Psychosocial Integrity chapt PDF

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PSYCHOSOCI ALI NTEGRI TYc ha pt .5a nd17 He a l t hpr omo t i on  Ap hi l o s op h yofwhol e ne s s , we l l n e s sa n dwe l l be i n g  En ha nc e dwh e nnur s e su nde r s t a nd o I nd i vi dua l i t y o Hol i s m o Home os t a s i s o Huma nn e e ds g oa l sa ndou t c o me st ha ta r er e a l i s t i ct ok e e pt e a c ht opr e v e nt i o no fdi s e a s e s Ma s l o w’ shi e r a r c h y

 p h y s i o l o gi cne e d n ut r i t i o ni smi s s i n gwi l ll os es y s t e me qu i l i b r i u m De v e l o p me n t a ls t a g et h e o r i e s  De s c r i bet y pi c a lb e ha vi or swi t hi nac e r t a i na g eg r ou p(i n f a nt ,c h i l d ,s c h ool a g e , a d ul t , mi ddl ea n dol de ra dul t)  Ex pl a i nt hes i gn i fic a nc eoft ho s eb e h a vi or s

 Pr e d i c tb e ha vi or st ha tmi g hto c c u ri nagi v e ns i t u a t i o n  Pr o vi d er a t i o na l et oc o nt r o lbe ha vi or a lma n i f e s t a t i o n s  Ca nb eu s e di npa r e n t a la n dpa t i e n te d uc a t i o n,c oun s e l i n g , a n da nt i c i p a t o r y gui d a n c e  Ta b l e1 72p g .3 7 5 o Ph y s i ol o g i c a lào xy g e n,wa t e r ,f oodt e mps e x ua l i t y,e x e r c i s e , r e s t– who? o Sa f e t ya nds e c u r i t y -pr o t e c t i o n,t r us t ,nof e a r– wh o ? o Lo v ea ndbe l o n g i n gn e e d s–ofa l li mpai r e d? o Se l fe s t e e m–pr i d e ,c o nfide nc e ,f e e lg o od?Who o Se l fa c t u a l i z a t i on -r e a c ht ohi g hpo t e nt i a lt oa c tu ns e l fis hl y ( p r of e s s i o na l s ) o Se l ft r a ns c e nd e n c e–c onn e c tt o–b e y onds e l f -he l p( pr i e s t ) The or i e so fde v e l opme nt y c ho a n a l y t i c a ld e v e l opme n t  Fr e u d—t h e o r yo fps  Pi a g e t —t he o r yofc o gn i t i v ed e v e l o pme n t  Er i c k s on —t he or yofps y c hos oc i a ld e v e l o pme nt  Ha vi g hur s t —t he o r yba s e donde v e l op me n t a lt a s ks  Go ul d—t h e o r yba s e do ns pe c i ficb e l i e f sa ndde v e l op me n t a lp ha s e s  Le vi n s on—t he o r yba s e do nt heor g a ni z i n gc o n c e p t sofi nd i vi dua ll i f e s t r uc t u r e  Kohl be r g —t he o r yofmo r a lde v e l opme n t  Gi l l i g a n —c o nc e pt i ono fmor a l i t yf r om t h ef e ma l ev i e wpoi nt  Fo wl e r —t h e or yo ff a i t hd e v e l op me n t

Er i ks o n ’ st h e o r yo fps y c ho s oc i a ld e v e l o pme nt

 St a g e sofde v e l opme n t o Tr us tv s .mi s t r us t( i n f a nc y ) -t r us ti no t h e r st ome e tn e e d s  Ex :wa r mt h,f o od ,c o mf o r t , f o r mi n go ft r u s ti no t h e r s  Mi s t r u s tc a nr e s u l tf r o mi n c o ns i s t e nt ,i n a d e q u a t eo runs a f ec a r e o Aut onomyvs . s hamea nddo ubt( t o ddl e r ) i nde pe nde nc e  Ex :t o dd l e rl e a r nsf r o mt hee n vi r o nme n ta n dg a i n s i n de p e nd e nc et h r ou g he n c o ur a g e me ntf r om c a r e gi v e r st of e e d, dr e s s ,a n dt o i l e ts e l f o I ni t i a t i v ev s . g ui l t( pr e s c hoo l ) -i n i t i a t i v ea ndr e s t r i c t i o n( r e pr i ma nds )  Se e ksoutn e we x pe r i e nc e sa n de xpl or e st h eh o wa ndwh yof a c t i vi t i e s o I ndus t r yv s . i nf e r i o r i t y( s c ho ol a g e ) -ac c ompl i s hme nt s  Foc us i n go nt hee ndr e s ul t so fa c hi e v e me nt s,t hes c hoo la g e d c hi l dg a i nsp l e a s ur ef r o mfini s h i n gp r o j e c t sa n dr e c e i v i n g r e c o g ni t i onf ora c c ompl i s hme n t s  I ft h ec hi l di sno ta c c e p t e db yp e e r so rc a n no tme e tp a r e nt a l e x pe c t a t i o n saf e e l i n gofi n f e r i or i t ya ndl a c kofs e l fwor t hmi g ht de v e l op o I de nt i t yv sr o l ec onf us i o n( a dol e s c e nc e ) -t r ans i t i o nmoo d  Wi t hma n yph y s i c a lc ha n g e so c c ur r i n gt hea dol e s c e n ti si n t r a n s i t i onf r om c hi l d h oodt oa d u l tho od .  Hor mon a lc ha n g e sp r o duc es e c o nda r ys e xc ha r a c t e r i s t i c sa n d moo ds wi n g s  Rol ec o nf u s i onoc c u r si ft hea do l e s c e nti sun a bl et oe s t a b l i s h i d e n t i t ya n das e n s eofd i r e c t i o n o I nt i mac yv s . i s o l a t i on( y oungadul t hood) -s e l fi de nt i t y  Thet a s ksf ort hey o un ga du l ta r et ouni t es e l fi d e n t i t ywi t h i d e n t i t i e so ff r i e n dsa ndt oma k ec o mmi t me n t st oo t h e r s  Fe a rofs u c hc o mmi t me n t sr e s u l t si ni s ol a t i o na n dl one l i n e s s o Ge ne r a t i vi t yv s . s t agna t i o n( mi ddl ea dul t ho od) -i n v o l v e me nt  I n v ol v e me n twi t hf a mi l y ,f r i e n ds , a n dc o mmuni t y  De s i r e dt oma k ec on t r i b u t i o nt ot hewo r l d  I ft a s kn o tme t s t a gna t i onr e s ul t sa n dt hepe r s o nb e c o me ss e l f a bs or be da n dob s e s s e dwi t hone so wnne e dsorr e gr e s s e st oa n e a r l i e rl e v e lo fc o pi n g o Eg oi nt e g r i t yv s . de s pa i r( l a t e ra dul t hoo d)–l i f er e mi ni s c e nc e  Re mi ni s c e nc ea b outl i f ee v e nt sp r o vi de sas e ns eoff ul fil l me nt a ndpur p os e

 Someol de ra du l t sma yno tb ef e a r f ulo fd y i n gi ft h e yf e e lt h e y ha v ea c h i e v e di n t e gr i t y o De v e l o pme nt a lg o a l sort a s ks o Ps y c h o s oc i a lc r i s e s o Thepr oc e s so fc o pi n g  I nf a n c ya n de a r l yc h i l d h ood  Ac h i e vi n gph y s i o l o gi cs t a b i l i t y  Le a r ni n gt oe a ts o l i df ood s  Le a r nt owa l k,t a l k  Si mp l ec o nc e pt sofs oc i a la n dp h y s i c a lr e a l i t y  Le a r ni n gt odi s t i n gu i s hb e t we e nr i g hta n dwr on g  Mi d dl ec hi l dho od  Le a r ni n gp h y s i c a ls ki l l sn e c e s s a r yf org a me s  Le a r ni n gt og e ta l on gwi t ha g ema t e s  De v e l o pi n gf u n da me n t a ls ki l l si nr e a d i n g ,wr i t i n ga n d ma t he ma t i c s  Ado l e s c e n c e  Ac c e p t i n go ne ’ sbo d ya n dus i n gi te ffe c t i v e l y  Ac h i e vi n gama s c u l i neo rf e mi n i n eg e n de rr ol e  Pr e pa r i n gf orac a r e e r Cul t ur a ldi v e r s i t yc o nc e ptc ha pt e r5 - De finec ul t ur e–s ha r e ds y s t e mo fb e l i e f s ,v a l ue sa ndb e ha vi or a le xp e c t a t i o ns t h a tpr o v i de ss o c i a ls t r u c t u r e sf orda i l yl i v i n g - Et h ni c i t y o Me mbe r sofas pe c i ficg r ou ps ha r i n gc ommondi s t i n c t i v es oc i a l& c ul t ur a lt r a i t s( s uc ha sr e l i g i on, di a l e c t s ,f o l k l o r e , e t c . ) ,t ha ta r eu s ua l l y pa s s e donf r o mg e ne r a t i o nt og e n e r a t i on - Ra c e o Cl a s s i fic a t i o nba s e dons ha r e db i o l o gi cc h a r a c t e r i s t i c s , g e n e t i c ma r k e r so rf e a t u r e s - Fe d e r a lc on s i de r a t i o n s o Ame r i c a nI nd i a no rAl a s k aNa t i v e -DM,LI VER o As i an–HTN,STROKE o Bl a c korAf r i c a nAme r i c a n– HTN, DM, SI CKLECELL o Na t i v eHa wa i i a norOt h e rPa c i ficI s l a n de r -LI VER,HTN o Wh i t e–Ca ,o be s i t y ,DM,HEARTDI SEASE Re l i g i o n

- Cul t u r ei si nflue n c e db yr e l i g i onwhi c hi nt ur na ffe c t sbe l i e f sa ndpr a c t i c e s a bou the a l t ha n di l l n e s s - Spi r i t u a la ndr e l i gi o usb e l i e f sa r ei mp o r t a n ti nma n ype o pl e ’ sl i v e s .The yc a n i n flu e nc el i f e s t y l e ,a t t i t u de s , a n df e e l i n g sa b outi l l n e s sa n dde a t h o Ex :j e h o v awi t n e s sdo n ’ ta c c e p tb l o odt r a ns f u s i o ns Cul t ur ea ndhe a l t h - Ho wd i ffe r e n tc u l t ur e svi e wt hef ol l o wi n gv a r i a bl e sa ffe c t she a l t hc a r ei n s i gn i fic a n twa y s o De fini t i o no fhe al t h–s t at eo fwe l l ne s s o Et i o l o gy  Wh a ta r et h eo r i g i n so fd i s e a s e ? o He a l t hp r omo t i ona n dp r o t e c t i on  Ho wi she a l t ha c hi e v e da ndma i nt a i n e d? o Pr a c t i o ne r sa n dr e me di e s  Wh oa n dwha tc a nh e a lap e r s o n?  Pg . 8 5bo x5 4 Cul t ur a l l yr e s pon s i v ec a r e - Ce n t e r e do np a t i e nt ’ sc ul t ur a lpe r s p e c t i v e s - I nt e g r a t e spa t i e nt ’ sv a l ue sa n db e l i e f si n t opl a no fc a r e - De v e l o pss e l f a wa r e n e s so fnur s e ’ so wnc ul t ur e ,a t t i t ud e s ,a ndbe l i e f s - Exa mi ne snur s e ’ sb i a s e sa n da s s umpt i o nsa b outd i ffe r e ntc ul t u r e s - Nu r s eg a i nkn o wl e d g ea n ds ki l l st oc r e a t ee n vi r o n me ntwhe r et r us tc a n de v e l op Cul t ur a li n flue n c e so nhe a l t h c a r e - i l l ne s sa r ec l a s s i fie da se i t he rn a t u r a lo run na t u r a l o “ n a t ur a l“ a r ec a u s e db yda n g e r ou sa g e n t ss u c ha sc o l da i rori mpu r i t i e s i nt hea i r ,wa t e ro rf o o d o un na t ur a li l l ne s sa r epu ni s hme n t sf orf a i l i n gt of ol l o wGo d’ sr ul e s r e s ul t i n gi ne vi lf o r c e sorwi t c hc r a f tc a u s i n gph y s i c a lo rme nt a lhe a l t h pr o b l e ms . o Ph y s i ol o g i c a lv a r i a t i on o Re a c t i on st opa i n o Me nt a lh e a l t h o Ge n de rr ol e s o La n gu a g ea ndc ommuni c a t i on o Spa c ea ndt i meo r i e n t a t i on

o Fo oda n dn ut r i t i o n o Fa mi l ys u ppo r t o So c i o e c o nomi cf a c t o r s Cl i e ntc ul t u r a la s s e s s me nt - Si xc a t e g o r i e sofi n f o r ma t i o nn e c e s s a r yf orac omp r e he n s i v ec u l t ur a l a s s e s s me ntofac l i e nta r e: o Et h ni corr a c i a lb a c kgr o und o La n gu a g ea ndc ommuni c a t i onp a t t e r n s o Cul t u r a lv a l ue sa ndnor ms o Bi o c ul t ur a lf a c t or s o Re l i gi o u sb e l i e f sa ndp r a c t i c e s o He a l t hb e l i e f sa n dp r a c t i c e s - I ti si mp o r t a n twhe nc a r i n gf orpa t i e n t sf r o m di ffe r e ntc ul t ur et ofir s ta s kho w t h e ywa n tt obet r e a t e dba s e do nt he i rv a l ue sa ndb e l i e f s - Pe r f or mac u l t u r a la s s e s s me n t - I nf or ma t i ona bou ta n yc u l t ur ei sg e ne r a la n dt ha ti tmu s tb ei ndi vi dua l i z e d f o rt h es p e c i ficp a t i e n to nc et hea c t ua li n t e r a c t i onb e g i ns Cul t ur a l l yApp r o pr i a t eCa r e - Re s p e c tc l i e n t sf o rt h e i rd i ffe r e ntb e l i e f s - Bes e ns i t i v et obe h a vi or sa n dpr a c t i c e sdi ffe r e ntf r o my o uro wn - Ac c ommo da t edi ffe r e nc e si ft he ya r eno td e t r i me n t a lt oh e a l t h - Li s t e nf orc ue si nt hec l i e nt ’ sc on v e r s a t i ont h a tr e l a yauni q uee t hni cbe l i e f a bou te t i ol o g y ,t r a ns mi s s i on ,pr e v e n t i on, e t c - Te a c hp os i t i v eh e a l t hha bi t si fc l i e n tpr a c t i c e sd e l e t e r i o ust og o odh e a l t h Fa c t o r si nflue n c i n gc o mmuni c a t i o n - Pe r c e pt i o n - Cul t u r e - Spa c ea nddi s t a nc e - Commun i c a t i o ne x c ha n g eo fi n f o r ma t i o n-g e n e r a t i n ga ndt r a ns mi t t i n g me a n i n gb e t we e n2o rmo r ep e o pl e Mo de sofc o mmu ni c a t i o n - Ve r ba l o Commu ni c a t i o np r oc e s s

- No n v e r ba l o Fa c i a le x pr e s s i ons o Po s t u r e o Ge s t ur e s o To uc h o Ph y s i c a la pp e a r a n c e Pr i n c i p l e sofc ommun i c a t i on - No n j u d gme nt a l - Pur p os e f u l - Ti mea ndpl a c e - Se t t i n gt hes t a g e - Ac c e p t i n gt h ec l i e n t - Ac t i v el i s t e n i n g o S=s i tf a c i n gt hec l i e n t o O=ope npo s t u r e o L=l e a nt o wa r dc l i e n t o E=e s t a bl i s he y ec o nt a c t o R=r e l a x Se l fc onc e pt - Se l fc on c e pt:me nt a li ma g eo fo ne s e l f o Po s i t i v es e l fc onc e pte s s e nt i a lt ome n t a la ndph y s i c a lh e a l t h o Di me n s i o ns  Se l fkn o wl e d g e  Wh oa mI ?  Se l fe x pe c t a t i o n  Wh oorwha tdoIwa ntt ob e ?

 Soc i a ls e l f  Ho wd oot he r ss e eme ?  Soc i a le v a l u a t i o n  Ho wwe l ld oIl i k emy s e l f ? - Fa c t o r st ha ta ffe c ts e l fc on c e p t o St a g eo fde v e l op me n t o Fa mi l yc ul t ur e o St r e s s or s o Re s o u r c e s o Hi s t o r yofs u c c e s sa ndf a i l u r e o I l l n e s s -

04/10/18

PSYCHOSOCIAL INTEGRITY 1. SELF-CONCEPT- MENTAL IMAGE OF ONESELF A. Positive self-concept essential to mental and physical health i.

Dimensions 1. Self-knowledge a. Who am I? 2. Self-expectation a. Who or what do I want to be? 3. Social Self a. How do others see me? 4. Social evaluation a. How well do I like myself?

2. FACTORS THAT AFFECT SELF-CONCEPT A. Stage of development B. Family and Culture C. Stressors D. Resources E. History of success and failure F. Illness

3. NURSING STRATEGIES TO IDENTIFY PERSONAL STRENGTHS A. Encourage Patients to identify their strengths B. Replace self-negation with positive thinking C. Notice and reinforce patient strengths D. Encourage patients to will strengths for themselves E. Help patients cope with necessary dependency related to age or illness

4. HELPING PATIENTS MAINTAIN SENSE OF SELF A. Communicate worth with looks, speech, and judicious touch B. Acknowledge patient status, role, and individuality C. Speak to patient respectfully if necessary D. Respect patient’s privacy and sensibilities E. Acknowledge and allow expression of negative feelings F. Help patient recognize strengths and explore alternatives

5. CONCEPT OF STRESS A. Stress i.

Condition in which the person experiences changes in the normal balanced state

B. Stressor i.

Any event or stimulus that causes an individual to experience stress

C. Responses are referred to as: i.

Coping strategies

ii.

Coping response

iii.

Coping mechanisms

D. Selected Stressors Associated with Developmental stages i.

Child  Beginning school, Establishing peer relationships, Peer completion

ii.

Adolescent Changing Physique, Relationships involving sexual attraction, Exploring Independence

iii.

Young Adult Marriage, Leaving Home, managing a home, getting started in an occupation, continuing one’s education, children

iv.

Middle Adult Physical changes of aging, maintaining social status and standard of living, helping teenage children to become independent, aging parents

v.

Older Adult Decreasing physical abilities and health, changed in residence, retirement and reduced income, death of spouse and friends

6. DISORDERS THAT CAN BE CAUSED OR AGGRAVATED BY STRESS A. Skin disorders Eczema, Pruritus, Urticaria, Psoriasis B. Respiratory DisordersAsthma, Hay fever, Tuberculosis

C. Cardiovascular Disorders Coronary artery disease, essential hypertension, congestive heart failure D. Gastrointestinal Disorders Constipation, Diarrhea, Duodenal ulcer, Anorexia nervosa (severe loss of appetite), Obesity, Ulcerative colitis E. Menstrual irregularities F. Musculoskeletal disorders Rheumatoid Arthritis, Low back pain, Migraine headache, Muscle tension G. Cancer H. Accident Proneness I.

Decreased immune response

J.

Metabolic disorders Hyperthyroidism, Hypothyroidism, Diabetes

7.

8. PHYSIOLOGICAL INDICATORS OF STRESS A. Pupils dilate B. Sweat production increases C. Heart rate and cardiac output increase D. Skin is pallid E. Sodium and water retention occurs F. Rate and depth of respiration increase

G. Urinary output decreases H. Mouth may be dry I.

Peristalsis of intestines decreases for serious threats

J.

Mental alertness improves

K. Blood sugar increases L. Anxiety M. Fear N. Anger O. Depression P. Unconscious ego defense mechanisms

9.

10.

CONGNITIVE INDICATORS OF STRESS

A. Problems solving

B. Structuring C. Self-control or self- discipline D. Suppression E. Fantasy or daydreaming

11.

DEFENSE MECHANISMS

A. CompensationA person attempt to overcome a perceived weakness by emphasizing a more desirable trait or overachieving in a more comfortable area i.

(Ex: a student who has difficulty with academics excel in sports

B. Denial A person who refuses to acknowledge the presence of a condition that is disturbing i.

Ex: despite finding a lump in her breast, a woman does not seek medical treatment

C. Displacement  A person transfers (displaces) an emotional reaction from one object or person to another object or person i.

Ex: An employee who is angry with a coworker kicks a chair

D. Identification  a focus on negative or feared traits EX: If you are afraid of someone , you can practically conquer that fear by becoming more like them  Stockholm syndrome is an extreme example where hostages identify with the terroists E. Introjection A person incorporates qualities’ or values of another person into one’s own ego structure. This mechanism is important in the formation of conscience during childhood i.

Ex: An older sibling tells his preschool sister not to talk to strangers, expressing his parents’ values to his younger sister

F. Minimization  allows you to decrease the intensity of a situation. When minimization is used to protect , it keeps the child from experiencing an intense feeling. i.

Ex: if parents divorce, most children feel responsible for their parents breakup so they minimize it by saying “ my parents don’t fight, they just agrue a lot” when adults use minimization it decreases the significance of

their behavior consequently they don’t recognize the effect their behavior has on others G. Projection  A person attributes thought or impulses to someone else i.

Ex: A person who denies any sexual feelings for a coworker accuses him of sexual harassment

H. Rationalization  A person tries to give a logical or socially acceptable explanation for questionable behavior (“behavior justification”) i.

I.

Reaction formation  A person develops conscious attitudes and behavior patterns that are opposite to what he or she would really like to do i.

J.

Ex: A patient who forgot to keep a health care appointment says “ If patients didn’t have to wait 3 months to get an appointment, they wouldn’t forget them.”

Ex: A married woman is attracted to her husband’s best friend but is constantly rude to him

Regression  A person returns to an earlier method of behaving i.

Ex: children often regress to soiling diapers or demanding a bottle when they are ill

K. Repression  A person voluntarily excludes an anxiety producing event from conscious awareness i.

Ex: A father may not remember shaking his crying baby

L. Sublimation  A person substitutes a socially acceptable goal for one whose normal channel of expression is blocked i.

Ex: A person who is aggressive toward others may become a star football player

M. Substitution through this defense mechanism the individual secures alternative or substitutive gratification comparable to those that would have been employed had frustration not occurred N. Undoing  A person uses an act or communication to negate a previous act or communication i.

Ex: A husband who was physically abusive to his wife may bring her an expressive present the next day

O.

12.

COPING

A. Dealing with change (either successfully or unsuccessfully) B. Coping strategy is natural or learned way of responding to changing environment or specific problem or situation

13.

SEXUALITY

A. All humans are sexual beings B. Sexuality individually expressed, highly personal phenomenon whose meaning evolves from life experience C. Physiological, psychosocial, cultural influences D. “Normal” varies among cultures, religions

14.

FACTORS INFLUENCING SEXUALTIY

A. Family, Culture, Religion, Personal expectations and...