Fundamental objectives of the psychiatric mental health nurse
The promotion and protection of mental health
The prevention of mental disorders
The
... [Show More] treatment of mental disorders
Recovery and rehabilitation
Psychiatric nursing roles
Instrumental in providing the structure, framework, and implementation of interventions to reach goals of the milieu model.
ex. provide safety for suicidal patients, do crisis intervention strategies, run groups, one to one counseling
Therapeutic Relationships
Therapeutic relationship is between the nurse and the patient are established to enhance patient growth.
-focuses on the patient's issues, problems, challenges, and concerns.
-communication techniques are used to identify and explore patient's needs, set goals, assist in development of new coping skills, and encourage behavioral changes.
Hildegard Peplau 199-1999
Theory of interpersonal relationships in nursing.
Established a systematic theoretical framework for psychiatric nursing.
-identified psychiatric nursing as an essential element of general nursing and as a distinct nursing specialty. She was the first to illustrate this.
Nurse-patient relationship (as the foundation of nursing practice) Relationship with patient is educative to help the patient/community strive to live more productively.
-this relationship is fluid, evolving process that moves through three distinct interlocking and overlapping phases.
1. orientation
2.working
3.termination
Factors hampering relationships
Lack of nurse availability
Lack of contact with nurse
Lack of nurse self-awareness
Nurse hold negative feelings about the patient, and nonverbal expression is present.
Factors beneficial to relationship
Being honest and congruent
Letting the patient set the pace
Listening to the patients concerns
Consistant, regular, and private interactions with the patient
Positive initial attitudes and preconceptions
Promoting patient comfort and balancing control
Patient demonstrating trust and actively participating in the relationship
Factors enhancing growth in others
Genuineness, congruence between verbal content and affect/behaviors
Empathy, understanding ideas expressed and feelings present in the other person.
Positive regard, implies respect; attitudes and actions (attending, suspending value judgements)
Helping clients develop resourses, awareness, encouragement shown toward positive behaviors
Positive regard behaviors
Mutually establishing times to begin and end and what will happen ie talking, activities, ect.
Being on time for all scheduled meetings
Actively listening to the patient
Neutral comments; nonjudgmental responses
Orientation phase
Establish boundries of the relationship
Role and responsibilities of the nurse and patient are identified
Confidentiality is agreed upon
Formal and or informal contact is set
-the time, place, date and duration of meetings
-mutual goals
-assessment of care planning
-termination terms
Working phase
Maintain the relationship
Gather further data
Promote patient problem-solving skills, self-esteem and communication
Facilitate behavioral change
Overcome resistance behaviors
Evaluate problems and goals, redefine prn
Practice and express alternative adaptive behaviors (role play and model)
Terminations phase
When: (any of these) symptoms have improved, patient discharged from facility, goals achieved, impasse in therapy, insurance runs out, change of staff
What: deal with intense feelings regarding the experience, summarize goals and objectives achieved, review patient plans for the future and finalize termination.
Defense mechanisms and anxiety
Anxiety: completely a natural part of living, its a healthy message in many cases.
Defense mechanisms: operates at an unconscious level where the ego, in an attempt to ward off intense anxiety or other overwhelming feelings, makes these to prevent the conscious awareness of threatening feelings.
Can cause distortions in the individual's preconceptions of reality.
What is a defense mechanism?
Compensation: counterbalance for deficiencies in one area by excelling in another area.
Denial: refusal to perceive or face unpleasant reality as it actually exists.
Displacement: the discharge of pent up feelings (usually hostility) unto something or someone else in the environment that is less threatening than the original source of the feelings.
ie. you know more than you think, I'm sure.
Identification: incorporates the image of an emulated person, then acting, thinking, and feeling like that person.
Intellectualiation: the overuse of abstract thinking or generalization to control or minimize painful feelings
Minimization: not acknowledging the significance on one's own behavior or feelings.
Projection: attributing one's own unacceptable motives or characteristics to another person or group
Rationalization: use of contrived socially acceptable and logical explanations to justify unpleasant material and to keep it out of the consciousness.
Reaction formations: prevention of awareness or expression of unacceptable desires by adoptionof the opposite behaviors in a n exaggerated way
Repression: disturbing thoughts, wishes, or experience are expelled from conscious awareness
Regression: returning to an earlier level of adaption
Sublimation: modification of an instinctual but socially unacceptable impulse into a constructive acceptable behavior
Splitting: Failure to integrate positive and negative aspects of self or others, resulting in polarized images of self and others as "all good" or "all bad"
Supression: conscious inhibition of an impulse, idea, or affect. The person is usually fully aware of the behavior.
Freud
Five psychosexual stages of development from infancy to adulthood.
Main focus is on the first five years of life's experiences and development.
Freud believed mental illness was a result of early intra-psychic conflict
Psychoanalytical therapy: behavior is meaningful, uncover the unconscious impulses and conflicts that influence behavior, increases ego consciousness, dream analysis; free association techniques.
Transference
The patient's feelings are projected onto the nurse or therapist that were originally held toward significant others in their life.
- feelings displaced in transference: desire for affection, desire fro gratification of dependency needs, love, hostility, jealousy, competitiveness.
Counter-transference
The health care worker's unconscious personal feelings are projected onto the patient.
Resistance in therapy
In psychoanalysis: process in which the ego opposes the conscious recall of unpleasant experiences.
In theory: patient puts road blocks to deal with identified issues.
Erik Erickson
Used to identify the person's development level for his or her age and qualified goals for each stage.
Can be helpful with making care plans to keep the goals realistic
Eight stages of development:
Infancy- trust vs. mistrust
Early childhood- Autonomy vs. shame and doubt
Preschool- Initiative vs. guilt
School age- industry vs. inferiority
Adolescence- identity vs. role confusion
Early adulthood- intimacy vs. isolation
Middle adulthood-generativity vs. self-absorption
Older Adult- integrity vs despair
Erikson's Ego theory
Describes the eight stages of development from infancy to late adulthood.
Stressed development influenced by the mother-child-father triangle (like Freud), but also felt cultural and social influences were very important.
Didn't feel the personality was fixed by age five.
His model's use in nursing:
-used to identify developmental level for age
-can help with the development of the care plan, to keep goals realistic
Harry Stack Sullivan Interpersonal theory
Goal of interpersonal psychotherapy is to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships.
Four main "problem areas":
-grief
-role disputes
-role transition
-interpersonal deficit
Sullivan's theory is the foundation for Peplau's nursing theory of interpersonal relationships.
Participant observer: the professional helpers cannot be isolated from the therapeutic situation if they are to be effective
Psychotherapeutic Environment
Group psychotherapy, family therapy, and educational/skills training programs can be incorporated into the patient's treatment.
-this is used in residential and day hospital settings today.
Behavioral Theories/Therapies
Based on the assumption that changes in maladaptive behavior occur without insight into the underlying causes
-successful in treatment for phobias, alcoholism, schizophrenia
Operant conditioning (skinner)
voluntary behaviors learned through consequences
Reinforcement (skinner)
the behavior responses elicited occur more frequently when reinforced.
positive reinforcement (skinner)
consequence is a pleasant or pleasurable experience
negative reinforcement (skinner)
removal of an objectable or aversive stimulus
Conditioning
Conditioning: pairs behavior with a condition that reinforces or diminishes the behavior's occurance.
Ivan Pavlov's classical conditioning theory
John B. Watson: behaviorism; personality traits and responses were socially learned through classical conditioning.
modeling
therapist provides a role model, demonstrates more effective behaviors to help patient cope
Cognitive Behavioral therapy
Eliciting automatic thoughts
testing automatic thoughts
identifying maladaptive underlying assumptions
testing the validity of the assumptions
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Humanistic theories
Maslow's Humanistic Theory
Hierarchy of needs
Emphasis on human potential and the client's strengths as key to success for the nurse-client relationship.
Establishes priorities for nursing interventions
Other therapies
Activity/recreational therapy
occupational therapy
family therapy
group therapy
electroconvulsive therapy
Primary prevention
Teaching stress reduction techniques
Offering seminars or classes to populations that are isolated or disenfranchised
Offering parenting classes
Secondary prevention
Early identification of mental illness
Early treatment interventions
Tertiary prevention
Reduce the residual effect of a disorder
Promote rehabilitation
Evidence based practice
Identification and application of empiric research evidence to solve clinical problems.
Applying research evidences to clinical situation and problems.
Specific interventions are incorporated to reach specific treatment outcomes.
Comprehensive care
Emphasis on symptom management, restoration, rehabiliation, a return to preillness level of function or better.
Goal is to engage again in purposeful activities and meaningful social relationships.
In psych, getting them as close to baseline as possible. They may never fully reach baseline.
Recovery and rehabilitation model
Designed to reintegrate patients into the community and to support them as they more actively participate in their own treatment.
Focuses on EBP, provides a set of strategies that enables patients to take responsibility for care and empowers them to learn to identify and define recovery goals. [Show Less]