NSG 526 FINAL EXAM 1 Latest 2024 Exam Graded A+|GUARANTEED PASS, Exams of Nursing

Download NSG 526 FINAL EXAM 1 Latest 2024 Exam Graded A+|GUARANTEED PASS and more Exams Nursing in PDF only on Docsity! NSG 526 FINAL EXAM 1 Latest 2024 Exam Graded A+|GUARANTEED PASS Group Therapy primary purpose The primary purpose of group therapy is to facilitate changes by the patient to address identified problems. A technique for dealing with an over talkative client and silence from other participants in a group during therapy make an observation about the group's silence and invite the others to comment the technique of "Information Giver". During group members sharing methods they personally use for dealing with problems CBT consists of active questioning, homework assignments, and dream survey. The therapist helps the patient consider personal ideas and beliefs in order to increase the patient's realization about how thoughts influence behaviors. Attachment Attempts to explain the dynamics of interpersonal relationships between humans. A child needs to form a relationship between at least one primary caregiver. Mileu Milieu therapy requires consideration of the client's social, economic, and cultural status. Complementary Alternative Medicine vs Western major difference Western medicine focuses on what is done to the patient whereas CAM focuses on mind-body interactions. Beck Beck developed the cognitive model of DEPRESSION and the concept that cognitive processing distortions underlie psychological disorders ACTIVE, TIME-LIMITED APPROACH According to BECK depression can be understood via 1) cognitive errors, and the 2) cognitive triad (i.e., negative views of SELF, a tendency toward interpreting EXPERIENCES/WORLD in a negative manner, and holding negative views of the FUTURE). 3. Schemas Beck's Cognitive Therapy suggests Depression is triggered when dysfunctional schemas are activated and give rise to negative cognitions and patterns of information processing that precipitate depression Albert Ellis Rational Emotive Therapy (RET) learning factual information from other members, for example about tmt or about access to services Corrective recapitulation of primary family experience (Yalom) Members often unconsciously identify the group therapist and other group members with their own parents and siblings in a process that is a form of transference specific to group psychotherapy. The therapist's interpretations can help group members gain understanding of the impact of childhood experiences on their personality, and they may learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships. Development of socializing techniques (Yalom) The group setting provides a safe and supportive environment for members to take risks by extending their repertoire of interpersonal behavior and improving their social skills. Imitative behavior (Yalom) One way in which group members can develop social skills is through a modeling process, observing and imitating the therapist and other group members. For example, sharing personal feelings, showing concern, and supporting others. Cohesiveness (Yalom) Is the primary therapeutic factor from which all others flow. Humans are herd animals with an instinctive need to belong to groups, and personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance, and validation. Existential Factors (Yalom) Learning that one has to take responsibility for one's own life and the consequences of one's decisions Catharsis (Yalom) The experience of relief from emotional distress through the free and uninhibited expression of emotion. When members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt. We refer to catharsis as "getting things off our chest." Interpersonal learning therapy group The FOCUS is change. The group provides the antidotes to maladaptive behaviors through feedback from others and encouragement to experiment with healthier behaviors, first within a group and then outside. The joint examination of inter group transference reactions allows members to replace processes that have a historical origin in the "THERE AND THEN" - the dynamic past with in those more appropriate to the HERE and NOW- the dynamic present Self-understanding (Yalom) This factor overlaps with interpersonal learning but refers to the achievement of greater levels of insight into the genesis of one's problems and the unconscious motivations that underlie one's behavior. Autocratic leader exerts control over the group and does not encourage much interaction among members. For example, staff leading a community meeting with a fixed, time-limited agenda may tend to be more autocratic Democratic leader supports extensive group interaction in the process of problem solving. Psychotherapy groups most often employ this leadership style Laissez-faire leader allows the group members to behave in any way they choose and does not attempt to control the direction of the group. In a creative group, such as an art group, the leader may choose this style of leadership, giving minimal direction to allow for a variety of responses Role of Information giver in a group session Shares facts or own experience as an authority figure Characteristics of an effective leader In any group, the leader must be thoughtful about communication techniques, since these have a tremendous impact on group content and process. Mileu therapy benefit It is an all-inclusive term that recognizes the people, setting, structure, and emotional climate as all important to healing Milieu therapy takes naturally occurring events in the environment and uses them as rich learning opportunities for clients. therapuetic community A well-managed milieu offers clients a sense of security and comfort. Milieu benefit to sexual disorders Therapeutic touch- type of integrative medicine useful in relieving premenstrual syndrome, depression, complications in premature babies, and secondary infections associated with human immunodeficiency virus (HN) infection; lowering blood pressure; decreasing edema; easing abdominal cramps and nausea; resolving fevers; and accelerating the healing of fractures, wounds, and infections. Yoga as a treatment approach Your Own Relation to God Always People use yoga for a variety of conditions and to achieve fitness and relaxation. Hatha is the most common type practiced in the united states poses, breathing , meditation, standing, balancing, twists, inversion movements Dolores Krieger and use of therapeutic touch- type of integrative care Dolores Krieger, a nursing professor at New York University healing is promoted by balancing the body's energies. practitioners focus completely on the person receiving the treatment, without any other distraction. Practitioners then assess the energy field, clear and balance it through hand movements, and/or direct energy in a specific region of the body. The therapist DOES NOT ACTUALLY TOUCH THE PT. After undergoing a session of therapeutic touch, clients report a sense of deep relaxation. Beck's Cognitive Triad in depressed patients. 1) Self- I'm worthless and ugly 2) World/experiences- people ignore me all the time 3) Future- I'm hopeless, things will never change) (Worthless, helpless, and hopelessness ) negative views of self tendency toward interpreting experiences in a negative manner holding negative views of the future Operant conditioning (BF SKINNER)- TYPE OF BEHAVIOR THERAPY Operant conditioning is the basis for behavior modification and uses positive reinforcement to increase desired behaviors. desired goals are achieved or behaviors are performed, clients might be rewarded with tokens. These tokens can be exchanged for food, small luxuries, or privileges. This reward system is known as a token economy. been useful in improving the verbal behaviors of mute, autistic, and developmentally disabled children. In clients with severe and persistent mental illness, behavior modification has helped increase levels of self-care, social behavior, group participation Behavioral therapy Behavioral therapy is base on the assumption that changes in maladaptive behavior can occur without insight into the underlying cause. This approach works best when it is directed at specific problems and the goals are well defined. Behavioral therapy is effective in treating people with phobias, alcoholism, schizophrenia, and many other conditions. 4 types behavioral therapy 1)Modeling 2)operant conditioning 3)systematic desensitization 4) aversion Systematic Desensitization (TYPE OF BEHAVIORAL THERAPY) Systematic desensitization is another form of behavior modification therapy that involves the development of behavioral tasks customized to the client's specific fears; these tasks are presented to the client while using learned relaxation techniques. The process involves four steps: The client's fear is broken down into its components by exploring the particular stimulus cues to which the client reacts. The client is incrementally exposed to the fear. The client is instructed in how to design a hierarchy of fears. The client practices these techniques every day. Girl- Swimming Approach to patient wanting to use CAM to treat his health conditions studies in the field are minimal when compared to those of conventional medicine. no standards or regulations that guarantee the safety or efficacy of herbal products. Consumers may waste a great deal of money and risk their health on unproven, fraudulently marketed, useless, or harmful products and treatments. Another concern regarding CAM therapies is that diagnosis and treatment may be delayed while clients try alternative interventions, which is common with mental health symptoms such as major depression and anxiety. Research on herbs such as St. John's wort, valerian, and ginkgo biloba and mind-body interventions such as yoga and meditation is extensive, and results are available on the NCCAM website. DBT Focus group (Yalom) size 4-7 people, inpatient HIGHER PATHOLOGIES LOWER FUNCTIONING PATIENTS, goal is to make this successful, non-anxiety producing so clients comfortable in group, simple tasks (drawing a picture, or making a meal) (Clients can be psychotic or severely depressed) 45 minutes leader must be flexible positive reinforcement should be used generously Heterogeneous group a group in which a range of differences exists among members Homogeneous group a group in which all members share central traits (e.g., men's group, group of clients with bipolar disorder) reasons a therapist to share personal information with patients using self-disclosure: demonstrate how you had changed similar automatic thoughts. 1) create therapeutic alliance 2) fostering interpersonal relationships altruism in therapy The act of 1 member helping another putting others needs before and learning that there is value in giving to others. This is believed to be a major factor in establishing group cohesion and community feeling. Interpersonal learning. it occurs when group members learn from one another. it involves exchange of feedback on relational styles through the rational experiences that occur in the here and now of the group. Overgeneralization- cognitive distortion affects people with depression or anxiety disorders. way of thinking where you apply one experience to all experiences, including those in the future. Ex. i once gave a poor speech, therefore I always screw up speeches. secure attachment- ainsworth a relationship in which an infant obtains both comfort and confidence from the presence of his or her caregiver caregiver: reacts quickly and positively to the childs needs. Child- distressed when caregiver leaves, happy when return, seek comfort when scared or sad. insecure-avoidant attachment Do not orientate to their attachment figure while investigating the environment. They are very independent figure both physically and emotionally. they do not seek contact with the attachment figure when distressed. Such children are likely to have a caregiver who is insensitive and rejecting their needs. The attachment figure may withdraw during difficult tasks ( and is often unavailable during times of distress) insecure ambivalent/resistant cling to parents, don't venture away when parent leaves they become very upset and when the parent returns they dont allow the parent to comfort them as if they are resentful and angry at the parent dont calm down as quickly parents of these children tend to be inconsistent insecure-disorganized attachment a pattern of attachment in which an infant seems confused or apprehensive and shows contradictory behavior, such as moving toward the mother while looking away from her. Abusive, neglectful, responds in frighening ways. No attaching behaviors, often appear dazed, confused or apprehensive in presence of caregiver. Children- no particular pattern of attachment. Effective group leader These children tend to behave in bizarre ways when threatened A-B-C theory ( Ellis) Activating event, belief, consequences (emotional and/or behavioral) Ellis- RET "Masturbatory" ideologies have 3 forms: I must do well and win approval or I am a rotten person/You must act kindly toward me or you are a rotten person/My life must remain comfortable or life hardly seems worth living. Ellis-RET Therapy consists of... for RET Therapy consists of detecting and eradication irrational beliefs, Disputing: Detecting irrationalities, debating them, discriminating between logical and illogical thinking, and defining what helps create new beliefs. Debating: Questioning and disputing the irrational beliefs. Discriminating: Distinguishing between wants and needs, desires and demands, and rational and irrational ideas. Defining: Defining words and redefining beliefs. Jean Piaget's theory of cognitive development suggests that children move through four different stages of mental development. Possible outcomes for patients with Schizophrenia when conducting a symptom management group Reduction in severity of symptoms Reduction in hospitalizations Shorter hospitalizations improvement in social relationships employment improved health, better job/income better living conditions, education/training Reinforcement while conducting group therapy Positive behavior is rewarded and motivated. Rules are established by the therapist that specifies behaviors to be rewarded. This technique is based largely on behaviorism. Tokens for example are used to note a reward; accumulated tokens are then rewarded with an established reward Silent Sam With such clients the goal is to find a way to get all members, especially those who are less verbal, to participate in all group sessions. "Mary, we haven't heard from you tonight." "Mary, I noticed that you haven't said much tonight. How has your week gone?" "Bill has just shared his frustrations with the group. Mary, I know you've said you felt frustrated insimilar situations. What advice can you give Bill?" [This example directly targets a silent client by asking him or her to offer advice or suggestions to another client.] Late laura Although most clients who come late to groups are aware of their behavior, some fail to understand the effect their behavior has on the group. Having the group respond to such clients is more likely to result in changes (e.g., coming to subsequent groups on time) than is being told they are late by group leaders. The following responses would be used only with clients who are repeatedly late or who miss several group meetings. "This is the third time Mary has been late. What suggestions can the group provide to help her get here on time?" "I'm wondering how others feel about Mary being late for group several times." [Although this response is more direct than the first example, open discussion of some issues can increase members' sensitivity to their own behavior, as well as help them understand how their behavior affects the entire group.] Tommie Therapist Such clients may have been attending a group for several sessions, or they may have considerable prior therapy experience. At times, such clients' interactions in groups will parallel those of a therapist. Although such advice can sometimes be helpful to group members, on other occasions the advice can be disruptive or too direct. "Bill, your comments have been helpful. Let's see how others view Mary's concerns." "Bill, that is one way of looking at how Mary can handle the situation. What additional options canothers offer Mary?" Chatty Cathy and Monopolizing Mike Such clients dominate group discussions. Group leaders need to find effective ways to interrupt such clients, as they are often unaware of the impact that their behavior has on the group. A strategy that group leaders can use when a Chatty Cathy client is talking is to direct questions to the group as a whole. For example: "Bill, it sounds like a lot has happened with you this week. I am wondering what has happened with other group members." (The group leader then calls on another member.) "Mary, how did your week go?" "Mary, you seem to have had a lot going on this past week. Let's take a look at what's been happening with you for a few more minutes, and then let's see how others have been doing this Discounting the positive reject positive experiences by insisting they don't count. If you do a good job, you may tell yourself that it wasn't good enough or that anyone could have done as well. Discounting the positive takes the joy out of life and makes you feel inadequate and unrewarded. Jumping to Conclusions: You interpret things negatively when there are no facts to support your conclusion Mind Reading Without checking it out, you arbitrarily conclude that someone is reacting negatively to you Fortune-telling You predict that things will turn out badly. Before a test you may tell yourself, "I'm really going to blow it. What if I flunk?" If you're depressed you may tell yourself, "I'll never get better." Magnification- cognitive distortion You exaggerate the importance of your problems and shortcomings, or you minimize the importance of your desirable qualities. This is also called the "binocular trick." Emotional Reasoning You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true." You assume that your negative emotions necessarily reflect the way things really are: "I feel terrified about going on airplanes. It must be very dangerous to fly." Or "I feel guilty. I must be a rotten person." Or "I feel angry. This proves I'm being treated unfairly." Or "I feel so inferior. This means I'm a second-rate person." Or "I feel hopeless. I must really be hopeless "Should statements" Dr. Albert Ellis has called this "musterbation." "Should statements" that are directed against yourself lead to guilt and frustration. Should statements that are directed against other people or the world in general lead to anger and frustration: "He shouldn't be so stubborn and argumentative." Labeling- cognitive distortion Labeling is an extreme form of all-or-nothing thinking. Instead of saying "I made a mistake," you attach a negative label to yourself: "I'm a loser." Personalization and blame Personalization occurs when you hold yourself personally responsible for an event that isn't entirely under your control. When a woman received a note that her child was having difficulties at school, she told herself, "This shows what a bad mother I am," They blame other people or their circumstances for their problems, and they overlook ways that they might be contributing to the problem: "The reason my marriage is so lousy is because my spouse is totally unreasonable." Thought process of focus by therapists using CBT Negative automatic thoughts (NATs) Underlying assumptions used in planning of behavioral therapy approaches All behavior, normal or abnormal, is acquired and maintained in identical ways (that is, according to the same principles of learning). Behavior disorders represent learned maladaptive patterns that need not presume some inferred underlying cause or unseen motive. Maladaptive behavior, such as symptoms, is itself the disorder, rather than it being a manifestation of a more basic underlying disorder or disease process. It is not essential to discover the exact situation or set of circumstances in which the disorder was learned; these circumstances are usually irretrievable anyway. Rather, the focus should be on assessing the current determinants that support and maintain the undesired behavior. Maladaptive behavior, having been learned, can be extinguished (that is, unlearned) and replaced by new learned behavior patterns. Treatment involves the application of the experimental findings of scientific psychology, with an emphasis on developing a methodology that is precisely specified, objectively evaluated, and easily replicated. Assessment is an ongoing part of treatment, as the effectiveness of treatment is continuously evaluated and specific intervention techniques are individually tailored to specific problems. Behavioral therapy concentrates on "here-and-now" problems, rather than uncovering or attempting to reconstruct the past. The therapist is interested in helping the client identify and change current environmental stimuli that reinforce the undesired behavior, in order to alter the client's behavior. Treatment outcomes are evaluated in terms of measurable changes. Research on specific therapeutic techniques is continuously carried out by behavioral therapists Schemas (Beck) are an abstract cognitive plan that serves as a guide for interpreting information and solving problems. it is the basis for molding data into cognitions, defined as any verbal or pictorial content According to BECK the presence of a negative schema is not enough to trigger depression Aversion Therapy (type of behavioral therapy) akin to punishment, is used widely today to treat behaviors such as alcoholism, sexual deviation, shoplifting, hallucinations, violent and aggressive behavior, and self-mutilation. Aversion therapy is sometimes the treatment of choice when other less drastic measures have failed to produce the desired effects. The following are three paradigms for using aversive techniques: 1. Pairing of a maladaptive behavior with a noxious stimulus (e.g., pairing the sight and smell of alcohol with electric shock), so that anxiety or fear becomes associated with the once- pleasurable stimulus 2. Punishment (e.g., punishment applied after the client has had an alcohol drink) 3. Avoidance training (e.g., client avoids punishment by pushing a glass of alcohol away within a certain lime limit DBT treats= Borderline Personality Disorder/suicidal/ self harm Difference in DBT is related to the use of Mindfulness, Meditation and Emotional Regulation in the DBT approach. long term tmt Beck Cognitive Theory certain cognitions (e.g., maladaptive beliefs, irrational thoughts, dysfunctional schemas, and problematic information processing) likely lead to emotional distress and behavioral difficulties and thus modification of cognitions and cognitive patterns is required to effect change. RET uses role playing, assertion training, desensitization, humor, operant conditioning, suggestion, support, etc. STEPS to RET (ellis) ● Identify the irrational belief ● Dispute the irrational belief ● Work with illogical thinking patterns and tendencies that distort reality ● Teach social problem solving skills ● Teach appropriate rational self statements ● In-vivo behavioral rehearsal and practice GOAL of RET (Ellis) The absence of negative consequences through behavioral change due to new rational thinking. Steps of Dolores Krieger Therapeutic Touch- USES HUMAN ENERGY FIELD - YOU DO NOT NOT NOT TOUCH THE CLIENT o The first step is centering, in which the practitioner focuses on his or her intent to help the patient. This step resembles meditation and is claimed to benefit the practitioner as well. o The second step is assessment, in which the practitioner's hands, from 5 to 10 cm, sweep over the patient's body from head to feet, "attuning" to the patient's condition by becoming aware of "changes in sensory cues" in the hands. o The third step is intervention, in which the practitioner's hands "repattern" the patient's "energy field" by removing "congestion," replenishing depleted areas, and smoothing out ill- flowing areas. · The resultant "energy balance" purportedly stems disease and allows the patient's body to heal itself According to Ainsworth, disorganization is a severe form of insecure attachment and a possible precursor of severe personality disorder and dissociative phenomena in adolescence and early adulthood. Ainsworth developed a strange situation, the research protocol for assessing the quality and security of an infant's attachment. In this procedure, the infant is exposed to escalating amounts of stress; for example, the infant and the parent enter an unfamiliar room, an unfamiliar adult then enters the room, and the parent leaves the room. self-help groups Group of people with similar problems meet together without therapist reliance on peers- NO PROFESSIONALS Yin and Yang two forces in the universe, according to Chinese Theory: Yin is the COLD passive, negative force, and Yang HOT the active, positive force Western HC system -cores Therapist is the most directive in this stage 2) working phase of group Group leader encourages problem solving Group leader should support conflict resolution Group members are empowered to develop confidence in their problem solving abilities and better support one another in their individual efforts to grow and change During the working phase, the leader facilitates communication and ensures that meetings begin and end on time. 3) termination phase of group The leader ensures that each member summarizes individual accomplishments and gives positive and negative feedback regarding the group experience. Members can experience feelings of loss or anger . It is important to address such feelings as part of the groups work toward successful termination SELF help groups are Ppl who have shared the experience of a common problem , illness , crisis or tragedy . Ran by a PEER. Support groups- are often run by an agency Ex. AA GA ( gamblers) OA ( over eaters ) NA ( narcotics) negative reinforcement example take aspirin for headache --> headache goes away --> use of aspirin in future more likely for headache pain positive punishment example adding more chores to the original chore list due to child not completing assigned chores= decreases the frequency of that response negative punishment example taking away a car for too many parking tickets positive reinforcement example student earns A in psych, mother pays him 10$ (good stimulus) goal behavior- increase good grades Research evidence exists that combining aromatherapy with massage reduces anxiety and fosters mood elevation and stress reduction (Maddocks-Jennings & Wilkinson, 2004). There are anecdotal reports that aromatherapy is useful for pain relief, memory improvement, and wound healing. Reflexology is a form of bodywork that focuses primarily on the feet. integrative medicine the combination of conventional medicine with complementary practices and treatments that have proven to be safe and effective alternative medicine a group of medical treatments, practices, and products that are used instead of conventional Western medicine milieu therapy It is an all-inclusive term that recognizes the people, setting, structure, and emotional climate as all important to healing. Milieu therapy takes naturally occurring events in the environment and uses them as rich learning opportunities for clients examples of cognitive distortions: all or nothing thinking, catastrophizing, discounting the positive, emotional reasoning, labeling, magnification/minimization, mental filter, mind reading, overgeneralization, personalization, should and must statements, tunnel vision c. Impersonal effectiveness d. Distress tolerance 2. Generalization DBT therapists use various techniques to encourage the transfer of learned skills across all settings. School, work, community. a. For example, the therapist might ask the person in threatment to talk with a partnent about a conflict. The person may use emotion regulation skills before and after discussion. 3. Motivational Enhancement: Uses individualized behavioral treatment plans to reduce problematic behaviors that may negatively impact quality of life. a. For Example, a therapist might use self monitoring tracking sheets so sessions can be adapted to address the most severe issues first. 4. Capability and motivational enhancement of therapists: Because DBT is used often for people with chronic mental illness, therapists receive supervision and support to prevent vicarious traumatization or burnout. 5. Structuring of the environment: Goal of therapy is to ensure positive, adaptive behaviors that are reinforced across all environmental settings. a. For example- a client who participates in multiple treatment programs might have the therapist ensure that each one is set up to reinforce all positive skills and behavior. For AVERSIVE PROTOCOL: the nurse therapist and treatment team must answer the questions: 1. Is this in the best interest of the client? 2. Does this violate the client's rights? 3. Is it in the best interest of society There are also major differences between RET and CBT: 1. Philosophic. RET addresses the philosophic basis of emotional disturbance as well as the distorted cognitions (the focus of CBT), which makes it more powerful. As you uproot your absolutistic demands, your cognitive distortions get corrected. Advantages of group therapy Engaging multiple clients in treatment at the same time, thereby saving costs Participants benefit not only from the feedback of the group leader but also that of peers who may possess a unique understanding of the issues Providing a relatively safe setting to try out new ways of relating to other people and practicing new communication skills Promoting a feeling of belonging Disadvantages of group therapy Time constraints in which an individual member may feel cheated for floor time, particularly in large groups Concerns that private issues may be shared outside the group Dealing with disruptive member behavior during an emotionally vulnerable point Integrative care is directed at healing and considers the whole person (mind, body, and spirit), along with the lifestyle of the person CAM is a form of integrative care. Integrative care places the client at the center of care, focuses on prevention and wellness, and attends to the client's physical, mental, and spiritual needs CAM research challenges include: The relatively recent use of some of these therapies in the United States Individual, cultural, and environmental variables Lack of or limited funding sources Time as a variable to measure change Interpretation and meaning of an experience Impact of other intervening life experiences Effect and timing of a specific intervention or approach on a particular problem, specifically placebo and experimental effects Personality, belief systems, spiritual practices, and temperament of both the researcher and participants Difficulty trying to standardize modalities, variations in methods, approach and skill of the researcher Influence of studying a phenomenon or person within a naturalistic setting Interpretation of results The recognized value of both qualitative and quantitative results Acknowledging the importance of the re he relationship between the healer and the one being healed Consumers are attracted to integrative care for a variety of reasons, including: A desire to be an active participant in one's health care and engage in holistic practices that can promote health and healing A desire to find therapeutic approaches that seem to carry lower risks than medications A desire to find less expensive alternatives to high-cost conventional care Positive experiences with holistic, integrative CAM practitioners, who tend to spend more time with and learn about their clients as a whole