NCLEX: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

IX. NONCOMPLIANCE AND UNCOOPERATIVE BEHAVIOR

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

A. Definition: consistently failing to meet the requirements of the prescribed treatment regimen (e.g., refusing to adhere to dietary restrictions or
take required medications).

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

B. Assessment:

  • Refuses to participate in routine or planned activities.
  • Refuses medication.
  • Violates rules, ignores limits, and abuses privileges; acts out anger and frustration.

C. Analysis/nursing diagnosis: noncompliance related to:

  • Psychological factors: lack of knowledge; attitudes, beliefs, and values; denial of illness; rigid, defensive personality type; anxiety level (very high or
    very low); cannot accept limits or dependency (rebellious counter dependency).
  • Environmental factors: finances, transportation, lack of support system.
  • Health-care agent–client relationship: client feels discounted and like an “object”; sees staff as uncaring, authoritative, controlling.
  • Health-care regimen: too complicated; not enough benefit from following regimen; results in social stigma or social isolation; unpleasant side effects.

D. Nursing care plan/implementation:

  • General goal: reduce need to act out by nonadherence.
    a. Take preventive action—be alert to signs of noncompliance, such as intent to leave against medical advice.
    b. Explore feelings and reasons for lack of cooperation.
    c. Assess and allay fears in client in reassuring manner.
    d. Provide adequate information about, and reasons for, rules and procedures.
    e. Avoid threats or physical restraints; maintain calm composure.
    f. Demonstrate tact and firmness when confronting violations.
    g. Offer alternatives.
    h. Firmly insist on cooperation in selected important activities but not all activities.
  • Health teaching: increase knowledge base regarding health-related problem, procedures, or treatments and consequences.

E. Evaluation/outcome criteria: follows prescribed regimen.

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III: Mental and Emotional Disorders in Children and Adolescents

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Children have certain developmental tasks to master in the various stages of development (e.g., learning to trust, control primary instincts, and resolve basic social roles.

I. CONCEPTS AND PRINCIPLES RELATED TO MENTAL AND EMOTIONAL DISORDERS IN CHILDREN AND ADOLESCENTS:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

  • Most emotional disorders of children are related to family dynamics and the place the child occupies in the family group.
  • Children must be understood and treated within the context of their families.
  • Many disorders are related to the phases of development through which the children are passing. (Erik Erikson’s developmental tasks for children are trust, autonomy, initiative, industry, identity, and intimacy.)
  • Emotional Disturbances in Children summarizes key age-related disturbances, lists main symptoms and analyses of causes, and highlights medical interventions and nursing plan/implementation.
  • Children are not miniature adults; they have special needs.
  • Play and food are important media to make contact with children and help them release emotions in socially acceptable forms, prepare them for traumatic events, and develop skills.
  • Children who are physically or emotionally ill regress, giving up previously useful habits.
  • Adolescents have special problems relating to need for control versus need to rebel, dependency versus interdependency, and search for identity and
    self-realization.
  • Adolescents often act out their underlying feelings of insecurity, rejection, deprivation, and low self-esteem.
  • Strong feelings may be evoked in nurses working with children; these feelings should be expressed, and each nurse should be supported by team members.

 

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

 

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

 

II. ASSESSMENT of selected disorders:

A. Autistic spectrum disorders (previously called childhood schizophrenia; most common form of pervasive developmental disorders [PDDs])—assessment (before age 3):

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

  • Disturbance in how perceptual information is processed (sensory integrative dysfunction); normal abilities present.
    a. Behave as though they cannot hear, see, etc.
    b. Do not react to external stimulus.
    c. Sensory defensiveness:
    (1)Might dislike specific food textures or temperatures.
    (2)Covers ears in response to loud noises.
    (3)Can’t concentrate if there are competing noises in environment.
    (4)Might dislike riding or climbing on play equipment.
    (5)Doesn’t like people standing too close or being touched.
    (6)Stimuli might be interpreted as threatening or anxiety provoking.
    (7)Responds in an exaggerated manner (cries, is negative, resistant, or rigid) when a situation makes it difficult for child to process.
    d. Low muscle tone results in inability to maintain stable positions or postures (e.g., standing on one leg); avoids gross and fine motor movement.
  • Lack of self-awareness as a unified whole—may not relate bodily needs or parts as extension of themselves.
  • Severe difficulty in social interaction and communicating with others—may be mute or echolalic and isolated.
  • Bizarre restricted and repetitive postures and gestures (banging head, rocking back and forth), and routines.
  • Disturbances in learning: difficulties in understanding and using language.
  • Etiology is unknown; but generally accepted that irregularities in brain structure or function may be congenital or acquired.
  • Prognosis depends on severity of symptoms and age of onset (can exhibit any combination of symptoms and behaviors).

B. Other pervasive developmental disorders include: Asperger’s disorder (speak at normal pace and have normal intelligence, but have stunted social skills,
limited and obsessive interests), childhood disintegration disorder (CDD), and Rett’s disorder.

Characteristics:

  • Hyperactivity.
  • Explosive outbursts.
  • Distractibility.
  • Impulsiveness.
  • Perceptual difficulties (visual distortions, such as figure-ground distortion and mirror reading; body-image problems; difficulty in telling left from right).
  • Receptive or expressive language problems.

C. Elimination disorders (functional enuresis)—related to feelings of insecurity due to unmet needs of attention and affection; important to preserve their self-esteem.

D. Separation anxiety disorders of childhood (school phobias)—anxiety about school is accompanied by physical distress. Usually observed with fear of
leaving home, rejection by mother, fear of loss of mother, or history of separation from mother in early years.

E. Conduct disorders—include lying, stealing, running away, truancy, substance abuse, sexual delinquency, vandalism, fire setting, and criminal gang activity; chief motivating force is either overt or covert hostility; history of disturbed parent-child relations.

III. ANALYSIS/NURSING DIAGNOSIS:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

A. Altered feeling states: anxiety, fear, hostility related to personal vulnerability and poorly developed or inappropriate use of defense mechanisms.

B. Risk for self-mutilation related to disturbance in self-concept, abnormal response to sensory input, and history of abuse.

C. Altered interpersonal processes:

  • Impaired verbal communication related to cerebral deficits, withdrawal into self, inability to trust other.
  • Altered conduct/impulse processes: aggressive, violent behaviors toward self, others, environment related to feelings of distrust and altered judgment.
  • Dysfunctional behaviors: age-inappropriate behaviors, bizarre behaviors; disorganized and unpredictable behaviors related to inability to discharge emotions verbally.
  • Impaired social interaction: social isolation/ withdrawal related to feelings of suspicion and mistrust, lack of bonding, inadequate sensory stimulation.

D. Personal identity disturbance related to lack of development of trust, organic brain dysfunction, maternal deprivation.

E. Altered parenting related to ambivalent or dissonant family relationships and failure of child to meet role expectations.

F. Sensory/perceptual alterations: altered attention related to disturbed mental activities.

G. Altered cognition process: altered decision making, judgment, knowledge, and learning processes; altered thought content and processes related to
perceptual or cognitive impairment and emotional dysfunctioning.

IV. NURSING CARE PLAN/IMPLEMENTATION in mental and emotional disorders in children and adolescents:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

A. General goals: corrective behavior—behavior modification.
B. Help children gain self-awareness.
C. Provide structured environment to orient children to reality.

D. Impose limits on destructive behavior toward themselves or others without rejecting the children.

  • Prevent destructive behavior.
  • Stop destructive behavior.
  • Redirect nongrowth behavior into constructive channels.

E. Be consistent.
F. Meet developmental and dependency needs.
G. Recognize and encourage each child’s strengths, growth behavior, and reverse regression.
H. Help these children reach the next step in social growth and development scale.
I. Use play and projective media to aid working out feelings and conflicts and in making contact.
J. Offer support to parents and strengthen the parent-child relationship.
K. Health teaching: teach parents methods of behavior modification.

V. EVALUATION/OUTCOME CRITERIA:

  • Destructive behavior is inhibited.
  • Demonstrates age-appropriate behavior on developmental scale.

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III: Midlife Crisis: Phase-of-Life Problems

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

Midlife crisis is a time period that marks the passage between early maturity and middle age.

I. ASSESSMENT:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

A. Commonly occurs between ages 35 and 45.
B. Preoccupied with visible signs of aging, own mortality.
C. Feelings: urgency that time is running out (“last chance”) for career achievement and unmet goals; boredom with present, ambivalence, frustration, uncertainty about the future.

D. Time of reevaluation:

  • Reassess: meaning of time and parental role (omnipotence as a parent is challenged).
  • Reexamine and contemplate change in career, marriage, family life.

E. Personality changes may occur. Women: traditional definitions of femininity may be challenged as become more assertive. Men: may be more introspective, sensitive to emotions, make external changes (younger mate, improve looks, new sports activity), mood swings.

F. Presence of helpful elements necessary to turn life’s obstacles into opportunities.

  • Willingness to take risks.
  • Strong support system.
  • Sense of purpose.
  • Accumulated wisdom.

II. ANALYSIS/NURSING DIAGNOSIS:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

  • Self-esteem disturbance (low self-esteem) related to loss of youth, faltering physical powers, and facing discrepancy between youthful ambitions and actual achievement (no longer a promising person with potential).
  • Altered role performance (role reversal) related to parents who previously provided security and comfort but now need care.
  • Altered feeling processes (depression) related to disappointments and diminished optimism as life is reconsidered in light of the reality of aging and death.

III. NURSING CARE PLAN/IMPLEMENTATIONlong-term goal: help individual to rebuild life structure.

A. Help client reappraise meaning of own life in terms of past, present, and future, and integrate aspects of time. Encourage introspection and reflection with questions:

  • What have I done with my life?
  • What do I really get from and give to my spouse, children, friends, work, community, and self?
  • What are my strengths and liabilities?
  • What have I done with my early dream, and do I want it now?

B. Assist client to complete four major tasks:

  • Terminate era of early adulthood by reappraising life goals identified and achieved during this era.
  • Initiate movement into middle adulthood by beginning to make necessary changes in unsuccessful aspects of the current life while trying out new choices.
  • Cope with polarities that divide life.
  • Directly confront death of own parents.

C. Health teaching: stress-management techniques; how to do self-assessment of aptitudes, interests; how to plan for retirement, aloneness, and use of
increased leisure time; dietary modification and exercise program.

IV. EVALUATION/OUTCOME CRITERIA:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

A. Gives up idealized self of early 20s for more realistically attainable self.

  • Talks less of early hopes of eminence and more on modest goal of competence.
  • Shifts values from sexuality to platonic relationships: replaces romantic dreams with satisfying friendships and companionships.
  • Modifies early illusions about own capacities.
  • Shifts values away from physical attractiveness and strength to intellectual abilities.

B. Comes to accept that life is finite and reconciles what is with what might have been; appreciates everyday human experience rather than glamour or power.

C. Through self-confrontation, self-discovery, and change, experiences time of restabilization; is reinvigorated, adventuresome.

D. Develops alternative abilities that release new energies.

E. Tries less to please everyone; others’ opinions less important.

F. Makes more efficient and well-seasoned decisions from well-developed sense of judgment.

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III: Mental Health Problems of the Geriatric Client

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

In general, problems affecting the elderly are similar to those affecting persons of any age. This section highlights the differences from the viewpoint of etiology, frequency, and prognosis.

I. CONCEPTS AND PRINCIPLES RELATED TO MENTAL HEALTH PROBLEMS OF THE GERIATRIC CLIENT:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

  • The elderly do have capacity for growth and change.
  • Human beings, regardless of age, need sense of future and hope for things to come.
  • An inalienable right of all individuals should be to make or participate in all decisions concerning themselves and their possessions as long as they can.
  • Physical disability due to the aging process may enforce dependency, which may be unacceptable to elderly clients and may evoke feelings of anger and ambivalence.
  • In an attempt to reduce feelings of loss, elderly clients may cling to concrete things that most represent, in a symbolic sense, all that has been significant to them.
  • As memory diminishes, familiar objects in environment and familiar routines are important in helping to keep clients oriented and in contact with reality.
  • Familiarity of environment brings security; routines bring a sense of security about what is to happen.
  • If individuals feel unwanted, they may tell stories about their earlier achievements.
  • Many of the traits in the elderly result from cumulative effect of past experiences of frustrations and present awareness of limitations rather than from any primary consequences of physiological deficit.

II. ASSESSMENT:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

A. Psychological characteristics of the geriatric client:

  • Increasingly dependent on others, not only for physical needs but also for emotional security.
  • Concerns focus more and more inward, with narrowed outside interests.
    a. Decreased emotional energy for concern with social problems unless these issues affect them.
    b. Tendency to reminisce.
    c. May appear selfish and unsympathetic.
  • Sources of pleasure and gratification are more childlike: food, warmth, and affection, for example.
    a. Tangible and frequent evidence of affection is important (e.g., letters, cards, and visits).
    b. May hoard articles.
  • Attention span and memory are short; may be forgetful and accuse others of stealing.
  • Deprivation of any kind is not tolerated:
    a. Easily frustrated.
    b. Change is poorly tolerated; need to have favorite chairs and established daily routine, for example.
  • Main fears in the aged include fear of dependency, chronic illness, loneliness, boredom, fear of being unloved, forgotten, deserted by those close to them, fear of death; fear of loss of control of one’s own life; a failing cognition; loss of purpose and productivity.
  • Nocturnal delirium may be due to problems with night vision and inability to perceive spatial location.

B. Psychiatric problems in aging:

  • Loneliness—related to loss of mate, diminishing circle of friends and family through death and geographic separation, decline in physical energy, loss of work (retirement), sharp loss of income, and loss of a lifelong lifestyle.
  • Insomnia—pattern of sleep changes in significant ways: disappearance of deep sleep, frequent awakening, daytime sleeping.
  • Hypochondriasis—anxiety may shift from concern with finances, job, or social prestige to concern about own bodily function.
  • Depression—common problem in the aging, with a high suicide rate; partly because of bodily changes that influence the self-concept, the older person may direct hostility toward self and therefore may be subject to feelings of depression and loneliness.
  • Senility—four early symptoms:
    a. Change in attention span.
    b. Memory loss for recent events and names.
    c. Altered intellectual capacity.
    d. Diminished ability to respond to others.

C. Successful aging:

  • Being able to perceive signs of aging and limitations resulting from the aging process.
  • Redefining life in terms of effects on social and physical aspects of living.
  • Seeking alternatives for meeting needs and finding sources of pleasure.
  • Adopting a different outlook about self-worth.
  • Reintegrating values with goals of life.

D. Causative factors of mental disorder in the aging client related to:

  • Nutritional problems and physical ill health related to acute and chronic illness:
    a. Cardiovascular diseases (heart failure, stroke, hypertension).
    b. Respiratory infection.
    c. Cancer.
    d. Alcohol dependence and abuse.
    e. Dentition problems.
  • Faulty adaptation related to physical changes of aging (e.g., depression, hypochondriases).
  • Problems related to loss, grief, and bereavement.
  • Retirement shock related to loss of status and financial security.
  • Social isolation and loneliness related to inadequate sensory stimulation.
  • Environmental change (relocation within a community or from home to institution): loss of family, privacy.
  • Hopelessness, helplessness related to condition and circumstances.
  • Altered body image (negative) related to aging process.
  • Depression related to helplessness, inability to express anger.

III. ANALYSIS/NURSING DIAGNOSIS:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

  • Self-esteem disturbance related to body image disturbance and altered family role.
  • Impaired social interaction related to social isolation and environmental changes.
  • Dysfunctional grieving related to loss and bereavement.
  • Altered feeling states and spiritual distress related to hopelessness, anxiety, fear, powerlessness.
  • Altered physical regulation processes related to physical ill health.
  • Sleep pattern disturbance related to insomnia and altered sleep/arousal patterns.

IV. NURSING CARE PLAN/IMPLEMENTATION:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

A. Long-term goal: to help reduce hopelessness and helplessness.
B. Short-term goal: to focus on ego assets.
C. Help elderly preserve what facet of life they can and regain that which has already been lost.

  • Help minimize regression as much as possible.
  • Help retain their adult status.
  • Help preserve their self-image as useful individuals.
  • Identify and preserve their abilities to perform, emphasizing what they can do.

D. Attempt to prevent loss of dignity and loss of worth—address them by titles, not “Gramps,” “sweetie,” or “honey.”

E. Reduce feelings of alienation and loneliness. Provide sensory experiences for those with visual problems:

  • Let them touch objects of various textures and consistencies.
  • Encourage heightened use of remaining senses to make up for those that are diminished or lost.

F. Reduce depression and feelings of isolation.

  • Allow time to reminisce.
  • Avoid changes in surroundings or routine.

G. Protect from rush and excitement.

  • Use simple, unhurried conversation.
  • Allow extra time to organize thoughts.

H. Be sensitive to concrete things they may want to keep.

I. Health teaching:

  • How to keep track of time (e.g., by marking off days on a calendar), to promote orientation.
  • How to keep track of medications.
    3. Exercises to promote blood flow.
    4. Retirement counseling:
    a. Obtaining satisfaction from leisure time.
    b. Nurturing relationships with younger generations.
    c. Adjusting to changes: physical health, retirement, loss of loved ones.
    d. Developing connections with own age group.
    e. Taking on new social roles.
    f. Maintaining a satisfactory and appropriate living situation.
    g. Coping with dependence on others, especially one’s children.

V. EVALUATION/OUTCOME CRITERIA:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

  • Less confusion and fewer mood swings.
  • Increased interest in activities of daily living and interaction with others.
  • Lessened preoccupation with death, dying, physical symptoms, feelings of sadness.
  • Reduced insomnia and anorexia.
  • Expresses feelings of belonging and being needed.

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III: Alterations in Self-Concept

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

I. ASSESSMENT:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

  • Self-derisive; self-diminution; and self-critical.
  • Denies own pleasure due to need to punish self; doomed to failure.
  • Disturbed interpersonal relationships (cruel, demeaning, exploitive of others; passive-dependent).
  • Exaggerated self-worth or rejects personal capabilities.
  • Feels guilty, worries (nightmares, phobias, obsessions).
  • Sets unrealistic goals.
  • Withdraws from reality with intense self-rejection (delusional, suspicious, jealous).
  • Views life as either-or, worst-or-best, wrong or right.
  • Postpones decisions due to ambivalence (procrastination).
  • Physical complaints (psychosomatic).
  • Self-destructive (substance abuse or other destructiveness).

II. ANALYSIS/NURSING DIAGNOSIS: Altered self-concept may be related to:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

  • Low self-esteem that is related to parental rejection, unrealistic parental expectations, repeated failures.
  • Altered personal identity (negative): self-rejection and self-hate related to unrealistic self-ideals.
  • Identity confusion related to role conflict, role overload, and role ambiguity.
  • Feelings of helplessness, hopelessness, worthlessness, fear, vulnerability, inadequacy related to extreme dependency on others and lack of personal responsibility.
  • Disturbed body image.
  • Depersonalization.
  • Physiological factors that produce self-concept distortions (e.g., fatigue, oxygen and sensory deprivation, toxic drugs, isolation, biochemical imbalance).
[sociallocker]

III. NURSING CARE PLAN/IMPLEMENTATION:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

A. Long-term goal: facilitate client’s self-actualization by helping him or her to grow, develop, and realize potential while compensating for
impairments.
B. Short-term goals:

  • Expand client’s self-awareness:
    a. Establish open, trusting relationship to reduce fear of interpersonal relationships.
    (1) Offer unconditional acceptance.
    (2) Nonjudgmental response.
    (3) Listen and encourage discussion of thoughts, feelings.
    (4) Convey that client is valued as a person, is responsible for self and able to help self.                                                                        b. Strengthen client’s capacity for reality testing, self-control, and ego integration.
    (1) Identify ego strengths.
    (2) Confirm identity.
    (3) Reduce panic level of anxiety.
    (4) Use undemanding approach.
    (5) Accept and clarify communication.
    (6) Prevent isolation.
    (7) Establish simple routine.
    (8) Set limits on inappropriate behavior.
    (9) Orient to reality.
    (10) Activities: gradual increase; provide positive experiences.
    (11) Encourage self-care; assist in grooming.                                                                                                                                            c. Maximize participation in decision making related to self.
    (1)Gradually increase participation in own care.
    (2)Convey expectation of ultimate self-responsibility.
  • Encourage client’s self-exploration.
    a. Accept client’s feelings and assist self-acceptance of emotions, beliefs, behaviors, and thoughts.
    b. Help clarify self-concept and relationship to others.
    (1)Elicit client’s perception of own strengths and weaknesses.
    (2)Ask client to describe: ideal self, how client believes he or she relates to other people and events.
    c. Nurse needs to be aware of own feelings as a model of behavior and to limit counter transference.
    (1)Accept own positive and negative feelings.
    (2)Share own perception of client’s feelings.
    d. Respond with empathy, not sympathy, with the belief that client is subject to own control.
    (1)Monitor sympathy and self-pity by client.
    (2)Reaffirm that client is not helpless or powerless but is responsible for own choice of maladaptive or adaptive coping responses.
    (3)Discuss: alternatives, areas of ego strength, available coping resources.
    (4)Use family and group support system for self-exploration of client’s conflicts and maladaptive coping responses.
  • Assist client in self-evaluation.
    a. Help to clearly define problem.
    (1) Identify relevant stressors.
    (2)Mutually identify: faulty beliefs, misperceptions, distortions, unrealistic goals, areas of strength.
    b. Explore use of adaptive and maladaptive coping responses and their positive and negative consequences.
  • Assist client to formulate a realistic action plan.
    a. Identify alternative solutions to client’s inconsistent perceptions by helping him or her to change:
    (1)Own beliefs, ideals, to bring closer to reality.
    (2)Environment, to make consistent with beliefs.                                                                                                                                       b. Identify alternative solutions to client’s self-concept not consistent with his or her behavior by helping him or her to change:
    (1)Own behavior to conform to self-concept.
    (2)Underlying beliefs.
    (3)Self-ideal.
    c. Help client set and clearly define goals with expected concrete changes. Use role rehearsal, role modeling, and role playing to see practical, reality-based, emotional consequences of each goal.
  • Assist client to become committed to decision to take necessary action to replace maladaptive coping responses and maintain adaptive responses.
    a. Provide opportunity for success and give assistance (vocational, financial, and social support).
    b. Provide positive reinforcement; strengths, skills, healthy aspects of client’s personality.
    c. Allow enough time for change.
  • Health teaching: how to focus on strengths rather than limitations; how to apply reality-oriented approach.

IV. EVALUATION/OUTCOME CRITERIA:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span III

  • Client able to discuss perception of self and accept aspects of own personality.
  • Client assumes increased responsibility for own behavior.
  • Client able to transfer new perceptions into possible solutions, alternative behavior.
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FURTHER READING/STUDY:

Resources:

 

 

 

 

 

 

 

 

 

 

 

 

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