Unit B

Psych/Mental Health

 

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 everything else

 

- 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.

 

Stress - anything that alters the whole Human Being. It is a myth that anyone can ever live stress free.

Fight or Flight - an organism response to stress

            - Find out what’s stressing the pt. What’s the pt’s perception? How can you help?

Fear - often has a specific object.

            - “I’m afraid to take this test.”

Anxiety - 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 clearly

 

-Ask your pt what will help w/anxiety & stress. Ask what has worked in the past.

Coping Mechanism - set of behaviors people under stress use in struggling to improve their situations. what is pt doing to feel better right now?

Defense Mechanism - 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

 

Self-Actualization

Fulfillment of unique potential

 

Esteem & Recognition

Self-esteem & the respect of others, success at work, prestige

 

Love & Belonging

Giving & receiving affection, companionship, & identification w/a group

 

Safety

Avoiding harm, attaining security, order, & physical safety

 

Physiologic Needs

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: very intimate

 

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

 

- Communication requires 2 parties: a Sender & a Reciever

- 90% of communication is non-verbal (body language, unseen energy...)

- 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 w/verbal information

-Crossed arms always means you’re closed to communication

-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”

 

Relationships

 

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

 

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

Cultural Care:

-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

 

Spirituality/Sexuality

 

- 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, & states

-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, & influences

Wholism - treatment of the whole person, not just a medical dx

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

-Identity - 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 -

            Threats to:

            -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.

ASK:

            -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 & Traditions

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...)

Family Forms:

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 Brady Bunch)

Intragenerational- more than 2 generations

Co-habitating Families- more than one family living under the same roof

Gay & Lesbian

Single Adults Living Alone

 

-How does your pt define family? Ask & observe. There is usually a family spokesperson.

Family Assessment:

-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.

Consider:

-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 the pt!!!

-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