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Autocratic

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Have personal goals for the group. Withhold info from the group members. "We will do it my way. My way is the best." Focus is on the leader. Members are dependent on the leader for problem solving, decision making, and permission to perform. Approach of leader is one of persuasion, striving to persuade others in the group that his or her ideas and methods are superior. High productivity with low morale.

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Democratic

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Focuses on the members of a group. Info shared with group to allow input from members. Members are encouraged to participate. "Decide what must be done,consider alternatives, make a selection, and proceed with the actions required to complete the task." The leader provides guidance and expertise. Lower productivity with a higher morale.

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Laissez-faire

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Allows people to do as they please. No direction from the leader. Leader's approach is non-involvement. Goals are undefined. No decisions are made, no problems are solved, and no action is taken. Members become confused and productivity and morale are low.

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Curative factors

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individuals can achieve these through interpersonal interactions within the group, some of which are present in most groups in varying degrees

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Instillation of hope

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By observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved.

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Universality

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individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing. Anxiety is relieved by the support and understanding of others in the group who share similar experiences

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Imparting of information

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knowledge is gained through formal instruction as well as the sharing of advice and suggestions among group members

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Altruism

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assimilated by group members through mutual sharing and concern for each other. providing assistance and support to others creates a positive self-image and promotes self-growth.

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Corrective recapitulation of the primary family group

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Group members are able to re-experience early family conflicts that remain unresolved. Attempts at resolution are promoted through feedback and exploration.

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Development of socializing techniques

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through interaction with and feedback from other members within the group, individuals are able to correct maladaptive social behaviors and learn and develop new social skills

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Imitative behavior

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one who has mastered a particular psychosocial skill or developmental task can be a valuable role model for others. individuals may imitate selected behaviors that they wish to develop in themselves

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Interpersonal learning

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the group offers many and varied opportunities for interacting with other people. insight is gained and regarding how one perceives and is being perceived by others.

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Group cohesiveness

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Members develop a sense of belonging that separates the individual ("I am") from the group ("We are"). Out of this alliance emerges a common feeling that both individual members and the total group are of value to each other.

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Catharsis

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Within the group, members are able to express both positive and negative feelings - perhaps feelings that have never been expressed before - in a nonthreatening atmosphere. Open expression of feelings is beneficial for the individual within the group.

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Existential factors

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The group is able to help individual members take direction of their own lives and to accept responsibility for the quality of their existence.

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Phases of group development

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Groups move through phases of life-cycle development.

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Phase I: Initial or orientation phase

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Leader and members work together to establish rules and goals. Members are introduced to each other. Leader is expected to orient members to specific group processes, encourage members to participate without disclosing too much too soon, promote an environment of trust and ensure that rules are established by the group do not interfere with fulfillment of goals. Trust has not been established and members will respond by being overly polite. Fear of not being accepted. Members may try to "get on the good side" of the leader. Power struggle may ensue as members compete for their position in the "pecking order"

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Phase II: Middle or working phase

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Ideally cohesiveness has been established. Productive work toward completion of task is undertaken. Problem solving and decision making occur. Cooperation prevails and difference and disagreements are confronted and resolved. Role of leader diminishes and becomes more of a facilitator. Some leadership functions are shared by certain members of thr group. The leader helps resolved conflict and continues to foster cohesiveness. Trust has been established. Members turn most often to each other than the leader. Accept criticism from each other using it constructively. Subgroups will form. Subgroups must be confronted and discussed by the entire group to maintain cohesiveness. Conflict is managed by the group with minimal assistance from the leader.

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Phase III: Final or termination phase

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The longer the group has been together the more difficult termination is. Should be discussed in depth for several meetings before the final meeting. A sense of loss that precipitates the grief proces may be in evidence, especially in successful groups. The leader encourages members to reminisce about what has occurred, to review goals and discuss outcomes, and encourage feedback about individual progress. The leader encourages members to discuss feelings of loss regarding group termination. Members may respond with denial and anger about termination. Successful group termination may help members develop the skills needed to deal with losses in other dimensions of their lives.

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Member roles within groups

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complete the task of the group, maintain or enhance group processes, fulfill personal or individual needs. Task roles and maintenance roles contribute to the success or effectiveness of the group. Personal roles satisfy needs of the individual members, sometimes to the extent of interfering with the effectiveness of the group.

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Coordinator

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Task role: clarifies ideas and suggestions that have been made within the group, brings relationships together to pursue common goals

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Evaluator

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Task role: examines group plans and performance, measuring against group standards and goals

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Elaborator

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Task role: explains and expands upon group plans and ideas

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Energizer

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Task role: encourages and motivates group to perform at its maximum potential

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Initiator

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Task role: Outlines the task at hand for the group and proposes methods for solution

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Orienter

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Task role: maintains direction within the group

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Compromiser

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Maintenance role: relieves conflict within the group by assisting members to reach a compromise agreeable to all

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Encourager

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Maintenance role: offers recognition and acceptance of others' ideas and contributions

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Follower

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Maintenance role: listens attentively to group interaction; is passive participant

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Gatekeeper

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Maintenance role: encourages acceptance of and participation by all members of the group

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Harmonizer

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Maintenance role: minimizes tension within the group by intervening when disagreements produce conflict

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Aggressor

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Individual role: expresses negativism and hostility toward other members; may use sarcasm in effort to degrade the status of others

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Blocker

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Individual role: resists group efforts; demonstrates rigid and sometimes irrational behaviors that impede group progress

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Dominator

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Individual role: manipulates others to gain control; behaves in authoritarian manner

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Help-seeker

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Individual role: uses the group to gain sympathy from others; seeks to increase self-confidence from group feedback; lacks concern for others or for the group as a whole

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Monopolizer

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Individual role: maintains control of the group by cominating the conversation

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Mute or silent memer

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Individual role: does not participate verbally; remains silent for a variety of reasons - may feel uncomfortable with self-disclosure or may be seeking attention through silence

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Recognition seeker

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Individual role: talks about personal accomplishments in an effort to gain attention for self

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Seducer

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Individual role: shares intimate details about self with group; is the least reluctant of the group to do so; may frighten others in the group and inhibit group progesses with excessive premature self-disclosure

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Stages of family development

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provider a valuable framework from which the nurse may study families, emphasizing expansion, contraction, and realignment of relationships as members experience developmental changes.

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Single young adult

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accepting separation from parents and emotional and financial responsibilty for self. Differentiation of self from family of origin. Development of intimate peer relationships. Establishment of self in respect to work and financial independence. Establishment of self in community and larger society.

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Family joined through marriage

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Committment to new system. Renegotiation must include the integration of contrasting issues. Renegotiate relationships with parents, siblings, and other relatives. Tasks include: establishing a new identity as a couple, realigning relationships with members of the extended family, and making decisions about having children.

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Family with young children

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Accepting new members into the system. Tasks include: making adjustments within the couple system to meet the responsibilities associated with parenthood while maintaing the integrity of the relationship, sharing equally in the tasks of childrearing, and integrating roles of extended family members into the newly expanded family organization

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Family with adolescents

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Increasing flexibility of family boundaries to permit children's independence and grandparents' frailties. Characterized by turmoil and transition. Tasks include: redefining the level of dependence so that adolescents are provided with greater autonomy while parents remain responsive to the teenager's dependency needs. Midlife issues of marriage, career, and aging parents need to be resolved.

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Family launching children and moving on in midlife

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Accepting a multitude of exits from the entries into the family system. Adult-to-adult relationships among grown children and their parents are renegotiated. Tasks include: reestablishing the bond of the dyadid couple relationship; realigning relationships to include grown children, in-laws, and new grandchildren, and accepting the additional caregiving responsibilites and eventual death of elderly parents.

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Family in later life

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Accepting the shifting of generational roles. Accepting the realities of limitations and death. Tasks include: exploring new social roles related to retirement and possible change in socioeconomic status; accepting some decline in physiological functioning; dealing with the deaths of spouse, siblings, and friends; and confronting and preparing for one's own death.

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Belittling feelings

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ignoring or minimizing another's feelings when they are expressed. encourages individual to withhold honest feelings to avoid being hurt by the negative response.

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Failing to listen

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one does not hear what the other individual is saying. not hearing the words by "tuning out" what is being said, or it can be "selective" listening, in which a person hears only a selective part of the message or interprets it in a selective manner.

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Communicating indirectly

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an individual does not or cannot present a message to a receiver directly, so seeks to communicate throguh a third person

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Presenting double-bind messages

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"damned if I do and damned if I don't" A family member may respond to a direct request by another family members, only to be rebuked when the request is fulfilled.

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Communication

answer

functional: clear, direct, open, and honest, with congruence between verbal and nonverbal dysfunctional: indirect, vague, controlled, with many double-bind messages

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Self-concept reinforcement

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Functional: supportive, loving, praising, approving, with behaviors that instill confidence dysfunctional: unsupportive, blaming, "put-downs," refusing to allow self-responsibility

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Family members' expectations

answer

functional: flexible, realistic, individualized dysfunctional: judgmental, rigid, controlling, ignoring individuality

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Handling differences

answer

functional: tolerant, dynamic, negotiating dysfunctional: attaching, avoiding, surrendering

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Family interactional patterns

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Functional: workable, constructive, flexible, and promoting the needs of all members dysfunctional: contradictory, rigid, self-defeating, and destructive

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Family climate

answer

Functional: trusting, growth-promoting, caring, general feeling of well-being dysfunctional: dustrusting, emotionally painful, with absence of hope for improvement

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Paradoxical intervention

answer

a contraindication in therapy or "prescribing the symptom." the therapist requests that the family continue to engage in the behavior that they are trying to change.

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Reframing

answer

"relabeling problematic behavior by viewing it in a new, more positive light that emphasizes its good intention." the behavior may not actually change but the consequences of the behavior may change because of a change in the meaning attached to the behavior.

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Differentiation of self

answer

ability to define oneself as a separate being. On a continuum from high levels and a clearly defined sense of self to low levels, or undifferentiated, in which the emotional fusion exists and the individual is unable to function separately from a relationship system. Healthy families encourage differentiation and the process of separation from the family ego mass is most pronounced during ages 2-5 and again between 13-15.

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Triangles

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three person emotional configuration that is considered the basic building block of the family system. Dysfunctional in that they offer relief from anxiety through diversion rather than through resolution of the issue.

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Nuclear family emotional process

answer

emotional functioning in a single generation. relationship between two people who form a couple. most open relationship occurs during courtship when most individuals chose partners with similar levels of differentiation. a degree of fusion occurs with permanent commitment

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family projection process

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spouses who are unable to work through the undifferentiation or fusion that occurs with permanent commitment may, when they becomes parents, project the resulting anxiety onto the children. manifested as a father-mother-child triangle. this behavior is called scapegoating and is harmful to the child's emotional stability and his or her ability to function outside the family

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Multigenerational transmission process

answer

the manner in which interactional patterns are transferred from one generation to another. attitudes, values, beliefs, behaviors, and patterns of interaction are passed along from parents to children over many lifetimes. Genograms: an overall picture of the life of the family over several generations can be conveyed

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Sibling position

answer

the position one holds in family influences the development of predictable personality characteristics. Can be used to dertermine the level of differentiation withing a family and the possible direction of the family projection process.

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Emotional cutoff

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differentiation of self from the perception of the child. all indivudals have some degree of unresolved emotional attachment o their parents and the lower the level of differentiation, the greater the degree of unresolved emotional attachment

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Societal emotional process

answer

compares society's response to stress to the same type of reponse seen in individuals and families in reponse to emotional crisis: stress creates uncomfortable levels of anxiety which leads to hasty solutions, which add to the problems and the cycle continues.

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Milieu

answer

therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. time is also devoted to personal problems and focus groups.

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Basic physiological needs are fulfilled

answer

promotes therapeutic community individuals do not move to higher levels of functioning until basic needs are met

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Physical facilities are conducive to achievement of the goals of therapy

answer

space is provided so that each client has sufficient privacy, as well as physical space, for therapeutic interaction with others. "home like atmosphere"

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Democratic form of self-government

answer

clients participate in the decision making and problem solving that affect the management of the treatment setting. accomplished through regularly scheduled community meetings where every member participates.

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Responsibilities are assigned according to client capabilities

answer

assign client responsibilities that promote achievement which will enhance self-esteem. increasing self-esteem is an ultimate goal of the therapeutic community. don't set a client up for failure.

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A structured program of social and work-related activities is scheduled as part of the treatment program

answer

Each client's therapeutic program consists of group activities in which interpersonal interaction and communication with other individuals is emphasized. Time is also devoted to personal problems. Structured schedule of activities is major focus. New coping strategies are learned and social skills are developed. Client personality and behavior change can be achieved.

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Community and family are included in the program of therapy in an effort to facilitate discharge from treatment

answer

attempt to include family members as well as certain aspects of the community that affect the client. important to keep as many links to the client's life outside of therapy as possible.

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psychiatrist

answer

serves as the leader of the team. Responsible for diagnosis and treatment, performs psychotherapy, prescribes medication and other somatic therapies

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Clinical psychologist

answer

conducts individual, group, and family therapy. administers, interprets, and evaluates psychological tests that assist in the diagnostic process.

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psychiatric clinical nurse specialist

answer

conducts individual, group, and family therapy. presents educational programs for nursing staff. provides consultation services to nurses who require assistance in the planning and implementation of care for individual clients

question

psychiatric nurse

answer

provides ongoing assessment of client condition, both mentally and physically. manages therapeutic milieu on a 24 hour basis. administers medications. assists clients with all therapeutic activities as required. focus is on one-to-one relationship development. consults with the clinical psychologist to review psychological testing results for the client

question

mental health technician

answer

functions under the supervision of the psychiatric nurse. provides assistance to clients in the fulfillment of their activities of daily living. assists activity therapists as required in conducting their groups. may also participate in one-to-one relationship development

question

psychiatric social worker

answer

conducts individual, group, and family therapy. is concerned with client's social needs, such as placement, financial support, and community requirements. conducts in-depth psychosocial history on which the needs assessment is based. works with client and family to ensure that requirements for discharge are fulfilled and needs can be met by appropriate community resources

question

occupational therapist

answer

works with clients to help develop independence in performance of activities of daily living. focus is on rehabilitation and vocational training in which clients learn to be productive, therby enhaving self-esteem. creative activities and therapeutic relationship skills are used.

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recreational therapist

answer

uses recreational activities to promote clients to redirect their thinking or to rechannel destructive energy in an appropriate manner. clients learn skills that can be used during leisure time and during time of stress following discharge from treatment

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music therapist

answer

encourages clients in self-expression through music

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art therapist

answer

uses the client's creative abilities to encourage expression of emotions and feelings through artwork

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psychodramatist

answer

directs clients in the creation of a "drama" that portrays real-life situations

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dietitian

answer

plans nutritious meals for all clients

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chaplain

answer

assesses, identifies, and attends to the spiritual needs of clients and their family members

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Phase 1 Assessment

answer

Phases of crisis intervention the crisis helper gathers info regarding the precipitating stressor and the resulting crisis that prompted the individual to seek professional help

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Phase 2 Planning of therapeutic intervention

answer

Phases of crisis intervention planning interventions, goals are established for crisis resolution and a return to or increase in the precrisis level of functioning

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Phase 3 Intervention

answer

Phases of crisis intervention actions identified in phase 2 are implemented

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Phase 4 Evaluation of crisis resolution and anticipatory planning

answer

Phases of crisis intervention Reassessment to determine if the stated objective was achieved.

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Deep breathing exercises

answer

Relaxation method sit in a comfortable position, place one hand on abdomen and the other on your chest, inhale slowly and deeply through your nose, breathe in as much as possible and hold your breath, begin exhaling slowly through your mouth pursing your lips, begin the inhale-exhale cycle again, continue exercises for 5-10 minutes

question

Progressive relaxation

answer

Relaxation method each muscle group is tensed for 5-7 seconds and then relaxed for 20 to 30 seconds

question

Modified prograssive relaxation

answer

Relaxation method the muscles are not tensed, the person concentrates on the feeling of relaxation within the muscle

question

Meditation

answer

Relaxation method gain mastery over attention, attention is concentrated solely on one thought or object

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Mental imagery

answer

Relaxation method uses the imagination to reduce the body's reponse to stress, frame of reference is personal and based on what each individual considers to be a relaxing environment

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Biofeedback

answer

Relaxation method use of instrumentation to become aware of processes in your body that you usually do not notice and to help bring them under voluntary control

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Stress management

answer

Considered a lifelong function. Nurses can help individuals recognize the sources of stress in their lives and identify methods of adaptive coping.

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assertive communication

answer

helps us feel good about ourselves and increases our self-esteem, helps us feel good about other people and increases our ability to develop satisfying relationships, honesty is basic to assertive behavior

question

Role of nurse in assertiveness training

answer

The nursing process Assessment: help clients become more aware Diagnosis: Coping, defensive; coping, ineffective; decisional conflict; denial, ineffective; personal identity, disturbed Outcome identifiication/Implementation: help client develop more satisfying interpersonal relationships, teach client techniques to use, role-playing Evaluation: whetheror not techniques are achieving the desired outcomes Encourage clients to become what they want to be, promote an improvement in self-esteem, and fostering a respect for their own rights and the rights of others

question

Assertiveness Diagnosis

answer

Coping, defensive; coping, ineffective; decisional conflict; denial, ineffective; personal identity, disturbed; powerlessness; rape-trauma syndrome; self-esteem, low; social interaction, impaired; social isolation

question

Passive-aggressive behavior

answer

individuals defend their own rights by expressing resistance to social and occupational demands. takes the form of passive, nonconfrontive action. devious, manipulative, and sly and undermine others with behavior that expresses the opposite of what they are feeling. highly critical and sarcastic. allow others to make choices for them and resist by procrastination, dawdling, stubborness, and "forgetfulness." low self-confidence, feel resentment and like they are beeing taken advantage of, goal is domination through retaliation, protest to others but won't confront the person making the demand, sulky, irritable, and argumentative, use actions instead of words to convey their message

question

Standing up for one's basic human rights

answer

Techniques that promote assertive behavior. "I have a right to express my opinion"

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Responding as a broken record

answer

Techniques that promote assertive behavior persistently repeating in a calm voice what is wanted

question

Clouding/fogging

answer

Techniques that promote assertive behavior concurring with the critic's argument without becoming defensive and without agreeing to change

question

Defusing

answer

Techniques that promote assertive behavior Putting off further discussion with an angry individual until he or she is calmer

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Using "I" statements

answer

Techniques that promote assertive behavior allows an individual to take ownership for his or her feelings rather than saying they are caused by another person

question

Self-esteem

answer

degree of regard or respect that individuals have for themselves and is a measure of worth that they place on their abilities and judgments. ability to say "I'm important" "I matter" and "I am competent" "I have something to offer to others and the world"

question

Power

answer

development of self-esteem feeling of control over their own life situation & some influence over others

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Significance

answer

development of self-esteem self-esteem enhanced when individuals feel loved, respected, and cared for

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Virtue

answer

development of self-esteem feel good about selves when actions reflect a set of personal, moral, and ethical values

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Competence

answer

development of self-esteem ability to perform successfully or achieve self-expectations and the expectations of others

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Consistently set limits

answer

development of self-esteem a structured lifestyle demonstrates acceptance and caring and provides a feeling of security

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Trust vs mistrust

answer

achieving trust results in positive self-esteem through self-confidence, optimism, and faith in gratification of needs.

question

Autonomy vs shame and doubt

answer

achievement results in a sense of self-control and the ability to delay gratification, as well as a feeling of self-confidence in one's ability to perform

question

Initiative vs guilt

answer

creativity is encouraged and performance is recognized and positively reinforced

question

Industry vs inferiority

answer

self-confidence is gained through learning, competing, performing successfully, and receiving recognition from significant others, peers, and aquaintances

question

identity vs role confusion

answer

positive self-esteem occurs when individuals are allowed to experience independence by making decisions that influence their lives.

question

Intimacy vs isolation

answer

positive self-esteem is promoted through this capacity for giving of oneself to another

question

generativity vs stagnation

answer

generativity promotes positive self-esteem through gratification from personal and professional achievements, and from meaningful contributions to others

question

ego integrity vs depair

answer

ego integrity results in a sense of self-worth and self-acceptance as one reviews life goals, accepting that some were achieved and some were not.

question

Boundaries

answer

personal space, both physical and psychological, that individuals identify as their own. the limit or degree to which individuals feel comfortable in a relationship. inner self: beliefs, thoughts, feelings, decisions, choices, experiences, wants, needs, sensations, and intuitions. physical include physical closeness, touching, sexual behavior, eye contact, privacy, and pollution. psychological include beliefs, feelings, choices, needs, time alone, interests, confidences, individual differences, and spirituality.

question

Rigid boundaries

answer

hard time trusting others, keep others at a distance, difficult to communicate with, reject new ideas or experiences, often withdraw

question

Flexible boundaries

answer

healthy boundaries. must be able to let go of their boundaries and limits when appropriate.

question

Enmeshed boundaries

answer

when two people's boundaries are so blended together that neither can be sure where one stops and the other begins.

question

Chronic low self-esteem

answer

long standing negative self-evaluating/feelings about self or self-capabilities. dependent on others' opinions, evaluation of self as unable to deal with events, exxagerates negative feedback about self, excessively seeks reassurance, expressions of guilt and shame, frequent lack of succes in life events, hesitant to try to new situations or new things, indecisive behavior, lack of eye contact, nonassertive behavior, overly conforming, passive behavior, rejects positive feedback about self

question

Manifestations of low self-esteem

answer

loss of appetite/weight loss, overeating, constipation or diarrhea, sleep disturbances, hypersomnia, complaints of fatigue, poor posture, withdrawal from activities, difficulty initiating new activities, decreased libido, decrease in spontaneous behavior, expression of sadness, anxiety, or discouragement, isolation, being unlovable, fearful of angering others, avoidance of situations of self-disclosure, tendency to stay in the background, sensitivity to criticism, expressin of feelings of helplessness, various complaints of aches and pains, pg. 285

question

Assessment

answer

assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. A thorough assessment involves collecting and analyzing data from the client, significant others, and health-care providers that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities.

question

Gathering client data

answer

The purpose of gathering client information is to enable the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client including information collected from the client, significant others, and health-care providers.

question

Nursing diagnosis

answer

a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable. altered sensory perception accurately reflects the client's symptoms of hearing things that others do not. describes a client's condition and facilitates the prescription of interventions. Delusional thinking, confusion, and disorientation are problems associated with the nursing diagnosis of altered thought processes. is a statement of a client's functional problem.

question

Outcomes

answer

should be specific, measurable, and realistically based on client capability. should be derived from the diagnosis and should include a time estimate for attainment. are most effective when formulated cooperatively by the interdisciplinary team members, client, and significant others.

question

Implementation

answer

Several specific interventions are included among the standards of psychiatric/mental health clinical nursing practice Coordination of care Health teaching and health promotion Milieu therapy Pharmacological, biological, and integrative therapies Prescriptive authority and treatment Pyschotherapy Consultation

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