Care of Clients with Maladaptive Patterns of Behavior (Acute & Chronic) 2021-2022 PDF

Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Course Outline School Year 2021-2022 COURSE DESCRIPTION: This course deal with concepts, principles, theories and techniques of nursing...

Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Course Outline School Year 2021-2022 COURSE DESCRIPTION: This course deal with concepts, principles, theories and techniques of nursing care management of clients with maladaptive patterns of behavior of individuals, families, population groups and communities, across the lifespan, in any health care setting. The learners are expected to provide safe, appropriate, evidence-based, holistic and individualized care to meet the full range of needs of the client experiencing psychiatric emergencies and/or those with mental health alteration/s through the principles and cultural/ethnic sensitivities. COURSE CREDITS 3 units Lecture and1-unit RLE Course Outcomes: 1. Apply knowledge of physical, social, natural and health sciences, and humanities in the holistic care of adult clients (individuals, families, population groups) with maladaptive patterns of behavior health needs in varied health settings. 2. Provide comprehensive safe, appropriate and holistic care to adult individuals, families, population groups with bio-psychosocial and behavioral needs and problems in varied health care settings utilizing nursing process. 3. Apply guidelines and principles of evidence-based practice in the delivery of care to clients with maladaptive patterns of behavior in varied health settings. 4. Practice nursing in accordance with professional standards, existing laws, legal, ethical and moral principles. 5. Communicate effectively with clients (individuals, families, population groups) and members of the health care team utilizing culturally appropriate language in both written and spoken means. 6. Document to include reporting up-to-date care of adult clients, families and population groups with physiologic and psychosocial health needs accurately and comprehensively. 7. Work effectively in collaboration with inter, intra, and multi-disciplinary and multi-cultural teams in caring for adult clients, families and population groups with physiologic and psychosocial health needs in varied health care settings. 8. Practice beginning management and leadership skills in the delivery of care for adult clients, families, and population groups with physiologic and psychosocial health needs in varied health care settings. 9. Conduct research with an experienced researcher or to enhance quality of psychiatric-mental health nursing care. 10. Engage in lifelong learning with a passion to keep current with local, national and global nursing development with regards to care of adult clients, families and population groups with mental/psychosocial health needs. 11. Demonstrate responsible citizenship and pride of being a Filipino nurse in the of clients with maladaptive patterns of behavior. 12. Apply techno-intelligent care systems and processes in the care of clients with maladaptive patterns of behavior. 13. Adopt the core values of nursing in the practice of psychiatric-mental health nursing. 14. Apply entrepreneurial skills necessary in the delivery of Psychiatric Mental Health Nursing (PMHN) care. TOPIC SESSION AL ACTIVITY Introductory Concepts in Psychiatric-Mental Session 1 Classroom Assessment Health Nursing Techniques ⎯ CATs are easy-to-implement Historical Perspectives in the Treatment of Mental Session 2 formative assessment Illness strategies that provide feedback on whether or not Theories of Psychopathology Session 3 students understand the lesson. These feedbacks will Therapeutic Relationship and the Therapeutic Session 4 help you make adjustments Use of Self early enough to make the Session 5 teaching-learning process Establishing the Therapeutic Nurse-Client Relationship more effective. Mental Status Examination Session 6 CAT: 3-2-1 ⎯ This strategy provides a structure for students to  Therapeutic and Nontherapeutic Communication Session 7 record their own comprehension and Electroconvulsive Therapy Session 8 summarize their learning. It also gives teachers Psychotherapies Session 9 opportunity to identify areas that need re-teaching, and Psychopharmacology Session 10 areas of student interest. Ego Defense Mechanisms Session 11 CAT: Muddiest Point Levels and Manifestations of Anxiety ⎯ Students respond to this one Session 12 question: “In today’s Psychiatric Emergencies-Rape, Child and Elder session, what was least Abuse Session 13 clear to you?” This technique will help you Anxiety-Related Disorders Session 14 determine which key points were missed by the Schizophrenia Session 15 students. Personality Disorders Session 16 Minute Paper ⎯ Towards the end of the Depressive and Bipolar Disorders Session 17 class, students are asked to use index cards or half- Trauma and Stress Related Disorders Session 18 sheets of paper to provide Obsessive-Compulsive and Related Disorders written feedback to the Session 19 following questions: Somatic Symptom and Related Disorders and 1. What was the most Dissociative Disorders Session 20 important thing you learned during this Eating Disorders Session 21 class? 2. What important question Substance Abuse Session 22 remains unanswered? Neurodevelopmental Disorders- Mental Session 23 Turn and Talk Retardation, ADHD & Autism ⎯ Develops the ability to think about what one knows, and to articulate one’s ideas in ways that other people can understand. Gets at least 50 per cent of the students talking in a given lesson. References: Videbeck, S. L., (2014). Mental and Psychiatric Health Nursing. 6th Edition. Lippincott, Williams and Wilkins. Philadelphia, PA. Townsend, M. C. & Morgan, K. I., (2018). Psychiatric Mental Health Nursing- Concepts of Care in Evidence-Based Practice. 9th Edition, FA Davis Company. Philadelphia, PA.. Prepared by: JOHN MARCO L. SEGOBRE Module Editor  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #1 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Lesson Title: INTRODUCTORY CONCEPTS IN PSYCHIATRIC Materials: NURSING Pen, paper, index card, book, and class List Learning Targets: At the end of the module, students will be able to: 1. Discuss the concept of Mental Health and Mental Illness. References: 2. Explain the roles and functions of the Mental Health Nurse. 3. Identify the factors affecting Mental Health. Videbeck, S. L., (2020). Mental and 4. Apply the roles and essential qualities of a mental health nurse Psychiatric Health Nursing. 8th Edition. in both the classroom and clinical setting; and, Lippincott, Williams and Wilkins. Philadelphia, 1. Describe the use of the American Psychiatric Association PA. Diagnostic and Statistical Manual of Mental Disorders V. A. LESSON PREVIEW/REVIEW Your classroom instructor for this subject, Care of Clients with Maladaptive Patterns of Behavior - Lecture, is ________________________. Listed below are the additional information vital in orientation: B. MAIN LESSON According to the World Health Organization (WHO, 2020), mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community. There is no single definition of Mental Health. The general accepted definition is a state of emotional psychological and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self - concept and emotional stability MENTAL HEALTH NURSING Also known as psychiatric nursing, is a specialized field of nursing practice that involves the care of individuals with a mental health disorder to help them recover and improve their quality of life. FACTORS AFFECTING MENTAL HEALTH 1. Individual- biologic makeup, autonomy, independence, self - esteem, capacity for growth, vitality, emotional resilience, reality orientation, belonging, coping and stress management 2. Interpersonal - effective communication, ability to help others, intimacy, connectedness, separateness 3. Social - cultural - sense of community, access to adequate resources, intolerance to violence, support of diversity among people, positive yet realistic view of one’s world, poverty MENTAL ILLNESS THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #1 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ A mental illness can be defined as a health condition that changes a person's thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning. Mental illness is defined by the American Psychiatric Association as a clinical significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with present distress such as a painful symptom, a disability, increased risk of suffering death, pain or a loss of freedom. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 5TH EDITION A taxonomic and diagnostic tool developed by the American Psychiatric Association used internationally as a principal authority for psychiatric diagnoses. It contains a set of specific diagnostic criteria for mental disorders each based on clinical experience and research. New addition to mental disorders includes: Internet Gaming Disorder ROLES OF THE MENTAL HEALTH NURSE 1. Stranger: the role assumed by both nurse and patient when they first meet 2. Resource person: provides health information to a patient who has assumed the consumer role 3. Teacher: helps the patient grow and learn from experience with the health care system 4. Leader: helps the patient participate in a democratically implemented nursing process 5. Surrogate: assumes roles that have been assigned by the patient, based on significant past relationships, as in the psychoanalytical phenomenon of transference 6. Counsellor: helps the patient integrate the facts and feelings associated with an episode of illness into the patient’s total life experience 7. Patient Advocate: enables the patient and his relatives to know their rights and responsibilities. 8. Case Manager: supervises over other nurses in providing coordination of care to a client diagnosed with a mental disorder 9. Researcher: identifies research questions, design and conduct scientific studies, collect and analyze data and report the findings of studies in the area of mental health. FUNCTIONS OF THE MENTAL HEALTH NURSE 1. Counselling: intervention and communication techniques, problem solving, stress management, behavior modification, crisis intervention 2. Milieu Therapy: maintain therapeutic environment, teaching skills, encourage communication between clients and others, promote growth through role modeling 3. Self - Care Activities: encourage independence, increase self - esteem, improve function and health 4. Psychologic Interventions: administer medications, teaching, client observation 5. Health Teaching 6. Case Management: implementation and evaluation of client care plan in a mental health facility 7. Health Promotion and Maintenance CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. 1. A mental health nurse who exercises supervision over other nurses in providing coordination of care to a client diagnosed with a mental disorder is performing which particular role? A. Researcher B. Case Manager C. Care Provider D. Patient Advocate Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #1 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ 2. The nurse is teaching a client important life skill that can be useful around the house when he leaves the mental health facility. The nurse is performing which function? A. Case Management B. Counselling C. Self - Care Activities D. Milieu Therapy Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. An individual who prefers to be alone and isolated may be at risk for mental disorders because which factor affecting mental health is impaired? A. Interpersonal factors B. Social - cultural factors C. Family factors D. Individual factors Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. According to the American Psychiatric Association, which is not a possible cause of mental disorder: A. Death of a parent B. Loss of a limb C. Rape D. A complete family Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 5. According to the World Health Organization, health involves wellness of the following human aspects, EXCEPT: A. Physical B. Mental C. Social D. Economic Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6. A nurse who is directly responsible for providing care to an individual client such as administering medication or teaching a life skill is performing which vital role of the mental health nurse? A. Case Manager B. Researcher C. Care Provider D. Patient Advocate Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. The nurse advises a client to join yoga classes as a method to relieve stress would be fulfilling the function of: THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 3  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #1 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ A. Health Teaching B. Counselling C. Milieu Therapy D. Psychotherapy Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 8. When a client presents at the Emergency Room with peculiar behaviors and a strong desire for self - harm, the diagnosis of the specific mental disorder of that client will have to be based on: A. Client verbalization B. Client behavior C. Client history D. Criteria from DSM V Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 9. A client develops a trusting relationship with a nurse he pictures as his brother. The nurse helps the client feed himself as he functions as a: A. Leader B. Stranger C. Resource Person D. Surrogate Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 10. Nurse C is investigating the effect of a new antipsychotic medication administered to the Schizophrenic clients in Pavilion 3 of a psychiatric unit. He is playing the role of: A. Advocate B. Counsellor C. Researcher D. Surrogate Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ C. LESSON WRAP-UP AL Activity: CAT: 3-2-1 Instructions: 1. As an exit ticket at the end of the class period 2. Record three things you learned from the lesson. 3. Next, two things that you found interesting and that you’d like to learn more about. 4. Then, record one question you still have about the lesson. Three things you learned: THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 4  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #1 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ 1. __________________________________________________________________________________ 2. __________________________________________________________________________________ 3. __________________________________________________________________________________ Two things that you’d like to learn more about: 1. __________________________________________________________________________________ 2. __________________________________________________________________________________ One question you still have: 1.___________________________________________________________________________________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 5  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #2 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Lesson Title: HISTORICAL PERSPECTIVES ON THE Materials: TREATMENT OF MENTAL ILLNESS Pen, paper, index card, book, and class List Learning Targets: At the end of the module, students will be able to: 1. Discuss the evolution of treatment for clients with mental illness References: 2. Identify the trends in treatment for clients with mental illness 3. Trace the development of Psychiatric Nursing practice. Videbeck, S. L., (2020). Mental and 4. Create a timeline brochure with key timelines in the evolution of Psychiatric Health Nursing. 8th Edition. treatment of clients with mental illness. Lippincott, Williams and Wilkins. Philadelphia, PA. A. LESSON PREVIEW/REVIEW Instruction: Define Mental Health. _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ B. MAIN LESSON Historical Perspectives on the Treatment of Mental Illness A. Ancient Times ⎯ Sickness indicated displeasure of the gods and was a form of punishment for sins and wrongdoing ⎯ Those with mental disorders were either considered divine or demonic depending on their behavior ⎯ In order to relieve the individual’s suffering, Trepanning, trepanation or trephining, the practice of drilling a hole into the skull to allow a passage for the spirit to escape was practiced. Trephination ⎯ Those seen as divine were worshipped and adored, those seen as demonic were punished or burned ⎯ Aristotle theorized that water, blood, yellow bile and black bile controlled one’s emotions. Imbalances between the 4 caused mental illness ⎯ In early Christian times (1 – 1000 AD), diseased were blamed on demons and those with mental illness were said to be possessed, priests performed exorcisms and if not effective those with mental illness were starved, imprisoned or whipped ⎯ During the Renaissance (1300 – 1600), those with mental illness but were harmless were left to wander the countryside or live-in rural communities, those who were violent were thrown in prison and starved ⎯ In 1547, the Hospital of St. Mary of Bethlehem was officially declared the first hospital for insane THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #2 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ ⎯ During the same times in the United States, those with mental illness were considered possessed and were punished or burned at stakes B. Enlightenment and Creation of Mental Institutions ⎯ Benjamin Rush believed that mental diseases were caused by irritation of the blood vessels in the brain. His treatment methods included bleeding, purging, hot and cold baths, and mercury, and he invented a tranquilizer chair (pictured) and a gyrator for psychiatric patients. Tranquilizer Chair Gyrator ⎯ In the 1790’s Phillippe Pinel in France and William Tuke formulated the concept of asylum, as a refuge or haven for those with mental illness, this began the movement for moral treatment of mental illness ⎯ In the United States, Dorothea Dix, began a campaign to reform the treatment of mental illness leading to the opening of 32 state hospitals that offered asylum which promoted adequate shelter, nutritious food and warm clothing ⎯ Within 100-year complaints against asylums, attendants were accused of abusing residents, locations were distant from families and their homes and the phrase “insane asylum” became a negative connotation C. Freud and the Treatment of Mental Disorders ⎯ Scientific study and treatment of mental disorders began with Sigmund Freud, Emil Kraepelin and Eugene Blueler in the 1800’s to early 1900’s ⎯ These men started the study of psychiatry and the diagnosis and treatment of mental disorders THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #2 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ ⎯ Freud challenged society to view human beings objectively, studied the mind, its disorders and treatments as no one before ⎯ Kraepelin began classifying mental disorders according to their symptoms and Bleuler coined the phrase “schizophrenia” D. Development of Psychopharmacology ⎯ In the 1950’s psychotropic drugs (drugs used to treat mental illness) were developed ⎯ Chlorpromazine (Thorazine), an antipsychotic drug and lithium, an antimanic drug were developed first ⎯ Over the following 10 years, monoamine oxidase inhibitors (antidepressants), haloperidol (antipsychotic), tricyclic antidepressants and benzodiazepines (antianxiety) were introduced ⎯ For the first time, drugs reduced the agitation, psychotic thinking and depression of people with mental disorders ⎯ Hospital stays were shortened, and many patients were well enough to go home ⎯ Noise, chaos and violence in the hospital setting were greatly diminished E. Move Toward Community Mental Health ⎯ In 1963, Deinstitutionalization, the shift from institutional care in state hospital settings to community facilities began ⎯ Community mental health centers provided less restrictive treatment and were located closer to a patient’s family, home and friends ⎯ The centers provided: emergency care, inpatient care, outpatient services, screening and education ⎯ 3 components of Deinstitutionalization: release of individuals from state institutions, diversion from hospitalization and development of alternative community services F. Mental Illness in the 21st Century ⎯ Many providers believe today’s clients to be more aggressive ⎯ People with severe and persistent mental illness may show signs of improvement in a few days but are not stabilized. They are discharged into the community without being able to cope with community living. ⎯ Many people have dual problems of mental illness and substance abuse. Use of alcohol and drugs exacerbates symptoms of mental illness ⎯ Up to one – third of adult homeless persons have serious mental illness and up to one – half have substance abuse problems Development of Psychiatric Nursing Practice ⎯ In 1873, Linda Richards graduated from the New England Hospital for Women and Children in Boston, she went on to improve nursing care in psychiatric hospitals and organized educational programs in state mental hospitals in Illinois. She is called the first American psychiatric nurse and believed that “the mentally sick should be at least as well cared for as the physically sick. ⎯ In 1882, the first training of nurses to care for persons with mental illness was conducted at the McLean Hospital in Waverly, Massachusetts which focused on nutrition, hygiene and activity. ⎯ The founder of the mental hygiene movement, Clifford Beers launched one of the earliest client-advocate health reform movements in the United States. He wrote the book, “A Mind That Found Itself” in 1908. ⎯ In 1913, Johns Hopkins was the first school of nursing to include a course in psychiatric nursing ⎯ The first psychiatric nursing textbook, Nursing Mental Disease, by Harriet Bailey was published in 1920 ⎯ Treatment such as insulin shock therapy (1935), psychosurgery (1936) and electroconvulsive therapy (1937) required nurses to use their medical – surgical skills in caring for people with mental illness ⎯ In 1950 the National League for Nursing required schools to include an experience in psychiatric nursing ⎯ In 1952, Hildegard Peplau described the therapeutic nurse – client relationship with its phases and tasks and wrote extensively about anxiety ⎯ Mellow’s 1968 work Nursing Therapy described the approach of focusing on the client’s psychosocial strengths and needs which suited those with severe mental illness ⎯ The American Nurses Association developed the first standards of care for psychiatric and mental health in 1973. These were revised in 1982, 1994 and 2000 THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 3  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #2 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ ⎯ The standards of care incorporate the phases of the nursing process, including specific types of interventions, for nurses in psychiatric settings and outline standards for professional performance: quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. 1. Benjamin Rush, the father of modern psychiatry utilized all of the following in the treatment of mental illness except: A. gyrator B. hot baths C. trephining D. tranquilizer chair Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. Dorothea Dix emphasized that all the following should be provided by an asylum except: A. Medication B. Nutritious Food C. Adequate Shelter D. Warm Clothing Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. In the 1950’s, this was the first medication developed to treat mania: A. Chlorpromazine B. Lithium C. Haloperidol D. Sertraline Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. In the late 1700’s this facility was developed to provide a safe environment for people with mental illness: A. Asylum B. Sanitarium C. Mental Hospital D. State Hospital Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 5. Aristotle theorized that the imbalance of 4 elements caused mental illness EXCEPT which one: A. Food B. Blood C. Yellow Bile D. Water Answer: ________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 4  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #2 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6. This refers to the practice of reducing emphasis on mental health care from inpatient facilities to community treatment centers: A. Sanitarium B. Deinstitutionalization C. Managed Care D. Primary Care Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. He had written the book, “The Mind That Found Itself”, from his experiences as a depressed client in 1908. A. Clifford Beers B. William Tuke C. Phillipe Pinel D. Eugene Blueler Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 8. This organization began the requirement for related learning experience in the psychiatric setting for students: A. American Nurses Association B. International Council of Nursing C. National League for Nursing D. America Psychiatric Nursing Association Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 9. During the ancient times, persons with mental illness who exhibit behaviors that harm others were: A. Hospitalized B. Worshipped C. Imprisoned D. Prayed For Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 10. This book emphasized that the treatment of persons with mental illness should focus on psychosocial strengths and needs: A. Mental Health Nursing Management B. Nursing Therapy C. Interpersonal Relations in Nursing D. Interpersonal Techniques: The Crux of Psychiatric Nursing Answer: ________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 5  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #2 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ C. LESSON WRAP-UP AL Activity: Minute Paper 1) What was the most useful or the most meaningful thing you have learned this session? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2) What question(s) do you have as we end this session? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 6  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #3 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Lesson Title: THEORIES OF PSYCHOPATHOLOGY Materials: Learning Targets: Pen, paper, index card, book, and class List At the end of the module, students will be able to: 1. Discuss the various Theories of Psychopathology. 2. Differentiate the various Theories of Psychopathology; and, References: 3. Create a matrix of the various Theories of Psychopathology. Videbeck, S. L., (2020). Mental and Psychiatric Health Nursing. 8th Edition. Lippincott, Williams and Wilkins. Philadelphia, PA. A. LESSON PREVIEW/REVIEW Instruction: Identify the period of the following events that entails to the treatment of mental illness. Period Answer 1. Sickness indicated displeasure of the gods and was a form of punishment for sins and wrongdoing. 2. Phillippe Pinel in France and William Tuke formulated the concept of asylum. 3. Many providers believe today’s clients to be more aggressive. 4. Chlorpromazine (Thorazine), an antipsychotic drug and lithium, an antimanic drug were developed first. 5. Deinstitutionalization, the shift from institutional care in state hospital settings to community facilities began. B. MAIN LESSON Sigmund Freud’s Psychosexual Theory ⎯ Developed in the late 19th and early 20th Century ⎯ The theory supports the notion that all human behavior is caused and can be explained. Sexual impulses and desires motivate human behavior. ⎯ Freud based the development of his theory on observation of women who displayed unusual behaviors such as disturbances of sigh and speech, inability to eat and paralysis of limbs. ⎯ He concluded that these behaviors resulted from childhood trauma or failure to complete tasks of psychosexual development. ⎯ Freud theorized that a personality is composed of the: a. ID (basic desires such as pleasure seeking, aggression and sexual impulses) b. EGO (adaptive behavior and balancing between the ID and SUPEREGO). c. SUPEREGO (the person’s moral and ethical concepts, values and expectation) ⎯ Anxiety, according to Freud, is generated between the balancing by the EGO of the ID’s impulsive instincts and the SUPEREGO’s morals and rules ⎯ Human personality functions in three levels: a. Conscious (perceptions and thoughts that a person is aware), b. Preconscious (perceptions and thoughts a person is not immediately aware but can recall with effort) and c. Unconscious (thoughts, feelings and perceptions that that motivate a person even though a person is unaware of them). A person represses into the unconscious memories of traumatic events too painful to remember. THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #3 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ ⎯ Freud stated that much of what a person does or says is motivated by thoughts, feelings and perceptions in the preconscious and unconscious. Freudian slips, slips of the tongue, are not accidents or coincidence but indications of feelings in the subconscious (found in the preconscious and unconscious). ⎯ Main context of the theory: sexual energy (libido) is the driving force behind human behavior PSYCHOSEXUAL STAGE AGE FOCUS Oral Birth to 18 Months Major site of tension or gratification is the mouth, lips, tongue, includes biting and sucking activities, Id present at birth, Ego starts to develop gradually Anal 18 – 26 Months Anus and surrounding area are major source of interest, acquisition of voluntary sphincter control, toilet training is started Phallic/Oedipal 3 – 5 Years Genital focus, stimulation and excitement, Penis is interest for both sexes, Masturbation is common, Girls wish to possess a penis (Penis Envy), Oedipal Complex (wish to marry opposite – sex parent) occurs Latency 5 – 11 Years Resolution of Oedipal Complex, Sexual desires are channeled into socially appropriate activity such as sports, Formation of the Superego Genital 11 – 13 Years Begins with puberty and biologic capacity for orgasm, Capacity for true intimacy starts to develop Erik Erikson’s Psychosocial Stages of Development ⎯ Involves eight specific stages of psychosocial development where a person must complete a life task essential to his/her own well – being and mental health ⎯ The different stages allow the person to achieve life’s virtues such as hope, purpose, love, fidelity, caring and wisdom ⎯ Each stage of psychosocial development is sequential and each stage is dependent on the completion of the previous stage and life task. PHASE VIRTUE FOCUS Trust vs. Mistrust (Infant) Hope Viewing the world as safe and reliable, relationships as stable, nurturing and dependable Autonomy vs. Shame and Doubt (Toddler) Will Achieving a sense of control and free will Initiative vs. Guilt (Preschool) Purpose Beginning development of a conscience, learning to manage conflict and anxiety Industry vs. Inferiority (School Age) Competence Emerging confidence in own abilities, taking pleasure in accomplishments Identity vs. Role Confusion (Adolescence) Fidelity Formulating a sense of self and belonging Intimacy vs. Isolation (Young Adult) Love Forming adult, loving relationships and meaningful attachments to others THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #3 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Generativity vs. Stagnation (Middle Adult) Care Being creative and productive, establishing the next generation Ego Integrity vs. Despair (Old Wisdom Accepting responsibility for one’s actions Age/Maturity) done throughout life John Piaget’s Cognitive Stages of Development ⎯ Human intelligence progresses through a series of stages based on age with the child at each successive stage demonstrating a higher level of functioning than at previous stages ⎯ Piaget believes that biologic changes and maturation are responsible for cognitive development ⎯ The theory is most useful when working with children. The nurse may better understand what child means if the nurse is aware of the child’s level of cognitive development. STAGE AGE FOCUS Sensorimotor Birth to 2 Years Develops a sense of self as separate, begins to form mental images, Object Permanence (objects do not cease to exist just because they are out of sight) Preoperational 2 – 6 Years Develops the ability express self through language, Understands the meaning of symbolic gestures, begins to classify objects Concrete Operations 6 -12 Years Begins to apply logic to thinking, understands spatiality and reversibility, increasingly social and able to apply rules Formal Operations 12 – 15 Years Able to think and reason in abstract terms, Further development of logical thinking and reasoning, Achieves cognitive maturity Abraham Maslow’s Hierarchy of Needs ⎯ Uses a pyramid to arrange and illustrate the basic drives or needs that motivate people ⎯ Each step up the pyramid is sequential where specific needs must be met in order to progress upwards. ⎯ The first level, at the bottom of the pyramid, consists of our short-term basic needs, also known as physiological needs: food, water, warmth, sex. ⎯ The second level consists of longer-term safety needs: security, order, stability. ⎯ The third level represents the social need for affiliation, also known as “love and belonging”. We want to be accepted by others around us. We want to have stable relationships. ⎯ The fourth level represents the need for esteem. Within our social groups we want to be recognized and admired as individuals who accomplish things. We want prestige and power. ⎯ Almost at the top of the pyramid, self-actualization is the desire to experience ever deeper fulfillment by realizing (actualizing) more and more of our human potential. ⎯ At the very top of the pyramid is the desire for self-transcendence — to experience, unite with and serve that which is beyond the individual self: the unity of all being. THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 3  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #3 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. 1. This theory of development focuses on the erogenous zones of the body. A. Cognitive Theory B. Psychosexual Theory C. Interpersonal Theory D. Psychosocial Theory Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. Under Eriksson’s Psychosocial Theory, an individual who expresses a sense of satisfaction with his decisions and actions in life is under which stage? A. Intimacy vs. Isolation B. Trust vs. Mistrust C. Ego Integrity vs. Despair D. Initiative vs. Guilt Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. This theory postulates that sexuality and sexual energy play a major factor on how an individual acts and behaves towards others and the environment: A. Psychosexual Theory B. Hierarchy of Needs C. Cognitive Theory D. Psychosocial Theory Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. A child proudly displays to his mother the good marks he obtained during activities while in school. Based on Erikson’s Psychosocial Theory, the child belongs to what stage? A. Industry vs. Inferiority B. Initiative vs. Guilt C. Trust vs. Mistrust D. Autonomy vs. Shame and Doubt Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 5. An adult who engages in nail biting behaviors during stressful situations may have unresolved issues during which stage of psychosexual engagement? A. Phallic Stage B. Latency Stage C. Oral Stage D. Genital Stage Answer: ________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 4  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #3 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6. Under Maslow’s Hierarchy of Needs, an individual who at work has not fulfilled/achieve which stage? A. Love and Belongingness B. Self – Actualization C. Physiologic Needs D. Esteem Needs Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. An individual who has decided to marry his/her partner is in what stage under the Psychosocial Theory: A. Preschool B. Toddler C. Young Adult D. Middle Adult Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 8. Toilet training children is performed at this stage of the Psychosexual Theory: A. Latent Stage B. Genital Stage C. Anal Stage D. Phallic Stage Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 9. Jojo, an 8-year-old boy wants his piggy bank full by Christmas, so he tells his dad every day to give him coins. This is a characteristic of one of Piaget’s Cognitive stages: A. Concrete Operations B. Formal Operations C. Pre-Operations D. Sensorimotor Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 10. A child who begins to build a group of friends in school and around the neighborhood is now under which cognitive stage of development? A. Preoperational Stage B. Formal Operations Stage C. Concrete Operations Stage D. Sensorimotor Stage Answer: ________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 5  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #3 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ C. LESSON WRAP-UP AL Activity: Muddiest Point In today’s session, what was least clear to you? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 6  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #4 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Lesson Title: THERAPEUTIC RELATIONSHIP AND THE Materials: THERAPEUTIC USE OF SELF Pen, paper, index card, book, and class List Learning Targets: At the end of the module, students will be able to: 1. Discuss the concept of therapeutic use of self. References: 2. Identify the components of a therapeutic relationship between the nurse and client. Videbeck, S. L., (2020). Mental and 3. Relate the need for a therapeutic relationship in providing care Psychiatric Health Nursing. 8th Edition. to clients with mental illness/disorders. Lippincott, Williams and Wilkins. Philadelphia, PA. A. LESSON PREVIEW/REVIEW Instruction: Enumerate the 3 components of personality and explain each briefly. 1. ______, _______________________________________________________________________ 2. ______, _______________________________________________________________________ 3. ______, _______________________________________________________________________ B. MAIN LESSON Therapeutic Use of Self- it is the planned use of one’s personality, insights, perceptions and judgments as part of the therapeutic process. ⎯ This is achieved by developing self-awareness and beginning to understand his or her attitudes, the nurse can begin to use aspects of his or her personality, experiences, values, feelings, intelligence, needs, coping skills, and perceptions to establish relationships with clients. ⎯ Nurses use themselves as therapeutic tool to form therapeutic relationships with the client to help him grow, change, heal ⎯ Self - awareness is key - nurses must understand themselves ⎯ Forget your experiences, opinions, ideas, culture, and values when dealing with your client ⎯ Respond to your client in the way they need it, NOT in the way you think they need it. Professional Boundaries- identify the parameters of the therapeutic relationship in which nurses provide care for the purpose of meeting the client’s therapeutic needs. The nurse is accountable and takes responsibility for setting and maintaining the boundaries of a therapeutic relationship regardless of the client’s actions or requests. Components of the Therapeutic Relationship 1. Trust - The nurse–client relationship requires trust. Trust builds when the client is confident in the nurse and the nurse’s presence conveys integrity and reliability. Trust develops when the client believes that the nurse will be consistent in his or her words and actions and can be relied on to do what he or she says. Some behaviors the nurse can exhibit to help build the client’s trust include being friendly, caring, interested, understanding, and consistent; keeping promises; and listening to and being honest with the client. Trust erodes when a client sees inconsistency between what the nurse says and does. ✓ Congruence – occurs when words said by the nurse or client match with their actions, this builds trust. Incongruent behaviors prevent building trust or reduces trust between the nurse and client. 2. Genuine Interest - When the nurse is comfortable with himself or herself, aware of his or her strengths and limitations, and clearly focused, the client will perceive a genuine person showing genuine interest. Clients with mental illness can detect when someone is exhibiting dishonest or artificial behavior such as asking a question and then not waiting for the answer, talking over the client, or assuring the client everything will be all right. The nurse should be open and honest and display congruent behavior. THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #4 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ ✓ Self-awareness, honesty, openness, self - disclosure (open up a certain experience to relate to the client) - client believes you work for his/her good 3. Empathy - the ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client. It is considered one of the essential skills a nurse must develop. Being able to put himself or herself in the client’s shoes does not mean that the nurse has had the same exact experiences as the client. Nevertheless, by listening and sensing the importance of the situation to the client, the nurse can imagine the client’s feelings about the experience. ✓ Listening & sensing - client shares feelings to the nurse 4. Acceptance - The nurse who does not become upset or respond negatively to a client’s outbursts, anger, or acting Empathy vs. sympathy out conveys acceptance to the client. Avoiding judgments of the person, no matter what the behavior, is acceptance. This does not mean acceptance of inappropriate behavior but acceptance of the person as worthy. The nurse must set boundaries for behavior in the nurse–client relationship. ✓ Avoid judgments of the client's behavior, cool, calm and collected during client's outbursts, anger or acting out but do not accept inappropriate behavior - client feels intact 5. Positive Regard - The nurse who appreciates the client as a unique, worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle. This unconditional, non-judgmental attitude is known as positive regard and implies respect. Calling the client by name, spending time with the client, and listening and responding openly are measures by which the nurse conveys respect and positive regard to the client. The nurse also conveys positive regard by considering the client’s ideas and preferences when planning care. ✓ Unconditional non-judgmental attitude, give full attention, communicate therapeutically, RESPECT - client feels he/she can make positive/meaningful contributions to care Starting Points for a Therapeutic Use of Self 1. Self – awareness - the process of developing an understanding of one’s own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths, and limitations and how these qualities affect others. Self-awareness allows the nurse to observe, pay attention to, and understand the subtle responses and reactions of clients when interacting with them. 2. Values - are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living. Sample values include hard work, honesty, sincerity, cleanliness, and orderliness. 3. Beliefs - are ideas that one holds to be true: for example, “All old people are hard of hearing,” “If the sun is shining, it will be a good day,” or “Peas should be planted on St. Patrick’s Day.” Some beliefs have objective evidence to substantiate them. For example, people who believe in evolution have accepted the evidence that supports this explanation for the origins of life. Other beliefs are irrational and may persist, despite these beliefs having no supportive evidence or the existence of contradictory empirical evidence. 4. Attitudes - are general feelings or a frame of reference around which a person organizes knowledge about the world. Attitudes such as hopeful, optimistic, pessimistic, positive, and negative, color how we look at the world and people. A positive mental attitude occurs when a person chooses to put a positive spin on an experience, comment, or judgment. CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. 1. A nurse who is able adequately determine what the client is feeling through listening from the client and sensing the true meaning of the client’s words is practicing which component of therapeutic relationship? A. Empathy B. Self – Awareness C. Positive Regard D. Genuine Interest Answer: ________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #4 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. This refers to a nurse’s personal set of standards about what is right and wrong when dealing with the client or other members of the healthcare team is: A. Beliefs B. Attitudes C. Values D. Self – awareness Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. When the nurse who aims to build trust with the client is conscious about his/her words being translated into action is practicing? A. Positive Regard B. Congruence C. Attitudes D. Acceptance Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. The nurse who patiently cares for his/her client and does not judge the client based on displayed behaviors is displaying which important component of the therapeutic relationship? A. Trust B. Genuine Interest C. Positive Regard D. Acceptance Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 5. When a nurse caring for a client with a mental illness/disorder has a good grasp of his/her own attitude, values, beliefs and feelings, the nurse has achieved: A. Self – awareness B. Trust C. Acceptance D. Genuine Interest Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6. These are ideas that the nurse holds to be true when caring for the client with a mental illness/disorder: A. Attitudes B. Beliefs C. Values D. Self – awareness Answer: ________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 3  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #4 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. A nurse who displays actions that are inconsistent with his/her words and display unexpected behaviors is not able to build: A. Positive Regard B. Genuine Interest C. Self - awareness D. Trust Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 8. Effective therapeutic use of self by the nurse requires that the nurse must be: A. Capable of complete assessment B. Knowledgeable on psychopharmacology C. Responds to the client according to the client’s needs D. Expert in psychotherapy Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 9. Appreciating the client as a person who has specific needs and worthy of respect is displaying which component? A. Positive Regard B. Genuine Interest C. Trust D. Empathy Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 10. Effective therapeutic use of self can only be achieved when the nurse has: A. Empathy B. Self – awareness C. Positive Regard D. Genuine Interest Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ C. LESSON WRAP-UP AL Activity: Formative Assessment 1. What specific part of the Main Lesson for this session do you find the most confusing? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 4  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #4 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ 2. What makes your answer in #1 confusing? What is the question in your mind? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________________ 3. Since that is your most confusing lesson, what are the interventions that you must do to understand the topic? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 5  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #5 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Lesson Title: ESTABLISHING THE THERAPEUTIC NURSE – Materials: CLIENT RELATONSHIP Pen, paper, index card, book, and class List Learning Targets: At the end of the module, students will be able to: 1. Identify the different phases of a therapeutic nurse – client References: relationship. 2. Discuss the specific functions of the nurse in establishing a Videbeck, S. L., (2020). Mental and therapeutic nurse – client relationship; and, Psychiatric Health Nursing. 8th Edition. 3. Create a brief guide for nurses to establish a therapeutic nurse – Lippincott, Williams and Wilkins. Philadelphia, client relationship. PA. A. LESSON PREVIEW/REVIEW Instruction: In 3-5 sentences explain how you can effectively use oneself in a therapeutic relationship. _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ ________________________________________________________________________________________________ B. MAIN LESSON The Therapeutic Nurse – Client Relationship ⎯ Purposeful, goal-directed relationships between a nurse and a client based on meeting the needs of the client ⎯ Based on Hildegard Peplau’s Therapeutic Nurse – Patient Relationship Theory. The model can be used to understand and document the progress of interpersonal interactions between the nurse and the patient/client. ⎯ Generally, contains 3 Phases: Orientation, Working and Termination or Resolution Phases ⎯ The relationship can only be developed when the nurse has developed self – awareness ⎯ The nurse-client relationship is conducted within boundaries separating therapeutic behavior from personal behavior 3 Phases of the Therapeutic Nurse – Client Relationship A. Orientation Phase ⎯ The orientation phase begins when the nurse and client meet and ends when the client begins to identify problems to examine. ⎯ During the orientation phase, the nurse establishes roles, the purpose of meeting, and the parameters of subsequent meetings; identifies the client’s problems; and clarifies expectations. ⎯ Before meeting the client, the nurse has important work to do. The nurse reads background materials available on the client, becomes familiar with any medications the client is taking, gathers necessary paperwork, and arranges for a quiet, private, comfortable setting. ⎯ This is a time for self-assessment. The nurse should consider his or her personal strengths and limitations in working with this client. ⎯ The nurse begins to build trust during the orientation phase. The following are important in this phase. a. Nurse – Client Contracts – outlines the responsibilities of the nurse and client, it should state the time, place and length of sessions, the timeframe, the treatment plan and those involved as well as specific responsibilities of both parties b. Confidentiality - respecting the client’s right to keep private any information about his or her mental and physical health and related care. c. Self – disclosure - revealing personal information such as biographical information and personal ideas, thoughts, and feelings about oneself to clients, improves rapport between the nurse and client but the nurse must be careful with providing his/her own personal information and must give this some thought. THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #5 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ B. Working Phase ⎯ Contains 2 subphases: Problem Identification (where the client identified issues or concerns that are causing problems) and Exploitation (where the nurse guides the client to explore feelings and responses to develop better coping skills and a more positive self – image ⎯ The Exploitation subphase is where behavior changes occur, and the client develops independence ⎯ Problems which can arise in this phase can be: a. Transference – the client unconsciously transfers to the nurse the feelings he/she has for others b. Countertransference – the nurse responds to the client based on personal unconscious needs and problems C. Termination of Resolution Phase ⎯ Begins when the problems are resolved and ends when the relationship between the nurse and client is ended ⎯ Clients feel termination as an impending loss by displaying anger or stating that the problem has not been resolved ⎯ The nurse can acknowledge the client’s angry feelings and assure the client these behaviors are normal when in the termination phase ⎯ When stalling behaviors occur or when the client tries to reopen old or resolved issues the nurse refocus the client on the newly learned behaviors and skills to handle the problem ⎯ The nurse must remember that it is inappropriate to agree to meet the client outside of the therapeutic relationship Specific Tasks and Behaviors During Each Phase of the Therapeutic Relationship Orientation Working – Problem Working - Exploitation Termination Identification Client ✓ Participates in ✓ Makes full use of ✓ Abandons old needs ✓ Seeks assistance identifying problems services ✓ Aspires to new goals ✓ Conveys needs ✓ Begins to be aware of ✓ Identifies new goals ✓ Becomes independent ✓ Asks questions time ✓ Attempts to attain new of helping person ✓ Shares preconceptions ✓ Responds to help goals ✓ Applies new problem- and expectations of ✓ Identifies with nurse ✓ Rapid shifts in solving skills nurse based on past ✓ Recognizes nurse as a behavior: dependent, ✓ Maintains changes in experiences person independent style of communication ✓ Explores feelings ✓ Exploitative behavior and interaction ✓ Fluctuates ✓ Self-directing ✓ Shows positive dependence, ✓ Develops skill in changes in view of self independence, and interpersonal ✓ Integrates illness interdependence in relationships and ✓ Exhibits ability to stand relationship with nurse problem-solving alone ✓ Increases focal ✓ Displays changes in attention manner of ✓ Changes appearance communication (more (for better or worse) open, flexible) ✓ Understands continuity between sessions (process and content) ✓ Testing maneuvers decrease Nurse ✓ Maintains separate ✓ Continues assessment ✓ Sustains relationship as ✓ Responds to client identity ✓ Meets needs as they long as client feels ✓ Gives parameters of ✓ Exhibits ability to edit emerge necessary meetings speech or control focal ✓ Understands reason for ✓ Explains roles attention shifts in behavior THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #5 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ ✓ Gathers data ✓ Shows unconditional ✓ Initiates rehabilitative ✓ Promotes family ✓ Helps client identify acceptance plans interaction to assist problem ✓ Helps express needs, ✓ Reduces anxiety with goal planning ✓ Helps client plan use of feelings ✓ Identifies positive ✓ Teaches preventive community resources ✓ Assesses and adjusts factors measures and services to needs ✓ Helps plan for total ✓ Uses community ✓ Reduces anxiety and ✓ Provides information needs agencies tension ✓ Provides experiences ✓ Facilitates forward ✓ Teaches self-care ✓ Practices active that diminish feelings of movement of Terminates nurse– listening helplessness personality Deals with client relationship ✓ Focuses client’s ✓ Does not allow anxiety therapeutic impasse energies Clarifies to overwhelm client preconceptions and ✓ Helps client focus on expectations of nurse cues ✓ Helps client develop responses to cues ✓ Uses word stimuli CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. 1. During the course of the interaction, the nurse shares to the client that they have the same favorite color and food to establish a closer working relationship between the two of them. This is an example of the use of: A. Nurse – Client Contracts B. Establishing Rapport C. Self - disclosure D. Maintaining the relationship Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. A client shows resistance to the nurse during the interaction due to past negative experience with another nurse. The client ignores the nurse during the interaction and does not participate in therapy. This phenomenon is known as: A. Countertransference B. Transference C. Poor Therapeutic Communication D. Lack of Rapport Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. When the client begins to show positive self – regard, this phase has already been reached: A. Termination B. Working – Problem Identification C. Orientation D. Working – Exploitation Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 3  Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) Module #5 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ 4.Nurse Angelo has started working on building a therapeutic relationship with an identified client. During the course of the initial interaction, the client states that he is not comfortable talking about his line of work. Nurse Angelo replies that he will not force the client to talk about things he does not want to talk about. This is an example of: A. Nurse – Client Contracts B. Confidentiality C. Establishing Rapport D. Self – disclosure Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 5. The nurse is listening attentively to the client to ensure proper assessment and begin building rapport between the two of them is performing a task in which phase: A. Termination Phase B. Working – Problem Identification C. Working - Exploitation D. Orientation Phase Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6. A client who has become more open and warmer when communicating with the nurse is now in which phase: A. Orientation Phase B. Termination Phase C. Working - Exploitation D. Working – Problem Identification Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. The nurse who is reviewing the client’s medical history and list of medications is performing tasks in which phase: A. Working – Exploitation B. Orientation Phase C. Termination Phase D. Working – Problem Identification Answer: ________ Rationale:________________________________________________________________________________________