BehaviorTherapy-SanJoseStateUniversity：行为疗法-圣何塞州立大学.ppt

1 Rolesofthenurseindifferenttreatmentmodalities settings Chia LingMao 2 IndividualPsychotherapy Foundation trustingrelationshipGoal changesinbehaviors self perceptions emotionalcomfort insightConceptualframework multipleincludingCBTBasic trust empathy helpingtheclientstohelpthemselves empowermentwithself esteem selfworthTransferenceManagedcare how whyPracticalproblem insurerswillnotcoverthecosts 3 Typesofindividualtherapies Classicpsychoanalysis unconsciousness RCognitivetherapy how irrationalthinkingBehavioraltherapy reshapingCognitive behavioraltherapy thoughtself responsibility self disciplineBrief solution focusedtherapy 4 Outcomeofpsychoanalysis InsightintorepressedconflictsRestructuringofthepersonalitybasedonintegrationofrepressedconflicts 5 CognitiveTherapy Theorist AaronBeck 1979 CognitiveTriad theinteractionoftheclient snegativeviewofself theworld thefutureHowtoperceiveanevent theeventitselfCognition theclient sconstructionofhisworldRolesofthenurse trustrelationships goals reviewfeelings noteaccomplishmentsUsingvoicingdoubtindealingwithclient scognitivedistortion 6 Techniquesofcognitivetherapy LookforidiosyncraticmeaningQuestiontheevidenceReattributeDe catastrophize FantasizeconsequencesExamineoptionsandalternativesWeightadvantages disadvantagesTurnadversitytoadvantageUsingthoughtstoppingUsedistraction 7 Outcomeofcognitivetherapy RecognitionofirrationalthinkingpatternsEnhancementoffunctionalresponses 8 BehavioralTherapy Theconceptsofbehaviortherapy stimulus response reinforcementBehaviorsaremeasurable observable Classicalconditioning S ROperantconditioningDiscriminativestimulus response reinforcingstimulusLearning extinctionIdentifytechniquesforincreasing decreasingabehavior 9 Behaviormodification ConditioningShapingExtinctionNegativeconsequenceTimeoutReinforcementModelingTokeneconomy 10 Nursingprocess behaviortherapy Assessment appropriate inappropriatebehaviors time frequency duration Dx expectedchangesPlan targetresponse decreasingorincreasing newskillsIntervention reinforcement Evaluation outcomes asplanned maintaining additionalchange ifneeded 11 Focus outcomeofbehavioraltherapy PromotionofdesirablebehaviorswithalternationsofundesirablebehaviorsReshapingofbehaviorwitheliminationofnegativebehaviors 12 Cognitive BehavioralTherapy FocusonmakingchangesincurrentwaysofthinkingandbehaviorNursingintervention self responsibilityNurseactingasacoach teacherinidentifyingofsituationsinvolvingundesirablethoughtsandactionsExample Pt Mywifemakesmesoangry N Whatisself defeatingaboutthestatementyoujustmade 13 Outcomeofcognitive behavioralTH ParticipatoryrelationshipbetweenclientandthetherapistResultsorientedClientlearningnewskills 14 Rational emotivetherapy RET Theorist AlbertEllis 1973 Presentperceptions thoughts assumptions beliefs values attitudes andphilosophiesasneedingmodificationorchange Should ought must ABCtheory InterventionisaimedatBA activatingeventB beliefaboutAC emotionalreactionIrrationalbelief negativeemotions 15 RolesofthenurseinRET Acceptance donotallowthepttocondemnthemselvesChallenge confronttheirrationalthinkingPresentcenteredHelptheptlearntotakeresponsibilityfortheirideasandbehaviors HomeworkassignmentsfocusonpositivestatementsandbehaviorsandskilldevelopmentRole playing modeling 16 OutcomeofRET ClientcontrolofbehaviorandthinkingAssumptionofresponsibilityandblameforirrationalbeliefs 17 GroupTherapy Definition evolutionLeadershipTypes autocratic democratic Laissez fairepowerGrouprolesGrouptaskroles initiator informationseeker informationgiver coordinator recorder Groupbuilding maintenanceroles encourager harmonizer gatekeeper Individualroles aggressor blocker recognitionseeker playperson 18 Groupdynamics GroupcontentGroupprocessPre interactionphase selectingmembers contract Orientationphase searchingforsimilarity buildingnorms politeness Workingphase attempttosolvetheproblems conflict cooperationTerminationphase evaluatestheexperienceandexploresmembers feelingsaboutitandtheimpendingseparation 19 Therapeuticfactorsofgrouptherapy InstillationofhopeUniversalityImpartingofinformationAltruismCorrectiverecapitulationoftheprimaryfamilygroupDevelopmentofsocializingtechniquesImitativebehaviorInterpersonallearningGroupcohesivenessCatharsis expressionofdeepemotionsExistentialfactors 20 Leadershipstyle DemocraticAutocraticLaissez fairs 21 Rolesofthegroupmember GroupmaintenanceroleIndividualrolesBlockerDominatorFollowerGatekeeper 22 FamilyTherapy BackgroundandevolutionFamilyburdenIatrogenicburden fromtheMHsystem professionalsObjectiveburden practicalproblemsSubjectiveburden grief fear guilt anger 23 Rolesofthehealthyfamily Respondingtofamilymembers needsCopingactivelywithlife sproblemsandstressedAccomplishingfamilytaskswithequaldistributionofpowerEncouraginginteractionamongfamilymembersandthecommunityPromotingpositivepersonalhealthpractices 24 Conceptualframeworkoffamilytherapy Structuralfamilytherapy MinuchinBoundary role sub system conflictsareresolvedinarationalmannerCommunicationtheory SatirIdentifiedpatientCommunicationstyleDistractor placator blamer Pseudomutuality pseudohostilitySystemtheory BowenCalgaryFamilyAssessmentModel 25 ConceptsinBowen stheory DifferentiationTriangulationNuclearfamilyemotionsystemFamilyprojectionprocessEmotionalcutoffMutigenerationaltransmissionprocessSiblingposition 26 FamilyAssessment CalgaryFamilyAssessmentModel Familystructure genogram ecomapFamilydevelopment lifecycle associatedtasksBeginningfamiliesEarlychildbearingfamiliesFamilieswithpreschoolchildrenFamilieswithschoolchildrenFamilieswithteenagersLaunchingcenterfamiliesFamiliesofmiddleyearsFamiliesinretirementandoldageFamilyfunctionCulturalconsideration 27 NursingDiagnoses FT AlteredfamilyprocessesIneffectivefamilycopingImpairedhomemaintenancemanagementRelatedissuesConceptofresilienceMajorconcernsofthecaregiver Resources NAMIConfidentiality canbeabarriertoincludingfamiliesincare 28 ConclusiononFamilyTherapy FamilyasasystemChangesinvolvewholesystemApplicationofchangetheory Prochaska 1992 Precontemplation contemplation preparation action maintenanceFamilymythsFamilyharmonyParentaldeterminismBreakdownofthefamilyMaterialism 29 ForensicNursing Background overlapbetweenthecriminaljusticecriminalization deinstitutionalizationClients victims perpetrators andtheirfamiliesRelatedissues legal ethical political administrative professional 30 Characteristicsoftheforensicsetting PhysicalsettingClientpopulationAuthoritarianinterpersonalenvironment 31 Characteristicsoftheforensicpopulation Poorjudgment limitedreasoningabilities historyofnotlearningformpastmistakes HighlevelofsubstanceabuseDepression suicidalideation aggressiveness irritability violencePersonalitydisorder chrmentalillnesses mentalretardation braininjuries DecreasedsocialskillsorphysicalstrengthCriminalizedlifestyle 32 CrisisIntervention Charactersofcrisisathreattohomeostasis anxiety confusion lossofproblemsolvingabilityCrisis danger opportunityShort 4 6weeks 33 Phasesofacrisis Increasedanxiety copingCopingfailed furtherincreasedanxietyEscalatedanxiety reachoutforhelpActivestateofcrisis 34 Balancingfactors RealisticperceptionoftheeventsCopingskillsSupportsystems 35 Nursingdiagnoses IneffectivecopingAnxietyDisturbedthoughtprocessesSituationallowself esteemSocialisolationImpairedsocialinteraction 36 Typesofcrises Maturationalordevelopmentalcrisis varioustaskindifferentstatesSituationalcrisis suddentraumaticeventiejoblossAdventitiouscrisis precipitatedbyanunexpectedeventie naturaldisasters 37 SomaticTherapy 38 ElectroconvulsiveTherapy Historicbackground 1938Mechanism unknownModernECTNursingcare beforeECT likebeforesurgeryExplanation fear stigma fear anxiety Physicalexam vitalsigns labdata spinalX rayConsentform preparationNPOfor8hours moveableaccessory AtropineEmptybladder 39 Nursingcare DuringECT typicalgrandmalseizurewithtonicandclonicphasesAfterECTRespiratoryproblems apnea oxygenConfusion disorientationMemoryimpairmentRecording 40 IssuesrelatedtoECT Advantages safety effect Disadvantages memoryimpairment CommunityCare Objectives ReviewrevolutionofcommunitymentalhealthDefine communitysupportsystem IdentifythelevelsofpreventiononMIDescriberolesofthenurseincommunitymentalhealthcare Landmarksincommunitymentalhealth 1946 NatlMHAct 1949 NIMN1955 MHStudyAct60 s CommunityMentalHealthCentersAct Deinstitutionalization70 s CommunitySupportProgramcasemanagers80 s MentalHealthSystemsAct90 s AmericanDisabilitiesAct pt srights2000 Healthypeople2010 NAMI NAMPNationalhealthgoal advocacy HealthyPeople2010 18 1 Reducethesuiciderate 18 2 Reducetherateofsuicideattemptsbyadolescents18 3 Reducetheproportionofhomelessadultswhohaveseriousmentalillness SMI 18 4 Increasetheproportionofpersonswithseriousmentalillness SMI whoareemployed 18 5 Developmental Reducetherelapseratesforpersonswitheatingdisorders includinganorexianervosaandbulimianervosa HealthyPeople2010 cont d 18 6 Developmental Increasethenumberofpersonsseeninprimaryhealthcarewhoreceivementalhealthscreeningandassessment 18 7 Developmental Increasetheproportionofchildrenwithmentalhealthproblemswhoreceivetreatment 18 8 Developmental Increasetheproportionofjuvenilejusticefacilitiesthatscreennewadmissionsformentalhealthproblems HealthyPeople2010 cont d 18 9 Increasetheproportionofadultswithmentaldisorders seriousmentalillness depression schizophrenia generalizedanxietydisorder whoreceivetreatment 18 10 co occurringsubstanceabuseandmentaldisorders18 munity basedjaildiversionprogramsforadultswithseriousmentalillness SMI 18 12 trackconsumers satisfactionwiththementalhealthservicestheyreceive HealthyPeople2010 cont d 18 13 operationalmentalhealthplanthataddressesculturalcompetence 18 14 operationalmentalhealthplanthataddressesmentalhealthcrisisinterventions ongoingscreening andtreatmentservicesforelderlypersons CommunitySupportSystem Anetworkofcaringandresponsiblepeoplecommittedtoassistingavulnerablepopulationtomeetitsneedsanddevelopitspotentialwithoutbecomingunnecessarilyisolatedorexcludedfromthecommunity Goalsofcommunitysupportsystem ImprovethecompetenceoftheclientAlleviatethesymptomsUsevarioustherapeuticconstructsImproveoutcomesInstallhopeActiveparticipationintherehab Developindividualskills Primaryprevention Healthpromotion continuedwell beingDiseaseprevention nopotentialthreatSecondaryprevention Screening referral crisisinterventionTertiaryprevention Rehabilitation socialskilltraining self helpgroups LevelsofPrevention ComponentsofaCommunitySupportSystem Availability adequateresourcesAccessibility outreach 24hoursservicesIntegration collaboration sharingContinuity inpt rehab Communityinvolvement communityresources grassrootwork empowerment advocacy ElementsofCaseManagement PsychiatricrehabilitationResourcelinkage Consultation liaisonAdvocacyCrisisinterventionHomecare improvedfunctionalabilityTherapies RangeofCommunity basedCare Homecare homeboundclientsOutreachservices forhomelessclientsResidentialservices Grouphomes temp permanenthousingHalfwayhouse chemicaldependencyApartmentlivingprogramsFostercareandboardinghomesSelf helpgroups Numbersr tCommunityMentallyill IntheU S 20 ofadults MI12 ofchildren mentaloremotionalpro 1 3ofhomelesshaveseriousMI 1 2haveasubstanceabuseproblem7 ofinmateshaveaseriousMI 12 4 requirepsyattention25 ofthosewhohaveMIreceiveTx ManyHIVinfectionorAIDScasesneedpsyTx Issuesr tcommunitycare ConceptsaboutMIierehabilitationStalledresourcesiefundingandplanningPovertyie SSIReinstitutionalization hosp jailSpecialeducationfordisabledchildrenStigma employment housing self esteemReforms ApplicationofNursingProcess AssessmentAggregatesandproblems bureauofcensus vitalstatistics survey localnewsIndividuals Severityofindividual sillness AmountofsupervisionrequiredbytheindividualDiagnosis communityoriented NursingProcess cont d PlanningMultidisciplinaryteamincludeskeypeopleandagenciesShort andlong termgoalsImplementationPrimary secondary tertiarypreventionsEvaluationOngoingprocess Homecare Def Partofacomprehensivehealthandmentalhealthcaresystemthataimstoprovideanarrayofhealth relatedservicestoclientsandfamiliesintheirplacesofresidence Residence privatehome residentialcarefacilities grouphomes Characteristicsofhomecare naturalsetting notanalternativetoinstitutionalcarereduceorpreventhospitalizationcost effectiverapidlygrowingandchangingfieldsinhealthcare eventhoughitisoneoftheoldestformsofambulatoryhealthcarecrisisintervention emergencyresponse Goalsofhomecare Teachingproblem solving stress reduction andcopingskillstotheclients familymembers caregiversProvidingrespiteandcommunityresourcesEducatingaboutMI MH medications relapseprevention andIPR communicationskillsCoordinatingmedical social spiritual communitybasedservices CareforthehomelesswithMI 5 ofthepeoplewithMIarehomelessCo morbidityieDM Respiratoryinfections asthma malnutrition dentalcaries STD thyroidproblems footproblems Rolesofnurseincaringforthehomeless Knowledge nostandardprotocolsPerformanassessment physical mentalstatus violence hopelessness spiritual substanceabuse IPR communicationImmediateneedsoftheclientCommunityresources Challenges Usetraditionalknowledge skillinnewsetting Overlappingofprofessionalandpersonalboundaries Short crisisorientedinpatientstay Intensiveoutpatientservices Widerrangeoftreatmentmodalities Multidisciplinarycollaboration Spirituality religion SpiritualityAperson sexperienceof orabeliefin apowerapartfromhis herownexistence anindividualsearchformeaningTheconceptofone srelationshipwithatranscendentrealityReligionOutwardpracticeofaspiritualsystemofbeliefs values codesofconduct andrituals Significanceofspirituality religion Socialsupport lowerdistressBettercopingwithphysicalillnessHealthierlifestylelowerincidenceofsubstanceabusewithpurposeinlifeDecreasedlevelofdepression anxietywithhigherlifesatisfaction Rolesofthenurse Clarifyingvalues WhatpeoplebelieveandwhatisimportanttothemInvolvinginterdisciplinaryteamEthicalconcernsDonotabusetheprofessionalstatusDonotmisrepresentthestateoftheresearchDonotimposeone sownvaluesonclients Culture AsetofstandardforbehaviorwhichagroupofpeopleattributetothosearoundthemandwhichtheyusedtoorienttheirownbehaviorAdesignforliving influenceseveryaspectofhumaninteraction EssentialFeaturesofCulture CultureislearnedCulturereferstosystemsofmeaningsCultureactsasashapingtemplateCultureistaughtandreproducedCultureexistsinaconstantstateofchangeCultureincludespatternsofbothsubjectiveandobjectivecomponentsofhumanbehavior OtherCulturalDomains Folkbeliefs religion canbeconfusedwith religiosity Stereotypinglabels avoidgeneralizationsEthnopharmacology geneticinfluence effect metabolismHerbaltherapies interactionswithmedsFolkhealers txapproaches e g hysteria psychosis ImpactofCulturalCompetency MoresuccessfulpatienteducationIncreasesinpt shealthcareseekingbehaviorMoreappropriatetestingandscreeningFewerdiagnosticerrors AvoidanceofdrugcomplicationsGreateradherencetomedicaladviceExpandedchoicesandaccesstohigh qualityclinicians ImplicationsforMentalHealthCare Itprovidesguidelinesforjudgmentof normality versus abnormality ofbehavior Itprovidesaproperunderstandingofhumanbeings whethertheirbehaviorisnormativeordeviant Ethics Character manners moral doinggoodKnowledgereasoningTheoriesAltruism loveothersoveroneselfEgoism individualfirstHedonism pleasureoverallothervaluesRationalpaternalisms Relativism subject