Psych-Mental Health Nursing

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Defense Mechanisms

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Compensation – is the covering up of a real or perceived weakness by emphasizing a trait one considers more desirable.
Denial – the refusal to acknowledge the existence of a real situation or the feelings associated with it.
Displacement – the transferring of feelings from one target to another that is considered less threatening or neutral.
Identification – an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires.
Intellectualization – an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis.
Introjection – the internalization of the beliefs and values of another individual such as that they symbolically become a part of the self to the extent that the feeling of separateness or distinctness is lost.
Isolation – the separation of a thought or a memory from the feeling tone or emotions associated with it (emotional isolation).
Projection – the attribution of feelings or impulses unacceptable to one’s self to another person. The individual “passes the blame” for these undesirable feelings or impulses to another, thereby providing relief from the anxiety associated with them.
Rationalization – the attempt to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors.
Reaction formation – the prevention of unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors.
Regression – the retreating to an earlier level of development and the comfort measures associated with that level of functioning.
Repression – the involuntary blocking of unpleasant feelings and experiences from one’s awareness.
Sublimation – the rechanneling of drives or impulses that are personally or socially unacceptable (i.e., aggressiveness, anger, sexual drives) into activities that are more tolerable and constructive.
Suppression –voluntarily blocking of unpleasant feelings and experiences from one’s awareness.
Undoing – the act of symbolically negating or canceling out a previous action or experience that one finds intolerable.

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Maslow's Hierarchy of Needs

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Physiological needs: basic fundamental needs include food, water, air, sleep, exercise, elimination, shelter, and sexual expression.
Safety and Security: Needs at this level are for avoiding harm, maintaining comfort, order, structure, physical safety, freedom from fear, and protection.
Love and Belonging: Needs are for giving and receiving of affection, companionship, satisfactory interpersonal relationships, and identification with a group.
Self-Esteem Esteem of others: The individual seeks self-respect and respect from others, works to achieve success and recognition in work, and desires prestige from accomplishments.
Self-actualization: the individual possesses a feeling of self-fulfillment and the realization of his or her highest potential.

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Concepts of Therapeutic relationship

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Social: Therapeutic:
Mutual focus casual setting Pt focused formal setting
Topic oriented lacks processing goal oriented involves processing
Unstructured past or future focus structured here and now focus
Informal formal
Subjective objective
Sympathetic empathetic
Qualities needed to be therapeutic:
Hope/optimism, respect, acceptance, privacy, sensitivity, availability, accountability, patience, spontaneity, objectivity, honesty, empathy, self-awareness, trust

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Phases of relationship

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1. Pre-orientation phase à prior to meeting pt, nurse focused on clarifying expectation, assessing self (strengths, weaknesses), establishing goals, looking over chart and Hx, preparing for the relationship
2. Orientation phase à Beginning to establish a rapport, mingle/get acquainted, assess situation, determine w/whom you wish to work, utilize resources/input from staff/family/chart, negotiate contract (include: intro, name, role, purpose, time, place, and duration, consider privacy and safety, confidentiality, responsibilities).
3. Working Phase à requires trust to get here, answer direct question when asked, clarify, set limits when necessary, examine issues in depth, problem-solve, health teaching, modify, add, delete behaviors, continue to assess, diagnose, review & revise care, implement plan.
4. Termination phase à starts day one with establishment of time frame/contract, establish closure of the relationship, evaluate pt progress, provide feedback r/t growth and areas in need of work, referral, summarize and establish goals for the next interaction.

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Diagnosis, outcome standards, care

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1. Diagnosis à Self-Concept Disturbance
2. Data to support à depressed, anxiety, negative self talk, low self esteem
3. Goal à Pt will demonstrate a positive self concept
4. Outcome standards à must be measurable, and pt centered