Positive Responses to Stress

• Adaptive behaviors maintain individual integrity and correlate with healthy responses and homeostasis.
• Maladaptive responses disrupt individual integrity and conflict intensifies, leading to negative outcomes.

Positive Responses to Stress

• Awareness is the first step; stress management requires acknowledging stressors and associated feelings.
• Relaxation techniques include sports, jogging, breathing exercises, and progressive relaxation.
• Meditation, practiced regularly (20 minutes, once or twice daily), reduces blood pressure, involves a comfortable position, closed eyes, and concentration on a single focus.
• Interpersonal communication is aided by a strong support system; talking through issues can be helpful.
• Problem-solving involves objective evaluation and applying a structured model, with assistance if needed.
• Pet care helps cope with life stressors; physical interaction like stroking a pet can be therapeutic.
• Music can relieve pain, improve motivation, enhance sleep, improve blood vessel function, and reduce stress.

Stages of Stress (ARE)

• Alarm Reaction: Fight-or-flight responses are initiated, pupils dilate, HR increases, airways relax, stomach activity is inhibited, epinephrine and norepinephrine are secreted.
• Resistance: The individual uses the initial physiological responses to adapt to the stressor and symptoms may disappear.
• Exhaustion: Occurs after prolonged stressor exposure when adaptive energy is depleted, resulting in diseases like headaches, mental disorders, coronary artery disease, ulcers, and colitis; without intervention, can lead to exhaustion or death.

Fight or Flight Syndrome

• Biological changes occur in response to stressful situations
• Symptoms arise from psychological or emotional stimuli similar to physical stimuli
• Psychological or emotional stressors can take longer to resolve than physical stressors

Ethical Egoism Framework

• Focuses on decisions that benefit the individual, without necessarily considering others.

Patient Rights

• Patients can legally refuse treatment unless immediate intervention prevents death or serious harm.
• The U.S. Constitution protects these rights through the First, Eighth, Fifth, and Fourteenth Amendments.
• In emergencies, medication can be given without consent to prevent harm, based on specific criteria
  • The patient's behavior is dangerous to themselves or others.
  • The medication provides a reasonable chance of helping the patient.
  • The patient is incompetent to evaluate the treatment's benefits.

Confidentiality

• The Fourth, Fifth, and Fourteenth Amendments protect privacy.
• State laws protect client record confidentiality
• Only those involved in a client's medical care can access their information without written consent.
• HIPAA grants individuals rights to access and correct their medical records and control information sharing; facilities own the document, but the client owns the information.
• Clients receive notice of privacy policies upon entering the healthcare system

Criteria for Involuntary Commitment

• Fourteenth Amendment protects against loss of liberty and ensures due process.
• Common criteria include:
  • Imminent danger to self (suicidal).
  • Danger to others (aggressive, violent, homicidal).
  • Inability to meet basic needs ("gravely disabled").
• Fourth Amendment protects against unlawful searches

Emergency commitments

• Occur when behavior is imminently dangerous to self or others. Initiated by relatives, friends, police, or healthcare professionals.
• Time-limited and require a court hearing within 72 hours.
• The court may discharge the individual or order involuntary hospitalization

Mentally Ill Person in Need of Treatment

• Involuntary commitment is for observation and treatment.
• May include individuals who:
  • Cannot make informed treatment decisions.
  • Are likely to harm themselves or others.
  • Cannot fulfill basic personal needs.
• Requires substantial evidence of abnormal conduct and clear evidence to ensure the protection of constitutional rights.

Involuntary Outpatient Commitment (IOC)

• Court-ordered outpatient treatment for individuals with mental illness.
• Preventive approach based on clinical assessment and future risk prediction.
• Requirements:
  • The person must have a mental illness.
  • The person is capable of surviving safely in the community with available supervision from family, friends, or others.
  • Based on the person’s psychiatric history, the person is in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness.
  • The person’s current mental status or the nature of their illness limits or negates their ability to make an informed decision to seek voluntary admission or comply with recommended treatment

The Gravely Disabled Client

• Defined as being in danger of serious physical harm due to inability to provide for basic needs.
• Determined not by lack of resources, but by the inability to use available resources.
• A guardian, conservator, or committee may be appointed by the court.
• Legal restoration of competency requires a court hearing.

Transference

• Patient unconsciously displaces feelings from their past onto the nurse, triggered by nurse's appearance or personality.
• Can manifest as affection or dependency, leading to anger when expectations are unmet.
  • Interventions:
  • The nurse shares observations about patient behavior and communication to explore meanings.
  • Assists the patient in recognizing influences on behavior and developing relationship skills.

Countertransference

• Nurse's emotional responses to the patient, transferring feelings from past experiences onto the patient.
• Related to unresolved feelings or responses to patient transference.
  • Interventions:
  • the Nurse develops awareness of factors influencing behavior to promote more adaptive strategies.
  • Peer or supervisory relationships are valuable for feedback

Empathy in Communication

• Ability to understand the patient's perspective beyond their behavior.
• Communicating this understanding while maintaining objectivity for problem resolution.
• Empathetic response is focusing on the patient's feelings instead of dwelling on personal feelings.

Stages of the Therapeutic Nurse-Client Relationship

• Preinteraction Phase: Preparation for the first patient encounter
  • Obtain available patient information
  • Examine personal feelings, fears, and anxieties
• Orientation Phase: Nurse and patient become acquainted
  • Creating an environment for trust and rapport.
  • Establishing a contract detailing expectations and responsibilities.
  • Gathering assessment information and identifying strengths and limitations.
  • Formulating nursing diagnoses and setting mutually agreeable goals
• Working Phase: Therapeutic work is accomplished
  • Maintaining trust, promoting insight, problem-solving, and overcoming resistance.
  • Continuously evaluating progress toward goal attainment.
• Termination Phase: Conclusion of the relationship
  • Progress towards goals, plan for continuing care, and recognition of feelings about termination.
  • Evaluate learning and summarize the relationship

Types of Groups

• Autocratic leaders set personal goals, withhold information, and focus on the leader; high productivity, low morale.
• Democratic leaders include member input, share information, and encourage participation; lower productivity, higher morale.
• Laissez-Faire leaders offer no direction, leading to frustration and low productivity and morale.
• Transformational leaders inspire and motivate teams towards a shared vision, fostering innovation and commitment to achieve organizational goals