UNIT II MAJOR DISORDERS AND CARING INTERVENTIONS

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UNIT II MAJOR DISORDERS AND CARING INTERVENTIONS

• Traditional Therapeutic approaches
• Psychobiology
• Suicide and Crisis Intervention
• Anger and Aggression
• Mood Disorders
• Schizophrenia
• Cognitive Disorders
• Anxiety Disorders

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Psychodynamic Theories
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Freud's Psychoanalytic Theory

• Levels of awareness
• Conscious - contains all of the material that
  the person is aware of
• Preconscious material that can be retrieved
  rather easily through conscious effort
• Unconscious repressed memories, passions, and
  unacceptable urges

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Freud's Psychoanalytic Theory Continued

• Personality structure
• Id
• Pleasure principle
• Reflex action
• Primary process
• Ego
• Problem solver
• Reality tester
• Superego
• Moral component

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Freud's Psychoanalytic Theory Continued

• Defense mechanisms and anxiety
• Operate on unconscious level
• Deny, falsify, or distort reality to make it less
  threatening

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Freud's Psychoanalytic Theory Continued

• Experiences during the early stages of life
  determine an individual's lifetime adjustment
  patterns and personality traits.

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Freudian Theory and Nursing

• Formation of personality
• Conscious and unconscious influences
• Importance of individual talk sessions
• Attentive listening

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Erikson's Ego Theory

• Eight stages of development
• Personality continues to develop through old age
• Failures at one stage can be rectified at another
  stage

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Erickson's Theory and Nursing

• Developmental model part of nursing assessment
• Helps determine what types of interventions are
  most likely to be effective

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Sullivan's Interpersonal Theory

• Purpose of all behavior is to get needs met
  through interpersonal interactions and decrease
  or avoid anxiety
• Security operations those measures that the
  individual employs to reduce anxiety and enhance
  security.
• Self system all of the security operations an
  individual uses to defend against anxiety and
  ensure self esteem

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Sullivan's Theory and Nursing

• Foundation for Hildegard Peplau's theory
• Participant observer
• Mutuality
• Respect for the patient
• Unconditional acceptance
• Empathy

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Humanistic Theories
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Maslows Hierarchy of Needs

• Human beings are active participants in life,
  striving for self-actualization
• Basic needs
• D-motives/deficiency needs
• Self-esteem and self-actualization
• B-motives/being needs

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Maslow's Theory and Nursing

• Emphasis on human potential and the client's
  strengths
• Prioritizing nursing actions in the nurse-client
  relationship

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Behavioral Theories

• Pavlov's classic conditioning theory
• Watson's behaviorism theory
• Skinner's operant conditioning theory
• Implications for nursing
• Altering targeted behaviors
• Behavior management

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Biological Theories

• Focus on
• Neurological
• Chemical
• Biological
• Genetic
• How do the body and brain interact to create
• Emotions
• Memories
• Perceptual experiences

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Biological Theories and Nursing

• Consider other influences that play a role in the
  development and treatment of mental disorders
• Social, environment, cultural, economic
• Focus on the qualities of a therapeutic
  relationship
• Apply newest findings of biological model in
  nursing practice

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Biological Theories

• Focus on
• Neurological
• Chemical
• Biological
• Genetic
• How do the body and brain interact to create
• Emotions
• Memories
• Perceptual experiences

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Nursing TheoriesPEPLAU INTERSPERSONAL
RELATIONS IN NURSINGPatricia BennerDorothea
OremSister Callista RoyBetty NeumanJoyce
Travelbee
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Peplau and the Therapeutic Relationship

• Peplau influenced by Sullivan's work
• Interpersonal Relations in Nursing (1952)
• Major paradigm shift in nursing
• Levels of anxiety

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Hildegard Peplau

• The art of nursing
• Provide care, compassion, and advocacy
• Enhance comfort and well-being
• The science of nursing
• Application of knowledge
• To understand a broad range of human problems and
  psychosocial phenomena
• To intervene in relieving clients' suffering and
  promote growth

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Therapeutic Approaches

• Classical psychoanalysis
• Transference
• Countertransference
• Psychodynamic and psychoanalytic
• ? oriented more to here and now
• Short-term dynamic psychotherapy
• ? ten or fewer sessions, best for the
  worried well
• Interpersonal psychotherapy
• ? used in specific problem areas grief,
  role disputes, role transition, interpersonal
  deficit

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Therapeutic Approaches Continued

• Cognitive therapy
• Behavioral therapy
• Modeling
• Operant conditioning
• Systematic desensitization
• Aversion therapy
• Milieu therapy
• Bruno Bettelheim

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ECT

• Procedure
• Advantages
• Potential adverse reactions

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Basic Concepts Related to Group Work

• Group Psychotherapy
• Specialized treatment intervention
• Led by trained leader or co-leaders
• Purpose is to treat clients with psychiatric
  disorders

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Advantages of Group Work

• Cost effective
• Client feels less isolated
• Clients receive peer feedback
• Teach different problem-solving approaches

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Phases of Group Development Roles of Leader and
Group

• Initial phase
• Leader Set up an atmosphere of respect,
  confidentiality, and trust
• Group Get to know one another
• Working phase
• Leader Encourage members to cooperate with each
  other and handle conflict
• Group Issues of power and control
• Mature phase
• Leader Keep group focused on therapeutic goals
  of individual members
• Group Develops functional norms and a sense of
  group identity
• Termination
• Leader Acknowledge the contributions of each
  member and the experience as a whole
• Group Prepare for the separation and for the
  future

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Informal Roles of Group Members

• Task
• Maintenance
• Individual roles

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Role of Group Leader

• Starting
• Maintaining
• Terminating

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Styles of Group Leadership

• Autocratic leader
• Democratic leader
• Laissez-faire leader

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Therapeutic Factors in Groups

• Instillation of hope
• Universality
• Imparting of information
• Altruism
• Corrective recapitulation of the primary family
  group
• Development of socializing techniques
• Imitative behavior
• Interpersonal learning
• Group cohesiveness
• Catharsis
• Existential resolution

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Basic Level Registered Nurse

• Able to assume responsibility for the following
  groups
• Medication education
• Sexuality
• Dual-diagnosis
• Multifamily
• Symptom management
• Stress management
• Community
• Self-care

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Advanced Practice Nurse

• Able to assume responsibility for the following
  groups
• Same groups as the basic level RN
• Psychotherapywith different types of
  theoretical foundations

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Patterns of Problematic Behaviors in Group Members

• Monopolizes group
• Complains but continues to reject help
• Demoralizes others
• Silent person