Purpose of a nurse's self eval...p66?

A nurse cannot help others until he/she helps himself. You must recognize your
emotional needs so they do not interfere with your ability to relate therapeutically with
the client.

Aggressive Behavior: stands up for own rights but abuses those of others, speaks in
demeaning manner or attacking manner, fails to monitor or control words

Assertive Behavior: stand up for own rights and respects those of others, Uses
expressive, directive, self enhancing speech. Chooses appropriate words and actions.
Examples uses I words, eye contact, congruent verbal and facial expressions

Passive Behavior: Do not stand up for own rights and accepts the domination and
bullying of others. Performs unwanted tasks and feels victimized.

Special communication techniques...p73

• Self Disclosure – always for the client’s benefit, never the nurses. Use to
educate, to facilitate therapeutic relationship and to provide a concrete reflection
that encourages reality testing. The rationale is that the client will in turn self
disclose.
• Touch – will communicate warmth, take potential reactions into consideration
(great for elderly/frail but a paranoid client may think it is confrontational), can be
procedural (part of a procedure) or nonprocedural (holding hand)
• Humor-enables us to perceive, appreciate and express what is funny, amusing or
absurd, has a positive influence on health, coping mechanism to handle difficult
situations, tension reliever, and decreases anxiety, Use to teach client difference
between hurtful and healthy humor, to create a more relaxed environment,

Therapeutic techniques to deal with transference and resistance...p75

• Resistance: lack awareness of problems in order to avoid anxiety
• Transference: client transfers feelings/attitudes about the other person to the nurse
• To deal with, be prepared to hear a client’s irrational and highly charged
responses, listen to the client and then use therapeutic techniques of clarifying and
reflecting to problem solve

Childhood Development
Freud: Psychosexual
Oral 0-1 Id selfish, cannot delay gratification feeding
Anal 2-3 Ego delay gratification & self control bowel training
Phallic 3-5 Superego values and rules, guilt & self esteem oedipal/electra
Latency6-12 Sex Represses mastery of learning relationship SS peers
Genital13 Mature Sex all other levels love and work

ONLY A PENIS LIKES GIRLS 3-6-13 inches

Erikson – Psychosocial
Trust/Mistrust 0-1 sense of hope care that satisfies basic oral/sensory needs
Autonomy/Shame 1-3 willpower independence and free choice
Initiative/Guilt 3-6 purpose plan tasks & join others, accepts responsib
Industry/Inferiority 7-11 competence learning and mastery of skills, peer interact
Identity/role confus 12-18 self how other view him, job choices, LT goals
Intimacy/Isolation 18-40 belonging close relationships, sex partner
Generativity/Stagnat 40-65 next gen guiding younger gen & giving back
Ego Integrity/Despair 65&on satisfaction/acceptance look back with acceptance
.

Piaget –Cognitive Development

Sensorimotor 0-2 in the moment thinking, self from other objects
PreOperational 2-7 here and now, symbols & words to represent objects, play
Concrete Op 7-11 past & present thinking, conserve, reverse ops, decenter
Formal Op 11-16 future thinking, abstract & hypo

Smart people cook fish

Reinforce and feedback as they relate to developing self regulation behaviors-

• Watson – classical conditioning
• Skinner- operant conditioning, consequences to learning situations:
reinforcement, extinction, punishment

Adult development...p94
• Jung’s life stage theory-and one goes through life, one develops inner exploratory
abilities that add meaning to life, personality differences become less distinct as
we age, final stage is maintaining a balance between wisdom and senility
• Erikson – see above

adult development midlife...p96

midlife crisis: mortality becomes real, perception health is changing , bad feelings about
relations and work, inability to enjoy leisure time, and stress caring for aging parents

adult development later life...p97-109

• Biologic-intrinsic (genetic) extrinsic (environment)
• Nervous system: nerve cells do not reproduce, neurotransmitters decrease,
causing memory issues, decrease serotonin sleeping, drinking & breathing, temp
regulation and affect, REM decreases,
• Cognition & Memory: crystallized intelligence(accumulation of experience) fluid
(attention or reaction time) decreases, automatic processing of info does not
change (starting car) , explicit memory declines, working memory does not
decline
• Locus of control: internal (have control over destiny) External (no control)
 • Sexual: new freedom since do not have to worry about pregnancy, frequency
declines, interest and ability do not, declines are due to lack of a partner, men
remain more active
• Retirement: life event surrounding retirement affect adaption more than
retirement itself (ex: having to retire early to take care of mom)

Frontal: motor functions, thinking, Broca’s area

Parietal: sensory perception, read map or clock or dressing oneself
Temporal: language, hearing, emotion, Wernicke’s area
Occipital: seeing, color, recognize items
Thalamus: info from PNS to CNS, filter sensory & direct to area to be interpreted
Hypothalamus: rest, body temp, thirst, hunger/sex
Hippocampus: encoding, consolidations & retrieval of memories
Amygdala: modulates common emotional states, affective responses

Understanding neurobiologic functioning:

• understand symptoms of psychiatric disorders are manifested behaviorally,
voices, suicide,
• nerve/synapses, dendrites, action potential, neurotransmitters

chronobiology...p122
• biological rhythms of the body ex circadian rhythms (metabolism, sleep
wakefulness, blood pressure, hormone levels)
• theory: dreams result from electrical activity in brain, mental disorders abnormal
brain wave patterns, incompetent brain circuits cause hallucinations, ECT
suppresses abnormal brain waves

definition of culture p130

ethnicity/race, structural background that shapes a person’s worldview, values, beliefs,
behaviors

role of the chaplain p138

spiritual support and pastoral counseling, contact appropriate representatives of faith, can
communicate with mentally ill

hyperreligiosity...p143
important to use a language that did not identify as religious, ordinary language rather
than spiritual language, avoid words that trigger response

auditory halluc... p251

see a difference between negative voices(hurt himself) and prophetic voices (religious)
& reluctance to take meds may dissolve

priveledged comm...p158
enacted by statutes to designated professionals, cleregy, attorneys, psychologist or
physicans, allow certain info given to professionals can remain secret during litigation,
only the client can assert or wave, excludes child, elder, impaired adult and domestic
violence

patient's right to refuse med...p161

voluntary and involuntary clients have right to refuse treatment, during emergency can
be forcibly medicated, as long as nurse follows due process meds can be given if
involuntary, the judge looks at if the client (if competent) would choose

confidentiality/...p157-158
• HIPPA-security and privacy of health info, any individually identifiable health
that is files, used or shared, mental health records have additional privacy
• Mental Health facility – client must sign a release of info document that tells what
will be released, who it will be shared with, purpose, period of time
• Case: if client does not sign form, may not give family info, but can ask if they
can share info

difference between conf...p157-158 again

Autonomy: having respect for an individuals decision or self/determination

beneficence: special duty and responsibility to do good and not harm others
Distributive justice: comparative treatment of individuals in the allotment of benefits
and burdens, cost v. benefit