351 Test #1: Psych

anxiety and grief are

responses to stress and if they go unresolved, they can become psychiatric disorders

The concepts of mental health and mental illness are

culturally defined

Individuals experience

both physical and psychological responses to stress.

how we treat mental illness is also

culturally defined and impacted by stigma

maslow based his mental health theory on

\-A “hierarchy of needs”

\-Self-actualization as fulfillment of one’s highest potential

mental health clients often don’t have

their safety and physiological needs met (homeless, no access to food)

mental health is the

Successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms

mental illness is

maladaptive (DSM5) responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms, and interfere with the individual’s social, occupational, and/or physical functioning.

Hans Selye defined stress as

\-the state manifested by a specific syndrome which consists of all the nonspecifically induced changes within a biologic system

\-fight or flight syndrome

Selye’s general adaptation syndrome had three stages

alarm reaction stage, stage of resistance, and stage of exhaustion

alarm stage

fight or flight, physiological effects and response to stress

resistance (adaptation stage)

becomes harder to adapt, body may rebound but there are still emotional and cognitive factors that get worse

exhaustion stage

resistance level decreases, medical therapy needed, death (can no longer adapt to stress)

physical responses to stress

\-Sustained physical responses to stress occur after a prolonged period of stress and promote susceptibility to many diseases of adaptation

\-fluid retention, increased BP, cardiac problems

\-decreased vulnerability to GAD due to adaptations like a support system

\-increased vulnerability to GAD with body’s inability to adapt

there are 2 primary psychological response patterns to stress:

anxiety and grief

A variety of thoughts, feelings, and behaviors are associated

with anxiety and grief, are experienced differently

Adaptation is determined by the extent to which the

thoughts, feelings, and behaviors interfere with an individual’s functioning, when they interfere this leads to a disorder/inability to adapt to stressors

anxiety

A feeling of discomfort and apprehension related to fear of impending danger. The individual may be unaware of the source of their anxiety, but it is often accompanied by feelings of uncertainty and helplessness

anxiety is

extremely common in our society

mild anxiety is

adaptive and can provide motivation for survival

Peplau has 4 levels of

anxiety

mild anxiety

special attention; increased sensory stimulation; motivational (increased productivity and perceptual field); can function at optimal level but not sustainable

moderate anxiety

something is wrong; nervousness/agitation; difficulty concentrating; able to be redirected; less alert; assistance with problem solving is needed

severe anxiety

trouble thinking/reasoning; tightened muscles; increased vital signs; restless; irritable, angry; centering on one thing; difficulty completing simple tasks; confusion, dread, horror

panic

fight, flight, freeze; increased vital signs; pupils dilate; cognitive processes focusing on defense; defenses slowly wear down; hallucinations/delusions; wild/desperate or withdrawn; convinced they are going crazy/losing control; life-threatening; reaches exhaustion phase quickly

At the __mild level__, individuals employ various coping mechanisms to deal with stress. A few of these include:

eating, sleeping, drinking, physical exercise

coping skills are coping behaviors that

enhance one’s adaption

At the __mild to moderate level of anxiety__, the strength of the ego is

tested

ego defense mechanisms are employed for

protection; are a response to anxiety

displacement

transference of feelings from one target to another that is considered less threatening or neutral

undoing

symbolic negation or cancellation of a previous action or experience that one finds intolerable

isolation

separating a thought or a memory from the feeling, tone, or emotions associated with it

denial

refusal to acknowledge the existence of a real situation or the feelings associated with it

introjection

internalization of the beliefs and values of another person, which symbolically become part of the self, to the extent that the feeling of separateness or distinctness is lost

identification

an attempt to increase self-worth by acquiring certain attributes and characteristics of a person one admires

regression

retreat to an earlier level of development and the comfort measures associated with that level of functioning

compensation

the act of covering up a real or perceived weakness by emphasizing a trait one considers more desirable

repression

the involuntary blocking of unpleasant feelings and experiences from one’s awareness

projection

the attribution to another person’s feelings or impulses that are unacceptable to one’s self

suppression

the voluntary blockage of unpleasant feelings and experiences from one’s awareness

rationalization

the attempt to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors

reaction formation

preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors

sublimation

rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive

intellectualization

an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis

Anxiety at the moderate to severe level that remains unresolved over an extended period can contribute to a number of

physiological disorders

Extended periods of repressed severe anxiety can result in

psychoneurotic patterns of behaving

(anxiety, dissociative disorders, somatic disorders, neuroses, still in touch with reality)

Extended periods of functioning at the __panic level__ of anxiety may result in

psychosis (losing touch with reality)

examples of psychotic disorders

schizophrenia, schizoaffective, and delusional disorders

grief

\-Subjective state of emotional, physical, and social responses to the loss of a valued entity

\-Loss may be real or perceived

patients can move backward or get stuck in stages for prolonged periods, which causes

mental disorders

five stages of grief

denial, anger, bargaining, sadness, happiness

grief

\-The experience of guilt for having had a “love-hate” relationship with the lost entity.

\-Guilt often lengthens the grieving process.

Anticipatory grieving is thought to

shorten the grief response when the loss actually occurs

Resolution

Length of the grief process is entirely individual. It can last from a few weeks to years and is influenced by a number of factors

\-triggers like an anniversary can cause a person to go back into grief stages

The length of the grief response is often extended when an individual has experienced a number of

recent losses and when he or she is unable to complete one grieving process before another one begins

Resolution of the grief response is thought to occur when an individual can

look back on the relationship with the lost entity and accept both the pleasures and the disappointments of the association.

\-regains organization, hobbies again

maladaptive grief responses

prolonged response, delayed/inhibited response; distorted response

prolonged response

preoccupation with loss many yrs after

delayed/inhibited response

\-can stay there for many years

\-stuck in denial stage

\-development of anxiety, somatic, eating, sleeping disorders

distorted response

person stuck in a stage (anger), exaggerated response, can turn inward to depression

legislation determines what is

right or good in society

ethics

A branch of philosophy that deals with distinguishing right from wrong

bioethics

Term applied to ethics when referring to concepts within the scope of medicine, nursing, and allied health

moral behavior

Conduct that results from serious critical thinking about how individuals should treat others

values

Personal beliefs about what is important and desirable

values clarification

A process of self-exploration by which people identify and rank their own personal values

right

A valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service

absolute right

when there is no restriction whatsoever on a person’s entitlement

legal right

right that society has agreed upon and formalized into low

utilitarianism

An ethical theory that promotes action based on the end result that produces the most good (happiness) for the most people

kantianism

Suggests that decisions and actions are bound by a sense of duty, morality of right and wrong to do the greater good

Christian ethics

do unto others as you would have them do onto you, love forgiveness,

natural law theories

\-Do good and avoid evil. Human knowledge of the difference between good and evil directs decision-making.

\-self-evident and determined by human nature

ethical egoism

decisions are based on what is best for the person making the decision

ethical dilemma

\-are situations that require individuals to make a choice between two equally unfavorable alternatives.

\-taking no action is considered an action

\-no clear right or wrong

\-no clear reason to choose one over the other

autonomy

people are always capable of making independent choices for themselves

beneficience

one’s duty to benefit or promote the good of others

advocacy

acting in another’s behalf, being a supporter or defender

nonmaleficence

the requirement that healthcare workers don’t harm their patients, intentionally or unintentionally

justice

the right of people to be treated equally and fairly regardless of race, gender, sexual orientation, marital status, medical diagnosis, social standing, economic level, or religious beliefs

veracity

one’s duty to be truthful

model for making ethical decisions

assessment (objective/subjective data), problem identification, planning (benefits and consequences of theories), implementation (act on decision made, communicate with others), evaluation

all clients whom a nurse attends to have the following rights:

•The right to treatment

•The right to refuse treatment (including medication)

•The right to the least restrictive treatment alternative (restraints can cause isolation and seclusion)

the Nurse Practice Act defines the legal parameters of professional and practical nursing with types of laws such as

statuary law and common law

civil law

•Protects the private and property rights of individuals and businesses

• Torts

• Contracts

criminal law

Provides protection from conduct deemed injurious to the public welfare

legal issue: confidentiality/right to privacy

•Health Insurance Portability and Accountability Act (H I P A A)

•Doctrine of privileged communication

•Exceptions: A duty to warn; suspected child or elder abuse

informed consent

a client’s permission granted to a provider to perform a therapeutic procedure after information about the procedure has been presented to the client with adequate time given for consideration of pros and cons

restraints and seclusion: false imprisonment

the deliberate and unauthorized confinement of a competent person with the intent to prevent them from leaving the hospital; this includes use of threats or medications that interfere with the client’s ability to leave the facility

statutory law

law that has been enacted by a legislative body, such as a county or city council, state legislature, or U.S. Congress

common law

derived from decisions made in previous cases, may differ from state to state

tort

violation of civil law in which a person has been wronged

hospitalization: voluntary admission

patient seeks ER commitment, is a threat to themselves or others and admits themselves

hospitalization: involuntary commitment

•Emergency commitments (kept for 72 hrs, have a hearing, may need more treatment for 14, 90, or 180 days)-gov law

•A mentally ill person in need of treatment

•Involuntary outpatient commitment

•A gravely disabled client

negligence

Failure to exercise the care toward others that a reasonable or prudent person would do in the circumstances.

malpractice

Act or continuing conduct of a professional that does not meet the standard of competence and results in provable damages to the patient

breach of confidentiality

revealing aspects about a client’s case or even for revealing that a person has been hospitalized which results in harm

defamation of character: libel and slander

when shared information is detrimental to the client’s reputation, the person sharing the information is liable for this

libel

written shared information that is detrimental to the client’s reputation

slander

oral defamation