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Roles of the nurse in different treatment modalities


Conceptual framework multiple including CBT ... Cognitive - behavioral therapy thought & action ... Cognitive-Behavioral Therapy. Focus on making changes in ... – PowerPoint PPT presentation

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Title: Roles of the nurse in different treatment modalities

Roles of the nurse in different treatment
  • Chia-Ling Mao

Individual Psychotherapy
  • Foundation trusting relationship
  • Goal changes in behaviors, self-perceptions,
    emotional comfort, insight
  • Conceptual framework multiple including CBT
  • Basic trust empathy helping the clients to
    help themselves empowerment with self-esteem
    self worth
  • Transference
  • Managed care -how why
  • Practical problem insurers will not cover the

Types of individual therapies
  • Classic psychoanalysis unconsciousness, R
  • Cognitive therapy how irrational thinking
  • Behavioral therapy - reshaping
  • Cognitive - behavioral therapy thought action
  • Rational emotive therapy situation, irrational
    belief - behavior
  • Choice therapy doing feeling
    self-responsibility self-discipline
  • Brief, solution-focused therapy

Outcome of psychoanalysis
  • Insight into repressed conflicts
  • Restructuring of the personality based on
    integration of repressed conflicts.

Cognitive Therapy
  • Theorist Aaron Beck (1979)
  • Cognitive Triad the interaction of the clients
    negative view of self, the world, the future
  • How to perceive an event the event itself
  • Cognition the clients construction of his
  • Roles of the nurse trust relationships, goals,
    review feelings, note accomplishments
  • Using voicing doubt in dealing with clients
    cognitive distortion

Techniques of cognitive therapy
  • Look for idiosyncratic meaning
  • Question the evidence
  • Reattribute
  • De-catastrophize, Fantasize consequences
  • Examine options and alternatives
  • Weight advantages disadvantages
  • Turn adversity to advantage
  • Using thought stopping
  • Use distraction

Outcome of cognitive therapy
  • Recognition of irrational thinking patterns
  • Enhancement of functional responses

Behavioral Therapy
  • The concepts of behavior therapy stimulus,
    response, reinforcement
  • Behaviors are measurable, observable,
  • Classical conditioning S - R
  • Operant conditioning
  • Discriminative stimulus, response, reinforcing
  • Learning, extinction
  • Identify techniques for increasing/ decreasing a

Behavior modification
  • Conditioning
  • Shaping
  • Extinction
  • Negative consequence
  • Time out
  • Reinforcement
  • Modeling
  • Token economy

Nursing process behavior therapy
  • Assessment appropriate/inappropriate behaviors,
    time, frequency, duration
  • Dx expected changes
  • Plan target response, decreasing or increasing,
    new skills
  • Intervention reinforcement () (-)
  • Evaluation outcomes (as planned) maintaining,
    additional change (if needed),

Focus outcome of behavioral therapy
  • Promotion of desirable behaviors with
    alternations of undesirable behaviors
  • Reshaping of behavior with elimination of
    negative behaviors

Cognitive-Behavioral Therapy
  • Focus on making changes in current ways of
    thinking and behavior
  • Nursing intervention self-responsibility
  • Nurse acting as a coach, teacher in identifying
    of situations involving undesirable thoughts and
  • Example
  • Pt My wife makes me so angry
  • N What is self-defeating about the statement
    you just made

Outcome of cognitive-behavioral TH
  • Participatory relationship between client and the
  • Results oriented
  • Client learning new skills

Rational-emotive therapy (RET)
  • Theorist Albert Ellis (1973)
  • Present perceptions, thoughts, assumptions,
    beliefs, values, attitudes, and philosophies as
    needing modification or change.
  • Should, ought, must .
  • ABC theory Intervention is aimed at B
  • A activating event
  • B belief about A
  • C emotional reaction
  • Irrational belief - negative emotions

Roles of the nurse in RET
  • Acceptance do not allow the pt to condemn
  • Challenge/confront the irrational thinking
  • Present centered
  • Help the pt learn to take responsibility for
    their ideas and behaviors.
  • Homework assignments focus on positive statements
    and behaviors and skill development
  • Role-playing modeling

Outcome of RET
  • Client control of behavior and thinking
  • Assumption of responsibility and blame for
    irrational beliefs

Outcome of RET
  • Client control of behavior and thinking
  • Assumption of responsibility and blame for
    irrational beliefs

Group Therapy
  • Definition evolution
  • Leadership
  • Types autocratic, democratic, Laissez-faire
  • power
  • Group roles
  • Group task roles initiator, information seeker,
    information giver, coordinator, recorder
  • Group building maintenance roles encourager,
    harmonizer, gatekeeper
  • Individual roles aggressor, blocker, recognition
    seeker, play person,

Group dynamics
  • Group content
  • Group process
  • Pre-interaction phase selecting members,
  • Orientation phase searching for similarity,
    building norms, politeness,
  • Working phase attempt to solve the problems,
    conflict, cooperation
  • Termination phase evaluates the experience and
    explores members feelings about it and the
    impending separation

Therapeutic factors of group therapy
  • Instillation of hope
  • Universality
  • Imparting of information
  • Altruism
  • Corrective recapitulation of the primary family
  • Development of socializing techniques
  • Imitative behavior
  • Interpersonal learning
  • Group cohesiveness
  • Catharsis expression of deep emotions
  • Existential factors

Leadership style
  • Democratic
  • Autocratic
  • Laissez-fairs

Roles of the group member
  • Group maintenance role
  • Individual roles
  • Blocker
  • Dominator
  • Follower
  • Gatekeeper

Family Therapy
  • Background and evolution
  • Family burden
  • Iatrogenic burden from the MH
  • Objective burden practical problems
  • Subjective burden grief, fear, guilt, anger

Roles of the healthy family
  • Responding to family members needs
  • Coping actively with lifes problems and stressed
  • Accomplishing family tasks with equal
    distribution of power
  • Encouraging interaction among family members and
    the community
  • Promoting positive personal health practices

Conceptual framework of family therapy
  • Structural family therapy Minuchin
  • Boundary, role, sub-system conflicts are
    resolved in a rational manner
  • Communication theory Satir
  • Identified patient
  • Communication style
  • Distractor, placator, blamer,
  • Pseudomutuality, pseudohostility
  • System theory Bowen
  • Calgary Family Assessment Model -

Concepts in Bowens theory
  • Differentiation
  • Triangulation
  • Nuclear family emotion system
  • Family projection process
  • Emotional cutoff
  • Mutigenerational transmission process
  • Sibling position

Family Assessment Calgary Family Assessment
  • Family structure genogram, ecomap
  • Family development/life cycle associated tasks
  • Beginning families
  • Early childbearing families
  • Families with preschool children
  • Families with school children
  • Families with teenagers
  • Launching center families
  • Families of middle years
  • Families in retirement and old age
  • Family function
  • Cultural consideration

Nursing Diagnoses (FT)
  • Altered family processes
  • Ineffective family coping
  • Impaired home maintenance management
  • Related issues
  • Concept of resilience
  • Major concerns of the care giver?
  • Resources NAMI
  • Confidentiality can be a barrier to including
    families in care

Family consultation vs. family therapy
  • Family consultation
  • services to the families
  • secondary prevention scan feeling, focus,
  • Clients symptoms spread distress through the
    family by a ripple effect
  • Family therapy
  • Clients symptom signal distress in the family
  • Involves the participation of the entire family
  • the family member with symptoms was not sick,
    he/she was the symptom bearer for a disturbed
    family system

Conclusion on Family Therapy
  • Family as a system
  • Changes involve whole system
  • Application of change theory (Prochaska, 1992)
  • Precontemplation, contemplation, preparation,
    action, maintenance
  • Family myths
  • Family harmony
  • Parental determinism
  • Breakdown of the family
  • Materialism

Forensic Nursing
  • Background overlap between the criminal justice
    mental health systems criminalization
  • Clients victims, perpetrators, and their
  • Related issues legal, ethical, political,
    administrative, professional

Characteristics of the forensic setting
  • Physical setting
  • Client population
  • Authoritarian interpersonal environment

Characteristics of the forensic population
  • Poor judgment, limited reasoning abilities,
    history of not learning form past mistakes,
  • High level of substance abuse
  • Depression, suicidal ideation, aggressiveness,
    irritability, violence
  • Personality disorder chr mental illnesses,
    mental retardation, brain injuries,
  • Decreased social skills or physical strength
  • Criminalized lifestyle

Crisis Intervention
  • Characters of crisis
  • a threat to homeostasis - anxiety, confusion,
    loss of problem solving ability
  • Crisis danger opportunity
  • Short 4-6 weeks

Phases of a crisis
  • Increased anxiety - coping
  • Coping failed - further increased anxiety
  • Escalated anxiety - reach out for help
  • Active state of crisis

Balancing factors
  • Realistic perception of the events
  • Coping skills
  • Support systems

Nursing diagnoses
  • Ineffective coping
  • Anxiety
  • Disturbed thought processes
  • Situational low self-esteem
  • Social isolation
  • Impaired social interaction

Types of crises
  • Maturational or developmental crisis various
    task in different states
  • Situational crisis - sudden traumatic event ie
    job loss
  • Adventitious crisis precipitated by an
    unexpected event ie, natural disasters

Somatic Therapy
Electroconvulsive Therapy
  • Historic background 1938
  • Mechanism unknown
  • Modern ECT
  • Nursing care before ECT like before surgery
  • Explanation fear, stigma, fear, anxiety
  • Physical exam - vital signs, lab data, spinal
  • Consent form preparation
  • NPO for 8 hours, moveable accessory,
  • Atropine
  • Empty bladder

Nursing care
  • During ECT typical grand mal seizure with tonic
    and clonic phases
  • After ECT
  • Respiratory problems apnea, oxygen
  • Confusion disorientation
  • Memory impairment
  • Recording

Issues related to ECT
  • Advantages - , safety, effect,
  • Disadvantages memory impairment

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