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30 Cards in this Set
- Front
- Back
“Abnormality”
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Some elements:
•Suffering •Maladaptiveness •Irrationality and Incomprehensibility •Unpredictability and loss of control •Vividness and Unconventionality •Observer Discomfort •Violation of moral and ideal standards |
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“Mental Illness”:
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•Has both objectiveand subjectivesymptoms.
•Has characteristics, e.g.: –Duration –Intensity –Cycles –Age of onset –Others •Has treatment options |
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Mental Illness in HistoryAncient Times:
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“Supernatural” Causes
•Trephining •“Possession” •Witches |
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Asylum
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–Sanctuary and Protection
–Isolated and Strange |
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Linda Richards
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–First US Psychiatric nurse
•Schools of Nursing |
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Psychotropic Drugs
1950’s-60’s |
•Chlorpromazine (Thorazine)
–Antipsychotic •Imipramine (Tofranil) –Antidepressant |
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Homelessness
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•25-50% with severe mental illness.
•33-50% with alcoholism and/or drug addiction. •Much overlap. •Evidence that homelessness can lead to mental illness. |
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The homeless mentally ill:
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•Most severely mentally ill men and women are not homeless.
Among those who are: •Younger onset •Personality D/O •Physical illness •ETOH/Drug abuse |
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DSM-IV Diagnosis
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Axis I -Major mental disorders
•Axis II -Personality Disorder or Developmental Disorder •Axis III -General medical conditions •Axis IV -Psychosocial & environmental conditions •Axis V -Global assessment of functioning (GAF) |
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Common Treatment Modalities
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•Individual Therapy
•Group Therapy •Milieu Therapy •Family Therapy •Cognitive-Behavioral Therapy •Psychopharmacological Therapy •Others |
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Legal & Ethical Issues
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•Therapeutic Boundaries
•Voluntary vs. involuntary admission –“Commitment” •Guardianship •Competency •Informed Consent •Patient Rights •Confidentiality •Reporting •Duty to Disclose •Elopement/Leaving AMA |
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Patient’s Rightsin the Mental Health Setting
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•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 |
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Standards of Psychiatric-Mental Health Nursing Practice: Standards of Care
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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 |
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Standards of Professional Performance
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Quality of Care
Performance Appraisal Education Collegiality Ethics Collaboration Research Resource Utilization |
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Therapeutic Use of Self
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•Usingone’s personality consciouslyand in full awarenessto establish relatedness and to structure nursing interventions.
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Goals of the therapeutic relationship
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•Promote use of healthy, adaptive relational and coping skills.
•Promote self-care and independence. •Facilitating communication of distressing thoughts and feelings (promote sense of being understood). •Assisting patients with problem solving to help facilitate ADLs •Helping the patient recognize self-defeating behaviors and test alternatives |
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Essential Elements in a Therapeutic Relationship
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•Genuineness
•Empathy •Positive Regard –Attitudes –Actions •Attending •Suspending Value Judgments •Helping Patients Develop Resources |
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Boundaries of the Therapeutic Nurse-Patient Relationship
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•Social vs. Therapeutic Relationships
•Guidelines –Defining the parameters of the relationship –Avoiding physical contact –Maintaining confidentiality –Minimizing self-disclosure –Accepting gifts –Addressing the person –Managing social encounters |
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Pre-Orientation Phase
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•Obtain information about the
client from chart, significant others, or other health team members. •Examine one’s own feelings, fears, and anxieties about working with a particular person. |
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Orientation PhaseCreating the Therapeutic Alliance
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•Establish the nurse-patient contract
•Purpose of the relationship •Duration of the relationship •Where, when, and how long we’ll meet •Confidentiality •Create an environment for trust and •Assessment -Identify client’s strengths & challenges. •Help with management of emotions •Provide support and structure •Establish goals •Establish a realistic plan of action |
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Working Phase
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•Maintain trust and rapport.
•Use problem-solving model to work toward established goals. •Promote client’s insight and perception of reality. •Help patient recognize and manage resistance behaviors. •Continuously evaluate progress toward goals. |
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Termination Phase:Facilitating a Healthy Closure
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•Therapeutic conclusion of relationship occurs when:
–Progress has been made toward attainment of the goals. –A plan of action for more adaptive coping with future stressful situations has been established. •Evaluation and summary •Final collaboration on discharge plans •The process of goodbye –Feelings about termination of the relationship are recognized and explored |
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Transference
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-Feelings that the pt develops toward the nurse
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Countertransference
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- feelings that the nurse may develop towars the pt.
-My be related to something that goes on with you or tells you someting about the pt or both |
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Nonverbal Communication
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•Eye Contact
•Five Senses •Use of Space •Gestures and Postures |
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The Duchenne Smile
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-genuine smile
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Therapeutic Communication:
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Interactive verbal and nonverbal strategies that:
1) Focus on the needs of the patient 2) Facilitate goal-directed, patient-oriented communication process. |
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Therapeutic Communication Techniques:
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•Are based on your attention to the patient’s behavioral, affective and cognitive communication.
•Communicate your listening, caring and understanding. •Encourage the patient to: –examine feelings, –explore problems, –build on strengths, and –develop new coping strategies. |
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Active Listening
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•To listen actively is to be attentive to what client is saying, both verbally and nonverbally.
•What nonverbal behaviors show the client that you are actively listening? |
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Therapeutic Communication Techniques
list |
•Using silence
•Accepting •Giving recognition •Offering self •Offering general leads •Giving broad openings •Placing the event in time or sequence •Making observations •Encouraging description of perceptions •Encouraging comparison •Restating •Reflecting •Focusing •Exploring •Giving information •Seeking clarification •Presenting reality •Voicing doubt •Seeking consensual validation •Verbalizing the implied •Encouraging evaluation’ •Attempting to translate fee•Suggesting collaboration •Summarizing •Encouraging formulation of a plan of actionlings into words |