Mental Health Exam 2 Review

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  1. Freud
    structure of the personality
    Id, ego, and superego
    Id - pleasure principle - immediate gradification - present at birth

    • Ego - reality principle - rational self - mediator to maintian harmony between the external world, the id and the superego
    • -develops at 4 -6 months

    • Superego - perfection principle - internalizes values and morals set forth by primary caregivers - develops between 3 to 6 years
    • ego-ideal - child is rewarded for good behavior and self esteem is enhanced - behavior becomes part of value system
    • conscious - child is punished for bad behavior - child learns moral pricipals and guilt results of child tries to disregards those principals
  2. Freud - Topagraphy of the mind
    Consciuos - all memories that remain in individuals awareness - smallest category - under control of the ego

    • preconscious - memories that are forgotten or are not in present awareness but can be recalled to the conscious
    • -partially under control of the superego

    unconscious - all memories that one is unable to bring to conscious awareness -unpleasant or nonessential memories that have been repressed- largest category
  3. Freud's Stages of Personality Development
    Oral - birth to 18 months - relief from anxiety through oral gratification of needs

    Anal - 18 mo to 3 years - learing independence and control, with focus on the excretory function

    • Phallic - 3 to 6 years - Indentification with parent of same gender, development of sexual identity, focus on genital organs
    • - Oedipus or Electra complex develops during this stage - desire to elimiante parent of same gender and possess parent of opposite gender

    Latency - 6 to 12 years - Sexuality repressed, focus on relationships with same-gender peers

    Genital 13 to 20 years - Libido reawakened as genital organs mature, focus on relationships with members of the opposite gender
  4. Sullivan's Stages of Development
    Infancy - Birth- 18 month - relief from anxiety through oral gratification

    Childhood - 18 mo to 6 years - Learning to experience a delay in personal gratification without undue anxiety

    Juvenile - 6 to 9 years - Learning to form satisfactory peer relationships

    Preadolescence - 9 to 12 years - Learning to form satisfactory relationships with persons of same gender , initiating feelings of affection for another person

    Early Adolescence - 12 to 14 years - Learning to form satisfactory relationships with persons of the opposite sex; developing a sence of identitiy

    Late Adolescence - 14 to 21 years - Establishing self-identity; experiencing satisfying relaitonships; working to develop a lasting intimate opposite-gender relationship
  5. Ego Defense Mechanisms
    1. Compensation - covering up a real or percieved weakness by emphasizing a trait one considers more desirable

    2. Denial - refusing to acknowledge the existence of a real situation or feelings associated with it

    3. Displacement - transfer of feelings from one target to another that is less threatening (mad at Dr - takes out on nurse)

    4. Identification - attempt to increase self-worth by acquiring attributes & characteristics on someone you admire

    5. Intellectualization - to avoid expressing emotions associated to a situation by using intellectural processes of logic, reasoning, and analysis

    6. Introjection - integrating belief & value system of another into one's ego structure (kids & parents)

    7. Isolation - separating thought or memory from the emotions associated with it

    8. Projection - Attributing feelings or impulses unacceptable to one's self to another person (he's coming on to me)

    9. Rationalization - make excuses or formulate logical reasons to justify unacceptable feelings or behaviors

    10. Reaction Formation - Preventing unacceptable thoughs or behaviors from being expressed by exaggerating opposite thoughs or types of behaviors

    11. Regression- Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning

    12. Repression - involuntarily blocking unpleasant feelings and experiences from one's awareness

    13. Sublimation - Rechanneling of drives or impulses that are personally or socially unacceptable into activites that are constructive (MADD)

    14. Suppression -The voluntary blocking of unpleasant feelings and experinces from one's awareness (I'll think about that tomorrow)

    14. Undoing - Symbolically negating or canceling out an experience that one finds intolerable
  6. Erikson's Stages of Development
    Infancy - Birth to 18 mo - Trust vs. Mistrust

    Early Childhood - 18 mo to 3 yrs - Autonomy vs. shame and doubt

    Late Childhood - 3 to 6 yrs - Initiative vs. guilt

    School Age - 6 to 12 years - Industry vs. inferiority

    Adolescence - 12 to 20 years - Identity vs. role confusion

    Young Adult - 20 to 30 years - Intimacy vs. isolation

    Adulthood - 30 to 65 years - Generativity vs. stagnaiton

    Old Age - 65 years to death - ego integrity vs. despair
  7. Erikson's Stages of Development
    Infancy = birth to 18 months

    Trust vs. Mistrust

    Major task: to develop a basic trust in the mothering figure and be able to generalize it to others

    • -infant lears to trust when basic need are consistantly meet
    • -Achievement results in self-confidence, optimism, faith, and hope for the future
    • -Nonachievement results in emotional dissatisfaction with self and others, suspiciousness, and difficulty with interpersonal relationships
  8. Erikson's Stages of Development
    Early Childhood
    Early childhood = 18 mo to 3 years

    Autonomy vs. shame and doubt

    Major task: to gain some self-control and independence withing the environment

    • -autonomy is achieved with parents encourage and provide opportunities for independent activities
    • -task is unresolved with parents restrict independent behaviors (phisically and verbally) or set child up for failure with unrealistic expectations
    • -achievement results in sence of self-control and ability to delay gratification. Feelings of self-confidence in one's ability to perform
    • -nonachievement results in lack of self-confidence, a lack of pride in the ability to perform, sence of being controlled by others, rage against self
  9. Erikson's Stages of Development
    Late childhood
    Late Childhood = 3 to 6 years

    Initiative vs. guilt

    Major Task: To develop a sence of purpose and the ability to initiate and direct own activites

    • -initiative is achieved when creativity is enoucraged and performance is recognized and positively reinforced
    • -task remains unresolved when creativity is stifled and parents consistantly expect higher level of performance than child produces
    • -Achievement results in ability to exercise restraint and self-control of inappropriate social rehaviors, assertiveness, dependability increases, child enjoys learning and personal achievement
    • -Nonachievement results in feelings of inadequacy and a sence of defeat. Guilt is experienced to an excessive degree. Child may view self as evil and in need of punishment
  10. Erikson's Stages of Development
    School Age
    School Age = 6 to 12 years

    Industry vs. Inferiority

    Major Task: To achieve a sence of self-confidence by learning, competing, perofrming sucessfully, and recieving recognition from significant others, peers, and aquantances

    • -Industry is achieved when encouragement is given to activities and responsibilities in the school and community, as well as in the home. Recognition is given for accomplishments
    • -Task remains unresolved when parents set up unrealistic expectations, when dicipline is harsh and tends to impair self-esteem, and when accomplishments are met with negative feedback.
    • -Achievement results in sence of satisfaction and pleasure in the interaction and involvement with others. Masters reliable work habits attitude of trustworthiness, conscientious, feels pride in achievement, enjoys play, desires balance between fantasy and "real-world" activities
    • -Nonachievement results in difficulty in interpersonal relationships, feelings of personal inadequacy, can't cooperate and compromise in group activites, can't problem solve or complete tasks sucessfully. May be passive and meek or overly aggressive to cover up feelings of inadequacy - may violate or manipulate rights of others to satisy his or her own needs or desires
  11. Erikson's Stages of Development
    12 to 20 years

    Identity vs. role confusion

    Major task: to integrate the tasks mastered in the previous stages into a secure sence of self

    • -Identity is achieved with adolescence are allowed to experience indepence by making decisions that influence their lives
    • -Lack of self-confidence is often expressed by deliquent and rebellious behavior
    • -Achievement results in sence of confidence, emotional stability, view of self as unique individual. Commitments made to value system, choice of career, and relationships with members of both genders
    • -Nonachievement results in sence of self-consciousness, doubt, and confusion about one's role in life. Personal goals are absent, commitments to relationships are nonexistant or brief.
  12. Erikson's Stages of Development
    Young Adulthood
    20 to 30 years

    Intimacy vs. Isolation

    major task: form an intense, lasting realtionship or a commitment to another person, cause, institution, or creative effort

    • -Intimacy is achieved when individual has capacity for giveing of oneself to another
    • -Task is unresolved when love in the home has been distorted through younger years
    • -Achievement results in capacity for mutual love and respect between two people and ability to pledge a total commitment to each other
    • -Nonachievement results in withdrawl, social isolation, aloneness. Unable to form lasting, intimate relationships, seeking intimacy through sexual encounters. No career extablished - occupational changes
  13. Erikson's Stages of Development
    30 to 65 years

    Generativity vs. stagnation

    mojor task: to achieve life goals established for oneself, while also considering the welfare of future generations

    • -Generativity results when the individual expresses satisfaction with this stage in life and demonstrates responsibility for leaving the world a better place
    • -Task reamins unresolved with earlier developmental tasks are not fulfulled and the individual does not achieve the degree of maturity required to derive gratification out of a personal concern for the welfare of others
    • -Achievement results in sence of gratification from personal and professional achievements and from meaningful contributions to others
    • -Nonachievement results in lack of concern for the welfare of others and total preocculation with the self. May be withdrawn, isolated, highly self-indulgent, no capacity for givign the self to others
  14. Erikson's Stages of Development
    Older Adulthood
    65 to death

    Ego Integrity vs. despair

    major task: to review one's life and derive meaning from both positive and negative events, while achieving a positive sence of self-worth

    • -Ego integrity is achieved when developmental tasks of other stages are completed and have little desire to make major changes in the way their life has progressed
    • -Task reamins unresulved when earlier tasks are not fulfulled - self-confidence, concern for others, and strong sence of self-identity are never achieved
    • -Achievement results in sence of self-worth and self-acceptance as one one reviews life goals. Sence of dignity from life experiences and does not fear death
  15. Interpersonal Theory – Sullivan
    Based on the belief that individual behavior and personality development are the direct result of interpersonal relationships

    • Major concepts of this theory:
    • Anxiety - feeling of emotional discomfort, toward the releif or prevention of which all behavior is aimed

    Satisfaction of needs - fulfullment of all requirements associated with an individual's physiochemical environment

    Interpersonal security - feeling associated with relief from anxiety - when all need are met one experiences a sence of total well-being

    Self-system - collection of experiences or security measures adopted by the individual to protect against anxiety

    • Relevance to nursing practice
    • Relationship development is a major psychiatric nursing intervention. Knowledge about the behaviors associated with all levels of anxiety and methods for alleviating anxiety help nurses assist clients in achieving interpersonal security and a sense of well-being.
  16. Theory of Psychosocial Development – Erikson
    Relevance to nursing practice

    Many individuals with mental health problems are still struggling to achieve tasks from a number of developmental stages. Nurses can plan care to assist these individuals to fulfill these tasks and move on to a higher developmental level.
  17. A Nursing Model - Peplau
    Applies interpersonal theory to nurse-client relationship development

    Correlates the stages of personality development in childhood to stages through which clients advance during the progression of an illness

    Sees interpersonal experiences as learning situations for nurses to facilitate forward movement in the development of personality

    • Relevance to nursing practice
    • Peplau’s model provides nurses with a framework to interact with clients, many of whom are fixed in, or because of illness have regressed to, an earlier level of
    • development. Using nursing roles suggested by Peplau, nurses may facilitate client learning that was not achieved in earlier experiences.
  18. Paplau's Six Nursing Roles
    Peplau identifies six nursing roles in which nurses function to assist individuals in need of health services:

    Resource person - provides information to help client understand their problem and situation

    Counselor - listens as the client reviews feelings related to difficulties they are experiencing in any aspect of life

    Teacher - identifies learning needs and proides information to the client and family

    Leader - directs the nurse-client interaction and ensures that appropriate actions are undertaken to facilitate achievement of the designated goals

    Technical expert - understands verious professional devices and possesses the skills to perform interventions that are in the best interest of the client

    Surrogate - one who serves as a substitute figure for another
  19. Carl Rogers
    Client centered theory

    If a client receives unconditional positive regard (UPR) and empathic understanding from a genuine and congruent therapist, then the client will grow as an individual
  20. BF Skinner - Behaviorist
    Behavioral Modification
    Assertiveness Training
    Operant Learning/Conditioning
    All behavior is learned

    behavior has consequences (+ or -)

    rewarded behavior tends to reoccur

    positive reinforcement increases the frequency of behavior, as does removal of negative reinforcers

    treatment modalites based on this theory include behavior modification, token economy, and systematic desensitization

    • Skinner was accredited with the following therapies.
    • Behavioral Modification - treatment modality aimed at changing undesirable behaviors using a system of reinforcement to bring about the modifications desired

    Assertiveness Training - Assertive behavior helps the individual stand up for their own basic human rights

    Operant Learning/Conditioning - The learning of a particular action or type of behavior that is followed by a reinforcement (could be negative or positive)
  21. positive reinforcement
    negative reinforcement
    reinforcement stimulus that increases the probability that the behavior will occur

    negative - Increasing the probability that a behavior will occur by removal of an undesirable reinforcement stimulus
  22. Most frequently seen defense mechanisms
    • Denial
    • Displacement
    • Projection
    • Rationalization
    • Reaction formation
  23. Maslow
    Theorist focused on wellness and factors contributing to mental health rather than focusing on factors contributing to mental illness

    The self actualized person is tolerant or welcoming of uncertainty, self accepting, inner directed, spontaneous, creative, caring, open, with a good sense of humor
  24. Maslow's Hierarcy of Needs
    • Self-actualization
    • Self-esteem
    • Love and belonging
    • Safety needs
    • Physiologic needs
  25. Stages of Anxiety - as defined by Peplau
    Mild - sledom a problem - it is adaptive and can provide motivation for survival

    Moderate - perceptual field diminishes Ex - person who is preparing for surgery

    • Severe - perceptual field is so diminished that concentration centers on one detail only or on many extraneous details, physical symptoms usually
    • present

    Panic - the most intense state, safety is # 1 concern
  26. Kubler-Ross
    The Guru of Grief

    Grief - the subjective state of emotional, physical and social responses to the loss of a valued entity; the loss may be real or percieved

    • Five stages of Grief
    • Denial
    • Anger
    • Bragaining
    • Depression
    • Acceptance

    • Anticipatory grief - experiencing the grief process before the actual loss occursResolution
    • - length of the grief process is entirely individual. It can last from a few weeks to years. It is influenced by a number of factors
  27. phobias
    irrational fear
  28. Peplau –phases of nurse-client relationship
    Pre-orientation - explore self perceptions, obtain info on client from chart, significant others, or other health team members

    • 2. Orientation - Establish trust, rapport, and contract
    • for working together, formulate nursing Dx, set goals agreeable to nurse and client, develop plan of action

    • 3. Working - promote client change, problem solve,
    • continuously evaluate porgress toward goal attainment

    • 4. Termination - progress has been made toward goal
    • attainment, plan for future care, feelings of terminating relationship explored, ensure therapeutic closure
  29. Transference
    • - client transfers feelings toward significant others in past
    • life to nurse
  30. counter-transference
    nurse transfers feeling toward significant others in past life to client or may be in response to transference feelings from client
  31. systematic desensitization
    tx for phobias - taught to relax and then asked to imagine various components of the phobic stimulus on a graded hierarchy, moving from that which produces the least rear to that which produces the most
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Mental Health Exam 2 Review
Mental Health Exam 2 Review
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