Quiz questions Flashcards
- Despite which psychotherapeutic framework clinicians apply (CBT, DBT, ACT…) what interpersonal attributes are central to therapeutic engagement?
Genuine interest and curiosity A friendly positive demeanour Non verbal communication skills (vocal qualities, eye contact, open posture) Active listening skills Empathy Respect
- How might you establish rapport with someone and create an environment conducive to therapeutic engagement?
- Find a comfortable (private) place to sit.
- Approach the person in an empathic non-judgmental manner.
Introduce yourself, your role - Ask what name the person would prefer to be called.
- Thank them for the opportunity to speak with them
- Check the person is comfortable. Offer the person something to drink or eat.
- Convey to the person that you are listening
- Take time to hear the person’s perspective and expectations
- Seek clarification from the person that you have understood their situation correctly
- When working from a strengths based perspective, what are clinicians interesting in exploring with people?
Abilities, assets, skills, needs, resources, and the person’s vision for the future.
Past successes- what works.
Exceptions to problems
How the person have coped through adversity
The person’s own goals.
What the person does well
What the person does that is good for them.
Hobbies, activities and interests the person derives passion of meaning from.
- What do you need to consider in responding to a woman who has just disclosed to you that she is the victim of domestic violence?
The woman needs to have confidence in the clinician they are disclosing to.
Engage in a sensitive, caring and open way. Emphasise safety.
Ask if she has disclosed this to anyone previously
‘This can be difficult to talk about’.
‘This is a safe place’.
‘We believe women, we want to support women, we take domestic violence seriously’
Ensure privacy
Discuss her safety on leaving the health facility
Concerns for any children/dependents
Supports that are available (family, friends, professional)
Services that may need to be coordinated for her. Social work, crisis accommodation, financial support.
May need to use an interpreter
- What are some of the challenges that young people in particular can encounter that impact on mental health?
Trauma
Drug and Alcohol misuse
Social media
Eating and dieting problems
Relationships with peers, bullying, not fitting in.
Difficult relationship with parents and other family members.
A physical illness
- What does the term ‘attachment’ mean and how does it relate to mental health and wellbeing?
Attachment refers to the relationship an infant develops with at least one parent. Positive ‘secure’ attachment is considered pivotal for a child’s successful social and emotional development, and in particular for learning how to regulate their emotions.
Unhealthy attachment can impact negatively on an individual’s sense of self and is associated with anxiety, depression, difficulties with emotional regulation and healthy adult relationships
- Similarly, what impact does childhood trauma have on children and how does it manifest in later life?
Child abuse and neglect is especially damaging due to the child’s vulnerability, their reliance on their care giver who is usually perpetrating or permitting the abuse, their developing brain, their developing attachment style, their entrapment in an unsafe and unpredictable environment.
Children instinctually maintain attachment at any cost, even with neglectful/abusive caregivers, creating distorted attachment styles which determine future adult relationships.
The severity, frequency, proximity and duration of child abuse experienced directly influences how much damage is done
Impact in adulthood
Interpersonal difficulties
Anxiety and panic
Difficulty managing emotions
Sleep and somatic disturbances
Mental and physical health issues
Cognitive impacts - learning, concentration, memory, dissociation
Harmful patterns of coping/soothing- Self harm, substance problems
Re-victimization & intergenerational trauma
Frequent contact with health, housing, welfare and criminal justice systems
Suicidal ideation and attempts
- In the workplace, what are some of the incivil and bullying behaviours that nurses may encounter?
Being allocated an unreasonable workloads and deadlines
Repeatedly asked to perform work under your competence level
Being ignored or excluded
Relevant information related to your work withheld
Over-checking
The silent treatment
Belittling
Sexist, racist comments
Humiliation and ridicule
For students
Verbal abuse in front of patients, other staff and students.
Overtly rejected by the clinical team with blunt reminders of their inferiority in the workplace.
Being excluded, having doors shut in their faces, not permitted to use the staff tea room.
Being made to feel a burden and not wanted in the clinical setting
“Power trips” from staff not normally in a position of power, such as ENs and AINs.
Targeted due to physical appearance (e.g. body shape, weight, height), age, introverted personality.
- How can nurses respond to these behaviours?
Work willingly
Cooperate with others
Don’t be too submissive
Use initiative
Take difficulties to a superior before complaining to others
Accept relevant criticism when conveyed appropriately
- What self-care strategies can nurses practice to manage work place stress and avoid burnout and compassion fatigue?
Be mentally prepared. Maintain social contact with healthy positive people. Exercise and diet. Prayer, meditation, relaxation. Time out for self-care. Holidays
- What are some of the risk and protective factors associated with mental health from an individual, social and structural level?
Protective factors Positive sense of self Good coping skills Family attachment Social skills Good physical health Positive experience of early attachment. Supportive and caring parents/family. Good communication skills. Supportive social relationships. Sense of social belonging. Community participation. Safe and secure living environment Economic security Employment Positive educational experience Access to support services Risk factors Low self esteem Low self efficacy Poor coping skills Insecure attachment in childhood Physical and intellectual disability Abuse a violence Separation and loss Peer rejection Social isolation Neighbourhood violence and crime Poverty Unemployment/economic insecurity. Homelessness School failure Social and cultural discrimination. Lack of support services.
- What leads to loneliness in older age and what is the impact?
Enforced change in living arrangements disrupts social contacts, but does offer new ones.
Loss of significant others, especially spouse/partner.
Sociable people who through illness (such as stroke) have their ability to socialize curtailed.
An ageing body may mean that people feel ugly. Loneliness feels wrong when the person believes that human beings are meant to be sociable.
To be lonely may be equated with unworthiness, looking, acting and thinking in ways that make it much harder for people to approach you.
A problem arises with people who are lonely and struggling with self care. Looking after hygiene, dealing with wounds, stomas, prostheses may be more difficult if the person has less reason/motivation to do so.
Loneliness in older persons is associated with a range of morbidities, including depression and suicide.
Loneliness is linked with deficits in self care and motivation. Shortfalls in nutrition, exercise and personal hygiene.
Socioeconomic conditions have an influence on loneliness. Housing, patterns of work, communication, cultural institutions, distribution of wealth and other resources.
Well educated, well organized and articulate older people are better equipped to build and sustain social networks. For example groups based on cultural interests such as art, reading, theatre, cooking.
People with significant retirement income are better equipped to travel and maintain contact with others.
At risk groups are those with enduring conditions, low income, history of MH problems, moved from a familiar environment to a new one.
- What are the fundamental approaches to working with people who hear voices?
Voices are a normal human experience and that voices have meaning for people and should not be ignored.
An important element in coping successfully with voices is accepting and working with them.
The more antagonistic the relationship the person has with voices the worse they become.
It is often helpful to set limits and structure the contact with the voices.
- What are some of the many ways people have found to cope with and manage their voices?
Voice hearing groups
Voice profiling
Dialoguing with voices
Setting limits
Medications
Be willing to experiment with strategies to cope, control and learn from voices.
Stay healthy- eat well, exercise, meditate, engage in activities that shift attention, keep a routine,
Avoid excessive alcohol and other substances.
Take time to relax- manage stress and anxiety
Pay attention to and monitor times when voices are less or more pronounced.
Maintain social contact
Read, listen to music
- What are common side effects of antidepressants?
Common- dry mouth, blurred vision, restlessness, tremor, headache, insomnia, constipation, somnolence.
Increased suicidal thinking
Weight gain- varies and may continue after cessation
Sexual problems- ↓ libido, erectile dysfunction, delayed orgasm
Hyponatraemia- elderly, female, low weight, diuretics, NSAIDS, chemo, carbemazepine, hypothyroid, diabetes, COPD, hypertension, cancers.
SSRIs and upper/lower GI bleeding (doubled with aspirin and NSAIDS)
