test 1 Flashcards
revolving door concept
a cycle of frequent psychiatric hospitalizations and discharges
professional boundaries
NCBSN, we should set boundaries with client to ensure a safe and trust worthy relationship
sigmund freud
father of psychoanalysis, all human behavior is caused and can be explained, psychosexual development
empathy
ability to understand and share another persona feelings (im on your side of help)
sympathy
feeling of concern for someone who is experiencing something difficult (pity)
therapeutic nurse client relationships goals
-Establish a working relationship
-Identify patients most important concerns: assess
patient’s perceptions
-Assess the client’s perception of the problem as it
unfolds
-Facilitate the client’s expression of emotions
-Teach the client/family necessary self-care skills
-Recognize the clients needs
phases of therapeutic relationship
-pre-interaction: explore own feelings, fantasies, and fears, analyze own professional strengths and limits, gather data about patient, plan first meeting
-orientation: why patient sought help, establish trust, communication, acceptance, contract, goals with patient
-working: start doing goals, overcome resistance behaviors
-termination: reality of separation, renew progress, explore feelings of anger
roles of nurse
-teacher: methods of coping skills, solving problems, medications, self care, community and family resources
-caregiver: physical nursing care
advocate: acting on clients behalf when they cannot do so (privacy and dignity)
-parent-surrogate: childlike behavior set clear and firm limits
therapeutic communication (appropraite responses)
Accepting, broad openings, exploring, general leads, making observations, presenting reality, reflecting, and restating
non therapeutic communication
Advising, challenging, defending, disagreeing, disapproving, reassuring, rejecting, requesting an explanation- using why?
nonverbal communication (facial expressin, dos and donts)
eye contact, no fidgeting, posture
delusions and delusional thinking
A belief or altered reality that is persistently held despite evidence or agreement to the contrary, generally in reference to a mental disorder and a false belief that is resistant to change, even when there is evidence that it is not true
carpers four patterns of knowing
Four patterns:
-Empirical (derived from nursing science)
-Personal (from life experience)
-Ethical (from moral nursing knowledge)
-Aesthetic (from art of nursing)
types of treatment settings
inpateint, outpatient, community based, residential
roles of nurse in community-based setting vs. inpatient settings
community based:
LOCALLY REFERRED TO AS
PROGRAM FOR ASSERTIVE COMMUNITY
TREATMENT (PACT) AND INTENSIVE
COMMUNITY TREATMENT (ICT), OR
COLLECTIVELY KNOWN AS PACT/ICT
* ONE OF THE MOST EFFECTIVE
APPROACHES (SEE BOX 4.5)
* PROBLEM-SOLVING ORIENTATION
* NO PROBLEM IS TOO SMALL.
* FREQUENT, INTENSE SERVICES; 24
HOURS A DAY
inpatient:
TYPICALLY BEGINS IN THE ED
* RAPID ASSESSMENT, STABILIZATION OF
SYMPTOMS, DISCHARGE PLANNING
* CLIENT-CENTERED
MULTIDISCIPLINARY APPROACH TO
BRIEF STAY
* IDENTIFY LONG-TERM ISSUES FOR
OUTPATIENT THERAPY
types of community based programs
-Nurses caring for patient in high-risk
homes
-Therapeutic communication and skills
are essential for caring for the patient
in the community
-Increased self-awareness about
culture, beliefs, behaviors and feelings
of others
-Collaboration with family, healthcare
providers
process and priority for admission to psychiatric facility
admission type, reason for admission, petition fo involuntary admission, evaluation, length of stay, insurance
criteria and purpose of involuntary admission
-Health care professionals respect clients wishes to not be treated unless danger to self or others
-Committed until no longer a danger
-State laws govern civil commitment process
-All other client rights remain intact
-Person can be detained in psychiatric facility for 48 to 72 hours on emergency basis
-Hearing conducted to determine further treatment need
-Similar laws from people with substance abuse issues
duty to warn
threat to self, other persons, property, and any disease
confidentiality for psychiatric patient
Each individual is entitled to have all identifying information that a provider maintains or knows about him remain confidential, HIPAA, if patient is proved to be a threat, report
HIPAA (health insurance portability and accountability act)
confidentiality, privacy, security
torts (intentional)
is a wrongful act that results in jury, loss, or damage (assault, battery, false imprisonment)
torts (unintentional)
causing harm through failure to act (negliegence and malpractice)
roles of interdisciplinary team
-recreational therapist: accompanies to movie
-art therapist: clients identify unconscious feelings through their drawings
-clinical psychologist: conducts psychological testing to help the psychiatrist determine correct diagnosis
-chaplain: serves spiritual needs of clients
-dietitian: monitors nutritional needs for client
-music therapist: relaxation techniques thru music
-psychiatric clinical nurse specialist: assertiveness training
-psychiatrist: provides electroconvulsive therapy for a depressed client
-psychiatric staff nurse: administers meds
-psychiatric social worker: appropriate placement for client in discharge
-occupational therapist: assists to increase self-esteem, small crafts for completion and display
-psychodramatist: perform in safe enviro. situation to painful in real life
-mental health tech: 1:1 with client day to day activities with client milleu unit
transference
what the patient feels towards the nurse
countertransference
what the nurse feels about the patient
objective data
what you can observe (vital signs)
subjective data
what the patient tells the nurse (feelings of…)
what is OARS?
O: open ended questions
A: affirmations
R: reflection
S: summarizing
erikson
8 stages of psychosocial needs
0-1 trust vs mistrust
1-3 autonomy vs shame/doubt
3-6 initiative vs guilt
7-11 industry vs inferiority
12-18 identity vs confusion
19-29 intimacy vs isolation
30-64 generative vs stagnation
65 onward integrity vs despair
maslow
hierarchy of needs
top- self-actualization
self-esteem
love and belonging
safety and security
bottom- physiological needs
term for having healthy responses to stressful circumstances or risky situations is
resilience
therapuetic communication interaction is most comfortable when the nurse and client are how far apart?
3-6 feet
when would a pateint be the most likely suitable for outpatient ?
reoccurring dui or recurring offenses
what should you say when someone asks about a patient
‘i cant confirm or deny the existence of that patient’
not guilty by reason of insanity (NGRI)
defense is used when there is an argument that an individual accused of a crime is not guilty because of the inability to control their actions or to understand the wrongfulness of an act.
ethics
is a branch of philosophy that defines the principles of our code of conduct regarding what is right or wrong
jean piaget
Sensorimotor- birth to 2 years
Child develops sense of self as separate from
the environment
Preoperational- 2 to 6 years
Develops ability to express self with language
Begins to classify objects
Concrete operations- 6 to12 years
Applies logic to thinking
Able to apply rules
Formal operations- 12 to 15 years
Child learns to think and reason in abstract terms
Further develops logical thinking
Achieves cognitive maturity
belief that personal abilities and efforts affect the events in ones life
self-efficacy
