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27 Cards in this Set
- Front
- Back
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Mental Illness
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if the person suffers from a disturbance of thought, mood, volition, perception, orientation or memory that impairs judgment or behavior to a significant extent
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don't have an MI if...
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-hold/refuses to hold a particular religion/philosophic/political belief
-take drugs/etoh -demonstrate antisocial behavior |
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what makes a bad nurse?
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ethnocentrism, stereotyping, cultural blindness, transference, countertrasnference
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cultural blindness
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saying/thinking one culture is the best or ignoring cultural differences and being insensitive
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transference
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(patient to nurse) patient transfers behaviors, words, etc that happened in the past to the nurse. Ex. nurse reminds pt of his mother and he didn't get along w/ her
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countertransference
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(nurse to pt)walk into a room & just like/dislike them based on irrelevant factors
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Factors in building a good therapeutic relationship
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RESPONSIBILITY
TIME (may take time to develop, pt might respond unpredictably, must recognize where the client is "at", silence is fine!) LISTEN (to pt & fam, w/o need to label, explain/interpret rather than try to understand) NAMES (use name, determine what they feel comfortable w/ and determine how they should address you) EYE CONTACT (based on circumstances & relationship) YOUR LANGUAGE (talk as if pt is present, no technical words, don't talk down, give them space to speak, don't ask irrelevant ?s) WATCH & LISTEN FOR CUES (lack of responsiveness or eye contact, avoidance/regressive body lang, verbal cues - "i'll prob be ok", "I think I understand" etc REASSURE ppl that you take them seriously |
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if the individual is ANGRY
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-acknowledge the anger
-give them time to calm down or compose self -record and id the anger -the motives behind the anger or beh |
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If the individual is SEDUCTIVE
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- don't return their beh
- try ignoring it -have a chaperone - determine the venue - leave door open - ask to leave - refer to a same sex clinician - explain the professional relationship/boundaries |
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If client is DEMANDING
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- state clearly what you will or will not do
-what your agencies is funded for and the parameters this implies - what are you skilled to do or can't do - be empathetic - provide alternatives - allow indivial some choices |
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If client is INQUISITIVE
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- ask personal Q's
- ask Q's to avoid issues - Needs ressurance - Is trying to undermine your ability - Is dissatisfieded from earlier experience |
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Patient interviewing
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-state name
-state role/status -Mention time restraints, ask if mind nrs writing notes, ask if pt feels at ease -explain purpose of interview -discover pts main probs -get info needed |
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Paplau's 6 nursing roles
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COUNSELING ROLE
LEADERSHIP ROLE SURROGATE ROLE STRANGER ROLE RESOURCE PERSON TEACHING ROLE |
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COUNSELING ROLE
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working w/ patient on current problems
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LEADERSHIP ROLE
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working w/ pt democratically
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SURROGATE ROLE
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standing in for a person in the pts life. Be careful of counter-/transference. Not to become a dependent role
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STRANGER ROLE
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accepting person objectively
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RESOURCE PERSON
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interpreting medical plan to pateitn
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TEACHING ROLE
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Offering info and helping pt learn
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Paplau's 4 phases of the relationship (in order)
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1) ORIENTATION - ther person & nrs mutually ID the person's prob
2) IDENTIFICATION - person ids w/ nurse, thereby accepting help 3) EXPLOITATION - person makes use of nurs's help 4) RESOLUTION - person accepts new goals and frees himself from the relationship |
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Acronym for MSE
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Appearance
Behavior Conversation Affect Perception through 5 senses Cognition |
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diagnostic manuals
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DSM IV; ICD X (internat'l classification of diseases
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What is an MSE?
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Reports individual's mental state and beh at time of interview
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why do an MSE?
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- here and now (synchronic)
- determine severity - risk to self/others - change over time (diachronic) - documentation - Common language - Hypothesis generation for what we think might be going on - Intervention implications - Sx reduction 1st goal of rx - need to be able to id s/s |
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What is included in history taking?
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-individual details
- id presenting probs - hx of presenting illness - personal hx - previous med hx - illicit drug use/etoh/ prescription abuse hx - premorbid personality (b4 got sick) - Family hx - cultural hx - collateral info |
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MSE - appearance
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age, gender, race/ethnic background, build, hair style & color, apparent health, level of hygiene (disheveled, unkempt, approp for weather), mode of dress (jewelry all at once, chg outift often), physical abnormalities, marks on body, response to you, psychomotor
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MSE - behavior
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- eye contact
- pts reax to present situation - describe pts motor activity - abnormality of movement - expressive gestures |
