PSYCHIATRIC NURSING

Mental Health Hygiene

Raymund D. Solis

I. INTRODUCTION

CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS

Health (DOH) Mental health

refers to the ability of people (couples, families and communities) to respond adaptively to internal

and external stressors

to reality. - a state of well being in which a person is able to cope with the normal stresses of daily life and his ability to realize his potentials.

- A balance in persons internal life and adaptation

 MENTAL HEALTH IS RELATIVE AND DYNAMIC Relative not the same to all people Dynamic changes at different point in time

Mental Hygiene the science that deals with the

measures to promote mental health, prevent mental illness and suffering and facilitate rehabilitation.

Mental Illness A state of imbalance characterized by a disturbance in persons thoughts, feelings and behavior. - Poverty and abuses are major factors which increase the risk of mental illness in the home.

Defining Characteristics of Good Mental Health

Positive state in which one is responsible, displays ones selfawareness, self directed, reasonably worry free and can cope with daily tensions

Simultaneous success at working, loving, and creating with the capacity for mature and flexible resolution of conflicts between instinct conscience, important other people and reality.

 It is the state in the relationship of the individual and environment in which the personality structure is relatively stable and the environmental stresses are within its absorptive capacity (good mental health). Ability to solve problems.

Fulfill ones capacity for love and work. (could satisfy ones relationship)

 Mental illness- is a mental disorder or condition manifested by disorganization and impairment of function that arises from various causes such as psychological, neurobiological and genetic.

 Psychiatric Mental Health Nursing - is organized around eight human response processes: activity, cognition, ecological , emotional, interpersonal, perception, physiologic, and evaluation.

 Psychiatric Nursing - is an interpersonal process that promotes and maintains behavior that contributes to integrated functioning. It is a specialized area of nursing practice employing theories of human behavior as its science and purposeful use of self as it part.

GOALS OF MENTAL HEALTH

Moving towards assisting client to: (CAMP F) - Cope with mental illness - Attain mental health - Maintain mental health. - Prevent mental Illness - Find meaning in mental illness experienced and suffering.

CONCEPTUAL APPROACHES TO MENTAL HEALTH

Attitude towards the individual self. Growth and Development and Self Actualization. Integrative Capacity Autonomous Behavior Perception of Reality Mastery of Ones Environment

Attitude towards the individual self.

This involves aspects related to persons:

self awareness self acceptance confidence level of self esteem sense of personal identification in relation to roles

SELF- CONCEPT the term given to the type of

self that lies between conscious awareness.
- a collection of attitude and ideas about the self. - a product of life experienced - it encompasses all that the person perceives knows and holds to be true about his or her identity. - what you believe you can do - perceive (how you perceive yourself)

4 ASPECTS OF SELF CONCEPTS

1. Body image physical dimension of
self concept. 2. Personal Identity refers to psychological aspect of self concept. 3. Self esteem - emotional component. 4. Role performance expression of self concept.
Self awareness noticing how self feels, things behave,

and senses at any given time. Self acceptance a regard to oneself with realistic concept of strength and weakness. related to introspection involves evaluation or determining why self reacts at it does

2. Growth and Development and Self Actualization.

Growth increase in size of a structure
- more on physical

Development - maturation of structures. - more on psychological. Self Actualization when all

individual goals have been achieved. Top most level of Abraham Maslows hierarchy of needs

 Growth and development refers to what a person does to his abilities and potentialities. - refers to persons involvement with outside interest and relationship and concerns with an occupation or ideas as well as its goals.

3. Integrative Capacity
Refers to the balance of psychic forces (ex. Id, ego, superego) Ability to tolerate anxiety and frustration in stressful situation.

Mild anxiety

good thing cause it will cause you to push things. will cause you panic and emotional paralysis

Moderate or severe anxiety

3 Psychic Energy
ID

Sexual and aggressive drive Born with it Operates on pleasure principle (reduce tension by immediate gratification) PRIMARY PROCESS THINKING (imagery)
IRRATIONAL and NOT BASED ON REALITY

EGO

CHIEF EXECUTIVE OFFICER Operates on REALITY PRINCIPLE SECONDARY PROCESS OF THINKING (logical and oriented on time) Major personality mechanisms that meditates between the person and the environment Major functions: adaptation to reality; modulation of anxiety; problem solving; control and regulate instinctual drives; mediate in drives and demands of reality; evaluate and judge the external world; REALITY TESTING; store of experiences in memory; direct motor activities and actions USE DE FENSE MECHANISMS to protect self CONSCIENCE, punishes one for something wrong that was done. EGO-IDEAL, rewards one for something good that was done. Residue of internalized values and moral training of early childhood .

SUPEREGO

4. Autonomous Behavior
- Ability to make ones own decision and react accordingly to his own convictions regardless of outside environment pressures and accept responsibilities for his actions.

5. Perception of Reality
- The persons perceptions of his environment and other people as well as his reactions towards them. - React depending on the culture

6. Mastery of Ones Environment

- Ability to adapt, adjust and behave appropriately in situations according to approve standard so that satisfactions are achieve. - Refers to the problem solving ability of a person.

FACTORS INFLUENCING MENTAL HEALTH

Inherited Characteristics
Nurturing During Childhood Life Circumstances

1. Inherited Characteristics
Theorists believe that no one is completely normal and that the ability to maintain a mentally healthy outlook on life is, in part, due to ones genes. Cognitive disability Schizophrenia or bipolar disorder

Ex.

2. Nurturing During Childhood

- Refers to familial child interactions Ex. Obsessive compulsive comply on the impose of their parents. Positive Nurturing starts with bonding at child birth and includes feelings of love, security, and acceptance. The child experiences positive interactions with parents and siblings. Negative Nurturing circumstances such as maternal deprivation, parental rejection, sibling rivalry and early communication failures. Poor nurturing develop poor self esteem, poor communication skills.

3. Life Circumstances
- Can influence ones mental health from birth.
Positive circumstances - are generally emotionally secure and successful in school and establish healthy interpersonal relationship. Negative circumstances poverty, poor physical health, unemployment, abuse, neglect and unresolved childhood loss generally precipitate feelings of hopelessness, helplessness, and worthlessness. These negative responses place a person at risk for: - depression, - substance abuse - Other mental health disorders.

CHARACTERISTICS OF EMOTIONAL MATURITY

Ability to deal constructively with reality Capacity to adapt to change Relatively free from symptoms produce by tensions and anxiety. Capacity to find more satisfaction in giving and receiving (more of reciprocation) Ability to relate to other people in a consistent manner with mutual satisfaction Capacity to redirect ones instinctive hostile energy into creative constructive outlets. Capacity to love.

FACTORS THAT INFLUENCE THE ABILITY TO ACHIEVE AND MAINTAIN EMOTIONAL MATURITY

1. Interpersonal Communication 2. Ego Defense Mechanisms 3. Significant Others or Support People 4. Personal Strategies.

1. Interpersonal Communication - communication between two

or more person - only as good as the interaction that occurs Intrapersonal Communication within self

5 Levels of Communication (POWELL) Level 5 Clich Conversation Level 4 Reporting facts Level 3 Revealing Ideas and Judgments Level 2 Spontaneous, Here and Now Emotions Level 1 Open, Honest Communication

 Level 5 Clich Conversation

no sharing of oneself occurs during this interaction. No real answers are expected No personal growth can occur at this level Ex.: How are you doing? Hows your new job? Talk to you later

Level 4 Reporting facts

reveals very little about oneself minimal or no interactions is expected from others No personal interaction occurs at this level

 Level 3 Revealing Ideas and Judgments

- Communication occurs under strictcensorship by the speaker, who is watching the listeners response for an indication of acceptance or approval.

Level 2 Spontaneous, Here and Now Emotions

-Revealing ones emotions take courage because one faces the possibility of rejection by the listener.

of the mind and heart, one may fear that such emotional honesty will not be tolerated by another. RESULT: the speaker may resort to dishonesty and superficial conversation to maintain contact with another person.

Powell (1969) states that if one reveals the contents

 Level 1 Open, Honest Communication

- occurs if two people share emotions

- they are in tuned with each other

capable of experiencing or duplicating each others reaction

interaction is termed: complete emotional and

personal communication it helps one maintain emotional maturity.

Open communication may not occur until people

relate each other over a period of time, getting to know and trust each other.

2. Ego Defense Mechanisms

Referred to as defense mechanism, described as mental processes Identified as usually unconscious, protective barriers that are use to manage instinct and affect in the presence of stressful situations. It can be therapeutic or pathologic, because all defense mechanisms include a distortion of reality, some degree of self-deception, and what appears to be irrational behavior.

Uses of defense mechanisms Self security protection Anxiety and fear Reduction Anxiety unexplained feeling of

Fear is an emotional response to

apprehension, tension or uneasiness

Mental conflict resolution. Esteem (self) protection.

recognizable object or threat, it decreases when the danger or threat subsides.

Four Levels of Defense Mechanisms

Level 1: Psychotic Mechanisms (common in health individual before Age 5) Delusional Projection Denial Distortion
Level 2: IMMATURE MECHANISMS (common in ages 3 15) Projection Schizoid fantasy Hypochondriasis Passive-aggressive behavior Acting Out

Level 3: NEUROTIC DEFENSE (common in aged 3 90) Intellectualization Repression Displacement Reaction Formation Dissociation Level 4:MATURE MECHANISMS Altruism Humor Sublimation

SPECIFIC DEFENSES
1.) Regression the backward turning to earlier patterns of behavior to solve personal conflict.
Example: A hospitalized patient making unnecessary request and demands for care and attention.

2.) Suppression conscious and deliberate withholding of words or deeds that reflect an unfavorable light on the self.
Example: A rape victim consciously forgetting about experience.

3.) Repression An involuntary, automatic banishment of unacceptable ideas or impulses into the unconscious. - The earliest type of defense available. - Considered the principal defense in early years.
Example: Mrs. de la Cruz, a victim of incest, does not know why she has always hated her uncle.

4.)

Compensation A conscious or unconscious attempt to balance a real or imagined deficiency in one area by developing other personal qualities to hide weakness. Example: An academically weak high school student become a star in the school play.

5.) Conversion Transforming an emotional problem into a physical symptom or outlet. An unconscious device.
Example: Mr. del Mar suddenly develops impotence after his wife discovers he is having an affair with his secretary.

Malingering Conscious, deliberate attempt to escape from an unpleasant task. 6.) Denial The UNCONSCIOUS disapproval of thoughts, feelings, wishes, needs which are consciously unacceptable. - Closely related to rationalization. - Not the same as lying which is conscious. - It protects the persons from finding out that he may be wrong.
Example: Mr. Carpio who is alcohol dependant states that he can control his drinking (when in fact he cannot).

7.) Rationalization Attributing acceptable motive to thoughts, feelings or behavior which really have unrecognized motives. - Stating other motives instead of the genuine one. - Used to avoid the full honesty of the situation.
Example: A student states, I got a 70 on the test because the teacher asked poor questions. MR. Bruno, a paranoid schizophrenia, states that he cannot go to work because he is afraid of his co-worker instead of admitting that he is mentally ill.

8.) Intellectualization The overuse of intellectual concepts of words to avoid effective experience or expression of feelings.
Example: Mr. Salvo talks about his sons death bout with cancer as being mercifully short without showing signs of sadness.

9.) Fixation The arrest of maturation at an earlier level of psycho sexual development. - Behavior appropriate at an earlier age is maintained at a time such behavior should have been outgrown.
Example: A childs attachment to a nursing bottle beyond the oral period.

10.) Identification The unconsciousness, wishful adoption (internalization) of the personality characteristics or identity of another individual generally one possessing attributes which the subject envies or admires. IMITATION their behavior in contrast to identification is conscious.
Example: Julia state to the nurse, when I get out of the hospital, I want to be a nurse just like you.

11.) Introjections The symbolic assimilation or talking into ones self a loved or hated persons or external object. This a form of identification.
Example: Without realizing it, a patient talks and acts like his therapist.

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12.) Projection Unconsciously making another persons or circumstances responsible for ones unacceptable thought or actions - It involves repression of undesirable qualities.
Example: A parents fulfilled desire may be projected on the child by demanding that the child prepare for a career which the parent would like to do, regardless of the childs interest and wishes.

13.) Reaction Formation over compensation or reversal formation. Example: Mothers unconsciously do not love their children often over compensates be becoming overly protective of them. 14.) Sublimation The substitution of unacceptable instinctual drives into socially acceptable expressions. Example: Excelling in sports to sublimate hostile impulse. 15.) Substitution Replacement of unattainable therapy or unacceptable activity into one which is attainable and acceptable therapy assuring possibility of success. COMPARABLE TO DISPLACEMENT. 16.) Dissociation The unconscious separation of painful feelings and emotions from an acceptable idea, situation or object. Example: Sleepwalking (somnambulism), amnesia, fugue.

A patient recalls that when she was sexually molested as a child, she felt as she was outside of her body watching what was happening without feeling anything

17.) Undoing An attempt to replace to a tone to make amends for some undesirable act by process that attempt to make it appear that the original act was never committed. Example: After spanking his son, a mother bakes his favorite cookies. 18.) Symbolization An idea of object is used to represent some other idea or object. Example: Fetal position. A rejected boyfriend rushes into marriage in the rebound. 19.) Displacement A transfer into another situation of an emotion in a previous situation where in expression would not have been socially acceptable. Example: A husband comes home and yells at his wife after a bad day at work.

20.) Fantasy Use of imagination or daydreaming 21.) Isolation the separation of an unacceptable impulse act idea form its memory origin, there by removing the emotional charge. Most commonly seen in obsessive compulsive neurosis. Example: PHOBIA / TABOOS Phobia an exaggerated and invariably pathological dread of some specific type of stimulus or situation.
Acrophobia dread of high places

Agoraphobia dread of open places

Algophobia dread of pain Astra(po)phobia dread of thunder and lightning Claustrophobia dread of closed or confined place Coprophobia dread excreta

 Hematophobia dread of sight of blood Hydrophobia dread of water Lalophobia or glossophobia dread of speaking Mysophobia dread of dirt or contamination Necrophobia dread of dead bodies Nyctophobia dread of darkness, night Pathophobia or Nosophobia dread of disease, suffering Peccatophobia dread of sinning Phonophobia dread of speaking aloud Photophobia dread of strong light Sitophobia dread of eating Taphophobia dread of being buried alive Thanatophobia dread of death Toxophobia dread of being poisoned Xenophobia dread of strangers Zoophobia dread of animals

3. Significant Others or Support People

With anyone who the person fells comfortable trusts and respects. Act as the sounding board, shock absorber of problem of a person Simply listener while one vents various feelings or emotions. He or she may interact as the need arises.

4. Personal Strategies.
Refers with dealing directly with ones emotions How to manage your own problems and stresses Alternate ways to reduce stress and enhance their well being while balancing responsibilities between work and time spent at home.

ROLES OF THE PSYCHIATRIC NURSE

Creator of the Therapeutic Environment Technical Nursing Role Therapist Socializing Agent Teacher Parent Surrogate

Creator of the Therapeutic Environment

It is an environment allows the client to:
Relax Feels secure physically and emotionally Is not afraid to share thoughts and feelings

Can be achieved when the people around the client are:

Honest Sincere Friendly yet firm Nonjudgmental

There is no cure to mental illness but we can provide support system, continuous medication, and therapeutic environment to restore to its optimum capacity.

 Technical Nursing Role

- Refers to our performance to nursing skills and procedure

Example:
Checking of vital signs Perform treatment procedures Administer medications Makes physical assessment

Communication skill- Most important

skill that we need

 Therapist
Achieved by your performance of your treatment modalities to the clients. The nurse uses the principle of psychotheraphy to help the client of his behavior, feelings and thoughts. Assist the client in finding solutions to his problems. The nurse must know to assess thoroughly the level of readiness of the patient to coordinate in the activity.

Do not ask questions starting with WHY.

 Socializing Agent
When you allow the patient to participate in group activities.

Counselor
Achieved when nurse shows active listening, and giving the client options, and possible solution to their problems. When the nurse assists the patient in identifying stressors that can cause anxiety and helps client find acceptable outlets of anxiety.

 Teacher
When nurse gives instruction or educates the client about certain medications or therapeutic intervention. When the nurse teaches the client to learn new skills such as game, song, dance, step or when the nurse becomes a role model of acceptable behavior. Transference - attribution of feelings to other person.

Client to therapist
Therapist to patient

Counter transference

 Parent Surrogate
Acts as parent substitute of the patient
When the nurse performs functions for the client originally provided by the mother such as bathing, dressing, or backrubs.

HISTORICAL PERSPECTIVE OF MENTAL ILLNESS

A.)ANCIENT TIMES sickness indicated displeasure of the gods and in fact was a punishment for sins and wrong doings. persons with mental disorder were viewed as being either demonic or divine depending on their behavior. Divine worshipped and adored Demonic ostracized, punished and sometimes burned.

Aristotle attempted to relate mental disorders to physical disorders and developed his theory that emotions were controlled by the amount of blood, water and yellow and black bile of the body. These four (4) substances or humors correspond to emotions of happiness, calmness, anger, sadness. Imbalance of the four humors causes mental illness. Treatment is aimed at restoring imbalance through blood letting, starving or purging.

 EARLY CHRISTIAN ERA (1-1000 AD)

primitive beliefs and superstitious were strong diseases are blamed and demons and mentally ill are possessed.

priest preformed exorcisms to rid the persons of evil spirits. if failed, incarceration in dungeons, flogging, starving and other brutal treatment were used.

 RENAISSANCE (1300-1600)
persons with mental illness were distinguished from criminals in England harmless were allowed wonders the countryside or live in rural communities. dangerous lunatics where still thrown in prison, chained and starved.

1547

declared as the first hospital for the insane.

Hospital of St. Mary of Bethlehem was official

1775

visitors at the institution were charged for a fee for the privilege of viewing and ridiculing the inmates, who were seen as animals, less than humans

B.)PERIOD OF ENLIGHTENMENT AND CREATION OF MENTAL INSTITUTION

1790
period of enlightenment concerning persons with mental illness. establishment of asylum is credited to Phillippe Pinel in France and William Tukes in England.

ASYLUM

a safe refuge or haven offering protection

this movement began the moral treatment of the mentally ill.

 1802 1887 Dorothea Dix began a crusade to reform the treatment of mentally ill in the U.S Dix is instrumental in opening 32 state hospitals that offered asylum to the suffering. She believed that society has obligation to persons who are mentally ill and promoted adequate shelter, nutritious food and warm clothing.

The period of enlightenment was short lived.

within 100 yrs. after the1st Asylum was established state hospitals were in trouble.

attendants were accused of abusing clients rural location of hospitals were viewed as isolating patients from family and their homes. insane asylum took on a negative connotation, rather than a protective haven.

C.)SIGMUND FREUD and TREATMENT OF MENTAL DISORDERS

period of scientific study and treatment of mental disorders began with Sigmund Freud (1856 1939) Emil Kraepolin (1856 1926) began classifying mental disorders according to their symptoms. Eugene Bleuler (1857 1939) coined the term schizophrenia.

Freud challenged the society to look at human beings objectively and studied the mind and its disorder and their treatment.

 D.)DEVELOPMENT OF PSYCHOPHARMACOLOGY
1950 development of psychotropic drugs (drugs used to treatment illness) chlorpromazine (Thorazine) antipsychotic drug. Lithium antimanic drug

After 10 yrs:
Monoamine oxides inhibitor antidepressants Haloperidol (Haldol) antipsychotic Tricyclic Antidepressants

thinking and depression improved the condition of the patient.

Drugs reduced agitation, psychotic

E.)HISTORY OF PSYCHIATRIC NURSING IN THE PHILIPPINES

The National Center for Mental Health (NCMH) was established thru Public Works Act 3258. It was first known as INSULAR PSYCHOPATIC HOSPITAL, situated on a hilly piece of land in Barrio Mauway, Mandaluyong, Rizal and was formally opened on December 17, 1928. This hospital was later known as the NATIONAL MENTAL HOSPITAL

On November 12, 1986, it was given its present name NATIONAL CENTER FOR MENTAL HEALTH thru Memorandum Circular No.48 of the office of the President.

 On January 30, 1987, NCMH was categorized as a Special Research Training Center and hospital under Department of Health.
Today, NCMH has an authorized bed capacity of 4,200 and a daily average of 3,400 in-patients. It sprawls on a 46.7 hectare compound with a total of 35 Pavilions/ Cottages and 52 Wards. The Center has an authorized personnel component of 1,993, consisting of 116 Doctors, 375 Nurses, 655 Nursing Attendants, 651 Administrative Staff and 196 Medical Ancillary Personnel. The NCMH is a special training and research hospital mandated to render a comprehensive ( preventive, promotive, curative, and rehabilitative ) range of quality mental health services nationwide. It also gives and creates venues for quality mental health education, training and research geared towards hospital and community mental health services nationwide.

MENTAL ILLNESS
Is a complex problem and is unique response involving an individuals personality as it interacts with his environment at a time when he is particularly vulnerable to stress The study of the individuals life experiences with consideration of genetic physiological interpersonal and cultural factors is a reasonable approach.

CAUSES OF MENTAL DISORDERS

1. PREDISPOSING FACTORS
Conditions in which make the individual susceptible to precipitating causes and thus more likely to develop psychosis.

2 PRECIPITATING FACTORS
exciting cause of psychiatry disorder they are highly emotional and critical situations

PREDISPOSING FACTORS

Inheritance Age- adolescence,

Social class differences

differences between the poor and the rich/ develop Inferiority Complex authoritarian lax ambivalent overly permessive

Sex Environmental and social factors:

financial depression war family relationships environmental factors family organization broken homes

menopause, senile periods

Family control patterns

Family Placement and roles

Family Health Environment Family Attitudes/practices/values

Segregations sororities Social change (forced retirement) Cultural conflicts.

oldest - youngest prettiest - ugliest

PRECIPITATING FACTOR Physical Precipitating causes:

Infection Fever Exhaustion Intoxicants narcotics, alcohol, bromides, barbiturates Benzedrine Organic conditions Trauma

Psychic Precipitating Causes

dynamic motivating and damaging causes of mental illness not easily identified or understood (emotions) strong emotions conflicts between conscious and unconscious drives disappointment rejection deprivation marital difficulties failure in ones ambition inferiorities economic reverses

NURSING PROCESS
A systematic process or a six step problem solving approach to nursing that also serves as an organizational framework for the practice of nursing. It sets the practice of nursing in motion and serves as a monitor of quality nursing care.

1. ASSESSMENT the collection of data about a person, family, or group by the methods of observing, examining, and interviewing. TWO TYPES OF DATA Subjective data

Objective data

obtained from the client, family members, or significant others provide information spontaneously during direct questioning or during health history involves interpretations of information by the nurse information obtained verbally from the client, as well as the results of: Inspection Palpation Percussion Auscultation

3 KINDS OF ASSESSMENT
1. Comprehensive assessment

includes all the dimensions of a person completed in collaboration with other health care professionals includes data related to the clients biological, cultural, spiritual, and social needs Physical examination
performed to rule out any physiologic causes of disorders such as anxiety, depression, or dementia

2. Focused assessment

the collection of specific data regarding a particular problem as determined by the client, a family member, or a crisis situation Example: suicide attempt includes the use of a specific screening instrument to evaluate data regarding a particular problem.

3. Screening assessment

ASSESSMENT DATA COLLECTION

discussion of the data collected by the nurse during a comprehensive assessment conducted in the psychiatric setting.

Data to be Assessed
Appearance Affect, or Emotional State Behavior, Attitude, and Coping Patterns Communication and Social Skills Content of Thought Orientation

Memory
Intellectual Ability Insight Regarding Illness or Condition Spirituality Sexuality Neurovegetative Changes

1. Appearance
physical characteristics, apparent age, peculiarity of dress, cleanliness, and use of cosmetics Facial Expression is a manner of non verbal communication in which emotions, feelings and moods are related.

2. Affect or Emotional State

Affect and emotion are commonly used interchangeably
Affect the outward manifestation of a persons feelings, tone, or mood. As a nurse you should assess congruently the language and the facial expression Relationship between the thought and process is of particularly significance

3. Behavior, Attitude, and Coping Patterns Factors for assessment:

Exhibit strange, threatening, suicidal, self injuries, or violent behavior. Evidence of any unusual mannerism or motor activity such as grimacing, tremors, tics, impaired gait, psychomotor retardation or agitation. Appear friendly, embarrasses, evasive, fearful. Resentful, angry, negativistic, or impulsive. Behavior overactive or underactive.

4. Communication and Social Skills

the manner in which the client talks enables us to appreciate difficulties with his thought processes

It is desirable to obtain a verbatim sample of the stream of speech to illustrate psychopathologic disturbances.

cont

 Factors to be considered:
They speak coherently The rate of speech slow, retarded, or rapid Clients whisper or speak softly, or do they speak loudly or shout.

There is delay in answers or responses, or so clients break off their conversation in the middle of a sentence and refuse to talk further.
They repeat certain words and phrases over and over cont

 Make up new words that have no meaning to others.

Their language obscene Their conversation jump from one topic to another They stutter, lisp, or regress in their speech They inhibit any unusually personality traits or characteristics that may interfere with their ability to socialize with others or adapt to hospitalization What cultural group or groups do they identify.

 Impaired Communication Following terminology is commonly used:

Blocking sudden stoppage in the spontaneous flow or stream of thinking or speaking for no apparent external or environmental reason.

Circumstantiality the person gives much unnecessary detail that delays meeting a goal or stating a point.
commonly found in clients with manic disorder and clients with some cognitive impairment disorders Individuals who use substances may also exhibit this pattern of speech.

Flight of Ideas over productivity of talk and verbal skipping from one idea to another. The ideas are fragmentary, although talk is continuous.

Perseveration is the persistent, repetitive expression of a single idea in response to various questions.
Verbigeration describes the meaningless repetition of incoherent words or sentences. Neologism a new word or combination of several words coined or self invented by a person and not readily understood by others Mutism refers to the refusal to speak even though the person may give indications of being aware of the environment. - occur from conscious or unconscious reasons.

5. Content of Thought
alterations in thought processes frequently sees in the psychiatric clinical setting. Can be related to a functional emotional disorder or to an organic condition.

A. Delusions B. Hallucinations C. Depersonalization D. Obsessions E. Compulsions

A. Delusions fixed false beliefs not true to

fact and not ordinarily accepted by other members of the persons culture.

- they cannot be corrected by an appeal to the reason of the person experiencing them

TYPES OF DELUSION
1. Delusions of reference or persecution - The client

believes that he or she is the object of environmental attention or is being singled out for harassment.

2. Delusion of alien control - The client believes his or her

feelings, thoughts, impulses, or actions are controlled by an external source.

3. Nihilistic delusion - The client denies reality or existence

of self, part of self, or some external object.

4. Delusion of self- deprecation - The client feels unworthy,

ugly, or sinful

5. Delusion of grandeur - A client experiences exaggerated

ideas of her or his importance or identity.

6. Somatic delusions - The client entertains false beliefs

pertaining to body image or body function.

7. Delusion of self accusation - False feeling of remorse or

guilt.

8. Delusion of Infidelity- pathologic feeling of jealousy that

his partner is unfaithful

9. Paranoid Delusion - false feeling of over suspiciousness

10. Thought control delusions

a. thought insertion - somebody inserted thought in
his mind

b. thought withdrawal - somebody look to withdraw

his thought

c. thought broadcasting - reacts, interact quickly

and believes that everybody can read his mind.

B. Hallucinations
- sensory perceptions that occur in the absence of an actual external stimulus. TYPES OF HALLUCINATIONS 1. Auditory hallucinationhears

2. Visual hallucination 3.Olfactory hallucination 4.Gustatory hallucination 5. Tactile hallucination -

seeing objects
smells taste feels movement

C. Depersonalization
feeling of unreality or strangeness concerning self, the environment or both. - these people may feel they are going crazy - causes include:
a. prolonged stress b. psychological fatigue c. substance abuse

D. Obsessions - insistent thoughts, recognized as arising from the self, usually regarded by the client as absurd and relatively meaningless, yet persistent despite his or her endeavors to be rid of them

E. Compulsion
- insistent, repetitive, intrusive, and unwanted urges to perform an act contrary to ones ordinary wishes or
standards.

6. Orientation

- ability to grasp the significance of their environment, an existing situation, or the

clearness of processes. conscious

Levels of Consciousness
1. Confusion- disorientation to person, place, or time, characterized by bewilderment and complexity

2. Clouding of consciousness- Disturbance in perception of thought that is slight to moderate in degree, usually owing to physical or chemical factors producing functional impairment of the cerebrum. 3. Stupor- a state in which the client does not react to or is unaware of the surroundings.- the client may be motionless and mute, but conscious.
4. Delirium- Confusion accompanied by altered or fluctuating consciousness.- disturbance in emotion, thought, and perception is moderate to severe.Ex. Infections, toxic states, head trauma 5. Coma- Loss of consciousness

7. Memory
- the ability to recall past experiences. Recent Memory ability to recall events in the immediate past and up to 2 weeks previously. - loss of memory may be seen in clients with dementia, delirium, or depression. Long-term Memory is the ability to recall remote past experiences such as place of birth, names, of school attended, occupational history, etc. - loss of memory is due to a physiologic disorder resulting in brain dysfunction.

Memory defects may result from:

lack of attention difficulty with recall or any combination of these factors

3 Disorders of Memory:
1. Hypermnesia abnormally pronounced memory 2. Amnesia - loss of memory 3. Paramnesia falsification of memory

8. Intellectual Ability

ability to use facts comprehensively

9. Insight Regarding Illness or Condition

Insight self understanding, or the extent of ones understanding about the origin, nature, and mechanisms of ones attitudes and behavior
Insightful clients are able to identify strengths and weaknesses that may affect their response to treatment.

10. Spirituality

by learning to take a spiritual history and understand a clients beliefs, values, and religious culture nurses become better equipped to evaluate whether these beliefs and values are helping or hindering the

11. Sexuality
express any concerns regarding sexual identity, activity, and function. Age and sex of the clinician may affect the response given.

12. Neurovegetative Changes

the client changes in psychophysiologic functions such as: sleep patterns eating patterns energy levels sexual functioning bowel functioning

usually complain of insomia or hypersomia, loss of appetite or increased appetite, loss of energy, decreased libido, and constipation, which are all signs of neurovegetative changes.

Sleep Pattern
Insomnia a symptom that have many different causes, and it occurs often in clients with psychiatric disorders. Acute or primary insomnia often caused by emotional or physical discomfort such as chronic stress, hyperarousal, poor sleep hygiene, environmental noise, or jet lag.it is not due to the physiological effects of a substance or a general medical condition.

Secondary insomnia related to a psychiatric disorder such as depression, anxiety, or schizophrenia; general medical or neurologic disorders; pain; or substance abuse.

DOCUMENTATION OF ASSESSMENT DATA

Criteria for the documentation:

Objective the nurse documents what the client says and does by stating facts and quoting the clients conversation. Descriptive the nurse describes the clients appearance, behavior and conversation as seen as heard. Complete Documentation of examinations, treatments, medications, therapies, nursing interventions, and the clients reaction to each should be made on the clients chart. what should be done by the client. Samples of the clients writing should be preserved.

Legible with the use of acceptable abbreviations only and no erasures. - correct grammar and spelling are important, and complete sentences should be used.

Dated important to note the day and the time of each entry. Logical presented in logical sequence. Signed should be signed by the person making the entry.

NURSING DIAGNOSIS
Is a statement of an existing problem or potential health problem that a nurse is both competent and licensed to treat. Clinical judgment about individual, family, or community responses to actual or potential health problems/ life processes. Provides basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.

Psychiatric nurse analyzes the assessment data before determining a nursing diagnosis.

 PSYCHIATRIC- MENTAL HEALTH NURSING (PMHN) DIAGNOSTIC SYSTEM

-organized 8 human response process:

activity cognition ecological emotional interpersonal perception physiologic evaluation

 Cues are facts collected during the assessment process.

Inferences are judgments that the nurse makes about the cues Actual Nursing Diagnosis based on clinical judgment of the nurse on review of validated data. Risk Nursing Diagnosis is based on clinical judgment of the clients degree of vulnerability to the development of a specific problem. Wellness nursing diagnosis is based on clinical judgment about an individual, group, or community transitioning from a specific level to higher level of wellness. Syndrome Nursing Diagnosis cluster of actual or high risk diagnoses that are predicted to be present because of a certain event or situation.

FACTORS OF NURSING DIAGNOSIS Validating data valid data can be assumed to be factual and true. Validation of data may occur by:
Rechecking data collected Asking someone to analyze the data Comparing subjective and objective data Asking the client to verify the data

To determine if a sufficient number of cues are present to confirm a nursing diagnosis, the nurse should consult a list of defining characteristics for the diagnosis suspected. Nursing diagnosis should not be written in terms of cues, inference, goals, patient needs, or nursing needs. Nursing diagnostic statements should not be stated or written to encourage negative responses by healthcare providers, the client, or the family.

OUTCOME IDENTIFICATION
Expected outcomes are measurable client oriented that are realistic in relation to the clients present and potential capabilities. Involve the other member of the health care team formulate the outcomes. Nurse and multidisciplinary team members understand the problems identified by the client and the outcomes the client hopes to achieve. cont.

 Expected outcomes serve as a record of change in the clients health status.

Outcomes are measurable client oriented goals are both short term and long term; they should be clearly stated by the nurse and should describe the expected end result of care.
Outcomes are consequences of a treatment or an intervention. Outcome statement should be directly related to the nursing diagnosis.

PLANNING
To guide therapeutic intervention and achieve expected outcomes. Is individualized, identifies priorities of care, identifies effective interventions, and includes client education to achieve the stated outcomes. The responsibilities of psychiatric nurse, client, and multidisciplinary team members are indicated. Documentation of the plan of care should allow access to it by team member and modification of the plan as necessary. Priority setting considers the urgency of the problem or need and its impact on the client. Maslows hierarchy of needs usually the guide for problem solving during formulation of plan care.

 General principles to remember when writing care plans:

Individualize or personalize the plan of care according to the nursing diagnosis or problem list
Use simple, understandable language to communicate information about the clients care Be specific when stating nursing action. Prioritize nursing care

State short and long term goals.

Indicate the responsible party for each client intervention.

IMPLEMENTATION Uses of various skills to implement the plan care Implement of care based on:
nursing theory establish trust with the client promotes the clients strengths sets mutual goals with the client to promote wellness.

 Intervention used by the nurses in clinical setting:

Counseling interventions to help the client improve or regain coping abilities. Maintenance of a therapeutic environment or milieu Structured interventions to foster self-care and mental and physical well-being. Psychobiologic interventions to restore the clients health and prevent future disability. Health education Case management Interventions to promote mental health and prevent mental illness.

Additional intervention used by clinical nurse specialist:

Individual, group, and child therapy Pharmacologic agent prescription Consultation with other health care providers

EVALUATION Focuses on the clients status, progress toward goal achievement, and ongoing reevaluation of the care plan. Four possible outcome may occur:
The client may respond favorably or as expected to nursing interventions. Short term goals may be met but long term goals may remain unmet. The client may be unable to meet or achieve any goals. New problems or needs maybe identified

All members of the multidisciplinary treatment team, as well as the client, should be encouraged to provide feedback regarding the effectiveness of the plan of care. As a result of evaluation process, the care plan is maintained, modified or totally revised.

STANDARD OF CARE
Standard I. Assessment - collects client health data. Standard II. Diagnosis -analyses the assessment data in determining diagnosis. Standard III. Outcome Identification - identifies expected outcomes individualized to the client. Standard IV. Planning -develops a plan of care that is negotiated among the client, nurse, family, and health care team and prescribes evidence-based interventions to attain expected outcomes. Standard V. Implementation - implements the interventions identified in the plan of care. Standard Va. Counseling: - uses counseling interventions to assist clients in improving or regaining their previous coping abilities, fostering mental health, and preventing mental illness and disability

Standard Vb. Milieu therapy:

- provides, structures, and maintains a therapeutic environment in collaboration with the client and other health care providers.

Standard Vc. Promotion of Self Care Activities : - structures interventions around the clients activities of daily living to foster self-care and mental and physical well-being. Standard Vd. Psychobiologic Interventions: - uses knowledge of psychobiologic interventions and applies clinical skills to restore the clients health and prevent future disability. Standard Ve. Health Teaching - through health teaching, assist clients in achieving satisfying, productive, and healthy patterns of living.

Standard Vf. Case Management - provides case management to coordinate comprehensive health services and ensure continuity of care. StandardVg. Health Promotion and Health Maintenance: - employs strategies and interventions to promote and maintain health and prevent mental illness.

Standard VI. Evaluation

Unit II: Development of the Person

Personality refers to the aggregate of the physical and mental qualities of the individual as these interact in characteristic fashion with his environment. expressed through behavior. It is the sum total of ones behavior it is complex, dynamic and unique. Factors that influence Personality a.) Heredity b.) Environment c.) Training

Theories of Personality
1.) Psychoanalytic Theory Sigmund Freud the father of psychoanalysis who stresses that early childhood experiences is important in the development of personality Personality Component a.) Id reflects basic or innate desires such as pleasure seeking behavior, aggression and sexual impulses. seeks instant gratification, causes impulsive, unthinking behavior and has no regard for rules or social convention. pleasure principle developed during infancy.

 b.) Superego reflects on moral and ethical concepts, values and parental and socials expectations the conscience the censoring force of the self developed during preschool age

c.) Ego the balancing or mediating force between the id and superego. represent mature and adaptive behavior that allows person to function successfully the integrator of personality operates on reality principle developed during toddler hood
Strict Superego leads to rigid, compulsive, unhappy person. Weak or Defective Superego leads to antisocial behavior, hostility, anxiety or guilt.

 2.) Interpersonal Theory (Harry S. Sullivan)

a.) Infancy - Self-concept is developed
- Mothering role is achieved by perception of the child as Good me if not Bad me.

- If satisfaction and security of the child is

achieved, he views himself as a worth while individual; but if an infant severely deprived, he develops Not me attitude. Type of play: Solitary Play

 3 PERSONIFICATION OF THE SELF

1.) Good me results from experiences of approval and tenderness and is associated with good feeling and about the self. 2.) Bad me results from experiences resulting from high anxiety situations and are associated with feelings of shame, guilt and low self-esteem. 3.) Not me develops in reaction to overwhelming anxiety arising from situations that provoked feeling of horror or dread.

 b.) Toddlerhood
- Emphasized the sense of POWER the child feels as he attempts to control himself and others. BEHAVIORAL TRAITS:
1.) Toddlers are headstrong and negativistic (their favorite word is No). 2.) Toddlers are naturally active, mobile and curious which make them vulnerable to accident. 3.) Temper tantrums are common. 4.) Type of play: Parallel Play

 c.) Pre-schooler - Known as Later Childhood

- Characterized by: Consensual Validation there is the use of language which can be consensually validated by others. BAHAVIORAL TRAITS 1.) Love to watch adults and imitate their behaviors. 2.) They are very creative and curious (Their favorite word is WHY). 3.) They love to tell lies, to brag and boast in order to impress others. 4.) They are very imaginative; imaginary playmates are common. 5.) They love offensive language. 6.) Question about sex should be answered honestly at the level of their understanding. 7.) Type of play: Associative Or Cooperative Play

 d.) Schooler

1.) Juvenile Era: (6 10 years old)

1.a. The child turn away from his parents as being the most significant people in his life and looks to peers of the same sex to fill the functions of providing him sense of security and companionship. 1.b. Period of gang loyalties 1.c. Child acquire the very important interpersonal tools: Ability to complete Ability to compromise

2.) Preadolescence (11 12 years old)

2.a. Child develop the ability to experience intimacy. 2.b. Chum Relationship an intense love relationship with a particular person of the same sex whom the child perceives to be very similar to himself.

 e.) Adolescence (12 18 years old)

1.) Known as the Early Adolescence. 2.) Establish relationship with the opposite sex. 3.) Adolescence experiences already sexual urges termed by Sullivan as LUST. 4.) Development of heterosexual relationship.

f.) Young of Early Adulthood (20 -40 years old)

1.) Known as Late Adolescence. 2.) There is incorporation of INTIMACY (which developed during pre-adolescence with a chum) and LUST (which developed in early adolescence) in heterosexual relationship.

 f.) Young of Early Adulthood (20 -40 years old)

1.) Known as Late Adolescence. 2.) There is incorporation of INTIMACY (which developed during pre-adolescence with a chum) and LUST (which developed in early adolescence) in heterosexual relationship.

humans are essential social being

human personality determined in the context of social interactions with other human beings. early life experiences with parents, especially the mother, influence an individual development throughout life.

 3.) Behavioristic Theory

behavior can be changed by a system of reward and punishment. derived form the works of Ivan Pavlov, John Watson and B.F. Skinner. concerned only with observable behavior not with intra psychic or interpersonal processes or the personality itself. all behavior are responses to a stimulus or stimuli from the environment. there are consequences that results from behavior broadly speaking reward and punishments behavior that are rewarded with reinforces tend to recur. POSITIVE REINFORCERS that follow a behavior increase the livelihood that the behavior will recur. NEGATIVE REINFORCERS that are removed after a behavior increases the livelihood that the behavior will recur

 4.) Cognitive Theory (Jean Piaget) Piaget believed that an individual has a genetically

predetermined intellectual or cognitive potential that develops according to the quality of childs interaction with the environment

GENETIC EPISTEMOLOGY the study of the nature of thought, especially the development of thinking. SCHEMA an innate knowledge structure which initially enable the person to behave an interact with the environment. COGNITVE DEVELOPMENT the development of the ability to think, remember and solve problems.

2 PROCESSES OF COGNITIVE DEVELOPMENT

1.) Assimilation

incorporation of a new knowledge to the existing knowledge.

modification of the existing body of knowledge in a person based on the newly acquired knowledge. The existing body of knowledge maybe changed refined a reinforced.

2.) Accommodation

FOUR PERIODS OF COGNITVE DEVELOPMENT 1.) Sensorimotor Assimilation vs. Accommodation

(0 2 years old ) a.) Cognitive Development a.1. Assimilation the process by which an individual acquires information or knowledge or by which experiences are integrated into an existing scheme. a.2 Accommodation process of creating a new scheme by modifying an existing scheme after an individuals interaction with the environment.
b.) This is a period based primarily on immediate experience through the sense. c.) Infant begins to display behavior which Piaget calls Primary Circular Reaction. d.) At this time, the child also achieves Object Performances (the awareness that is independent of his own action and perception).

2) Pre Operational Thought

old)

(2 6 years

Stage I: Pre-conceptual Thought (2 4) years old) - characterized by Egocentricity expressed in relating everything to himself Stage II: Perceptual Intuitive ( 4 6 years old) - characterized by: reason can be given for belief and reactions but still considered pre-logical and termed as pre-operational intuitive behavior. Jean Piaget described thinking of children as: 1. Egocentric thoughts are primarily centered to themselves 2. Irreversible inability to go back and rethink a process or concept or to conserve such process or concept

3.) Concrete Operation (7 -11 years old)

Not egocentric able to understand cause and effect in concrete situation but cannot yet reason hypothetically.

Major Events : a.) Conservation refers to the retention of the same properties even if they are arranged differently reshaped. b.) Reversibility refers to completion of certain operation in the reverse order and ending up the same.

or

Development proceeds from Pre-Logical to Logical thought.

Concrete

Deals with visible concrete objects and relationship. Increase intellectual and conceptual development.

Accommodation is developed modifies ideas to fit reality. Believes that animate and remote inanimate objectives (sun, moon) have life.
Intellectual development proceeds and relations and can handle numbers.

4.) Formal Operation

Logical

(11 15 years old)

- Employs logical reasoning - Development proceed from Logical Concrete to - Solution to all kinds of categories of problem. - Abstract thinking is fully utilized. - Develops capacity to use hypothetic reasoning and considers all possible solutions problem. Believe that only plants, animal and people have life. - Logical, mathematical and scientific reasoning are completed

STAGES OF GROWTH and DEVELOPMENT a.) Psychosexual Development (Sigmund Freud)

I. Oral Phase (1 1 yrs old)
Mouth erogenous zone; area of satisfaction and pleasure. Period of complete dependence. Greatest need security

II. Anal Phase (1 3 yrs old)

Anus site of tension and sensual gratification Primary source of pleasure is elimination or retention. Critical period of toilet training and urination. Greatest need Power First experience with discipline and authorities. Retention and expulsion (forcing out) are experienced as pleasurable especially because these functions come under the childs control. Child uses this new skill to pleasure or annoy parenting adult. Bowel control : 18 months Daytime Bladder Control: 2 yrs. old Nighttime Bladder Control: 3 yrs.

III. Phallic Stage (3 6 yrs old)

Indicative Behaviors

Genital Region erogenous zone; the primary source of pleasure.

a.) Masturbation b.) Fantasy c.) Play activities, experimentation with peers and questioning of adults about sexual topics.

Girls develop penis envy

Girls: Elektra Complex

Boys: Oedipal Complex Because of the desire to posses parent of the opposite sex, the child develops guilt feelings and fear of punishments by parent of the same sex (castration complex) Imitation of parent of the same sex or internalization of the traits.

IV. Latency (6 12 yrs old)

Stage of development marked by expanding peer relationship. Libido is channeled into school, home, organization activities, and hobbies relationship with peers. Time for increased intellectual activity. Significant other are the school and neighbors.

V. Genital Phase Puberty

Child becomes sexually nature Libido is centered again to the genital area Characterized as establishment of relationship with the opposite sex

b.) Psychosocial Theory (Erik Erikson) 1.) Infancy : Trust vs. Mistrust

Task: Development of trust in oneself, other people, the environment and meaningfulness of existence.

Trust: When needs are meet consistently by mother or primary caregiver. The child will be able to relate well with others, share and has optimism and hope in life. Mistrust: If needs are not met, child develops mistrust, hostility, suspiciousness, engages in excessive testing behaviors later in life, fears affection and becomes withdrawn.

2.) Early Childhood: Autonomy vs. Shame and Doubt

Autonomy: Support and encourage the child to explore the environment

Task: The need to establish a differentiation between the self and its own will and pressure from the outside influence. Supportive and consistent toilet training leads to development of self confidence that he can control himself and the environment.

Shame and Doubt: If the mother rejects childs attempt to explore the environment and the parents lack of confidence to the abilities of the child. Child becomes insecure and learns to become ashamed of himself.

 3.) Initiative vs. Guilt Major Task: Accomplishment proper sex rule identification resulting to resolution of Oedipus complex. Failure leads to improper sex rule identity. Initiative to explore and reach security outside the home could lead to guilt. The sense of badness may develop which could restrict initiative. Child is ready to learn quickly and to mature and to cooperate successfully with others. Social Skill: Cooperative Play 4.) Industry vs. Inferiority Major Tasks: Acquisition of competence Child is halfway outside the family world. This is the active period of socialization. Child works with others and produce thing which should be recognized to prevent inferiority. Peer most important person. The child learns to win recognition by finishing tasks to completion, producing things, solving problems
Frequent Asking Is Initiative

Cont. Early Childhood

Social Skill Parallel play

Anal needs are of primary importance Father emerges as the important figure Development of muscular maturation. This sets the scene of two simultaneous sets of social modalities holding on or letting go Primary need: Power It is the obsessive-compulsive phase of development

Strong Shame and Doubt will result to:

Rebelliousness Stubbornness or compliance Compulsiveness like being meticulous and perfectionist Cleanliness Jealousy Over compensatory control

3.) Preschool : Initiative vs. Guilt(Development of Conscience)

Major Task: Accomplishment proper sex rule identification resulting to resolution of Oedipus complex. Failure leads to improper sex rule identity.

Initiative to explore and reach security outside the home could lead to guilt. The sense of badness may develop which could restrict initiative. Child is ready to learn quickly and to mature and to cooperate successfully with others. Frequent Asking Is Initiative

Social Skill: Cooperative Play 4.) School Age: Industry vs. Inferiority
Major Tasks: Acquisition of competence

Child is halfway outside the family and world. This is the active period of socialization. Child works with others and produce thing which should be recognized to prevent inferiority. Peer most important person. The child learns to win recognition by finishing tasks to completion, producing things, solving problems

5.) Puberty : Identity vs. Role Diffusion

Major Tasks: Acquisition of fidelity.

Diffusion the sense of ones own identity or diffusion of identity because of attempt to be too many person. 6.) Young Adulthood : Intimacy vs. Isolation Characteristic:
Task: Establishment of friendship and eventually a satisfying marriage.

Rapid physical development advent of sexual maturity precipitate. Search for self identity, period of rapid physiologic or psychologic revolution. Emancipation from family, heterosexual relationship, develops ideology and philosophy of life; highest incidence of Schizophrenia

Human closeness and sexual fulfillment. Forms mutually regulating work procreation and recreation. Arrives at working philosophy of life. Tolerant. Has a mastered environment.

7.) Mid- Adulthood : Generativity vs. Self Absorption and Stagnation

Major Tasks:Acquisition of ability to care.

Generativity is reflected in the individual establishments

and guiding the next generation. The person is productive and creative in both career and family. There is willingness to assume responsibility for others.

8.) Older Adult : Integrity vs. Despair Integrity - is achieved when the individual accepts
responsibility for what his life has been and finds it has worth.

Characteristics:
Wisdom is achieved. Period of Reminiscence characterized by a unifying philosophy for life.

III. THE INTERACTING NURSE-PATIENT RELATIONSHIP

Communication - refers to the reciprocal exchange of ideas, beliefs, attitude or feelings between or among persons. A. Mode of Communications 1. Verbal the transmission of message using the spoken or written language. 2. Non verbal actions or behaviors that communicate a message without speaking.
Facial expressions Posture Manner of dress Body language Hand gestures Proxemics

 GENERAL PRINCIPLES 1. Non- verbal communication is multi-channeled. 2. Non- verbal communication is relatively spontaneous. 3. Non- verbal communication is relatively ambiguous. 4. Non verbal communication may contradict verbal messages. 5. Non- verbal communication is very culture bound. RELATED TERMS: Kinesics the study of communication through body
language.

Proxemics

the study of peoples use of interpersonal space. is a zone of space surrounding a person that is felt to belong to that person. the marking off and defending of certain areas as their own. said. refers to how something is said rather than what is

Personal Space Territoriality

Paralanguage

INTERPERSONAL DISTANCE ZONES: 1. Public Distance (12 ft and beyond); for actors total strangers, important officials. 2. Social Distance (4-12 ft); for social gatherings, friends and work situations. 3. Personal Distance (18 inches 4 ft); close friends. 4. Intimate Distance (0 18 inches); parents and children, lovers, husband and wife. COMPONENTS OF COMMUNICATION 1. Sender source of information 2. Message information being transmitted. 3. Channel mode of communication 4. Receiver recipient of communication 5. Feedback return response 6. Context the setting of communication

 THERAPEUTIC NURSE-PATIENT RELATIONSHIP

Definitions: Nurse-Patient Relationship results from a series of interaction between a nurse and a patient/ client over a period of time, with the nurse focusing on the needs and problem of the person/family/group while using the scientific knowledge and specific skills of the nursing profession. Therapeutic Nurse-Patient Relationship a mutual learning experience and a corrective emotional experience for the patient; the nurse uses herself and specified clinical technique in working with the patient to bring about behavioral change.

Goals of the Therapeutic Nurse-Patient Relationship:

1. Self-realization, self-acceptance and increased genuine self-respect. 2. Clean sense of personal identity and an improved level of personal integration. 3. An ability to form intimate,interdependent, interpersonal relationship with a capacity to give and receive love. 4. Improve functioning and increased ability to satisfy needs and achieve realistic personal goals.

Characteristics of Therapeutic Nurse-Patient Relationship:

1. Listening perceiving the patients message in the cognitive and affective domains. 2. Warmth feeling of cordiality and affection. 3. Genuineness being oneself and not acting out a role; being open & truthful. 4. Attentiveness demonstrating a concentration of time and/or attention on the patient. 5. Empathy understanding the patients feelings; viewing the world as the patient does. 6. Positive Regard accepting the patient as he is; nonjudgmental. 7. Humor ability to see the funniness of a situation to be amused by ones own imperfection, to see the funny side of the otherwise serious situation. 8. Consistency maintaining the same basic attitude toward the client, so that he derives security from being able to predict her behavior.

Response of Patients and Nurse in the NPR:

Resistance patients attempt to remain unaware of anxiety-producing aspects within herself. Transference the experiencing of feelings, drives, attitudes, fantasies, and defenses toward a person in the present that do not befit that person but rather are a repetition of reactions originating with significant others during early childhood, unconsciously displaced onto figures in the present. Counter-transference involves feelings of the nurse (positive or negative) toward the patient, such as special concern, sexual attraction, anger, impatience or resentment.

Considerations in Setting Limits for Patients:

1. The most general consideration is that the nurse cannot be completely permissive or completely restrictive. 2. The nurse should take into account the patients degree of comfort and feeling of being respected which may result from limits set on his behavior. 3. The nurse should also take into account the consequences of the limits set on his behavior.

4. The nurse should also consider her own feelings and attitudes in restricting a patient.
5. The effect of limit setting on a relationship of the nurse and patient. 6. The extent to which the nurse will be able to maintain the limits set for the patient. 7. The time at which a limit is set and the nurses attitude in setting it.

Indications or Signs of a Non-Therapeutic/Distorted Involvement

Distorted Involvement - the nurse uses the patient primarily for her own emotional needs and purposes. 1. Excessive worry over the patient. 2. Feeling of intense hatred for him. 3. Preoccupations with him to the exclusion of other patients or being constantly overcome with pity for him. 4. Being possessively attached to a patient that she resents to anyones relationship with or interest in him. 5. Feeling that no one else can nurse him as well as she can. 6. Being frequently upset when the patient is upset or when things dont go right for him. 7. Unable to accept anyones point of view concerning activities with the patient. 8. Joke or tease in harsh belittling manner.

 The nurse Patient Interaction

- A single encounter engaged in by a particular setting for the purpose of facilitating the patients recovery through the utilization of the nurses special knowledge and skills, professional not social and is directed toward moving patients from maladaptive behavior

Phases of the Nurse Patient Interaction

1. Pre-orientation Phase
Begins when the nurse is assigned to a patient Phase of NPR in which the patient is excluded as an active participant Nurse feels certain degree of anxiety Includes all of what the nurse thinks and does before interacting with the patient *Major task of the nurse: to develop self-awareness Other tasks: Data gathering, planning for first interaction

Joharis Window
Known to self
Known to others

Not known to self

Public self I Private self III

Semi-public self II Area of the Unknown IV

Not known to others

2. Orientation phase.

The purpose of the orientation phase is to become acquainted; gain rapport; demonstrate genuine caring and understanding; and established trust. The orientation phase usually last from 2 to 10 sessions, but with some patients can take many months. *Major task of the nurse: To develop a mutually acceptable contract Other tasks

Determine why the patient sought help Establish rapport, develop trust, assessment
Ways to Build trust and security (first level of an interpersonal experience): Be confident- follow contract, keep appointments. Allow patient to be responsible for contract. Convey honesty. Show and caring and interest. When patient is unable to control behavior, nurse set limits and/or provide appropriate alternatives outlets.

Discuss the contract: dates, times, and place of meetings; duration of each meetings; purpose of meetings; role of both patient and nurse; use information obtained; arrangements for notifying patient/ nurse if unable to keep appointment.
Facilitate the patients ability to verbalize his or her problem.

Be aware of themes:

Content (what the patient is saying). Process (how the patient interacts). Mood (hopeless, anxious). Interaction (did the patient ignore you, was he or she submissive, did he or she dominate conversation

Observation and assess the patients strengths and positive aspects of his or her personality. Include the patient in identification of his or her own attributes. Identify patients problems, nursing diagnosis, outcome criteria, and nursing interventions; formulate nursing care plan.

Patient Responses to Orientation Phase

May willing engage in the therapeutic relationship. May test you and the limits of the relationship: May be late for meetings May end meeting early. May play nurse (you) against the staff. May not remember your name or appointment time: Put information on a card and give this to patient. Reinforce contract in early meetings and restate limits if necessary. May attempt to shock: May use profane words. May share an experience that patient feels will shock or frighten you. May use bizarre behavior. May focus on nurse in an attempt to see if nurse is competent. Focus on patient.

3. Working phase.

This phase begins when the patient assumes responsibility to uphold the limits of the relationship. Focus is on the here and now. The purpose of the working phase is not to bring about positive changes in the patients behavior.

Set priorities when determining patient needs:

Preserve life and safety: is patient suicidal, not eating, smoking in bed while medicated, acting out behavior harmful to others?

Modify behavior that is unacceptable to others: such as e.g., acting out of hostile verbalization, bizarre behavior, withdrawal, poor hygiene, and inadequate social skills. Identify with patients those behaviors he or she is willing to change; set realistic goals. Make goal testable and attainable for successful experiences. This will increase sense of self worth and help patient accept need for growth.

Working Phase
It is highly individualized. More structured that the orientation phase The longest and the most productive phase of the NPR. Limit setting is employed *Major Task of the Nurse: Identification and resolution of the patients problems. - Other Tasks: Planning and Implementation

Patient Response to Working Phase

May use less testing, less focusing in nurse, fewer attempts to shock nurse. May remember anticipate appointment with nurse. May use more description and clarification to facilitate understanding; wants you to know how he/she feels. May be more responsive in interaction. May improve appearance. May bring up topic he/she wished to discuss.

May confide more confidential materials. The working phase is painful for patient, and is reached when change occurs as problems are analyzed and discussed by patient and nurse.

4. Termination phase.

The purpose of this phase is to dissolve the relationship and assure the patient that he or she can be independent in some or all of his or her functioning. - Ideally the termination phase should begin during orientation phase. The more independent and involved relationship required longer time for termination. Termination usually occurs if the patient has improved sufficiently for the relationship to end, but it may occur if as patient is transferred or you as a nurse leave the agency.

 Termination Phase - It is a gradual weaning process. - it is a mutual agreement. - It involves feelings of anxiety, fear and loss. - it should be recognized in the orientation phase. -* Major Task of the Nurse: To assist the client to review what he has learned and transfer his learning to his relationship with others. - Other task: Evaluation

WHEN TO TERMINATE: - When goals have been met/ accomplished. - When the patient is emotionally stable. - When the patient exhibit greater independence. - When the patient is able to cope with separation anxiety, fear and loss.

Methods of decreasing the involvement:

Space your contracts farther apart (not usually necessary in the student clinical experience). Reduce the usual length of time you spend with patient. Change the emotional tone of the interactions by:
Not responding to or following up clues that led to new areas to investigate. Focusing on the future oriented material.

Some patient may want to work up to the last meeting; use your judgment.

What to discuss with patient about termination

Help patient to discuss his/her feelings about it. Have patient talk about gains he/she has made. (Include negative aspects of sessions also) Share with the patient the growth you in him/her. Express benefits you have gained fore the experience. Express your feelings regarding leaving patient. Never give patient your address or telephone number.

Patient Responses to Termination

May deny separation. May deny significance of relationship and/or termination May express anger or hostility (overtly or covertly). Anger openly express to nurse, may be a natural and healthy response to events. Patient feels secure enough to show anger. Nurse responses to above in accepting, neutral manner. May display marker change in attitude toward nurse/therapist; may make critical remarks about nurse or be hostile because of pending break of emotional ties. If the nurse doesnt understand the reason for the patients reaction, he/she may react with anger or defensiveness and block the termination process. May display a type of grief reactions. It takes time to get over the loss, which is why it is important to start the termination process early. May feel the rejected and experience increased negative self-concept. May terminate relationship prematurely. May regress to exhibition of old symptoms. May request premature discharge. May make suicide attempt. May be accepting but may still express regret or fell momentary resentment. This is healthy response. Make a clean break or you may hinder the patient realization that relationship often must and do, terminate.

THERAPEUTIC NURSING PROCESS

The nurse promotes goal-directed activities that help to alleviate the discomfort of the client by promoting growth and satisfying interpersonal relationships. Characteristics: Goal directed Understanding, empathic Concreteness Honest, open communication Acceptance; nonjudgmental attitude

ORIENTATION PHASE (Teach them!) Trust and Rapport Environment (Therapeutic) Assess clients strength and weaknesses Contract (Therapeutic) Help communicate

WORKING PHASE (Provide therapeutic experience) Promote Positive self concept Realistic goal setting Organize support system Verbalize feelings (encourage) Implement action plan Develop positive coping behaviors Evaluate the results of plan of action

TERMINATION PHASE (Take Pride!) Promote self care Recognize increasing anxiety Increase independence Demonstrate emotional stability Environmental support

Differentiating SOCIAL and THERAPEUTIC Relationship

Differentiation Characteristics Goal Termination Identification Resources used

SOCIAL INTERACTION Personal and intimate Doing favor for mutual benefit Not defined May not occur Variety during interaction

THERAPEUTIC RELATIONSHIP Personal but NOT intimate Promoting functional use of ones latent inner resources Defined in the beginning By client with help of the nurse Specialized professional skills for intervention

Focus of therapeutic relationship is in helping clients (RELEASE)

Reinforces self-worth Enhance self-concepts and confidence Learn coping strategies Examine relationship Achieve Growth Solve Problems Extinguish (let go) of unwanted behavior

THERAPEUTIC COMMUNICATION TECHNIQUES

Technique Offering self

Description/Definition The nurse offers to stay with the client and either talk or just sit quietly.

Example Let me sit with you for 15 minutes and read a story. Id like to eat lunch with you. Lets walk to the cafeteria together. Where would you like to begin. Talk more about What would you like to tell me about yourself? Tell me whats been in your mind? Im interested in hearing about issues of concern to you.

Providing broad opening

The nurse invites the client to select a topic

Making an observation

The nurse acknowledges that something or someone exists or has changed in some way.

You appear anxious. I notice that you have been coming to lunch with the group. You have drawn a picture> Thats a new hairstyle, isnt it? I noticed on the chart that today is your birthday.
Lets try to figure this out together. Lets talk and see if we can work together to understand this. Perhaps we can discuss this and see what offended you. (Silence)

Suggesting collaboration

The nurse makes an offer to work together with the client.

Providing silence

The nurse allows the verbal conversation to stop to provide a time for quiet contemplation of what has been discuss, formulation of thoughts about how to proceed, or for intension reduction.

Accepting messages

The nurse acknowledges that he or she has heard and understood what he client has said.

Yes Okay Nodding Uh hmmm. (Smiling) Um-hmm. (Nodding) I hear what youre saying. I understanding. Go on Talk more about Then what? Please go on. And? You said you liked Carl best. Can you tell me about Carl? Your said you get more satisfaction out of helping out at the flower shop. Id like to hear more about that. These dreams you mentioned. What are they like? What seems to be the problem? Tell me more about Give an example of what you mean. Lets look at this more closely. You said you hate all your brothers. Tell me about Carlo first. Youve briefly mentioned three different suicide attempts. For now, Id like to focus on just what was going on with you at the time of the first attempt. Lets return to the last point you made and talk more about that.

Providing general leads

The nurse provides brief interjections that let the client know that he or she is on the right track and should continue.

Exploring

The nurse asks the client to describe something in more detail or to discuss more fully.

Focusing

The nurse selects one topic for exploration from among several possible topics presented by the client.

Asking for clarification

The nurse lets the client know that what was said was unclear. If necessary, the nurse asks for clarification or provides input regarding how to make the message clearer.

Im not sure that I understand what youre saying. Do you mean? I didnt understand what you meant then. Can you say that in different words? Let me repeat back to you what I think I heard you say.
Child: Ugh! Thats poo poo! Nurse: The medecine tastes pretty bad, huh? Adolescent: I called Ralph on the big white porcelain telephone. Nurse: You vomited. Adult: Im down. Nurse: You feel depressed?

Restating

The nurse paraphrases what the client has said. This paraphrased message may be fed back to the client in the form of a statement or a question to provide the client the opportunity and clarify further.

Seeking consensual validation

The nurse attempts to verify with the client that a certain term means the same thing to both parties.

You want moo moo? Does moo moo mean milk? When you say your brother is crazy, does the word crazy mean kind of wild? Tell me if we both understand the word the same way. Were you frightened before or after the movie? Tell me what went on before the fight broke out the gym?

Placing events in time or sequence

The nurse asks the client to explain more about when an event occurred (placing the event in time) or to explain the sequence of a series of events.

RESPONSE 1. False reassurance

EXAMPLE Dont worry; you will be better in few weeks. Dont worry; I had an operation just it; it was a snap.

2. Giving advise
3. Rejecting 4. Belittling

What you should do is If I were you, I would do

I dont it when you Please, dont ever talk about Everybody feels the way. Why, shouldnt feel that way.

5. Probing
6. Overloading

Tell me more about your relationship other men.

Hi, I am Joann, your student nurse. How old are you? What brought you to the hospital? How many children you have? Do you want to fill out your menu right now? Not giving enough information so that the meaning is clear; withholding information. Gee, the weather is beautiful outside.

7. Under loading 8. Clichs

ALPHABET OF THERAPEUTIC COMMUNICATION Accepting Broad opening Clarifying Opening Present reality Questions not answerable not yes or no Demonstrate unconditional positive regard Reflecting Exploring Sharing of observation Focusing Trust General leads Using silence Here and now behavior Validating Informing What is said and more important than why it is said Jargon, figure of speech Xplore alternatives rather than answer of solution Keep respect You are interested to listen Master active listening Zest up-show interest Never advise

NONTHERPEUTIC COMMUNICATION False reassurance; Giving advise; Rejecting; belittling; Probing; Overloading; Underloading

Best responses are those that:

Encourages client to express more fully Reflects or re-states what the client has earlier said Reflects the feelings that are identified and encourage expression of these feelings Encourage hope (never with false assurance) Clarifies clients statement Acknowledges clients non verbal behavior Uses silence but expresses being there Informs Clarifies and validates

Remember to:
Focus on client Accept client as s/he is Be honest and consistent Attempt to establish good relationship (rapport) Allow client then family to make decision Answer according to nursing action Do not provide response that implies that the client is unworthy Select the most comprehensive (global) answer Focus on the feeling of client

Never:
Give response that belittles, negates or devalue Advice or show approval or disapproval Ask for explanation or why Avoid Be defensive

PSYCHOSOCIAL ASSESSMENT
PSYCHIATRIC HISTORY To identify patterns of functioning that are as well as patterns that create problems in the clients everyday life. A. General history of client information B. Components of psychiatric history Obtain general demographic Pertinent personal history Previous mental health hospitalization Presenting symptoms Family history Personal profile

MENTAL STATUS EXAMINATION

A. General appearance attitude and behavior. B. Characteristics talks and stream of thought. Description: posture, gait, activity, facial expression, mannerisms Disturbances include deviations of activity, distortions in mobility (waxy flexibility or dyskinesia), uncooperativeness, and changes in personal hygiene. Descriptors: emphasis on form, rather than content of clients verbal communication: loudness, flow, speed, quality, logic, level of coherence. Disturbances include the following patterns: Mutism extreme form of negativism Circumstantialitiy beating around the bush Perseveration repetition of a single word or phrase over and over Flight of ideas rapid transition from one topic to another, without completing the original thought (common in manic) Blocking sudden cessation of thought Echolalia repeating exactly what is heard Neologism inventing words only he understands Verbigeration Pressured speech -

C. Content of thought.

Descriptors: what is central theme? How does client view himself ( self-concept)? Is suicidal of homicidal ideation present? If so, what is potential lethality? Disturbance include: special preoccupations and experiences such as Hallucinations sensory perceptions that have no external stimuli Illusions misperception of an external stimuli Delusions false belief Depersonalization subjective sense of feeling unreal, strange, unfamiliar or emotional numb Obsessions maladaptive persistent patterns of thought, images or feelings that generate anxiety Compulsions maladaptive urges to act on impulse (ritualistic behaviors) Preoccupations recurrent thought or center of particular idea or thought with an intense emotional component Phobias irrational fear fantasies and daydreams. Descriptors: clients report of subjective feeling (mood or affect) and examiners observation of clients pervasive of dominant state. Disturbances include deviations such as elation incongruence, and depression disassociation. apathy

D. Emotional state

E. Sensorium and intellect

Determine degree of clients awareness and level of intellectual functioning, general ability to grasp information and calculate; abstract thinking; memory (recall of remote past and recent experiences, retention and recall of immediate impressions; and reasoning and judgment). Disturbances of orientation in terms of time, place, person and self memory retention attention information judgment

ANXIETY
Definition:
A diffused unpleasant uneasiness, apprehension, or fearfulness stemming from anticipated danger. The source of which is unidentifiable.
It is the basic element of behavior. Serves as a signal which alerts an individual to defensive action to handle exhibition. Necessary for ones survival. It is an emotion and a subjective experience of the individual. It is an energy and as such cannot be observed directly. It can only be inferred from the persons behavior. Emotion without a specific object. It is provoked by the unknown. It therefore precedes all new experiences like entering school, moving to new places, starting a new job, etc. It is communicated personally.

Characteristics

Precipitating Factors to Anxiety Two Categories:

Threat to biological integrity refers to the disturbance in homeostasis i. e., temperature control, vasomotor stability, etc. Threat to self esteem refers to the threat to the tendency of an individual toward maintaining established views of self and the values and patterns of behavior he uses to resist changes in self view.
Sense of helplessness Sense of isolation (alienation) Sense of insecurity (Threat to identity)

Behavior Response to Anxiety

Anger Defensive behavior Irritation Complaining Crying Denial Withdrawal Forgetfulness Quarreling

Levels of Anxiety
Level Effects Upon the Ability to Observe Effects Upon the Ability on What is Happening

1. Mild

Person is alerted, sees, hear, and grasps more the previously -Level this can motivate learning and can produce growth and creativity in the individual. -Associated with the tension of everyday living

-Increased awareness and alertness -Attention is possible. -Skills in seeing relations can be used.

2. Moderate

Persons perceptual field is narrowed sees, hears, grasps less but can attend to more if directed to do so.

Selected in attention i. e., individuals fails to notice what goes on in situations peripheral to the immediate focus but can notice if attention is pointed there by another observer.

3. Severe

Perceptual field is greatly reduce. HEARING IS NOT POSSIBLE -He tends to focus on a specific detail and all his behavior aimed at getting relief.

Dissociating tendencies operate to panic i. e., the person does not notice what goes on in a situation (specifically communication with reference to the self). And there is inability to do so even when attention is pointed to this direction by another observer.
Person becomes immobilized (emotional paralysis) Increase motor activity Decrease ability to relate to others

4. Panic

Involves disorganization of the personality. -Individual experience loss of control -Unable to do things even with direction -Distorted perception -Lost of rational thought

Level of Anxiety depends on the following factors:

Maturity of individual The understanding of the illness Level of the self esteem Use of coping mechanisms

GENERAL INTERVENTION FOR ANXIETY For the patient with severe or panic level of anxiety.

Goal: To lessen the degree of anxiety through supportive and protective measures.

Limits environmental stimuli. Establish a supportive and trusting relationship. Keep demands at a level the patient can handle. Minimize problem solving activities. Do not confront the patient about coping mechanisms. Provide physical activities to release energy. Administer prescribed tranquilizers in a time manner. It gives immediate relief in acute distress or to stabilize the patient so that he will be able to participate in the process of therapy.

For the patient with moderate anxiety.

Goal: To help patient develop the capacity to tolerate anxiety and use it consciously and constructively.
Teach about precipitating stressors, coping strategies, adaptive and maladaptive responses. Use the problem solving process to help the patient recognize onset of anxiety, situational stressors and coping abilities. Promote relaxation responses. Provide explanations/information briefly and repeat if necessary.

KEY NURSING INTERVENTIONS TO REDUCE ANXIETY

1. Provide a calm and quiet environment
Rationale: to identify and reduce stimulation, which includes

exposure to situations and interactions with other patient that could provoke anxiety

2. Ask patients to identify what and how they feel

is happening on them.

Rationale: to help patient increase their recognition of what

3. Encourage patients to describe and discuss their feelings

Rationale: To help patients to increase their awareness of

the connection between feelings and behavior.

4. Help patients to identify possible causes of their feelings.

Rationale: To assist patients in connecting their feelings with earlier experiences.

5. Listen carefully to patients expression of helplessness and hopelessness.

Rationale: To assess for help-harm, patients could be

suicidal because they want to escape their pain and do not think they ever feel better.

6. Ask patients if they feel suicidal or have a plan to hurt themselves

Rationale: To assess for help-harm and to initiate

suicides precautions as necessary.

7. Plan and involve patients in activities such as going for walks or playing recreational games.
Rationale: To help patients release nervous energy

and to discourage preoccupation with self.

KEY NURSING INTERVENTIONS IN PROBLEM SOLVING

1. Discuss with the patients their present and previous coping mechanism
Rationale: To reinforce effective adaptive coping.

2. Discuss with the patients the meaning of problems and conflicts

Rationale: To help patients appraise stressors, explore their

personal values and define the scope and seriousness of their problems

3. Use supportive confrontation and teaching.

Rationale: To increase patients insight into the negative

effects of their maladaptive and dysfunctional coping behaviors.

4. Assist patients in exploring alternative solutions and behaviors

Rationale: To increase adaptive coping mechanisms.

5. Encourage patients to test new adaptive coping behaviors through role-playing or implementation
Rationale: To provide an opportunity for patients to practice

new behaviors.

6. Teach patients relaxation exercises.

Rationale: To reduce the level of anxiety. These techniques

help patients to manage or control anxiety on their own.

7. Promote the use of hobbies and recreational activities

and anxiety.

Rationale: To help patient deal with routine feelings of stress

DETRIMENTAL INTERVENTIONS IN ANXIETY

Pressuring the patient to change prematurely.

Disapproving verbally a patients behavior

Asking patient a direct question that place him on the defense Confrontation. Focusing in a critical way on the anxious feelings of the patient with other patients.

Lacking awareness of her (nurse) own behavior.

Withdrawing from the client.

CRISIS THEORY AND INTERVENTION

Crisis theory - is based on a body of concept that has, when applied, great potential for improving mental health. CRISIS refers to the state of the reacting individual who finds himself in a hazardous situation oin which the habitual problem solving activities are not adequate and do not lead rapidly to the previously achieved balance state. CRISIS INTERVENTION means the entering into the life situation of man individual, family or group to alleviate the impact of a crisis including stress in order to help mobilize the resources of those directly affected, as well as those who are in the significant social orbit.

CONCEPTS:
1. CRISIS INTERVENTION CAN OFFER THE IMMEDIATE HELP THAT A PERSON IN CRISIS NEEDS INORDER TO REESTABLISH EQUILIBRIUM.

2. CRISIS IS AN UPSET IN A STEADY STATE

A person in crisis is at a turning point. He finds himself in a hazardous situation He face a problem he cannot readily solve by using the coping mechanisms that have work for him before. As a result, his tensions and anxiety increases. He becomes less able to find a solution. He feels helpless and caught in a state of great emotional upset and feels unable to take action on his own to solve his problem.

3. THERE ARE THREE TYPES OF CRISIS a. Normal developmental or Maturation life crisis e.g. birth, school age, marriage, pregnancy, etc. b. Abnormal and accidental or Situational life crisis e.g. accident, death, illness, etc. c. Combination of developmental and accidental crisis e.g. pregnancy in women who are victims of rape.

4. CRISIS IS SELF LIMITING IN A TEMPORAL SENSE.

Some solutions are sought which will lead to the previous state of equilibrium, or a higher or lower level of functioning.

5. THERE ARE CERTAIN TYPICAL CHARACTERISTICS OF THE PERIOD OF CRISIS.

Phases of crisis
a. Initial there is rise in tension in response to initial impact of stress. b. Intermediate emergency problem solving mechanisms are called forth which may lead to actual solution of the problem. c. Third Phase major disorganization if no solution

occurs.

6. THE PERSON IN CRISIS EMPLOYS VARIOUS CHARACTERISTIC COPING PATTERNS Maladaptive uses avoidance, fantasy, regression, panic Adaptive able to verbalize, seek and use help from the environment.

7. THE PERSON IN CRISIS BECOME MORE SUSCEPTIBLE TO THE INFLUENCE OF SIGNIFICANT OTHERS IN THE ENVIRONMENT.

a. The degree of activity of the helping person does not have to be high. b. Time of intervention should be of strategic importance.

8. CRISIS INTERVENTION IS DESIGNED TO FACILITATE ADAPTIVE COPING PATTERNS ON THE PART OF INDIVIDUAL, FAMILY OR COMMUNITY.

a. Help is given during the period of time when this individual in crisis is working at establishing coping patterns.

9. CRISIS HAS GROWTH PROMOTING POTENTIALS , NOT AN ILLNESS.

a. With help given at the proper time, people in crisis can come through trouble in a healthy way. b. Crisis may enable the individual to establish new coping mechanism which serve to strengthen his capacity to deal with life problems, thereby raising his level of mental health