Roles of the nurse in different treatment modalities

1
Roles of the nurse in different treatment
modalities

• N127A
• Chia-Ling Mao

2
Individual Psychotherapy

• Foundation trusting relationship
• Goal changes in behaviors, self-perceptions,
  emotional comfort, insight
• Conceptual framework multiple including CBT
• Basic trust empathy helping the clients to
  help themselves empowerment with self-esteem
  self worth
• Transference
• Managed care -gthow gt why
• Practical problem insurers will not cover the
  costs

3
Types of individual therapies

• Classic psychoanalysis unconsciousness, R
• Cognitive therapy how irrational thinking
• Behavioral therapy - reshaping
• Cognitive - behavioral therapy thought action
• Rational emotive therapy situation, irrational
  belief -gt behavior
• Choice therapy doing gt feeling
  self-responsibility self-discipline
• Brief, solution-focused therapy

4
Outcome of psychoanalysis

• Insight into repressed conflicts
• Restructuring of the personality based on
  integration of repressed conflicts.

5
Cognitive Therapy

• Theorist Aaron Beck (1979)
• Cognitive Triad the interaction of the clients
  negative view of self, the world, the future
• How to perceive an event gt the event itself
• Cognition the clients construction of his
  world
• Roles of the nurse trust relationships, goals,
  review feelings, note accomplishments
• Using voicing doubt in dealing with clients
  cognitive distortion

6
Techniques of cognitive therapy

• Look for idiosyncratic meaning
• Question the evidence
• Reattribute
• De-catastrophize, Fantasize consequences
• Examine options and alternatives
• Weight advantages disadvantages
• Turn adversity to advantage
• Using thought stopping
• Use distraction

7
Outcome of cognitive therapy

• Recognition of irrational thinking patterns
• Enhancement of functional responses

8
Behavioral Therapy

• The concepts of behavior therapy stimulus,
  response, reinforcement
• Behaviors are measurable, observable,
• Classical conditioning S -gt R
• Operant conditioning
• Discriminative stimulus, response, reinforcing
  stimulus
• Learning, extinction
• Identify techniques for increasing/ decreasing a
  behavior

9
Behavior modification

• Conditioning
• Shaping
• Extinction
• Negative consequence/ punishment
• Time out
• Reinforcement
• Modeling
• Token economy

10
Nursing process behavior therapy

• Assessment appropriate/inappropriate behaviors,
  time, frequency, duration
• Dx expected changes
• Plan target response, decreasing or increasing,
  new skills
• Intervention reinforcement () (-)
• Evaluation outcomes (as planned) maintaining,
  additional change (if needed),

11
Focus outcome of behavioral therapy

• Promotion of desirable behaviors with
  alternations of undesirable behaviors
• Reshaping of behavior with elimination of
  negative behaviors

12
Cognitive-Behavioral Therapy

• Focus on making changes in current ways of
  thinking and behavior
• Nursing intervention self-responsibility
  self-discipline
• Nurse acting as a coach, teacher in identifying
  of situations involving undesirable thoughts and
  actions
• Example
• Pt My wife makes me so angry
• N What is self-defeating about the statement
  you just made

13
Outcome of cognitive-behavioral th.

• Participatory relationship between client and the
  therapist
• Results oriented
• Client learning new skills

14
Rational-emotive therapy (RET)

• Theorist Albert Ellis (1973)
• Present perceptions, thoughts, assumptions,
  beliefs, values, attitudes, and philosophies as
  needing modification or change.
• Should, ought, must .
• ABCD theory (Ellis, 1962) Intervention is aimed
  at B
• A activating event/antecedent behavior
• B belief about A
• C emotional reaction /consequence of the
  belief
• D disputation of those maladaptive belief
• Irrational belief -gt negative emotions

15
Roles of the nurse in RET

• Acceptance do not allow the pt to condemn
  themselves
• Challenge/confront the irrational thinking
• Present centered
• Help the pt learn to take responsibility for
  their ideas and behaviors.
• Homework assignments focus on positive statements
  and behaviors and skill development
• Role-playing modeling

16
Outcome of RET

• Client control of behavior and thinking
• Assumption of responsibility and blame for
  irrational beliefs

17
Group Therapy

• Definition evolution
• Leadership
• Types autocratic, democratic, Laissez-faire
• Power
• Group roles
• Group task roles initiator, information seeker,
  information giver, coordinator, recorder
• Group building maintenance roles encourager,
  harmonizer, gatekeeper
• Individual roles aggressor, blocker, recognition
  seeker, play person,

18
Group dynamics

• Group content
• Group process
• Pre-interaction phase selecting members,
  contract
• Orientation phase searching for similarity,
  building norms, politeness,
• Working phase attempt to solve the problems,
  conflict, cooperation
• Termination phase evaluates the experience and
  explores members feelings about it and the
  impending separation

19
Therapeutic factors of group therapy

• 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 factors

20
Family Therapy

• Background and evolution
• Family burden
• Iatrogenic burden from the MH
  system/professionals
• Objective burden practical problems
• Subjective burden grief, fear, guilt, anger

21
Roles of the healthy family

• Responding to family members needs
• Coping actively with lifes problems and stressed
• Accomplishing family tasks with equal
  distribution of power
• Encouraging interaction among family members and
  the community
• Promoting positive personal health practices

22
Conceptual framework of family therapy

• Structural family therapy Minuchin
• Boundary, role, sub-system
• Communication theory Satir
• Identified patient
• Communication style
• Distractor, placator, blamer,
• Pseudomutuality, pseudohostility
• System theory Bowen
• Calgary Family Assessment Model -

23
Concepts in Bowens theory

• Differentiation
• Triangulation
• Nuclear family emotion system
• Family projection process - scapegoat
• Emotional cutoff
• Mutigenerational transmission process
• Sibling position

24
Family Assessment Calgary Family Assessment
Model

• Family structure genogram, ecomap
• Family development/life cycle associated tasks
• Beginning families
• Early childbearing families
• Families with preschool children
• Families with school children
• Families with teenagers
• Launching center families
• Families of middle years
• Families in retirement and old age
• Family function
• Cultural consideration

25
Nursing Diagnoses (FT)

• Altered family processes
• Ineffective family coping
• Impaired home maintenance management
• Related issues
• Concept of resilience
• Major concerns of the care giver?
• Resources NAMI
• Confidentiality can be a barrier to including
  families in care

26
Family consultation vs. family therapy

• Family consultation
• services to the families
• secondary prevention scan feeling, focus,
  finding
• Clients symptoms spread distress through the
  family by a ripple effect
• Family therapy
• Clients symptom signal distress in the family
• Involves the participation of the entire family
• the family member with symptoms was not sick,
  he/she was the symptom bearer for a disturbed
  family system

27
Conclusion on Family Therapy

• Family as a system
• Changes involve whole system
• Application of change theory (Prochaska, 1992)
• Precontemplation, contemplation, preparation,
  action, maintenance
• Family myths
• Family harmony
• Parental determinism
• Breakdown of the family
• Materialism

28
Forensic Nursing

• Background overlap between the criminal justice
  mental health systems criminalization
  deinstitutionalization
• Clients victims, perpetrators, and their
  families
• Related issues legal, ethical, political,
  administrative, professional

29
Characteristics of the forensic setting

• Physical setting
• Client population
• Authoritarian interpersonal environment

30
Characteristics of the forensic population

• Poor judgment, limited reasoning abilities,
  history of not learning form past mistakes,
• High level of substance abuse
• Depression, suicidal ideation, aggressiveness,
  irritability, violence
• Personality disorder chr mental illnesses,
  mental retardation, brain injuries,
• Decreased social skills or physical strength
• Criminalized lifestyle

31
Crisis Intervention

• Characters of crisis
• a threat to homeostasis -gt anxiety, confusion,
  loss of problem solving ability
• Crisis danger opportunity
• Short 4-6 weeks

32
Phases of a crisis

• Increased anxiety -gt coping
• Coping failed -gt further increased anxiety
• Escalated anxiety -gt reach out for help
• Active state of crisis

33
Balancing factors

• Realistic perception of the events
• Coping skills
• Support systems

34
Nursing diagnoses

• Ineffective coping
• Anxiety
• Disturbed thought processes
• Situational low self-esteem
• Social isolation
• Impaired social interaction

35
Types of crises

• Maturational or developmental crisis various
  task in different states
• Situational crisis - sudden traumatic event ie
  job loss
• Adventitious crisis precipitated by an
  unexpected event ie, natural disasters

36
Somatic Therapy
37
Electroconvulsive Therapy

• Historic background 1938
• Mechanism unknown
• Modern ECT
• Nursing care before ECT like before surgery
• Explanation fear, stigma, fear, anxiety
• Physical exam - vital signs, lab data, spinal
  X-ray
• Consent form preparation
• NPO for 8 hours, moveable accessory,
• Atropine
• Empty bladder

38
Nursing care

• During ECT typical grand mal seizure with tonic
  and clonic phases
• After ECT
• Respiratory problems apnea, oxygen
• Confusion disorientation
• Memory impairment
• Recording

39
Issues related to ECT

• Advantages - , safety, effect,
• Disadvantages memory impairment

40
(No Transcript)