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Flashcards in Intro to Psych Nursing Deck (117):
1

Self-Stigma

Patient is aware of public's negative view of mental illness, and agree with the public's perception

2

Label Avoidance

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

Recovery

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

Acute Stress as it relates to Mental Illness

Acute stress can lead to physiologic overload, which in turn can have a negative impact on a person’s health

5

Chronic Stress as it relates to Mental Illness

Chronic stress is clearly associated with negative health incomes.

6

Person-Environment Relationship

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

Appraisal

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

What two factors determine if a person experiences stress response?

1. Person-Environment relationship
2. Appraisal

9

Person-Environment Relationship Personality Types

Types A, B, C, and D

10

Type A Personality

1. Competitive
2. Aggressive
3. Ambitious
4. Impatient
5. Alert
6. Tense
7. Restless

11

Type B Personality

1. Relaxed
2. Easygoing
3. Easily satisfied

12

Type C Personality

1. Introverted
2. Respectful
3. Conforming
4. Compliant
5. Eager to please

13

Type D Personality

1. Increased negative emotions
2. Pessimism
3. Non-sharing of emotions

14

Emotional Stress Responses

1. Negative emotions
2. Positive emotions
3. Borderline emotions
4. Nonemotions

15

Negative Emotions

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

Positive Emotions

An emotional stress response

- Occur when there is movement toward or attainment of a goal: happiness, pride, relief, and love

17

Borderline Emotions

An emotional stress response

- Are somewhat ambiguous: hope, compassion, empathy, sympathy, and contentment

18

Nonemotions

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

Coping

- Deliberate, planned, and psychological activity to manage stressful demands
- Positive coping leads to adaptation
- Teach patients how to adapt to stress

20

Adaptation

Person's ability to survive and flourish.

21

The three important areas that adaptation effects

1. Health
2. Psychological well-being
3. Social functioning

22

Human Response to Stress: Overall Goals

1. Resolve stressful person-environment situations
2. Reduce the stress response
3. Develop positive coping skills

23

Human Response to Stress: Goals for those at risk for stress

1. Recognize the potential for stressful situations
2. Strengthen positive coping skills

24

Assessment of the Biologic Domain of Mental Health

1. Gender differences
2. Review of systems
3. Physical functioning
4. 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