Nur 1520 Test 1 Outline

I) Mental Health and Illness (Ch. 1, pg. 3-6) – 6 TQ’s
A) Influences:
1) Biological
(a) Prenatal: Lack of O2 to brain, Maternal illness, Smoking, drugs, alcohol
(b) General Health
(c) Brain: Genetic, Injury
2) Psychological
(a) Formed by interactions (positive & negative) – influences how you act in situations
3) Sociocultural
(a) Family stability: Mobility, single-parent home, divorce
(b) Economics: Unemployment, homeless
(c) Community: Drugs, crimes
4) Cultural Variance (differences in cultures)
 Comparison of Mental Health & Mental Illness handout
o Mental Health
 Reflects a person’s approach to life by:
 Communicating emotions
 Giving & receiving
 Working alone as well as with others
 Accepting authority
 Displaying a sense of humor
 Coping successfully w/ emotional conflict
o Mental Illness
 Reflects a person’s inability to cope with stress resulting in:
 Disruption
 Disorganization
 Inappropriate reactions
 Unacceptable behavior
 Reflects a person’s inability to respond according to the person’s expectations & demands
 Mental Health-Mental Illness Continuum handout:
o Mental Health o Mental Illness
 Cultural Factors  Cultural Factors
 Sense of community  Substance abuse or dependence
 Support of diversity among people  Violence
 Intolerance of violence  Poverty
 Adequate resources  Ageism
 Interpersonal Factors  Sexism
 Effective communication  Homelessness
 Intimacy  Classism
 Helping others  Racism
 Balance of separateness &  Lack of resource
connection  Interpersonal Factors
 Individual Factors  Ineffective communication
 Positive self-worth  Manipulation
 Vitality  Excessive dependency
 Meaningful life  Withdrawal from relationships
 Sense of harmony  Loss of emotional control
 Positive identity  Individual Factors
 Biologic factors  Worries
 Loss of meaning in life
 Sense of disharmony
 Fears
 Anxiety
 Biologic factors

,II) Communication (Ch. 6, pg. 102-113) – 18 TQ’s
 Giving & receiving information
 Involves a sender & a receiver
 A learned process
 Verbal & non-verbal
A) Factors influencing communication
1) General attitude – may block out communication
2) Cultural – possible language barriers; customs
3) Age/Developmental level
4) Environmental – time & place
(a) Territoriality – innate tendency to own space
 “Neutral” area, e.g. interview room rather than own office or client’s room
(b) Density – number of people w/in a given environmental space
(c) Distance
1 Intimate: 0-18 inches
2 Personal: 18-40 inches (Therapeutic communication)
3 Social: 4-12 feet
4 Public: > 12 feet
B) Types of communication
1) Verbal
2) Non-verbal (65-95% of effective communication)
(a) Appearance/Dress
(b) Body movement & posture
(c) Touch
 Functional-Professional – impersonal/business-like
o Procedural touch – ex: obtaining BP
 Social-Polite – handshakes – impersonal, but conveys acceptance
 Friendship-Warmth – strong liking
 Love-Intimacy – emotional attachment/attraction
 Sexual Arousal – express physical attraction only
(d) Facial expressions
(e) Eye behavior
 Opens communication (less than 3 seconds)
 Gazing – indicates strong emotions (more than 3 seconds)
o Staring – always inappropriate; register disapproval of behavior
(f) Voice
o Paralanguage (vocal cues) – Audible
 Pitch (sound) – High/Low
 Tone (emotion) – Happy/Angry
 Loudness – precursor to violence
(g) Congruence – face is expressing what words are being said
 Noncongruence – ex: laughing when speaking about mother's death
C) Therapeutic Communication
 Requires skill
 Demonstrates empathy (understanding)
 Responds to patients thought, needs, & concerns
 Allows free expression of thoughts & feelings
 Non-judgmental, discourages defensiveness, & promotes trust
1) Techniques – “tools” of psychosocial intervention
 Therapeutic Communication Techniques handout
o Using silence
 Gives opportunity to collect & organize thoughts or change topic to one of greater concern
o Accepting
 Conveys reception & regard
 “Yes, I understand.”

, o Giving recognition
 Acknowledging; Better than complimenting
 “I see you made your bed.”
o Offering self
 Making oneself available; Increases feelings of self-worth
 “I’ll stay with you awhile.”
o Giving broad openings
 Allows client to take initiative in introducing topic; Emphasizes importance of client’s role in
interaction
 “What would you like to talk about today?”
o Offering general leads
 Encourages to continue
 “Yes, I see.” “Go on.”
o Placing events in time/sequence
 Clarifies relationship of events in time
 “When did this happen?” “What seemed to lead up to…?”
o Making observations
 Encourages client to recognize specific behaviors & compare perceptions w/ nurse
 “You seem tense.”
o Encouraging description of perceptions
 Verbalize what is being perceived
 “Are you hearing the voices again?”
o Encouraging comparison
 Help recognize life experiences that tend to recur & aspects of life that are changeable
 “Was this something like…?” “What was your response the last time this situation occurred?”
o Restating
 Repeating main idea; Allows clients to clarify if necessary
 Cl: “I can’t study. My mind keeps wandering” Ns: “You have trouble concentrating.”
o Reflecting
 Referring questions & feelings back; Valuing client’s point of view; Used when asked for advice
 Cl: “My sister won’t help toward my mother’s care. I have to do it all!” Ns: “You feel angry when
she doesn’t help.”
o Focusing
 Taking notice of 1 idea/word; Used when moving rapidly from one thought to another; NOT
therapeutic – anxious
 “This point seems worth looking at more closely. Perhaps you & I can discuss it.”
o Exploring
 Delving further w/ one who remain on superficial level of communication; Do NOT probe
 “Please explain that situation in more detail.”
o Seeking clarification & validation
 Explain a vague/incomprehensible; Searching mutual understanding
 “Tell me if my understanding agrees w/ yours.”
o Presenting reality
 Used when client has a misperception of environment
 “I understand that the voices seem real to you, but I do not hear any voices.”
o Voicing doubt
 Expressing uncertainty; Often w/ delusional thinking
 “That seems rather doubtful to me.”
o Verbalizing the implied
 Putting into words what was implied/said indirectly; Clarifies that which is Implicit rather than
Explicit
 Cl: (Mute) Ns: “It must have been difficult for you when your husband died in the fire.”; Cl: “It’s
a waste of time to be here. I can’t talk to you or anyone.” Ns: “Are you feeling that no one
understands?”