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Mental Health Exam 1

Terms in this set (25)

•What if I say the wrong thing?
No one magic phrase can solve a client's problems; likewise, no single statement can significantly worsen them. Listening carefully, showing genuine interest, and caring about the client are extremely important. A nurse who possesses these elements but says something that sounds out of place can simply restate it by saying, "That didn't come out right. What I meant was..."
•What will I be doing?
In the mental health setting, many familiar tasks and responsibilities are minimal. Physical care skills or diagnostic tests and procedures are fewer than those conducted in a busy medical-surgical setting. The idea of "just talking to people" may make the student feel as though he or she is not really doing anything. The student must deal with his or her own anxiety about approaching a stranger to talk about sensitive and
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personal issues. Development of the therapeutic nurse-client relationship and trust takes time and patience.
•What if no one will talk to me?
Students sometimes fear that clients will reject them or refuse to have anything to do with student nurses. Some clients may not want to talk or are reclusive, but they may show that same behavior with experienced staff; students should not see such behavior as a personal insult or failure. Generally, many people in emotional distress welcome the opportunity to have someone listen to them and show a genuine interest in their situation. Being available and willing to listen is often all it takes to begin a significant interaction with someone.
•Am I prying when I ask personal questions?
Students often feel awkward as they imagine themselves discussing personal or distressing issues with a client. It is important to remember that questions involving personal matters should not be the first thing a student says to the client. These issues usually arise after some trust and rapport have been established. In addition, clients genuinely are distressed about their situations and often want help resolving issues by talking to the nurse. When these emotional or personal issues are addressed in the context of the nurse-client relationship, asking sincere and necessary questions is not prying but is using therapeutic communication skills to help the client.
•How will I handle bizarre or inappropriate behavior?
The behavior and statements of some clients may be shocking or distressing to the student initially. It is important to monitor one's facial expressions and emotional responses so that clients do not feel rejected or ridiculed. The nursing instructor and staff are always available to assist the student in such situations. Students should never feel as if they will have to handle situations alone.
•What happens if a client asks me for a date or displays sexually aggressive or inappropriate behavior?
Some clients have difficulty recognizing or maintaining interpersonal boundaries. When a client seeks contact of any type outside the nurse-client relationship, it is important for the student (with the assistance of the instructor or staff) to clarify the boundaries of the professional relationship (see Chapter 5). Likewise, setting limits and maintaining boundaries are needed when a client's behavior is sexually inappropriate. Initially, the student might be uncomfortable dealing with such behavior, but with practice and the assistance of the instructor and staff, it becomes easier to manage. It is also important to protect the client's privacy and dignity when he or she cannot do so.
•Is my physical safety in jeopardy?
Often students have had little or no contact with seriously mentally ill people. Media coverage of those with mental illness who commit crimes is widespread, leaving the impression that most clients with psychiatric disorders are violent. Actually, clients hurt themselves more often than they harm others. Staff members usually closely monitor clients with a potential for violence for clues of an impending outburst. When physical aggression does occur, staff members are specially trained to handle aggressive clients in a safe manner. The student should not become involved in the physical restraint of an aggressive client because he or she has not had the training and experience required. When talking to or approaching clients who are potentially aggressive, the student should sit in an open area rather than in a closed room, provide plenty of space for the client, or request that the instructor or a staff person be present.
Overachievement in one area to offset real or perceived deficiencies in another area
• Napoleon complex: diminutive man becoming emperor
• Nurse with low self-esteem working double shifts so that her supervisor will like her
Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature
• Teenager forbidden to see X-rated movies is tempted to do so by friends and develops blindness, and the teenager is unconcerned about the loss of sight
Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue
• Diabetic person eating chocolate candy
• Spending money freely when broke
• Waiting 3 days to seek help for severe abdominal pain
Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings
• Person who is mad at the boss yells at his or her spouse
• Child who is harassed by a bully at school mistreats a younger sibling
Dealing with emotional conflict by a temporary alteration in consciousness or identity
• Amnesia that prevents recall of yesterday's auto accident
• Adult remembers nothing of childhood sexual abuse
Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage
• Never learning to delay gratification
• Lack of a clear sense of identity as an adult
Modeling actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or occupational goal
• Nursing student becoming a critical care nurse because this is the specialty of an instructor she admires
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Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions
• Person shows no emotional expression when discussing serious car accident
Accepting another person's attitudes, beliefs, and values as one's own
• Person who dislikes guns becomes an avid hunter, just like a best friend
Unconscious blaming of unacceptable inclinations or thoughts on an external object
• Man who has thought about same-gender sexual relationship but never had one beats a man who is gay
• Person with many prejudices loudly identifies others as bigots
Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect
• Student blames failure on teacher being mean
• Man says he beats his wife because she does not listen to him
Reaction formation
Acting the opposite of what one thinks or feels
• Woman who never wanted to have children becomes a supermom
• Person who despises the boss tells everyone what a great boss she is
Moving back to a previous developmental stage to feel safe or have needs met
• A 5-year-old asks for a bottle when new baby brother is being fed
• Man pouts like a 4-year-old if he is not the center of his girlfriend's attention
Excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness
• Woman has no memory of the mugging she suffered yesterday
• Woman has no memory before age 7, when she was removed from abusive parents
Overt or covert antagonism toward remembering or processing anxiety-producing information
• Nurse is too busy with tasks to spend time talking to a dying patient.
• Person attends court-ordered treatment for alcoholism but refuses to participate
Substituting a socially acceptable activity for an impulse that is unacceptable
• Person who has quit smoking sucks on hard candy when the urge to smoke arises
• Person goes for a 15-minute walk when tempted to eat junk food
Replacing the desired gratification with one that is more readily available
• Woman who would like to have her own children opens a day care center
Conscious exclusion of unacceptable thoughts and feelings from conscious awareness
• Student decides not to think about a parent's illness to study for a test
• Woman tells a friend she cannot think about her son's death right now
Exhibiting acceptable behavior to make up for or negate unacceptable behavior
• Person who cheats on a spouse brings the spouse a bouquet of roses
• Man who is ruthless in business donates large amounts of money to charity