Test 1 Flashcards
1
Q
Stress
A
Relationship between individual and environment that taxes/exceeds ability to cope and endangers well being
2
Q
Environmental stress
A
Creates unexpected change in life pattern of the individual, requires significant adjustment in lifestyle, and taxes personal available resources
3
Q
Reactions/Responses to Stressful Events
A
Biological
Psychological (Individual perception of stressor)
4
Q
Cognitive appraisal
A
A personal interpretation to a situation and possible reactions to it
5
Q
Biological Responses
A
The Fight or Flight Syndrome
General Adaptation Syndrome
6
Q
General Adaptation Syndrome (GAS)
A
Alarm Reaction stage
Stage of resistance
Stage of exhaustion
7
Q
Alarm Reaction stage
A
Physiological response to the stressor
Sympathetic nervous system and endocrine system are activated
*Epinephrine and cortisol
8
Q
Stage of resistance
A
Body begins to repair, but still on high alert
9
Q
Stage of exhaustion
A
Body will adapt and learn how to live with high stress levels, body will continue to secrete cortisol (blood pressure stays elevated)
10
Q
Stage of exhaustion symptoms
A
Irritability Frustration Poor concentration Difficulty remembering things Fatigue Burn out Depression Anxiety Poor sleep
11
Q
Epinephrine
A
Increases heart rate to circulate oxygen
12
Q
Cortisol
A
Elevates blood pressure, blood sugar, and fat
Body is in a hyper metabolic state
13
Q
Primary appraisal
A
A judgment about the situation
Irrelevant
Benign-positive
Stressful
14
Q
Irrelevant Primary appraisal
A
The outcome of the stressor has no significance
15
Q
Benign-positive Primary appraisal
A
Leading to growth, good positive stress, stimulating
16
Q
Stressful Primary appraisal
A
Outcome is a threat or a challenge, overwhelming (ex: death or new diagnosis
17
Q
Secondary appraisal definition
A
How cope with stress?
Coping strategies
Choose best option
Ability to be effective
18
Q
Secondary appraisal (how it’s used)
A
Good or bad coping strategies
Choosing the best options for them
The ability to be effective
19
Q
Predisposing factors influence our responses/reactions
A
Genetics
Past experiences
Existing Conditions
20
Q
Individual responses - Two controls
A
Thoughts and reactions
21
Q
Thoughts
A
What we think and how we feel when stressed
22
Q
Reactions
A
What do we do, behave or react when we are stressed
23
Q
Mild Anxiety
A
Anxiety that can enhance learning
24
Q
Moderate Anxiety
A
Perception diminishes, body aches
25
Severe Anxiety
Attention span very limited, physical and emotional symptoms
26
Panic (Anxiety)
Unable to focus, misperceptions, losing control, communication ineffective
27
Psychological Adaptation to Stress
Grieving
Stages of Grieving
Anticipatory Grief
Maladaptive Grief Responses
28
Grieving (Psychological Adaptation to Stress)
Personal loss
Perception of being alone
Failure
29
Anticipatory Grief
Grief prior to actual loss, may cause emotional disengage
30
Maladaptive Grief Responses
Occur when people lose the ability to function in areas of life, prolonged grief (denial or anger), prevents individual from moving forward
31
Adaptive Stress Response
Homeostasis
32
Maladaptive Stress Response
Disequilibrium
33
Adaptive coping strategies
```
Awareness
Relaxation
Meditation
Interpersonal communication with caring other
Problem-solving
Pets
Music
Nutrition – diet and hydration
Sleep
Physical exercise
Cry
Laughter
Talking
```
34
Maladaptive coping strategies
```
Drinking
Sleeping
Physical exercise
Smoking
Crying
Laughing
Talking
```
35
Defense Mechanisms Purpose
Protect ego
| Decrease anxiety
36
Defense Mechanisms Benefits
```
Adaptive
Protective mechanisms (unconscious or conscious)
```
37
Crisis defined
Disequilibrium
38
Crisis ultimate goal
Self esteem and growth
39
Crisis assistance required
Problem solving skills
40
Common Characteristics of a Crisis
All individuals experience
Precipitated by specific identifiable events
Personal by nature
Acute and time limited
Potential for psychological growth or deterioration
41
Phases in the Development of a Crisis
Exposure to stressor
Common coping strategies are not helpful and anxiety increases
Utilize all (recognized) resources to decrease distress
Major disorganization occurs if no resolution
42
Adaptation to Crisis
Perception of event
Availability of support
Availability of adaptive coping mechanisms
43
Communication
Transaction between the sender and the receiver
Both participants perceive each other, listen to each other, and simultaneously engage in the process of creating meaning in a relationship
44
Therapeutic communication
Caregiver verbal and nonverbal techniques that focus on the care receiver’s needs and advance the promotion of healing and change
Encourages exploration of feelings and fosters understanding of behavioral motivation
Nonjudgmental, discourages defensiveness, and promotes trust
45
Nontheraputic communication
Barriers to open communication
| Decrease effective communication
46
Active Listening
To listen actively is to be attentive to what client is saying, both verbally and nonverbally
47
SOLER
```
Sit squarely facing the client
Observe an open posture
Lean forward toward the client
Establish eye contact
Relax
```
48
Assertive Communication
Promotes equality in human relationships and enables us
| Helps us feel good about ourselves and increases our self-esteem
49
Assertive behavior
To act in our own best interests
To stand up for ourselves without undue anxiety
To express honest feelings comfortably
To exercise personal rights without denying the rights of others
50
Nonassertive behavior
Sometimes called passive behavior
| Seek to please others at the expense of denying their own basic human rights
51
Aggressive behavior
Defend their own basic rights by violating the basic rights of others
Feelings are often expressed dishonestly and inappropriately
52
Passive-aggressive behavior
Respond to others by appearing passive and accepting of other’s demands while behaving in ways that suggest anger and resentment are their true feelings
Sometimes called indirect aggression, the behavior takes the form of passive, nonconfrontational action
53
Mental Health/Mental Illness - Maslow
An individual’s quest for self-actualization
| Hierarchy of needs
54
Hierarchy of needs
```
Physiologic needs
Safety and security
Love and belonging
Self-esteem and esteem of others
Self-actualization
```
55
Jahoda’s 6 Indicators of Mental Health
```
Positive attitude toward self
Growth, development, and the ability t0 achieve self-actualization
Integration
Autonomy
Perception of reality
Environmental mastery
```
56
Mental Health definition
“The successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms”
57
Culture - Mental Illness
A particular society’s entire way of living, encompassing shared patterns of beliefs, feelings, and knowledge that guide people’s conduct and are passed from generation to generation
58
Incomprehensibility - Mental Illness
The inability of the general population to understand the motivation behind the behavior
59
Cultural relativity - Mental Illness
The “normality” of behavior is determined by the culture
60
Mental Illness
“Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational, or physical functioning”
61
Recovery Model
“Recovery from mental health disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential”
62
4 Dimensions of Recovery
Health
Home
Purpose
Community
63
Guiding Principles of Recovery
```
Merges from hope
Person- driven
Occurs via many pathways
Holistic
Supported by peers and allies
Supported through relationships and social networks
Culturally- based and influenced
Supported by addressing trauma
Involves individual, family, and community strengths and responsibility
Based on respect
```
64
The Tidal Model
Mental health nursing recovery model
The metaphor of water is used to describe how individuals in distress can become emotionally, physically, and spiritually shipwrecked.
Focus is on the individual’s personal story
65
The Tidal Model - 10 Commitments
```
Value the voice
Respect the language
Develop genuine curiosity
Become the apprentice
Use the available toolkit
Craft the step beyond
Give the gift of time
Reveal personal wisdom
Know that change is constant
Be transparent
```
66
The Tidal Model - 10 Competencies
```
Active listening
Use of stories, anecdotes
Show interest
Unique plan of care
Identify best tools
Best first step
Importance of time
Improve self confidence
Awareness of change
Share all treatment plans
```
67
The Wellness Recovery Action Plan (WRAP)
A structured system for monitoring uncomfortable and distressing through planned responses, reducing, symptoms and, modifying or eliminating those also includes plans for responses from others symptoms. It when a person’s symptoms have made it impossible to continue to make decisions, take care of him/her and keep him/herself safe
68
The Wellness Recovery Action Plan (WRAP) - Step 1
Developing a Wellness Toolbox
| Strategies and skills the individual has used to relieve stress
69
The Wellness Recovery Action Plan (WRAP) - Step 2
Daily Maintenance List
1) Description of wellness
2) List of things needed to do to stay healthy
3) To do list
70
The Wellness Recovery Action Plan (WRAP) - Step 3
Triggers
1) List of possible stressful events
2) Items from toolbox to use if needed
71
The Wellness Recovery Action Plan (WRAP) - Step 4
Early Warning Signs
1) Identify subtle signs indicating that things are getting worse
2) Develop a plan to respond to the early warning signs-should bring relief or prevent escalation
72
The Wellness Recovery Action Plan (WRAP) - Step 5
Things Are Breaking Down or Getting Worse
1) List of symptoms that are occurring that indicate that the situation has worsened
2) Develop a plan to deal with these symptoms
73
The Wellness Recovery Action Plan (WRAP) - Step 6
Crisis Planning
1) Gathers information about the person when well
2) Identifies when someone needs to take over
3) Provides names of support people
4) Includes names of health care providers
5) Includes preferred treatments
6) Includes preferred treatment facilities
7) Includes facilities to be avoided
8) Description of expectations from support people
9) Indicators of when support is no longer needed
74
The Psychological Recovery Model definition
“the establishment of a fulfilling, meaningful life and positive sense of identity founded on hopefulness and self-determination” (Andresen, Oades, and Caputi , 2011, pg. 40).
Focuses on the person’s self-determination in the course of his or her recovery process
75
The Psychological Recovery Model - 4 Components
Hope
Responsibility
Self and identity
Meaning and Purpose
76
The Psychological Recovery Model - 5 Stages
```
Moratorium
Awareness
Preparation
Rebuilding
Growth
```
77
Moratorium
Dark despair and confusion, life is on hold
78
Awareness
Recovery is possible, a self-capable of being well
79
Preparation
Resolution to begin the work of recovery
80
Rebuilding
Takes the first steps needed for building a meaningful life
81
Growth
Ongoing continual self-improvement
82
Ethics
A branch of philosophy that deals with distinguishing right from wrong
83
Bioethics
Term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health
84
Values
Personal beliefs about what is important and desirable
85
Values clarification
A process of self-exploration by which people identify and rank their own personal values
86
Moral behavior
Conduct that results from serious critical thinking about how individuals ought to treat others
87
Right
A valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service
88
Absolute right
When there is no restriction whatsoever on the individual’s entitlement
89
Legal right
A right on which the society has agreed and formalized into law
90
Ethical Dilemmas
Ethical dilemmas occur when moral appeals can be made for taking either of two opposing courses of action
Taking no action is considered an action taken
91
Ethical Principles - Autonomy
Emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected
92
Ethical Principles - Beneficence
Refers to one’s duty to benefit or promote the good of others
93
Ethical Principles - Nonmaleficence
Abstaining from negative acts toward another, includes acting carefully to avoid harm
94
Ethical Principles - Justice
A principle based on the notion of a hypothetical social contract between free, equal, and rational persons. The concept of justice reflects a duty to treat all individuals equally and fairly
95
Ethical Principles - Veracity
A principle that refers to one’s duty to always be truthful
96
ECT Electroconvulsive therapy
The induction of a grand mal (generalized) seizure through the application of electrical current to the brain
Administered every other day 3X week: most clients need 6 to 12 treatments
97
ECT Electroconvulsive therapy Indications
Severe depression or mania after medication therapy has been unsuccessful
98
ECT Electroconvulsive therapy Mechanisms of Action
Increases in the circulating levels of serotonin, norepinephrine, and dopamine
The most common side effects are temporary memory loss and confusion
99
What does every patient have the right to do?
Refuse medication regardless of admission status
100
Legal Issues in behavioral Nursing
Confidentiality and Right to Privacy
Informed Consent
Restraints and Seclusion
Commitment Issues
101
Confidentiality and Right to Privacy - Communication
Verbal
| Written
102
Written Communication
Belongs to client
Excludes child/elder abuse, communicable diseases & information under duty to warn
Privileged communication
Duty to Warn
103
Informed Consent - Rights of Treatment
Prepared to make decision
Inform re: available treatments including risks
Consent can be withdrawn at any time
104
Informed Consent - Special Considerations
Mentally/legally incompetent to make decision necessary to preserve life or avoid serious injury
Refusing treatment endangers the life or health of another
Emergency in which client in no condition to make decision
Child
Therapeutic Privilege
105
Anger/Aggression definition
An emotional state that varies in intensity from mild irritation to intense fury and rage
Causes physiological changes (e.g., increased heart rate, blood pressure, and levels of biogenic amines).
106
Anger/Aggression
Anger need not be a negative expression.
Anger is a normal human emotion that, when handled appropriately and expressed assertively, can provide an individual with a positive force to solve problems and make decisions concerning life situations.
Anger becomes a problem when it is not expressed, and when it is expressed aggressively.
107
Anger/Aggression - Assessing Risk Factors
Prevention is the key issue in the management of
| aggressive or violent behavior
108
Anger/Aggression - Three factors are important considerations in identifying extent of risks
Past history of violence
Client diagnosis
Current behavior
109
Anger/Aggression - Client diagnosis
Client diagnoses associated with violence:
Substance use disorders
Schizophrenia
Major depression
Bipolar disorder
Neurocognitive disorders
Antisocial, borderline, and intermittent explosive personality disorders
110
Anger/Aggression - “prodromal syndrome”
```
Rigid posture
Clenched fists and jaws
Grim, defiant affect
Talking in a rapid, raised voice
Arguing and demanding
Using profanity and threatening verbalizations
Agitation and pacing
```
111
Restraints
Leather straps in emergency only
Every 10-15 minutes assess and document
Circulation, Respiration, Nutrition, Hydration, Elimination
112
Seclusion
Patient must be informed about seclusion protocol
Must have consent from client, unless emergency
May be requested by client
113
JCAHO guidelines - Restraints and Seclusion
Restraints can be applied, or client placed in seclusion without an order in emergency event only
Verbal or written order from MD must be received and documented within 1 hour
114
Restraints and Seclusion - Orders must be renewed
Every 4 hours for adults
Every 2 hours for 9-17 year olds
Every hour for under 9 years old
115
Restraints and Seclusion - MD must assess the client within
4 hours for adults, 2 hours for clients under 18
116
Restraints and Seclusion - Re-evaluated every
8 hours for adults and every 4 hours for under 18
117
Commitment Issues
Voluntary admissions
| Involuntary commitments
118
Involuntary commitments
Emergency commitments
The mentally ill person in need of treatment
Involuntary outpatient commitment
The gravely disabled client
119
Nursing Liability
Malpractice and negligence
Invasion of privacy
Assault and battery
False imprisonment
120
Nursing Liability - Types of lawsuits that occur in psychiatric nursing
Breach of confidentiality
| Defamation of character (Libel, slander)
121
Therapeutic Use of Self
“ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions”
Nurses must possess self-awareness, self- understanding, and a “philosophical belief about
life, death, and the overall human condition”
122
The Johari Window
Open/public
Blind
Secrets
Unconscious
123
Essential Conditions - Therapeutic Use of Self
```
Rapport
Trust
Respect (Unconditional positive regard)
Genuineness
Empathy
```
124
Phases of the Nurse-Patient Relationship
Pre-interaction
Orientation
Working
Termination
125
Transference
You remind patient of someone, transferring thoughts or feelings to nurse (positive or negative)
126
Countertransference
Patient reminds you of someone, thoughts and feelings (positive or negative) are placed on the patient
127
Types of Boundaries
Rigid
Flexible
Enmeshed or Nonexistent
128
Unhealthy boundaries
Negative role modeling
| Abuse or neglect
129
Professional Boundaries
Self-disclosure
Gift-giving
Touch
Friendship or romantic association
130
Cultural Concepts
“An entire way of living, encompassing shared patterns of belief, feeling, and knowledge that guides people’s conduct and are passed down from generation to generation.” (Griffith, Gonzalez, & Blue, 2003 as cited in Townsend, 2015, pg. 96.)
131
Spiritual Concepts
“The human quality that gives meaning and sense of purpose to an individual’s existence. Spirituality exists within each individual regardless of belief system and serves as a force for interconnectedness between self and others, the environment, and a higher power.” (Townsend, 2015, pg. 109)
132
Spiritual Needs
```
Meaning and purpose in life
Faith
Hope
Love
Forgiveness
```
133
Risk for Spiritual Distress
Risk factors could be physical, psychosocial, developmental, or environmental.
134
Automatic thoughts
Occur rapidly in response to a situation and without rational analysis
Often negative and based on erroneous logic
Also called cognitive errors a cognitive distortion
135
Arbitrary inference
conclusion with no facts
136
Overgeneralization
all or nothing thinking
137
Dichotomous thinking
black or white thinking
138
Selective abstraction
conclusion based on part of the information that is usually negative
139
Magnification
exaggerating the negative
140
Minimization
undervaluing the positive
141
Catastrophic thinking
always thinking the worst will happen
142
Personalization
taking responsibility for all situations
143
Socratic Questioning/dialogue
Question the client to help then come to a more realistic point of view
144
Guided relaxation
Deep breathing or meditation activity to help the individuals recognize their ability to control their thoughts
145
Role play/ behavioral rehearsal
A situation is played out to help the client see the reality of the events and identify their feelings
146
Generating Alternatives
Broader range of possibilities why someone is acting the way that they are
147
Examining the evidence
Looking at the facts
148
Decatastrophizing
Bringing events into proper perspective
149
Reattribution
Not to blame for all adverse life events
150
Dysfunctional Thought recordings
Rating emotional response
151
Cognitive rehearsal
Plan ahead for potential automatic thoughts
152
Cognitive Restructuring (reframing)
Replace the negative with positive
153
Behavioral Therapy
Behavior is considered to be maladaptive
-If it is age-inappropriate
-If it interferes with social and occupational functioning
-If it is misunderstood by others in terms of cultural inappropriateness
The basic assumption of behavioral therapy is that problematic behaviors are learned and, therefore, can be unlearned
154
Techniques used to modify maladaptive behavior patterns by reinforcing more adaptive behaviors
```
Modeling
Token system
Time out
Desensitization
Cognitive Behavioral Therapy (CBT)
```
155
Cognitive Behavioral Therapy (CBT)
The client learns to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behavior accordingly.
156
Dialectical Behavioral Therapy (DBT)
Intense work with a therapist to help the client change unhealthy or disruptive behavior by changing the view of the world. A dialectic thinker would consider multiple factors in the world before integrating them into their personal way of thinking
157
Well being therapy
journal positive events
158
Positive Psychotherapy
build positive emotions
159
Identify signature strength
personal assessment
160
Gratitude Visit
letter, art, phone call, visit...
161
Gratitude Therapy
I am thankful for...
162
Daily Affirmations
Focus on positives not negatives
163
Build strengths to foster hope
small success gives hope for continued success
164
Family
A family is whoever they say they are and can be determined by choice or biology
165
Stages of Family Development
```
Single Young Adult
Newly Married
The Family With Young Children
The Family With Adolescents
The Family Launching Grown Children
The Family in Later Life
```
166
6 Elements of Family Functioning
```
Communication
Self-Concept Reinforcement
Family Members Expectations
Handling Differences
Family Interactional Patterns
Family Climate
```
167
Dysfunctional Family Roles - Addict
Trouble, embarrassment
168
Dysfunctional Family Roles - Enabler
Super responsible
169
Dysfunctional Family Roles - Adult child/Hero
Pride
170
Dysfunctional Family Roles - Scapegoat
Diverts attention
171
Dysfunctional Family Roles - Lost child
Relief
172
Dysfunctional Family Roles - Mascot
Fun and humor
173
Family Systems Theory
Differentiation of self
174
Structural Model
Facilitate change in the family structure, or transactional pattern that are contributing to the dysfunction in the family
175
Strategic Model
Enhanced Communication
176
Double-bind Communication
Creating no win situations
177
Pseudo- mutuality
Creating the facade that you enjoy one another’s company and like being together
178
Pseudohostility
Creating the facade of chronic conflict and alienation in order to deny feelings of tenderness and intimacy
179
Marital Schism
Chronic disequilibrium with recurrent threats of separation
| Parents compete for the loyalty of the children
180
Marital Skew
One partner dominates and has control over the other
181
Strategic Model Techniques - Paradoxical intervention
Requesting that the family continue to engage in the behavior they are trying to change
182
Strategic Model Techniques - Reframing
Changing the conceptual and/or emotional setting or viewpoint in relation to which situation is experienced and placing it in another frame that changes it’s entire meaning
