Chapter 10

Self-Awareness

a.      Understanding own beliefs, thoughts, motivations, and limitations and how they affect others. Requires introspection.

b.     Can give a nurse objective and realistic feedback so they can improve self

Self-Disclosure

a.      Telling the patient personal information

b.     Don’t do it, you wont com across as rude

c.      It is not therapeutic

d.     Conversations should focus on patients not the nurse

the verbal communication skills

Acceptance

Confrontation

Doubt

Interpretation

Observation

Open-ended statements

Reflection

Restatement

Silence

Validation

techniques that inhibit communication

Advice

Agreement

Challenges

Reassurance

Disapproval

defense mechanisms

Acting out

Affiliation

Altruism

Anticipation

Autistic fantasy

Denial

Displacement

Dissociation

Help-Rejecting complaining

Humor

Idealization

Intellectualization

Isolation of affect

Omnipotence

Passive aggression

Projection

Projective identification

Rationalization

Reaction formation

Repression

Self-assertion

Self-observation

Splitting

Sublimation

Suppression

Undoing

Acceptance

Definition:

• Encouraging & receiving info in nonjudgmental manner

Example:

• Patient: I have done something terrible.

  Nurse: I would like to hear about it. It’s OK to discuss it with me.

Use:

• Establishing trust and developing empathy

Confrontation

Definition:

• Presenting patient with a different reality of the situation

Example:

• Patient: My doctor won’t talk to me.

  Nurse: I was in the room yesterday when you refused to speak with him.

Use:

• Used cautiously to immediately redefine the patient’s reality. However, it can alienate the patient if used inappropriately. A nonjudgmental attitude is critical for confrontation to be effective.

Doubt

Definition:

• Expressing or voicing doubt when patient relates a situation

Example:

• Patient: My best friend hates me. She never calls me.

  Nurse: From what you have told me, that does not sound like her. When did she call you last

Use:

• Used carefully and only when the nurse feels confident about the details. It is used when the nurse wants to guide the patient toward other explanations.

Interpretation

Definition:

• Putting words to what the patient is implying or feeling

Example:

• Patient: I could not sleep because someone would come into my room and rape me.

  Nurse: It sounds like you were scared last night.

Use:

• Used in helping the patient identify underlying thoughts or feelings

Observation

Definition:

• Stating to the patient what the nurse is observing

Example:

• Nurse: You are trembling and perspiring. When did this start?

Use:

• Used when a patient’s behaviors (verbal or nonverbal) are obvious

Open-ended statements

Definition:

• Introducing an idea & letting the patient respond

Example:

• Nurse: Trust means…

  Patient: That someone will keep you safe.

Use:

• Used when helping the patient explore feelings or gain insight

Reflection

Definition:

• Redirecting the idea back to the patient for classification of important emotional overtones, feelings, experiences; gives patients permission to have feelings they may not realize they have

Example:

• Patient: Should I go home for the weekend?

  Nurse: Should you go home for the weekend?

Use:

• Used when the patient is asking for the nurse’s approval or judgment; use of reflection helps the nurse maintain a nonjudgmental approach

Restatement

Definition:

• Repeating the main idea expressed, lets the patient know what was heard

Example:

• Patient: I am angry!

  Nurse: (Silence)

  Patient: My wife had an affair

Use:

• Used when the patient needs to express ideas but may not know quite how to do it; with silence, the patient can focus on putting thoughts together

Silence

Definition:

• Remaining quiet but nonverbally expressing interest during an interaction

Example:

• Patient: I am angry!

  Nurse: (Silence)

  Patient: My wife had an affair

Use:

• Used when the patient needs to express ideas but may not know quite how to do it; with silence, the patient can focus on putting thoughts together

Validation

Definition:

• Clarifying the nurse’s understanding of the situation

Example:

• Nurse: Let me see if I understand.

Use:

• Used when the nurse is trying to understand a situation the patient is trying to describe

Advice

Definition:

• Telling a patient what to do

Example:

• Patient: I am struggling at work.

  Nurse: You should probably find a new job

Use:

• The nurse solves the patient’s problem, which implies that the nurse knows best and may not be the appropriate solution; it also encourages dependency on the nurse

Agreement

Definition:

• Agreeing with a particular viewpoint of a patient

Example:

• Patient: Abortions are sinful.

  Nurse: I agree.

Use:

• The patient is denied the opportunity to change their view now that the nurse agrees.

Challenges

Definition:

• Disputing the patient’s beliefs with arguments, logical thinking, or direct order

Example:

• Patient: I’m a cowboy.

  Nurse: If you are a cowboy, what are you doing in the hospital?

Use:

• The nurse belittles the patient and decreases the patient’s self-esteem.The patient will avoid relating to the nurse who challenges.

Reassurance

Definition:

• Telling a patient that everything will be OK

Example:

• Patient: I don’t think I will ever get better.

  Nurse: Hang in there. Everything will turn out just fine.

Use:

• The nurse makes a statement that may not be true. The patient is blocked from exploring their feelings.

Disapproval

Definition:

• Judging the patient’s situation and behavior

Example:

• Patient: I’m so sorry. I did notmean to kill my mother.

  Nurse: You should be. How could anyone kill their mother?

Use:

• The nurse belittles the patient. The patient will avoid the nurse.

Acting out

Definition:

• Using actions rather than reflections or feelings during periods of emotional conflict

Example:

• A teenager gets mad at his parents and begins staying out late at night.

Affiliation

Definition:

• Turning to others for help or support (sharing problems with others without implying that someone else is responsible for them)

Example:

• An individual has a fight with her spouse and turns to her best friend for emotional support.

Altruism

Definition:

• Dedicating life to meeting the needs of others (receives gratification either vicariously or from the response of others)

Example:

• After being rejected by her boyfriend, a young girl joins the Peace Corps.

Anticipation

Definition:

• Experiencing emotional reactions in advance or anticipating consequences of possible future events and considering realistic, alternative responses or solutions

Example:

• A mother cries for 3 weeks before her last child leaves for college.

Autistic fantasy

Definition:

• Excessive daydreaming as a substitute for human relationships, more effective action, or problem-solving

Example:

• A young man sits in his room all day and dreams about being a rock star instead of attending a baseball game with a friend.

Denial

Definition:

• Refusing to acknowledge some painful aspect of external reality or subjective experience that would be apparent to others (Psychotic denial is used when there is gross impairment in reality testing.)

Example:

• A teenager’s best friend moves away, but the adolescent says he does not feel sad.

Displacement

Definition:

• Transferring a feeling about, or a response to, one object onto another (usually less threatening) substitute object

Example:

• A woman has an argument with her boss. She comes home from work and yells at her children.

Dissociation

Definition:

• Experiencing a breakdown in the usually integrated functions of consciousness, memory, perception of self or the environment, or sensory and motor behavior

Example:

• An adult relates severe sexual abuse experienced as a child but does it without feeling. She says that the experience was as if she were outside her body watching the abuse.

Help-Rejecting complaining

Definition:

• Complaining or making repeated requests for help that disguise covert feelings of hostility or reproach toward others, which are then expressed by rejecting the suggestions, advice, or help that others offer (Complaints or requests may involve physical or psychological symptoms or life problems.)

Example:

• A college student asks a teacher for help after receiving a bad grade on a test. Every suggestion the teacher has is rejected by the student.

Humor

Definition:

• A college student asks a teacher for help after receiving a bad grade on a test. Every suggestion the teacher has is rejected by the student.

Example:

• A college student asks a teacher for help after receiving a bad grade on a test. Every suggestion the teacher has is rejected by the student.

Idealization

Definition:

• Attributing exaggerated positive qualities to others

Example:

• An adult falls in love and fails to see the negative qualities in the other person.

Intellectualization

Definition:

• Excessive use of abstract thinking or the making of generalizations to control or minimize disturbing feelings

Example:

• After rejection in a romantic relationship, the rejected explains the relationship dynamics to a friend.

Isolation of affect

Definition:

• Separation of ideas from the feelings originally associated with them

Example:

• The individual loses touch with the feelings associated with a rape while remaining aware of the details

Omnipotence

Definition:

• Feeling or acting as if one possesses special powers or abilities and is superior to others

Example:

• An individual tells a friend about personal expertise in the stock market and the ability to predict the best stocks

Passive aggression

Definition:

• Indirectly and unassertively expressing aggression toward others. There is a facade of overt compliance masking covert resistance, resentment, or hostility.

Example:

• One employee doesn’t like another, so he secretly steals her milk from the office refrigerator. She is unaware of his hostile feelings.

Projection

Definition:

• Falsely attributing to another one’s own unacceptable feelings, impulses, or thoughts

Example:

• A child is very angry at a parent but accuses the parent of being angry.

Projective identification

Definition:

• Falsely attributing to another one’s own unacceptable feelings, impulses, or thoughts. Unlike simple projection, the individual does not fully disavow what is projected. Instead, the individual remains aware of their own affect or impulses but misattributes them as justifiable reactions to the other person. Frequently, the individual induces the very feelings in others that were first mistakenly believed to be there, making it difficult to clarify who did what to whom first.

Example:

• A child is mad at a parent, who in turn becomes angry at the child but may be unsure of why. The child then feels justified at being angry with the parent.

Rationalization

Definition:

• Concealing the true motivations for one’s own thoughts, actions, or feelings through the elaboration of reassuring or self-serving but incorrect explanations

Example:

• A man is rejected by his girlfriend but explains to his friends that her leaving was best because she was beneath him socially and would not be liked by his family.

Reaction formation

Definition:

• Substituting behavior, thoughts, or feelings that are diametrically opposed to one’s own unacceptable thoughts or feelings (this usually occurs in conjunction with their repression)

Example:

• A wife finds out about her husband’s extramarital affairs and tells her friends that she thinks his affairs are perfectly appropriate.

Repression

Definition:

• Expelling disturbing wishes, thoughts, or experiences from conscious awareness (The feeling component may remain conscious, detached from its associated ideas.)

Example:

• A woman does not remember the experience of being raped in the basement but does feel anxious when going into that house.

Self-assertion

Definition:

• Expressing feelings and thoughts directly in a way that is not coercive or manipulative

  Example:

• An individual reaffirms that going to a ball game is not what she wants to do

Self-observation

Definition:

• Reflecting feelings, thoughts, motivation, and behavior and responding to them appropriately

Example:

• An individual notices an irritation at his friend’s late arrival and decides to tell the friend of the irritation.

Splitting

Definition:

• Compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive image

Example:

• Self and object images tend to alternate between polar opposites: exclusively loving, powerful, worthy, nurturing, and kind or exclusively bad, hateful, angry, destructive, rejecting, or worthless. One friend is wonderful and another former friend, who was at one time viewed as being perfect, is now believed to be an evil person.

Sublimation

Definition:

• Channeling potentially maladaptive feelings or impulses into socially acceptable behavior

Example:

• An adolescent boy is very angry with his parents. On the football field, he tackles someone very forcefully.

Suppression

Definition:

• Intentionally avoiding thinking about disturbing problems, wishes, feelings, or experiences

Example:

• A student is anxiously awaiting test results but goes to a movie to stop thinking about it.

Undoing

Definition:

• Words or behavior designed to negate or to make amends symbolically for unacceptable thoughts, feelings, or actions

Example:

• A man has sexual fantasies about his wife’s sister. He takes his wife away for a romantic weekend.

Social well-being

involves developing a sense of connection and a well-developed support system.

Environmental well-being

involves living in pleasant, stimulating environments that support a healthy lifestyle.

Spirituality

a way of being in the world in which a person feels a sense of connectedness to self, others, and/or a higher power or nature: a sense of meaning in life; and transcendence beyond self, everyday living, and suffering”

1.     Gives hope and helps with coping

Responsibility of the nurse

Containment

Process of providing safety, security, and involves patient’s access to food & shelter

Validation

Process of providing safety, security, and involves patient’s access to food & shelter

Structured Interaction:

purposeful interaction that allows patients to interact with others in a useful way

1. Ex: explaining rules and consequences of violations

Open communication:

the staff and patient willingly share information. Staff members invite patient self-disclosure within the support of a nurse–patient relationship.

Diathesis

a.      Genetic predisposition that increases susceptibility of developing a disorder.

b.     When stress is associated with the development or exacerbation of a mental illness

Type A

Competitive

Aggressive

Ambitious

Impatient

Alert

Tense

Restless

They think, speak, and act at an accelerated pace and reflect an aggressive, hostile, and time-urgent style of living that is often associated with increased psychophysiologic arousal

Type B

Relaxed

Easy going

Easily satisfied

Accepting

Engage in less risky health behaviors like alcohol and smoking

Type C

Difficulty expressing emotions

Introverted

Respectfully

Conforming

Compliant

Respond to stress with depression and hopelessness

Increased risk of Breast cancer with women

Type D

Negative emotions

Pessimism

Socially inhibited

Unlikely to show emotions to others

Poor mental health status

Acute CAD and diebeties

Devaluation

Definition:

• Attributing exaggerated negative qualities to self or others

Example:

• A boy has been rejected by his long-time girlfriend. He tells his friends that he realizes that she is stupid and ugly.