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NURS2103 Summary Notes Table of Contents Glossary ..................................................................................................................................................................................... 7 Topic List .................................................................................................................................................................................... 8 Part 1: The Therapeutic Relationship......................................................................................................................................... 9 Phase 1: Introduction and Beginning .................................................................................................................................... 9 Therapeutic Relationship in Nursing ................................................................................................................................ 9 Three-Phase Model .......................................................................................................................................................... 9 Professional vs. Social Relationships ................................................................................................................................ 9 Formal vs. Informal Relationships .................................................................................................................................. 10 Phenomena Occurring in 1-1 Relationships ................................................................................................................... 10 Culture, Values & Beliefs ................................................................................................................................................ 11 Self-Disclosure................................................................................................................................................................ 11 Establishing Therapeutic Relationship – Concerns ......................................................................................................... 11 Orientation (Beginning) Phase ....................................................................................................................................... 11 Signs of a Successful Therapeutic Relationship .............................................................................................................. 13 Phase 2: Working (Middle).................................................................................................................................................. 14 Three-Phase Model ........................................................................................................................................................ 14 Working Middle Phase: Considerations ......................................................................................................................... 14 Therapeutic Goals .......................................................................................................................................................... 14 Behavioural Analysis ......................................................................................................................................................14 Constructive Change in Behaviour ................................................................................................................................. 15 Goals, Task + Interventions of Working (Middle) Phase ................................................................................................16 Outcomes of Orientation + Working Phases of Therapeutic Relationships ...................................................................17 Phase 3: Termination (End) ................................................................................................................................................. 17 Considerations ...............................................................................................................................................................17 Different Forms of Termination ..................................................................................................................................... 17 Factors Influencing Reaction to Termination ................................................................................................................. 18 Termination Readiness................................................................................................................................................... 18 The Effect of Termination on HCP .................................................................................................................................. 18 Goals, Tasks + Interventions........................................................................................................................................... 18 Gift Giving ......................................................................................................................................................................19 Part 2: Recovery Informed Practice + Protective Empowering ................................................................................................ 20 Recovery as Context for Practice ........................................................................................................................................ 20 Protective Empowering (Chiovitti, 2011) ............................................................................................................................ 21 Mental Health Patient’s Experience of the Therapeutic Relationship (Shattell, 2007) ....................................................... 22 Part 3: Anxiety, Trauma + Stress-Related Disorders ................................................................................................................ 24 Anxiety, Trauma + Stress-Related Disorders ....................................................................................................................... 24 HPA Axis .............................................................................................................................................................................. 24

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Anxiety Disorders ................................................................................................................................................................ 25 Anxiety, Unhelpful Anxiety + Stress ...............................................................................................................................25 Unhelpful Anxiety + Life Stressors.................................................................................................................................. 25 Generalised Anxiety Disorder (GAD) .............................................................................................................................. 26 Obsessive-compulsive Disorder (OCD) ........................................................................................................................... 26 Panic Disorder (PD) ........................................................................................................................................................27 Agoraphobia................................................................................................................................................................... 27 Social Anxiety Disorder (SAD)......................................................................................................................................... 27 Specific Phobia ............................................................................................................................................................... 27 Helping People Live with Anxiety ........................................................................................................................................ 28 Psychopharmacology ..................................................................................................................................................... 28 Clinical Management .....................................................................................................................................................28 Psychological (‘Talking’) Therapies................................................................................................................................. 28 Trauma + Stressor-related Disorders .................................................................................................................................. 29 Posttraumatic Stress Disorder (PTSD) ............................................................................................................................ 29 Adjustment Disorder (AD) .............................................................................................................................................. 29 Treatment + Nursing Interventions..................................................................................................................................... 29 Part 4: Understanding + Treating OCD..................................................................................................................................... 31 Obsessions .......................................................................................................................................................................... 31 Compulsions........................................................................................................................................................................ 31 OCD in DSM-5 .....................................................................................................................................................................31 Diagnostic Criteria .......................................................................................................................................................... 32 Facts .................................................................................................................................................................................... 32 Terminology ........................................................................................................................................................................ 32 Diagnostic Challenges ......................................................................................................................................................... 32 Causes ................................................................................................................................................................................. 33 Environmental Risk Factors ............................................................................................................................................ 33 Neuroscience ...................................................................................................................................................................... 33 Contribution of Brain Regions in OCD ................................................................................................................................. 33 Limbic System ................................................................................................................................................................34 Chronic Stress .....................................................................................................................................................................34 HPA Axis ......................................................................................................................................................................... 34 Treatment ........................................................................................................................................................................... 34 CBT ................................................................................................................................................................................. 34 Medications.................................................................................................................................................................... 34 Surgery ........................................................................................................................................................................... 34 Serotonin ............................................................................................................................................................................35 Function Outside CNS.....................................................................................................................................................35 SSRI Side Effects .................................................................................................................................................................. 35 Rare but serious ............................................................................................................................................................. 35 Delay in SSRI Therapeutic Effect ....................................................................................................................................36

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Use During Pregnancy .................................................................................................................................................... 36 Examinable Content ............................................................................................................................................................ 36 CBT for OCD: Review of Treatment Techniques (Geffken, 2004) ........................................................................................ 36 Paediatric OCD (Keeley, 2007) ............................................................................................................................................ 37 Part 5: How the Brain Works ...................................................................................................................................................38 Major Regions of Brain........................................................................................................................................................38 Cerebrum ....................................................................................................................................................................... 38 Limbic System ................................................................................................................................................................38 Thalamus + Brainstem .................................................................................................................................................... 38 Regions of Brain .................................................................................................................................................................. 38 Cerebrum ............................................................................................................................................................................ 38 Prefrontal Cortex ............................................................................................................................................................ 38 The Limbic System ..............................................................................................................................................................39 Structures ....................................................................................................................................................................... 39 Thalamus + Brainstem.........................................................................................................................................................39 Neurons ..............................................................................................................................................................................40 Structure + Function....................................................................................................................................................... 40 Neurotransmitters .............................................................................................................................................................. 40 Synapse + NTs ................................................................................................................................................................40 NT Receptors .................................................................................................................................................................. 40 Terminating Signal..........................................................................................................................................................41 Medications ........................................................................................................................................................................ 41 Targeting Enzymes ......................................................................................................................................................... 41 Targeting Reuptake Pumps ............................................................................................................................................ 41 Support Neurons (Neuroglia) .............................................................................................................................................. 41 Neuroplasticity.................................................................................................................................................................... 42 Prenatal Neuroplasticity................................................................................................................................................. 42 Neuroplastic Changes..................................................................................................................................................... 42 Conceptualizing Mental Illness ...........................................................................................................................................42 Examinable Content ............................................................................................................................................................ 42 Part 6: Mood Disorders............................................................................................................................................................ 44 Major Depressive Disorder .................................................................................................................................................44 DSM-V Criteria................................................................................................................................................................44 Features .........................................................................................................................................................................44 Epidemiology.................................................................................................................................................................. 44 Characteristics ................................................................................................................................................................ 45 Treatment Responsiveness ............................................................................................................................................ 45 Influences on Outcome of Psychotherapy ..................................................................................................................... 45 Nursing Interventions.....................................................................................................................