NSG 526 Clinical Modalities Exam 1 2023/2024 with complete solution

NSG 526 Clinical Modalities Exam 1 1. DSM 5 classification of Psychiatric illness: The DSM-5 is a diagnostic manu- al. It does not provide theories of cause, management, or treatment options. It lists 22 major categories of mental disorders with more than 150 individual illnesses. The DSM-5 is organized in an attempt to follow the lifespan with neurodevelop- mental disorders that occur early in life listed first and neurocognitive disorders that occur at the end of life listed last. It is organized this way to assist the diagnostic decision-making process. 2. What constitutes a mental disorder?: -a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behav- ior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning -associated with significant distress or disability in social, occupational, or other important activities -an expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder 3. Scope and standards of Practice: Ï Define NP roles and actions Ï Identifies competencies assumed to be held by all NPs who function in a particular role Ï Varies broadly from state to state Ï Advanced practice PMHNP standards are identified in Psychiatric-Mental Health Nursing: Scope and Standards of Practice 4. Standard of Practice: Ï Authoritative statements regarding the quality and type of practice that should be provided Ï Provide a way to judge the nature of care provided Ï Reflect the expectation for the care that should be provided to clients with various illnesses Ï Reflect professional agreement focused on the minimum levels of acceptable performance Ï Can be used to legally describe the standard of care that must be met by a provider Ï May be precise protocols that must be followed or more general guidelines that recommend actions 5. Purpose of the Psychiatric Interview: to gather information necessary to understand, diagnose, and treat the client. Per textbook (Perese)-The purpose of the psychiatric interview are to understand the patient's illness to evaluate the effect of the illness on the patient's life and create a beginning diagnosis and treatment plan 6. Therapeutic alliance: The clinician uses his or her therapeutic self-calm, warm, understanding, kind, respectful, concerned, and focused to create a therapeutic alliance. It is through the therapeutic alliance in the context of an ongoing relation- ship that the clinician is able to help the patient change. The patient has likely had questions in his or her mind and since deciding to seek help such as "Will I be safe or threatened, or will I be rejected?" and "Can this person help me?" 7. Therapeutic alliance: An important part in building a therapeutic relationship is to help the patient feel accepted. Regardless of the patient's actual presentation, the clinician should assume that the patient is anxious and seek to maintain the anxiety within workable limits. The clinician needs to demonstrate empathy which is the ability to understand what the patient feels, by using empathetic statements such as "It sounds to me as if you have been feeling some very painful emotions." 8. Important components of therapeutic alliance: 1. The therapist and patient work collaboratively to create therapeutic change through an affectionate bond 2. Agreement on goals of therapy 3. The therapist's ability to be empathetic and involved in therapy 4. The ability of the patient to do the work of therapy 9. the key to successful psychotherapy: therapeutic alliance -It is the strength of the bond and connection that can be built between you and your therapist over time. Without a trusting and respectful therapeutic alliance, no meaningful therapy can happen. 10. Hildegard Peplau's Interpersonal relations In Nursing: earliest modern nursing theory. Enabled nursing to establish the groundwork for Advanced Practice Nursing (APN) (first role was Clinical Nurse Specialist in Psychiatric Nursing). 11. Psychotherapy: holistic treatment that relies on the nurse's processing of what the patient is experiencing. 12. Silence: -Therapeutic -Purposeful absence of verbal communication while continuing to focus on the client -Nodding, maintaining eye contact 13. Accepting: -Therapeutic -Indicating (verbally and nonverbally) that what is heard is acknowledged; does not necessarily indicate agreement with what was said -Nodding: Yes, um-hmm, I follow what you said. 14. Giving recognition: -Therapeutic -Acknowledgment; indicating awareness -I notice you've combed you hair. I see you're dressed this morning 15. Giving information: -therapeutic -Providing facts; answering questions -Visiting hours are from 2:00 PM to 4:00 PM. All clients are scheduled to attend the group meeting. 16. Offering self: -therapeutic -Making yourself available without conditions or an expected response. -I'll sit with you. I'll stay with you for 15 minutes. 17. Giving broad openings: -therapeutic -Giving the initiative to the client -Where would you like to start? What is on your mind this morning? 18. Offering general leads: -therapeutic -Encouraging the client to continue. -And then? Go on. 19. Placing the event in time or sequence: -therapeutic -Clarifying the time of an event or the relationship between events. -Was that before or after...? What happened just before that? 20. Making observations: -therapeutic 21. Encouraging description of perceptions: -therapeutic 22. Encouraging comparison: -therapeutic 23. Reflection: -therapeutic 24. Exploring: -therapeutic 25. Seeking clarification: -therapeutic 26. Presenting reality: -therapeutic 27. Voicing doubt: -therapeutic 28. Verbalizing the implied: -therapeutic 29. Attempting to translate into feelings: -therapeutic 30. Encouraging formulation of a plan of action: therapeutic 31. Summarizing: therapeutic 32. Reassuring: Non-therapeutic 33. Approving: Non-therapeutic 34. Disapproving: Non-therapeutic 35. Rejecting: Non-therapeutic 36. Advising: Non-therapeutic 37. Probing: Non-therapeutic 38. Challenging: Non-therapeutic 39. Defending: Non-therapeutic 40. Requesting an explanation: Non-therapeutic 41. Indication of the existence of an external source: Non-therapeutic 42. Belittling feelings: Non-therapeutic 43. Making stereotypical comments: Non-therapeutic 44. Giving literal responses: Non-therapeutic 45. Introducing an unrelated topic: Non-therapeutic 46. four sequential phases in the interpersonal relationship:: orientation, iden- tification, exploitation, and resolution 47. The orientation phase: defines the problem. It starts when the nurse meets the patient, and the two are strangers. After defining the problem, the orientation phase identifies the type of service needed by the patient. The patient seeks assistance, tells the nurse what he or she needs, asks questions, and shares preconceptions and expectations based on past experiences. Essentially, the orientation phase is the nurse's assessment of the patient's health and situation. 48. The identification phase: includes the selection of the appropriate assistance by a professional. In this phase, the patient begins to feel as if he or she belongs, and feels capable of dealing with the problem which decreases the feeling of helplessness and hopelessness. The identification phase is the development of a nursing care plan based on the patient's situation and goals. 49. The exploitation phase: uses professional assistance for problem-solving alternatives. The advantages of the professional services used are based on the needs and interests of the patients. In the exploitation phase, the patient feels like an integral part of the helping environment, and may make minor requests or use attention-getting techniques. When communicating with the patient, the nurse should use interview techniques to explore, understand, and adequately deal with the underlying problem. The nurse must also be aware of the various phases of communication since the patient's independence is likely to fluctuate. The nurse should help the patient exploit all avenues of help as progress is made toward the final phase. This phase is the implementation of the nursing plan, taking actions toward meeting the goals set in the identification phase. 50. The final phase: is the resolution phase. It is the termination of the professional relationship since the patient's needs have been met through the collaboration of patient and nurse. They must sever their relationship and dissolve any ties between them. This can be difficult for both if psychological dependence still exists. The patient drifts away from the nurse and breaks the bond between them. A healthier emotional balance is achieved and both become mature individuals. This is the evaluation of the nursing process. The nurse and patient evaluate the situation based on the goals set and whether or not they were met. 51. The nurse has a variety of roles in Hildegard Peplau's nursing theory. The six main roles are:: stranger, teacher, resource person, counselor, surrogate, and leader 52. Interpersonal Therapy Goals: -Focus on difficulties patients are experiencing in current relationships and the ways relationships can be handled -Change pattern of communication -To alter expectations within relationships -To use social supports to help patients deal with stressors and improve their environment -To relieve symptoms -To build social skills 53. Indications: -Complicated bereavement/grief -Marital and interpersonal conflicts such as role disputes -Life events such as role transitions - Isolation, lack of support, interpersonal deficits 54. Three Phases: Early: Therapist identifies depressive symptoms, evaluates patient, generates a diagnosis, takes an interpersonal inventory: Nature of inter- actions with others Identification of reciprocal relationships and determination if needs were satisfied -Discussion of satisfying and dissatisfying aspects of the relationship -Recent changes in key relationships -Changes patient desires in relationships 55. Middle phase: Patient and therapist derive more specific strategies to deal with stressors 56. Termination phase: -Consolidate gains -Foster independence in the person -Review risk of relapse and reappearance of depressive symptoms -To contract again for continuation of treatment as needed 57. Group Therapy: The primary purpose of group therapy is to facilitate changes by the patient in order to address identified problems. The group should be able to share the group experience and the leader should assure dominant members are brought to the attention of the group so they are able to address issues within the process. A person explaining to the group ways that person is able to cope with things is called an "information giver". A technique where special favors or awards are given to assure patient participation and involvement in group therapy is called Reinforcement. 58. CBT: Cognitive behavioral therapy: works by having an active and ques- tioning therapist. It involves homework assignments, dream description, looking at ideas and beliefs the patient has about themselves with a goal to increase sub- jectivity about thoughts governing their behavior. Some interventions to consider when using Cognitive Behavioral Therapy include encouraging the patient to ana- lyze early parental relationships, the underlying meaning of behavior, identification of negative thoughts, and the effect of thoughts on feelings and behaviors. 59. Interpersonal: IPT: is a treatment for depression that focuses on relationship issues that may be the cause or the result of depression. IPT to be useful in the treatment of other issues such as anxiety, bipolar disorder, eating disorders, and borderline personality disorder. IPT is typically delivered during 16 weekly sessions over three phases of treatment (Initial Sessions, Intermediate Sessions, and Ter- mination). During the Initial Sessions, the therapist will provide you with education about depression, how your life situations may be contributing to depression, and how depression may affect your daily life. The Intermediate Sessions focus on one or two problem areas that are most concerning to you and may be contributing to your depression. These areas include dealing with major life changes, conflict with others, grief related to the death of a significant person, or problems making or keeping social connections. During Termination, the therapist will work with you to review progress, explore possible stressors that may contribute to depression, discuss how skills learned in IPT can continue to be used, and evaluate the need for further treatment. 60. Sullivan Infancy (Birth-18. months): Gratification of needs 61. Sullivan Childhood (18 mo-6 yrs): Delayed gratification 62. Sullivan Juvenile era(6-9 yrs): Formation of peer group 63. Sullivan Preadolescence (9-12 yrs): Developing relationships within same gender 64. Sullivan Early Adolescence (12-14 yrs: Identity 65. Sullivan Late Adolescence (14-21 yrs): Forming lasting, intimate relation- ships 66. Sullivan explained about three types of self:: The 'good me'versus the 'bad me'based on social appraisal and the anxiety that results from negative feedback · The 'not me' refers to the unknown, repressed component of the self 67. Sullivan's theory explains about: anxiety, self-system and self-esteem 68. Security operations: those measures that the individual employs to reduce anxiety and enhance security. 69. Self-system: all of the security operations an individual uses to defend against anxiety and ensure self esteem 70. In milieu therapy: you spend a significant amount of time in a home-like envi- ronment, interacting with other people as you conduct ordinary activities through- out the day. You may attend group or individual therapy sessions as part of your schedule. You'll establish your treatment goals and make decisions for yourself, as well as participate in making decisions for the community. As challenges arise in the course of your day, you learn new ways of responding from your peers and counselors. How long you stay in MT will vary from program to program, but the goal is usually to return to the larger society either when your treatment goals are met or within a specific period. 71. Cognitive therapy: a psychotherapy developed by Aaron Beck. One of the therapeutic approaches within the larger group of CBT. Helps patients to overcome difficulties by identifying and changing dysfunctional thinking, behavior, and emo- tional responses 72. Behavioral: broad term referring to either psycho-, behavior analytical, or a combination of the two therapies. In its broadest sense, the methods focus on either just behaviors or in combination with thoughts and feelings that might be causing them. Breaks down into three disciplines: applied behavior analysis ABA, cognitive behavioral therapy CBT, and habit reversal training HRT. 73. Psychoanalysis: Psychoanalysis is unique in its assumption that motivating forces derive from unconscious mental processes. The unconscious conflicts may become conscious via free association, a treatment method in which a client ex- presses all thoughts freely and without censoring him-or-her-self. Freud concluded that talking about emotional issues had the potential to heal the wounds causing mental illness. 74. The SAD PERSONs scale is an effective clinical tool used to determine suicide risk: S-ex A-ge D-epression P-revious attempts E-thanol abuse R-elational loss S-ocial supports lacking O-rganized plan N-o spouse S-ickness 75. Impulse Control: Is the ability to delay, modulate or inhibit the expression of behaviors and feelings. A client who describes recent history of binge drinking and indiscriminate sexual contacts has poor impulse control as well as the person who storms out of an interview when difficult topics are broached. Understanding the patient's impulse control is an integral part of determining potential for acting on suicidal and homicidal thoughts. 76. Cognition and Sensorium: 1. Orientation to person, place, time and situation 2. Ability to abstract: explain proverbs 3. Memory and concentration 4. An estimate of intellectual functioning 5. Judgement, the ability to weigh consequences of doing or not doing something. 77. Orientation Phase: Establish: Rapport & Trust -Set parameters of the relationship (Time frame) -Purpose of the meeting Formal or informal contract - spells out the participation & responsibilities of both parties -Confidentiality -Termination begins