Universal Experiences

Question 1

what is the universal experience of “crisis”

Answer 1

• stress, anxiety
• Tips scale towards illness side of wellness-illness continuum
• Conceptualized as a stimulus, a process, a response, & a state – it may be more accurate to describe stressors as stimuli and stress as a response or reaction to them
• Subjective
• Caused by internal and external factors
• A response to demands that exceed ones ability to cope
• Occurs on a continuum with anxiety and crisis

Question 2

what are the 3 components of the stress response

Answer 2

• physiological
• cognitive
• emotional

Question 3

types of crises: (2)

Answer 3

• Developmental (usually short lived) – retirement, empty nest, puberty
• Situational – illness, death of a loved one, separation or divorce, loss of job, moving, traumatic experience, unplanned pregnancy

Question 4

crisis intervention

Answer 4

• Early intervention, stabilization, facilitate understanding, problem solving, encourage self-reliance

Question 5

role of RPN in crisis

Answer 5

• Establish a therapeutic relationship
• Gather relevant data
• Bear witness to their pain
• Validate their feelings
• Provide education
• Teach new coping skills
• Offer hope

Question 6

physiological response: general adaptation syndrome (SELYE)

Answer 6

stage 1: alarm reaction

Stage 2: resistance stage

Stage 3: exhaustion stage

Question 7

Physiological component of stress response

Answer 7

a. i.e. sweating, increased heart rate, increased adrenaline, cortisol etc.
b. Important for life threatening evolutionary responses

Question 8

Cognitive component of stress reaction

Answer 8

a. Stress impairs the more complex part of your brain
b. Not focused on thinking about problem
c. Physiological response takes over

Question 9

emotional component of stress response

Answer 9

a. Triggers stress
b. Emotional component -> cognitive offline -> physiological component -> emotional component

Question 10

body functions/systems affected by stress

Answer 10

cardiovascular, respiratory, GI, MS, GU, dermatological

Question 11

cognitive component of stress response considers what

Answer 11

considers the appraisal of stressors and how they influence the stress response

Question 12

what is the Lazarus & Folkman: Cognitive Appraisal Theory:

Answer 12

• the person is under stress only if they perceive themselves to be
• primary appraisal: what does this situation mean to me
• secondary appraisal: can I cope with it

Question 13

The cognitive-behavioural triangle of the emotional component of stress

Answer 13

emotions – thoughts – behaviour

Question 14

Anxiety in the emotional component of stress

Answer 14

apprehension or dread in response to internal or external stimuli that can be experiences in physical, emotional, cognitive (e.g., distorted negative thoughts), and/or behavioural ways (e.g., avoidance, procrastination)

Question 15

Levels of anxiety:

Answer 15

• Mild: slight arousal that enhances perception, learning and productivity
• Moderate: increased arousal with tension, nervousness and perception is narrowed
• Severe/pain: it is consuming, poor focus, very uncomfortable and requires intervention. Overpowering & frightening

Question 16

what influences how someone will cope with stress and anxiety

Answer 16

• Coping can be affected by biology, environment, education and awareness, models of healthy coping mechanisms

Question 17

describe adaptive coping

Answer 17

• strategies that minimize/reduce or eliminate the stress response
• Strategies can be short-term/immediate, or longer-term adaptations
• E.g., sleep (behavioural), meditation (cognitive + physiological ), journaling/for self-awareness (cognitive), exercise (physiological, phycological, spiritual), nutrition (physiological), music (spiritual)

Question 18

describe maladaptive coping

Answer 18

• may temporarily be “effective”, but cause longer term negative consequences and results in worsening distress
• Defense mechanisms – denial, projection, regression etc.
• E.g., substance use, binge eating, overexercising

Question 19

define comfort and pain

Answer 19

The capacity to self soothe emotional/cognitive challenges

Question 20

Factors that influence the experience of pain & comfort:

Answer 20

physiological, psychological, developmental, sociocultural & spiritual factors
- Physiological e.g., high tolerance to pain - biological

Question 21

Comfort & the role of the RPN:

Answer 21

• Comfort is closely related to caring
• An essential part pf our role as RPN
• May involve consolation, support or assistance to promote well-being
• Comforting is not pitying

Question 22

Hope (hopelessness) =

Answer 22

hope is the anticipation of a continued good or of an improvement in, or lessening of something unpleasant

Question 23

Power (powerlessness) =

Answer 23

the perception & process of gaining or maintaining control or influence over aspects on one’s environment

• A client receiving mental health treatment can at times feel powerless. What are some circumstances or experiences that contribute to this? – marginalized population
• We must recognize &minimize the power differential inherent in our therapeutic relationships and our practices as RPNs
• The goal is to empower our clients by mobilizing their strengths

Question 24

what are the 4 concepts of loss

Answer 24

• grief
• actual loss
• perceived loss
• bereavement

Question 25

grief

Answer 25

the emotional response (subjective) to the perception of loss

Question 26

actual loss

Answer 26

A loss of a person or object that can no longer be felt, heard, known or experienced

Question 27

perceived loss

Answer 27

a loss that cant be seen by others

Question 28

Bereavement

Answer 28

the response to the loss or death of a loved one

Question 29

Common symptoms of Grief

Answer 29

- Feeling physically drained - Cant sleep - Forgetful, cant think clearly - Appetite changes - Physical symptoms: chest pains, headaches - Poor concentration - Senses or dreams about the deceased - Guilt - Tearfulness - Sadness that comes in waves - Numbness

Question 30

Factors that impact grieving

Answer 30

The grieving perons: - Personality and temperament before the loss (external vs. internal locus of control) - Degree of attachment with the person who died - Culture & religious - Nature of the loss e.g., sudden or traumatic - Presence of preexisting mental illness & coping skills - Amount of support they have - Number of previous losses person as experienced (grief is cumulative) - The bereaved person feels responsible in some way for the loss

Question 31

Differentiating Normal Grief from Depression

Answer 31

- Normal Grief: o Self-esteem intact o Good days and bad days o Maintains feelings of hope o Able to experience pleasure o Accept comfort from others o Physical symptoms are transient - Clinical depression: o Self-esteem is disturbed o Feels persistent dysphoria o Feelings of hopelessness o Anhedonia is prevalent o Does not response to support from others o Expresses chronic physical complaints

Question 32

Complicated Grief =

Answer 32

stuck in the grieving process. Defined as unhealthy mourning following a death, lasts at least 6 months

Question 33

signs of complicated grief

Answer 33

o Pt doesn’t progress through the stages of grief o Preoccupation with the deceased or death o Recurrent intrusive images o Avoidance of painful reminders of death o Grief response continues to impact daily living o Seek to isolate or avoid support systems o Extreme feelings of guilt/worthlessness o Meet criteria for major depression

Question 34

Anticipatory grief =

Answer 34

the emotional experience of the normal grief response before the loss occurs

Question 35

Role of the RPN: GRIEF

Answer 35

- Assess the client’s stage in the grief process (gather acute baseline) - Develop trust. Show empathy and unconditional positive regard - Provide ongoing support (friends, support groups etc) - Help client actualize the loss by talking about it (reviewing events of the loss helps increase awareness) - Help client identify and express feelings (repressed feelings of guilt/anger can stall grieving) - Understand and explain in the normal grief process - Be present and bear witness to their pain - Identify maladaptive coping strategies (avoidance of pain can stall grieving)

Question 36

Integrity (death, dying, acceptance)

Answer 36

- Integrity stems from the latin word ‘integer’ which means whole & complete - The quality of having an inner sense of wholeness and consistency of character - you demonstrate consistency in your values, beliefs, and actions in all areas of your life - satisfaction of attaining own life goals - integrity contributes to trust and authenticity - maintaining patient sense of integrity is a key role of the nurse e.g., dying patient, grieving patient

Question 37

what are the 7 universal experiences

Answer 37

- hope - crisis - comfort - connectedness - loss - power - resiliency