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29 Cards in this Set
- Front
- Back
Grief
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The subjective state of emotional, physical, and social responses to the loss of a valued entity; the loss may be real or perceived.
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. |
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5 Stages of Grief
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Denial
Anger Bargaining Depression Acceptance developed by Kubler-Ross |
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Peplau’s four levels of anxiety
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Mild - seldom a problem
Moderate - perceptual field diminishes Severe - perceptual field is so diminished that concentration centers on one detail only or on many extraneous details Panic - the most intense state |
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Anxiety
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A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness
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Hans Selye
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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 |
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Maslow identified
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A “hierarchy of needs”
Self-actualization as fulfillment of one’s highest potential |
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The Fight-or-Flight Syndrome
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Initial stress response
Sustained stress response Sustained physical responses to stress promote susceptibility to diseases of adaptation |
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Adaptation
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is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual’s functioning.
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DSM-IV-TR Multiaxial Evaluation System
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Axis I - Clinical disorders and other conditions that may be a focus of clinical attention
Axis II - Personality disorders and mental retardation Axis III - General medical conditions Axis IV - Psychosocial and environmental problems Axis V - The measurement of an individual’s psychological, social, and occupational functioning on the GAF Scale |
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defense mechanisms
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At the mild to moderate level, the ego calls on defense mechanisms for protection, such as
Compensation Denial Displacement Identification Intellectualization Introjection Isolation Projection Rationalization Reaction formation Regression Repression Sublimation Suppression Undoing |
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Anxiety at the moderate to severe level
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that remains unresolved over an extended period can contribute to a number of physiological disorders--for example, migraine headaches, irritable bowel syndrome, and cardiac arrhythmias.
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Extended periods of repressed severe anxiety
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can result in psychoneurotic patterns of behaving--for example, anxiety disorders and somatoform disorders.
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Extended periods of functioning at the panic level of anxiety
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may result in psychotic behavior; for example, schizophrenic, schizoaffective, and delusional disorders.
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Self Awareness
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A process by which the therapist gains recognition of his/her own feelings, beliefs and attitudes and the impact these may have on therapist-client interactions.
At times, therapist’s values may be in conflict with those held by the client. The therapist should not impose his/her values on the client. |
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therapeutic interpersonal relationship
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the process by which nurses provide care for clients in need of psychosocial intervention.
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GAF Scale
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is a numeric scale (0 through 100) used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and described in the DSM-IV-TR on page 34.
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Conditions Essential to Development of a Therapeutic Relationship
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Trust
Rapport Respect Genuineness Empathy Acceptance of person Unconditional Positive Regard |
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Phases of a Therapeutic Relationship
Pre-interaction phase |
Examine one’s own feelings, fears, and anxieties about working with a particular client.
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Phases of a Therapeutic Relationship
Orientation (Introductory ) Phase |
nurse and client meet and roles established
purposes and parameters of future meetings established expectations are clarified and client’s problems identified nurse builds trust, may establish a contract, and discusses confidentiality and need to share information with the treatment team. |
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Phases of a Therapeutic Relationship
Working Phase |
Ongoing problem identification
examination of client’s feelings and responses to identified issues and problems development of coping strategies, behavior change, increase in self esteem and independence during this phase, may see transference and counter-transference. Therapeutic work is accomplished. |
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Phases of a Therapeutic Relationship
Termination or Resolution Phase |
occurs when mutually agreed upon goals are met or issues are resolved.
when the relationship is terminated for some other reason, like hospital discharge. New material is not raised during the termination phase must deal with feelings of anger and/or abandonment that may occur. |
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Behaviors that diminish therapeutic relationships
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Inappropriate boundaries
feelings of sympathy rather than empathy encouraging client dependency non-acceptance of a client as person |
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Working Phase Problems
Transferance |
client unconsciously transfers to the nurse feelings and behavioral predispositions formed
From the person from his or her past (Saddock 7 Saddock, 2007). Triggered by things like nurse’s appearance or personality. Can translate into anger, affection, excess dependency on the nurse. |
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Working Phase Problem
Cross Transference |
Cross Transference - refers to nurse’s behavioral and emotional response to the client.
Nurse: Over-identifies with client’s feelings. Develops a social or personal relationship with client. Encourages client dependence. Has difficulty setting limits with client. |
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Boundaries in Nurse-client Relationship
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Material: physical boundary
Social: established within a culture & define how an individual is expected to behave. Personal: defined by the individual and include physical and emotional boundaries like how closely they stand with another and how much they want to express their emotions. Professional: limit & outline expectations for appropriate professional relationships with clients. |
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Problem –Solving Model
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Identify what is troubling the client @ this time.
2.Encourage client to discuss changes they would make. 3. Discuss which changes are possible & which ones are not and their feelings. 4. Help client explore alternative ways of coping. 5. Discuss strategies and alternatives the client desires. |
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Problem –Solving Model (con't)
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6. Weigh the benefits & consequences of each.
7. Assist client to select an alternative. 8. Encourage them to implement the change. 9. Provide positive feed-back for the client’s attempts to create change. 10.Assist client to evaluate outcomes of the change & modify as needed. |
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Therapeutic Communication
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An interpersonal interaction between the nurse and client during which the nurse focuses on the clients specific needs to promote an effective exchange of information
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Therapeutic communication techniques
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Offering self
silence reflection exploring restating clarifying |