ncm 101 mental hygiene

8/13/2019 NCM 101 Mental Hygiene

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NCM-A Finals

Mental Health- relative and dynamic

Relative not the same to all people

Dynamic changes at different point in time

Positive state in which one is responsible, displays onesself awareness, self directed, reasonable

worry freeand can cope with daily tensions

Simultaneous success at working, loving, and creatingwith the capacity for mature and flexible

resolution of conflicts between instinct conscience, important other peopleand reality.

It is the state in the relationship of the individualand environmentin which the personality structure

is relatively stable and the environmental stresses are within its absorptive capacity (good mental

health.

!bility to solve problems.

"ulfill one#s capacity for love and wor$. (could you satisfy one#s relationship

!bility to cope with crises without assistance beyond the support of family and friends.

It could maintain a state of well being such as enjoying life, setting goals, and realistic limits

becoming independent, dependent, or interdependentas the need arises without permanently losingone#s independence.

!sychic "nergy

%# $d present at birth& instinctual drive for pleasure and immediate gratification, unconscious& pleasure

principle(wants.

'. "godevelop as sense of self that is distinct from world of reality.

- perates on reality principlewhich determines whether the perception has a basis in reality or

is imagined.

- )ses secondary process thin$ing by *udging reality and solving problems#

- +ictates your needs.

. %uperego develops as person unconsciously incorporates standards and restrictions from parents toguide behaviors, thoughts, and feelings.

- oncious awareness of acceptableunacceptable thoughts, feelings, and actions /conscience0.

!sychiatric &ursing

- speciali1ed area of nursing, employing theories of human behavior as it science and the purposeful

use of health as it art.%cience theories of human behavior

'rt purposeful use of self.

- self awareness

(oharis )indows

*pen self that is $nown to

you and $nown to others

+lind self

revealed by feedbac$

- )n$nown to you but

$nown to others

!rivate openedby self

revelation

- secrets

lose-.nknown /

-not $nown to you and to

others

- an be opened bysituationsincidence

0*'1% *2 M"&3'1 Health

2oving towards assisting client to3

%. !ttain mental health

'. 2aintain mental health.

. Prevent mental Illness

4. 5o cope with mental illness

6. 5o find meaning in mental illness experienced and suffering.


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*&"!3.'1 '!!R*'H"% 3* M"&3'1 H"'13H

1. Attitude towards the individual self.5his involves aspects related to persons3

a. self awarenessb. self acceptance

c. confidence

d. level of self esteem

e. sense of personal identification in relation to roles

self concept the term given to the type of self that lies between conscious awareness.

- a collection of attitude and ideas about the self.

- ! product of life experienced

- It encompasses all that the person perceives $nows and holds to be true about his or heridentity.

- 7hat you believe you can do- Perceive (how you perceive yourself

4 '%!"3% *2 %"12 *&"!3%

%. +ody image physical dimension of self concept.

- it is the entire gamut of human expression through the 6 senses as well as the physical

representation of movement, express through dancing and gestures.

- 8ow to present ourselves to others physically affects how other perceives us socially andemotionally.

'. !ersonal $dentity refers to psychological aspect of self concept.

- 2ore of the individual.

- It prefers to the perception of internal and external reality.

- inner world of the client in case by feelings, thought and tribute learning.

- 2anifested by3 !ctions and 9anguage.

56- :erbal (less effective

756- ;on :erbal (more effective

- It is unconscious stratum mental data by which individual is unaware.. %elf esteem- emotional component.

- +escribe as the degree of value or worth ascribe to the self.

-


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$. %erception of &ealit!- 5he person#s perceptions of his environment and other people as well as his reactions towards

them.

- x. ognitive disability

Schi1ophrenia or bipolar disorder

:# &urturing During hildhood

- x. *bsessive compulsive comply on the impose of their parents.

a. !ositive &urturing starts with bonding at child birth and includes feelings of love, security,

and acceptance. 5he child experiences positive interactions with parents and siblings.

b. &egative &urturing circumstances such as maternal deprivation, parental re*ection, sibling

rivalry and early communication failures. !oor nurturing develop poor self esteem, poor communication s$ills.

# 1ife ircumstances

- an influence one#s mental health from birth.

!ositive circumstances- are generally emotionally secure and successful in school and establish

healthy interpersonal relationship.

&egative circumstances poverty, poor physical health, unemployment, abuse, neglect andunresolved childhood loss generally precipitate feelings of hopelessness, helplessness, and

worthlessness#

5hese negative responses place a person at ris$ for3

%. depression,

'. substance abuse

. *ther mental health disorders#

H'R'3"R$%3$% *2 "M*3$*&'1 M'3.R$3;

%. !bility to deal constructively with reality'. apacity to adapt to change

.


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/5al$ to you later0

1evel 4 Reporting facts

- reveals very little about oneself

- minimal or no interactions is expected from others- ;o personal interactionoccurs at this level

1evel Revealing $deas and (udgments

- ommunication occurs under strict censorship by the spea$er, who is watching the listener#s

response for an indication of acceptance or approval.

1evel : %pontaneous, Here and &ow "motions

-


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?. +enial 5he );;SI)S disapproval of thoughts, feelings, wishes, needs which are consciously

unacceptable.

losely related to rationaliAation.

;ot the same as lying which is conscious.

It protects the persons from finding out that he may be wrong.

>xample3 2r. arpio who is alcohol dependant states that he can control his drin$ing (when in

fact he cannot.@. xample3! student states, /I got a @D on the test because the teacher as$ed poor Cuestions0.

2xample32r. Salvo tal$s about his son#s death bout with cancer as being mercifully short without

showing signs of sadness.

G. "ixation 5he arrest of maturation at an earlier level of psycho sexual development.

Eehavior appropriate at an earlier age is maintained at a time such behavior should havebeen outgrown.>xample3 ! child#s attachment to a nursing bottle beyond the oral period.

%D. Identification 5he unconsciousness, wishful adoption (internali1ation of the personality

characteristics or identity of another individual generally one possessing attributes which the

sub*ect envies or admires.

I2I5!5I; their behavior in contrast to identification is conscious.

>xample3 Hulia state to the nurse, /when I get out of the hospital, I want to be a nurse *ust li$e you.

%%. Intro*ections 5he symbolic assimilation or tal$ing into one#s self a loved or hated persons or external

ob*ect. 5his is a form of identification,>xample3 7ithout reali1ing it, a patient tal$s and acts li$e his therapist.

%'. Pro*ection )nconsciously ma$ing another persons or circumstances responsible for one#s

unacceptable thought or actions

It involves repression of undesirable Cualities.>xample3 ! parent#s fulfilled desire may be pro*ected on the child by demanding that the child

prepare for a career which the parent would li$e to do, regardless of the child#s interest

and wishes.

%.


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'lgophobia dread of pain

'stra-po/phobia dread of thunder and lightning

laustrophobia dread of closed or confined places

oprophobia dread of excreta

Hematophobia dread of sight of bloodHydrophobia dread of water

1alophobia or glossophobia dread of spea$ingMysophobia dread of dirt or contamination

&ecrophobia dread of dead bodies

&yctophobia dread of dar$ness, night

!athophobia or &osophobia dread of disease, suffering

!eccatophobia dread of sinning

!honophobia dread of spea$ing aloud!hotophobia dread of strong light

%itophobia dread of eating3aphophobia dread of being buried alive

3hanatophobia dread of death

3o8ophobia dread of being poisoned

Benophobia dread of strangers

Coophobia dread of animals

3. Significant Others or Support People- 7ith anyone who the person fells comfortable trusts and respects.

- !ct as the sounding board, shoc$ absorber of problem of a person

- Simply listener while one vents various feelings or emotions.- 8e or she may interact as the need arises.

4. Personal Strategies.-


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1!"period of enlightenment concerning persons with mental illness. establishment of asylum is credited to Phillippe Pinel in "rance and 7illiam 5u$es in

>ngland.

'%;1.M a safe refuge or haven offering protection this movement began the moral treatment of the mentally ill.

1#"2 $ 1## +orothea +ix began a crusade to reform the treatment of mentally ill inthe ).S. +ix is instrumental in opening ' state hospitals that offered asylum to the suffering.

She believed that society has obligation to persons who are mentally ill and promoted

adeCuate shelter, nutritious food and warm clothing.

the period of enlightenment was short lived.J within %DD yrs. after the%st !sylum was established state hospitals were in trouble.

J attendants were accused of abusing clients

J rural location of hospitals were viewed as isolating patients from family and their

homes.

J /insane asylum0 too$ on a negative connotation, rather than a protective haven.

#/%$0M.&D 2R".D and 3R"'3M"&3 *2 M"&3'1 D$%*RD"R%

period of scientific study and treatment of mental disorders began with Sigmund

"reud (%F6? %GG

>mil Kraepolin (%F6? %G'? began classifying mental disorders according to their

symptoms.

>ugene Eleuler (%F6@ %GG coined the term /schi1ophrenia.0

"reud challenged the society to loo$ at human dLbeings ob*ectively and studied the

mind and its disorder and their treatment.

D#/D";5!9

8>!958 thru 2emorandum ircular ;o.4F of the office of the President.

n Hanuary D, %GF@, ;28 was categori1ed as a Special


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It also gives and creates venues for Cuality mental health education, training and research geared

towards hospital and community mental health services nationwide.

R*1" *2 3H" !%;H$'3R$ &.R%"

1. Creator of the %herapeutic En&ironment

It is an environment allows the client to3


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+#9# !R"D$%!*%$&0 2'3*R%

- onditions in which ma$e the individual susceptible to precipitating causes and thus more li$ely

to develop psychosis.

Inheritance

!ge-adolescence, menopause, senile periods

Sex female ( more mental disorder before

2ale (more mental disorder now >nvironmental and social factors3

- financial depression

- war

- family relationships

- environmental factors

- family organi1ation bro$en homes

"amily 8ealth >nvironment

"amily !ttitudespracticesvalues

Social class differences differences between the poor and the rich develop $nferiorityomple8

"amily control patterns

- authoritarian

- lax- ambivalent

- overly permessive

"amily Placement and roles

- oldest - youngest

- prettiest - ugliest

Segregations sororities

Social change (forced retirement

ultural conflicts.

+#: !R"$!$3'3$&0 2'3*R%

- exciting cause of psychiatry disorder- they are highly emotional and critical situations

+#:a !hysical !recipitating causesF

Infection

"ever

>xhaustion

Intoxicants narcotics, alcohol, bromides, barbiturates Een1edrine

rganic conditions

5rauma

+:b !sychic !recipitating auses

- dynamic motivating and damaging causes of mental illness not easily identified or understood

(emotions

strong emotions

conflicts between conscious and unconscious drives

disappointment

re*ection

deprivation

marital difficulties

failure in one#s ambition

inferiorities

economic reverses

'-(SI' P(OCESS- ! systematic process or a six step problem solving approach to nursing that also serves as

an organi1ational framewor$ for the practice of

nursing.

- It sets the practice of nursing in motion and serves as a monitor of Cuality nursing care.

%3"!% *2 &.R%$&0 !R*"%%

9# '%%"%%M"&3 the collection of data about a person, family, or group by the methods of observing,

examining, and interviewing.

3)* 3;!"% *2 D'3'

%ubjective data obtained from the client, family members, or significant others


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- provide information spontaneously during direct Cuestioning or during health history

- involves interpretations of information by the nurse

*bjective data information obtained verbally from the client, as well as the results of3

Inspection

Palpation

Percussion !uscultation

G$&D% *2 '%%"%%M"&3

9# omprehensive assessment includes all the dimensions of a person

Ecompleted in collaboration with other health care professionals

Eincludes data related to the clients biological, cultural, spiritual, and social needs!hysical e8amination performed to rule out any physiologic causes of disorders such as anxiety,

depression, or dementia

:# 2ocused assessment the collection of specific data regarding a particular problem as determined by the

client, a family member, or a crisis situation

"8ampleFsuicide attempt

# %creening assessment includes the use of a specific screening instrument to evaluate data regarding a

particular problem.

During any assessment, the psychiatric nurse uses the ff#F

%. &ursing History and assessment tool uses to obtain factual information:# *bserve client appearance and behavior

# "valuate the clients mental or cognitive status

'%%"%%M"&3 D'3' *11"3$*&

- discussion of the data collected by the nurse during a comprehensive assessment conducted in

the psychiatric setting.

9# 'ppearance

- physical characteristics, apparent age, peculiarity of dress, cleanliness, and use of cosmetics

2acial "8pression is a manner of non verbal communication in which emotions, feelings and

moods are related.

:# 'ffect, or "motional %tate

'ffect the outward manifestation of a person#s feelings, tone, or mood.

- !ffect and emotion are commonly used interchangeably- !s a nurse you should assess congruently the language and the facial e8pression

-


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$mpaired ommunication E

"ollowing terminology is commonly used3

a# +locking sudden stoppage in the spontaneous flow or stream of thin$ing or spea$ing

for no apparent external or environmental reason.b# ircumstantiality the person gives much unnecessary detail that delays meeting a goal

or stating a point.- commonly found in clients with manic disorder and clients with some cognitive

impairment disorders

- Individuals who use substances may also exhibit this pattern of speech.

c# 2light of $deas over productivity of tal$ and verbal s$ipping from one idea to another.

5he ideas are fragmentary, although tal$ is continuous.

d# !erseveration is the persistent, repetitive expression of a single idea in response tovarious Cuestions.

e#


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c# DepersonaliAation

E feeling of unreality or strangeness concerning self, the environment or both.

- these people may feel they are /going cra1y0

- causes includeF

a. prolonged stress b. psychological fatigue

c. substance abuse

d# *bsessions

- insistent thoughts, recogni1ed as arising from the self, usually regarded by the client asabsurd and relatively meaningless, yet persistent despite his or her endeavors to be rid of

them.

e# ompulsions

E insistent, repetitive, intrusive, and unwanted urges to perform an act contrary to one#s

ordinary wishes or standards.

@# *rientation

- ability to grasp the significance of their environment, an existing situation, or the clearness of

conscious processes.

1"


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- the ability to recall past experiences.

Recent Memory ability to recall events in the immediate past and up to ' wee$s previously.

- loss of memory may be seen in clients with dementia, delirium, or depression.

1ongEterm Memory is the ability to recall remote past experiences such as place of birth,names, of school attended, occupational history, etc.

- loss of memory is due to a physiologic disorderresulting in brain dysfunction.

Memory defects may result fromF

a# lac$ of attention

b# difficulty with recall

c# or any combination of these factors

Disorders of MemoryF

9# Hyperamnesia abnormally pronounced memory :# 'mnesia E loss of memory

# !aramnesia falsification of memory

# $ntellectual 'bility

- ability to use facts comprehensively

?# $nsight Regarding $llness or ondition

- $nsight self understanding, or the extent of one#s understanding about the origin, nature, andmechanisms of one#s attitudes and behavior

- Insightful clients are able to identify strengths and wea$nesses that may affect their responseto treatment.

95# %pirituality

- by learning to ta$e a spiritual history and understand a client#s beliefs, values, and religious

culture

- nurses become better eCuipped to evaluate whether these beliefs and values are helping or

hindering the client.

99# %e8uality

- expressany concerns regarding sexual identity, activity, and function.

- !ge and sex of the clinician may affect the response given.

9:# &eurovegetative hanges

- the client changes in psychophysiologic functions such as3

a# sleep patterns

b# eating patterns

c# energy levels

d# se8ual functioning

e# bowel functioning

- usually complain of insomia or hypersomia, loss of appetite or increased appetite, loss ofenergy, decreased libido, and constipation, which are all signs of neurovegeattive changes.

%leep !attern

$nsomnia a symptom that have many different causes, and it occurs often in clients with psychiatricdisorders.

'cute or primary insomnia often caused by emotional or physical discomfort such as chronicstress, hyperarousal, poor sleep hygiene, environmental noise, or *et lag.

- it is not due to the physiological effects of a substance or a general medical condition. %econdary insomnia related to a psychiatric disorder such as depression, anxiety, or schi1ophrenia&

general medical or neurologic disorders& pain& or substance abuse.

D*.M"&3'3$*& *2 '%%"%%M"&3 D'3'

riteria for the documentationF

%. *bjective the nurse documents what the client says and does by stating facts and Cuotingthe client#s conversation.

'. Descriptive the nurse describes the client#s appearance, behavior and conversation as seen

as heard.. omplete +ocumentation of examinations, treatments, medications, therapies, nursing

interventions, and the client#s reaction to each should be made on the client#s chart.

- what should be done by the client.

- Samples of the clients writing should be preserved.

4. 1egible with the use of acceptable abbreviations only and no erasures.- correct grammar and spelling are important, and complete sentences should be used.

6. Dated important to note the day and the time of each entry.

?. 9ogical presented in logical seCuence.


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@. %igned should be signed by the person ma$ing the entry.

&.R%$&0 D$'0&*%$%

Is a statement of an e8isting problemor potential health problemthat a nurse is both competentand licensed to treat.

linical judgmentabout individual, family, or community responses to actual or potential health

problems life processes. Provides basis for selection of nursing interventions to achieve outcomes for which the nurse is

accountable.

Psychiatric nurse analy1es the assessment data before determining a nursing diagnosis.

!%;H$'3R$E M"&3'1 H"'13H &.R%$&0 -!MH&/ D$'0&*%3$ %;%3"M

-organi1ed F human response process3

%. activity

'. cognition

. ecological

4. emotional

6. interpersonal

?. perception@. physiologic

F. evaluation

ues are facts collected during the assessment process.$nferences are *udgments that the nurse ma$es about the cue#s

'ctual &ursing Diagnosis based on clinical *udgment of the nurse on review of validated data.

Risk &ursing Diagnosis is based on clinical *udgmentof the client#s degree of vulnerability to the

development of a specific problem.

)ellness nursing diagnosis is based on clinical *udgment about an individual, group, or community

transitioning from a specific level to higher level of wellness.

%yndrome &ursing Diagnosis cluster of actual or high ris$ diagnoses that are predicted to be present

because of a certain event or situation.

2'3*R% *2 &.R%$&0 D$'0&*%$%


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+ocumentation of the plan of care should allow access to it by team member and modification of

the plan as necessary.

Priority setting considers the urgency of the problem or need and its impact on the client.

2aslow#s hierarchy of needs usually the guide for problem solving during formulation of plancare.

0eneral principles to remember when writing care plansF Individuali1e or personali1e the plan of care according to the nursing diagnosis or problem list

)se simple, understandable language to communicate information about the client#s care

Ee specific when stating nursing action.

Prioriti1e nursing care

State short and long term goals.

Indicate the responsible party for each client intervention.

$M!1"M"&3'3$*&

)ses of various s$ills to implement the plan care

Implement of care based on3o nursing theory

o establish trust with the client

o promotes the client#s strengths

o sets mutual goals with the client to promote wellness.

Intervention used by the nurses in clinical setting:

ounseling interventions to help the client improve or regain coping abilities.

2aintenance of a therapeutic environment or milieu

Structured interventions to foster self-care and mental and physical well-being.

Psychobiologic interventions to restore the client#s health and prevent future disability.

8ealth education

ase management

Interventions to promote mental health and prevent mental illness.

Additional intervention used by clinical nurse specialist3

Individual, group, and child therapy

Pharmacologic agent prescription onsultation with other health care providers

"


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provides, structures, and maintains a therapeutic environment in collaboration with the client

and other health care providers.

%tandard


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developed during toddler hood

Strict Superego leads to rigid, compulsive, unhappy person.

7ea$ or +efective Superego leads to antisocial behavior, hostility, anxiety or guilt.

'. Interpersonal 5heory (8arry S. Sullivan

a. Infancy- Self-concept is developed

- 2othering role is achieved by perception of the child as /=ood me0 it not /Ead me0.

- If satisfaction and security of the child is achieved, he views himself as a worth while

individual& but if an infant severely deprived, he develops /;ot me0 attitude.

- 5ype of play3 Solitary Play

b. 5oddlerhood

- >mphasi1ed the sense of P7>< the child feels as he attempts to control himself and

others.

- E>8!:I

%. 5oddlers are headstrong and negativistic (their favorite word is /;o0.

'. 5oddlers are naturally active, mobile and curious which ma$e them vulnerable to

accident.. 5emper tantrums are common.4. 5ype of play3Parallel Play

c. Pre-schooler

- haracteri1ed by3 onsensual :alidation there is the use of language which can be

consensually validated by others.

- E!8!:I

%. 9ove to watch adults and imitate their behaviors.

'. 5hey are very creative and curious (5heir favorite word is /78M0.

. 5hey love to tell /lies0, to brag and boast in order to impress others.

4. 5hey are very imaginative& imaginary playmates are common.6. 5hey love offensive language.

?. Auestion about sex should be answered honestly at the level of their understanding.

@. 5ype of play3Associative Or Cooperative Play

d. Schooler%. Huvenile >ra3 (? %D years old

%.a. 5he child turn away from his parents as being the most significant people in

his life and loo$s to peers of the same sex to fill the functions of providing him

sense of security and companionship.

%.b. Period of gang loyalties

%.c. hild acCuire the very important interpersonal tools3

- !bility to complete

- !bility to compromise

'. Preadolescence (%% %' years old

'.a. hild develop the ability to experience intimacy.

'.b. hum Relationship an intense love relationship with a particular person

of the same sex whom the child perceives to be very similar to himself.

e. !dolescence (%' %F years old

%. Known as the >arly !dolescence.

'. >stablish relationship with the opposite sex.

. !dolescence experiences already sexual urges termed by Sullivan as 1.%3#

4. +evelopment of heterosexual relationship.

f. Moung of >arly !dulthood ('D -4D years old

%. Known as 9ate !dolescence. '. 5here is incorporation of I;5I2!M (which developed during pre-adolescence

with a chum and 1.%3 (which developed in early adolescence in heterosexual

relationship.

humans are essential social being

human personality determined in the context of social interactions with other human beings. early life experiences with parents, especially the mother, influence an individual development

throughout life.


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. Eehavioristic 5heory

behavior can be changed by a system of reward and punishment.

derived form the wor$s of Ivan Pavlov, Hohn 7atson and E.". S$inner.

concerned only with observable behavior not with intra psychic or interpersonal processes or

the personality itself. all behavior are responses to a stimulus or stimuli from the environment.

there are conseCuences that results from behavior broadly spea$ing reward and punishments behavior that are rewarded with reinforces tend to recur.

PSI5I:> I;"=!5I:> I;";>5I >PIS5>29=M the study of the nature of thought, especially the development of

thin$ing.

S8>2! an innate $nowledge structure which initially enable the person to behave an interact

with the environment.

=;I5:> +>:>9P2>;5 the development of the ability to thin$, remember and solveproblems.

' PSS>S " =;I5I:> +>:>9P2>;5

%. !ssimilation incorporation of a new $nowledge to the existing $nowledge.

'. !ccommodation modification of the existing body of $nowledge in a person based on the newly

acCuired $nowledge. 5he existing body of $nowledge maybe changed refined a reinforced.

")< P>


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%olution to all kinds of categories of problem#

- !bstract thin$ing is fully utili1ed.

- +evelops capacity to use hypothetic reasoning and considers all possible solutions problem.

Eelieve that only plants, animal and people have life.- 9ogical, mathematical and scientific reasoning are completed

%3'0"% *2 0R*)3H and D"le$tra omplex

Eoys3 edipal omplex

Eecause of the desire to posses parent of the opposite sex, the child develops guilt

feelings and fear of punishments by parent of the same sex (castration complex

Imitation of parent of the same sex or internali1ation of the traits.

I:. 9atency (? %' yrs old

Stage of development mar$ed by expanding peer relationship.

9ibido is channeled into school, home, organi1ation activities, and hobbies relationship

with peers. 5ime for increased intellectual activity.

Significant other are the school and neighbors.

:. =enital Phase Puberty

hild becomes sexually nature

9ibido is centered again to the genital area

haracteri1ed as establishment of relationship with the opposite sex

b#/ !sychosocial 3heory -"rik "rikson/

%. Infancy 3 5rust vs. 2istrust

3 5as$3 +evelopment of trust in oneself, other people, the environment andmeaningfulness of existence.

5rust3 7hen needs are meet consistently by mother or primary caregiver. 5he child will

be able to relate well with others, share and has optimism and hope in life.

2istrust3 If needs are not met, child develops mistrust, hostility, suspiciousness, engagesin excessive testing behaviors later in life, fears affection and becomes

withdrawn.

'. !utonomy vs. Shame and +oubt

!utonomy3 Support and encourage the child to explore the environment

3 Supportive and consistent toilet training leads to development of self

confidence that he can control himself and the environment.


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Shame and +oubt3 If the mother re*ects child#s attempt to explore the environment and

the parents# lac$ of confidence to the abilities of the child. hild becomes

insecure and learns to become ashamed of himself.

. Initiative vs. =uilt

2a*or 5as$3 !ccomplishment proper sex rule identification resulting to resolution ofedipus complex. "ailure leads to improper sex rule identity.

Initiative to explore and reach security outside the home could lead to guilt.5he sense of /badness0 may develop which could restrict initiative.

hild is ready to learn Cuic$ly and to mature and to cooperate successfully with others.

- 2reIuent 'sking $s $nitiative

Social S$ill3 ooperative Play

4. Industry vs. Inferiority

2a*or 5as$s3 !cCuisition of competencehild is halfway outside the family world. 5his is the active period of sociali1ation.

hild wor$s with others and produce thing which should be recogni1ed to prevent

inferiority.

!eer most important person. 5he child learns to win recognition by finishing tas$s to

completion, producing things, solving problems.

6. Identity vs. stablishment of friendship and eventually a satisfying marriage.

haracteristicF

8uman closeness and sexual fulfillment.

"orms mutually regulating wor$ procreation and recreation.!rrives at wor$ing philosophy of life.

5olerant.

8as a mastered environment.@. =enerativity vs. Self !bsorption and Stagnation

2a*or 5as$s3 !cCuisition of ability to care.

0enerativity J is reflected in the individual establishments and guiding the next

generation. 5he person is productive and creative in both career and family. 5here is

willingness to assume responsibility for others.

F. Integrity vs. +espair$ntegrityis achieved when the individual accepts responsibility for what his life has been

and finds it has worth.haracteristicsF

7isdom is achieved.

Period of


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Personal Space is a 1one of space surrounding a person that is felt to /belong0 to that

person.

5erritoriality the mar$ing off and defending of certain areas as their own.

Paralanguage refers to how something is said rather than what is said.

Interpersonal +istance one

Public distance (%' feet and beyond for actors, total strangers, important officials Social +istance ( 4-%' feet for social gatherings, friends and wor$ situations

Personal +istance (%F inches 4 feet close friends

Intimate +istance ( D-%F inches parents and children, lovers, husband and wife

b#


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%'. >xploring !scertains the meaning of a

patient behavior

/9et#s tal$ more about it.0

/7ould you describe it more

clearlyB0

%. =iving information Provides to focus on reality and

$eeps patient oriented

/2y name is R0

/:isiting hours areR0

/I#m ta$ing you to theR0

%4. Presenting Strives to focus on reality andencourages patient to give up his

fantasies

/I see no one else in the room.0/5hat sound was a car

bac$firing.0

/Mour mother was not here. I#m a

nurse.0

%6. :oicing doubt !n attempt to get patient to

rethin$ his ideas.

/Isn#t the unusualB0

/ncouraging >ncourages patients to tal$ /7hat are you feeling with regard

toRB0

%G. Suggesting ommunicates support to the

patients and that the nurse#sgenuine interest in the patient

have understand the patient#s

message

/Perhaps you and I can discover

that produces you anxiety.0

'D. Summari1ing Indicates that the nurse have

understand the patient#s message

/8ave I got this straightB0

/Mou#ve said that0

+uring the past hours, you and I

have discussedR0

'%. >ncouraging formulation of a

plan of action

>ncourages patient to thin$

independently

/;ext time this comes up, what

might you do to handle itB0

*ther 3herapeutic 3echniIues "8amples

%. Making *bservations----------------- Mou appear tense.

!re you uncomfortable when youRB

I notice that you#re biting your lips.

It ma$es me uncomfortable when youR

:# "ncouraging omparison EEEEEEEEEEEEEE7as this something li$e RB

8ave you had similar experiencesB

# %eeking larification EEEEEEEEEEEEEEEEEEI#m not sure that I follow.

4# !resenting Reality EEEEEEEEEEEEEEEEEEEEEEI see no one else in the room.

5hat sound was a car bac$ firing.

Mour mother is not here, I#m a nurse.

=# %eeking consensual validation EEEEEEE5ell me whether my understanding of it

agrees yours.

!re you using this word to convey the ideaB

@#


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:/ Patient3 2y wife pushes me around *ust li$e my

mother and sister did.

;urse3 It is your impression that women aredomineeringB

7# "ncouraging evaluation EEEEEEEEEEEEEEE7hat are your feelings in regard toRB

+oes this contribute to your discomfortB

# 'ttempting to translate EEEEEEEEEEEEEEEPatient3 I#m dead.

;urse3 !re you suggesting that you feel lifelessB or is

it that life seems without meaningB

Patient3 I#m way out in the ocean.

;urse3 It must be lonely or you seem to feel deserted.

?# %uggesting ollaboration EEEEEEEEEEEE Perhaps you and I can discuss and discover what

produces your anxiety.

E.'. ;on- 5herapeutic - communication that is a barrier to the expression of free expression of feelings.;on-therapeutic communication may provide disruption to the treatment process

5>8;IA)> >QP9!;!5I; >Q!2P9>

%. Eelittling Statement tents to ma$e light of

the patient#s fear and beliefs.


24/37

I don#t want to hear aboutR

:# Disapproving EEEEEEEEEEEEEEEEEEEEEEEEEEEEEE5hat#s bad.

I#d rather you wouldn#tR

# !robing EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE5ell me your life historyR

;ow tell me aboutR4# hallenging EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEut how can you be President of the ).S.B

If you#re dead, why is your heart beatingB

=# 3esting EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE7hat day is thisB

+o you $now what $ind of hospital this isB

+o you still have the idea thatR

@# ReIuesting an e8planation EEEEEEEEEE7hy do you thin$ thatB

7hy do you feel this wayB

7hy did you do thatB

7# $ndicating the e8istence

of an e8ternal source EEEEEEEEEEEEEEEEEE7hat ma$es you say thatB

7ho told you that you were HesusB

7hat made you do thatB

# 0iving literal responses EEEEEEEEEEEEEEPatient3 I#m an easter egg.

;urse3 7hat shape, or you don#t loo$ li$e one.

?# .sing denial EEEEEEEEEEEEEEEEEEEEEEEEEEEEEPatient3 I#m nothing.

;urse3 f course you are something, everybody is

somebody.

Patient3 I#m dead.

;urse3 +on#t be silly.

95# $nterpreting EEEEEEEEEEEEEEEEEEEEEEEEEEEEE7hat you really mean isR

)nconsciously you are sayingR

3herapeutic ommunication 3echniIues

9# .sing broad openings open-ended comments or Cuestions and other broad openings can

help the client begin, continue, or focus the expression of communication. 5o use broadopenings3

a# 7ait for the client to finish his or her message.

b# )se phrases such as3

/5ell me about what#s bothering you.0

/8ow are you feeling todayB0 & /7hat does this mean to youB0

/Is there something you would li$e to tal$ aboutB0

/7hat are you thin$ing aboutB0

/7here would you li$e to beginB0

c# =ive client sufficient time to respond.

>xample3 Hovie, a %-year old married woman, is admitted to a psychiatric unit because ofdepression and alcohol abuse.

lient3 I shouldn#t be here& this is a mista$e. 7hat#s wrong with meB

;urse3 9et#s start, Hovie, with some basic information. 7hat can you tell me about

coming to this hospitalB

:# larifying 2eelings when clarifying the patient#s feelings3

a.


25/37

b. )se an open, Cuestioning tone of voice& that is, a nondirective and noninterrogating

one.

c. 7ait until the client responds.

>xample3

lient3 I don#t $now what happened I left the children at the neighbor and went to a

bar *ust to see who was there. I wo$e up the next morning in a motel with a strange

man (begins to cry, put her clenched fists to her eyes.

;urse3 Mou#re frightened and ashamed because you don#t $now what happened and you

wo$e up in strange placeB

lient3 It was so scary. I#m afraid it will happen again. I wouldn#t leave even when my

husband came for me. I feel so humiliated.

# Reflecting 2eelings when reflecting the client#s feelings3

a. State your comprehension of the feeling message, using emotional and feeling

descriptive words.

b. )se a nonCuestioning tone of voice.c. 7ait until the client responds.

>xample3

lient3 I don#t $now who I am anymore (wipes eyes, lights a cigarette, tal$s in awhisper. I#m drawn to go to any bar eventhough I tell myself it won#t happen

again.

;urse3 Mou feel frightened and ashamed that you#re not in control of yourself.

lient3 I can#t seem to control my actions when those feelings come over me.

4# larifying ontent when clarifying the content of the client#s communication3

a. xample3

lient3 2y brother is a diabetic and my sister has hypoglycemia problems. I read in a

maga1ine that people who drin$ a lot may have trouble burning up sugar in their

blood.;urse3 Mou thin$ because of the history of diabetes and your sister#s glucose tolerance, you

may have a glucose problem, too.

lient3 Mes, I#m wondering if the doctor would chec$ my blood.

@# onfronting 2eelings when confronting the client feelings3

a. +escribe the emotional message or feelings you are perceiving.b. +escribe the client#s ongoing behavior that is influencing your perceptions.

c. Identify the contradictions using a Cuestioning tone of voice.

d. 7ait for the client#s response.

>xample3 Hovie has been less depressed since intensive therapy began one wee$ ago. She is

ta$ing an antidepressant medication and is participating actively in the unit

program. 5he team has noticed incongruence in Hovie#s expression of feelings

toward her husband. Hovie discusses her feelings of love and need for closenesswith her husband, but refuses his phone calls and does not open his letters. 5heteam has decided to confront Hovie with her behavior.

lient3 I love my husband so much, and I $now he understands why I go to bars when

I#m upset.

;urse3 Mou feel your husband $nows you love him so much that he accepts your

behavior when you became anxious. !re refusing his calls and not opening his

letters contrary to those strong feelings of love you say you feel for himB


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lient3 Sometimes I feel so confused. I hate him at times and then, at other times, feel

overwhelming love for him.

7# onfronting ontent when confronting the content of the client#s communication3a. +escribe the message you are perceiving, using cognitive terms.

b. +escribed the mixed-content messages you are perceiving, using the specific

cognitive terms of the client.

c. Identify the contradictions using a non-Cuestioning tone of voice.d. 7ait for the client#s response.

>xample3

lient3 2y husband isn#t interested in visiting me. I $now 6D miles is a long way to come,

but he won#t ma$e the effort.

;urse3 Mou thin$ your husband doesn#t care about you because he hasn#t visited you, but

you told me you sent him a letter as$ing his not to come. I#m confused, Hovie.

lient3 7ell, don#t you thin$ he should $now I really didn#t mean for him not to comeB

;urse3 I#m sure he#s trying to do what you want and not to visit you if that#s your reCuest.

8e has called everyday.

# xample3

lient3 I don#t thin$ I have a drin$ing problem. I thin$ all my trouble stems from my parent#s

divorce when I lost my friends and home.

;urse3 Mou#re having difficulty accepting the fact that you are an alcoholic, and it is easier

to blame your parents for your problems.

lient3 I feel so uncomfortable when I loo$ at the other people at our meetings who are soopen about being alcoholics I guess I can#t or don#t want to accept the fact that I#m

li$e them.

?# %elfEDisclosure the nurse reinforces a genuine regard for, and respect of, the client by

means of the therapeutic use of self. Self-disclosure may be used after the client describes a

feeling or an emotional message. 7hen self-disclosing3

a. larify the client#s message or feeling tone.

b. +escribe similar experiences or feeling of your own.

c. 7ait for the client#s response.

>xample3

lient3 I#m very frightened to go to the employment agency and applyfor a *ob.

;urse3 I thin$ I $now what you mean. I#ve always felt scared when I

had to apply for a new *ob.

95# 0iving $nformation communicating facts to the client is a common component of

intervention. 5he cognitive, goal-directed function meets an identified ob*ective for the

client. 7hen giving information to the client3a. State the purpose of the activity, procedure, or situation.

b. +escribe the activity, procedure, or situation.

c. Identify the components of the activity, procedure, or situation.

>xample3

lient3 I signed some $ind of a contract yesterday about drugs and passes, but can#tremember all the facts.

;urse3 >ach client signs a contract with our unit within '4 hours of admission. 5his

contract identifies the rules and regulations about drugs and 'D-minute, free- time

passes. 5he contract you signed stated two things3

a. I do not have any drugs with me nor will I ta$e any drugs that are not a part

of my treatment.


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b. I will sign out when I leave the unit, identifying where I#m going in the

hospital, and will return in 'D minutes.

99# %ilence when using silence3

a# +escribe the behavior that needs the client#s response.

b# )se an open, Cuestioning, or declarative tone of voice.c# 7ait for the client#s response.

>xample3 Hovie had signed a behavioral contract to attend !lcoholics !nonymous meetingsheld at another area in the hospital.

;urse3 Mou didn#t attend the !! meeting last night.

lient3 I *ust R(Hovie puts her head in her hands& silence follows for about '-

minutes. She then begins to cry. It#s so hard for me to see myself as analcoholic. (Silence for about % minute. I feel so ashamed and even unclean

when I go to those meetings.

;urse3 Mou feel humiliated and dirty.

lient3 I $now it#s not the people there. It#s accepting myself as I am and not the

ma$e-believe that I#ve been living.

9:# Directing when directing the client#s interaction3

a# )se nonverbal or succinct, open-ended Cuestioning, or declarative statements.

b# 7ait for client#s response.>xample3

;urse3 Mou were saying

lient3 I $now that when my husband called last night, I wanted to be $ind and

considerate about the out-of-town trip he needs to ta$e, but

;urse3 Please go on, Hovie.

9# Kuestioning freCuently, the nurse uses direct Cuestions or indirect Cuestion-li$e responses

during therapeutic communication. pen-ended Cuestions are helpful ways to elicit the

/how0, /what0, /where0, /when0 of the client#s behavior.

>xamples3 /7ill you elaborateB0 & /7ill you give me an exampleB0 /!m I correctB0 5he nurse avoids as$ing Cuestions that reCuire on answer of /yes0 or /no0 and those that

are probing and interrogative during the therapeutic communication. ! client may become

defensive or may intellectuali1e when as$ed the /why0 of a behavior.

94# %ummariAing when summari1ing the interaction with the client3

a. xample3

&urse3 Hovie, during the last ' wee$s, you#ve said that you accept the fact that you

abuse alcohol, you have complied with the behavioral contract, and you have attended

two !! meetings a wee$ for the past two wee$s.

lient3 I#ve gotten something out of them, too. I#ll continue until my stay here ends,

rightB

;urse 3 !s I recall, that is correct, but let#s loo$ at the behavioral contract.

9=# $nterviewing is a specific type of guided and limited intercommunication with an identifiedpurpose. !n interview is usually conducted to collect a database for analysis and decision-

ma$ing purposes. 5he nurse commonly uses structured assessment tools and Cuestionnaires to

gatherand categori1e data.

=uidelines for interviewing include the following3

a. onduct sessions seated in a private, comfortable area with adeCuate

lighting and hearing distance.

b. !t the beginning of each session, plan and discuss with the client the length

and purpose of the session.

c. bserve, listen, and use facilitative communication techniCues.

d. onvey a professional demeanor through dress and manner.

e. Summari1e the interaction at the end of the session and ma$e arrangements

with the client for the next session.

f. Positively reinforce the client#s attention, effort, and so on.

*ther 3herapeutic 3echniIues "8amples


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'. 'ccepting EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE I follow what you said

;odding

. 0iving RecognitionEEEEEEEEEEEEEEEEEEEEE =ood morning, 2r. S. I notice that you#ve combed your hair.

4. *ffering %elfEEEEEEEEEEEEEEEEEEEEEEEEEEEEE I#ll stay here with you.

I#m interested in your comfort.=# !lacing the event in time or

$n seIuenceEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE 7hat seemed to lead up toRB

7as this before or afterRB

?. Making *bservations----------------- Mou appear tense. !re you uncomfortable when youRB

I notice that you#re biting your lips.

It ma$es me uncomfortable when youR

7# "ncouraging description

*f perceptionsEEEEEEEEEEEEEEEEEEEEEEEEEE 5ell me when you feel anxious.

7hat is happeningB

7hat does the voice seem to be sayingB

7# "ncouraging omparison EEEEEEEEEEEEEE7as this something li$e RB

8ave you had similar experiencesB

# 2ocusing EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE5his point seems worth loo$ing at more

closely.

?# "8ploring EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE5ell me more about that.

7ould you describe it more fullyB

7hat $ind of wor$B

95# %eeking larification EEEEEEEEEEEEEEEEEEI#m not sure that I follow.

99# !resenting Reality EEEEEEEEEEEEEEEEEEEEEEI see no one else in the room.

5hat sound was a car bac$ firing.

Mour mother is not here, I#m a nurse.

9:#


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;urse3 !re you suggesting that you feel lifelessB or is

it that life seems without meaningB

Patient3 I#m way out in the ocean.

;urse3 It must be lonely or you seem to feel deserted.

97# %uggesting ollaboration EEEEEEEEEEEE Perhaps you and I can discuss and discover what

produces your anxiety.

9# "ncouraging formulation

of plan of action EEEEEEEEEEEEEEE 7hat could you do to let your anger out harmlesslyB

E.'. ;on- 5herapeutic - communication that is a barrier to the expression of freeexpression of feelings. ;on-therapeutic communication may provide disruption

to the treatment process.

&on E3herapeutic 3echniIues "8amples

9# Reassuring EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE I wouldn#t worry aboutR

>verything will be all right.

Mou#re coming along fine.

:# 0iving approval EEEEEEEEEEEEEEEEEEEEEEEEEE5hat#s good.

I#m glad that youR

# Rejecting EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE9et#s not discussR

I don#t want to hear aboutR

4# Disapproving EEEEEEEEEEEEEEEEEEEEEEEEEEEEEE5hat#s bad.I#d rather you wouldn#tR

=# 'greeing EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE5hat#s right.

I agree.

@# Disagreeing EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE5hat#s wrongR

I don#t believe that.

I definitely disagree with.

7# 'dvising EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEI thin$ you shouldR

7hy don#t youR

# !robing EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE5ell me your life historyR

;ow tell me aboutR

?# hallenging EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEut how can you be President of the ).S.B

If you#re dead, why is your heart beatingB

95# 3esting EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE7hat day is thisB

+o you $now what $ind of hospital this isB

+o you still have the idea thatR

99# Defending EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE5his hospital has a fine reputation.

;o one here would lie to you.

Eut +r. E is a very able psychiatrist.

I#m sure that he has your welfare in mindwhen he R

9:# ReIuesting an e8planation EEEEEEEEEE7hy do you thin$ thatB

7hy do you feel this wayB

7hy did you do thatB


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9# $ndicating the e8istence

of an e8ternal source EEEEEEEEEEEEEEEEEE7hat ma$es you say thatB

7ho told you that you were HesusB

7hat made you do thatB

94# +elittling feelings EEEEEEEEEEEEEEEEEEEEEEEPatient3 I have nothing to live for. I wish I wasdead.

;urse3 >verybody gets down in dumps or

I#ve felt that way sometimes

9=# Making stereotyped comments EEEEEE;ice whether we#re having.

I#m fine and how are youB

It#s for your own good.

Hust listen to your doctor and ta$e part inactivities, you#ll behome in no time.

9@# 0iving literal responses EEEEEEEEEEEEEEPatient3 I#m an easter egg.

;urse3 7hat shape, or you don#t loo$ li$e one.

97# .sing denial EEEEEEEEEEEEEEEEEEEEEEEEEEEEEPatient3 I#m nothing.

;urse3 f course you are something, everybody is

somebody.

Patient3 I#m dead.

;urse3 +on#t be silly.

9# $nterpreting EEEEEEEEEEEEEEEEEEEEEEEEEEEEE7hat you really mean isR

)nconsciously you are sayingR

9?# $ntroducing an unrelated topic EEEEEEPatient3 I#d li$e to die.

;urse3 +id you have visitors this wee$endB

E. 58> 9I;I!9 I;5>7

2ental Status >xamination# 3H"R'!".3$ &.R%"E!'3$"&3 R"1'3$*&%H$!

DefinitionsF

&urseE!atient Relationship results from a series of interaction between a nurse and a patientclient over a period of time, with the nurse focusing on the needs and problem of the

personfamilygroup while using the scientific $nowledge and specific s$ills of the

nursing profession.

3herapeutic &urseE!atient Relationship a mutual learning experience and a correctiveemotional experience for the patient& the nurse uses herself and specified clinical

techniCue in wor$ing with the patient to bring about behavioral change.

3ypes of Relationship

Differentiation %ocial Relationship 3herapeutic Relationship

haracteristics Personal and Intimate Personal but not intimate

0oal +oing favor for mutual benefit Promoting functional use of one#s

latent inner resources

3ermination ;ot defined +efined in the beginning

$dentification of &eed 2ay not occur Ey the client with help of the nurse

Resources .sed :ariety during interaction Speciali1ed professional s$ills for

intervention


31/37

0oals of the 3herapeutic &urseE!atient RelationshipF

%. Self-reali1ation, self-acceptance and increased genuine self-respect.

'. lean sense of personal identity and an improved level of personal integration.. !n ability to form intimate, interdependent, interpersonal relationship with a capacity to give

and receive love.

4. Improve functioning and increased ability to satisfy needs and achieve realistic personal

goals.

haracteristics of 3herapeutic &urseE!atient RelationshipF

%. 9istening perceiving the patient#s message in the cognitive and affective domains.

'. 7armth feeling of cordiality and affection.. =enuineness being oneself and not acting out a role& being open truthful.

4. !ttentiveness demonstrating a concentration of time andor attention on the patient.

6. >mpathy understanding the patient#s feelings& viewing the world as the patient does.

?. Positive xcessive worry over the patient.

'. "eeling of intense hatred for him.

. Preoccupations with him to the exclusion of other patients or being constantly /overcome

with pity0 for him.

4. Eeing possessively attached to a patient that she resents to anyone#s relationship with or

interest in him.6. "eeling that no one else can nurse him as well as she can.

?. Eeing freCuently upset when the patient is upset or when /things don#t go right0 for him.

@. )nable to accept anyone#s point of view concerning activities with the patient.

F. Ho$e or tease in harsh belittling manner.

3he nurse !atient $nteraction

! single encounter engaged in by a particular setting for the purpose of facilitating the patient#s

recovery through the utili1ation of the nurse#s special $nowledge and s$ills, professional not social

and is directed toward moving patients from maladaptive behavior.

!hases 5f &urseE!atient $nteraction


32/37

Orientation phase.5he purpose of the orientation phase is to become acCuainted& gain rapport&

demonstrate genuine caring and understanding& and established trust. 5he orientation phase usually last

from ' to %D sessions, but with some patients can ta$e many months.

%. Euild trust and security (first level of ant interpersonal experience3a. >stablished contract.

b. Ee confident- follow contract, $eep appointments.c. !llow patient to be responsible for contract.

d. onvey honesty.

e. Show and caring and interest.

f. 7hen patient is unable to control behavior, nurse set limits andor provide appropriate

alternatives outlets.

'. +iscuss the contract3 dates, times, and place of meetings& duration of each meetings& purpose ofmeetings& role of both patient and nurse& use information obtained& arrangements for notifying

patient nurse if unable to $eep appointment.

. "acilitate the patient#s ability to verbali1e his or her problem.

4. Ee aware of themes3

a. ontent (what the patient is saying.

b. Process (how the patient interacts.

c. 2ood (hopeless, anxious.

d. Interaction (did the patient ignore you, was he or she submissive, did he or she dominateconversationB.

6. bservation and assess the patient#s strengths and positive aspects of his or her personality.Include the patient in identification of his or her own attributes.

?. Identify patients# problems, nursing diagnosis, outcome criteria, and nursing interventions&

formulate nursing care plan.

!atient Responses to *rientation !hase

%. 2ay willing engage in the therapeutic relationship.

'. 2ay test you and the limits of the relationship3a. 2ay be late for meetings

b. 2ay end meeting early.

c. 2ay play nurse (you against the staff.. 2ay not remember your name or appointment time3

a. Put information on a card and give this to patient.

b.


33/37

?. 2ay bring up topic heshe wished to discuss.

@. 2ay confide more confidential materials. 5he wor$ing phase is painful for patient, and is reached

when change occurs as problems are analy1ed and discussed by patient and nurse.

Termination phase 5he purpose of this phase is to dissolve the relationship and assure the patient

that he or she can be independent in some or all of his or her functioning.Ideally the termination phase should begin during orientation phase. 5he more

independent and involved relationship reCuired longer time for termination. 5ermination usually occurs if

the patient has improved sufficiently for the relationship to end, but it may occur if as patient is transferred

or you as a nurse leave the agency.

Methods of decreasing the involvement3

'. Space your contracts farther apart (not usually necessary in the student clinical experience.

.


34/37

'&B$"3;

DefinitionF

T ! diffused unpleasant uneasiness, apprehension, or fearfulness stemming from anticipated danger.

5he source of which is unidentifiable.

haracteristics

T It is the basic element of behavior.

T Serves as a signal which alerts an individual to defensive action to handle exhibition.

T ;ecessary for one#s survival.

T It is an emotion and a sub*ective experience of the individual.

T It is an energy and as such cannot be observed directly. It can only be inferred from the person#s

behavior.T >motion without a specific ob*ect.

T It is provo$ed by the un$nown. It therefore precedes all new experiences li$e entering school,

moving to new places, starting a new *ob, etc.

T It is communicated personally.

!recipitating 2actors to 'n8iety

3wo ategoriesF

a# Threat to biological integrity refers to the disturbance in homeostasis i. e., temperature control,

vasomotor stability, etc.b# Threat to self esteem refers to the threat to the tendency of an individual toward maintaining

established views of self and the values and patterns of behavior he uses to resist changes in self

view.

a. Sense of helplessness

b. Sense of isolation (alienation

c. Sense of insecurity (5hreat to identity

+ehavior Response to 'n8iety

!nger

+efensive behavior

Irritation

omplaining

rying

+enial

7ithdrawal

"orgetfulnessAuarreling

1"


35/37

notice if attention is pointed there

by another observer.

# %evere Perceptual field is greatly reduce.

8>!

- 8e tends to focus on a

specific detail and all his

behavior aimed atgetting relief.

+issociating tendencies operate to

panic i. e., the person does not

notice what goes on in a situation

(specifically communication with

reference to the self. !nd there isinability to do so even when

attention is pointed to this

direction by another observer.

4# !anic Involves disorgani1ation of the

personality.

- Individual experienceloss of control

- )nable to do things even

with direction

- +istorted perception

- 9ost of rational thought

Person becomes immobili1ed

(emotional paralysis

Increase motor activity+ecrease ability to relate to others

1evel of 'n8iety depends on the following factorsF

%. 2aturity of individual

'. 5he understanding of the illness

. 9evel of the self esteem

4. )se of coping mechanisms

0"&"R'1 $&3"RM ;);5I;S 5 +)> !;QI>5M

%. Provide a calm and Cuiet environment


36/37

5o help patients release nervous energy and to discourage preoccupation with self.

K>M ;);5I;S I; P2 S9:I;=

%. +iscuss with the patients their present and previous coping mechanism

!+M S5!5>

a. ! person in crisis is at a turning point.

b. 8e finds himself in a ha1ardous situation

c. 8e face a problem he cannot readily solve by using the coping mechanisms that have

wor$ for him before.d. !s a result, his tensions and anxiety increases.

e. 8e becomes less able to find a solution.

f. 8e feels helpless and caught in a state of great emotional upset and feels unable to ta$e

action on his own to solve his problem.

. 58> ! 58> 5MP>S "


37/37

4. 9" 9I2I5I;= I; ! 5>2P;S>.

a. Some solutions are sought which will lead to the previous state of eCuilibrium, or a

higher or lower level of functioning.

6. 58> ! >

a. Initial there is rise in tension in response to initial impact of stress.b. Intermediate emergency problem solving mechanisms are called forth

which may lead to actual solution of the problem.

c. 5hird Phase ma*or disorgani1ation if no solution occurs.

?. 58> P>P!55> P> 2 S)S>P5IE9> 5 58> I;"9)>;> "

SI=;I"I!;5 58> >;:I;5.

a. 5he degree of activity of the helping person does not have to be high.

b. 5ime of intervention should be of strategic importance.

F. ;5I; IS +>SI=;>+ 5 "!I9I5!5> !+!P5I:> PI;=

P!55> P!

ncm 101 mental hygiene

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