NUR 101 Unit Six Commonalities of Nursing Care to promote Psycho-socio-cultural Safety – Flashcards

-Erik H. Erikson (1963, 1964) adapted and expanded Freud's theory of development to include the entire life span, believing that people continue to develop throughout life. He described eight stages of development -Erikson's theory proposes that life is a sequence of developmental stages or levels of achievement. Each stage signals a task that must be accomplished. The resolution of the task can be complete, partial, or unsuccessful. Erikson believed that the more success an individual has at each developmental stage, the healthier the personality of the individual. Failure to complete any developmental stage influences the person's ability to progress to the next level. These developmental stages can be viewed as a series of crises or conflicts. Successful resolution of these crises supports healthy ego development. Failure to resolve the crises damages the ego. -Erikson's eight stages reflect both positive and negative aspects of the critical life periods. The resolution of the conflicts at each stage enables the person to function effectively in society. Each phase has its own developmental task, and the individual must find a balance between.

Developmental stages associated with specific tasks or crises •Tasks may be completely, partially or not resolved; outcome affects future stages •Task resolution →healthier personality; failure to resolve tasks → damage to ego

•Birth to 18 months •Trust vs. mistrust 1)INDICATORS OF POSITIVE RESOLUTION -Learning to trust others 2)INDICATORS OF NEGATIVE RESOLUTION - Mistrust, withdrawal, estrangement **Class example Bonding to caregiver through eye contact and being held Build trust when caregivers ANSWERS to baby crying feeds baby and suckle / nutritional/ non nutritional ( pacifier) trust is then established with infant and basic needs are met

18 months to 3 years •Autonomy vs shame and doubt 1)INDICATORS OF POSITIVE RESOLUTION *-Self-control without loss of self esteem - Ability to cooperate and to express oneself 2)INDICATORS OF NEGATIVE RESOLUTION- -Compulsive self-restraint or compliance -Willfulness and defiance **Class example Give child choices to build autonomy

•3 to 5 years •Initiative vs guilt 1)INDICATORS OF POSITIVE RESOLUTION Learning the degree to which *assertiveness and purpose influence the environment Beginning ability to evaluate one's own behavior 2)INDICATORS OF NEGATIVE RESOLUTION Lack of self-confidence Pessimism, fear of wrongdoing Over control and over restriction of own activity **Class example -Assertiveness, Beginning ability to evaluate one's own behavior Negative = becomes pessimistic

•6-12 years •Industry vs inferiority 1)INDICATORS OF POSITIVE RESOLUTION -Beginning to create, develop, and manipulate -Developing sense of competence and perseverance 2)INDICATORS OF NEGATIVE RESOLUTION -*Loss of hope, sense of being mediocre -*Withdrawal from school and peers **Class example Am i competent ? Can i do things? Negative- becomes antisocial

•12-20 years •Identity vs role confusion 1) INDICATORS OF POSITIVE RESOLUTION -Coherent sense of self -Plans to actualize one's abilities 2) INDICATORS OF NEGATIVE RESOLUTION - Feelings of confusion, indecisiveness, and possible antisocial behavior **Class example

•18-25 years •Intimacy vs isolation 1)INDICATORS OF POSITIVE RESOLUTION -Intimate relationship with another person *-Commitment to work and relationships 2)INDICATORS OF NEGATIVE RESOLUTION -Impersonal relationships *-Avoidance of relationship, career, or lifestyle commitments **Class example -Can I form meaningful relationships

•25-65 years •Generativity vs stagnation 1)INDICATORS OF POSITIVE RESOLUTION -Creativity, productivity, concern for others * How can i be of service to others ? 2)INDICATORS OF NEGATIVE RESOLUTION *-Self-indulgence, self concern, lack of interests and commitments **Class example

•65 years - death •Integrity vs despair 1)INDICATORS OF POSITIVE RESOLUTION -Acceptance of worth and uniqueness of one's own life -Acceptance of death 2)INDICATORS OF NEGATIVE RESOLUTION -Sense of loss, contempt for others **Class example How did I do in life ? Do i have worth? Was i succesful in life? End phase acceptance of Death

•Developmental •Physical •Physiological •Psychosociocultural •Chemical •Microbiological

Parenting patterns, Critical time ( success/ failures) (a period when a individual ability to adapt is limited because of age and level)/ Critical Life periods (Erickson infant Trust Vs Mistrust) ( Erickson older adult Integrity VS shame and despair),

Trauma (Emotional not expected), Motor vehicle accident, Loss of Limbs

Disease process, Loss of appetite, Menstrual disturbances * if ill how does this affect my relationship with others

Anxiety ( ability to adapt), cultural back round ( what are the expected norms), Panic , Feelings of Isolation, Depression, Homelessness, Fear, Anger , Sleep deprivation, Excessive dependence, (Perceptual influences -belief value, life experiences, family structure impact how we perceive)

Alcohol , Drugs ( cause distorted emotional perception)

Infectious disease, TB ( isolation can effect emotional status) , Aids , (depressed immune systems)

•Anxiety •Fear

A common reaction to stress is anxiety, a state of mental uneasiness, apprehension, dread, or foreboding or a feeling of helplessness related to an impending or anticipated unidentified threat to self or significant relationships. -Anxiety can be experienced at the conscious, subconscious, or unconscious level. ** Anxiety is vague and related to BOTH the present and future ** Anxiety is NOT TO A SPECIFIC threat ** Example A person has anxiety about surgery and its outcome

Fear is an emotion or feeling of apprehension aroused by impending or seeming danger, pain, or another perceived threat. The fear may be in response to something that has already occurred, in response to an immediate or current threat, or in response to something the person believes will happen **Fear Emotional response to actual or present danger fear is FOR THE FUTURE not the present ** FEAR is to a SPECIFIC threat ** Example Fear a person is afraid of surgery specifically A person is fearful of driving home cars are dangerous

•Physiologic •Psychological

Elevated gluscose levels from flight or flight response, Increase in P, RR, BP, Pal sweaty, Diaphorisis, Xerostomia ( dry mouth ), Upset somach , Diareha , Change in appetite, Urinary frequency , Pupils dilated

Anxiety ( Mild / Moderate/Severe),Panic,Fear, Anger, Depression, Crying, Withdrawn, Mental illness( bipolar ect),Confusion, Unkempt appearance, Self-loathing, Distorted perception of surroundings, and Unconscious ego defense mechanisms (pg 1082), Misplaced blame, Denial , Restlessness, **Withdrawn Restlessness( sleep affected) Irritable, Angry , Dizzy , Crying Loss of motivation, Poor job performance , Defense mechanisms on unconscious level PERCEPtual influences - belief , values , life experience, family structure all impact our coping mechanisms

•Perception/learning •Motor activity •Vital signs -Mild anxiety produces a slight arousal that enhances perception, learning, and productive abilities. Most healthy people experience mild anxiety, perhaps as a feeling of mild restlessness that prompts a person to seek information and ask questions. ( pg 1083)

-Feelings of increased arousal and alertness -Increased questioning ( **Good for learning

Mild restlessness, Sleeplessness

NO change

•Perception/learning •Motor activity •Vital signs •Verbal changes Moderate anxiety increases the arousal to a point where the person expresses feelings of tension, nervousness, or concern. Perceptual abilities are narrowed. Attention is focused more on a particular aspect of a situation than on peripheral activities.

- More Narrowed focus attention ** may become inattentive **Tunnel vision -Able to focus but selectively inattentive *Learning is impaired from increase of arousal

Tremors, facial twitches, and shakiness * increased tension of muscles

Slightly increased respiratory and heart rates *RR Up , HR UP

-Voice tremors and pitch changes

•Perception/learning •Motor activity •Vital signs •Verbal changes **"Severe anxiety consumes most of the person's energies and requires intervention." Perception is further decreased. The person, unable to focus on what is really happening, focuses on only one specific detail of the situation generating the anxiety * QSEN interventions for severe anxiety

-Inability to focus or concentrate -Easily distracted -Learning severely bimpaired ** cant concentrate / learn/ easily distracted " May focus on one detail"

-Increased motor activity -inability to relax -Fearful facial expression **extream tension , Inability to relax , fearful facial expression

Tachycardia, hyperventilation -Other Headache, dizziness, nausea

Communication difficult to understand

•Perception/learning •Motor activity •Verbal changes •Vital signs •Other Panic is an overpowering, frightening level of anxiety causing the person to lose control. It is less frequently experienced than other levels of anxiety. The perception of a panicked person can be affected to the degree that the person distorts events.

Perception distorted or exaggerated **Unable to Learn or Function

-Increased motor activity, agitation -Unpredictable responses ** Extreme tension, Tremble, Aggitation, unpredictable response ,Poor motor coordination

Communication may not be understandable

Dyspnea, palpitations, choking, chest pain, or pressure

Feeling of impending doom, Paresthesia (typically tingling or pricking ("pins and needles")), sweating, loss of control *Worst level of anxiety

1)Anxiety: Vague, uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by the anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with a threat 2) Caregiver Role Strain: Difficulty in performing the family caregiver role. 3)Compromised Family Coping: Usually supportive primary person (family member or close friend) provides insufficient, ineffective, or compromised support, comfort, assistance, orencouragement that may be needed by the client to manage or master adaptive tasks related to his or her health challenge. 4)Defensive Coping: Repeated projection of falsely positive self-evaluation based on a self-protective pattern that defends against underlying perceived threats to positive self-regard. 5)Disabled Family Coping: Behavior of significant person (family member or other primary person) that disables his or her capacities and the client's capacities to effectively address tasks essential to either person's adaption to the health challenge. 6) Ineffective Coping: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use resources. 7) Ineffective Denial: Conscious or unconscious attempt to disavow the knowledge or meaning of an event to reduce anxiety/fear, but leading to the detriment of health. 8)Post-Trauma Syndrome: Sustained maladaptive response to a traumatic, overwhelming event. 9) Relocation Stress Syndrome: Physiological and/or psychosocial disturbance following transfer from one environment to another.

Demonstrate empathy, warmth, and genuineness ■ Provide factual information as necessary and appropriate ■ Use techniques of reflection and clarification to facilitate expression of concerns ■ Use a calm, reassuring approach ■ Encourage gradual mastery of the situation ■ Introduce client to persons (or groups) who have successfully undergone the same experience

The overall client goals for persons experiencing stress related responses are to: -Decrease or resolve anxiety. - Increase ability to manage or cope with stressful events or circumstances. - Improve role performance.