Flashcards
module 1 Introduction to developing a therapeutic relationship
Cards in this deck (33)
- 1stigmaStigma is a well-documented global barrier to health-seeking behavior [1], engagement in care [2], and adherence to treatment [3] across a range of health conditions [4, 5]. As a distinguished and labelled difference [6], stigma, Goffman notes, enables varieties of discrimination that ultimately deny the individual/group full social acceptance, reduce the individuals’ opportunities [7], and fuel social inequalities [8]. Stigma influences population health outcomes by worsening, undermining, or impeding a number of processes, including social relationships, resource availability, stress, and psychological and behavioral responses, exacerbating poor health [9].
- 2Health Stigma and Discrimination FrameworkIn order to intervene to halt the stigmatization process or mitigate the harmful consequences of health-related stigma, or stigma associated with health conditions, the existence of a clear, multi-level theoretical framework to guide intervention development, measurement, research, and policy is critical.
In the context of health-related stigma reduction, socio-ecological levels have been defined as public policy (national and local laws and policies), organizational (organizations, social institutions, workplaces), community (cultural values, norms, attitudes), interpersonal (family, friends, social networks), and individual (knowledge, attitudes, skills) [37]. - 3Health Stigma and Discrimination Framework
- 4Health Stigma and Discrimination Framework: drivers and facilitatorsThe first domain refers to factors that drive or facilitate health-related stigma. Drivers vary by health condition, but are conceptualized as inherently negative [18]. They may range from fear of infection through casual contact for communicable diseases and concerns about productivity due to poor health for chronic conditions, to authoritarianism and social judgment and blame. Conversely, facilitators may be positive or negative influences [33], for example, the presence or absence of occupational safety standards and protective supplies in health facilities can minimize or exacerbate stigmatizing avoidance behaviors towards populations with infectious diseases by healthcare workers [38]. Drivers and facilitators determine whether stigma ‘marking’ occurs, through which a stigma is applied to people or groups according to a specific health condition or other perceived difference such as race, class, gender, sexual orientation, or occupation. Intersecting stigma occurs when people are ‘marked’ with multiple stigmas [39].
- 5Health and discrimination framework: ManifestationsOnce a stigma is applied, it manifests in a range of stigma experiences (i.e. lived realities) and practices (i.e. beliefs, attitudes, and actions). Stigma experiences can include experienced discrimination, which refers to stigmatizing behaviors that fall within the purview of the law in some places, such as refusal of housing [33], and experienced stigma, or stigmatizing behaviors that fall outside the purview of the law such as verbal abuse or gossip [33]. The legal distinction is included as responding to a stigma manifestation that is illegal may require a different response (e.g. litigation) compared with a manifestation that is not illegal.
- 6health and discrimination framework: ManifestationsAnother stigma experience is internalized or ‘self-stigma’, which is defined as a stigmatized group member’s own adoption of negative societal beliefs and feelings, as well as the social devaluation, associated with their stigmatized status [40]. Perceived stigma (i.e. perceptions about how stigmatized groups are treated in a given context) [41] and anticipated stigma (i.e. expectations of bias being perpetrated by others if their health condition becomes known) are also classified as stigma experiences [42].
- 7health and discrimination framework: ManifestationsFinally, secondary or ‘associative’ stigma, which refers to the experience of stigma by family or friends of members of stigmatized groups or among healthcare providers who provide care to members of stigmatized groups [43], is included under stigma experiences. Stigma practices can include stereotypes (i.e. beliefs about characteristics associated with the group and its members), prejudice (i.e. negative evaluation of the group and its members), stigmatizing behavior (i.e. exclusion from social events, avoidance behaviors, gossip), and discriminatory attitudes (i.e. belief that people with a specific health condition should not be allowed to participate fully in society). We included stereotypes and prejudice under ‘drivers’ and ‘manifestations’, as they both fuel and are reinforced by the stigmatization process.
- 8health and discrimination framework: outcomesWe postulate that stigma manifestations subsequently influence a number of outcomes for affected populations, including access to justice, access to and acceptability of healthcare services, uptake of testing, adherence to treatment, resilience (i.e. the power to challenge stigma) [34, 44], and advocacy. They also influence outcomes for organizations and institutions, including laws and policies, the availability and quality of health services, law enforcement practices, and social protections.
- 9stigma interventionIdeally, we want to interrupt the process prior to the application of stigma. Thus, interventions often target the removal of the drivers of stigma or the shifting of norms and policies that facilitate the stigmatization process. However, once a stigma is applied to people with a specific disease or health condition and once it manifests in experiences or practices, interventions are needed to mitigate harm and shift harmful attitudes and behaviors that compromise the general health and wellbeing of affected communities. Stigma-reduction interventions are most effective when they include components directed at a range of actors and socio-ecological levels. A multi-component intervention, for example, may seek to support individuals with leprosy to cope with experienced stigma and overcome internalized stigma, as well as reaching out to community members to shift harmful norms about leprosy.
- 10practical applicationFirstly, social exclusion rooted in stigma appears to be a response to threat, varying across health-related stigma to the degree to which the source of threat is physical (such as fear of biological contagion, fear of violence and harm) or symbolic (such as aversion based on perceptions that the person does not adhere to central cultural values). Across the various health-related stigmas, people negatively stereotype, display prejudice toward, and discriminate the group and its members, although the content of the stereotype (e.g. being promiscuous, unclean) and the rationalization for the bias differ across the groups. In addition, these conditions differ in the extent to which they are concealable and thus in the way people cope with and manage their stigmatized identity, but all involve anticipated, experienced, and internalized stigma.
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- 14self-awarenessKnowing about oneself is not an easy task; it is a painful and time-consuming process. This process starts with conscious awareness and struggling for change through continuous efforts.
"The central task of the basic professional school of nursing is viewed as the fullest development of the nurse as a person who is aware of how she functions in a situation". So this very well emphasizes the importance of self-awareness in nursing education as well as in nursing care. this will lead to competency in provision of high quality nursing care and finally greater satisfaction in client care. Further analysis of different literature shows that self-awareness is a dynamic and transformative process of self-reflection and change. Eventually, self-awareness is the use of self-assessment to analyze and guide behavior in a genuine way; which enables nurses to create an environment which helps in promoting interpersonal relationship with the patients. - 15self awarenessEckroth-Bucher (2010), defines the concept as "Self-awareness involves the cerebral exercise of introspection. This attribute reflects the cognitive exploration of own thoughts, feelings, beliefs, values, behaviors, and the feedback from others." (p. 297). Self-awareness is getting to know about one self as a person and the important things in life which influences us in different ways. It also includes the reflection on how our attitude and belief can influence others. If we get the awareness of our own life then we can understand another person better. The concept is further elaborated by the authors; self-awareness is the continuous process of understanding and knowing of one's own identity, beliefs, thoughts, traits, motivations, feeling and behavior and to recognize how they affect others in different ways. In addition, it involves objectively examining one's personal beliefs, attitudes, strengths and limitations. (Boyd, 2005; Stuart and Laaia, 2005). why do people react towards you the way they do.
- 16self awarenessIn general, self-awareness is important for personal growth; it helps an individual to manage self and to improve performance. It further helps in setting appropriate and realistic goals, and career and manage personal life stressors.
Self-awareness is a core personality strength that can help us manage our businesses, our careers and our lives. When we lack self-awareness skills, we tend to make the same mistakes and encounter the same obstacles over and over again. But when we know where our unique strengths and limitation lie, we're better equipped to face challenges, solve problems, choose our battles, make decisions, and predict the outcomes of those decisions. (Para 1). - 17self awarenessMoreover, going through the process of self-awareness and then using it in a healthy way is important. Infact it is a first step towards taking better care of yourself and it also helps in becoming resilient. Furthermore, it helps in engaging in healthy behaviors and ultimately helps in becoming better nurses and leads to better client care. Some people have very good understanding and evaluation of their feelings and emotions but for some it needs time and conscious effort to develop selfawareness. It is really crucial that one should listen to the inner dialogue to have more self-awareness of the needs and behaviors. Then finally recognizing the unhealthy behavior and justifying them and changing them into healthier ones.
- 18self awarenessTo support the significance of self-awareness in nursing profession, Scheick (2011) further claims that "Nursing students and nurses bring not only caring to their wounded clients but also at times their own unresolved personal stress. Especially without mindful awareness, projection of the nurse's unacknowledged emotional encumbrances (counter transference) threatens the effectiveness of nurse-client relationship" (p.114). Looking at the literature evidences, it is really important that as nurses we should have the understanding of our verbal and non-verbal gestures. We should learn how to react and manage different situations rather than avoiding them. Being a nurse we care for our patients from different sociocultural background and different value systems.
- 19self awarenessSelf-awareness is considered as the key aspect for therapeutic communication skills. Nurses self-awareness can help direct the communication towards the needs of the patient thus creating a therapeutic environment for care.
It is important for nurses to understand their own attitude, behavior and values because they are always in interaction with people who are unique and not necessarily have same characteristics.
e are dealing with people so we should know what our motives are and how our emotions and reaction can affect others.
The process of self-awareness compels nurses to examine their own value positions so these biases and prejudices are not projected on to others and so nurses do not reject others who do not share similar values. (Eckroth-Bucher, 2001). Thus by effective use the self as a tool 'nurses must possess knowledge of their personal response pattern s, strengths and limitations (Eckroth- Bucher,2001; Stuart and Laaia, 2005). - 20how to become self-awareThe literature identifies some practical ways which can be utilized to become self-aware are asking for feedback from genuine person, reflection on one's own actions, journal writing, talking to a mentor or friend, practicing mindfulness and meditation.
- 21reflectionFurther review of literature gives certain strategies which can be easily adopted to better understanding of self includes "Keeping a reflective diary, learning about body language and using models of reflection" (Winson, 2007, p.59).
- 22Johari Window model and Self-AwarenessThis model has total four quadrants (Open, blind, hidden and unknown) and each quadrant gives different information about self. The open area means that we know and others also know about us, whereas the blind mean that people know about us but we do not have the awareness of that particular characteristic. Hidden means we know but others do not know about us and finally the unknown is something which no one knows including us. The more wide the open quadrant, the more self-aware the person will be. So it's better that to talk to people about self and get feedback from colleagues and friends to decrease the hidden, blind and unknown quadrants. This is also at times a painful process, as one has to do self-disclosure/ exposure and listen to people feedback which is not always easy to accept specially the areas for improvement.
In this frame work they have given three practical stages for change and those are Now, Transition and Regroup stage. - 23Johari Window model and Self-AwarenessBy identifying those gaps, in Now stage, it gives the insight and it may need help from colleagues. After knowing the aspect to have more developmental need then the individual can find resources or ways to work on that limitation or need in the Transition phase. Finally, in the last stage it is Regroup phase where the change has already occurred and in this phase it may have helped the individual in reducing the hidden or unknown areas and we can find interesting things about self. It may also be a painful process as it is not easy to let go of individual weaknesses but one needs to be more receptive to change and to be a better person and a better professional nurse to understand self and others.
- 24David, a 32 year old man presents to the local emergency department. He has presented with a leg injury and has been waiting for 4 hours to see a doctor. He is currently in the waiting room and has approached the triage nurse for the third time asking when he will be seen. He appears to be getting agitated and has started to walk around the waiting room and has clenched fists. Please write down some ways that you might provide validationI
- 25Lisa, a 64 year old female has arrived to the intensive care unit to speak with the nurse looking after her 32 year old daughter Sally. Her daughter has been put on life support after being involved in a major car accident. The treating team have just told her that it is unlikely that she will regain consciousness and have advised that they should turn life support off. The treating team have left and Lisa begins to sob. Please write down some ways that you might provide validationi
- 26Sarah is a 21 year old pharmacy student who has developed panic attacks three weeks ago. Sarah worries about leaving her unit as she has experienced panic attacks at random times. She is worried about leaving her unit to attend her classes and is worried that she will fail her studies. Sarah told her mother about her panic symptoms and her mother told her she has nothing to worry about, everything in her life is good. Please write down some ways that you might provide validationi
- 27Lucy is a 5 year old girl on the paediatric ward who tells you that she is having nightmares and tells you there is a monster in the corner of the room. She has called out for the fourth time tonight. When you come to her, she is sweating and highly distressed. She now says the monster wants to lock her in the closet and that the tall lady with the grey dress and cap is scaring her and won’t stop looking at her (Normally a parent would be present for children, but for this scenario, there is no care giver present). Please write down some ways that you might provide validationi
- 28Barry and Marjorie are an elderly couple who have been admitted to a nursing home. They have lived together for 60 years and Marjorie needs to move to the higher care section of the nursing home due to her advancing dementia. Barry is struggling to cope with their separation. Barry sits on the edge of his bed sobbing and Marjorie continues to call out Barry’s name from the other end of the corridor, this upsets Barry even more. Please write down some ways that you might provide validationi
- 29Hazel is a 84 year old lady with dementia who tells you that it is 1974. Hazel does not realise that is it 2020 and that her husband Bill has passed away. Hazel keeps approaching the nurse on duty to ask when her husband Bill is coming home. When the nurse explains that Bill has passed away, Hazel becomes irate and calls the nurse a witch and a liar. Please write down some ways that you might provide validationi
- 30Holly is a 17 year old female who presents to her local emergency department as she is not sure where to go. She thinks that she might be pregnant and doesn’t want to tell her parents. She is highly distressed about this. She tells you she is in year 12 at Mercy college and isn’t sure what to do. She tells you that her parents are really strict and would be very angry if they discovered she was pregnant as they have forbidden her from having a boyfriend. Please write down some ways that you might provide validationi
- 31Sharon is a 38 year old woman, who is single with two young children. She has recently discovered she has breast cancer. She tells you that she has no family to support her and she is worried about how her illness will impact on her children. She tells you that she is worried that she will die and that her children will be left without a family. Please write down some ways that you might provide validationi
- 32Sarah is a 30 year old female who has been admitted to the maternity unit for observation as she is 36 weeks pregnant with a placenta previa. She has a history of schizophrenia and overheard a midwife saying that she didn’t think Sarah would be capable of caring for her child as she has schizophrenia. Sarah becomes distressed about this and tells you that she is trying really hard and has taken her medications and wants to do everything to ensure that her baby is well cared for. She thinks that maybe she isn’t good enough to be a mother. Please write down some ways that you might provide validationi
- 33torch in the darkthe torch in a dark room illuminates objects which represent thoughts feeling or exterior stimuli such as things you see or hear. while the torch represents your conciousness
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- university Therapeutic Use of Self 2 Flashcards on module 1 Introduction to developing a therapeutic relationship, created by Avalon Frost on 04/02/2022.
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