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Characteristics That Influence a GroupSizeDefined purposeDegree of similarity among membersRulesBoundariesContent (what is said in the group)Process (underlying dynamics among group members)

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Therapeutic Factors Common to All Groups

Instillation of hopeUniversalityImparting of informationAltruismCorrective recapitulation of primary family groupDevelopment of socializing techniquesImitative behaviorInterpersonal learningGroup cohesivenessCatharsisExistential resolution

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Basic Level Registered Nurse (Cont.) Symptom-management groups Stress-management groups Therapeutic community meeting groups Support and self-help groups



Characteristics of Family FunctionAbility to provide for safety of membersQuality of resources and support systemsUnderlying issues Cultural concernsDevelopmental needs



Characteristics of FamilyFunction (Cont.)Patterns of behavior and interactionResponses to stressorsAbility to interact with support servicesParenting skillRelationships and interactionsOverall flexibility or resilience



Types of Families

Nuclear familySingle parent familyUnmarried biological or adoptive familyBlended familyCohabitating familyExtended familyCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Overview of Family TherapyInsight-oriented family therapyFocuses on developing increased self, other, and family awareness among family membersBehavioral family therapyFocuses on changing behaviors of family members to influence overall patterns of family interactionsCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Nursing ProcessDiagnosis ImplementationCounseling and communication techniquesNonjudgmental manner promotes open and flexible communicationPerspective of each family member is elicited and heardPharmacological interventions



Outcomes IdentificationReduce dysfunctional behavior of individual family members and resolve or reduce conflictsMobilize family resources, encourage adaptive family problem-solving behaviors, improve familys communication skills, heighten awareness and sensitivity to other family members emotional needsStrengthen familys ability to cope with major life stressors and traumatic events, including chronic physical or psychiatric illnessImprove integration of family system into societal system



Early Stress-Response TheoriesFight-or-flight responseBody prepares for situation that individual perceives as threat to survivalNew research indicates that men and women have different neural responses to stressCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Stress ResponsesNeurotransmitter Stress ResponseSerotonin synthesis more activeMay impair serotonin receptor sites and brains ability to use serotoninImmune Stress ResponseInteraction between nervous system and immune system during alarm phase of GASNegatively affects bodys ability to produce protective factors



Mediators of the Stress ResponseStressorsPhysicalPsychologicalPerceptionIndividual temperamentSocial supportSupport groupsCultureSpirituality and religious beliefs



Managing Stress Through Relaxation TechniquesDeep breathing exercisesProgressive muscle relaxationRelaxation response MeditationGuided imageryBiofeedbackPhysical exerciseCognitive reframingJournaling Humor



AnxietyAnxiety Apprehension, uneasiness, uncertainty, or dread from real or perceived threatFear Reaction to specific dangerNormal anxiety Necessary for survivalLevels of AnxietyMild anxietyModerate anxietySevere anxietyPanic



Defenses Against AnxietyDefense mechanismsAutomatic coping stylesProtect people from anxietyMaintain self-image by blocking FeelingsConflictsMemoriesCan be healthy or unhealthyCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Clinical PictureSeparation anxiety disorderDevelopmentally inappropriate levels of concern over being away from a significant other Panic disorderPanic attacksAgoraphobiaExcessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing Specific phobias



Clinical Picture (Cont.)Social anxiety disorderSevere anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by othersGeneralized anxiety disorderExcessive worry that lasts for monthsOther anxiety disordersSubstance-induced anxiety disorder Anxiety due to a medical condition



Obsessive-Compulsive Disorders ObsessionsThoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mindCompulsionsRitualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety Obsessive-compulsive disorderBody dysmorphic disorderHoarding disorder



Anxiety DisordersEpidemiologyComorbidityEtiologyBiologicalGeneticsNeurobiological



Application of the Nursing ProcessAssessmentGeneral assessment of symptomsSelf-assessmentAssessment guidelines: anxiety and obsessive-compulsive disordersNursing diagnosisOutcomes identification PlanningCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Application of the Nursing Process (Cont.)ImplementationMild to moderate levels of anxietySevere to panic levels of anxietyCounselingTeamwork and safetyPromotion of self-care activities



Implementation Pharmacological interventionsAntidepressantsAnti-anxiety drugsOther classesPsychobiological interventionsIntegrative therapyHealth teaching



Other InterventionsCognitive therapyBehavioral therapyRelaxation trainingModelingSystematic desensitizationFloodingResponse preventionThought stoppingCognitive-behavioral therapyCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


CrisisProfound disruption of normal psychological homeostasisNormal coping mechanisms fail Results in inability to function as usualAcute and time-limitedType of CrisisMaturational New developmental stage is reachedOld coping skills no longer effectiveLeads to increased tension and anxiety



Types of Crisis (Cont.)Situational Arise from events that areExtraordinaryExternal Often unanticipated Adventitious Unplanned and accidentalNatural disasterNational disasterCrime of violence



Outcomes of CrisisDepend onRealistic perception of the eventAdequate situational supportsCrisis interventionAdequate coping mechanisms Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Phases of Crisis Phase 1

Conflict or problemSelf-concept threatenedIncreased anxietyUse of problem-solving techniques and defense mechanismsResolve conflict or problemReduce anxiety



Phases of Crisis Phase 2Defense mechanisms failThreat persistsAnxiety increasesFeelings of extreme discomfortFunctioning disorganizedTrial-and-error attempt to solve problem and restore normal balance Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Phases of Crisis Phase 3Trial-and-error attempts failAnxiety can escalate to severe level or panicAutomatic relief behaviors mobilized (i.e., withdrawal and flight)Some form of resolution may be devised (i.e., compromising needs or redefining situation) Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Phases of Crisis Phase 4Problem is unsolved and coping skills are ineffectiveOverwhelming anxietyPossible serious personality disorganization, depression, confusion, violence against others, or suicidal behavior Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Application of the Nursing ProcessAssessmentGeneral assessmentAssessment of perception of precipitating eventAssessment of situational supportsAssessment of personal coping skillsSelf assessmentIneffective copingOutcomes identification ImplementationBasic levelPatient safetyAnxiety reduction



Nursing Process (Cont.)Crisis interventionPrimary careSecondary careTertiary care



Clinical PictureSomatic symptom disorder (SSD)Illness anxiety disorder (previously hypochondriasis)Conversion disorderPsychological factors affecting medical conditionFactitious disorder



Somatic Symptom DisorderDistressing symptomsMaladaptive response Without significant physical findings and medical diagnosisSuffering is authentic High level of functional impairmentCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Illness Anxiety Disorder Misinterpretation of physical sensationsOverconcerned for health and preoccupied with symptomsExtreme worry and fear Course of illness chronic and relapsingCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Conversion DisorderNeurological symptoms in the absence of a neurological diagnosis Presence of deficits in voluntary motor or sensory functionsCommon symptomsparalysis, blindness, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, or episodes resembling epilepsy La belle indiffrence versus distressCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Application of the Nursing ProcessAssessmentPsychosocial factorsCoping skillsSpirituality and religionSecondary gainsCognitive styleAbility to communicate feelings and emotional needsDependence on medicationSelf-assessment



Application of the Nursing Process Nursing diagnosisIneffective copingOutcomes identificationInterventionsPsychosocial interventionsPromotion of self-care activitiesAssertiveness training Psychobiological interventionsPharmacological interventionsHealth teaching and health promotion



Factitious DisordersArtificially, deliberately, and dramatically fabricate symptoms or self-inflict injuryGoal of assuming a sick roleMalingering



SchizophreniaEpidemiologyLifetime prevalence of schizophrenia is 1% worldwideNo difference related toRaceSocial statusCultureComorbiditySubstance abuse disordersNicotine dependenceAnxiety, depression, and suicidePhysical health or illnessPolydipsia

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EtiologyBiological factorsGeneticsNeurobiologicalDopamine theoryOther neurochemical hypotheses Brain structure abnormalitiesPsychological and environmental factorsPrenatal stressorsPsychological stressorsEnvironmental stressors



Phases of SchizophreniaPhase I AcuteOnset or exacerbation of symptomsPhase II StabilizationSymptoms diminishing Movement toward previous level of functioningPhase III MaintenanceAt or near baseline functioningCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Positive Symptoms Alterations in thinkingDelusions False, fixed beliefsConcrete thinking Inability to think abstractlyAlterations in speech Associative loosenessClang associationsWord saladNeologismsEcholalia



Positive Symptoms (Cont.)Other disorders of thought or speechReligiosityMagical thinkingParanoiaCircumstantialityTangentialityCognitive retardationAlogia, or poverty of speechFlight of ideasThought blockingThought insertionThought deletion

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Positive Symptoms (Cont.)CatatoniaMotor retardationMotor agitationStereotyped behaviorsWaxy flexibility

EchopraxiaNegativismImpaired impulse control Gesturing or posturingBoundary impairment

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*Alterations in Behavior


Affective SymptomsAssessment for depression is crucialMay herald impending relapseIncreases substance abuseIncreases suicide riskFurther impairs functioningCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Outcomes IdentificationPhase I AcutePatient safety and medical stabilizationPhase II StabilizationHelp patient understand illness and treatmentStabilize medicationsControl or cope with symptomsPhase III MaintenanceMaintain achievementPrevent relapseAchieve independence, satisfactory quality of lifeCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Planning Phase I AcuteBest strategies to ensure patient safety and provide symptom stabilization Phase II StabilizationPhase III MaintenanceProvide patient and family educationRelapse prevention skills are vitalCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


InterventionsAcute PhasePsychiatric, medical, and neurological evaluationPsychopharmacological treatmentSupport, psychoeducation, and guidanceSupervision and limit setting in the milieuMonitor fluid intakeStabilization and Maintenance PhasesMedication administration/adherenceRelationships with trusted care providersCommunity-based therapeutic services



InterventionsCounseling and communication techniquesHallucinationsDelusionsAssociative loosenessHealth teaching and health promotionPsychobiological InterventionsAntipsychotic medicationsFirst-generationSecond-generationThird-generation



First-Generation Antipsychotics Dopamine antagonists (D2 receptor antagonists)Target positive symptoms of schizophreniaAdvantageLess expensive than second generation DisadvantagesExtrapyramidal side effects (EPS)Anticholinergic side effectsTardive dyskinesiaWeight gain, sexual dysfunction, endocrine disturbancesCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Second-Generation Antipsychotics Treat both positive and negative symptomsMinimal to no extrapyramidal side effects (EPS) or tardive dyskinesia Disadvantage tendency to cause significant weight gainCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


Third-Generation AntipsychoticAripiprazole (Abilify)Dopamine system stabilizerImproves positive and negative symptoms and cognitive functionLittle risk of EPS or tardive dyskinesia



Potentially Dangerous Responses to AntipsychoticsAnticholinergic toxicityNeuroleptic malignant syndrome (NMS)Agranulocytosis



Other InterventionsIndividual and group therapyPsychoeducationMedication prescription and monitoringBasic health assessmentCognitive remediationFamily therapyCopyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.*


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