Psych-Exam I Study Guide

8/3/2019 Psych-Exam I Study Guide

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Exam I Study Guide Fall 2011

Defense Mechanisms

1. Compensation-covering up of a real or perceived weakness by emphasizing

a trait one considers desirable.

Ex.-A physically handicapped boy is unable to participate in football, so hecompensates by becoming a great scholar

2. Denial-Refusing to acknowledge the existence if a real situation or the

feelings associated with it.

Ex.- A woman drinks alcohol every day and cannot stop, failing to

acknowledge that she has a problem.

3. Displacement-The transfer of feeling from one target to another that is

considered less threatening or that is neutral.

Ex.-A client is angry with his physician, does not express it, but becomes

verbally abusive with the nurse.

4. Identification-An attempt to increase self-worth by acquiring certain

attributes and characteristics if an individual one admires.

Ex.-A teenager who required lengthy rehabilitation after an accident decides

to become a -physical therapist as a result of his experience.

5. Intellectualization-An attempt to avoid expressing actual emotions

associated with a stressful situation by using the intellectual processes of

logic, reasoning, and analysis.

Ex-Ss husband is being transferred with his job to a city far away from her

parents. She hides anxiety by explaining to her parents the advantages

associated with the move.

6. Introjection- Integrating the beliefs and values of another individual into

ones own ego structure.Ex.-Children integrate their parents value system into the process of

conscience formation. A says to friend, Dont cheat. Its wrong.

7. Isolation-Separating a thought or memory from the feeling, tone, or emotion

associated with it.

Ex-A young woman describes being attacked and raped, with showing any

emotion.

8. Projection-Attributing feelings or impulses unacceptable to ones self to

another person.

Ex-Sue feels a strong sexual attraction to her track coach and tells her friend,

Hes coming on to me!

9. Rationalization-Attempting to make excuses or formulate logical reasons to

justify unacceptable feelings or behaviors.

Ex-John tells the rehab nurse, I drink because its the only way I can deal

with my bad marriage and my worse job.

10. Reaction Formation-Preventing unacceptable or undesirable

thoughts or behaviors from being expressed by exaggerating opposite

thoughts or types of behaviors.


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Ex-Jane hates nursing. She attended nursing school to please her parents.

During careers day, she speaks to prospective students about the excellence

of nursing as a career.

11. Regression-Retreating in response to stress to an earlier level of

development and the comfortmeasures associated with that level of

functioning.Ex-When 2 year old Jay is hospitalize for tonsillitis he will drink only from a

bottle, even though his mom states he has been drinking from a cup for 6

months.

12. Repression-Involuntarily blocking unpleasant feelings and

experiences from ones experience.

Ex-An accident victim can remember nothing about his accident.

13. Sublimation-Rechanneling of drives or impulses that are personally or

socially unacceptable into actives that are constructive.

Ex-A mother whose son was killed by a drunk driver channels her anger and

energy into being the president of the local chapter of Mothers Against Drunk

Drivers.

14. Suppression-The voluntary blocking of unpleasant feelings and

experiences from ones awareness.

Ex-Scarlett OHara says, I dont want to think about that now. Ill think about

that tomorrow.

15. Undoing-Symbolically negating or cancelling out an experience that

one finds intolerable.

Ex-Joe is nervous about his new job and yells at his wife. On his way home he

stops and buys her some flowers.

Therapeutic Communication


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Theraputic Communication cont


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Transference and Counter-transference

Transference occurs when the client unconsciously attributes (or transfers) to

the nurse feelings and behavioral predispositions formed toward a person from his

or her past.

Triggered by nurses appearance or personality that reminds the client of the

person

Interfere with the therapeutic interaction when the feelings being expressed

include anger and hostility

Anger toward the nurse can be manifested by uncooperativeness and

resistance to the therapy.

Transference can also take the form of overwhelming affection for or

excessive dependency on the nurse

The nurse is overvalued and the client forms unrealistic expectations of the

nurse. When the nurse is unable to fulfill those expectations or meet the

excessive dependency needs, the client may become angry and hostile.

Interventions


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Relationship doesnt need to terminated

o Unless creates a serious barrier to therapy or SAFTEY

Work with patient to sort out the past from the present

Assist Pt to id the transference

Reassign a new and more appropriate meaning to the nurse-Pt relationship

Goal---guide patient to independence

o By teaching them to assume responsibility for behaviors, feelings, and

thoughts

o Assign the correct meaning to relationship

Base on present not past

Countertransference refers to the nurses behavioral and emotional response to

the client. These responses may be related to unresolved feelings toward significant

others from the nurses past, or they may be generated in response to transference

feelings on the part of the client.

Interfere with therapeutic relationship when initiate the following types of

behaviors:

o The nurse overidentifies with the clients feelings because they remind

him or her of problems from the nurses past or present.

o The nurse and client develop a social or personal relationship.

o The nurse begins to give advice or attempts to rescue the client.

o The nurse encourages and promotes the clients dependence.

o The nurses anger engenders feelings of disgust toward the client.

o The nurse feels anxious and uneasy in the presence of the client.

o The nurse is bored and apathetic in sessions with the client.

o The nurse has difficulty setting limits on the clients behavior.

o The nurse defends the clients behavior to other staff members.

Interventions

Usually should not terminate relationship

Support from other staff members to identify feelings and behaviors and

recognize the occurrence

Evaluative sessions after encounter with PT maybe helpful

o Nurse and other staff should discuss and compare the exhibited

behaviors

Phases of relationship development


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The Preinteraction Phase

The preinteraction phase involves preparation for the first encounter with the client.

Tasks include:

Obtaining available information about the client from his or her chart,

significant others, or other health team members. From this information, the

initial assessment is begun. This initial information may also allow the nurse

to become aware of personal responses to knowledge about the client. Examining ones feelings, fears, and anxieties about working with a particular

client. For example, the nurse may have been reared in an alcoholic family

and have ambivalent feelings about caring for a client who is alcohol

dependent. All individuals bring attitudes and feelings from prior experiences

to the clinical setting. The nurse needs to be aware of how these

preconceptions may affect his or her ability to care for individual clients.

The Orientation (Introductory) Phase

During the orientation phase, the nurse and client become acquainted. Tasks

include: Creating an environment for the establishment of trust and rapport

Establishing a contract for intervention that details the expectations and

responsibilities of both the nurse and client

Gathering assessment information to build a strong client database

Identifying the clients strengths and limitations

Formulating nursing diagnoses.

Setting goals that are mutually agreeable to the nurse and client.

Developing a plan of action that is realistic for meeting the established goals.

Exploring feelings of both the client and nurse in terms of the introductory

phase.Introductions often are uncomfortable, and the participants may experience some

anxiety until a degree of rapport has been established. Interactions may remain on

a superficial level until anxiety subsides. Several interactions may be required to

fulfill the tasks associated with this phase.

The Working Phase


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The therapeutic work of the relationship is accomplished during this phase. Tasks

include:

Maintaining the trust and rapport that was established during the orientation

phase

Promoting the clients insight and perception of reality

Problem-solving using the model presented earlier in this chapter

Overcoming resistance behaviors on the part of the client as the level of

anxiety rises in response to discussion of painful issues

Continuously evaluating progress toward goal attainment

The Termination Phase

Termination of the relationship may occur for a variety of reasons: the mutually

agreed-on goals may have been reached; the client may be discharged from the

hospital; or, in the case of a student nurse, it may be the end of a clinical rotation.

Termination can be a difficult phase for both the client and nurse. The main task

involves bringing a therapeutic conclusion to the relationship. This occurs when: Progress has been made toward attainment of mutually set goals.

A plan for continuing care or for assistance during stressful life experiences is

mutually established by the nurse and client.

Feelings about termination of the relationship are recognized and explored.

Both the nurse and the client may experience feelings of sadness and loss.

The nurse should share his or her feelings with the client. Through these

interactions, the client learns that it is acceptable to have these feelings at a

time of separation. Through this knowledge, the client experiences growth

during the process of termination.

NOTE: When the client feels sadness and loss, behaviors to delay termination maybecome evident. If the nurse experiences the same feelings, he or she may allow

the clients behaviors to delay termination. For therapeutic closure, the nurse must

establish the reality of the separation and resist being manipulated into repeated

delays by the client.

Culture and healthcare needs


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Ethical /legal commitment, confidentiality

Confidentiality and Right to Privacy

An individuals privacy is protected by the Fourth, Fifth, and Fourteenth

Amendments to the U.S. Constitution. Most states have statutes protecting the

confidentiality of client records and communications. The only individuals who have

a right to observe a client or have access to medical information are those involved

in his or her medical care.

HIPAA

Until 1996, client confidentiality in medical records was not protected by federal

law. In August 1996, President Clinton signed the Health Insurance Portability and

Accountability Act (HIPAA) into law. Under this law, individuals have the rights to

access their medical records, to have corrections made to their medical records,

and to decide with whom their medical information may be shared. The actual

document belongs to the facility or the therapist, but the information contained

therein belongs to the client. This federal privacy rule pertains to data that are

calledprotected health information (PHI) and applies to most individuals and

institutions involved in health care. Notice of privacy policies must be provided to

clients on entry into the health care system. PHI are individually identifiable healthinformation indicators and relate to past, present, or future physical or mental

health or condition of the individual, or the past, present, or future payment for the

provision of health care to an individual; and (1) that identifies the individual; or (2)

with respect to which there is a reasonable basis to believe the information can be

used to identify the individual (U.S. Department of Health and Human Services,

2003). These specific identifiers are listed in Box 44. Pertinent medical information


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may be released without consent in a life-threatening situation. If information is

released in an emergency, the following information must be recorded in the

clients record: date of disclosure, person to whom information was disclosed,

reason for disclosure, reason written consent could not be obtained, and the specific

information disclosed.

Psychobiology and Neurotransmitters mechanisms of action


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Psychobiology systems associated with mental illness, theories (etiology) ofdepression.


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1. Care and management of the patient in crisis: A sudden event in ones lifethat disturbs homeostasis, during which usual coping mechanisms cannotresolve the problem

2. Types of crisisPhase 1. The individual is exposed to a precipitating stressor; anxiety increases;previous problem solving techniques are employed

Phase 2. When previous problem- solving techniques do not relieve the stressor,anxiety increase furtherPhase 3. All possible resources, both internal and external are called on to resolvethe problem and relieve the discomfort.Phase 4. If resolution does not occur in previous phases. Caplan states that thetension ounts beyond a further threshold or its burden increases over time to abreaking point. Major disorganization of the individual with drastic results oftenoccurs.signs and symptoms-nursing care,

treatment interventions including medication management (side effects and patienteducation).

3. Nursing ProcessAssessment- collects comprehensive health data that is pertinent to the patientshealth or situationDiagnosis- analyses the assessment data to determine diagnose or problems,including level of riskOutcome identification- identifies expected outcomes for a plan individualized to thepatient or to the situation. They must be measureable and include a time estimatefor attainment. Be realistic.Planning- develops a plan that prescribes strategies and alternatives to attainexpected outcomes. For each diagnosis identified, the most appropriateinterventions, based on current psychiatric/ mental health nursing practice andresearch, are selected. Client education and necessary referrals are included.

Implementation- interventions selected during the planning stage are executed,taking into consideration the nurses level of practice, education, and certification.

The care plan serves as a blueprint for delivery of safe ethical , and appropriateintervention.Evaluation- evaluate the effecter, progress of expected outcomes

4. Stress adaptation- Core concept: maladaptation occurs when anindividuals physical or behavioral response to any change in his or herinternal or external environment results in disruption of individual integrity orin persistent disequilibrium

Adaptive coping strategiesAwareness- initial step in managing stress is awareness, as one becomes aware ofstressors, he or she can omit, avoid, or accept themRelaxation- engaging in large motor activities, sports, breathing exercisesMeditation, Interpersonal communication with caring other, Problem solving, Pets,music

5. Freuds Theories of personality:Core Concept: The combination of character, behavioral, temperamental, emotional

and mental traits that are unique to each specific individual


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ID: the locus of instinctual drives; the pleasure principle. Present at birth,instinctual drives that seek to satisfy needs and achieve immediate gratification. ID-Driven behaviors are impulsive and may be irrationalEgo: Rational self or the reality principle begin to develop between the ages of 4and 6 months. Primary function of the ego is one of mediator, that is to maintainharmony among the external world, the id, and the superego.

SuperEgo: If the id is identifies as the pleasure principle, and the ego the realityprinciple, the superego might be referred to as the perfection principle. Thesuperego develops between 3-6 years internalizes the values and morals set forthby primary caregivers. Derviced out of system of rewards an punishments.Superego assisted the ego in the contrl of id impulses. When the superego becomesrigid and punitive, problems with low self confidence and low self esteem arise.

6. Ethical decision making model1. Assessment: gather the subjective and objective data about a situation.

Consider personal values as well as values of others involved in the ethicaldilemma

2. Problem Identification: identify the conflict between two or morealternative actions

3. Plan: explore the benefits and consequences of each alternative, considerprinciples of ethical theories, select an alternative

4. Implementation: act on the decision made and communicate thedecision to others

5. Evaluation: evaluate the outcome.

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Psych-Exam I Study Guide