Week 2: CH 2,3,6,7 Flashcards
What are the components of the psychotherapeutic management model.
Nurse-Patient relationship, psychopharmacology, and milieu management
Explain the psychotherapeutic management model
- Therapeutic Nurse-Patient Relationship: communication skills. Respect and a desire to help. Understanding: mental mechanisms, adaptation styles, coping strategies, therapeutic intervention skills.
- Psychopharmacology: therapeutic versus toxic dosage levels. Use during pregnancy. Use with older adults. Side effects. Interactions. Patient teaching.
- Milieu Management: safety, structure, norms, limit setting, balance, environmental modification
What is the continuum of care?
Provides individuals with a wide range of treatment options.
First step after a mental health problem is suspected is to confirm its existence.
It identifies residential services, outpatient services, and self-help resources.
Discharge planning.
Nurses function is to assess the individual’s current level of functioning and then direct them to appropriate resources.
Talk about the Psychoanalytic Model
Theory of personality originated by Sigmund Freud that emphasized unconscious processes or psychodynamic factors as the basis for motivation and behavior.
id: all at birth, wanting to experience pleasure. Immediate gratification, enabling the individual to strive for pleasure through the use of fantasies and images. Compulsive and without morals.
Ego: reality principle and strives to meet the demands of the id while maintaining the well being of the individual by distinguishing fantasy from reality. Experiences anxiety and uses defense mechanisms for protection. influences by heredity, environmental factors, and maturation. Controls id impulse and mediates between the id and reality.
Superego: Concerned with right and wrong, the conscience. Internalization of what parents teach their children about right.wrong through reward/punishments.Provides ego with an inner control to help control the id.
Consciousness: material within an individual’s awareness. One small part of the mind.
Defense mechanisms: Protect the ego and diminish anxiety. Primarily unconscious behaviors.
Talk about the Developmental Model
Erikson built on Frued’s model by including psychosocial and environmental influences along with the Freudian psychosocial concepts.
Life cycle form birth to death.
Life span development occurs in 8 stages.
Growth reflects mastery of critical tasks.
Lack of mastery interferes with functioning.
What are the 8 stages in the developmental model.
Trust vs. mistrust Autonomy vs. shame and doubt Initiative vs. guilt Industry vs. inferiority Identity vs. role diffusion Intimacy vs. isolation Generative lifestyle vs. stagnation Integrity vs. despair
Talk about the Interpersonal Model
Henry Sullivan developed a comprehensive exam of interpersonal and inter-group relationships called the interpersonal theory of psychiatry.
Healthy person as a social being with the ability to live effectively in relationships with others.
Relationships viewed as the source of anxiety and maladaptive behaviors and negative personality formation.
What are the key concepts of the interpersonal model
The goal is to develop mature, satisfactory, and anxiety free relationships.
Therapy by analyzing the patient’s interpersonal processes and test new skills.
Talk about the Cognitive-Behavioral Models
Aaron Beck and Albert Ellis.
Cognitive Therapy: Irrational beliefs, automatic thoughts influence behavior.
Self-defeating behaviors can be challenged
Confront irrational thinking, automatic thoughts.
Reality testing and problem solving aimed at correcting faulty cognitions.
What is the Cognitive Behavior Therapy?
Uses cognitive and behavioral techniques
Goal is to work on directly changing behaviors as well as changing faulty thinking
What is the motivational enhancement therapy?
Uses motivational interviewing to increase willingness to change habits related to addictions
What is the dialectical therapy?
Changing self-mutilating behaviors
Explain Seyle’s Stress-Adaptation Theory
Alarm reaction: +1 to +2 anxiety
-Mobilization; activation of fight-or-flight mechanism
Stage of resistance: +2 to +3 anxiety
-Adaptation to stress within individual’s capabilities
Stage of exhaustion: +3 to +4 anxiety
-Loss of ability to resist stress; depletion of resources
What is Lazarus’s Interactional Model?
Focus: Psychological aspects of stress
Basis of coping: Cognitive appraisal of threat
Primary appraisal—judgment about event
Secondary appraisal—determines response
Reappraisal—based on new information
Personal and environmental factors influence appraisal
The Integrative approach is when a….
Nurse selects concepts from various models to provide best explanation of patient’s behaviors, problems, and needs
What is the interpretation of communication?
Patient: culture, experience, coping ability, psychopathology.
Nurse: culture, experience, knowledge of psychopathology, and skills to guide.
What are the communication themes?
Content themes go beyond the words a patient is saying and examine underlying messages about patient’s perceptions of themselves and their problems over time. (beliefs, values, self-concept, self-esteem, helplessness, hopelessness, suspiciousness, risk for suicide)
Mood themes relate to affect and the feelings conveyed while patients discuss their issues and concerns. (shame, guilt, anger, sadness, and fear)
Interaction themes involves examining the ways in which patients relate to family, friends, other patients, and staff.
What are the environmental considerations?
Privacy
Furniture
Temperature
Proxemics: way in which people perceive and use environmental, social, and personal space during interactions.
What are the kinesic considerations?
Body language: Facial expression, Eye movement, Gestures, Mannerisms, Eye contact
Might be incongruent with words
Validate meaning
What is social communication?
Equal disclosure Spontaneous Meets personal needs of both Confidentiality might or might not be observed Listener might not be objective
What is therapeutic communication?
Patient-centered Planned Directed by professional Meets patient’s needs Listener objective Information shared with health team
What is therapeutic use of self?
Verbal and nonverbal communication
Silence and therapeutic listening
Components: Being actively alert, Using eye contact, Attending posture, Concentrating, Being patient, Displaying openness
Silence and Therapeutic Listening
Offering empathy/support Asking questions Assimilating information Organizing, synthesizing, and interpreting information Validating and clarifying information Responding verbally and nonverbally Summarizing Giving feedback
Therapeutic Use of Self
Sensitivity: recognizes important cues and make decisions about the priority of these cues.
Objectivity: process of remaining open to as many aspects of patients, their problems, and potential solutions as possible.
Empathy: ability to recognize and understand the patient’s feelings and point of view objectively.
Therapeutic Use of Self, cont’d
Genuineness -Congruence -Authenticity -Honesty -Nonevaluative -Sets limits Touch: Use with caution -Might violate personal space -Might be misinterpreted
Common Inferences
Nurse’s:
- Fears
- Feelings
- Lack of knowledge
- Insecurity
- Ineffective responses
Ineffective Responses and Behaviors
Not fully listening, not paying attention
Looking too busy, ignoring the patient
Seeming uncomfortable with silence, fidgeting
Being opinionated, arguing with the patient
Avoiding sensitive topics, changing the topic
Being superficial or using clichés
Having a closed posture, avoiding eye contact
Making false promises or reassurances
Giving advice or talking too much
More ineffective responses and behaviors
Laughing or smiling inappropriately Showing disapproval or being judgmental Belittling feeling or minimizing problems Being defensive or avoiding the patient Making flippant or sarcastic remarks Lying or being insincere
