Mental Health Chapter 8 PDF

Chapter 8 Intervention in Groups Copyright ©2019 F.A. Davis Company Introduction § Healthcare professionals not only share their personal lives with groups of people, but also encounter multiple group situations in their professional operations. Copyright ©2019 F.A. Davis Company Group, Defined § A...

Chapter 8 Intervention in Groups Copyright ©2019 F.A. Davis Company Introduction § Healthcare professionals not only share their personal lives with groups of people, but also encounter multiple group situations in their professional operations. Copyright ©2019 F.A. Davis Company Group, Defined § A collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose Copyright ©2019 F.A. Davis Company Functions of a Group § Socialization: The teaching of social norms occurs through group interaction. § Support: Fellow group members are available in times of need. § Task completion: Groups can assist in endeavors that are beyond the capacity of one individual alone. § Camaraderie: Individuals receive joy and pleasure from interactions with significant others. Copyright ©2019 F.A. Davis Company Functions of a Group (continued) § Information sharing: Learning takes place when group members share their knowledge with the others in the group. § Normative influence: Different groups enforce established norms in various ways. § Empowerment: Change can be made by groups at times when individuals alone are ineffective. § Governance: Large organizations often have leadership that is provided by groups rather than by a single individual. Copyright ©2019 F.A. Davis Company Types of Groups § Task groups: Groups are formed to accomplish a specific outcome or task. § Teaching groups: The focus is to convey knowledge and information to a number of individuals. Copyright ©2019 F.A. Davis Company Types of Groups (continued_1) Supportive/therapeutic groups: The primary concern is to prevent possible future upsets by teaching the participants effective ways of dealing with emotional stress arising from situational or developmental crises. Copyright ©2019 F.A. Davis Company Types of Groups (continued_2) Therapeutic groups versus group therapy § Group therapy has a sound theoretical base, and leaders generally have advanced degrees in psychology, social work, nursing, or medicine. § Therapeutic groups are based to a lesser extent on theory. The focus is on group relations, interactions among group members, and the consideration of a selected issue. Copyright ©2019 F.A. Davis Company Types of Groups (continued_3) Self-help groups § Composed of individuals with a similar problem § Serve to reduce the possibilities of further emotional distress leading to pathology and necessary treatment § May or may not have a professional leader; run by members; leadership often rotates from member to member Copyright ©2019 F.A. Davis Company Clicker Question 1 1. A client expresses a desire to begin attending the self-help group Alcoholics Anonymous. Which nursing response gives the client pertinent information about this type of group? A. “In this type of group, membership is always within a fixed timeframe.” B. “Group members receive comfort and advice from others undergoing similar experiences.” C. “The purpose of this type of group is to convey information to a number of individuals.” D. “The function of this type of group is to accomplish a specific outcome.” Copyright ©2019 F.A. Davis Company Clicker Question Answer 1 Correct Answer: B A A is a type of self-help group. In this type of group, members share their experiences and strengths and receive comfort and advice from others undergoing similar experiences. The nurse is giving the client pertinent information about A A. Copyright ©2019 F.A. Davis Company Physical Conditions That Influence Group Dynamics § Seating: Best when there is no barrier between the members; for example, a circle of chairs is better than chairs set around a table. § Size: Size of the group makes a difference in the interaction among members; seven or eight members provide a favorable climate for optimal group interaction and relationship development. Copyright ©2019 F.A. Davis Company Physical Conditions That Influence Group Dynamics (continued) § Membership: Two types of groups exist Open-ended groups: Members leave and others join at any time during the existence of the group. Closed-ended groups: All members join at the time the group is organized and terminate membership at the end of a designated period. Copyright ©2019 F.A. Davis Company Therapeutic Factors of Groups § Instillation of hope: By observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved. § Universality: Individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing. Copyright ©2019 F.A. Davis Company Therapeutic Factors of Groups (continued_1) § Imparting of information: Group members share their knowledge with each other. Leaders of teaching groups also provide information to group members. § Altruism: Individuals provide assistance and support to each other, thereby helping to create a positive self-image and promote self-growth. Copyright ©2019 F.A. Davis Company Therapeutic Factors of Groups (continued_2) § Corrective recapitulation of the primary family group: Group members are able to re-experience early family conflicts that remain unresolved. § Development of socializing techniques: Through interaction with, and feedback from, other members of the group, individuals are able to correct maladaptive social behaviors and learn and develop new social skills. Copyright ©2019 F.A. Davis Company Therapeutic Factors of Groups (continued_3) § Imitative behavior: Group members who have mastered a particular psychosocial skill or developmental task serve as valuable role models for others. § Interpersonal learning: Group offers varied opportunities for interacting with other people. § Group cohesiveness: Members develop a sense of belonging rather than separating the individual (“I am”) from group (“we are”). Copyright ©2019 F.A. Davis Company Therapeutic Factors of Groups (continued_4) § Catharsis: Within the group, members are able to express both positive and negative feelings. § Existential factors: The group is able to assist individual members to take direction of their own lives and to accept responsibility for the quality of their existence. Copyright ©2019 F.A. Davis Company Clicker Question 2 2. After a supportive-therapeutic group, a nurse hears one client say to another, “I never thought that other people had the same problems I have.” The nurse ascertains that this statement represents which curative factors described by Yalom? A. Catharsis B. Group cohesiveness C. Universality D. Imitative behavior Copyright ©2019 F.A. Davis Company Clicker Question Answer 2 Correct Answer: C According to Yalom, the curative factor of universality occurs when group members realize they are not alone in their feelings and experiences. Copyright ©2019 F.A. Davis Company Phases of Group Development Phase I. Initial or orientation phase § Leader and members work together to establish rules and goals for the group. § Leader promotes trust and ensures that rules do not interfere with fulfillment of the goals. § Members are superficial and overly polite. Trust has not yet been established. Copyright ©2019 F.A. Davis Company Phases of Group Development (continued_1) Phase II. Middle or working phase § Productive work toward completion of the task is undertaken. § The leader role diminishes and becomes one that is more of a facilitator. § Trust has been established among the members and cohesiveness exists. § Conflict is managed by the group members themselves. Copyright ©2019 F.A. Davis Company Phases of Group Development (continued_2) Phase III. Final or termination phase § A sense of loss, precipitating the grief process, may be experienced by group members. § The leader encourages the group members to discuss these feelings of loss and to reminisce about the accomplishments of the group. § Feelings of abandonment may be experienced by some members. Grief for previous losses may be triggered. Copyright ©2019 F.A. Davis Company Leadership Styles Autocratic § Focus is on the leader, on whom the members are dependent for problemsolving, decision making, and permission to perform. § Production is high, but morale is low. Copyright ©2019 F.A. Davis Company Leadership Styles (continued_1) Democratic § Focus is on members, who are encouraged to participate fully in problem-solving of group issues, including taking action to effect change. § Production is somewhat lower than with autocratic leadership, but morale is much higher. Copyright ©2019 F.A. Davis Company Leadership Styles (continued_2) Laissez-faire § There is no focus in this type of leadership. § Goals are undefined, and members do as they please. § Productivity and morale are low. Copyright ©2019 F.A. Davis Company Clicker Question 3 3. During a group meeting, a client raises the concern that noise at the nurses’ station keeps him awake at night. The nurse, present in the meeting, interrupts, stating, “I’ll handle this matter. We need to move on.” The nurse is demonstrating which type of leadership style? A. Democratic B. Autocratic C. Laissez-faire D. Surrogate Copyright ©2019 F.A. Davis Company Clicker Question Answer 3 Correct Answer: B This is an example of an autocratic leadership style that restricts client participation in planning care. The nurse is in control and client autonomy is limited. Copyright ©2019 F.A. Davis Company Member Roles Members play one of three types of roles within a group. § Task roles: Serving to complete the task of the group § Maintenance roles: Maintaining or enhancing group processes § Individual (personal) roles: Fulfilling personal or individual needs Copyright ©2019 F.A. Davis Company Psychodrama § Group therapy that employs a dramatic approach Clients become “actors” in life-situation scenarios. § An identified client (called the protagonist) is selected to portray a life situation. § Other members of the group play the roles of people with whom the protagonist has unresolved issues. Copyright ©2019 F.A. Davis Company Psychodrama (continued) § Group members who do not participate in the drama act as the audience, and the group leader is called the director. § The purpose is to provide the patient with a safe place in which to confront unresolved conflicts in an effort to progress toward resolution. § Nurses who work as psychodramatists require specialist training beyond the master’s degree. Copyright ©2019 F.A. Davis Company The Family as a Group § Family therapy: family is viewed as a system in which the members are interdependent Major goal: facilitate system change rather than focus on any one individual as the one in need of treatment § Assessment tool: genogram Copyright ©2019 F.A. Davis Company Role of the Nurse in Group Interventions § Nurses who work in psychiatry may lead various types of therapeutic groups, such as client education groups, assertiveness training, support groups for clients with similar problems, parent groups, transition to discharge groups, and others. Copyright ©2019 F.A. Davis Company Role of the Nurse in Group Interventions (continued) § Guidelines set forth by the American Nurses Association specify that nurses who serve as group psychotherapists should have a minimum of a master’s degree in psychiatric nursing. Copyright ©2019 F.A. Davis Company