ANCC PMHNP CHPT 3 EXAM QUESTIONS AND ANSWERS

Recovery Recovery is the single most important goal in the transformation of mental health care of the past 2 decades. Four major dimensions of recovery include: health, home, purpose, and community (U.S. Department of Health and Human Services [DHHS], Substance and Mental Health Services Administration, 2015). PMHNP interventions follow evidence-based practice guidelines, are always client goal-directed, and take into account the client's ethnicity and culture. PMHNPs help clients to recognize strengths, set attainable goals, and have hope for their future. A key part of the PMHNP's work is to use empirical evidence in educating their clients, clients' families, and the community about mental health, psychiatric illness, and effective management of illness. The PMHNP oversees and guides the psychiatric-mental health nurse in designing evidence-based health information and educational programs that are geared to consumer learning needs, ability, and readiness to learn. PMHNPs care for people with co-occurring medical and psychiatric disorders. Principles of mental health recovery are integrated into all levels of mental healthcare (American Psychiatric Nurses Association [APNA], 2012). CLASSIFICATION OF PSYCHIATRIC DISORDERS: DSM-5 CLASSIFICATION OF PSYCHIATRIC DISORDERS: DSM-5 Prior to May of 2013, psychiatric disorders were classified using standard criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association [APA], 2000). Unlike previous editions, the DSM-5 does not use multiaxial classifications (APA, 2013). The DSM-5 classifies mental illnesses on the basis of specific criteria that have been tested for reliability when used by mental health professionals. Emphasizes dimensional assessments THERAPEUTIC RELATIONSHIP THERAPEUTIC RELATIONSHIP Assumes the client and nurse enter into a mutual, interactive, interpersonal relationship specifically to focus on the identified needs of the client Therapeutic relationships are focused on the client's needs, and are goal-directed, theory-based, and open to supervision. The following are a few characteristics of a therapeutic relationship: * Genuineness * Acceptance * Nonjudgment * Authenticity * Empathy * Respect * Professional boundaries * The therapeutic relationship has specific and sequential phases (see Table 3-1). * Transference and countertransference are key concepts in the nurse-client relationship. ** Transference: Displacement of feelings for significant people in the client's past onto the PMHNP in the present relationship ** Countertransference: The nurse's emotional reaction to the client based on her or his past experiences Signs indicating the presence of countertransference in the PMHNP include: * Intense emotional reactions, positive or negative, on first contact with client; * Recurrent anxiety or uneasiness while dealing with the client; * Uncharacteristic carelessness in interaction and follow-up with client; * Difficulty empathizing; * Resistance to others treating or interacting with the client; * Preoccupation with or dreaming about the client; * Frequently running overtime or cutting time short with client; * Depression or other strong emotions during or after interaction with client; and * Feedback from others over involvement with client. The PMHNP is expected to monitor her or his reaction to clients to constantly assess for the presence of countertransference. If identified, countertransference is usually dealt with through the supervisory process and in talking to coworkers about the issues. * Provided in peer-peer or peer-supervisor relationship * Examines interpersonal dynamics inherent in the PMHNP's relationship with clients PHASES OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP PHASES OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP Introduction (Orientation) Working (Identification and Exploitation) Termination (Resolution) PHASES OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP Introduction INTRODUCTION (Orientation) NURSING ACTION Creating a trusting environment Establishing professional boundaries Establishing the length of anticipated interaction Providing diagnostic evaluation Setting mutually agreed-upon treatment objectives COMMON CLIENT BEHAVIOR Initial hesitancy by the client to participate fully in assessment and treatment planning (approach avoidance) PHASES OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP Working WORKING (Identification and Exploitation) NURSING ACTION Clarifying client expectations and mutually set goals Implementing treatment plan Monitoring health Undertaking preventative health care Measuring outcomes of care Evaluating outcomes of care Reprioritizing plan and objectives as indicated COMMON CLIENT BEHAVIOR Transference—client (countertransference—nurse) Client resistance to care practices Client resistance to change PHASES OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP Termination TERMINATION (Resolution) NURSING ACTION Reviewing client's progress toward objectives Establishing long-term plan of care Focusing on self-management strategies Disengaging from relationship Referring client to other services as needed COMMON CLIENT BEHAVIOR Client resistance to termination Regression Reemergence of symptoms or problems Erickson's stages Erikson's Theory Erikson developed his eight stages of psychosocial development based on Freud's psychosexual theory. Infancy Trust vs. Mistrust From birth to 12 months of age, Ability to form relationships Early Childhood Autonomy vs. Shame/Doubt As toddlers (ages 1-3 years) Self control, self-esteem, will power Late Childhood Initiative vs. Guilt Once children reach the preschool stage (ages 3-6 years) self-directed, goal formation School-age Industry vs. Inferiority During the elementary school stage (ages 6-12), Ability to work, sense of accomplishment Adolescense Identity vs. Role Confusion In adolescence (ages 12-18) Personal sense of identity Early adulthood Intimacy vs. Isolation People in early adulthood (20 - 35) Committed relationships Middle Adulthood Generativity vs. Stagnation When people reach their (35-65) Ability to give time, give of themselves, to care for others Late Adulthood Integrity vs. Despair From 65 and up Fulfillment and comfort with life Psychodynamic (Psychoanalytic) Theory Sigmund Freud Psychoanalytical theory assumes that all behavior is purposeful and meaningful. All behavior has meaning. Most mental activity is unconscious—urges, feelings, and fantasies that would be unacceptable to the person's values if consciously experienced. Conscious behaviors and choices are affected by unconscious mental content. Childhood experiences shape adult personality Mind and personality are made up of the id, ego, and super ego. Id = "I want" Ego = "I think, I evaluate" Super ego - "I should" or "I ought" FREUD'S PSYCHOSEXUAL STAGES OF DEVELOPMENT Oral stage 0-18 months Sucking, chewing, feeding, crying *Schizophrenia, Substance abuse, Paranoia Anal stage 18 months-3 years Sphincter control, activities of expulsion and retention *Depressive disorders Phallic stage 3-6 years Exhibitionism, masturbation with focus on Oedipal conflict, castration anxiety, and female fear of lost maternal love *Sexual identity disorders Latency stage 6 years-puberty Peer relationships, learning, motorskills development, socialization *Inability to form social relationships Genital stage Puberty-forward Integration and synthesis of behaviors from early stages, primary genital-based sexuality *Sexual perversion disorders Defense Mechanisms (part of the ego - unconscious) Denial - Avoidance of unpleasant realities by unconsciously ignoring their existence Projection - Unconscious rejection of emotionally unacceptable personal attributes, beliefs, or actions by attributing them to other people, situations, or events Regression Return to more comfortable thoughts, behaviors, or feelings used in earlier stages of development in response to current conflict, stress, or threat Repression Unconscious exclusion of unwanted, disturbing emotions, thoughts, or impulses from conscious awareness Reaction formation Often called overcompensation; unacceptable feelings, thoughts, or behaviors are pushed from conscious awareness by displaying and acting on the opposite feeling, thought, or behavior Rationalization Justification of illogical, unreasonable ideas, feelings, or actions by developing an acceptable explanation that satisfies the person Undoing Behaviors that attempt to make up for or undo an unacceptable action, feeling, or impulse Intellectualization Attempts to master current stressor or conflict by expansion of knowledge, explanation, or understanding Suppression Conscious analog of repression; conscious denial of a disturbing situation, feeling, or event Sublimation Unconscious process of substitution of socially acceptable, constructive activity for strong unacceptable impulse Altruism Meeting the needs of others in order to discharge drives, conflicts, or stressors