NHA CCMA PSYCHOLOGY

Trust vs. Mistrust

Birth-18 months

Infants form an attachment with and develop trust in their primary caregiver (usually mom) and then generalize bonds to others, trust their own body as they learn gross and fine motor skills

Achieving tasks = self-confidence, optimism that caregivers will meet the infant's basic needs

Non-achievement = suspiciousness, struggles with interpersonal relationships

Autonomy vs. Shame and Doubt

2-3 y/o (toddlers)

Toddlers develop sense of independence, autonomy, self-control and acquire language skills; parents should be firm but tolerant with toddlers

Achieving tasks = self-control, voluntary delaying of gratification

Non-achievement = anger with self, lack of self-confidence, no sense of pride in the ability to perform tasks

Initiative vs. Guilt

3-6 y/o (pre-schoolers)

Children look for new experiences but will hesitate when adults reprimand them/restrict them from trying new things; have active imagination and are curious about everything around them; will start feeling guilt about some of their actions, which is part of the natural development of moral judgement

Achieving tasks = assertiveness, dependability, creativity, personal achievement

Non-achievement = inadequacy, defeat, guilt, deserve punishment

Industry vs. Inferiority

7-12 y/o (school-age children)

Children need to receive recognition for accomplishments to provide reinforcement and build self-confidence; if achievements are met with negative response, inferiority can be established; require acknowledgement of their successes

Achieving tasks = competence, self-satisfaction, trustworthiness and increased participation in activities and taking on more responsibilities at school, home, community

Non-achievement = inadequacy, inability to compromise or cooperate with others

Identity vs. Role Confusion

12-20 y/o (adolescents)

Adolescents try to figure out where they fit in and what direction their life should take; if role confusion sets in, adolescents become followers, which can lead to poor decision-making

Achieving tasks = emotional stability, ability to form committed relationships, and sound decision-making

Non-achievement = lack of personal goals/values, rebelliousness, self-consciousness, lack of self-confidence

Intimacy vs. Isolation

20-35 y/o (young adults)

Young adults think about partnership, marriage, family, career

Achieving tasks = mutual self-respect and love, intimacy, commitment to others and to a career

Non-achievement = social isolation and withdrawal, multiple job changes/lack of productivity or fulfillment in one job, inability to form long-term, intimate relationships

Generativity vs. Stagnation

35-65 y/o (middle adults)

Adults continue raising children and some become grandparents; want to help mold future generations so involve themselves in teaching, coaching, writing, social activism

Achieving tasks = professional and personal achievement and active participation in serving the community and society

Non-achievement = self-preoccupation without capacity to give and share with others

Ego Integrity vs. Despair

> 65 y/o (older adults)

Adults retire, children (if they have any) are not living at home; volunteer to retain feeling of usefulness; bodies succumb to age-related changes, health problems become a major concern (esp as friends/loved ones die)

Achieving tasks = wisdom, self-acceptance, sense of self-worth as life draws to a close

Non-achievement = dissatisfaction with life, worthlessness, helplessness to change, depression, anger, inability to accept that death will occur

Erikson's Theory

Development of the ego

Maslow's Hierarchy of Needs

physiological (lowest), safety, love/belonging, esteem, self-actualization (highest)

Stages of Grief: Denial

"No, not me."

"The test is wrong, I don't have cancer."

"I can't be dying! I'm only 22!"

Cannot or will not believe that the loss is happening or has happened; might deny existence of illness and refuse to discuss therapeutic interventions

MA should support pt without reinforcing the denial; give written information about the disease and treatment options

Stages of Grief: Anger

"Why me?"

"Why didn't the doctor catch this sooner?"

"How could God let this happen? I'm a good person!"

Might aim feelings of hostility at others, including healthcare staff (b/c they cannot fix or cure the disease)

MA should not take the pt's anger personally but should help them understand that becoming angry is an expected response to grief

Stages of Grief: Bargaining

"Yes, me, but..."

"If I just keep trying different therapies, eventually one will work."

"If I can just get better, I will quit smoking forever."

Attempt to avoid the loss by making a deal (i.e. wanting to live long enough to attend a particular family occasion); searching for alternative solutions; hoping for previous life, life itself, postponement of death

MA should listen with attention and encourage pt to express feelings

Stages of Grief: Depression

"Yes, it's me."

"I have no future now that I'm paralyzed."

"I feel tired all the time and I don't have the energy to do anything."

Reality of situation takes hold, grieving person feels sad/lonely/ helpless; regret and self-blame for not taking better care of themselves; may talk openly or withdraw and say nothing about it

MA should sit with pt and not put pressure on them to share feelings but instead convey support/understanding

Referrals to support group or for counseling

Stages of Grief: Acceptance

"Yes, me, and I'm ready."

"Mom lived a full life. I'm going to make sure her last days are comfortable."

"Even though I've lost my sight, life isn't over."

Come to terms with the loss and start making plans for moving on with life despite loss or impending loss; willing to "make the best of it" and formulate new goals and enjoy new relationships; death imminent = make funeral and burial arrangements, reach out to friends/family; may still have some depression with humor and friendly interaction

MA should offer encouragement, support, additional education to pt and family/friends

MMSE Orientation

Time: years, season, month, date, day

Place: name of place, floor, city

"It is April 23rd, I am on the 3rd floor of the hospital."

MMSE Registration

Name 3 unrelated objects and ask pt to repeat them

"Table, rock, canoe."

MMSE Attention and Calculation

Ask pt to begin at 100 and count backward by 7 five times

"93, 86, 79, 72, 65."

MMSE Language

Name an object you point to

Repeat statement

3-stage command

Read direction and follow it

Write a sentence

Copy a design

Apathy

"I don't care what she puts in my evaluation because I'm going to get a better job soon."

Compensation

"I ate a lot of candy yesterday, but I also ate a big green salad."

Conversion

"I get a severe headache every time I see my ex with his new wife."

Denial

"I am healthy and fit. There is no way I have cancer, so I don't need all those tests."

"My health problems are enough as they are! I don't need to deal with waiting all day for the doctor, too."

Displacement

Dissociation

"I am always getting into fights with my neighbors, which is odd because I teach an online course about conflict resolution."

Identification

"I could pass that certification test just like she just did, and I haven't even studied the material."

Intellectualization

"He didn't break up with me because he didn't love me. He just had too much on his plate at work at the time."

Introjection

"My dad says I should stand up for myself, so I am going to be more assertive."

Physical avoidance

"I can't go to that hospital because that's where my father died."

Projection

"She leaves more charts incomplete than I do, so why am I getting this warning?"

Angry patient upset about a diagnosis when they were not proactive about following through with care

Rationalization

"My partner drinks every night to make himself less anxious about work."

Reaction formation

"I really hate being in the military, but I always sign some people up at recruitment events."

Regression

"I can't do all that paperwork, and you can't make me."

Sucking on thumb, wetting the bed, "baby language"

"That's not fair"

Repression

"They tell me I was hurt in the robbery, but I can't remember anything about it."

Sarcasm

"You have a nice office if you like living in caves."

Sublimation

"When I was a kid, I used to like to pull wings and legs off of insects I'd catch. Now I'm a biology teacher."

Woman with breast cancer diagnosis becomes spokesperson for early breast cancer detection due to her own personal experience getting a delayed mammogram

Suppression

"The doctor said I need more tests, but I'm going to take my vacation first."

Undoing

"I had a big fight with my wife last night, but I'm going to buy her flowers on my way home today."

Verbal aggression

"Why would you ask me that when you can't even control your children?

Depression

Sadness, hopeless, helpless, little interest in life, indecisiveness, fatigue, sleep disturbances, weight changes, social withdrawal, thoughts of self-harm

Anxiety

Apprehension, dread, or uneasiness similar to fear but based on an unclear threat; restless, muscle tens, difficulty sleeping

Severe = panic; can't think clearly, lost focus, pulse and breathing rates high, sweating, trembling, headache, dizziness, nausea, chest pain

Obsession

an idea or thought that takes over the mind and cannot be forgotten

Compulsion

uncontrollable urge to perform an act repeatedly

How do children 4-6 y/o perceive death?

Interested in it

How do children 6-11 y/o perceive death?

Death is final, but only happens to some people

Delusion

false belief

paranoia

an irrational suspiciousness or distrust of others

Environmental stressor

Situations that cause enough stress to become obstacles to achieving goals or having a positive experience such as:

-the environment (pollution, UV rays, overcrowding, language/cultural barriers, racial/ethnic discrimination)

-events (death, theft, vandalism, car accidents, assault, job/school problems)

-disasters (fires, flood, tornado, earthquake, hurricane, war)

-PTSD

Socioeconomic stressor

Stressors involving financial situations

Cycle of working and struggling to make ends meet, paying debts, unexpected expenses, job loss, retirement, changes in economy, identity theft, lack of job security, involuntary job loss, loss of home or vehicle, lack of health insurance

Growth

Physical changes that occur in the body; increase in size, strength

Development

Physiological, emotional, mental, social, maturational changes