Unit 10 Psycho-Socio-Cultural Safety

ID

• “Baby”

• Part of the personality that wants instant gratification

Super Ego

• “Goodie 2 shoes”

• Part of the personality that is strict and rigid. Maintains perfection and order

Ego

• Arbitrates between id and super ego

• Equally both parts

• Makes up our personality

Erikson Stages Defined As:

Developmental stages associated with specific tasks or crises » Everyone has a different perception

Critical Period

• A point in which an individual is vulnerable.

• How does the person respond?

• You can tell if a person has mastered developmental stage depending how they handle the situation

Task Completion

Can be complete fully, partially, or not at all

Outcome affects future stages

Constant building.

Task Resolution

Healthier Personality

Mastery of a Stage

• 2 components (favorable / unfavorable)

• Can’t move to next stage without completing the previous ones

Times of Crises

Although stage is mastered, you can fall back to previous stages (may have to re-master)

Failure to Resolve Task

• Affects ability to achieve the next stage/task

• Regress a stage back

Erikson’s Stages of Development

Infancy, Early Childhood/Toddler, Late Childhood/Preschooler, School Age, Adolescence, Young Adulthood, Adulthood, Maturity

Infancy (Baby)

• Birth to 18 months

• Trust vs. Mistrust

Trust in individuals, trust in the environment » all needs are met

Infancy (Baby) Positive Resolution

Trust others

Infancy (Baby) Negative Resolution

Mistrust » can lead to difficulty bonding

Caused by a discontinuance of care, and separation

Early Childhood/Toddler

• 18 months to 3 years » Independence is key

• “I can be on my own” “Value attached to autonomy”

Autonomy vs. Shame and Doubt

Early Childhood/Toddler Positive Resolution

Self control, without loss of self esteem

Early Childhood/Toddler Negative Resolution

• Compulsive

• Self-restraint

• Doubt themselves – child will accept defeat (especially with those who are perceived to be bigger than them)

• Defiant » Tantrums if not allowed to do things themselves

Late Childhood/Preschooler

• 3 to 5 years » Try new things and feeling good about accomplishment

• Learning degree to which they can assert themselves and how they can influence the environment

Initiative vs. Guilt

Late Childhood/Preschooler Positive Resolution

Late Childhood/Preschooler Negative Resolution

• Lacking self confidence

• Pessimistic

• Fear of wrong doing

• Over controlling

• Over restriction of their own activity

• Experiments w/ imagination

School Age

• 6-12 years » Begin to create/develop

• “Am I competent”

Industry vs. Inferiority

School Age Positive Resolution

• Beginning to create, develop and manipulate their environment

• Have a sense of perseverance

• Starts building confidence

• Build Self-Esteem to prevent from feeling inferior

School Age Negative Resolution

• Lose hope

• Sense of being only “okay'“ / mediocre

• Withdrawn from peers

• Social isolation

• Feeling of inferiority

Adolescence

• 12-20 Years » Awkward time in adolescence

• “Who am I” / “What do I do in my life?'“

• Finding yourself

Identity vs. Role Confusion

Adolescence Positive Resolution

• Coherent sense of self

• Plan to actualize their own ability and future

Adolescence Negative Resolution

• Feeling confused about their identity

• Indecisive

• Anti-social behavior

Young Adulthood

• 18-25 years

• Relationship formation/ connecting with others

• Can I form a meaningful relationship with others

Intimacy vs. Isolation

Young Adulthood Positive Resolution

• Develop intimate relationship and are committed

Young Adulthood Negative Resolution

• Impersonal relationship

• Avoid relationships » Isolation

• Cannot solidify lifestyle commitments

Adulthood

• 25-65 years

• How can I be of service to others

Generativity vs. Stagnation

Adulthood Positive Resolution

• Develop creativity and concern for others

Adulthood Negative Resolution

• Person becomes self-indulgent / self-concerned

• Lack of interest and commitment with others

• “All about me”

Maturity

• 65 years - death

• How did I do? » Reminiscent

Integrity vs. Despair

Maturity Positive Resolution

• Accept their worth and uniqueness of life

• Accept death

Maturity Negative Resolution

• Sense of loss

• Has regret, hatred for people or events that happened in their life

• Regret life choices

Culture

Thoughts, communication, actions, customs, beliefs, values, institutions of racial, ethnic, religious, or social groups » prevents biases

Contributing Factors

Developmental, Physical, Physiological, Psycho/socio/cultural, Chemical

Developmental

• Critical time

  • Period in life when person’s ability to adapt is limited because of their age

  • Linked to age

  • Some people who experience trauma at a certain age can be catastrophic

Physical

• Trauma

  • Burn, motor vehicle accident, violence

Physiological

• Illness

  • Cancer, neuromuscular diseases etc

Psycho/socio/cultural

• Fear

• Cultural background

• Gender

Chemical

• Substances

  • Prescription drugs

  • Alcohol

  • Illegal Substances

Microbiological

• TB, Aids/HIV, Hepatitis, Zika

• All have negative connotations associated with them

Clinical Manifestation

Anxiety (2 components), Fear

Anxiety

• Common reaction to stress » Threat to self

• Caused by emotional conflict

• Occurs in levels, stages and degrees

• Happens in reaction to something felt or perceived as danger

• Described as

  • Vague and uneasy feeling

  • Feeling of dread

  • Apprehension

  • Does not occur/respond to a specific threat

• Can be experienced at a conscious or subconscious level

• Can be indistinguishable rom fear at times

Physiologic Anxiety

• Can chance vital signs – sympathetic nervous system – “fight or flight”

• Can be so devastating it can change the way someone acts

• Change in appetite

• Pupil dilation

• Pulse rises, respirations & BP rises

• Mouth can be dry

• Diaphoresis (sweating)

Psychological Anxiety

• Irritable / angry

• Restless

• Crying

• Dizziness

• Nervous

• Sleep pattern disturbances

• Emotional outburst

• Loss in motivation

• Decreased productivity

• Decrease urinary output

Fear

• More specific

  • Attached to something, ex; fear of spiders

Contributing Factors (Anxiety & Fear)

• Family structure

• Past experiences

• Developmental level

• Coping mechanisms

Nursing Interventions

Show respect, identify strengths, provide factual information, foster autonomy, incorporate family, help patient adapt good coping strategies, talk to your patient, lifestyle changes/modifications, deep breathing, communication techniques, learn about patient’s culture

Show Respect

Know their name, don’t use honey or sweetie

Identify Strengths

• Use of past coping strategies

  • Talk with the patient

  • Identify past stressful situations that they overcame

Providing Factual Information

Decreases the fear of the unknown

Fostering Autonomy

Allow patient to participate in their care

Incorporate Family

Able to adapt better to lifestyle changes

Help Patient Adapt Good Coping Strategies

Cognitive, behavioral, time management/time blocking, emotional focus strategy

Cognitive

The way they are emotionally connected

Behavioral

Change in behavioral patterns

Talk To Your Patient

Refer to social groups