient
  • Ex: Elderly patient reminds you of your grandma- the problem here is then you are not being fair with your other pts. Medsurg role you spend more time in the room bc she looks like your grandma.
42
Q

Relationship Boundaries

A
  • Strive for a well-defined therapeutic nurse-patient relationship
  • Clear boundaries around the therapeutic relationship will provide a safe space for the patient to explore feelings and treatments
  • Don’t become too social with patients, don’t let your needs trump the patient’s needs and maintain strict boundaries pertaining to romantic/sexual relationships.
43
Q

Explore your own feelings and perceptions including

A

-People who have used and abused illegal drugs
-People who use sexually vulgar language
-Both women and men who identify as lesbian or gay and they make romantic advances toward you
-People who have attempted suicide
-People who have a history of sexually or physically abusing children
-Extremely religious people
People who do not believe in a god

44
Q

Phases of Relationships

A
  • Pre-orientation Phase
  • Introductory/Orientation Phase
  • Working Phase
  • Termination Phase
45
Q

Phases of a Relationship: Pre-Orientation Phase

A
  • Self-exploration
  • Gather data about your pt. read ahead about them or previous SBAR
  • Plan for first meeting- how do I dx pt.
46
Q

Phases of a Relationship: Introductory/Orientation Phase

A
  • Determine why patient sought treatment- asking pt more about themselves. Exemplified by knowing their CC.
  • Establish trust and open communication
  • Explore patient’s thoughts, feelings, and actions
  • Identify patient’s problems and define goals with patient
47
Q

Phases of a Relationship: Working Phase

A
  • Most of the therapeutic work is carried out in this phase
  • Goal: actual behavioral change (Explore stressors)
  • Promote patient’s insight and use of coping mechanisms
  • Overcome resistance behaviors
48
Q

Phases of a Relationship: Termination Phase

A

Establish reality of separation

Review progress & attainment of goals

49
Q

Communication Process

A 
Stimulus
Sender
Message
Mode
Receiver
Feedback
50
Q

Factors that affect communication include

A
  1. Personal factors: emotions, mood, stress, personal bias, culture, language cognitive, problem solving abilities, knowledge level
  2. Environmental factors: noise, privacy, accommodations, presence of others
  3. Relationship factors: relationships, social standing, power

NURS 419 (11 decks)

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