Week 4 Flashcards
(82 cards)
1
Q
What knowledge informs psychiatric nursing?
A
- personality development theory
- human needs theory
- biological theories
- social determinants perspectives
2
Q
Define psychosomatic.
A
a psychological state that contributes to physical illness
3
Q
Who are the psychoanalytic theorists?
A
SIGMUND FREUD (unconscious access to dreams & free association) ANNA FREUD (applied ego psychology to psychoanalytic treatment with focus on child analysis and defence mechanisms)
4
Q
Define the Cathartic Method.
A
talk therapy
- expressing or letting out aggression and anger should reduce the feeling of aggression
- re-experiencing of a traumatic event and expressing the strong emotions that are associated with them
5
Q
Define Gestalt Therapy.
A
create role-play situations to facilitate safe expression of emotions
6
Q
Define Conscious.
A
aware of events, thoughts & feelings with the ability to recall them
7
Q
Define unconscious.
A
thoughts & feelings that are outside awareness & are not remembered
8
Q
What are the levels of consciousness?
A
CONSCIOUS
PRECONSCIOUS (easily retrieved unconscious material with conscious effort)
UNCONSCIOUS
9
Q
Define the ID.
A
ID – Primitive and unconscious part of personality, the “it” that is present when born. Produces instincts, drives, wishes. Does not like frustration but lacks problem solving ability and acts according to the PLEASURE PRINCIPLE and PRIMARY PROCESS
10
Q
Define the pleasure principle.
A
drives the id to seek immediate gratification of all needs, wants and desires; when this causes tension Id needs to find way to discharge the tension
11
Q
Define the primary process.
A
to discharge energy rather than act out the id forms a mental image of a desired object to substitute for an urge in order to diffuse tension and anxiety
12
Q
Define the EGO.
A
MEDIATOR. The problem solver and reality tester that acts to avoid/ reduce anxiety. It is our moral component.
13
Q
Define the secondary process.
A
thinking and reasoning capabilities of the ego
14
Q
Define identification.
A
able to differentiate subjective experience, memory mages and objective reality
15
Q
Define the reality principle.
A
the ego has capacity to delay gratification. Person considers reality to implement plan.
16
Q
Define SUPEREGO.
A
MORAL COMPONENT. Both in the conscious and unconscious. Last part of personality to develop (by age 7). Represents the ideal, seeks perfection as opposed to seeking pleasure or engaging reason.
17
Q
What imbalance between the id, ego and superego occurs when the person lacks self control?
A
Id is too powerful
18
Q
What imbalance between the id, ego and superego occurs when the person becomes self critical, and suffer from feelings of inferiority?
A
Superego is too powerful
19
Q
What are ego defence mechanisms?
A
develop to manage anxiety and environment; operate in unconscious and deny, falsify, or distort reality to make it less threatening
20
Q
Freud’s psychosexual stages of development premise.
A
(in first 5 yr learn lifetime adjustment patterns and personality structure)
21
Q
Nursing implications of Freud’s theory
A
- personality formation
- conscious and unconscious influence
- importances of talk sessions
- attentive listening and focus on underlying themes
22
Q
Define transference.
A
unconscious redirecting of feelings from one person to another
23
Q
Define counter-transference
A
the emotional reaction of the nurse to the client; this is why we require self awareness and supervisory guidance
24
Q
What is psychodynamic therapy composed of?
A
- MORE THAN 20 SESSIONS
- use free association, dream analysis, transference/counter-transference
- agreed focus and # of session, meet weekly, intervene to keep on track or interpret, focus on here and now, clear expectations, specific current goals, focus on improving the worst symptoms, improving coping skills and gaining understand
25
Who is psychotherapy good for?
clients with a clearly limited area of difficulty, who are intelligent, psychologically minded and motivated to change.
- NOT for clients with psychosis, severe depression, borderline personality disorders
26
Erikson's stages of development.
| Trust vs mistrust.
0-1.5
27
Erikson's stages of development.
| Autonomy vs shame and doubt.
1.5-3
28
Erikson's stages of development.
| Initiative vs guilt.
3-6
29
Erikson's stages of development.
| Industry vs inferiority
6-12
30
Erikson's stages of development.
| Identity vs role confusion.
12-20
31
Erikson's stages of development.
| Intimacy vs isolation
20-35
32
Erikson's stages of development.
| Generativity vs self-absorption.
35-65
33
Erikson's stages of development.
| Integrity vs despair
65+
34
How does Erikson's stages of development help with nursing process?
important to assess to help determine what types of interventions are most likely effective
35
What is Sullivan's Interpersonal Theory?
Based on the idea that observation of interpersonal relation is easier to learn about the person.
Purpose of all behaviour is to get needs met through interpersonal interactions and to reduce or avoid anxiety
36
Define anxiety as from Sullivan's theory.
painful feeling that arises from social interaction or prevents biological needs from being met
37
Define Security Operations.
personal strategies to reduce anxiety and increase security
38
Sullivan's learning theory was the foundation of ____ theory
Peplau's
39
What was Sullivan's psychotherapeutic environment characterized by?
accepting atmosphere with many opportunities to practice interpersonal skills and develop relationship
40
Peplau suggest's what about PARTICIPANT OBSERVER?
- prof cannot be isolated from the therapeutic relationship
- Peplau suggests that nurses need to interact with pt as human beings: use mutuality, respect, unconditional acceptance, and empathy
41
Components of Interpersonal Psychotherapy.
- SHORT TERM
- originated from Meyer and Sullivan
- assumes INTERACTIONS and SOCIAL CONTENT influence psychiatric disorder
- improve interpersonal functioning and social satisfaction
- TARGETS grief, dispute, role transition, or interpersonal deficit
42
Peplau's theories in nursing.
- art and science
- interpersonal relations book
- foundation for psychiatric nursing
- advanced theory and practice in nursing
- NURSE-PT relationship is the foundation
- shifted from medical paradigm to interpersonal relationship model
- identified stages to the nurse pt rel'nship
- introduced process recording
43
How did Peplau apply Sullivan's theory of anxiety to nursing practice?
- describe dif. levels of anxiety (mild, moderate, severe and panic)
- interventions to lower anxiety
- aim to improve pt's ability to think and function
44
Behavioural theories.
- personality consists of learned behaviours
- shaped by CONDITIONING (pairing behaviour with a condition which reinforces or diminishes the behaviours occurrence
- PAVLOV'S CLASSICAL CONDITIONING
- WATSON'S personality learned through classical conditioning
- SKINNER OPERANT CONDITIONING (positive and negative reinforcement)
45
Behavioural theories applied to nursing.
modifying or replacing behaviours and behaviour management
46
Where is behavioural therapy applied?
- specific clear problems
- phobies, alcoholism, schizophrenia
(don't need to understand underlying cause)
47
What are some types of behavioural therapies?
- MODELLING (model and imitate)
- OPERANT CONDITIONING (+ and - reinforcement)
- SYSTEMATIC DESENSITIZATION (coping techniques, manageable amounts, and systematic exposure)
- AVERSION THERAPY (uses negative stimuli; risk of abuse)
48
Cognitive theory.
dynamic interplay btw individuals and the environment
- thoughts come before feelings and action
- thoughts based on unique perspectives (may or may not be based in reality
49
Rational-emotional Behaviour Therapy (REBT).
- Aim is to eradicate core irrational beliefs; recognizes thoughts that are not accurate, sensible or useful
50
What type of thoughts are examples of negative thinking that can lead to depression and anxiety?
should
could
musts
ought
ex. "i ought to be able to pay" "I should be think"
51
Cognitie-Behavioural therapy (CBT).
- based on how ppl feel and act is determined by the way they think about the world and their place in it
- depressed pt have stereotypical patterns of negative thinking that distort thinking and information processing
- teaches pt to challenge negative thoughts
- Use for DEPRESSION, ANXIETY, and PHOBIAS
52
Define Schemata.
assumptions about themselves and other and the world around us
53
Application of CBT to nursing.
- CBT can help nurses own thought process
| - Challenge negative thoughts not based on fact/evidence and replace them with more realistic views of the world
54
Humanistic theories.
- MASLOW'S HIERARCHY OF NEEDS (introduced the idea of self actualization)
- Experiences shape a persons
- Human beings are active participants in life, striving for SELF-ACTUALIZATION
- humans need fulfilment
- 6 stages of the most basic needs for survival (once lower needs are met, higher needs are able to emerge)
55
Maslow's 6 stages to hierarchy of needs.
PHYSIOLOGICAL NEEDS – basic survival.
SAFETY – physical, emotional, law and order.
BELONGING AND LOVE – love, affection, family and home.
ESTEEM – self regard and respect from others.
SELF-ACTUALIZATION – achievement of inner peace through being all one can be.
Later COGNITIVE (knowledge) and AESTHETIC were added.
56
Humanistic theories applied to nursing theory.
- emphasis on HUMAN POTENTIAL and the pt's STRENGTHS is an important part of developing the nurse client relationship
- HIERARCHY helps prioritize needs
57
Psychopharmacology.
- 1950's drugs for MH emerged
- leads us to believe abnormal behaviour is part of DISEASE PROCESS
- not the pt's fault
58
Biological theories.
- focus on neurological, chemical, biological, genetic
| - how the body an d brain interact creates emotion, memories, perceptual experiences
59
Biological theories applied to nursing.
Consider other influences that play a role in the development and treatment of mental disorders (social, environmental, cultural, economic)
- Focus on qualities of a therapeutic rel'n, understanding pt perspective, communicating to facilitate recovery
60
Milieu therapy.
Use total environment (pl, setting, structure, and emotional climate are all important to healing)
61
Usual admission criteria..
- imminent danger of harming themselves,
- imminent danger of harming others, and
- unable to care for basic needs, rendering them in imminent danger of harming themselves
62
Where are pt in the MH setting usually admitted from?
- Emergency Department
| - Then direct admission by psychiatrist or doctor
63
How can involuntary admission be contested?
under the review process established by legislation
64
What are the pt's rights?
- retain rights as citizen (to be informed of rights promptly, to retain a laser, to have their admission reviewed, to contest txt)
- clients need for safety must be balanced against their rights as citizens
- MH facilities have written rights applicable to provincial or territorial legislation
65
Treatment plan details.
- Made within 72 hrs
- Pt care plans provide guideline for pt's care during stay
- Nurses often lead in the development of the plan
- Involve pt and family
- multidisciplinary team members obtain data and prepare assessments
- FIRST urgent data (VS, suicide risk, other health issues, psychiatric assessment)
- Follow customized clinical pathway
66
Nursing care in MH setting.
- PROVIDE REASSURANCE TO FAMILY AND PT
- INITIAL ASSESSMENT
- ENSURING SAFETY
- PHYSICAL ASSESSMENT
- MILIEU
- STRUCTURED GROUP ACTIVITIES
- DOCUMENTATION
- MEDICATION ADMINISTRATION/MANAGEMENT
- CRISIS MANAGEMENT
- DISCHARGE MANAGEMENT
- MEDICAL EMERGENCIES
67
How do you ensure safety?
through pt, nurse, staff, &families collaboration; good pt assessment, respectful attention to pt concerns; recognize and deescalate dangerous situations; inspect patients’ person and belongings, review the unit, track the patients’ location, work with visitors.
68
What does the nurses initial assessment include?
safety concerns, learning needs of pt, and initiating a therapeutic rel'n
69
What should the physical assessment include?
metabolic syndrome, diabetes, heart disease
70
How can you use milieu therapy?
use surroundings and physical environment to manage behavioural crisis, create safety, and reduce suicide risk
71
Social influence on psychiatric care settings per time.
1950:
PHARMACEUTICALS
1960-70: TRANSINSTITUTIONALIZATION (integration of psychiatric care into community)
1970-80:
SHORTER HOSPITAL STAYS; not enough resources
1990's-current:
National advocacy , recovery movement, national MH strategies
72
Nursing skills for Out Pt care.
- Strong problem solving and clinical skills
- Cultural competence
- Flexibility
- Knowledge of community resources
- Autonomy (independence, self-governing)
73
Nursing role in Community MH.
- Provide nursing care and assist with meds management (direct supervision)
- Consult as part of the multidisciplinary team
- Leadership role with MH treatment team
- Research and preceptorship
74
Nursing in out pt and community setting.
```
- Biopsychosocial assessment (Box 6-2)
(Patients ability to cope with the demands of living in the community. Includes biology, social environment and skills and psychological characteristics)
- Biopsychosocial case management
- Promoting continuation of treatment
- Interprofessional team member
```
75
What does biopsychosocial assessment include?
- Housing
- Income and sources of income
- Family and support system
- Substance abuse history and current issues
- Physical well-being
- Cultural challenges
76
MH PRIMARY PREVENTION strategies
aim at healthy population to inform on coping skills
77
MH SECONDARY PREVENTION strategies.
early detection and treatment to head off more serious problems
78
MH TERTIARY PREVENTION strategies.
Services for chronic psychiatric pts to promote the highest level of community functioning
79
What is ACT?
ASSERTIVE COMMUNITY TREATMENT
- intense type of case management
- For those with serious persistent psychiatric symptoms
- Work in home, agencies, clinics, hospitals or on the street
- mobile team of nurses, social workers, psychologists and psychiatrists
80
Community MH centres are/have...
```
Main resource in the community
Emergency services
Day hospital
Medication administration
Individual and group therapy
Interprofessional teams
```
81
Ethical issues.
- may occur; use model to assist in ethical implications
| - role of the nurse is to act in the best interest of the pt and society
82
Name 4 barriers to txt.
stigma
finances
geographical limitations
policy issues
