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47 Cards in this Set

  • Front
  • Back
Theory =
a hypothetical etiology
Therapy =
a set of treatment strategies based on this hypothesis
Types of Theories
•“Intra”personal:
•Biological
•Psychoanalytic
•Developmental
•Sociological
•Cognitive-Behavioral
•Integrated Models
Intra-personal
(=within one individual)
Biological Theory
Mental illness occurs because:
Structural abnormality
Maldistribution of NTs
Abnormal functioning
Hereditary neurophysiological functioning
(I’m just wired that way)
Psychoanalytic Theory and the Father of Modern Psychiatry
...
•Superego -Ego -Id
•Drives
•Defenses
•Psychosexual Development
•Insightleads to change
•Standing on the shoulders
Defense Mechanisms
•Altruism
•Sublimation
•Humor
•Suppression
•Repression
•Displacement
•Reaction Formation
•Somatization
•Undoing
•Rationalization
•Passive Aggression
•Acting-Out Behaviors
•Dissociation
•Devaluation
•Idealization
•Splitting
•Projection
•Denial
Stages of Psychosexual Development
•Oral
-dependent
•Anal
learning to postpone gratification
-Phallic
-learning sexual identity
Latency
-less sexuality
-cogniktive development, relationships with same sex
Genital
-age > 12, goal is to have relationships
Latency
-less sexuality
-cogniktive development, relationships with same sex
Erik Erikson’s Developmental Theory
•Each stage of life has its own emotional crisis, with critical tasksto be mastered.
•Mastery of critical tasks enables progress in development.
•Adult problems are due to developmental “holes”
Genital
-age > 12, goal is to have relationships
Erikson’s Life Stages
•Trust vs. Mistrust (0-18 mo)
•Autonomy vs. Shame & Doubt (18 mo-3 yrs)
•Initiative vs. Guilt (3-6)
•Industry vs. Inferiority (6-12)
•Identity vs. Role Confusion(12-20)
•Intimacy vs. Isolation(20-30)
•Generativity vs. Stagnation (30-65)
•Integrity vs. Despair(65+)
Maslow’s Hierarchy of Needs
Self-ActualizationSelf-Esteem and Esteemof OthersLove and BelongingSafety and SecurityPhysiological
Erik Erikson’s Developmental Theory
•Each stage of life has its own emotional crisis, with critical tasksto be mastered.
•Mastery of critical tasks enables progress in development.
•Adult problems are due to developmental “holes”
Sociological Theories
•“No man is an island, entire of itself”
•Termites, Telepathy & the Nobel Prize
•Social Psychology
•Group Dynamics
•Relational Theory
•Interpersonal Theory -Sullivan
Erikson’s Life Stages
•Trust vs. Mistrust (0-18 mo)
•Autonomy vs. Shame & Doubt (18 mo-3 yrs)
•Initiative vs. Guilt (3-6)
•Industry vs. Inferiority (6-12)
•Identity vs. Role Confusion(12-20)
•Intimacy vs. Isolation(20-30)
•Generativity vs. Stagnation (30-65)
•Integrity vs. Despair(65+)
Maslow’s Hierarchy of Needs
Self-ActualizationSelf-Esteem and Esteemof OthersLove and BelongingSafety and SecurityPhysiological
Sullivan’s Interpersonal Theory
•Healthy person is social, able to live effectively in relationships with others
•Relationships are the source of:
•anxiety
•behaviors
•personality traits
•We long for decreased tension, we figure out waysto do this, and we keep doingwhatever works.
Sociological Theories
•“No man is an island, entire of itself”
•Termites, Telepathy & the Nobel Prize
•Social Psychology
•Group Dynamics
•Relational Theory
•Interpersonal Theory -Sullivan
Peplau’s Addendum to Sullivan’s Theory...
“The nurse’s relationship with the patient is a microcosm which can serve as a way to learn to function adaptively, confidently and effectively in other relationships.”
Sullivan’s Interpersonal Theory
•Healthy person is social, able to live effectively in relationships with others
•Relationships are the source of:
•anxiety
•behaviors
•personality traits
•We long for decreased tension, we figure out waysto do this, and we keep doingwhatever works.
microcosm
-a miniscule version of the social work
Peplau’s Addendum to Sullivan’s Theory...
“The nurse’s relationship with the patient is a microcosm which can serve as a way to learn to function adaptively, confidently and effectively in other relationships.”
A Nursing Model: Peplau
•Applies interpersonal theory to nurse-client relationship development
•Correlates the stages of personality development in childhood to stages through which clients advance during the progression of an illness
•Sees interpersonal experiences as learning situations for nurses to facilitate forward movement in the development of personality
microcosm
-a miniscule version of the social work
A Nursing Model: Peplau
•Applies interpersonal theory to nurse-client relationship development
•Correlates the stages of personality development in childhood to stages through which clients advance during the progression of an illness
•Sees interpersonal experiences as learning situations for nurses to facilitate forward movement in the development of personality
A Nursing Model –Peplau
Four stages of personality development
–Stage 1 –Learning to count on others
–Stage 2 –Learning to delay satisfaction
–Stage 3 –Identifying oneself
–Stage 4 –Developing skills in participation
Cognitive & Behavioral Theories
•Rational-Emotive Therapy
•Thinking leads to behaving
•Irrationalthoughts cause problems by maintaining self-defeating behaviors.
•We can change our thinking.
•A-B-C, nurse’s role is “D”.
Standards of Psychiatric-Mental Health Nursing Practice: Standards of Care
I. Assessment
II. Diagnosis
III. Outcome Identification
IV. Planning
V. Implementation
Va. Counseling
Vb. Milieu Therapy
Vc. Self-Care Activities
Vd. Psychobiological Interventions
Ve. Health Teaching
Vf. Case Management
Vg. Health Promotion and Health Maintenance
Legal & Ethical Issues
•Therapeutic Boundaries
•Voluntary vs. involuntary admission
–“Commitment”
•Guardianship
•Competency
•Informed Consent
•Patient Rights
•Confidentiality
•Reporting
•Duty to Disclose “Tarasoff”
•Elopement/Leaving AMA
Patient’s Rightsin the Mental Health Setting
•Right to treatment
•Right to treatment in least restrictive setting
•Right to giveor refuseconsent to treatment
–exceptions made for emergencies
•Right to confidentiality
•Right to freedom from restraint and seclusion
–Try other methods first
•Some rights suspended in patient’s interest
–documentation is critical
•The challenge of keeping watch
–Report
–Constant observation
–Documentation
–Do’s and Don'ts
–The Bathroom
Safety for All -Overview
Take your own pulse first.
•Prevention skills
•De-escalation skills
•Personal safety
•Behavioral “Code”
•Restraints
Personal Safety
•Stance and balance
•Use of space
•Head height
•Cornering
•Self-defense need-to-knows
Solid Object PersonWhat
Calm
•Centered
•Balanced
•Direct Eye Contact
•Verbally Reassuring
•Firm
•Non-threatening……but NOT vague or “wishy washy”
Solid Object Person
Factors Promoting Agitation in the Hospitalized Patient
- noise
-dependency
-lack of sleep or food
-fever
-pain
-anxiety
Definition of Restraint
•Includes a physical restraint or drug used to control behavior or restrict movement that is not part of the patient’s standard treatment
•A device attached (or adjacent) to the patients body that cannot be easily removed by the patient, which restricts movement
•It is the intended use, not the device itself, which determines if it is a restraint
Definition of Seclusion
•The involuntary confinement of a person in a room or an area from which the person is physically prevented from leaving or from which exit is denied
Key Points…
•Base use on patient’s assessed needs.
•Ensuring safe application and removal
•Systematic release of restrained limbs
•Modifying the treatment plan
•Assessing readiness for release
•Helping patients meet behavior criteria for discontinuing
Very Frequent Monitoring:
Assess the need for ongoing restraint (or less restrictive)
Rights and dignity respected
Skin, CSM, proper application
ROM, and/or ambulate as needed
Offer food, fluids, and elimination
The Physician’s Order
Reason
Alternatives
Type
Duration
Time/date restraint startedor renewed
Time/date order signed
Keeping Restrained Patients Safe
•Signs of distress
•Vital signs
•Food and fluids
•Circulation and Range of Motion
•Hygiene and toileting
•Physical status and comfort
•Psychological status and comfort
Vulnerable Patient Populations
•Patients with sensory deficits
•Patients with cognitive deficits
•Patients with physical limitations
•Patients with trauma history
•Confused patients
•Children and adolescents
•Elders
Vulnerable Patient Populations