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Pschososial Integrity

Pschososial Integrity

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Published by: api-3818438 on Oct 18, 2008
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Coping Mechanisms (also called defense mechanisms)
Definition: psychological techniques that the personality develops to manage anxiety, aggression,
hostility, etc.
Coping mechanisms represent conflicts between the id and superego
Used by both mentally healthy and ill individuals
May be used consciously, but are usually unconscious
Types of coping mechanisms
Types of Coping Mechanisms
1.Compensation - extra effort in one area to offset real or imagined lack in another area
Example: Short man becomes assertively verbal and excels in business.
2.Conversion - A mental conflict is expressed through physical symptoms
Example: Woman becomes blind after seeing her husband with another woman.
3.Denial - treating obvious reality factors as though they do not exist because they are consciously
Example: Mother refuses to believe her child has been diagnosed with leukemia. "She just
has the flu."
4.Displacement - transferring unacceptable feelings aroused by one object to another, more
acceptable substitute
Example: Adolescent lashes out at parents after not being invited to party.
5.Dissociation - walling off specific areas of the personality from consciousness
Example: Adolescent talks about failing grades as if they belong to someone else; jokes
about them.
6.Fantasy - a conscious distortion of unconscious wishes and need to obtain satisfaction
Example: A student nurse fails the critical care exam and daydreams about her heroic role
in a cardiac arrest.
7.Fixation - becoming stagnated in a level of emotional development in which one is comfortable
Example: A sixty year old man who dresses and acts as if he were still in the 1960's.
8.Identification - subconsciously attributing to oneself qualities of others
Example: Elvis impersonators.
9.Intellectualization - use of thinking, ideas, or intellect to avoid emotions
Example: Parent becomes extremely knowledgeable about child's diabetes.
10.Introjection - incorporating the traits of others
Example: Husband's symptoms mimic wife's before she died.
11.Projection - unconsciously projecting one's own unacceptable qualities or feelings onto others
Example: Woman who is jealous of another woman's wealth accuses her of being a gold-
12.Rationalization - justifying behaviors, emotions, motives, considered intolerable through
acceptable excuses
Example: "I didn't get chosen for the team because the coach plays favorites."
13.Reaction Formation - expressing unacceptable wishes or behavior by opposite overt behavior
Example: Recovered smoker preaches about the dangers of second hand smoke.
14.Regression - retreating to an earlier and more comfortable emotional level of development
Example: Four year old insists on climbing into crib with younger sibling.
15.Repression - unconscious, deliberate forgetting of unacceptable or painful thoughts, impulses,
feelings or acts
Example: Adolescent "forgets" appointment with counselor to discuss final grades.
16.Sublimation - diversion of unacceptable instinctual drives into personally and socially acceptable
Example: Young woman who hated school becomes a teacher.
17. Therapeutic Communication - Characterizes the Nurse-Client Relationship
Nurse-client relationship: a therapeutic professional relationship in which two people interact
1.The nurse who possesses the skills and ability to provide counseling, crisis intervention,
health teaching, etc. and
2. The client who seeks help for some problem
Phases of the nurse-client relationship
Five characteristics of nurse-client relationship

1.Mutual definition: together, nurse and client define relationship
2.Goal direction: purpose, time, and place are specific
3.Specified boundaries: in time, space, content, and confidentiality
4.Therapeutic communication: nurse eases trust and open communication by these

interpersonal techniques
5.Nurse helps client toward resolution
18. Griefo
1. A universal phenomenon; it occurs across the lifespan

2. There are many types of loss
1. loss of external objects
2. loss of significant other: through death, divorce
3. loss of environment: by moving, taking a new job, hospitalization
4. loss of an aspect of self: may include a body part, physiologic or psychologic

3. Response to loss depends on
1. one's personality
2. culture
3. previous experience with loss
4. one's values
5. perceived value of loss
6. support system
4. Types of Grief

1. Anticipatory grief: person learns of impending loss and responds with processes of mourning, coping, interaction, planning, and psychosocial reorganization

2. Disenfranchised grief: person experiences a loss that is not or cannot be openly
acknowledged, publicly mourned, or socially supported
3. Mourning: process used to resolve grief

4.Tasks of mourning (common to the models of grief) spellR-E-A-L
1.Real: accept that the loss is real
2.Experience the emotions associated with the loss
3.Adjust or re-adjust to life and activities
4.Let go: move on with one's own life

5.Grief theory models

5. Nursing care in grief
1. Support client's effective coping mechanisms
2. Don't take client's responses personally

3. Listen attentively

4. Help client with problem solving and decision making as indicated
5. Encourage the client and/or significant others to ventilate
6. Utilize therapeutic touch as appropriate
7. Assist in discussions of future plans as appropriate

19. Stress Management
Stress: a universal phenomenon, stress requires change or adaptation so that the person can
maintain equilibrium
Stress can be internal or external
Nature of stressor involves:

1. Intensity
2. Scope
3. Duration

4. Other stressors: their number and nature
Categories of stressors - and examples

1. Physical - drugs or alcohol
2. Psychological - such as adolescent emotional upheaval, or unexpressed anger
3. Social - isolation, interpersonal loss
4. Cultural - ideal body image
5. Microbiologic - infection

The greater the stressor as preceived by the client, the greater the stress response
Stress response involves both localized and general adaptation

G. Factors affecting stress response
1. Personal: heredity, gender, race, age personality, cognitive ability
2. Sociocultural: finances, support systems
3. Interpersonal: self-esteem, prior coping mechanisms
4. Spiritual: belief system
5. Environmental: crowding, pollution, climate
6. Occupational: work overload, conflict, risk

G.Physiologic indicators of stress
H.Emotional/behavioral indicators of stress
I.Stress can cause a variety of emotional and physical disorders
J.Stress management strategies

K. The non-compliant client does not cooperate with the treatment plan
1. Behavior characteristics

a. does not take prescrived medication
b. continues activities restricted by provider of care, such as smoking
c. does not follow prescribed activities, such as exercise

1. Nursing interventions
a. explore the reasons for non-compliance
lack of understanding - reinforce teaching
lack of family support - involve family and support groups
side effects - refer to provider of care
finances and access - refer to Social Services
negative attitude toward treatment - encourage expression
a. express genuine concern for client
b. discuss imporvement potential
2. Schizophrenia
G.Definition: a multifaceted psychosis with early onset; criteria from DSM IV as follows:
1.When disease is in active phase, client shows psychotic behaviors. (Psychosis is severe
ego dysfunction. Psychosis is also part of other DSM-IV diagnoses of dysfunctions of
thought and sensorium.)
2.Findings involvemany psychological processes

3. Previously, client had functioned at a higher level
4. Schizophrenia normally sets in before 30 years of age
5. Findings last six months or more
6. Not caused by affective or organic mental disorder

7.Involves hallucinations and/or delusions
H.General characteristics of schizophrenia
- six losses:S-S-O-B- E-R

1.Self-care often fails
2.Social adjustment is impaired
3.Orientation to the environment is lost
4.Boundaries between self/others dissolve

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