Theories and Theorists Flashcards
Psychological theories
What are the key elements of the ANA code of ethics
compassion
respect
comittment
advocacy
accountability
responsibility to the profession
Why do you use a patient’s first language when speaking to them?
shows respect to the person… it puts the person as the WHO you are treating, instead of WHAT you are treating.
Nurses no longer use the words retarded or retardation to describe someone with
intellectual or developmental disability (IDD)
What words should you not say in any situation with a psych patient?
nut job (nut)
demented
insane
wacko
Schizo
loony
bonkers
madman
loco
fruitcake
crazy
Stigma is
negative stereotype leads to an attitude or belief that would cause one to view a person with mental illness as inferior, dangerous, or unstable
Stigma leads to _____________ creating ___________
stigma - prejudice - discrimination
Prejudice is
through and feelings of negative viewpoint
Discrimination is
action against a person due to their disorder
- at the workplace (not getting a job)
- withdrawal from family negativity
Discrimination creates a major
barrier to mental health tx and recovery
The lack of treatment and recovery from discrimination contributes to what emotions
fear and rejection
Fear and rejection from stigma result in
social isolation and reduced opportunities
Mental health is
dynamic and shifting and can range from mild to severe
Mental health is _____________ with psychological, emotional, and social.
Mental Health is influenced by
genetics
brain chemistry
life experiences
Mental health is defined as
State of well-being in which individual realizes potential, copes with normal stresses, works productively, contributes to community
Mental health if successful leads to
successful performance of mental and emotional functioning
Resilience
ability to recover from and adjust successfully to stressors, loss, and trauma
bouncing back when struggling
Successful performance of mental functioning includes what behaviors
engagement in productive activity,
engage in fulfilling relationships,
adapt to change,
cope with adversity
rational, communication, learning, emotional growth, resilience, and self-esteem
NAMI (National Alliance on Mental Illness) ideas on mental health
Affects a person’s thinking, mood and feeling
Can make it difficult to relate to others
May affect ability to function day to day
Treatable
Attributes of Mental Health
accurate appraisal of reality
ability to love and experience joy
capacity to deal with conflicting emotions (sad and happy at same time)
ability to deal w/o fear, guilt, or anxiety
ability to take responsibility for own actions
control own behavior
think clearly(problem solving, judgement, reason logic, insightful conclusions)
relate (relationships, empathy)
self-defined spirituality
negotiate each task
productive
self-concept and aelf-value
play and laugh
Factors affecting mental health
genetics
spirituality
culture
community
personality
beliefs
experiences
negative influences (stressors, poverty, bad parenting)
Which factor describes the pathophysiology of mental health?
biological manifestation of the disease abnormality
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is the
Guidebook for categorizing and diagnosing psychiatric mental health disorders in the US.
- criteria
- id symptoms and quantify
- underlying causes
The ability to function is finding life enjoyable, what is the dysfunction (opposite)?
loss of interest or pleasure
The ability to function is Optimistic about needs being met, what is the dysfunction (opposite)?
Discouraged or hopeless mood
The ability to function is Ability to recognize cues and act appropriately
what is the dysfunction (opposite)?
The ability to function is Sees environment accurately
what is the dysfunction (opposite)?
Inaccurate perception of environment
The ability to function is Understands consequences
what is the dysfunction (opposite)?
Hallucinations or delusions
The ability to function is Performs within abilities
what is the dysfunction (opposite)?
Deterioration in work performance
The ability to function is Recovery from minor failures
what is the dysfunction (opposite)?
Inability to maintain steady employment
The ability to function is Reasonable self confidence
what is the dysfunction (opposite)?
Lacks self confidence
The ability to function is Resourcefulness
what is the dysfunction (opposite)?
Inability to function independently
The ability to function is Stable Strong relationships
what is the dysfunction (opposite)?
Unstable or intense relationships
The ability to function is Variety of social support
what is the dysfunction (opposite)?
Lack of support
The ability to function is Ability to problem solve and cope in ways that are not harmful
what is the dysfunction (opposite)?
Poor coping that creates further dysfunction
coping destruction is self meditated with
drug
alcohol
sex
food
T/F: Mentally health means being always logical and rational
False - myth
When depression occurs what else usually occurs?
anxiety
Schizophrenia affects men and women
equally (earlier in men)
Major Depressive is 2x more in
women
Bipolar affects both genders
equally
Anxiety Disorders frequently occur with what types of disorders
eating and substance abuse
OCD’s first s/s begin
childhood and adolescent
PTSD develops how
immediately or delayed
310% Vietnam veterans
_____ times more suicides than homicides
2.5
Health seeking behaviors
developed countries seek help from psychiatrists, NP
indigenous cultures see a spiritual component
- seek shaman, healer
Culture Bound Syndrome
Running amok
Pibloktoq
Anorexia Nervosa
Running amok
SE Asia
- someone runs around being violent
- mass shooters
Pibloktoq
uncontrollable desire to remove clothing and exposing oneself to the extreme cold
- lack of sun, Vit. D, or too much Vitamin A - fish
culture sees as possessions
Anorexia Nervosa
restrict their food intake relative to their energy requirements through eating less, exercising more, and/or purging food through laxatives and vomiting
Psychoanalytic theory uses what theorist
Sigmund Freud
- Austrian neurologist
Sigmund Freud is the father of
psychiatry
According to Freud, psychological disturbances occur as
early trauma
What are the 3 mental activities of Freud?
conscious
preconscious
unconscious
Conscious is the
current awareness
- influenced by pre and unconscious
Preconscious
lies immediately below the surface and is accessible
Unconscious
most primitive feelings
drives and memories reside
unbearable and traumatic
(totally repressed)
ID
primitive
pleasure seeking and impulsive (immediate gratification)
Ego
problem solver and reality tester
-use defense mechanisms
- self-esteem and expression of self
Superego
moral component of the personality
- conscience
Conscience
sense of what is right or wrong
Stages of personality development in Freud
Oral - ID dominant - trust
Anal - ego develops - delay immediate gratification
Phallic - superego - develop sex id
Latency - sexuality expressed - same-sex relationships
Genital - form close relations with opposite sex
Psychoanalytic Therapy
3-5 times a week for many years
Know and understand the unconscious
Emotionally painful process
Free association
Psych knows best
- dream analysis and intentional journaling
Dream Analysis
dreams were urges of the unconscious mind that were revealed by dreams (key to the the unconscious)
Intentional Journaling
helps you understand why you may act, think or behave certain ways in certain situations
Dream Analysis is the key to the
unconscious
Free Association
let the pt talk about whatever they want
What is the different between psychoanalytic and psychodynamic therapy?
dynamic is more modern
Psychodynamic Therapy
Shorter number of sessions
Therapeutic relationship
Transference
Countertransference
Transference
patient projects feelings unto therapist
Countertransference
therapist’s unconscious response to the patient (need professional)
Repression is an
unconscious mechanism employed by the ego to keep disturbing or threatening thoughts from becoming conscious
What are the defense mechanisms used to relieve anxiety?
repression
denial
projection
displacement
regression
sublimation
Denial involves
blocking external events from awareness
- too much to handle, the person refuses to experience them
Projection involves
individual attributing their own unacceptable thoughts, feelings, and motives to another person
Displacement is to
satisfying an impulse (aggression) with substituting object
Regression is a
mvmt back in psychological time when one is faced with stress
- suck thumb again or wet the bed
Sublimination
satisfying an impulse (aggression) with a substitute object in a socially acceptable way
- sport
- constructive
Five of the most important properties of defense mechanisms are as follows:
managing unconscious conflict
most part unconscious
discrete
many psychiatric disorders
adaptive and pathological
Cognitive Dissonance
hold 2 or more contradictory beliefs.
- adopt new belief and discard old (change in behavior)
- discard new and keep old (no change)
- combine 2 into 1 new belief
Interpersonal Theory is founded by who
Herbert “Harry” Stack Sullivan – American psychiatrist
Interpersonal Theory believes what is the cause of such alterations
social and interpersonal problems
Sullivan believes humans are driven by the need for
interaction
What according to Harry is the most painful human experience
loneliness
According to Interpersonal Theory, Early relationship with primary caregiver is crucial for
personality development
According to Interpersonal Theory, Anxiety is based on
approval or disapproval of significant caregiver
According to Interpersonal Theory, All behavior is based on
avoiding anxiety and threats to self esteem
Interpersonal Theory, focuses is on the
“good me”
According to Interpersonal Theory, perosnality can be influenced as a
child or adult
Interpersonal Therapeutic Model
therapist is very active participant and observer
- actively change maladaptive behaviors and distorted views for other to modify them
FOCUS ON THE HERE AND NOW
Interpersonal Therapeutic Model emphasis on
patient’s life and relationships at home, work, and socially
Interpersonal Therapeutic Model is often used in
marriage and relationship counseling
Behavioral Theories include
Ivan Pavlov - Classic Conditioning - dogs
Watson - classic - Lil-Albert
Skinner - operant
Classical Conditioning
– involuntary behavior or reflexes can be conditioned to respond to neutral stimuli (Pavlov)
- Personality traits and responses, adaptive and maladaptive, are learned (Watson)
Operant Conditioning
– voluntary behaviors are learned through consequences of positive reinforcement or negative reinforcement/punishment
- Positive reinforcement Causes good behavior to occur again. Negative reinforcement stops behavior.
changes a behavior
Pavlova and his dogs experiment
accustomed to getting food after bell was rung. Later dogs salivated in response to the sound of the bell alone
Lil-Albert experiement by Watson
By making banging sounds behind him while he was exposed to white fur – terrified him
Which theorist involves classical conditioning?
Pavlov - behavior
Watson - personality;learned
Which theorist involves operant conditioning?
Skinner
Behavioral Therapeutic Model
attempts to correct or eliminate maladaptive behavior
The behavioral Therapeutic Model includes these 3 topics
Systematic desensitization
Aversion therapy
biofeedback
Systematic desensitization
Based on classical conditioning
Relaxation
Exposure to anxiety provoking stimulus.
Aversion therapy
classical operant conditioning
Eradicate unwanted habits by associating unpleasant consequences with them.
Antabuse
biofeedback
Control of physiological responses such as breathing, HR, BP, breathing by providing visual or auditory feedback of physiological response and then using relaxation techniques to change these physiological responses.
Provide calming techniques and see the body relax via VS
Antabuse
alcohol addiction throws up the alcohol when drinking preventing them from liking it
Humanistic Theory is related to what theorist
Maslow
Humanistic Theory is concerned with the
huamn potential for development, knowledge attainment, motivation, and understanding
- Hierarchy of Needs
What needs are the most important and dominant in Maslow’s Hierarchy of Needs? (greatest to least)
Physiological Needs
Safety and Security
Love and Belonging
Self-esteem
Self-actualization
Physiological Needs
breathing
food
water
shelter
clothing
sleep
Safety and Security
health
employment
property
family
social stability
Love and Belonging
friendhsip
family
intimacy
sense of connection
Self-esteem
confidence
achievement
respect of others
Self-actualization
morality
creativity
spontaneity
acceptance
- can be achieved until all others are met
The humanistic therapeutic model was created by what theorist
Carl Rogers
- american psychiatrist
person centered care (40s)
The humanistic Therapeutic Model refers to psch patients as
clients
In the humanistic Therapeutic Model, Carl Rogers depicts people as
healthy and good
- clients are in the best position to explore, understand, and identify solutions to their problems
In the humanistic Therapeutic Model, clients have an innate
self-actualizing tendencies to grow, develop and realize their full potential
In the humanistic Therapeutic Model, focus is on
self awareness and the present
In the humanistic Therapeutic Model, the therapist needs to
- seeks clarification and encourages
- congruent, empathetic, and respectful
Congruent is the therapist needs to be
on the same page as the pt
-free will of the patient and
- unconditional positive regard
Cognitive Theory was developed by
Aaron T Beck
Cognitive Theory believes
Depressed people have standard patterns of negative self-critical thinking
- Cognitive appraisals lead to emotional responses, on how one perceives the event.
problematic behaviors from your perception of reality
Cognitive Behavior Therapy seeks to
modify negative thoughts leading to dysfunctional emotions and actions
Schemata
unique assumptions about ourselves, others and the world
Automatic thoughts (cognitive distortions) are
rapid unthinking responses
Cognitive distortions are common in what illnesses?
anxiety and depression
Replace distortions with
rational thoughts
Black and White Thinking
reducing complex outcomes into absolutes (no gray)
Overgeneralization
Using a bad outcome (or a few bad outcomes) as evidence that nothing will ever go right again in that situation (it will always go wrong)
Labeling
A form of generalization where a characteristic or event becomes definitive and results in an overly harsh label for self or others that one friend is always late
Mental Filter
- focusing on a negative detail or bad event and allowing it to taint everything else
Disqualifying the positive
Maintaining a negative view by rejecting information that supports a positive view as being irrelevant, inaccurate, or accidental
Jumping to conclusions
Making a negative interpretation despite the fact that there is little or no supporting evidence
Mind Reading
Inferring negative thoughts, responses, and motives of others
Predictive Thinking
anticipating that things will turn out badly as an established fact- the party is going to be bad because you think it is
Magnification/Minimization
Exaggerating the importance of something (e.g., a personal failure or the success of others) or reducing the importance of something (e.g., a personal success or the failure of others)
Catastrophizing
An extreme form of magnification in which the** very worst is assumed to be a probable outcome**
Emotional reasoning
- Drawing a conclusion based on an emotional state
Should/must
rigid self-directives that presume an unrealistic amount of control over external events
Personalization
Assuming responsibility for an external event or situation that was likely out of personal control
Biological Theory means
mental disorders have physical causes
- will respond to physical treatment
What incidence occurred resulting in the Biological Theory
In the 1950’s a surgeon noticed that surgical patients were calmed by chlorpromazine (Thorazine) as a pre-anesthetic agent
Soon was used for Schizophrenia which reduced restraint and seclusion – and calmed them
In biological therapy, what is the primary biological tx for mental disorders?
psychopharmacology
- antidepressants, antipsychotics, antianxiety, mood stabilizers, psychostimulants - Adderall, amphetamines, caffeine
What are other treatment plans for biological theory of psych?
correcting hormone imbalances - thyroid
regluating deficient diets (avocado, blood sugar)
sleep regulation (hallucinations and delusions)
electroconvulsive therapy
repetitive transcranial magnetic stimulation
magnetic seizure therapy
vagus nerve stimulation
deep brain stimulation
rTMS (repetitive transcranial magnetic stim)
– electromagnetic device to deliver rapidly pulsed magnetic field to the cerebral cortex to activate neurons
MST
– uses higher frequency electronic pulses instead of electricity to induce a seizure. - focal
Vagus Nerve Stimulation
– stimulates the vagus nerve which results in improved levels of neurotransmitters
DBS
– surgically implanted electrodes stimulates a certain part of the brain
memeo 2 13 miutes
Theory of Cognitive Development
Piaget
- maturation pattern of cognitive processing
Theory of psychosocial developemnt
Erik Erikson – eight predetermined life stages in which developmental tasks should be accomplished
Theory of Object Relations
Interpersonal theorists who emphasizes that past relationships influences a person’s self worth
Theory of Moral Development
-Kohlberg applied Piaget’s theory to moral development (how people progressively develop a sense of morality).
- Carol Gilligan – ethics of care theory focuses on forming relationships and putting the needs of those for whom we care above those of strangers
Psychoanalytic Theory
theorist
tenet
model
Freud
- Unconscious thought; psychosexual development
- Psychoanalysis to learn unconscious thoughts; the therapist is nondirective and interprets meaning
Interpersonal Theory
theorist
tenet
model
Sullivan
- Relationships are the basis for mental health or illness
- Therapy focuses on the here and now and emphasizes relationships; therapist is an active participant
Behavioral Theory
theorist
tenet
model
Pavlov, Watson, Skinner
- learn behavior through conditioning
- modification addresses maladaptive behaviors by rewarding adaptive behavior
Cognitive Theory
theorist
tenet
model
Beck
- Negative and self-critical thinking cause depression
- therapists assist in identifying negative thought patterns and replacing them with rational ones; Therapy often involves homework
Biological Theory
theorist
tenet
model
Many
- heavily influenced by and/or cause changes to the brain and/or neurotransmitters resulting in changes in thinking and behavior
- Neurochemical imbalances are corrected through medication and talk therapy (cognitive –behavioral therapy)
Nursing Models were discovered by
Hildegard Peplau
Peplau’s nursing model is regarded as around
Interpersonal relationships in nursing strongly influenced the outcome of the patient
-Mild anxiety
-Moderate anxiety
-Severe anxiety
-Panic anxiety
Behavioral System Theory
theorist
focus of nursing
example
Good attainment Theory
theorist
focus of nursing
example
Culture care Theory
theorist
focus of nursing
example
system model Theory
theorist
focus of nursing
example
self-care deficit Theory
theorist
focus of nursing
example
Dynamic nurse pt relationship Theory
theorist
focus of nursing
example
Transpersonal caring Theory
theorist
focus of nursing
example
Mental Health recovery model in psychiatric nursing
- Living adaptively with chronic mental illness and substance abuse
- Shifts the responsibility of care from the provider to the patient
- Emphasizes hope, social connection, empowerment, coping strategies and meaning in life
Group Therapy
optimum 6-10 people
- interpersonal theory
- provides support
- private, comfortable seats, arranged to see each other
Task Role in Group Therapy
keep group focused
attend to business at hand
Maintenance Role in Group Therapy
Keep group together
Provide interpersonal support
Group Leader in Group Therapy
structure
size, composition, purpose
timing
start communication
Ensures each member summarizes accomplishments and gives positive and negative feedback
Autocratic Leader
– exerts control over the group
Democratic Leader
– supports extensive group interaction in the process of problem solving
laissez-faire leader
– allows group to behave however they want and doesn’t attempt to control the direction of the group
Education groups
Requires expert leadership and careful planning
task groups
Time limited and have a common goal, team leader facilitates team building and cooperation
support groups
People with common concerns and may be facilitated by a supportive leader or by group members
therapy groups
Led by professional group therapists. Therapists can be directive and confrontational, or a more hands off approach
Benefits of Group Therapy
Altruism
Cohesiveness
Interpersonal Learning
Guidance
Catharsis
Identification
Family reenactment
Self understanding
Instillation of hope
Universality
Existential Factors
Altruism
Giving help to others
Cohesiveness
Feeling connected and belonging
Interpersonal Learning
Learning from other members
Guidance
Receiving help and advice
Catharsis
Releasing feelings and emotions
Identification
Modeling after member or leader
Family reenactment
Testing new behaviors in a safe environment
Self-understanding
Gaining personal insights
Instillation of hope
Feeling hopeful about one’s life
Universality
Feeling that one is not alone
Existential Factors
Coming to understand what life is about
Roles of BSN and AND IN PSYCHIATRY
Medication Education groups
Dual-diagnosis groups (co-lead WITH therapist
Symptom management groups
Stress management groups
Self-care groups
No psychotherapy
- ONLY THERAPY IF PRACTITIONER WITH SPECIALTY
Milieu
environment and social structure
- inpt or structure output
- safe to test new behaviors
**increase ability to interact adaptively with outside community
- group met for goals (orient, encourage, eval) - nurse led
Therapeutic Milieu effects
Increase patient self esteem
Decrease social isolation
Encourage appropriate social behaviors
Educate patients in basic living skills
Recreational groups
Physical activity groups
Creative Art groups
Storytelling
Family Therapy
Improve communication
Understand and manage special family situations
Improve functioning of the home environment
Identify and shift dysfunctional interactions and dynamics
Mobilize family strengths and resources
Strengthen family problem solving behavior
Deinstitutionalization
– care shifted from long-stay psyche hospitals to community health services
(labeled insane)
Olmstead Act Decision
keeping people with mental illness confined in hospitals for treatment of mental illness violated their rights in that mental illness was considered a disability and institutionalization was a violation of the Americans with Disabilities Act… therefore, services MUST be provided in the most integrated setting… to include treatment in the community.
How is mental health care moving into the future?
essential to overall health
family driven
disparities eliminated
early screening. assessment, and referrals
research
telehealth
Primary Care Providers in Outpt for psych
Lessens stigma
Disadvantages
Time constraints
Lack of expertise in psychiatry
Patient-Centered Medical Homes Model (PCMHs)
Comprehensive Care
Patient centered - holistic relationships
Coordinated care
Accessible - extended hours
Quality and safety
Psychiatric rehab services
– social model which emphasizes and supports recovery and integration into society rather than a medical model of dysfunction. (development of social skills, acquisition of optimal social, working, living and learning environment
Community Mental Health Centers
JFK 63
- opposed to institutionalization. Legislation led to state laws and budget favoring community care.
- comprehensive to prevent and tx
Pysch Home Health
Decreases hospitalizations
Alternate to clinical settings
Reimbursement requires patient to be homebound need help
Intensive outpatient programs (IOPs)and Partial hospitalization programs (PHPs)
able to work and live at home
IOP - 1/2 day
PHP - 6 hours
Assertive Community Treatment (ACT)
goal
keep patient at optimal level of wellness, crisis intervention, decrease jail and hospitalizations
CW 2-3x week
RN monthly (long injections, med monitoring, assessments, advocate
Extended Observation Unit (EOC)
23 hour - goal is to keep patient at optimal level of wellness, decrease jail and hospitalizations
out of jail= stabilize and not hospitalize
- acute crisis
Role of Nurses in Oupt Care Settings
Registered nurse who has graduated from nursing program
Develop and implement a plan of care with multidisciplinary team
Assess patient and living arrangements
Education
Refer to community supports
Supervise unlicensed care staff
Applies nursing process based on theory, standards, ethics
Provides health teaching & maintenance
Coordinates care & community resources
Community health nurses promotes community interventions such as stress reduction classes and facilitate grief support groups
Oupt Care settings
Psychiatric-mental health advanced practice RN
Graduate of Master’s Program or Doctor of Nursing Practice (DNP) program as Advanced Practice Nurse: (CNS) or (NP)
Assessment, diagnosis and treatment
Psychotherapy & group therapy
Consultation
Medication Prescriptive Authority
Education
Inpt care settings
Public psych hospitals
General hospital psych units
Private psych facilities
Specialty settings: Pedi, Geriatric, VA, Forensic, ETOH and Drug Abuse
24 nursing care
Safe and structured setting
Patients needing protection from suicidal ideation, aggressive impulses, medication adjustment and monitoring, crisis stabilization, substance use detoxification and behavior modification
May be admitted voluntarily or involuntarily
Unlocked or locked units to prevent elopement or “AWOL”
AWOL
away without leave
Elopement
leaving before D/C
Inpt Care Settings do what
eat meals
receive meds
attend activities
participate in therapies
active until they are unable to make a decision
Right to refuse tx as long as not declared incompetent
Nurses are responsible for managing
the treatment environment (milieu)
- purposeful manipulation
-cope better
-interact appropriately
-relate to others more effectively through learning new skills
Your responsibility with any and every patient is their
safety.
If there is ever a reason to violate a policy, it would be due to
Elements of effective milieu
Safety
Structure (rules and boundaries)
Norms - rights and responsibilities
Limits
Balance - therapy and least restrictive environment
Environmental modification
Locked windows- elopement
Platform beds heavy, can’t take them apart
Heavy furniture with rounded corners
Sprinklers and shower heads tend to be flushed mounted – suicide and weapon
Role of Psychiatric Nurses in Inpatient Care Setting
Registered nurse who has graduated from nursing program
Applies nursing process based on theory, standards, ethics
Provides health teaching & maintenance
Coordinates care & community resources
Maintains safety and manages milieu
Addresses legal issues
Provides pharmacological, biological, & integrative therapies
What are the legal issues with nursing psych?
Voluntary vs involuntary status (paperwork must be in order prior to allowing a patient into a locked unit)
Consent for all psychiatric medications to include teaching on purpose and side effects
State Acute Care System
- not guilty by reason of insanity
Big Spring
