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230 Cards in this Set
- Front
- Back
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Identify components of the World Health Orgaization definition of mental health.
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state of complete physical, mental, and social wellness, not merely absence of disease or infirmity
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How does the American Psychiatric Association define mental disorders?
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A mental disorder “ is a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom
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Describe factors that contribute to mental health/ illness.
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Individual Factors
Interpersonal factors socio/ cultural factors |
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Individual factors that contribute to mental health/illness
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Biologic make-up, autonomy, independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, a sense of belonging, reality orientation, and coping or stress management abilities
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Interpersonal Factors that contribute to mental health/illness
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Effective communication, ability to help others, intimacy, and a balance of separateness and connectedness
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Socio/Cultural factors influencing a persons mental health/illness
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A sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic view of one’s world
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Identify the purposes the DSM-IV-TR serves
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is a taxonomy published by the American Psychiatric Association and used by all mental health professional that describes all disorders according to specific criteria
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Axis I
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major psychiatric disorders
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Axis 2
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personality disorders and mental retardation...longterm
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Axis 3
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Medical Conditions
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Axis 4
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Stressors....Housing, legal problems, education problems etc..
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Axis 5
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Global Assessment of Function (GAF)...higher the score the more functional
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Mental Illness in Ancient times
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sickness represented displeasure of the gods, punishment for wrongdoing; treatments were harsh including starving, purging, bloodletting, imprisonment
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period of enlightenment
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(1790’s) saw the creation of asylums or safe havens to offer protection
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Community Mental Health Act of 1963
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Focus on least restrictive treatment and treatment in the individual’s own community
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Decade of the Brain
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1990’s incredible increase in research and paradigm shift to more biological understandings of disorders.
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What are the three intervention categories only
appropriate for advanced practice nurses? |
psychotherapy
Consultation Prescribe medications |
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4 Standards of Care: interventions specific to nurses...
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Milleu
Health teaching and promoting Format care Administering pharmacological, biological, integrated therapies |
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phenomena of concern
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12 areas of concern that mental health nurses focus on when caring for clients
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4 areas of the brain
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cerebrum
cerebellum brain stem limbic system |
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cerebrum
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part of the brain responsible for memory and emotional expression and language and visual coordination....cerebrum contains 2 hemispheres and 4 lobes
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Cerebellum
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responsible for coordination of movements and postural adjustment
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Brain stem
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contains vital centers for resp. and CV functions. Influences motor activity, sleep, consciousness and awareness. and is associated with stress, anxiety, and impulsive behavior.
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limbic system
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regulates activity, sensation, and emotion...disturbances in the llimbic system have accounted for memory loss and dementia
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neurotransmitter
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neurons that aid in the transmission of information through out the body. relay messages across the synapse to the receptor cells, then transported back from the synapse to the axon.
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4 types of neurotransmitters
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Dopamine
Norepinephrine Epinephrine Seritonin |
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Dopamine
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control of complex movements, motivation, cognition, and regulation of emotional responses.
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Norepinephrine
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most prevalent
plays a role in changes in attention, learning and memeory and sleep and wakefulness and mood regulation |
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Epinephrine
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noradrenaline
adrenaline controls fight or flight response |
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Seritonin
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controls food intake, sleep and wakefulness, temp. regulation, pain control, sexual behaviors, regulation of emotions
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CT scan
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serial xrays of brain
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MRI (magnetic resonance imaging)
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radio waves from brain detected from magnet
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PET (positron emission tomography)
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radioactive tracer injected into bloodstream and monitored as client performs activities.
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SPECT (single photon emission computed tomography)
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Same as PET
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Biological factors that can influence mental health
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Brain structural abnormalities
neurotransmitter abnormalities stress and the immune system infection hormonal influences nutrition, medical illness, medications |
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non biological (inherited) factors that can influence mental health
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Identification of specific genetic factors
twin studies adoption studies family studies |
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Halidol
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conventional antipsychotics...(butyrophenones)...high potency
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Thorazine (chlorpromazine)
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phenothyiazine....low potency
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Atypical antipsychotics
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Clozapine (Clozaril)
Fazclo (clozapine) Risperidone (Risperdal) |
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SSRI's
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Zoloft
Prozac Paxil |
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MAOI's (Anti-depressants)
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Nardil
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antipsychotics
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Haldol
Abilify Thorazine Clozaril clozepine Risperdal |
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antianxiety (anxiolytic)..Bezodiazepines
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Xanax
Valium Klonopin Ativan Restoril |
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Nonbenzodiazepine (anxiolitic)..antianxiety
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BuSpar
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mood stabalizers
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Lithium
Depakote |
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EPS
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Extrapyramidal side effects....serious neurological symptoms that are the major side effects of antipsychotic drugs
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dystonia
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acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing.
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pseudoparkinsonism
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stiff, stooped posture, mask-like facies, decreased arm swing, shuffling, festinated gait, drooling
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Akathisia
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intense need to move about. Restless, anxious and agitated
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NMS
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neuroleptic malignant syndrome....potentially fatal reaction to an antipsychotic drug. Rigidity, high fever, ustable BP, diaphoresis,pallor and elevated levels aof enzymes.
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Tardive Dyskinesia
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a syndrome of permanent involuntary movements, symptoms include involuntary movements of the tongue, facial and neck muscles, upper and lowere extremeties. lip smacking, blinking, grimacing, tongue thrusting and protruding
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Describe the major concepts of psychoanalytic theory(Freud)
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ID
Ego Superego |
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Id
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innate desires, pleasure seeking, aggression, and sexual impulse
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Ego
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Mature adaptive behavior
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Superego
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Moral Ethical values, Parental
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compenstation
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overachievement in one area to offset real or percieved deficiencies in another area..
napoleon complex |
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Conversion
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expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature...
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denial
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failure to acknowledge an unbearable condition....
Diabetic eating chocolate |
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Displacement
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ventilation of intense feelings toward persons less theratening than the one who aroused those feelings...
Person who is mad at thier boss....yells at thier spouse |
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Dissociation
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dealing with emotional conflict by a temporary alteration in consciousness or identity..
Amnesia that prevents recall of yesterdays auto accident |
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Fixation
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immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage....
lack of a clear sense of identity as an adult |
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identification
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modeling actions and opinions of influential others while searching for their identity, or aspiring to reach a personal, social or occupational goal...
Nursing student becoming a critical care nurse because this is the specialty of an instructor she admires |
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Intellectualizen
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separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions....
person shows no emotional expression when discussion serious car accident |
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Introjection
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accepting another persons attitudes, beliefs and values as ones own...
person who dislikes guns becomes a avid hunter, just like his best friend |
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Projection
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unconscious blaming of unacceptable inclinations or thoughts on an external object...
person with many prejudices loudly identifies others as bigots |
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rationalization
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excusing own behavior to avoid guilt, resposibility, conflict, anxiety, or loss of self respect....
student blames failure on teacher being mean |
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reaction formation
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acting the opposite of what one thinks or feels...
Person who despises the boss, tells everyone what a great boss she is |
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regression
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moving back to a previous developement stage to feel safe or have needs met....
Five year old asks for a bottle when new baby brother is being fed |
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Repression
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excluding emotionally painful or anxiety-provoking thought and feelings from conscious awareness....
woman has no memory of the mugging she suffered yesterday |
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Resistance
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Overt or Covert antagonism toward remebering or processing anxiety-producing information.,,,,
person attends court ordered treatment for alcoholism but refuses to participate |
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Sublimation
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substituting a socially acceptable activity for an impulse that is unacceptable....
person goes for a 15 minute walk when tempted to eat junk food. |
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substitution
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replacing the desired gratification with one that is more readily available...
women who would like to have her own children...opens a day care. |
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suppression
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conscious exclusion of unacceptable thoughts and feelings from conscious awareness....
woman tells a friend she cannot think about her sons death right now. |
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Undoing
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exhibiting acceptable behavior to make up for or negate unacceptable behavior....
person who cheats on spouse brings the spouse a bouquet of flowers |
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trust vs. mistrust
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infant...viewing teh world as safe and reliable..nurturing, stable and dependable
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autonomy vs. shame and doubt
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toddler....achieving a sense of control and free will
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initiative vs. guilt
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preschool....beginning development of a conscience, learning to manage a conflict and anxiety
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industry vs. inferiority
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school age....emerging confidence in own abilities; taking pleasure in accomplishments
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identity vs. role confusion
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adolescence....formulating a sense of self and belonging
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intimacy vs. isolation
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young adult.....forming adult, loving relationships and meaningful attachments to others.
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generativity vs. stagnation
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middle adult.....being creative and productive; establishing the next generation
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ego integrity vs. despair
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maturity.....accepting responsibility for ones self and life
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key concepts of Interpersonal Theory(Sullivan)
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infancy
childhood juvenile preadolescence adolescence |
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Infancy
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Primary need for bodily contact and tenderness
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Childhood
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parents are viewed as source of praise and acceptance
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Juvenile
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shift to the syntaxic mode begins (thinking about self and others based on analysis of experiences in a variety of situations.
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Preadolescence
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move to genuine intimacy with friend of the same sex
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Adolescence
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lust is added to interpersonal equation.
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behaviorism
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focuses on behaviors and behavior changes, rather than explaining how the mind works
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prototaxic
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characteristic of infancy to childhood...Brief unconnected experiences
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parataxic
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early childhood connects experiences in sequence
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syntaxic
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school aged.....more predomnant analyze experiences in variety fo settings
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cognitive therapy
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focuses on immediate thought processing....how a person perceives or interprets his or her experience and determines how he or she feels and behaves
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All behavior is....
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learned
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Rational emotive thereapy
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people make themselves unhappy through "irrational beliefs and automatic thinking"--the basis for the technique of changing or stopping thoghts
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logotherapy
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life must have meaning and therapy is the search for that meaning
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gestalt theory
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emphasizes self awareness and identify thoughts and feelings in the here and now
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reality therapy
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focuses on the persons behavior and how that behavior keeps the person from achieving life goals
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maturational crises
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predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career.
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situational crises
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unanticipated or sudden events that threaten the individuals integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family memeber
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adventitious crises
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social crises...occurs with natural disasters, such as floods, earthquakes....etc...
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crisis intervention
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includes a variety of techniques based on the assessment of the individual
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directive interventions
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are designed to access the persons health status and promote problem solving, such as offering the person new info,knowledge, or meaning; raising the persons self awareness
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supportive interventions
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deal with the persons need for empathetic understanding, such as encouraging the person to identify and discuss feelings, serving as a sounding board for the person
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crisis
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is a turning point in an individuals life that produces and overwhelming emotional response.
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group
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is a number of persns who gather in a face to face setting to accomplish tasks that require cooperation, collaberation, or working together.
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beginning stage of a group
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commences as the group begins to meet...introduction...selecting a leader...group purpose is discussed....rules and expectations are reviewed
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working stage of a group
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begins when members focus their attention on the purpose or task the group is trying to accomplish
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final stage of a group
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occurs before the group disbands....work is reviewed and focus is on accomplishments
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group therapy
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clients participate in sessions with a group of people.
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psychotherapy group
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learn about their behavior and to make positive changes in their behavior by interracting and communicating with others as a member of the group
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open groups
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ongoing and run indefinately, allowing members to join or leave the group as they need to
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closed groups
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are structured to keep the same members in the group for a specified number of sessions
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family therapy
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form of a group therapy in which the client and his or her family members participate
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education group
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provides information to members on a specific issue---for instance, stress management, medication management, or assertiveness training.
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support groups
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organized to help members who share a common problem to cope with it
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self help group
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members share a common experience, but the group is not a formal or structured therapy group.
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psychiatric rehabilitation
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provides services to people with severe and persistant mental illness to help them to live in the community
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psychosocial interventions
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nursing activities that enhance the clients social and psychological functioning and improve social skills, interpersonal relationships and communication
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milieu therapy
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focuses on here and now...the individual is respected, makes descisions about own care...planned use of people, resources, and activities in teh environment to assis in improving interpersonal skills, social functioning and performing the ADL's
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Interdisciplinary team
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pharmacist
psychiatrist psychologist psychiatric nurse psychiatric social worker occupational therapist recreation therapist vocational rehab. specialist |
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therapeutic relationship
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a professional alliance in which the nurse and client join together for a defined period of time to achieve health related treatment goals
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factors that enhance a therapeutic relationship...
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Trust
Genuine INterest Empathy Positive regard Self awareness and ther. use of self communication skills professionalism encouraging independance |
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Empathy
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involves understanding the situation from the clients point of view without losing objectivity..."Empathy is the ability of the nurse to percieve the meaning and the feelings of the client and to communicate that understanding to the client:"
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Sympathy
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feelings of concern or compassion for another.....often ends up focusing on the nurses feelings......AVOID!!
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self awareness
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the process of developing an understanding of ones own values, beliefs, motivations, prejudices, strengths and limitations and how these quantities affect others
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values
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abstract standards that give a person a sense of right and wrong and establish a code of conduct
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beliefs
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ideas one holds to be true. beliefs can be evidence based or irrational
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attitudes
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general feelings, or a frame of reference around which a person organizes knowledge about the world
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empirical knowing
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(science of nursing) what we are taught in class
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Personal knowing
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experience
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ethical knowing
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moral knowledge of nursing/ code of ehtics
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Aesthetic knowing
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art of nursing
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nonverbal attending
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leaning toward the client, eye contact, being relaxed, having arms resting at the side, interested but neutral attitude
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verbal attending
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avoid communication judgments or negative opinions
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intimate relationship
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people emotionally committed to one another
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phases of the nurse-patient relationship
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introductory phase
working phase termination phase |
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intro phase
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preinteraction phase
helps client focus uses word stimuli shows unconditional acceptance |
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working phase
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identification
exploitation-intensive exploration and elaboration meets needs continues assessment reduces anxiety |
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termination phase
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sustains relationship as long as the client feels necessary
promotes family interaction teaches self care terminates nurse-client realtionship |
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transference
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unconscious response in which the pt. experiences feelings and attitudes toward the nurse originally associated with another significant person in their life
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Counter transference
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the nurse identifies the patient with individuals in thier past resulting in emotional responses that interefere with the ther. relationship
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judgmental attitudes
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attitudes on the part of the nurse about mental illness, behavior, values or attitudes of the patient
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cultural incompetence
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not understanding the norms, customs, attitudes, beliefs, values of the culture
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Boundary violations
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boundary is the line between a therapuetic and non therapeutic relationship. Crossing the line is a boundary violation. Boundaries protect the patient and the nurse and help maintain a safe and professional relationship.
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Example of boundary violations
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wanting to be friends
not maintaining confidentiality physical contact or any sexually oriented behavior giving out personal info to pts. accepting/giving gifts seeking contact after termination |
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roles of a nurse in a therapeutic relationship
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Teacher
Caregiver Advocate Parent Surrogate |
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Peplaus nursing roles
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Stranger
resource person teacher leader surrogate counselor |
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verbal
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what is said or content
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congruency
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when content and process agree
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Nonverbal
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(behavior such as facial expression, tone of voice, hesitancy, distance from speaker, or process)
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Context
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(environment or situation, including culture)
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Incongruency
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(when content and process do not agree; nonverbal is more accurate)
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Touching
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Touch may be comforting and supportive
– Touch also is an invasion of intimate and personal space – Nurse must evaluate whether the client perceives touch as positive or threatening and unwanted; never assume that touching a client is acceptable |
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Active listening
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refraining from other internal mental activities and concentrating exclusively on what the client says
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Active observation
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watching the speaker’s nonverbal actions as he or she communicates
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Concrete messages
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specific and clear; abstract messages are unclear and vague and require interpretation
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accepting
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indicating reception
yes.. I follow what yu said.. Nodding |
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Broad openings
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Allowing the client to take the initiative in introducing the topic...
--Is there somthing you would like to talk about? --Where would you like to begin? |
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Consensual validation
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searching for mutual understanding, for accord in the meaning of words
---tell me whether my understanding of it agrees with yours'' |
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Encouraging comparison
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asking that similaritied and differences be noted..
--was it something like....? --have you had similar experiences? |
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Encouraging description of perceptions
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asking the client to verbalize what he or she perceives...
--tell me when you feel anxious? ---what is happening? |
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encouraging expression
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asking the client to appraise the quality of his or her experiences
--What are your feelings in regard to......? --Does this contribute to your distress? |
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Exploring
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delving further into subject or idea
---Tell me more about that.. --would you describe it more fully? --what kind of work? |
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Focusing
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concentrating on single point.
--This pint seems worth looking at more closely. --Of all the concerns youve mentioned, which is more troublesome? |
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formulating a plan of action
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asking the client to consider kinds of behavior likely to be appropriate in future situations
--what could you do to let your anger out harmlessly? --next time this comes up, what might you do to handle it? |
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General leads
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giving encouragement to continue
---go on ---And then? --tell me about it |
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giving information
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making available the facts that the client needs
--My name is... --Visiting hours are... --My purpose in being here is.... |
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giving recognition
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acknowledging, indicating awareness
---Good morning Ms..... ---I noticed you have combed your hair... |
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Making observations
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verbalizing what the nurse percieves
---You appear tense ---I notice that you are biting your lip,,, |
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Offering self
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make oneself available
---Ill sit with you for a while... ---Ill stay here with you. ---im interested in what you think |
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placing event in time or sequence
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clarifying the relationship of events in time
--What seemed to lead up to.....? --Was this before or after....? --When did this happen? |
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Presenting reality
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offering for consideration that which is real
--I see no one else in the room. --that sound was a car back firing --Your mother is not here; I am a nurse. |
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reflecting
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directing client actions, thoughts, and feelings back to client.
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Restating
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repeating the main idea expressed
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Seeking information
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seeking to make clear that which is not meaningful or that which is vague.
--Im not sure that I follow. --Have I heard you correctly? |
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Silence
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absence of verbal communications, which provides time for the client to put thoughts or feelings into words, to regain composure or to continue talking.
--Nurse says nothing but continues to maintain eye contact and conveys interest |
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Suggesting collaboration
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offering to share, to strive, to work with the client for his or her benefit.
--Perhaps you and i can discuss and discover the triggers for your anxiety. |
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Summerizing
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organizing and summing up that which is gone before
--have i got this straight? --You said that... --During the past hour, you and I have discussed... |
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Translating into feelings
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seeking to verbalize clients feelings that he or she expresses only indirectly.
--client---im dead. --nurse---are you suggesting that you feel lifeless? |
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verbalizing the implied
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voicing what the client has hinted at or suggested
--client---I cant talk to you or anyone...Its a waste of time. --nurse---Do you feel that no one understand? |
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Voicing doubt
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expressing uncertainity about the reality of the clients perceptions
--Isnt that unusual? --Really? --That is hard to believe. |
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Belittling feelings expressed
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misjudging the degree of the clients discomfort
--client--I have nothing to live for....I wish i were dead. --nurse--Everyone gets down in the dumps, or Ive felt that way myself |
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Challenging
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demanding proof from the client
--But how can you be the president of the US? --If you are dead, why is your heart beating? |
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Defending
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attempting to protect someone or something from verbal attack
--This hospital has a fine reputation. --Im sure your doctor has your best interests in mind. |
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Disagreeing
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opposing the clients ideas
--thats wrong. --I definately disagree with... |
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Disapproving
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denouncing the clients behavior or ideas
--Thats bad. --Id rather you wouldnt... |
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Giving approval
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sanctioning the clients beahvior or ideas
--Thats good. Im glad that .... |
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Giving literal responses
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responding to a figurative comment as though it were a statement
--cllient--they are looking in my head with a tv camera. --nurse---try not to watch tv. or what channel? |
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Indicating the exsistence of an external source
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attributing the source of thoughts, feelings, and behavior to others or to outside influences
--what makes you say that? --what made you do that? |
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Interpreting
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asking to make conscious that which is unconscious
--What you really mean is... --Unconsciously you are saying.... |
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Introducing and unrelated topic
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changing the subject
--Client---Id like to die. --nurse---Did you have visitors last evening? |
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Making stereotyped comments
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offering meaningless cliches or trite comments
--Its for you own good --Keep your chin up --just keep a positive attutude and you will be up in no time |
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Probing
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persistent questioning of the client
--Now tell me about this problem. You know i have to find out. --tell me about your psychiatric history. |
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Reassuring
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indicating that there is no reason for anxiety or other feelings of discomfort.
--I wouldnt worry about that --Everything is going to be alright --Your coming along just fine |
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Rejecting
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refusing to consider or showing contempt for the clients ideas or behaviors
--Lets not discuss... --I dont want to hear about .... |
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requesting an explanation
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asking the client to provide reasons for thought, feelings, behaviors, events.
--Why do you think that? --Why do you feel that way? |
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Testing
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appraising the clients degree of insight,
--Do you know what kind of hospital this is? --Do you still have the idea that..? |
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Using denial
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refusing to admit that a problem exists
--client--Im nothing --nurse--of course you are something---everybody is something |
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nonverbal communication skills
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facial expression
body language vocal cues eye contact silence |
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Cultural considerations
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the nurse must be aware of cultural differences in
-speech patterns and habits -styles of speech and expression -eye contact -touch -concept of time -health and health care |
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self efficacy
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belief that personal abilities and efforts affect the events in our lives
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culture
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all the socially learned behaviors, values, beliefs, customs and ways of thinking of a population that guide its members views of themselves and the world.
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hardiness
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ability to resist illness when under stress
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Resilience
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having a healthy response to stressful circumstances or risky situations
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Resourcefulness
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involves using problem solving abilities and believeing that one can cope with adverse or novel situations
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spirituality
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involves the essence of a persons being and his or her beliefs about the meaning of life and the purpose for living
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Sense of Belonging
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feeling of connectedness with or involvement in a social system of environment of which the person feels integral part
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social networks
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groups of people whom one knows and with whom one feels connected.
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social support
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emotional sustenance that comes from friends, family memebers, and even health care providers who help a person when a problem arises.
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Culturally Competent
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nursing care means being sensitive to issues related to culture, race, gender, sexual orientation,social class, economic situation and other factors
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social organization
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family structure and organization, religious values and beliefs, ethnicity, and culture, all of which affect a persons role and therefore his or her health and illness behavior.
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Time orientation
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whether one views time as precise or approximate
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Environmental control
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refers to a clients ability to control the surroundings or direct factors in the environment
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African AMerican response to illness
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affectionate, hugging, touching, eye contact
Tone maybe loud and animated respect privacy, respectful approach, handshake appropriate Family: nuclear, extended, matriarchal, may include close friends Flexiable, nonlinear, life issues take priority over keeping appt. |
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American Indians response to illness
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respect communicated by avoiding eye contact
Quiet and reserved Light touch handshake family varies, may be matrineal or patrilineal clan Time: flexible, nonlinear, flow with natural cycles rather than scheduled, rigid appts. |
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Japanese American response to illness
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quiet and polite, reserved, formal,little eye contact with authority figures
tone: soft, conflict avoided Touching uncommon, small bow, handshake with younger generation Family oriented, self subordinate to family unit; family structure hierarchical, interdependent Time: promptness, important, often early for appts |
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Mexican American response to illness
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avoid direct eye contact with authority figures
Tone: respectful and polite Touch by strangers not appreciated, handshake polite and welcomed Mostly nuclear families with extended family and godparents; family comes first Time: present-oriented, time viewed as relative to situation |
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Deinstitutionalization
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is a deliberate shift from institutional care to community
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Professional organizations identify.......................of care that describe the resposibilities for which nurses are accountable
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Standard
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Psychotropic drugs
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are those that are used to treat mental illness
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Case Management
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involves the use of an individual who coordinates and manages all of the care required by a client
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Utilization review firms
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developed to controll the expenditure fo insurance funds, require providers to seek approval before the delivery of care.
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Disruptions in the _______ system of the brain cause anger and rage
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Limbic
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half life
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is the time that is required for half the drug to be removed from the bloodstream
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Akathisia
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an individual who is exhibiting a rigid posture or gait with an intense feeling of restlessness
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Anxiolytic medications
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target GABA, the major inhibitory neurotransmitter of the brain
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Depot Injections
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can be beneficial for individuals who have difficulty regularly taking thier medications
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Assertive community treatment programs
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provide intense, problem solving oriented approaches to community based treatment for those with mental illnesses
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mobile crises
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consist of professionals who are called to the scene of a stabalized crisis situation when the police believe that mental health issues are involved
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