N3481 Exam 1 Study Guide
● Discuss cognitive reframing and its impact on negative and irrational thought processes, discuss
how reframing distorted thoughts helps with certain anxiety disorders and identify situations
where this therapeutic tool might be most useful.
○ Cognitive reframing is used to change the individual’s perception of stress by reassessing a
situation and replacing irrational beliefs with more positive self-statements. When the perceptio
of the situation is changed, the sympathetic nervous system is not as stimulated, which decrea
anxiety and stress. This technique can be used in any situation where the patient is experiencin
negative thoughts from anxiety or depression. It reframes their thoughts to be more productive,
which lowers their sympathetic response.
● Discuss the characteristics of negative thinking in depression the tendency to overgeneralize and
identify associated responses, interventions and supportive measures the nurse could employ.
○ Characteristics (Beck’s Cognitive Triad)
■ A negative, self- deprecating view of self: “I really never do anything well; everyone
else seems smarter.”
■ A pessimistic view of the world: “Once you’re down, you can’t get up. Look around,
poverty, homelessness, sickness, war, and despair are every place you look.”
■ The belief that negative reinforcement (or no validation for the self) will continue:
“It doesn’t matter what you do; nothing ever gets better. I’ll be in this stupid job the
rest of my life.
○ Interventions
■ Cognitive Behavioral Theory
● Identifying and testing negative cognition
1
, ● Developing alternative thinking patterns
● Rehearsing new cognitive and behavioral responses
● Discuss characteristics common among people who attempt suicide.
○ Current/Past psychiatric disorders
○ Anhedonia, impulsivity, hopelessness, anxiety/panic, insomnia, command hallucinations
○ Family history of suicide
○ Triggering events leading to humiliation, shame or despair
○ Change in treatment: discharge from psychiatric hospital, provider or treatment change
○ low levels of serotonin!
○ twin study shows more likely to for SI in identical than fraternal twins
○ biological relatives increased risk rather than adopted
○
● Discuss important assessment questions for your patient with suicide ideation.
○ SAD PERSONS includes risk factors
○ “You have said you are depressed. Tell me what that is like for you?”
○ “When you feel depressed, what thoughts go through your mind?”
○ “Have you ever thought about taking your own life in the past? Now? Do you have a plan?
Do you have the means to carry out your plan? Is there anything that would prevent you
from carrying out your plan?”
● Discuss your interventions and therapeutic communication with your bereaved patient who has
experienced a loss.
○ Interventions
■ Use methods that can facilitate the grieving process
2
, ● Give your full presence; use appropriate eye contact, attentive listening, and
appropriate touch
● Be patient with bereaved in times of silence. Do not fill silence with empty
chatter
■ Know about and share with the bereaved information about the phenomena that
occur during normal mourning process, because they may concern some people
(intense anger at the deceased, guilt, symptoms the deceased had before death,
unbidden floods of memories). Give the bereaved support during the occurrence of
these phenomena and a written handout for reference
■ Encourage the support of family and friends. If no support is available, refer the
patient to a community bereavement group. (Bereavement groups are helpful even
when a person has many friends or much family support.)
■ Offer spiritual support and referrals when needed.
■ When intense emotions are in evidence, show understanding and support.
○ Therapeutic Communication
■ When you sense an overwhelming sorrow
● “This must hurt terribly.”
■ When you hear anger in the bereaved person’s voice
● “I hear anger in your voice. Most people go through periods of anger when
their loved one dies. Are you feeling angry now?”
■ If you discern guilt
● “Are you feeling guilty? This is a common reaction many people have. What
are some of your thoughts about this?”
■ If you sense fear of the future
3
, ● “It must be scary to go through this.”
■ When the bereaved seems confused
● “This can be a confusing time.”
■ In almost any painful situation
● “This must be very difficult for you.”
■ reaffirmation of hope, encourage problem solving, use resources, convey to person
that the unbearable can be survived and you are not alone
● Discuss the stages and the work of grieving and give examples of what happens in each.
○ Shock and disbelief
○ Denial
○ Sensation of somatic distress
■ A woman whose husband died of a stroke complains of weakness and numbness on
her left side
○ Preoccupation with the image of the deceased
■ A man whose wife has recently died states “I just can't stop thinking about my wife.
Everything I see reminds me of her. We picked up this seashell on our honeymoon. I
remember every wonderful moment we had together. The pain is so great, but the
memories just keep coming.” His friends notice that when he talks, his hand
gestures and expressions are very like those of his recently deceased wife.
○ Guilt
○ Anger
○ Change in behavior (depression, disorganization, panic, restlessness)
○ Reorganization of behavior directed toward a new object or activity
○ Acceptance
4
● Discuss cognitive reframing and its impact on negative and irrational thought processes, discuss
how reframing distorted thoughts helps with certain anxiety disorders and identify situations
where this therapeutic tool might be most useful.
○ Cognitive reframing is used to change the individual’s perception of stress by reassessing a
situation and replacing irrational beliefs with more positive self-statements. When the perceptio
of the situation is changed, the sympathetic nervous system is not as stimulated, which decrea
anxiety and stress. This technique can be used in any situation where the patient is experiencin
negative thoughts from anxiety or depression. It reframes their thoughts to be more productive,
which lowers their sympathetic response.
● Discuss the characteristics of negative thinking in depression the tendency to overgeneralize and
identify associated responses, interventions and supportive measures the nurse could employ.
○ Characteristics (Beck’s Cognitive Triad)
■ A negative, self- deprecating view of self: “I really never do anything well; everyone
else seems smarter.”
■ A pessimistic view of the world: “Once you’re down, you can’t get up. Look around,
poverty, homelessness, sickness, war, and despair are every place you look.”
■ The belief that negative reinforcement (or no validation for the self) will continue:
“It doesn’t matter what you do; nothing ever gets better. I’ll be in this stupid job the
rest of my life.
○ Interventions
■ Cognitive Behavioral Theory
● Identifying and testing negative cognition
1
, ● Developing alternative thinking patterns
● Rehearsing new cognitive and behavioral responses
● Discuss characteristics common among people who attempt suicide.
○ Current/Past psychiatric disorders
○ Anhedonia, impulsivity, hopelessness, anxiety/panic, insomnia, command hallucinations
○ Family history of suicide
○ Triggering events leading to humiliation, shame or despair
○ Change in treatment: discharge from psychiatric hospital, provider or treatment change
○ low levels of serotonin!
○ twin study shows more likely to for SI in identical than fraternal twins
○ biological relatives increased risk rather than adopted
○
● Discuss important assessment questions for your patient with suicide ideation.
○ SAD PERSONS includes risk factors
○ “You have said you are depressed. Tell me what that is like for you?”
○ “When you feel depressed, what thoughts go through your mind?”
○ “Have you ever thought about taking your own life in the past? Now? Do you have a plan?
Do you have the means to carry out your plan? Is there anything that would prevent you
from carrying out your plan?”
● Discuss your interventions and therapeutic communication with your bereaved patient who has
experienced a loss.
○ Interventions
■ Use methods that can facilitate the grieving process
2
, ● Give your full presence; use appropriate eye contact, attentive listening, and
appropriate touch
● Be patient with bereaved in times of silence. Do not fill silence with empty
chatter
■ Know about and share with the bereaved information about the phenomena that
occur during normal mourning process, because they may concern some people
(intense anger at the deceased, guilt, symptoms the deceased had before death,
unbidden floods of memories). Give the bereaved support during the occurrence of
these phenomena and a written handout for reference
■ Encourage the support of family and friends. If no support is available, refer the
patient to a community bereavement group. (Bereavement groups are helpful even
when a person has many friends or much family support.)
■ Offer spiritual support and referrals when needed.
■ When intense emotions are in evidence, show understanding and support.
○ Therapeutic Communication
■ When you sense an overwhelming sorrow
● “This must hurt terribly.”
■ When you hear anger in the bereaved person’s voice
● “I hear anger in your voice. Most people go through periods of anger when
their loved one dies. Are you feeling angry now?”
■ If you discern guilt
● “Are you feeling guilty? This is a common reaction many people have. What
are some of your thoughts about this?”
■ If you sense fear of the future
3
, ● “It must be scary to go through this.”
■ When the bereaved seems confused
● “This can be a confusing time.”
■ In almost any painful situation
● “This must be very difficult for you.”
■ reaffirmation of hope, encourage problem solving, use resources, convey to person
that the unbearable can be survived and you are not alone
● Discuss the stages and the work of grieving and give examples of what happens in each.
○ Shock and disbelief
○ Denial
○ Sensation of somatic distress
■ A woman whose husband died of a stroke complains of weakness and numbness on
her left side
○ Preoccupation with the image of the deceased
■ A man whose wife has recently died states “I just can't stop thinking about my wife.
Everything I see reminds me of her. We picked up this seashell on our honeymoon. I
remember every wonderful moment we had together. The pain is so great, but the
memories just keep coming.” His friends notice that when he talks, his hand
gestures and expressions are very like those of his recently deceased wife.
○ Guilt
○ Anger
○ Change in behavior (depression, disorganization, panic, restlessness)
○ Reorganization of behavior directed toward a new object or activity
○ Acceptance
4
