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144 Cards in this Set

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  • Back
__________, emphasized an individuals motivation in the continuous quest for self-actualization. Identified 5 levels of needs
1- physiological needs
2- safety and security
3- love and belonging
4- self-esteem, esteem of others
5- self-actualization
________, wanted to know how to change behaviors, how do people learn. Worked at getting people to change their beliefs. hottest therapy today.
A- situation
B- beliefs
C- emotional
D- change behaviors
Aaron Beck
Albert Ellis
__________, people learn by watching people.
-good role models
___________, looked at children with stages.
Sensorimotor- birth-2
Pre-operational- 2-6
Concrete operations - 6-12
Formal operations- 12-15 +yrs
Jean Piaget
________, applied interpersonal theory to nursing practice and to nurse-patient relationship-development
4 stages:
1. orientation
2. identification
3. exploitation
4. resolution
________, believed that people developed because of relationships with others.(therapeutic relationships)
major concepts include:
satisfaction of needs
interpersonal security
_______, created these stages:
1- oral stage (birth-18 months)
2- anal stage ( 18 months- 3yrs)
3- phallic stage (3-6)
4- latency stage (6-12)
5- Genitial stage (13-20)
_______, looked at Freuds development of age-related stages and thought it focused more on tasks to get to the next stage.
Trust vs mistrust
autonomy vs shame and doubt
initiative vs guilt
industry vs inferiority
identity vs role confusion
_______, the perfection principle. It internalizes the values and morals set forth by primary caregivers.
-important in the socialization of the individual because it assists the other two.
-right and wrong
_______, also called rational self or the reality principle begins to develop between ages 4 and 6 months.
-experiences the reality of the external world, adapts to it and responds to it.
-maintains harmony
_______. the pleasure principle.
-present at birth
-driven behaviors are impulsive and may be irrational
________, combination of good and bad traits that make us who we are.
Name the 3 illness that can be traced in family history (biological)
1. schizophrenia
2. bipolar
3. depression
Defense Mechanism____________________-
an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires.
Ex- a teenager who required lengthy rehabilitation after an accident decides to become a physical therapist as a result of his experiences.
Defense mechanism_______________-
an attempt to avoid expressing actual emotions associated with a stressful situation by using the intelluctual processes of logic, reasoning & analysis
Ex- sarah's husband is being transferred with his job to a city far away from her parents. she hides anxiety by explaining the advantages associated with the move to her parents.
defense mechanism_______________-
integrating the beliefs and values of another individual into ones own ego structure.
Ex- children integrate their parent's value system into the process of conscience formation. A child says to a friend " don't cheat, it's wrong"
defense mechanism___________________-
separating a thought or memory from the feeling, tone or emotion associated with it.
Ex- a young women describes being attacked and raped with showing any emotion.
Defense mechanism________________-
attributing feelings or impulses unacceptable to ones self to another person.
Ex- Sue feels a strong sexual attraction to her track coach and tells her friend "he's coming on to me"
Defense mechanism_________________-
attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors.
Ex- John tells the rehab nurse " I drink because its the only way I can deal with my bad marriage and my worse job"
Defense mechanism__________________-
preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors
Ex- Jane hates nursing. she attended nursing school to please her parents. During workday, she speaks to perspective students about the excellence of nursing as a career
Reaction formation
Defense mechanism___________________-
retreating in response to stress to an earlier level of development and the comfort measures associated with that level of functioning.
Ex- when 2yr old Jay is hospitalized for tonsillitis, he drinks only from a bottle, even though his mom states he has been drinking from a cup for 6 months.
Defense mechanism_______________-
involuntarily blocking unpleasant feelings and experiences from one's awareness.
Ex- an accident victim can remember nothing about his accident
Defense mechanism________________-
Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive.
Ex- a mother whose son was killed by a drunk driver channels her anger and energy into being the President of the local chapter of mothers against drunk drivers.
Defense mechanism_______________-
The voluntary blocking of unpleasant feelings and experiences from one's awareness.
Ex- Scarlet O'Hara says, "I don't want to think about that now, I'll think about that tomorrow".
Defense Mechanism- symbolically negating or canceling out an experience that one finds intolerable.
Ex- Joe is nervous about his new job and yells at his wife. On his way home he stops and buys her some flowers and himself a new video game.
Defense mechanism________________-
The transfer of feelings from one target to another that is considered less threatening or that is neutral.
Ex- a patient is angry at his physician does not express it, but become verbally abusive with the nurse.
Defense Mechanism_________________-
Refusing to acknowledge the existence of a real situation or the feelings associated with it.
Ex- a women drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem.
Defense mechanism_______________-
Covering up a real or perceived weakness by emphasizing a trait one considers more desirable.
Ex- a physically handicapped boy is unable to participate in football, so he _________ by becoming a great scholar.
Therapeutic technique______________-
Gives the patient the opportunity to collect and organize thoughts, to think through a point, or to consider introducing a topic of greater concern than the one being discussed.
Using silence
Therapeutic technique__________-
Conveys an attitude of reception and regard.
Ex- Yes, I understand what you said. eye contact; nodding
Therapeutic technique_______________-
Includes acknowleding and indicating awareness. It is better than complimenting which reflects the nurse's judgement.
Ex- "hello Mr. J, I notice that you made a ceramic ash try in OT"
"I see you made your bed"
Giving recognition
Therapeutic technique______________-
Making oneself available on an unconditional basis, thereby increasing patients feelings of self-worth.
Ex- "I'll stay with you awhile"
"we can eat out lunch together"
"I'm interested in you"
Offering self
Therapeutic technique_______________-
allows the patient to take the initiative in introducing the topic; it emphasizes the importance of the patients role in the interaction.
Ex- What would you like to talk about today?"
Tell me what you are thinking.
Giving broad openings
Therapeutic technique______________-
Offers the patient encouragement to continue.
Ex- "yes, I see"
"go on"
"and after that"
Offering general leads
Therapeutic technique_________________-
Clarifies the relationship of events in time so that the nurse and patient can view them in perspective.
Ex- "what seemed to lead up to ..."
"Was this before or after...?"
"when did this happen?"
Placing the event in time of sequence
Therapeutic technique_____________-
Verbalizing what is observed or perceived. This encourages the patient to recognize specific behaviors and compare perceptions with the nurse.
Ex- "you seem tense"
"I notice you are pacing a lot"
"you seem uncomfortable when you..."
making observations
Therapeutic technique_____________-
Asking the patient to verbalize what is being perceived; it is often used with patients experiencing hallucinations.
Ex- "tell me what is happening now"
" are you hearing the voices again?"
"what do the voices seem to be saying"
Encouraging description of perceptions
Therapeutic technique_______________-
Asking the patient to compare similarities & differences in ideas, experiences or interpersonal relationships. This helps the patient recognize life experiences that tend to recur and those aspects of life that are chageable.
Ex- "Was this something like...?"
"what was your response the last time this situation occurred?"
"how does this compare with the time when..."
Encouraging comparison
Therapeutic technique_____________-
The main idea of what the patient has said is repeated; this lets the patient know whether or not an expressed statement has been understood and gives him/her the chance to continue or to clarify if necessary.
Ex- pt-"I cant study, my mind keeps wandering"
Nurse- You have difficulty concentrating
pt- I cant take that new job, what if I cant do it?
nurse- Youre afraid you will fail in this new position
Therapeutic technique______________-
questions & feelings are referred back to the pt so that they may be recognized & accepted & so that the pt may recognize that their point of view has value. Good technique to use when the pt asks the nurse for advice
Pt- "what do you think I should do about mary's drinking?"
Nurse- "what do you think you should do"
Pt- "my sister wont help. I have to do it all"
Nurse"you feel angry when she doesn't help"
Therapeutic technique____________-
taking notice of a single idea or even a single word; it works esp. well with a pt who is moving rapidly from one thought to another. Not therapeutic when the pt is very anxious. Focusing should not be pursued until the anxiety level has subsided.
Ex-"this point seems worth looking at more closely. Perhaps you and I can discuss it together"
Therapeutic technique____________-
Delving further into a subject, idea, experience or relationship; it is esp. helpful with pt's who tend to remain on a superficial level of communication. However, if the pt chooses not to discuss further info, the nurse should refrain from pushing or probing in an area that obviously creates discomfort.
ex- "please explain that situation in more detail" "Tell me more about that particular situation"
Therapeutic technique______________-
Includes striving to explain that which is vague or incomprehensible & searching for mutual understanding; clarifying the meaning of what has been said facilitates & increases understanding for both pt and nurse.
Ex- "i;m not sure that I understand. would you please explain"
"tell me if my understanding agrees with yours"
Do I understand correctly that you said"
Seeking clarification and validation
Therapeutic technique______________-
when the pt has a misperception of the environment, the nurse defines reality or indicates his/her perception of the situation for the pt.
"I understand that the voices seem real to you, but I do not hear any voices"
"there is no one else in the room but you and me"
Presenting reality
Therapeutic technique_________________-
Expressing uncertainty as to the reality of the pt's perceptions; it is ofen used with pt's experiencing delusion thinking.
Ex- "I find that hard to believe"
"That seems rather doubtful to me"
Voicing doubt
Therapeutic technique_____________-
Putting into words what the pt has only implied or said indirectly; it can also be used with the pt who is mute or is otherwise experiencing impaired verbal communication. Clarifies what is implicit rather than explicit.
pt- "it a waste of time to be here. I can't talk to you or aqnyone"
Nurse-"are you feeling that no one understands?"
pt- (Mute)
Nurse"it must have been very difficult for you when you husband died in the fire"
verbalizing the implied
clinical disorders and other conditions that may be a focus of clinical attention. Includes all mental disorders (except personality disorders and mental retardation)
Axis I
Personality disorders and mental retardation. These disorders usually begin in childhood or adolescence and persist in a stable form into adult life.
Axis II
Tyoe of relationship built on trust.
-needs and goals of patient
-time element: comes to an end
________treatment plan-
everyone on team need to sign off, plan must be generated within 1st 8 hrs of admission. Nurse usually does 1st one.
Within 1st 24 hrs the team meets and updates the plan.
Interdisciplinary treatment plan
Person who has input into the care of the patient. attend weekly client care conferences and provides inservice education.
-serves as leader of the team
-responsible for diagnoses and treatment of mental disorders.
-performs psychotherapy, prescribes meds and other somatic therapies.
Type of relationship where it is superficial.
-no particular focus, only looks at social needs.
This person is responsible for negotiating with multiple health care providers to obtain a variety of services for the pt.
-need a baccalaureate degree in nursing with 3 yers of appropriate clinical experience.
Case worker/manager
This is the 1st person.
they have to sign off on care plan
they have direct involvement
Therapeutic _______________,
-short relationship
-assess pt, offer yourself for 10 min to listen to patients feelings, validate them, but don't work on them.
Personal value system-__________________,
-don't be phony
-don't put on an act
-if you say something, follow through
Type of technique that when the nurse denies that a problem exists, he/she blocks discussion with the patient and avoids helping the patient identify and explore areas of difficulty.
pt- "I'm nothing"
nurse- "of course your something. Everybody is somebody"
Better to say- "you're feeling like no one cares about you right now"
Using denial
Type of technique that attempts to protect someone or something from verbal attack. To defend what the pt has criticized is to imply they have no right to express ideas, opinions, or feelings. defending does not change the pt's feelings any may cause the pt to think the nurse is taking sides.
"No one here would lie to you"
"You have a very capable doctor"
BETTER TO SAY- I will try to answer your questions & clarify some issues regarding your treatment.
Technique of ____________________-
-sanctioning or denouncing the pt's ideas or behavior; it implies that the nurse has the right to pass judgement on whether the pt's ideas or behaviors are good or bad and that the pt is expected to please the nurse.
"That's good, I'm glad that you ..."
BETTER TO SAY: "let's talk about how your behavior invoked anger in the other patients at dinner"
GIving approval or disapproval
Non- therapeutic technique____________-
what you really mean is ...
Unconsciously you are saying...
Non- therapeutic technique_____________-
why are you upset?
Why do you think that?
Why did you do that?
Requesting an explanation
Personal Value system________________-
establishing a special connectiveness with someone, through verbal/nonverbal
Non- therapeutic technique____________-
I know just how you feel.
Everyone gets depressed at times
Belittling the clients feelings
Good morning, Mr. Jones
I see you showered this morning
Making observations
client- I have so much to do. I take care of the house and 3 kids, I work part-time. How can you expect me to fit in 30 min for relaxation exercises?
Nurse- It's hard for you to see how you could fit one more activity into your busy day.
Encourage a person to speak by waiting
Using silence
Is there something you'd like to talk about?
Share with me how your pass went?
Where would you like to begin?
Focused opening statement
general attitude.
How they are interacting and how much.
Interactive behavior
someone depressed
normal expression
Full range affect
Axis______-Psychosocial & environmental
problems that may affect the diagnoses, treatment and prognosis of mental disorders named on other axis's.
Include problems r/t primary support group, social environment, education, occupation, housing economics, access to health care services, interaction with legal system or crime and other types of psychosocial and environmental problems
Axis IV
makes things bigger than what they are
Type of relationship that involves an emotional commitment on our part.
-more in depth
-a particular goal, people try hard to maintain this relationship.
-trust goes into this relationship
_________________, conducts individual group and family therapy.
-administers, interprets and evaluates psychological tests that assist in the diagnostic process
Clinical psychologist
Phase of therapeutic alliance:_________-
-involves preparation for the 1st encounter with the patient
-tasks involve: obtaining valuable info
about the patient
-examining one's feelings, fears, and anxieties about working with a particular patient
-initial assessment is done/ begun
Type of boundary_________-
-occurs when 2 peoples boundaries are so blended together that neither can be sure where one stops and the other begins or one's individuals boundaries may be blurred with anothers.
-may be unable to differentiate their feelings, wants and needs from the other persons.
Personal value system-________________-
-Basis is communication
-Look at someone through their point of view
cliches and trite expressions are meaningless in a nurse-pt relationship. when the nurse makes empty conversation, it encourages a like response from the patient.
"I'm fine and how are you?"
"hang in there, it's for your own good"
"Keep your chin up"
BETTER TO SAY- The therapy must be difficult for you at times, how do you feel about your progress at this point?"
Making sterotyped comments
asking the pt to provide the reasons for thoughts, feelings, behaviors and events. Asking "why" a pt did something or feels a certain way can be very intimidating and implies that the pt must defend their behaviors or feelings.
"why do you think that?"
"why did you do that?"
BETTER TO SAY- "describe what you were feeling just before that happened."
Requesting an explanation
telling the pt what to do or how to behave implies that the nurse known what is best and that the pt is incapable of any self-direction. It nurtures the pt in the dependent role by discouraging independent thinking.
"I think you should..."
"why don't you..."
BETTER TO SAY- "what do you think you should do?"
Giving advice
Non-therapeutic technique__________-
pt- they pounded nail in my head
nurse- That must have hurt.
pt- They're looking in my head with a television
Giving literal responses
Non-therapeutic technique_________-
pt- I'm really depressed.
Nurse- Oh, did you have visitors this afternoon?"
Changing the subject
Non-therapeutic technique___________-
Nice weather today
it's for your own good
keep your chin up
Making stereotyped comments
Personal value system______________-
-where are you coming from
-Deal with it, come to grips with who you are.
Self awareness
Non-therapeutic technique____________-
I think you should...
why don't you....
What you should do is....
Giving advice
Have I got this straight?
You've said that...
During the past hour you and I have discussed...
I'm not sure that I follow
What would you say is the main point of what you said?
pt- I'm confused about this
Nurse- You're confused?
pt- my brother has the nerve to ask for money.
Nurse- asking for money makes you angry?
Reflecting content and feelings
Technique_____________________- with this technique the therapist seeks to make conscious that which is unconscious, to tell the pt the meaning of his experience. "What you really mean is..." "unconsciously you're saying..."
Better technique- the nurse must leave interpretation of the pt's behavior to the psychriatrist. the nurse has not been prepared to perform this technique and in attempting to do so may endanger other nursing roles with the patient.
normal mood to fit the situation
-pulled in
-they don't give you the full expression
Constrictive range
Poverty of speech means_____________
actual stimulation but misinterpretation.
Personal value system_____________,
#1 characteristic. Pt must feel that you care , that your compassionate and will look after the patients best interest.
Process by which nurses provide care for patients in need of psychosocial intervention
assist the patient and family members with psychosocial issues, including those associated with the diagnosis of mental illness.
-provides information on community resources
Social worker
Therapeutic __________________-
-will develop with long term care
- a long term relationship
Type of boundary
-new ideas or experiences can't get in.
-a person who has a narrow perspective on life, see's things one way and can't discuss matters that lie outside their field of vision
-may be difficult to bond with
Phase of therapeutic alliance________-
-the nurse & pt become acquainted.
-tasks include: creating environment for trust and rapport, establishing a contract for intervention, identifying patients strengths and limitations, nursing diagnosis, setting goals, develop plan of action, exploring feeling
(Introductory phase)
Phase of therapeutic alliance_______-
-therapeutic work of the relationship
tasks include: maintaining trust and rapport, promoting the pt's insight and perception of reality, problem solving using the model, overcoming resistance, behaviors on the part of the pt as the level of anxiety rises in response to discussion of painful issues, continously evaluating progress toward goal attainment
Working phase
attributing the source of thoughts, feelings and behavior to others or to outside influences. This encourages the pt to project blame for their thoughts or behaviors on others rather than accepting the responsibility personally.
"What nakes you say that?"
"What made you do that?"
"what made you so angry last night?"
Better TO say: "You became angry when your brother insulted your wife"
Indicating the existence of an external source of power
Technique_____________- Indicating accord with or opposition to the pt's ideas or opinions; it implies that the nurse has the right to pass judgement on whether the pt's ideas or opinions are right or wrong. Agreement prevents the pt from later modifying their point of view without admitting error. Disagreement implies inaccuracy provoking the need for defensiveness on the part of the patient.
"Thats right, I agree"
"I don't believe that"
Better to say- "Lets discuss what you feel is unfair about the new rules"
Agreeing/ disagreeing
Technique________________- Indicates to the pt that there is no cause for anxiety, thereby devaluing the pt's feelings; it may discourage the pt from further expression of feelings if they believe they will only be downplayed or ridiculed.
Better- "we will work on that together"
Don't say- "I wouldn't worry about that if I were you"
"Everything will be all right"
Giving reassurance
Non-therapeutic technique___________-
But how can you be president?
If you're dead, why is your heart beating?
Person value system-________________-
-acceptance of individual
-everybody has worth
-unconditional acceptance
Non-therapeutic technique___________-
Your doctor is quite capable
This hospital is well equipped
She's a good nurse
Non-therapeutic technique____________-
I wouldn't worry about...
Everything will be all right
You're coming along fine
Using reassuring cliches
I see no one else in this room
That sound was a car backfiring
I don't hear any voices other than your and mine
Presenting reality
I'll stay with you a little while
I would like to sit with you for a while
Offering self
and then?
Tell me about it
interpret sensory and data that really isn't there.
-no stimulation
-Brain plays tricks on them
a changing mood. Depressed one minute and then happy the next.
mood changes with the situation
Labile mood
a lot of flatness with some appropriate affect (expression)
-global assessment of functioning. allows the clinician to rate the patients overrall functioning on the global assessment of functioning scale (GAF). This scale represents in global terms a single measure of the pt's psychological, social and occupational functioning.
Axis V
Can't organize their thinking, words or thoughts, everything is scrambled.
Word salad
acts as case manager for care. Assesses the patient and family need, establishes the goal of care. Supervises and assists caregivers, evaluates care, serves at pt advocate and provides educational information as needed to pt, family and caregivers.
provides physical care when needed
Type of boundary___________-
-healthy boundary
-individuals are able to let go of their boundaries and limits when appropriate.
-one must be aware of who is considered safe and when it is safe to let others invade our personal space
Phase of therapeutic alliance__________-
-end of relationship, can be difficult.
Tasks include: bringing a therapeutic conclusion to the relationship.
This occurs when:
-progree has been made toward attainment of mutally set goals
-a plan for continueing care of for assistance during stressful life experiences is mutually established by the nurse and patient
Termination phase
Persistent questioning of the patient or pushing for answers to issues the pt does not wish to discuss. This causes the pt to feel used and valued only for what is shared with the nurse and places the patient on the defensive.
"tell me how your mother abused you"
"tell me how you feel toward your mother now that she is dead"
Better : The nurse should be aware of the pt's response and d/c the interaction at the first sign of discomfort
Technique_____________- When the nurse misjudges the degree of the pt's discomfort, a lack of empathy and understanding may be conveyed. The nurse may tell the pt to perk up or snap out of it. This causes the pt to feel insignificant or unimportant. When one is experiencing discomfort,it is no relief to hear that others are or have been in similar situations.
pt- I have nothing to live for, I wish I was dead
Nurse-Everybody gets down in the dumps, I feel that way at times myself.
Better- "You must be very upset. Tell me whar you are feeling right now"
Belittling feelings expressed
-refusing to consider or showing contempt for the pts ideas or behavior. this may cause the pt to discontinue interaction with the nurse for fear of further rejection.
"let's not discuss..."
"I dont want to hear about..."
Better to say- "Let's look at that a little closer"
Non-therapeutic technique_________-
Let's not talk about that.
I don't want to hear about...
Personal value system_______________,
-implies risk taking
-need to convey a level of confidentiality.
Non-therapeutic technique___________-
You're wrong
That's not true
No it isn't
Disagreeing with the patient
Uh HUm
I follow what you said
My name is ...
Visiting hours are....
My purpose in being here is...
I'm taking you to the...
Giving information
You sound very upset with this situation
you appear tense
observing feelings
Technique_________________- Changing the subject causes the nurse to take over the direction of the discussion. This may occur to get something that the nurse wants to discuss with the pt or to get away from a topic that they would prefer not to discuss.
pt- I dont have anything to live for
nurse- did you have visitors this weekend.
Better technique- the nurse must remain open and free to hear the pt, to take in all that is being conveyed both verbally and nonverbally.
Introducing an unrelated topic
a substantial emotion over a period of time. (depressed, anxious, tired)
-how they feel doesnt change
observing facial expressions
General medical conditions.
Include any current general medical condition that is potentially relevant to the understanding or management of the individuals mental disorder.
Axis III
Thinking about body parts
First insane asylum called__________
St. Marys of Bethelem
Dorothy ________ was the first to start a mental hospital that looked at treating people differently.
First mental hospital that looked at more humane ways of treatment was located in ___________________.
A reformer in medical education who became known as the father of american psychiatry.
Benjamin Push
Dementia praecox= dementia in the young in the early 1900's. Blueler termed this by another name called_____________
First antipsychotic drug that was used by accident in 1952
Drug used for depression
Predominant illness in hospital is
Community mental health act of 1963. What did the act do?
-passed by J.F. Kennedy
Act provided federal money to local governments to establish infra-structures for people who were homeless.
Case management started in the ____
ACT- team that intensly case manages high risk people
_______________- established in 1979.
-a public service
Act that passed in 1990 where Industry cannot discriminate against people with a mental illness in the work place
American Disability act