ALL BEHAVIOR HAS MEANING!!!!!
- No one part of
a human is any more important than another, besides keeping the body alive.
- The whole human
is greater than the sum of its parts
- All parts effect
- It’s human
nature to think bad things are “my fault”
-Easy opening questions:
- Where were you born & raised?
- What did your dad do for a living?
-Pts will tell you
exactly what the problem is, you just have to let them! They WANT to talk.
-It is a nurse’s
job to get pts where they are willing & able to go.
- anything that alters the whole Human Being. It is a myth that anyone can ever live stress free.
Flight - an organism response to stress
- Find out what’s stressing the pt. What’s
the pt’s perception? How can you help?
- often has a specific object.
- “I’m afraid to take this test.”
- vague & overwhelming sense that something terrible will happen
- “If I fail this test
I’ll lose my loans, fail out, won’t be a nurse, get stuck in my dead end fast food job, and my life will be horrible.”
Mild Anxiety - heightened sensitivity,
relatively healthy, can make it easier to study/retain information
Moderate Anxiety - coming up on a big
test (for example), it’s harder to focus, harder to retain information
Panic - absolutely impossible to think
-Ask your pt what will help w/anxiety & stress.
Ask what has worked in the past.
- set of behaviors people under stress use in struggling to improve their situations. what is pt doing to feel better right
- automatic psychological processes that protect the self by allowing the person to deny or distort a stressful event or to
restrict awareness & reduce the sense of emotional involvement.
Maslow’s Hierarchy of Needs
Fulfillment of unique
Esteem & Recognition
the respect of others, success at work, prestige
Love & Belonging
Giving & receiving
affection, companionship, & identification w/a group
Avoiding harm, attaining
security, order, & physical safety
Biologic need for
food, shelter, water, sleep, oxygen, sexual expression
Erikson’s Eight Development Stages
Trust vs Mistrust - birth-1yr, ability
to trust others & sense of one’s own trustworthiness, a sense of hope; withdrawal & estrangement; built through
mom, trust in self
Autonomy vs Shame & Doubt - 1-3yrs,
self-control w/o loss of self-esteem, ability to cooperate & express oneself; compulsive self-restraint or compliance,
defiance, willfulness; built through parents; I do it myself vs I can’t do it myself
Initiative vs Guilt - 4-5yrs, realistic
sense of purpose, some ability to evaluate one’s own behavior; self-denial & self-restriction; built through family;
sense of “perfect” sense of ideal, discover genitals
Industry vs Inferiority - 6-11yrs, realization
of competence, perseverance, feeling that one will never be “any good,” withdrawal from school & peers, kids
who know everything...are figuring it all out
Identity vs Role (identity) Diffusion
- 12-20yrs, coherent sense of self; plans to actualize one’s abilities; feelings of confusion, indecisiveness, possibly
antisocial behavior; they know who they are vs they don’t; form cliques - in groups vs out groups
Intimacy vs Isolation - 20-40yrs, capacity
for love as mutual devotion, commitment to work & relationships, impersonal relationships, prejudice; partners in friendship:
Generativity vs Stagnation (Self-Absorption)
- 40-60yrs, creativity, productivity, concern for others; self-indulgence, impoverishment of self; divided labor & shared
household; I like where I am vs I don’t
Integrity vs Despair - 60-death, acceptance
of the worth & uniqueness of one’s life; sense of loss, contempt for others; select groups- people like us, facing
mortality; must resolve all unresolved issues of the past
- Communication requires 2 parties: a Sender &
- 90% of communication is non-verbal (body language,
- 10% of communication is verbal
Double-Bind Communication: verbal says
one thing, non-verbal is overwhelmingly different
- (bad) “Hi Stella, do you want to get out of bed now?”
- (better) “Stella, it’s time to get out of bed, do you want to now or after breakfast?”
-negatively impacts self-esteem because it makes
people choose against themselves & gives them positive reinforcement for doing it. Double-bind communication shames people
into choosing against themselves
-As a sender, make sure non-verbals are congruent
-Crossed arms always means you’re closed to
-Keep your hands out of your pockets
-The higher your head, the more power you have
-Don’t cross your legs or ankles
-Be aware of cultural context for non-verbals (eye
contact, personal space, shaking hands)
-Use the appropriate level of language for your pt
(pay attention to pts native language, cultural context of language, orientation,
hearing ability) and use language slightly more sophisticated than what the pt uses (don’t ask a 4 year old to micturate)
-Forms of address: do not assume you can call pts
by their first name - ALWAYS use Mr. or Mrs. & let the pt tell you to call them otherwise
-NEVER CALL A PT “DEAR” or “SWEETIE”
Social Relationships- mutual responsibility
for mutal benefit - we often decide in 10 seconds who we want to know
Therapeutic Relationships- not mutual!
Pt always gives more. Pt centered, goal directed - to help pt get where willing or able to go
Pts have a right to know your name, who you are &
what you’ll do.
DO NOT BURDEN PATIENTS
WITH INFORMATION ABOUT YOURSELF!
Patients are desperate to talk, we have to let them!
Trust is key: never say I’ll be back in a minute...
you never know when you’ll get caught up in something else
This relationship with the pt is your most important
tool & w/o it you can’t help the pt
Be empathic, not sympathetic. Be trustworthy Be accepting- people have a right to be any way they want & almost all people
are doing the best they can.
Beneath all anger is either pain or fear
Culture - effects all relationships,
sense of self, spiritual self
-diversity training is meant to let you know yours is not the only culture...people are different
-Culturally Sensitive - implies that the nurse
possesses some basic knowledge of & constructive attitudes toward health traditions of diverse cultural groups
-Culturally Appropriate - nurse applies underlying background knowledge
-Culturally Competent - nurse understands &
attends to total context of the pt’s situation & uses combination of knowledge, attitudes, & skill
Reframing - cheap vs. frugal - use reframing
to avoid prejudice
Primary Cultural Characteristics
- race, ethnic origin, gender, age, religious/spiritual identity
Secondary Cultural Characteristics
- childhood home, job, education
- They are the 2 most fundamental human drives; they
are most important, which is why psychotic people focus on them
Spirituality - belief that there is
something outside ourselves; this belief system gives you meaning & purpose in life
Religion - rituals/behaviors/traditions
based on spiritual beliefs
- Spirtual/Religious beliefs dictate beliefs
about the causes of health/illness: good karma, wrath of God, fate, chance...
“God did that” “God allowed that” “the devil does that”
-Churches (especially Asian) are often community
health centers, they can provide translators
-It is our job to help pt support/practice beliefs
system unless it is pt/institution threatening
Sexuality - more than just sex, more
than just behaviors
- medicine is a male model driven system
- every relationship is influenced by sex
- “do you have any concerns about how your
physical condition will affect your sexual/marital/intimate life?”
The Concept of Family
-The family has a significant impact on the lives & health of its members
-Family members influence one another’s health beliefs, practices,
-The concept of family is highly individualized
-In Illness, family roles change - parents often become like children
-Family is defined biologically, legally, culturally, & socially
-Nurses assess & plan for: individuals, families, communities
Individuality - unique person w/unique DNA make-up, experiences,
Wholism - treatment of the whole person, not just a medical
Homeostasis - fragile equilibrium
Total Character - emotions, beliefs, values, self-concept, self-esteem,
self-worth, approach to life, perceptions of the world
Self-Concept - subjective image, perception of physical, emotional
& social attributes or qualities
- psychological self, internal sense of individuality, how we think, perceive & feel, how you see yourself & the world
-Body Image - physical self, psychological & mental images of internal
& external body
-Self-esteem - emotional self, self-confidence, self-respect, sense of self-worth
-Roles - social self, set of behaviors/participation in social groups
Self-Concept Stressors -
-Identity- rape, assault, relationship conflicts, ETOH abuse, death of a family member or spouse
-Body Image- incontinence, obesity, colostomy, tracheostomy, CVA, mastectomy
-Self-esteem- loss of job, marital stress, imposed social isolation
-Role- loss of ability to perform role d/t illness, loss of job, inability to function as a mother, father, etc...
-Nurses must display unconditional
acceptance of pt w/an altered self-concept
-How do we do this? Remember that acceptance is not necessarily approval.
-how has your illness effected your life?
-what changes have you made in life since the illness?
-what areas of life do you feel you have control over?
-how do you see yourself?
-describe what’s different since your illness.
-what areas of your life are out of control?
-how do you feel about your body?
-Psychological factors & related nursing Dx:
-ineffective role performance, anxiety, body-image disturbance, impaired social interactions, impaired communication,
ineffective coping, powerlessness, social isolation
Community - collection of people w/shared attribute of lives
(religion, heritage, neighborhood proximity, illness, etc...)
Family - Family of Origin - the family you are born into
Family of Affiliation - the family you choose, can be the same
as biological family, is defined by the individual
Role of Family - Protection
- economically, moral support, advocate when necessary
Socialization - we learn
rules, roles, responsibilities, social values, consequences
Passing down of Values &
Roles w/in the Family - personal responsibilities are different
from person to person - who is the caretaker? Who is in charge? Who decides on our diet? Should we drink? Smoke?
-when/why do these roles change? (illness, death, divorce...)
Traditional- nuclear family
2 Career- both parents work
Single Parent- by choice, or d/t adoption, death, divorce, separation...
Adolescent- teen parents are often not prepared
Foster/Adoptive- can lead to identity issues, self-esteem issues
Blended- parents bring unrelated children into one house (The
Intragenerational- more than 2 generations
Co-habitating Families- more than one family living under the
Gay & Lesbian
Single Adults Living Alone
-How does your pt define family? Ask & observe. There is usually a family
-all families have unique characteristics & dynamics
-everyone’s bx depends on & effects everyone else’s bx
-family relationships are complex!
-assess family function. Is it working? How does the function of the family
effect this pt? How do they interact? Assess strengths & weaknesses.
-cultural background, race/ethnicity, influences on health beliefs &
values, spirituality (ask the pt how he or she gets through things like this), & assess family roles & abilities to
cope, risk factors for health problems (age, family hx, sex/race, sociological factors)
Don’t try to figure things out or solve things for the pt - Empower
-Strong families use clear communication, problem solving skills, commitment
to each other, sense of belonging, shared spirituality
-help families with: information (especially regard medications & Dx),
management (day to day planning), support (what resources do you have), strategies (for compliance)
-remember that families almost never really keep secrets from each other
-remember that people marry & become friends with other people who are
just as functional/mentally dysfunctional as they are