Intro to Psych Nursing Flashcards
(117 cards)
1
Q
Self-Stigma
A
Patient is aware of public’s negative view of mental illness, and agree with the public’s perception
2
Q
Label Avoidance
A
Avoiding treatment or care in order not to be labeled as being mentally ill, is another type of stigma, and one of the reasons, that so few people with mental health problems actually receive help
3
Q
Recovery
A
Journey of healing and transformation enabling the person with mental health problem to lead a meaningful life in community of choice while striving to achieve full potential
- Single most important goal
4
Q
Acute Stress as it relates to Mental Illness
A
Acute stress can lead to physiologic overload, which in turn can have a negative impact on a person’s health
5
Q
Chronic Stress as it relates to Mental Illness
A
Chronic stress is clearly associated with negative health incomes.
6
Q
Person-Environment Relationship
A
Has to do with the interpersonal and psychosocial aspects of stress
It is the interaction between an individual and the environment that change throughout a stress experience. It is based on the values and beliefs people they carry with them in life, as well as personality factors and factors related to the individual’s social and physical environment.
7
Q
Appraisal
A
A given event or situation may be extremely stressful to one person but not to another. The more important or meaningful the outcome, the more vulnerable the person is to stress. Appraisal is the process where all aspects are considered—the demands, constraints, and resources are balanced with personal goals and beliefs.
8
Q
What two factors determine if a person experiences stress response?
A
- Person-Environment relationship
2. Appraisal
9
Q
Person-Environment Relationship Personality Types
A
Types A, B, C, and D
10
Q
Type A Personality
A
- Competitive
- Aggressive
- Ambitious
- Impatient
- Alert
- Tense
- Restless
11
Q
Type B Personality
A
- Relaxed
- Easygoing
- Easily satisfied
12
Q
Type C Personality
A
- Introverted
- Respectful
- Conforming
- Compliant
- Eager to please
13
Q
Type D Personality
A
- Increased negative emotions
- Pessimism
- Non-sharing of emotions
14
Q
Emotional Stress Responses
A
- Negative emotions
- Positive emotions
- Borderline emotions
- Nonemotions
15
Q
Negative Emotions
A
An emotional stress response
- Occur when there is a threat to, delay in, or thwarting of a goal or a conflict between goals: anger, fright, anxiety, guilt, shame, sadness, envy, jealousy, and disgust
16
Q
Positive Emotions
A
An emotional stress response
- Occur when there is movement toward or attainment of a goal: happiness, pride, relief, and love
17
Q
Borderline Emotions
A
An emotional stress response
- Are somewhat ambiguous: hope, compassion, empathy, sympathy, and contentment
18
Q
Nonemotions
A
An emotional stress response
- Connote emotional reactions but are too ambiguous to fit into any of the preceding categories: confidence, awe, confusion, and excitement
19
Q
Coping
A
- Deliberate, planned, and psychological activity to manage stressful demands
- Positive coping leads to adaptation
- Teach patients how to adapt to stress
20
Q
Adaptation
A
Person’s ability to survive and flourish.
21
Q
The three important areas that adaptation effects
A
- Health
- Psychological well-being
- Social functioning
22
Q
Human Response to Stress: Overall Goals
A
- Resolve stressful person-environment situations
- Reduce the stress response
- Develop positive coping skills
23
Q
Human Response to Stress: Goals for those at risk for stress
A
- Recognize the potential for stressful situations
2. Strengthen positive coping skills
24
Q
Assessment of the Biologic Domain of Mental Health
A
- Gender differences
- Review of systems
- Physical functioning
- Pharmacological assessment
25
Biologic Domain Assessment: Gender Differences
It is now known that people experience stress differently depending on their gender. Whereas males are more likely to respond to stress with a fight or flight response, females have less aggressive responses; they “tend and befriend.”
26
Biologic Domain Assessment: Review of Systems
A systems review can elicit the person’s own unique physiologic response to stress and can also provide important data on the effect of chronic illnesses
27
Biologic Domain Assessment: Physical Functioning
Typically, sleep is disturbed, appetite either increases or decreases, body weight fluctuates, and sexual activity changes. Physical appearance may be uncharacteristically disheveled—a projection of the person’s feelings. Body language expresses muscle tension, which conveys a state of anxiety not usually present. Because exercise is an important strategy in stress reduction, the nurse should assess the amount of physical activity, tolerance for exercise, and usual exercise patterns
28
Biologic Domain Assessment: Pharmacologic Assessment
In assessing a person’s coping strategies, the nurse needs to ask about the use of alcohol, tobacco, marijuana, and any other addictive substances. If a psychiatric disorder is present, the nurse should assess medication compliance, especially if the psychiatric symptoms are reappearing
29
Nursing Interventions for the Biologic Domain of Mental Health
1. Activities of daily living
2. Nutrition
3. Exercise
4. Relaxation techniques
5. Referral for hypnosis or biofeedback
30
Assessment of the Psychological Domain of Mental Health
1. Emotions and their severity
2. How the person reacts to emotions
3. Coping Strategies
31
Two types of Coping Strategies
1. Problem focused
| 2. Emotion focused
32
Problem Focused Coping Strategy
In problem-focused coping, the person attacks the source of stress and solves the problem (eliminating it or changing its effects), which changes the person–environment relationship.
33
Problem or Emotion Focused Coping?
When noise from the television interrupts a student’s studying and causes the student to be stressed, the student turns off the television and eliminates the noise.
Problem Focused
34
Problem or Emotion Focused Coping?
An abused spouse is finally able to leave her husband because she realizes that the abuse will not stop even though he promises never to hit her again
Problem Focused
35
Problem or Emotion Focused Coping?
A husband is adamantly opposed to visiting his wife’s relatives because they keep dogs in their house. Even though the dogs are well cared for, their presence in the relative’s home violates his need for an orderly, clean house and causes the husband sufficient stress that he copes with by refusing to visit. This becomes a source of marital conflict. One holiday, the husband is given a puppy and immediately becomes attached to the dog, who soon becomes a valued family member. The husband then begins to view his wife’s relatives differently and willingly visits their house more often
Emotion Focused
36
Problem or Emotion Focused Coping?
A mother is afraid that her teenage daughter has been in an accident because she did not come home after a party. Then the woman remembers that she gave her daughter permission to stay at a friend’s house. She immediately feels better
Emotion Focused
37
Nursing Interventions for the Psychological Domain of Mental Health
1. Assist patients to develop appropriate problem-solving strategies
2. Have the patient discuss the person-environment situation and develop alternative coping strategies
38
Assessment of the Social Domain of Mental Health
1. Recent life changes
2. Social network
- Size and extent of the network
- Functions that the network serves
- Degree of reciprocity between the patient and other network members
- Degree of interconnectedness
39
Nursing Interventions of the Social Domain of Mental Health
1. Facilitation of family functioning
2. Assistance in expanding social network
3. Support of family unit functioning
4. Parent education
5. Family therapy
40
Compensation
Allows a person to overcome weakness and achieve success
41
Denial
Refusing to acknowledge some painful aspect of external reality or subjective experience that would be apparent to others
42
Displacement
Transferring a feeling about, or a response to, one object onto another (usually less threatening), substitute object
43
Identification
Helps a person avoid self-devaluation; attempt to increase self-worth by acquiring certain attributes of an individual one admires
44
Intellectualization
Helps protect a person from pain and traumatic events; attempt to avoid expressing actual emotions associated with a stressful situation by using logic, reasoning, and analysis
45
Introjection
Internalization of the beliefs and values of another individual such that they symbolically become a part of the self to the extent that the feeling of separateness or distinctness is lost
46
Isolation
Separation of ideas from the feelings originally associated with them
47
Minimization
Allows a person to decrease responsibility for own behavior; not acknowledging the significance of one's own behavior
48
Projection
Allows a person to deny the existence of shortcomings and mistakes; protects self image
49
Rationalization
Helps a person cope with the inability to meet goals or certain standards; attempting to make excuses to formulate logical reasons to justify unacceptable feelings or behaviors
50
Reaction Formation
Aids in reinforcing repression by allowing feelings to be acted out in a more acceptable way; substituting behavior that is diametrically opposed to one's own unacceptable thoughts or feelings
51
Regression
Allows a person to return to a point in development when nurturing and dependency were needed and accepted with comfort
52
Repression
Protects a person from a traumatic experience until he/she has the resources to cope; an unconscious mechanism by which threatening thoughts, feelings, and desires are kept from becoming conscious
53
Sublimation
Protects a person from behaving in an irrational, impulsive way; Channeling potentially maladaptive feelings or impulses into socially acceptable behavior
54
Supression
Intentionally avoiding thinking about disturbing problems, wishes, feelings, or experiences
55
Substitution
Helps a person achieve goals and minimizes frustration and disappointment
56
Undoing
Allows a person to appease guilty feelings and atone for mistakes
57
A high school student too small to play football becomes the star long distance runner for the track team
Compensation
58
A man whose brother is in ICU spends his time speaking to the nursing staff about his condition and treatment plan instead of visiting with his brother
Intellectualization
59
A father spanks his child and the next evening brings home a present for him
Undoing
60
A person with excessive, primitive sexual drives invests psychic energy into a well-defined religious value system
Sublimation
61
An adult throws a temper tantrum when he does not get his way
Regression
62
A woman drinks alcohol every day and cannot stop, failing to acknowledge she has a problem
Denial
63
A physically challenged young man who is unable to participate in sports compensates by becoming a great scholar
Compensation
64
A person says "don't believe everything my wife tells you. I wasn't so drunk that I couldn't drive"
Minimization
65
An executive resents his boss for calling in a consulting firm to make recommendations for change in his department but verbalizes complete support of the idea and is exceedingly polite and cooperative
Reaction Formation
66
A woman wants to marry a man exactly like her dead father and settles for someone who looks a bit like him
Substitution
67
A man is rejected by his girlfriend, but explains to his friends that her leaving was best because she was beneath him socially and would not be liked by his family
Rationalization
68
A husband and wife are fighting, and the husband becomes so angry he hits a door instead of his wife
Displacement
69
A psychiatric client claims to be the Son of God, drapes himself in a sheet and blanket, performs miracles on the other clients and refuses to respond unless addressed as Jesus
Introjection
70
Scarlett O'Hara says "I don't want to think about that now. I'll think about that tomorrow."
Suppression
71
A mother spanks her child too hard and says it was all right because he couldn't feel it through his diapers anyway
Rationalization
72
A woman loses touch with the feelings associated with a rape while remaining aware of the details
Isolation
73
A student nurse imitates the nurturing behavior she observes one of her instructors using with clients
Identification
74
A teenager's best friend moves away, but the adolescent says he does not feel sad
Denial
75
A woman does not remember the experience of being raped in the basement, but does feel anxious when going into that house
Repression
76
A teenage with strong competitive and aggressive drives becomes the star football player on his high school team
Sublimation
77
A teacher writes an easy examination, and then constructs a grading curve that makes it difficult to earn a high grade
Undoing
78
A mother is told that her child must repeat a grade in school and she blames this on the teacher's poor instructions
Projection
79
A person says "I didn't try to kill myself; I just took some pills because my head hurt"
Minimization
80
A 7 year old tells his little sister "don't talk to strangers." He was told this by his teachers and parents
Introjection
81
A teenage who required lengthy rehabilitation after an accident decides to become a physical therapist
Identification
82
A teenager, seeing his best friend killed in a car accident, becomes amnesic about the circumstances surrounding the accident
Repression
83
A student is anxiously awaiting test results but goes to a movie to stop thinking about it
Suppression
84
A wife finds out about her husband's extramarital affairs and tells her friends that she thinks his affairs are perfectly appropriate
Reaction Formation
85
A child is mad at her mother for leaving her for the day, but says she is really mad at the sitter for serving her food she does not like
Displacement
86
A college professor's fiancee breaks the engagement. He shows no remorse, but instead tries to analyze the situation and figure out why she broke off the engagement
Intellectualization
87
A critically ill patient allows the nurse to bathe and feed him
Regression
88
A husband forgets to pay a bill and blames his wife for not giving it to him earlier
Projection
89
Self-Determinism
- The right to choose one's own health-related behaviors
- Could possibly be different from those recommended by health professionals
- A basic and fundamental psychological need
* *A self-determined individual is internally motivated to make choices based on personal goals, not to please others or to be rewarded. That is, a person engages in activities that are interesting, challenging, pleasing, exciting, or fun, requiring no rewards other than the positive feelings that accompany them because of inner goals, needs, drives or preferences
90
Two key values of self-determinism
1. Personal autonomy
| 2. Avoidance of dependence on others
91
The Patient Self-Determination Act
Requires that agencies receiving Medicare or Medicaid reimbursement to inform patients at the time of reimbursement to inform patients at eh time of admission of their right to be a central part of any and all health care decisions made about them or for them
92
Psychiatric Advance Directives
Allow patients, while competent, to document their choices of treatment and care
93
Competency
It is generally agreed that competence, or the degree to which the patient can understand and appreciate the information given during the consent process, refers to a patient’s cognitive ability to process information at a specific time. A patient may be competent to make a treatment decision at one time and not be competent at another time. Competence is also decision specific, so that a patient may be competent to decide on a simple treatment with a relatively clear consequence but may not be competent to decide about a treatment with a complex set of outcomes. A competent patient can refuse any aspect of the treatment plan
** Competence is necessary to give consent
94
How to determine competency
During the assessment, can they...
1. Communicate choices
2. Understand relevant information
3. Appreciate situation and consequences
4. Use a logical thought process to compare risks and benefits of treatment options
95
Least Restrictive Environment
- A person cannot be restricted to an institution when he or she can be successfully treated in the community
- Medication cannot be given unnecessarily
- Use of restraints or locked room only if all other "less restrictive" interventions have been tried first
96
First line of restraints/seclusion
Verbal = its almost like a warning
97
Second line of restraints/seclusion
Chemical intervention = medications
98
Third line of restraints/seclusion
Physical/mechanical interventions = last resort
99
When can you restrain or seclude a patient?
1. Their behavior is harmful to themselves or 3rd party
2. Least restrictive measures are insufficient to protect patient/others from harm
3. Decrease in sensory overstimulation (seclusion only) is needed
4. When the patient anticipates that a controlled environment would be helpful and requests it
100
When can you NOT seclude a patient?
1. Extremely unstable medical/psychiatric conditions without direct observation
2. Delirium or dementia without direct observation
3. Severe drug reactions or overdoses
4. Desire for punishment or convenience of staff
101
Types of Committment
1. Voluntary
| 2. Involuntary
102
Voluntary Committment
- Person retains full civil rights
| - Free to leave at any time, even against medical advice
103
Involuntary Committment
- Court ordered
| - Without the patient's consent
104
The three common elements of involuntary committment
The patient must be...
1. Mentally disordered
2. Dangerous to self or others
3. Unable to provide for basic needs
105
Mandates to Inform
- A legal obligation to breach confidentiality
| - Judgement that the patient has harmed someone or is about to injure someone
106
Assault
Threat of unlawful force to inflict bodily injury upon another. An assault must be imminent and cause reasonable apprehension in the individual
107
Battery
The intentional and unpermitted contact with another
108
Medical Battery
Intentional and unauthorized harmful or offensive contact, occurs when a patient is treated without informed consent. For example, a clinician who fails to obtain consent before performing a procedure is subject to being accused of medical battery. Also, failure to respect a patient’s advance directives is considered medical battery
109
False Imprisonment
The detention or imprisonment contrary to provision of the law. Facilities that do not discharge voluntarily committed patients upon request can be subject to this type of litigation.
110
Negligence
Breach of duty of reasonable care for a patient for whom a nurse is responsible that results in personal injuries. A clinician who does get consent but does not disclose the nature of the procedure and the risks involved is subject to a negligence claim
111
Autonomy
- Respecting the the rights of others to make their own decisions
- Each person has the right to self-determination
112
Beneficence
- Relates to the quality of doing good and can be described as charity
- Example: spending extra time to help calm an extremely anxious patient
113
Justice
- The duty to treat all fairly
| - Example: the ICU nurse devotes an equal amount of time to a patient who has AIDS as to the VIP who is there for a CABG
114
Nonmaleficence
- Requirement that health care providers do no harm to their patients, either intentional or unintentional
- Maintain loyalty and commitment to the patient
- Examples: Maintain expert nursing skill throughout nursing education; A nurse stays after her shift to comfort a bipolar patient that learned his mother has died
115
Paternalism
- The belief that knowledge and education authorize professionals to make decisions for the good of the patient
- This principle can be in direct conflict with the mental health recovery belief of self-determinism
- Example: mandatory use of seat belts
116
Veracity
- The duty to communicate truthfully
- Limitations may be placed on this principle when knowing the truth would produce harm or interfere with the recovery process
- Lying is never justified
- Examples: The nurse describes the purpose and side effects of psychotropic medications in a truthful and non-misleading way
117
Fidelity
- Faithfulness to obligations and duties
- Keeping promises
- Important in establishing trusting relationships
