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Suicidality
all suicide-related behaviors and thoughts of completing or attempting suicide
Suicidal ideation
thinking about & planning one's own death
suicide attempt
nonfatal, self-inflicted destructive act with intent to die
parasuicide
voluntary, apparent attempt at suicide, in which the aim is not death
lethality
probability that a person will successfully complete suicide
Risk Factors - Suicide
-psychological - drugs, psychosis, depression -social - problem with finances, legal, family, social isolation
Nursing Assessment
-warning signs -elicitation of plan -determination of severity of intent -evaluation of availability of means -sudden improvement may mean the person has developed a plan
Nursing Interventions - Suicide
-Safety -Commitment to treatment -Psychoeducation (change negative thought patterns, stigma reduction) -Developing supportive networks
Short-term outcomes
maintaining safety averting suicide mobilizing the patient's resource
Long-Term outcomes
Maintaining the patient in ward -enabling patient and family to identify and manage suicidal crises -widening support network
Crisis
State of dysequilibrium from a stressful situation, a crisis will occur if any of the following balancing factors are absent
Maturational Crises
significant developmental events requiring role changes
Situational crises
occur when a specific life event upsets and individual's psychological equilibrium
Traumatic Crises
unexpected or unusual evens affecting a person or group of people dramatically as in violent, natural disasters
Nursing Intervention-Crisis
1. safety and basic needs 2. pharmacological interventions to reduce intensity 3. mobilize social support to respond to needs
Psychological First Aid
A: Arousal-decrease excitement by providing safety, comfort and consolation B: behavior: assist survivors to function more effectively C: reality testing and clear information be provided upon disorientation
Disaster
sudden, overwhelming,catastrophic event that causes great damage and destruction
Prewarning of Disaster
preparing victims for possible evacuation of the environment, mobilization of resources, and review of community disaster plans
Disaster Event Occurs
provide resources, assistance, and support as needed
Recuperative effort
implement strategies for healing the sick, preventing complications and repairing damages
Grief
intense, bipsychosocial reaction to the lost of a loved one that includes pain, sadness and desolation
Bereavement
process of mourning and coping
Phases of Bereavement
1. shock and disbelief 2. acute mourning 3. resolution
Dual Process Model of Grieving
Loss-oriented coping & restoration- oriented coping
Loss-oriented
preoccupation with the deceased (memories or wondering how person would react)
Restoration-oriented
preoccupation with stressful events as a result of death including financial, funeral or new identity
Traumatic Grieving
1. suddenness and lack of anticipation 2. violence, mutilation and destruction 3. preventability and randomness of death 4. multiple deaths 5. mourner experienced significant threat to personal survival
Nursing Interventions-Grieving
-assess for suicide or self harm -listen -link to support systems -refer to therapist/psychiatrist
Confrontation
-Awareness of nonproductive behavior -suggestion of more constructive behavior
C.A.R.E Benefits
-no longer immobilized by a situation -take control without aggression -remain calm, controlled, assertive -create a work environment we desire -contributes to empowered professional nurse
Reasons for Confrontation
-behavior is destructive -behavior invades our rights or rights of others
C.A.R.E
Clarify Articulate Request Encourage
Experience of suffering
Nurses witness suffering and distress
Shadow grief
picking up client's sadness, leads to burnout
Compassion fatigue
nurses ignore their responses to be overwhelming with emotional demands
Common Sources of Distress
-loss of control -change -sense of threat -unrealized expectation
Step 1 - Distressed Client
Assessment of -thoughts -feelings -request
Step 2 - Distressed Clients
Choose appropriate communication strategy and desired outcome
Step 3 - Distressed Client
Implementation and Evaluation of communication strategy
Psychoeducation (Group)
enhance knowledge, improve skills and solve problems
Task (Groups)
focus on completion of specific activities such as planning a week's menu
Decision - making (Groups)
groups that plan activities, develop unit rules and select learning materials
Supportive Groups
focus on helping individuals cope with their illness and problems
Psychotherapy Groups
treat individual's emotional problems and can be implemented from various theoretic perspectives
Self-help Groups
led by people with concerts about coping with a specific problem or life crisis
Age-Related Groups
for specific age groups
Altruism
learning to give to others
Universality
finding out other people share the same problems
Instillation of hope
hope is required to keep patients in therapy
Interpersonal learning
analogue of therapeutic factors in individual therapy, such as insight
catharsis
open expression of affect to purge to cleanse self
Existential factors
ultimate concerns of existence, death, isolation, freedom and meaningless
Teaching Process
1. assessment 2. identify needs 3. planning 4. implementation 5. Evaluation
Stages of Change
1. precontemplation-not intending to take action in forseeable future 2. contemplation - intend to change in next 6 months 3. preparation - intending to take action in the next month 4. action - made modifications in their lifestyle in last 6 months 5. Maintenance - working to prevent…
Process of Change (experiential)
1. consciousnessraising - increased awareness of cause consequences and cures for behavior 2. dramatic relief - increasing emotional experiences which will enable improved feelings if action is taken 3. environmental reevaluation - affective and cognitive assessments of how the behavior…
Stages of Change (behavior)
1. stimulus control- removes cue for unhealthy habits 2. helping relationships - caring support and acceptance (buddy) 3. counter condition - learning healthy behaviors 4. reinforcement management - consequences for taking steps in certain direction 5. self liberation - belief you can…
Anorexia Nervosa
Restricting or eating very little food -eating excess food followed by vomiting

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