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NURSE 2100: FINAL
Suicidality |
all suicide-related behaviors and thoughts of completing or attempting suicide
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Suicidal ideation
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thinking about & planning one's own death
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suicide attempt
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nonfatal, self-inflicted destructive act with intent to die
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parasuicide |
voluntary, apparent attempt at suicide, in which the aim is not death
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lethality |
probability that a person will successfully complete suicide
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Risk Factors - Suicide
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-psychological - drugs, psychosis, depression
-social - problem with finances, legal, family, social isolation
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Nursing Assessment
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-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
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Nursing Interventions - Suicide
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-Safety
-Commitment to treatment
-Psychoeducation (change negative thought patterns, stigma reduction)
-Developing supportive networks
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Short-term outcomes
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maintaining safety
averting suicide
mobilizing the patient's resource
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Long-Term outcomes
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Maintaining the patient in ward
-enabling patient and family to identify and manage suicidal crises
-widening support network
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Crisis
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State of dysequilibrium from a stressful situation, a crisis will occur if any of the following balancing factors are absent
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Maturational Crises
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significant developmental events requiring role changes
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Situational crises
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occur when a specific life event upsets and individual's psychological equilibrium
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Traumatic Crises
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unexpected or unusual evens affecting a person or group of people dramatically as in violent, natural disasters
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Nursing Intervention-Crisis
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1. safety and basic needs
2. pharmacological interventions to reduce intensity
3. mobilize social support to respond to needs
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Psychological First Aid
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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
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Disaster |
sudden, overwhelming,catastrophic event that causes great damage and destruction
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Prewarning of Disaster
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preparing victims for possible evacuation of the environment, mobilization of resources, and review of community disaster plans
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Disaster Event Occurs
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provide resources, assistance, and support as needed
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Recuperative effort
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implement strategies for healing the sick, preventing complications and repairing damages
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Grief |
intense, bipsychosocial reaction to the lost of a loved one that includes pain, sadness and desolation
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Bereavement |
process of mourning and coping
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Phases of Bereavement
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1. shock and disbelief
2. acute mourning
3. resolution
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Dual Process Model of Grieving
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Loss-oriented coping & restoration- oriented coping
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Loss-oriented
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preoccupation with the deceased (memories or wondering how person would react)
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Restoration-oriented
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preoccupation with stressful events as a result of death including financial, funeral or new identity
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Traumatic Grieving
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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
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Nursing Interventions-Grieving
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-assess for suicide or self harm
-listen
-link to support systems
-refer to therapist/psychiatrist
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Confrontation |
-Awareness of nonproductive behavior
-suggestion of more constructive behavior
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C.A.R.E Benefits
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-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
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Reasons for Confrontation
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-behavior is destructive
-behavior invades our rights or rights of others
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C.A.R.E
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Clarify
Articulate
Request
Encourage
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Experience of suffering
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Nurses witness suffering and distress
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Shadow grief
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picking up client's sadness, leads to burnout
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Compassion fatigue
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nurses ignore their responses to be overwhelming with emotional demands
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Common Sources of Distress
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-loss of control
-change
-sense of threat
-unrealized expectation
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Step 1 - Distressed Client
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Assessment of
-thoughts
-feelings
-request
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Step 2 - Distressed Clients
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Choose appropriate communication strategy and desired outcome
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Step 3 - Distressed Client
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Implementation and Evaluation of communication strategy
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Psychoeducation (Group)
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enhance knowledge, improve skills and solve problems
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Task (Groups)
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focus on completion of specific activities such as planning a week's menu
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Decision - making (Groups)
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groups that plan activities, develop unit rules and select learning materials
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Supportive Groups
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focus on helping individuals cope with their illness and problems
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Psychotherapy Groups
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treat individual's emotional problems and can be implemented from various theoretic perspectives
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Self-help Groups
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led by people with concerts about coping with a specific problem or life crisis
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Age-Related Groups
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for specific age groups
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Altruism |
learning to give to others
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Universality |
finding out other people share the same problems
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Instillation of hope
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hope is required to keep patients in therapy
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Interpersonal learning
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analogue of therapeutic factors in individual therapy, such as insight
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catharsis
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open expression of affect to purge to cleanse self
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Existential factors
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ultimate concerns of existence, death, isolation, freedom and meaningless
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Teaching Process
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1. assessment
2. identify needs
3. planning
4. implementation
5. Evaluation
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Stages of Change
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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 relapse
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Process of Change (experiential)
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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 affects other people
4. social liberation - increased opportunities or alternatives
5. self-reevaluation - affect assessments of one own self
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Stages of Change (behavior)
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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 change
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Anorexia Nervosa
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Restricting or eating very little food
-eating excess food followed by vomiting
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