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Pschososial Integrity

Pschososial Integrity

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I.
Coping Mechanisms (also called defense mechanisms)
A.
Definition: psychological techniques that the personality develops to manage anxiety, aggression,
hostility, etc.
B.
Coping mechanisms represent conflicts between the id and superego
C.
Used by both mentally healthy and ill individuals
D.
May be used consciously, but are usually unconscious
E.
Types of coping mechanisms
Types of Coping Mechanisms
1.Compensation - extra effort in one area to offset real or imagined lack in another area
o
Example: Short man becomes assertively verbal and excels in business.
2.Conversion - A mental conflict is expressed through physical symptoms
o
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
intolerable
o
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
o
Example: Adolescent lashes out at parents after not being invited to party.
5.Dissociation - walling off specific areas of the personality from consciousness
o
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
o
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
o
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
o
Example: Elvis impersonators.
9.Intellectualization - use of thinking, ideas, or intellect to avoid emotions
o
Example: Parent becomes extremely knowledgeable about child's diabetes.
10.Introjection - incorporating the traits of others
o
Example: Husband's symptoms mimic wife's before she died.
11.Projection - unconsciously projecting one's own unacceptable qualities or feelings onto others
o
Example: Woman who is jealous of another woman's wealth accuses her of being a gold-
digger.
12.Rationalization - justifying behaviors, emotions, motives, considered intolerable through
acceptable excuses
o
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
o
Example: Recovered smoker preaches about the dangers of second hand smoke.
14.Regression - retreating to an earlier and more comfortable emotional level of development
o
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
o
Example: Adolescent "forgets" appointment with counselor to discuss final grades.
16.Sublimation - diversion of unacceptable instinctual drives into personally and socially acceptable
areas.
o
Example: Young woman who hated school becomes a teacher.
17. Therapeutic Communication - Characterizes the Nurse-Client Relationship
o
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
o
Phases of the nurse-client relationship
o
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
Loss
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

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

1. Intensity
2. Scope
3. Duration

4. Other stressors: their number and nature
o
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

o
The greater the stressor as preceived by the client, the greater the stress response
o
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
i.
lack of understanding - reinforce teaching
ii.
lack of family support - involve family and support groups
iii.
side effects - refer to provider of care
iv.
finances and access - refer to Social Services
v.
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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