Psychosocial nursing diagnosis is the best-known gateway for treating psychological disorders. Psychosocial is the combination of two words, psycho (meaning mental or psychological) and social, which collectively gives a meaning of mental disorders affected by social factors. There are different diseases, which are classified as psychosocial disorders. Most common are eating, developmental, dissociative, cognitive, factitious, mood and various other disorders. Adjustment and anxiety disorders are also classified as psychosocial disorders. All these disorders are impacted by social factors as well as mental conditions and can be treated by psychosocial nursing diagnosis.
Social factors responsible for psychosocial disorders:
Common communal factors which induce or aggravate such illnesses are peer pressure, fear of becoming unfit for the society, social and economic conditions, maternal support, relationships and religious matters. These factors are most likely to affect an individual’s mental health and leads him to some serious conditions like schizophrenia, and drug abuse. The effects of these factors can be eradicated by psychosocial nursing diagnosis, and this method is commonly practiced nowadays.
Types of psychosocial disorders:
Considering the types of psychological disorders, there are many.
• Eating disorders are getting common in western countries. These illnesses include serious diseases like bulimia nervosa and anorexia nervosa. Both these disorders are more common in females and particularly teenage girls. Girls suffering from Anorexia nervosa fear weight gain and restrict their diet. This causes excessive weight loss and weakness. This disease emerges in early adulthood and if untreated for a long time; it can cause many nutritional problems. The psychological factor involved in this disease is the course of physical changes through which a girl passes at the beginning of her puberty. Social factors include fear of being unfit for the society. Bulimia nervosa is also an eating illness and is characterized by self-induced vomiting after eating. Both these diseases can be treated by psychosocial nursing diagnosis.
• Some adjustment disorders are also faced by individuals. Fear of getting into new places can be treated by psychosocial therapy.
• Cognitive disorders include illnesses like Alzheimer’s disease, Parkinson’s disease and many others, which are related to solving sums and memory. Dementia is a common problem which occurs due to mental disorders. Social factors like less exposure to practice, play an important role in aggravating them. Amnesia is also a term used for memory loss. Short-term memory loss usually occurs due to anxiety and lack of coordination. When an individual keeps himself pre-occupied with the fear of imminent actions, the brain memory cells do not function properly, and memory is affected.
• Dissociative disorders are those in which memory loss leads to the complete unawareness of identity. It is probably the most crucial which can be solved only by psychosocial nursing diagnosis and other therapies.
• Some psychological diseases arise due to other medical reasons as well. For instance, psychosis due to AIDS, disorders emerging out due to epilepsy, and depression due to diabetes. To deal with such illnesses, common practice is to eradicate the root cause. If the depression is caused due to diabetes, firstly, treatment for diabetes is ensured. After that, the subject problem is dealt with psychosocial nursing diagnosis.
• Various mood disorders are also identified. These include bipolar illness and major depressive illness. These are actually types of depression. Depression is caused due to stress and anxiety. Anxiety disorders have become major problem in western countries. According to recent research, about 18% of adults and teenagers in United States have at least one anxiety disorder. Reasons of such issues are commonly rooted in the society due to the social lifestyle.
PSYCHOSOCIAL INTERVENTION TECHNIQUES
1.Nursing Care Evaluation
2.Psychological aspects Treatment
3.Managing Mental Health questionnaires
4.How to handle the emotional aspects in an interview.
5.Know therapies (individual, family …)
- It is a direct relationship between two people. Directly transmits feelings of both.
- It uses a symbolic communication channel, preferably but not exclusively oral oral. We must learn to manage the look.
- There is a role assignment, to do an interview you have to ask permission.
According to its purpose; types:
Depending on the degree of structure; types:
Questions and answers
Structuring conducting the interview
Structuring the recording and processing of information.
Structuring the interpretation of information.
Basic conditions for a successful interview:
The data that we ask must be accessible (nursed until age)
Knowledge and understanding by the interviewee of their role and how it has to pass the information we request.
There has to be motivation enough for the respondent to assume their role and meet the requirements.
Phases of an interview:
Clearly define what you want to evaluate.
Set selection criteria (whom I interviewed).
Guidelines for Conducting the interview (presentation, questions, if you want to help …)
That type of record we have and how I will develop the information.
Depth knowledge of the subject to be treated.
Before interviewing anyone, must know the details of the respondent on the issue.
Make a diagram of action.
Brief introduction: aspects of the interviewer, the interviewee, the situation, the process that will develop and achieve goals.
The information we have to give the patient does not have to go all at once but through dialogue.
The respondent must tell us why attends the center and waiting for the interview.
Once we know we both make a leveling expectations (reducing uncertainty interviewed through structured efforts of the interviewer).
Develop an agreement on how you will conduct the interview (have reserves in case one fails) with the contract increased the motivation (to ensure confidentiality), if named do sign a consent form.
Body of the interview:
Initial: open and facilitated
Media: specification and clarification.
Final: confrontation and synthesis.
Things to positive effect in the interview:
Demonstrate competence and experience.
Having an open spontaneous and expressive style.
Demonstrate warmth, empathy and conclusiveness.
Things with negative effect on the interview:
Attitudes distant, domineering, controlling and hostile.
Make a brief summary of the information obtained, this provides a basis for dialogue and discussion (we used this to lighten dark areas, incomplete or unconscious).
Guide the conversation toward the future, making at two levels:
Asking the patient how he sees his future
The interviewer has to give the respondent to perform tasks in the immediate future.
We must end the interview on a positive moment and rounded (not things we can be outstanding). Do not cut the patient when we are showing a negative mood either through expression or their utterances.
Self-reports / questionnaires:
They are a set of questions that the patient is responding, eg Lagner and Zung.
economic: in time and personnel.
We reported the subjective experience of the patient.
It allows us to explore motor behavior, physiological and cognitive.
It is not always objective, the patient can lie to us.
We used to detect problem behaviors
We used to evaluate the results of therapy.
We use it to investigate.
Types of self reports in Mental Health:
General: GHQ: Goldberg SM questionnaire (28 items)
Specific: measure about us:
Depression and Zung Lagner.
Self-observation and self-registration:
Is to pay attention to their own behavior and is linked to the car registration.
Targeting what we observed in our own behavior.
We can use it as:
Evaluation method: if we want this method to be successful we need to ensure that the patient identifies the behavior we want to observe, record comprises methods and recognizes the importance of obtaining reliable data.
When we make a car registration targeting evaluation methods need: the frequency of a behavior, the duration and intensity.
In the car registration records are collected, the behavior itself and the consequences.
Self observation is indicated to promote self.
It is important for people who have a personal history of dependence between. The characteristics of a dependent are: difficulty making decisions and passivity.
People with rigid behaviors and have feelings of helplessness.
People who feel that their actions are not just environmental effects.
In people with no real skills to change their behavior.
Self useful observation when we want to change behaviors almost automatic and we have to be especially careful and never indicate the observation car with suicidal people with recurrent obsessive thoughts.
1. Behavioral therapy:
Basic principles upon which rests the TC:
Both abnormal and normal behavior is learned and kept likewise.
The social environment is largely responsible for the maintenance of learning and behavior of both the normal and abnormal.
The primary goal of treatment is the problem behavior itself.
To address any behavior must crumble into very small components (such behavior). Based on a scientific approach and that as a result of them can replicate.
1. Systematic awareness: (It is the most common treatment for phobic disorders).
Is to develop a hierarchy of feared situation.
Training in muscle relaxation techniques.
Subjecting the patient to a treatment that consists in associating the link that produces less anxiety with muscle relaxation until it no longer produces anxiety.
2. Exposure therapy:
We subject the patient to the feared situation but anxiety-provoking.
Exposure instructions refer to the patient needs to know that anxiety is a curve, increases, reaches a maximum and then decreases. Over time curve becomes flatter.
Exposure therapy assisted by the therapist
Exposure therapy group.
Flood: submit the patient to the highest level of phobic anxiety.
Exposure therapy the patient himself being performed at the individual level.
It consists in associating an event to cause the execution of a behavior we want to change.
It’s called positive reinforcement: when the application of that event increases behavior. Positive reinforcement is usually considered pleasant but need not be.
They are used in all therapies.
The most widely used positive reinforcement is verbal attention. In the case of behavioral therapy used positive reinforcement but consciously. (Using a lot in schizophrenic prosocial behavior …)
It’s called negative reinforcement: refers to a process by which a behavior decreases. Overall negative reinforcement reinforcement associate unpleasant but is not necessarily so.
Example: patients with anorexia nervosa who do not want to eat them threatens to put them in a nasogastric tube if not gain weight.
A variety of reinforcements theory is called:
EXTINGUISHING: a procedure which involves the removal of positive reinforcement for behavior and thus decrease reaches disappear.
Example: in a patient admitted for control and positive reinforcement and avoid behavior appears. It’s theme of nurses teach the family this technique once the patient is discharged.
PUNISHMENT: aversive stimulus is applied to undesirable behavior.
Used very little and usually when life is at risk and failed patient management positive reinforcement.
A variety of punishment:
Aversion therapy: is to associate an unpleasant stimulus with undesirable behavior. (Alcohol + = nausea medication).
It is based mainly on classical conditioning and is most effective if involved in unwanted behavior. Typical example: alcoholism.
4. Modeling (or drama):
In this procedure, the therapist performs a desired behavior to the patient imitate him.
To make a modeling technique we have to analyze the behavior that we want to modify and break it down into simple elements to imitating the therapist and the patient will be able to copy the.
5. Social skills training:
It is used in people who have problems interacting with others.
Both individual and group level.
First analyzes of social skills deficits in behavioral terms concretos.Y then used positive reinforcement or modeling is performed.
- Alcoholism (addiction)
- Depressive disorders
- Somatic diseases:
- Risk factors for cardiovascular diseases (hypertension, hipercolerestomía, overweight).
- Prevent or improve headaches
- Sleep Disorders
- Gastrointestinal problems
- Bronchial asthma.
You can also use behavioral therapy for medication non-compliance.
2. Cognitive Therapy:
Any “event” we live is accompanied by a “cognitive appraisal” and based on that assessment we live a certain “emotional state”. This emotional state leads to a “conceptual bias”. This results in a “conduct” in relation to this event lived.
Event emotional state
If the cognitive assessment is erroneous, the emotional state is depressed or anxious what will lead to a disoriented behavior.
Cognitive appraisals incorrect.
The most common:
Selective Abstraction: reach a conclusion, just looking at some of the information.
Arbitrary Inference: a conclusion without sufficient evidence, or despite having evidence to the contrary.
Absolutist thinking: I qualify myself or my experiences as all or nothing.
Magnification or minimization: is to overestimate or underestimate the importance of a personal attribute, a life event, or a future possibility.
Personalization: is to relate external events to oneself and all this without any real basis for doing so.
It is important to differentiate it from paranoia and delusions (the difference is the degree of conviction).
Catastrophic thinking: always imagine the worst that can happen.
Adaptive and maladaptive schemas:
Thoughts that help or hinder us in our lives. (Photocopies)
3. GROUP THERAPY:
It is based on relationships that are crucial to the psychological development. Moreover, these are the foundations of personality and behavior patterns, would be about 5 years but is modified throughout life.
The number of people we serve is greater than we can meet the individual level. It is also more effective.
It is used for both psychiatric and non-psychiatric patients.
Instilling hope is to give people hope that being in the group will help to improve the situation we are living
Universality: think that only happens to you.
Disseminate information: it is an activity that can be used to group level in various ways, mainly two:
Groups of EPS
Activity of the therapist and the other members.
Altruism: experience of being useful to other group members.
Development of socializing techniques (eg, diabetes)
Catharsis: refers to the release of emotions that occur when you share my concerns in the group.
Corrective recapitulation of the primary family group: a change about how you see your family.
Existential factors: the group is a place to share feelings about the existential feelings of every human being (death, loneliness, freedom …)
Group Cohesion: refers to the attraction of the group members to the group. The members of a cohesive group are accepted, and are inclined to support you establish meaningful relationships.
Group cohesion is the precondition for any change in the group.
Interpersonal learning: refers to the activity that results when a person changes their behavior in the field observing the behavior of other members of the group.
Interpersonal learning steps:
When you get to a group are manifestations of interpersonal pathology.
Feedback is given and it can self-observation, and so begins to share reactions. I examine how I feel to share the reactions (catharsis). Following is an understanding of the opinion I have of myself. From this develops a sense of responsibility. Then, an awareness of my power to make the change, and finally made the change by a high affection.
Decision to establish a group:
determine the field (referred to in that context we will develop the TG refers to the physical space where they will take place meetings) and group size (6 to 8 people). It has to have certain characteristics: privacy, comfort, it is in a pleasant …
decide on the frequency and duration of group sessions (about 90 min. minimum or 120 min. maximum).
Open or closed group
Deciding whether or not to co-therapist.
Time of forming the group:
the therapist must decide objectives (better to have them written and measurable)
select patients who may meet the objectives sought by the group.
Prepare patients for TG must be given an explanation from a rational point of view the process of TG, also describing the type of queries that are expected to perform in the group of patients.
Establish a contract on the attendance at meetings.
Creating expectations about the effects of TG
Anticipating some of the problems that will appear on the group’s life, such as conflicts with other peers, discouragement, frustration …
construction and maintenance of the group:
create the culture of the group (which is going to be in the group?)
identify and resolve common problems are frequent subpools, conflicts are created.
Use appropriately aid.
Types of Groups:
Interaction oriented groups:
The duration of this group is indefinite (up to fix the problem)
Attendance is voluntary
They usually last between 1 and 2 years
change the character of the people
Main therapeutic factors:
corrective recapitulation of the primary family group.
patients with high-functioning.
They must want to change.
They must be able to tolerate an interpersonal approach.
Acute patient groups:
Group life is indefinite.
Attendance is generally mandatory.
Each patient is usually between 1 to 2 days, or weeks (depending on the length of your income)
Objective: To restore the functions are altered.
Main therapeutic factors:
Inclusion criteria: the patient must be able to tolerate the group.
Groups of post-hospitalization follow:
Group life is indefinite and is part of a comprehensive program regarding the monitoring of hospitalized patients.
The assistance often is mandatory.
There is usually a fixed number of sessions (5-6)
Main therapeutic factors:
irritating behavior (advice)
patients requiring follow-up or post-hospital care
able to tolerate the frame group and attend meetings required.
Clinical groups control medication:
Group life is indefinite.
Attendance is voluntary
The patient’s stay in the group is indefinite.
Objective: support, education and maintenance functions.
Main therapeutic factors:
Inclusion criteria: people who are able to tolerate the group setting.
Groups oriented behavior therapy:
The life of the group is limited. This is usually between 6 and 12 sessions.
Support group is voluntary
The average patient stay is what does the group
Objective: behavioral change
Main therapeutic factors: behavior modification techniques, universality and irritating behavior.
Inclusion criteria: patients with specific medical problems that are subsidiary Behavioral modification (eg eating disorders)
Groups specializing in medical conditions:
The life of the group is limited (6-12 sessions)
Attendance is voluntary
The average patient stay is the duration of the group
Objectives: education, support and expertise
Main therapeutic factors:
Inclusion criteria: patients with specific medical problems who want a higher education (eg diabetics)
Groups specializing in life events:
Life is limited (8-10 sessions)
Attendance is voluntary and often flexible.
The average length of stay of the patient is the same as does the group
Objective: To support, catharsis and socialization
Main therapeutic factors:
Inclusion criteria: patients who have had a life event in your life (eg Grief, rape, divorce …)
4. Family therapy:
Not only is a therapy also is a conceptual orientation of those problems.
As a consequence, evaluation and treatment of the individual problems must be performed in the context of the family unit. This approach, besides giving importance to the family, gives importance to cultural factors and socio-economic
The purpose of this therapy is to modify dysfunctional family patterns
The theories of this T. family, that family is considered an open system that works in relation to a socio-cultural context, and evolves over the life cycle.
Principles governing family functioning:
Context: the individual’s problems must be understood in a social context.
Interaction: the connections between biopsychosocial factors and transactional patterns are essential to understand mental health problems
Fit: dichotomies: function / dysfunction, normality / pathology should be considered in relation to the fit between the individual and his family and the context
Causality: Causality of problems, both physical and mental, should be understood as processes or recurring circular and mutually reinforcing.
No additionality: the family is more than the sum of its parts:
TF structural involves three distinct processes: meeting, approval and structuring.
This is done in 3 distinct phases:
In the 1st phase, the therapist aims to interact and harmonize with the family to get access to the system and thus get enough influence to create change.
In the 2nd phase, the therapist evaluates experimentally the family, making its members represent a current problem facing them and putting them under pressure to test their limits and emotional flexibilities. At this time, the therapist makes the diagnosis and structural map of the immediate family camp.
In Stage 3: the therapist guidelines and tasks designed to restructure the family. 1 What it does is block dysfunctional coalitions. And then finally t promotes functional partnerships are strengthened and reinforced parental subsystems generational boundaries.
Systemic strategic approach: families act in a certain way for two reasons:
They think it’s the best way to solve the problem.
They ignore other ways to solve it.
Therapist functions: stop approaches ineffective. Each family must define what is normal or healthy.
The therapist’s responsibility is limited to initiate change that will lift the family inefficient pattern you are using.
The goal: solving the problem that is queried
Relabeling and reframing: the redefinition of a problem or situation, so formal, visible from a new perspective. Useful for changing visions rigid, stereotyped responses and reproaches unproductive.
Give behavioral tasks.
Behavioral therapy approach: applying T.Conductual family level, the most important are family rules and communication processes.
The goal and treatment of problems are defined as specific observable behaviors.
What we have to do is guide the therapist family in learning more effective ways of relating. They work mainly communication issues and problem solving.
A lot of research is being done on causes, symptoms and treatments of all the psychosocial disorders, which emerge out frequently. So far, best treatment is psychosocial nursing diagnosis and therapy.