Ethics
Autonomy
Emphasizes the right of people to determine their own destinies and assumes that individuals are capable of making choices for themselves.
Maslow's Hierarchy of Needs
-Physiological (food water air sleep exercise)
-Safety/security (avoiding self harm, maintain comfort, physical safety)
-Love/belonging (giving/receiving affection, companionship, participating in a group)
-Self esteem (seeking esteem from self or others, working to achieve success/recognition/prestige)
-Self actualization (feeling of fulfillment and realization of one’s highest potential)
Peplau's Four Levels of Anxiety
Mild: Seldom a problem, Prepares people for action.
Moderate: Perceptual field begins to diminish. Attention span and the ability to concentrate decrease, and assistance with problem-solving may be required.
Severe: Perceptual field diminishes greatly--> Virtually all overt behavior is aimed at relieving the anxiety.
Panic: The most intense state--> Prolonged panic anxiety can lead to physical and emotional exhaustion and can be life-threatening.
Sympathetic vs Parasympathetic Nervous System
The autonomic nervous system is influenced heavily by emotions and is implicated in a number of psychophysiological disorders.
This system has two distinct divisions:
1. Sympathetic division: dominant in stressful situations and prepares the body for fight or flight. Results in an increase in heart rate and respirations.
2. Parasympathetic division: dominant in relaxed situations. Results in a normal heart rate and promotes elimination functions.
Name 3+ Therapeutic Factors of a Group
Instillation of hope: By observing the progress of others in the group with similar problems, a group member garners hope that their problems can also be resolved.
Universality: Individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing.
Imparting of information: Group members share their knowledge with each other. Leaders of teaching groups also provide formal instruction to group members.
Altruism: Individuals mutually share and provide concern for one another, thereby helping to create a positive self-image and promote self-growth.
Catharsis. Within the group, members are able to express both positive and negative feelings—perhaps feelings that have never been expressed before—in a nonthreatening atmosphere.
Existential Factors. The group is able to help individual members take direction of their own lives and to accept responsibility for the quality of their existence.
Corrective recapitulation of the primary family group: Group members are able to re-experience early family conflicts that remain unresolved.
Development of socializing techniques: Through interaction with, and feedback from, other members of the group, individuals are able to correct maladaptive social behaviors and learn and develop new social skills.
Imitative behavior: Group members who have mastered a particular psychosocial skill or developmental task serve as valuable role models for others.
Interpersonal learning: Group offers varied opportunities for interacting with other people.
Group cohesiveness: Members develop a sense of belonging rather than separating the individual (“I am”) from group (“we are”).
Beneficence vs Nonmaleficence
Beneficence refers to the duty to benefit the good of others. Nurses who act in the interest of their clients are beneficent. This includes knowing when to act on a client’s behalf.
Nonmaleficence refers to the requirement that health-care providers do no harm to their clients.
General Adaptation Syndrome
Physical response to stress, as defined by Selye, Acute stress results in flight or flight, prolonged stress may result in maladaptive response.
1. Alarm reaction stage - Fight-or-flight syndrome responses are initiated.
2. Stage of resistance - using the physiological responses of the first stage the person attempts to adapt to the stressor. If adaptation occurs, the third stage is prevented or delayed. Physiological symptoms may disappear.
3. Stage of exhaustion: After prolonged exposure to the stressor the body becomes adjusted. The adaptive energy is depleted, and diseases of adaptation may ensue (headache, mental disorders).
Transference vs Countertransference
Transference and countertransference are potential issues in the working phase.
Transference occurs when the patient unconsciously displaces to the nurse feelings formed toward a person from their past.
Countertransference refers to the nurse’s behavioral and emotional response to the patient. These responses may be related to unresolved feelings toward significant others from the nurse’s past, or they may be generated in response to transference feelings on the part of the patient.
Name 4 neurotransmitters & their functions
•Dopamine: Functions include regulation of movements and coordination, emotions, and voluntary decision-making ability. Increased levels are associated with mania and schizophrenia. Associated with emotional stability in the limbic system.
• Serotonin: May play a role in sleep and arousal, libido, appetite, mood, aggression, and pain perception. Associated with happiness and wellbeing. Implicated in certain psychopathological conditions including anxiety states, mood disorders, and schizophrenia.
•Norepinephrine: resulting in fight or flight. Functions include regulation of mood, cognition, perception, cardiovascular functioning, and sleep. Implicated in mood disorders such as depression and mania, anxiety states, and schizophrenia.
•Inhibitory Amino Acids: Includes gamma-aminobutyric acid (GABA) and glycine. Prevents postsynaptic excitation, interrupting the progression of electrical impulse at the synaptic junction. GABA is associated with relaxation, and has been implicated in anxiety disorders, movement disorders, and forms of epilepsy. Glycine has been implicated in certain types of spastic disorders.
•Excitatory Amino Acids: Includes glutamate and aspartate. Function in the relay of sensory information and regulation of motor and spinal reflexes. Implicated in the etiology of certain neurodegenerative disorders, such as Huntington’s disease, temporal lobe epilepsy, and spinal cerebellar degeneration.
See chart in book for full list!
Three Phases of Group Development
1. Orientation Phase: Leaders and members work together to establish the rules that will govern the group. Goals of the group are established, and members are introduced to each other. The leader is expected to orient members to specific group processes and ensure that rules established by the group do not interfere with fulfillment of the goals. Members have not yet established trust.
2. Middle/Working Phase: cohesiveness has been established within the group. This is when the productive work toward completion of the task is undertaken. The role of the leader diminishes and becomes more one of facilitator. Trust has been established among the members.
3. Final/Termination Phase: the group comes to an end. Termination should be mentioned from the beginning of the group. The leader encourages the group members to reminisce about what has occurred within the group, to review the goals and discuss the actual outcomes, and to encourage members to provide feedback to each other about individual progress within the group.
Advocacy
acting on another’s behalf, either by being a supporter or defender.
Diasthesis Model
AKA vulnerability-stress model
Explains a disorder, or its trajectory, as the result of an interaction between a predisposed vulnerability (genetic, psychological, biological, situational), AKA the diathesis, and stress caused by life experiences.
Ex: one may be predisposed to depression but can experience it once a stressor occurs such as a parent dies later in life.
Effective Communication
Effective communication includes several strategies, including restating what a client said using their exact words to confirm, reflecting to direct focus back, clarifying questions to explore/gather more information, summarizing what was said
Barriers to effective communication include giving advice/false reassurance, asking irrelevant questions, changing the topic, asking why questions or too many questions.
See book for full list of communication strategies/therapeutic communication techniques!
Name & Describe Three Types of Brain Stimulation
1. Electroconvulsive Therapy: Uses electrical current to induce brief seizure activity while the client is anesthetized. The exact mechanism of ECT is still unknown. Indications: Major Depressive Disorder, Schizoaffective Spectrum Disorders, Acute Mania Episodes. Contraindications: Cardiovascular disorders and cerebrovascular disorders. ECT is not a permanent cure. Weekly or monthly maintenance ECT can decrease the incidence of relapse.
2. Transcranial Magnetic Stimulation:
TMS is similar to ECT but does not induce seizure activity.
● TMS is commonly prescribed daily for a period of 4 to 6 weeks. TMS can be performed as an outpatient procedure, lasts 30 to 40 min. A noninvasive electromagnet is placed on the client’s scalp, allowing the magnetic pulsations to pass through. FDA approved for the treatment of major depressive disorder for clients who are not responsive to pharmacological treatment
3. Vagus Nerve Stimulation: FDA approved for resistant depression. VNS is commonly performed as an outpatient surgical procedure. The VNS device delivers around-the-clock programmed pulsations, usually every 5 minutes for a duration of 30 seconds. Therapeutic antidepressant effects usually take several weeks to achieve.
Define Crisis & Risk Factors
Acute (4-6 week) event during which a client experiences an emotional response that cannot be managed with the client’s normal coping mechanisms. This is a result of a specific personal identifiable event, and results in either psychological deterioration or growth.
Crises can be something personal to an individual, or widespread such as a natural disaster or man-made disaster.
Risk Factors: Accumulation of losses, current life stressors, concurrent mental and physical health issues, excessive fatigue or pain, age, developmental stage.
Ethical Decision Making Nursing Process
Note: the steps that may be used in making ethical decisions closely resemble the nursing process:
1.Assessment: Gather the subjective and objective data about a situation. Consider personal values as well as values of others involved in the ethical dilemma.
2.Diagnosing the problem
3.Problem Identification: Identify the conflict between two or more alternative actions.
4.Planning:
-->Explore the benefits and consequences of each alternative.
-->Consider principles of ethical theories.
-->Select an alternative.
5.Implementation: Act on the decision made and communicate the decision to others.
6.Evaluation: Evaluate outcomes.
Ego Defense Mechanisms
Ego defense mechanisms may be employed by the ego in the face of threat to biological/psychological integrity for protection at mild-moderate levels of anxiety. There are adaptive and maladaptive responses (listed in book).
Types of Community Based Programs
Partial hospitalization programs provide intense short-term treatment for clients who are well enough to go home every night and who have a responsible person at home to provide support and a safe environment
Assertive community treatment (ACT) includes nontraditional in home case management teams and treatment by an interprofessional team for clients who have severe mental illness and are noncompliant with traditional treatment.
Community mental health centers provide a variety of services for a wide range of community clients, including: ● Educational groups ● Medication dispensing programs ● Individual and family counseling programs
Psychosocial rehabilitation programs provide a structured range of programs for clients in a mental health setting, including: ● Residential services ● Day programs for older adults
With psychiatric home care, there are four criteria that must be met. The client must be homebound, have psychiatric diagnosis, need the skills of the mental health nurse and a plan of care developed by the health care provider.
Name 2 hormones secreted by the pituitary gland & their functions
The pituitary gland is split into two major lobes, each of which has its own hormones. See notes for full list!
•Oxytocin: Stimulates contraction of the uterus at the end of pregnancy, stimulates release of milk from the mammary glands, and is also released in response to stress and during sexual arousal. This is known as the "cuddling hormone".
•Growth hormone: Responsible for growth in children, as well as continued protein synthesis throughout life. Deficiency has been noted in many patients with major depressive disorders, and several growth hormone abnormalities have been noted in patients with anorexia nervosa.
•Antidiuretic hormone (ADH): Conserves body water and maintains normal blood pressure. Release is stimulated by pain, emotional stress, dehydration, increased plasma concentration, and decreases in blood volume. Alteration may be one of the factors contributing to polydipsia in about 10% to 20% of patients with severe mental illness, particularly those with schizophrenia.
•Thyroid-stimulating hormone: Integral to the metabolism of food and the regulation of temperature. Studies have correlated various forms of thyroid dysfunction with mood disorders, anxiety, eating disorders, schizophrenia, and dementia.
Four Phases of a Crisis
Phase 1: The individual is exposed to a precipitating stressor. Anxiety increases; previous problem-solving techniques are employed.
Phase 2: When previous problem-solving techniques do not relieve the stressor, anxiety increases further. The individual begins to feel a great deal of discomfort at this point. Coping techniques that have worked in the past are attempted, only to create feelings of helplessness when they are not successful. Feelings of confusion and disorganization prevail.
Phase 3: All possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort. New problem-solving techniques may be used, and, if effectual, resolution may occur at this phase, with the individual returning to a higher, lower, or previous level of pre-crisis functioning.
Phase 4: If resolution does not occur in previous phases, anxiety may reach panic levels. Cognitive functions are disordered, emotions are labile, and behavior may reflect the presence of psychotic thinking.
All Clients Have These Three Rights
There are basic rights that all clients have when being treated by a nurse.
1. The right to treatment
2. The right to refuse treatment (including medication)
3. The right to the least-restrictive treatment alternative (guides the use of chemical and mechanical restraints)
SOLER
SOLER is an active listening acronym:
S: Sit squarely facing the patient. This gives the message that the nurse is there to listen and is interested in what the patient has to say.
O: Observe an open posture. Posture is considered “open” when arms and legs remain uncrossed. This suggests that the nurse is “open” to what the patient has to say. With a “closed” posture, the nurse can convey a somewhat defensive stance, possibly invoking a similar response in the patient.
L: Lean forward toward the patient. This conveys to the patient that you are involved in the interaction, interested in what is being said, and making a sincere effort to be attentive.
E: Establish eye contact. Direct eye contact is another behavior that conveys the nurse’s involvement and willingness to listen to what the patient has to say. The absence of eye contact, or the constant shifting of eye contact, gives the message that the nurse is not really interested in what is being said.
R: Relax. Whether sitting or standing during the interaction, the nurse should communicate a sense of being relaxed and comfortable with the patient. Restlessness and fidgeting communicate a lack of interest and may convey a feeling of discomfort that is likely to be transferred to the patient.
Name & Define 5+ Major Types of Therapy
1. Psychodynamic psychotherapy: employs the same tools as psychoanalysis, but it focuses more on the client’s present state, rather than their early life
2. Interpersonal psychotherapy: assists clients in addressing specific problems. Goal is to improve interpersonal interactions which impacts mental health/psychiatric manifestations. Considered a brief psychotherapy. Goal is to improve interpersonal skills through specific interventions targeted at resolving identified problems.
3. Cognitive therapy: focuses on individual thoughts and behaviors to solve current problem. Premise: thoughts come before feelings and actions.
4. Behavioral therapy: based on the theory that behavior is learned and has consequences. Behavioral therapy has been used successfully to treat clients who have phobias, substance use or addictive disorders, and other issues.
5. Cognitive behavioral therapy (CBT): uses both cognitive and behavioral approaches, key=what clients think influences their feelings and behaviors.
6. Dialectical behavior therapy: a cognitive-behavioral therapy for clients who have a personality disorder and exhibit self-injurious behavior.
7. Milieu therapy: a scientific structuring of the environment in order to effect behavioral changes and to improve the psychological health and functioning of the individual. The therapeutic nurse-client relationship is foundational to mental health nursing care.
8. Reality Therapy: Defined by Glasser, All humans have 5 basic needs (survival, freedom, fun, power, and love/belonging) that we attempt to satisfy through our behavioral choices. Suggests that all individuals are responsible for what they choose to do.
Other: Group/family therapy, cognitive reframing, relaxation therapy, assertiveness training, modeling, operant conditioning, systematic desensitization, aversion therapy, and more.
Levels of Nursing Community Prevention
These are levels of prevention are used by nurses when implementing community care interventions/teaching.
1. Primary – promotes health, prevention of mental health problems from occurring
Ex: A nurse teaches a community education program on stress reduction techniques.
2. Secondary – early detection
Ex: A nurse screens older adults in the community for depression.
3. Tertiary – focus on rehabilitation, prevention of problems in clients with previous diagnoses. Mental illness is present and with tertiary prevention, the goal is to prevent further deterioration or complications.
Ex: A nurse leads a support group for clients who have completed a substance use disorder program.
Goal of Crisis Intervention
The goal of crisis intervention is resolution of the individual’s immediate crisis and restoration to at least the level of functioning that existed before the crisis period or possibly to a higher level of functioning.