RNSG 2213 Mental Health Nursing

• Anxiety- a state of feeling apprehension, uneasiness, uncertainity, or dread resulting from a real or perceived threat whose actual source is unknown or unrecognized

• Universal human experience • Normal anxiety provides energy to carry out tasks involved with living and striving toward goals • Dysfunctional behavior is often a defense against anxiety • Body reacts in similar ways physiologically to both fear and anxiety (fear reaction to specific danger)

Levels of Anxiety
• Mild
• Normal response to everyday living • Ability to perceive in sharp focus • Problem solving becomes of effective

• Severe
• Perceptual field greatly reduced • Learning & problem solving not possible

• Panic
• Markedly disturbed behavior • Inability to process environmental stimuli • Possible loss of touch with reality

• Moderate
• Perceptual field narrows • Selective inattention • Problem solving reduced

Levels of Anxiety
• Mild
• Slight discomfort, restlessness, or mild tension-relieving behaviors

• Severe
• Appears dazed and confused, experience a sense of doom, & intensified somatic complaints

• Moderate
• Physical tension, pounding heart, increased pulse & respiratory rate, diaphoresis, and mild somatic symptoms

• Panic
• Hallucinations may be experienced, physical behavior erratic, uncoordinated, and impulsive • Automatic behaviors are used to reduce anxiety

• Mild to Moderate anxiety
– Help client focus and solve problems with specific communication techniques
– Open-ended questions, broad openings, and clarification seeking

– Provide a calm presence, recognition of person’s distress, and willingness to listen

• Severe to panic levels
– Priority client safety and safety of others – Meet physical needs (fluids & rest) to prevent exhaustion – Quiet, safe environment reduce environmental stimuli – Medications – Restrain only if other methods have failed – Communicate via firm, short, simple statements, point out reality if are distortions

Defenses against Anxiety
• Defense mechanisms protect the individual against anxiety and from the awareness of internal or external dangers or stressors. • Used by everyone to lower anxiety, maintain ego function, and protect the sense of self • Maladaptive use can lead to distortions in reality and self-deception

Properties of Defense Mechanisms
• Defenses are a major means of managing conflict & affect • Defenses are relatively unconscious • Defenses are discrete • Defenses are reversible • Defenses are adaptive as well as maladaptive

Most Healthy Defenses
• Altruism
– emotional conflicts & stressors are dealt with by working with others

• Sublimation
– the unconscious process of substituting constructive & socially acceptable activity for strong impulses that are not acceptable

• Humor
– A way of dealing with stress or emotional conflicts using amusing or ironic aspects of the conflict or stressors

• Suppression
– The conscious denial of disturbing situations or feelings

Intermediate Defenses
• Repression
– The exclusion of unwanted experiences or emotions from the conscious awareness; also the cornerstone of the defense mechanisms

• Displacement
– Placing emotions associated with a particular person, object, or situation onto another person, object, or situation that is nonthreatening

• Reaction formation
– overcompensation

Intermediate Defenses
• Somatization
– The transfer of anxiety from the psychological to a physical symptom that has no organic cause

• Undoing
– Making up for an argument with someone by giving a gift to “undo”

• Rationalization
– Justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener

Immature Defenses
• Passive aggression
– Dealing with emotional conflict or stressors by indirectly & unassertively expressing aggression toward others

• Acting out behaviors
– Dealing with emotional conflicts or stressors by actions rather than reflections or feelings

• Dissociation
– Feeling unattached to self, others, or environment

• Devaluation
– Giving negative value to self or others to try to appear “good” and reduce stress & anxiety

Immature Defenses
• Idealization
– Emotional stressors are dealt with by idealizing or exaggerating another’s qualities

• Splitting
– Inability to integrate positive & negative attributes to another at the same time; the all or nothing way of dealing with stressors; prevalent in individuals with borderline personality disorder

• Projection
– Placing one’s own negative attributes onto another person, object, or situation; also called “blaming” or “scapegoating”

• Denial
– Escaping from unpleasant realities by ignoring their existence; a hallmark defense mechanism in alcohol or drug addicted individuals (“I can stop drinking or taking drugs anytime I want to.”)

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