Mental Health Chapter 7-8

8/14/2019 Mental Health Chapter 7-8

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Group WorkP r a c e S ~ ~ a 6onmltRoles

Role d t h e Grow Leader&DUP 8 f t ' t l ~

:g~ag@ f GronpDmlopnrentGroup h e 8?h2ps df Grotlp1

Foms~d GronpsPsychotherapy Gmups

tangential

blocking

scapegoating

cgnfidenWty

thebry base

social skills


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not :Mapppt ia te inappropriate

&&& *;@a*E, ; , - m s

components af an interaction are content and process:

look at the no- developing in the group, and deter-es of d e c t i v e group action.

!&h&&on-a marl&& &&ng or h @ k g g&&'m (am w - ~ &

Be&& m

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I ;ommynWon smcture m e f a to the exchange of though- andmessages. L ~ o k twho talks to whom, who listens o whom, aad whorespomb to w k m Also be awatx of who do= not partidpate in thecommunication Smctuce.

SocimneCriC structure &fa o prefmence and intapersonalmacy. Look at who refers to w h m iD the group and who sits next towhom carefuny obgewe phHiml proxbify, fadal qmssion, m e fMice, and eye eontact

The environment Mmnc& the gratqh and development of the

Iup. Group enpironmenf nclude$ room s&et phydd location, type

of iimim Cie,, mnfkrtable chairs], seating aanganats, nd edu-cational rwmces ( i . ~ , lackboard, video). 6bsex&%on &the @oupatmosphere. is imptmt, Ts the guup mngerrid and frimdly? Areunplmmt feelings expressed? Do group membem cT.imgrec.7 Arememhtem sparttaneous or WitMrawn?

FUNCTIONSOF CRWUPSW e re two basic functions oFgrpups: task and maintenanm The

task function keeps he gzoup on target and g& the jab done, Some

miltian, g%ng or uking fm fee&actC, wortbat@+ surmnarizing, an dbehaviors that omm daring task are initiating artiviQ, s e w nfar-

evalqa&. %k functidn can be slow moving m 6 e d e b 9 & needto be defixed, and ~ m d n 5 o wntmt

The &&ee h & m i is to stwng&en the group spidt and$a&& tbe me& of p u g members. Some behaviors dmZng mainte-nance are standard setting1 CQnsWUs esting, e n ~ u r a g h g ,nmgtzing,and a m i n s BOUD feeha ~~ unctions ereate an &ec." .,tive g&up atmosphere among pronp members so t h y can attempt toworktogetha in a smooth and maan& If maintenance func-

rions are ipadqateI nonfunctianal bef~avims uch aS the folkmi%usuauy occur:W Blocking-resjstiug eontributiam of other group members or

going off on a tangent with welated infarmationW Domibati@-manipulatiw& conwolung

GXovnk+-ho~'sing mom& dismpting the group, mimickinganothCr group mernba:

6 Self-confessing-telling all, using the group a s o u n b g bomd

m t h d r a ~ - p u B n g away from the group althou$h remain-ing phsgiraIly in the group; sometimes -8- to other* orwandering f r m the subject

4 &apegoating-someone bearing the Mame for o T h S I


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I aewnqcr~y i,~scrcunity gfigtita~iom [,'.La*i3

wuw$u@pum .I,2 comic% .Ft'ustmon arwh t l on

:Resistance

8 CGihesiqn r.rmng,m& brooirvuar%neVd roles


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Yalom has described cua tim f a e s hat occur in the p u p .Some of Yalonts cur&% factors W d e he f o i l *

Installation and maintaunee of hope

'Others have the same problems as I do."

m UM6aliW"We are people-all in the same boat'*

H A&miml

'? am n w utting then& of others above my anm ae]E8I elf-wldersstanding

T mlea mbg whpl Wnkand feeltheway1 do.

I have some hang-ups from lox ago."

Group cohesivenessT e- to a group now, and I ain being accepted ?q thers."

m Catharsis'T gn kgbming to express my pos ith~ ndnegative feelingsw a r d other group membm . I Eke being able to say what

bothem me!

TYPES OF GROUPS

hts, feelings, coptng sl(llls, and social support.

June32D .$eptemBW I!IY2%e@ks, Vew Wedbesday)

Nurses may encounter many types- of groups. The primary parpose ofa group is to be therapeufic to the gmup m e m k through support-ing, ducating, motiva~g , nd problem solving with them. A gmupneeds a purpose statement* length oftime to meet and date, time+ andplace of meeting. Becoming moxe popular in outpatient settings areclosed groups with specific membmhfp, specific time flames, and aset number of sessions. See F g u e 7-2 for a typical announcement of aspeeiahzd gmup meetin& Following are some sample groups

The tea- group presents specific information Active partidpatianby the members is- encouraged Ceg, a four-week nutritional g r o q ledby the dietician for catdiac elients, a ~lledication roup m-led by a nurseand pharmacist for inpatient ps;]rchit.ric clients).

Discussion Group ibThe d i s ~ ~ ~ s i o nroup encourages communication and ' ~ e building ofthe indi~dual's elf-esteem. It usually had an educational and %&ha-


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porthe empathy and -bing loneliness. In most cases, &mt@must have a rea* abiiiy suitable for na~lgathg n eqfompace andhand m m b t i a n o operate a wmputes moase.

FQcuSed Task GroupsGroup d occur in a wide varietg- of situations n our work env2-ronment task groups? team meetings, and mmdtees. We are

asslgntd themes or problenns t~ mlve through working with others, Ifa w om m i tree is not fuilctioning at an optfnxun l e d obsewe lowvvorkbehavioz sod&zhg, pbyfuhms, casual wnvezsing, attitude Boringnot humesd wasting my meld nd leadershir, style (no dkctiola),A$ o q fa& must look at the time avaikhleand wUt dedsions need tobemade. AUocath?g five minnw to agenda setting can ave time andmake cemb that each undmtands the problems to be dis-cum?& an& h esourm needed. Setting priodtia and h e i t sallom the p u p o be 8 d e et have a sense of o m a t i o n Listp r a b l m on a c b a l k b d or flip &art and then number according toimportanceper group comensus-Why are we- erel Vhat are w& sup-

posed to do? How are We ping m get it all dane? Vhat is our h efkme? What are ow go&? {ag., protocol far tbe sujcidaI p%tient, doc-umentation guiddim~ or a mental status exam, a stahdard of * ire thafmeets JCQlHD crlterial? Task p u p s are dear, wnciser and amm-plished pro+ide consistency and continuiq for the patient care andintrease team-unit fficiency and overaIJ safisfaction

Psychotherapy GroupAIlotbm type of group is: a psyddtlrerapy p u p ed by a therapiiFtGroup therapis@ oul be p~ydxhtrists, qch010gist social wmkersL r

ahneed practice nurses. It is imprtant &at the p u p herapfisx haveParpert knowledge apd e q d c n c e n the dynamim oaf hwnan behaviarand psy&opatholag~n The group is approached k m he theBpisVstheo'pbase. A theory base is asystematic, organized knowledge basetha~ elp$ m e d y n e ,predia, or a p w phenomenon leg., whatishap* in tbe group, to the group members). This theorg baseserves as a gtrtde for ahe therapist when leading he goup intera&oZ3:therefore, dMng a t h e m h e s N t e different from qerimenM,g,pmrtieing, or "doing t h q y y the seat of your pan='

The Maring are mample of theurakal approache%:

Dialectical Behavioral Therapy. Dialectical behavioral t b q qis cognitive-behavioral hesapy with the addftion of psych.ciocialskills. DBT W S eveloped by M a h a Iinw for a sueaiflc -i6:

Iaddine pmnality disorder. Thwapy plus ski& mi&g

den@' fnotionalre$ulato~md ndulatb~lr loo^ at the M m & -edness d b W ~ r a l atwns mtributes to interpwonaI eEecti-ese.

PO ~ t a l lhr: roup & m s on the i n W u a l witbin tfie goup. Role-plqhg is used to help the idvidaaI pupmember explore his o ~ h e rfeeliqp, Some therapists use the hot seat approach. A person w e n -mfes on his OP her pmhlem as the g r o q o h m .

I trzlnsaettonal AnalYsls. ~ m pabas^ b h v i o m and comma-cafian pttezm a r ~ t bsemd and analyzed according to the rmdult-child-I parenttramaction m d e ~I OonrmunlcaTio~ heory. The gmnp is eked far idkctive eom-

munication patternr;. Panems am identified and problem solvedh u g h he estabhbent of feedbad channels.The therapist modelsgaod ~ u n i c a ~ ntyles to clfminish &sfinmianal m-ronby the gmup members.

In psychofhrapy groups* he grow memberis m selected for a,p u p hrough an interviewing pm-, and pmom&im grid b W -

iors ate considered. The group eq&ence W Escilitate behaviardchanges and allow fur reaIiy t&sting and risk-* in as& en*-ment. The goal is rhat the group membm e q m h n ~ e .n inaeasein wtag and belongmg and a dewease ia IoneIinms and sdafion

pgYChodmma. A g r a q memba dr " rly aefs out or reliveg a@EmasEd ifet ts the grow m d e s a Mfe e n m e a t or theclimt tt, deal with difhd't ~ e s o ~ ~ dssues in%e h w nd now. TheOther g m p me;mbas act a8 an interactiod audience. Mmm fl81410)OM pssrchodrama toda~i t s & P F ~ F s ~ d6 O S W -ked clienrgmqs.

Clie*rts wiih ehmnic inePtaI illnesses rre fkeipently isolated and needb weIap and wss their social shtns. The he goal oft& groupis to * e w e he ~m0unC f anxiety experend by clients in socialinteractions and provide a safe e d r ~ n m e n t here they can be sociala d iendly. POX gmup of e l d e x ~ a ~ ~ c i n gmap may be appro-priate: Per$ons wfth mebltal jllnmses way enjw @amhg a barbeaeWith outd00T galne5 and acli@ies. Dav-hosM dienrs mau enimr =


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rocess .&


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&-help grow for the client Wbaf infomation would then m e garher prior to nbkmg his mwmmd&on?5 R What grade of education he dienttbished,Q B. Characteristics ofthe dent's neigbboxhoodQ C, The Jient's reading ability and band coordinatioaCI D. The &enre ability to perfom independent transfers.

F. betine the following.

: Briefly answer the ollowing.1 D&e norm as it pertains to group an d give emnpIe6 of n

"-pW and impkit norm.


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Stressor8 in Adult and Teenage PregmcyNwsing Care of he Unwed Prepant Teenager

Primary BondingCoping with a StiIIborn or Malformed Infant

Posp~.ima Depression

Mother$ wiih Mental DiordwThe Hospitalized Child

Coping Mefhods of he Hoapitdbed ChiId

-- postpatturn depressionteratogenic

m p i o n


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m ~ m ~il ml$.;p~.n~!,,m,&trgl4a e&@$O:n h~ bmn pinon holdr n ~

rrer:eon~~s@@~qqv@kkschoQI.

.mESSORS IN AR@;&T, - H~D EENAGE PI@GNANCY"~he.p%g&nt t g w h m e if&cult&e x&ptingto the.q=-.$OD f prqgnmcy mle 8%3.&e :muat face th e admLalghysid, and n r e t a h ~ l i c & g c ~ q f ~ ~ b ~ , ~ s h e ~adtime

adj,ust to fhe changes ~f,&olqsm@ be must.adapt o tbe role ofparmrhoed We seill the mle &age to a8uIthowd She. mast

BQwon's stage &Wmtitymd,t:&e me-time ac~ompj&ho-ffin~ey&ns bdlaffm. She mmt disc@i+?t*vJio~&~&s:%eke she who,she 8 pipason, ~ g foI

%dependence is blrs&ed by t and e m & od rpJ@p&@,E m in & 0pbistr&etletl s&q6 w a g &.G-ge &m pqpmq and p m e o 6 & kcg

d.knowledge:@esriseto aqggtz4 t&qe&tic fw? .y~un$',@!WUg& WO* 5a b 's@ d@&$bping and has not y&

;rw l!? abiIligfl2 d& at:fhhgs 4$wtiinm hep9niculmiastanee.m t h o ~ tthis &iE$ .she has &tienl~+esng&ing rhe f i i t q .@,m

Q?hile shehas nom StteSSDr;Sb ace, theadol-t h m. mpG@ ,&li@ h e l $ , s t i U ~ L ~ h w ~ ~ ~d d o p i n g haself-concept

Xher . m a l pirtner

refrwsto acknowl+ his

@a-pation ar mte, the pirh &kdngqt~& -ed. Ew m y y lso

I ADULT PREGNANCY TEENAGE PREGNANCY I: i ~ t t . ~ ~a ~ ~ u r rg ~9 , p ~ .I~NIIUwlm normona Goan! !wgm....

~

~i PEaught:g~,bg g$:grl?hcy . .ahbV edofescenceand h~ gj;-

. ':,&U{@~~tp.$.Ne:f&leo,P:~efie&djus~ta.;.&:~fe;af:~gg~-~n~~~~#~.,. %b.t&g:R&:rtf:mr@wb

~4GWW7Bll~hhe'.sWg,e of ,Ama,mBli& ~ e ~ s & ~ e . u j % & e n ~ f ~ ~:fn@iwwgng:.@:qainlthe &&the stage ofin1-ae,yaanb.s.@ge&'f.mptivlp s i r n ~ t t a n e . ~ ~ s ! ~ a o p eni,M'kfie

& ,:.,.~;,; 8 , . . .~ , k & ; : stage ofg@nerafWtyg ! $ ,,.-p,d -?


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,,j@ w, which %&her lowers her seIf-worth as well as gSng hera d s 4 inaneiaI burdenss

Temagers are categorizes according to yo- middle, and lateadoles&n= Pregnanq ha s been increasing in the youngest grmp.This young adolescent thinla in the present She g i x s little thought tothe possible effects of coitus. Knowledge of her body, pregnancy, andcontraception is limited and what knowledge she does haw is oftenimrrect There is usually no lasting relationship be- the young

teen and her boy&iend She often becomes p r w t ollowing the firstsexual experience. Denial is a common defense mechanism and shemay deny the pregnancy even when it is evident to others. If sheaccepts the pregnancy, 6b.e often d&es responsibility This blame isplaced on her sexual partner, who is then despised. Adoptionis seldomconsiderzd. More ofteq, the balgr is turned over to the grandparents toraise as the mother's sibhg.

The middle adolescent is a littlemore sophisticated in her knowl-edge. She is aw& of the possible eeects of coitus. She knows h u tcontraceptives but manytimes fails to use thea There are many the-ories to "plain this. If the gfrl irlllses contraceptives, she is obviouslyplanning on having s d elationships, which goes against herparentally instilled values and makes her a %ad" girl If coitus is notplanned, she can save her selfconcept by blaming "the moment? orpassion. Pregnancy is actually sought by some middle teens because itmeans maturity and independence to them It may also be a rebelliousact sainst her parents. In some groups, it is sirnpIy the *id1 hing to do.TKmaWr the reason, the Zpiddle adolacent usuaUy denies responsi-bility forthe pr ep mq . She o f t a blames her paenI5,

The middle teen rarely has a desire to m a ~ y er boyfj!iend, butshe does need his support. Wahout his suppork she experiencesincreased anxiety. Even thrmgh she may have msciously or nncon-sciously sought the pregnancy, she often has unrealistic fantasies and

ambivalent feelings about motherhood The pregnant teen demon-mates her extreme anxiety fh~ough ebellion, anger, disinterest andboredom, as well as numerous somatic complaints. She is usual& veryfrghtened of me d i a care arrd seeks care late, ifat all. Because of anx-ietyand distrust of authority, she may be uncooperative during exam-inations and may not follow through on directions. TYLebaby may beraised bythe grandpments. In other cases, he teenis forced to assumecomplete care to the detriment of her education and s o d ife.

The late adolescent girl freqwnfly aims her relationship withher sexual partner as meaningM and often has planned to m a w Mat some time in the future. Even if marriage is not sought when preg-nancy s discovered, recognition and support ffom Yhe SeYual partnerseem8 to be important Athough older adobe& males tend to am pt

: wponsibilitp for pa- more &n than yotmgs adelescents, thewst nXi0tity still reject the g i 5 Unfortnnate& the old= a d o k c a t isalso the one mest 6 ejected &the W y kib gscl is &ie to rrc-og&e fbe h h n a n o d a l , and motional p m b h o be faced as asingle mother. W i m t ti p needed suppopt, she is apt to bemmed-ed Bnd o fbi hat no one ma. A l h u g h &ols are now

, mare leniem the older adoiescent is &en &rmd to quit sdhoolIbextux of f b n e j d an$ time ConsWnB. M Q B ~ regnant adole5centskeep their i n h t 3 , bur abortion and a&ption are a"ept&Ie a k m -tives%r some,

'Uwglns eareof th r u n w e d Pregn;mt:feenmf@rXt%$easy to stemtype all a@zed p ~ m tdo1wcnts, but-&qde notb~rntl~ nti, ix cafeg~zy A I t h ~ ~ t h e r am marrypmbtems,, sqme~m&gw ltre prouddef6 ppepmeyand lmk forward w ~ae xp&-m m of motkrhocrd & withany a*g cJient it 1s importsnt tW rtren=*,get to b o u * & w .

.Mazy Aan is Bkea ykvs old. She pwents h e r a t &eclinicb a m e

she h&has msse d 8ome

perfads. She:&not w-

tain hCMt She st@ wety f i e er blood pressure h,taken q d submits telqmanty to a we&t check @hererebels~ t t h e m - ~ & & , g ~ & ~ ~ ~ @sa- 90 ot do elmPX h y Ami acted @ s& did because @hewgs~Eghtened de&

Wgs &at &.e ledd not undmtand. She was emiboulasse& selfcon-:@&& .anddisbtfiul of a t h e new pmple mrmd her:

Before the nmse can &e&dy help &Q he or she must3wdop.a trusting relati-hip. 'BUST takes thne; several *its may ~ &..~@eiL t wdaldbc d& if ow m s e . mw M q nn each time she

~ t o t h ~ c l i n i c B d w e l o p ~ t t h e n r u s g n e & m xplainanpro.$ W mbefm they am done in terms t b t tfte r e q q mde~statldri;Magdmn is, still demloping ber aB@ytq W n g & d rather than+p&c terms. Sin@she is weriendn$ s m , gp-11s should, be& $bPl t ,using visual kteriBls whenmrpgssibla DevelopingWt ab4 avobw wntinuity, acceptingM a q withput clific'imj,a p dm-, and .mm

tvith. the. ti~d@l&~ent s ngt m y T& ~amse,&.dd nut fqwW&i$akss ,M@Q pn's nee& o n & ~& & fsit &&q,&XI ag & ~ t ~ l 3 . i 3 p i >&@& to&& to a m o n whom shehas ~ b & d ,'w@,- @-magw c o & ~ m w , ~ a'q&& ' =>

,;~e+i&;;i& c9m a h , e m &

yVrth s.Iftile, or a , l e ~ W ~ ~1 . e r & y ~ ~f i aw.

Chapter 8 ~ ~ O U U I I U~ e c mF awrna ana m ~ a are


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FIGURE8-2 Characterrstics of tne Adolescent Communicationpattern.

the teemger will ~nrPace onwerbally. Ho few a d o l e s w wiIIo E e ~ nformation without dire3 questioning. You@ and middlem a g e m && in speck& tams nd espmd IftaaOyto cpe-sW11~. fthe nmse ash *Can p eII me abozlt it'? the msvw is lib:& to besimply TeahhP o get tbe ight the m e hould say TEII meabaut it" Teen8 also use the hngu@ge &@ermtlx

M m 5e I ew gou have a new motoxbike."Qtent: Qh yeah, its wmo!Nurse: *It's arn01 Wt does &at mean?"C3- Tmlre d y squid It8 qurll, real bad"Nme: You mwn it% ool'?m e %ght Its s -a-ad bikk"

To express m&m, a teen rnag say, *I don'tha= my W onsFaighr" or Tm hung wetB A "bummd means thing.^ ate not- good

Young and middle &&w ay not be ware of their fernstw he~maynotbave he words ta enpress their feelings. mefl n ado-

lescent descrk% n expdence, she ma$ start over several time% eca~seshe bas a feat- of not b&g & m o d . It takes good obserpath andtiming to initiate thempeufic communication Wth the adolescent.

We: Sfou lo& Me you b v e lM go- last &end Badm M a l y h 1 "

client T\Tab'pkceofcak:aaNme: %at L se e yau have a sad face. What did the doctor

tell PUPCIfefi: *Oh,n&g!Nurse: %e cadiimed fhe ppregm~xy, idn't Be?"Client: T s real b-aP

%m&nzss T& n a @t.@ktbe nitia@ee,%uchm fayAnn,.: ere ar e Scmw kings +need@ &class." isleas e f f w k ecause

@e %ddlesWt ay or .m q not comply.To detennfne Mmy Am-1~6 nee&, the nurse shbuld g&er Mgr-

mt.(en &qt:

B Ph.attpi+q$aancy n d , p . d o d mwn to her. er Eeuel of anxi*1 W ffed tbe grqnancy has on kretreladionship with her

W a n d er b o r n a dI Elth whatotbep M o p men t a l srresmrs she is dealbg

. The 1 4 f her need for fuEument fo Maslm &b' .W @b@idqgicaL i ow and belonging RePzdsbeing met??

R How she sees k g & i m n'R m a t plans she has for hemelfmd her babjrR DVhat shc?.fMs #he. needs fmm theawse~

The nussingm:m@then d~,&mil&that he;&s tbe fo&*strmgfhs and wwe9ses:

sw8n~tno WeiIR~~ee~en. he a m p a responsibility for . hehas ngt .toldherthe -4 m y nd fearS rep-.She ha s mnttriaed suppun . er fntm plans are-m er bofiead71se schaaI.has a program for I ha has an ~ 1 n r d k d c 8 i ~p p t g l l m t t ~ sf p*@mcJ ma

pmutJl~odI he feds she needs prepma- . erphysid s a w i

timfor labof md delivery @$l elong in^ n@& aremd pwnthood threatenedShe has the ,sapport of herbogfrmdJ's ayens

~ A & q A r m ,iks all feem&sG needs fbf:suppost o f h e r ~ M p hemap neitrd el^ .@.,gaining t & , re fed to so&~shces or a &&ingnme might EX@& s ~ p k o a hen &e sbeh her -psrents. M q nn

ma$ &$-fitt&,d* m& j demommw how&@!migh&& ,rn:!&..- E& family nejem her, she,a eed aref&& ma six*.,

,S.~ce~h%$@~:@@&ed ae:nw ?m *@& be@ g & ~ ; h 3 m @ , q , && &&. NeDa@@ or


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individUany during her clinic visits. Preparation for labor shouldihcIude relaxation exercises and some type of breathing techniques tolessen anxiety during labor: Probably the most important thing thenurse can do for Mary A m , and teenagers like her, is to provide sup-port and be there when she needs someone.

Doring labor, Mary AM has the same needs rn any other moth-er relief of paitt i n f o m o ~ ~nd emotional support She needs tohave the person she trusts, whether it be her mother, her bqhend, orboth, with ha.

To help the young motherafter

birth, the nurse should manipu-late the environment to provide sqccess experiences for her. Sheshould provide compliments and gently wnect mistakes. If the girldecides to keep her baby, rooming-in should be encouraged so that themother can learn to eare for her infant with the nurse's help. If she isplanning on putting the baby up for adoption, she may want to see thechlld and care for it while the baby is in the hospital When the babyis adopted, she will face separation anxiety, but not seeing the babyoften muses lasting anxiety. Sics the young mother is in the hospitalfor such a shoa time, referral for home health nursing &ce is usu-ally indicated.

PRIMARY BONDING

Primary bondingis the process of establishing an intimate interde-pendent attachment a m o ~ g other, fkther, and infant @gwe 8-31.Research on bondmg, which began to surface in the 1960s indicatesthat bonding is impurtant to the child's future interpmonal relatian-ships. It also shows that infirm not bonded to their mothem h he crit-icaI immediate postparhnn period were more apt to be abused andneglected. Children who were not bonded expeximxd more anxietyand wereless able to cope with s m s . T he bonded person is the child'sP m upport

Bonding nomdly begins in the prenatal period when the moth-er feels quickening (the Grst movemeats of the baby,) The motherthen ca n be seen massaging her growing abdomen, delighting in fetalmovements, and taIking to the fetus. The immediate postpartum peri-od seems to be most mcial Some mothers who have had negativefeelings about being pregnant have effeaiveIy bonded ta the infantduring the time just after birth. Although bonding may occur late, itseems to be mare diBcult and intervention is usually essential

Natural bonding is initiatd by either the parent or the infantthrough behavior to which the other person responds. The baby aiesand he mother picks the baby up and cuddles him or h a he babystops crying and molds himself or herself to the moth& body The

Flburr: u-5 some oonalng Denavlon are eye-to-eye contact andholding th e baby no more than 17 Inches from th e parent'sface.

mother fuaher responds by smiling. Eye contact, skin-to* contact,and touchmg seem to be essential to the pro- Ipigure 8-41. If notintedmxl with bonding occurs automatidy The p r o w can beenhanced premtaDy and postnatally

Bondmg is enrnuraged prenatally by allowing parents to Iisten ofetal heart tones, teachkg them to massage the mother's abdomenand showing them how to feel and recognize fetal parts. In the post-natal period, the parent is taught to hold the infantno more than sev-enteen inches lom the &GZ The infant cannot see clearly beyond smenteen inches Eye-to-eye contact is important Talking to the infantshould be encouraged. Some mothers feel ulcomfortable alking to aninfant They may feel as ifthey are taIking to a dolLor a wall. The nursecan help by pointing out the babys responses.

FIGURE 8-4 Factors that enhance bonding.

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qmowing the mother to care for the bab, hduding feeding,

w g i n g diapers, and bathing, abo enwurages bonding. The youngmothet in particular shodd be encouraged to pro* physicaI cate forher infirrrt Eooming-in helps the bonding process. The nurse super-vbing the infads care should compliment the mother and-orrectians. It" the mother is having drffcultywith the baby's cate andbecomes upset, it is important that the nurse not take over. The. moth-er sometimes believe6 the baby evaluates her agaiwlt the more skiUednurse and her sdf-concept is lowered. OE course this is not tme, but itis nonetheless a real c o r n o the mother. Instead o m, henurse should help the mother to relax and then assist her with mg-gestions. If the environment is manipulated to give he mother suceess,her self


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The nurse should point out the baby% healthy a s p f the ehildhas a name, it should be used and the child should ah3ys be referredto by the correct sex As hey care for the child nurses should be alertfor s i p of anxi* in the mother and &ow her o withdraw from thechild if the mother feels the need

If the infant dies or was born dead, allowing the parents m seethe child prevents deniaL The infant mayhave been deformedan d the death anticipated, but the event is stressfuI. This parenttoo, needs to have time with the baby to wmpIete the gnef process.

Crying should be enwuraged Nurses may also feel like crying. Bydoing so, they share the sadness with the mts.

POSTPARTUM DEPRESSION

As previously stated, pregnruyr i s a -cant strPsscn. with normalmood flucflations. Repressive s y m m mqy o m r,ifaIready pres-ent, map worsen The continuing stigma ofmenfd ilhess contrhtesto the undeneporhg of depressive symptoms by p m t nd lactat-ing women. Some contributing fadom to depression during pre-cy and lactation are:

r chronic f i ~ ~ d a laainEveryday life hasslesEI Disrupted or abusive relatiomhips

Unstable housing -gemen&S Social isoIation

Homonal influences and fluctnationsW H f t q of depression or medical problemsr Lack of community resources

postdel&my, ome women may have a brief period ofthe "blues:d e ther women are dinically depressed or psychotic It is impor-cant to rewgnize the symptom of pos- depression:

Letdown eelingr IlTitabiity

Loss of appetiteI nsomnia

W e t yThe mather cria easily and may complain of discomfort and an nabil-ityto concentrate. t is imporantto diffkntiate the symptom ofpost-parnun blues and postpartum depression in terms of the number ofepisodes, intensity, and *ten= of symptoms. -

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in a foster home, or the parental rights of the parent have been temunated Due to the complexity ofthese issue, women's mental h e m sa major issue of the millennium. Continued reseveh is needed in thearea@ f pregnancy and kcfation and their relationship to a woman'mental health and women's rights.

THE HOSPITALIZED CHILD

The child's response to hospitakation depends in part on his or he-developmenral stage. Very young children do not understand wby themust be hospitalized and often see it as punishment If the d 3 d ha.,an y concept af illness, it is thought to be due to &obedience. Althoughr e p s f o n is a defense mechanism obsmed in aU age groups, it ismost common in the verqi young child One who h a een drhki.ngfrom a cup may seek comfort in a bottle during hospitalization

When the hospitalized child is removed from all that is familiahe or she Iwks o the bonded pason for support If that person ismisslng, anxiety increases. This is h o r n as separation anxiety, whichis normally seenin children between seven months and three years ofage. In the hospital, sepaation an~iety may be seen m children up to

hur or tke years of age and occasionally in oJda children W e n theparent leaves, the child exhibiting separation anxiety responds withtemper t;lntrums, crying, md atfempts at clingkg to the parent It isimportant to the child that at least one parent remain and participatem his or her care if at all possibl~ fboth parents must leave, they beedto understand that separation anxiety is a n m a l reaction The childwho is old enough to uadmtaad should be toId that the parent is leav-ing but will return. It is best that he par& not sne& am The nurseshould be sure that the child has hi s or her securlty blanket or afavorite toy nearby

Although preschoolers sdfl see hospitalization as punishmentthae is an increased awareness of the hospital experience. Fantasiesme c o m m a intrusive procedures can be d e eIy f ? t g h W gthrough fantasy. The preschooler knows the missing parent willreturn However, he or she worries that the parent wiII not be able tofind him or her, particularly ifthe child is moved Bleeding is extreme-

frightming as children think all their blood may wme out A smallbandage o h essens m e t y as efTectnrely as a kiss.

The school-age child's hospiiahtion causes anxi* mainlybecause of immobility, a possibility of bodily ham, and a loss offriends and parents. This child may be embarrassed w h n forced tosullrender privacy. Though he or she is not expect& to have separationanxi*, the child sees the loss of parents as a stress and is relievedwhen the parent is around This child's concept 0fiUms-s is dependent

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stregs. Hm and why are common words in the preschooI grdup. Atother time, &klreX~ display dependence by saying '?XiiIl you stay withme?" or hostility with '"I will ha lu.' Regression to a more securestage &devebpent i8 most comm0.n in this age grou

Denial is the mosr c o m m o n mechanismseen in children andadolescents, but the agial is usually temparkuy. Children who usedenial do not a m he extent of their llness. They may be m m o perative, overfflmpllaisaut, or even stoic about painful pr0cedm'~S.Another ~i~eehanism s inte7leohlakation. Cbildren who fhtsmethod disassociate themselves from the i1lnes.s and view t objective-ly. They display an inter~st n factual @pacts; it is as if they were dis-oussing someone else,

Some children cape by acting out Children who itct exhibita@mSOn and uicaopefativeness. Theae Mdrm may disconnect N&om their m, ide their medications, or refuse to Stay in bedChildren who are depressed often act om Almost all ehildren usemauipulation, which e f f e w essens anxiety.

C h i M r e ~eed ,to know what procednm win. be done and forewarned about dismmfort The infarmation needs to be presented in aw q he ehild undefstwds. Pupp&, stmyteying, gatilw,. a d iddlingequipment are ways of preparing children for proeedureS. Presdhool -,ma&+is::&>&, ....- ~ ~ ~ . +

children need ta follow their usual routine. School-agechildren

heed &r@m&d& $ . w i @ ~ l ~ p ~ .to knowfhat their thiilgs at home wilI not be @sturbedvvbile hey W . . .. # -away: An duldren need to have their He rourines changed as little aspossible for a s e w of senuity.


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I ffer to move the mether & he matsmiQ flwon Th- mofhershauld be the one to make the &oice of moving to a m t e momor to another department Ethe mother d d e s o move, she shouldbe cited by the riming ST& sb she does not feel forgotten.

Parents need to have trutlfd information about their childJscondition and be e n m a g d o talk together regarding their feel-ings. The nurse canbest help b y w he parent know it is & rightto about the event and by following he parents cues. The nurse

can point out the baby's healthy aspm. The child's name and sexshould be used. The nurse needs to be alat o signs of &eQ in theP-

Mild deprmion occurs in a large percentage of p o s r p mclients. It lasts only one to two weeks and requires no treatment"I% mother, however, needs support ~ndetstanding mt and nutri-tion S m epression oceurs in 1 o 2 percent of p o s t p a mdknts and requires immediate detection and treatmeflt When awoman with a &om mental &order b pre$nsnt the riskversus benefit of wnGnuing me$ication must be msidered.Collaboration between all p r o v k h lobstetria, primary care, andmental health) must o m s a pmtection to both mother and child.

The child'$ response to hospidkation depends on the devel-opmental l e d ofthe child and the parents' concept of i I k s . Otherfactors are previous h o s p i ~ t i o n s , he child's support system andthe Ehild's &ping methods.

The h o a v i W child has beenmoved f?om all that is fam&lat He or sh i i s sometimes subjected to embarrassing procedurRsand strict d e s . There is often an inteauption in his or her dard-opmental needs.

The hospitalized child should have a parent near and be toldwhat is going to happen and why His m her routine should bea g e d s M e as possible. Children cope d t h stress in di ffmtways. The vay young child cries, has tantrums, and ehgs to thew e n t Olda chiIdren may use denjaI, intelleczualization, aacting 0U4

SUGGESTED RCTlVltlES

Attend a prenatal class in wbich preparation for Iabor anddelivery is discrussed

B Voluntee~ ime in a home for upwed mothers, if one is *a-

able in yourarea

id a d q w i t ha play thempist Observe th e therapist'sonses to and &em on children

an agescppropri;ne a far a pediauic clienthaalte a list of bonding behaviors observed while visiting or car-jng fm a mother and her newborn.

With a small group of classmates, discuss feehgs towards thebirth of a malformed child.

OW AND COMPREHEND' Multiple choice. Select the one best answer

DPhieh actor wntributes to &notional W e s t a t i o m ofpregnancy?Q A. psychotic disordersQ B. somatic disorders

' QC

neurotic disordersO D. normal physiological dlanges3. which developmental tasks must th e pregnant teen

a ~ o m p ~ 7Q R utonomy and generati*O B. trust and initiativea . identity and intimacyP D. autmomy and identity

3. S e l e ~ he factor commonly present when a middle adolescentbecomes pregnantP G i p m e eLI B. failure of birth-wntml methodsQ C. owwhelming pasgionP D. rebeDon againsf her parents

% Boading should be encouraged because itP A. assmes that the child will no t be abusedGI B. pxwnts postnatal complicatiom and depression.Q C, aids in involution and hoflllonal *ability,0 D. is impo-t in the chilchilds future nterpersonal

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5. When teadung parents to bold th& inf&S, whkh -&onwonld the n m ndude to promote bonding? "Hold fheinfant

P d o more than 17 inches from the fabe!O B. only when the chdd is wmpped securely."P C, in the football hold for safety d e n baadIingfla D, y from the face to avoid disease m i s s ^ . "

6. Which &&me mechanfstn would the nurse expect &om par-ents

of a maEo111ledchild?

P k ationalimpion0 B. i n t e f l a l i z a t i a0 C. deniai0 D, reattion f o r m a h

il The mother of a malfonaed child can be& be helped byU A. giving atmnqUfllzer m allmiare &eQ.

B being transferred Emm the s&tssful matem* depart-ment

0 C. w&im her face mliw an&for&g her m touch the*t-

0 D. allowing her to talk about hex feelin@ f she des$es.8. Whl& defense meohmbm is most wmnody seen the

pug hospttakd ehild?0 tl denial0 B. r a p s i o na G f w y0 D. identification

9. Sel& the moat common defense mechanism seen iny5unge pregnant ado lseentP A denirzlP B.reg~ssionP GfantaSy0 D. identifieation

10. Which stressor is most likdyto mme anxiety in a hospital-k d , chool-age child?P R mmobiliy13 B. lack of opponunity Em cratbit)ia Cmi&ngschoal

D. loss of independence

Documents

Mental Health Chapter 7-8