Health defined byWHO

The state of complete physical, mental,

and social wellness, not merely the
absence of disease.
Mental Health
Mental Health

The state of emotional, psychosocial, and

social wellness.

Evidenced by coping, positive self-

concept, and emotional stability.

Dynamic and ever changing state.

Influencing Factor
1. Individual factors

Biologic make-up, sense of harmony,

emotional resilience, vitality, ability to find
meaning in life, spirituality, positive identity.
1. Interpersonal factors

Effective communication, ability to help

others, intimacy, a balance of separateness and
connection.
1. Social/cultural factors

Sense of community, access to adequateness

resources, intolerance of violence
Mentally Healthy
1. Has realistic knowledge of oneself.
2. Accepts ones own weakness and strengths.
3. Has the ability to show genuine concerns
regarding others.
4. Is more directed by inner than outer value.
5. Can take care of ones self without hurting
others in the process.
6. Is able to tolerate stress and frustrations
with normal and effective coping
mechanism
Mental Disorder
by American Psychiatric Association
Clinically significant behavioral or
psychological syndrome or pattern that
occurs in an individual and that is
associated with present distress (painful
syndrome) or disability or with a
significantly increased risk of suffering
death, pain, disability or an important
lost of freedom
Mentally ill
1. Unsatisfied with ones characteristics,
abilities and accomplishments.
2. Creates ineffective or unsatisfying
interpersonal relationship.
3. Unsatisfied with ones place in the world.
4. Ineffective coping and adaptive mechanisms
in handling events in ones life.
5. Lack of personal growth
Influencing Factor
1. Individual factors

Biologic make-up, anxiety, worries and fears,

sense of disharmony in life and loss of
meaning in ones life.
1. Interpersonal factors

ineffective communication, excessive

dependency or withdrawal from relationship
and loss of emotional control.
1. Social/cultural factors

Violence, homelessness, poverty, and

discrimination.
Treatment of
Mental illness
Historical Perspective
Ancient
times

Displeasure of the gods

Punishment for sins and wrongdoing

Viewed as being divine or demonic

Divine: worshipped or adored

Demonic: Punished / burned

Aristotle (382-322 BC)

Relates mental disorder with physical

disorder.

The amount of blood, water, yellow and

black bile in the body controls emotion.

Relates to happiness, calmness, anger and

sadness.
Early Christian times
Early Christian times (1 1000 AD )

Primitive beliefs and superstitions was

strong

All diseases are blamed on demons

All mentally ill are possessed

Renaissance
Renaissance (1300 1600)

Harmless: allowed to wonder the country

sides

dangerous lunatics: prison, chained,

starved
Renaissance
Renaissance (1300 1600)

1547: Hospital of St. Mary of Bethlehem

Hospital for the insane

1775: visitors are charged with fee for

viewing

Same year:

Mentally ill possessed or evil

Witch hunts
Period of
Enlightenment
Creation of Mental
institutions

1790: concerns for mentally ill began

Asylum in England

1802-1887 (US)

Opening of 32 state hospitals that offer asylum

Asylum was short lived

Attendant were accused of abuse.

Rural loc. Of hospital are viewed as an

isolation

insane asylum
Sigmund Freud
Father of Psychoanalysis

All Human behavior is caused and can be

explained.
Sigmund Freud
Three components of
personality
Freud described the human personality as being:
1. Id
2. Ego
3. Super Ego
Id

contains our primitive drives and operates

largely according to the pleasure principle,
whereby its two main goals are the seeking of
pleasure and the avoidance of pain.

It has no real perception of reality and seeks to

satisfy its needs through what Freud called the
primary processes that dominate the existence
of infants, including hunger and self-protection.

The id has 2 major instincts:

1. Eros: the life instinct that motivates people to focus on
pleasure-seeking tendencies (e.g., sexual urges).
2. Thanatos: the death instinct that motivates people to use
aggressive urges to destroy.
Id
Id
Id
Super Ego

The Super ego contains our Values and social

morals, which often come from the rules of right
and wrong that we learned in childhood from
our parents.

the conscience.

The Super ego is a counterbalance to the

Id, and seeks to inhibit the Id's pleasure-
seeking demands, particularly those for sex
and aggression.
Ego

Unlike the Id, the Ego is aware of reality and hence

operates via the reality principle,

it recognizes what is real and understands that

behaviors have consequences. This includes the
effects of social rules that are necessary in order to
live and socialize with other people.

It uses secondary processes (perception,

recognition, judgment and memory) that are
developed during childhood.

The dilemma of the Ego is that it has to

somehow balance the demands of the Id and
Super ego with the constraints of reality.
Three levels of awareness
Freud identified three different parts of the mind, based on our level of
awareness.
1. Conscious mind
2. Preconscious mind
3. Unconscious mind
Conscious mind
State of awareness
The conscious mind is where we are paying
attention at the moment.
Perceptions, thoughts, and emotions that
exist in the persons awareness such as being
aware of happy feelings or thinking about
loved one
It includes only our current thinking
processes and objects of attention, and hence
constitutes a very large part of our current
awareness.
Preconscious mind
Not currently in persons awareness,
but can recall them
The preconscious includes those things
of which we are aware, but where we
are not paying attention. We can
choose to pay attention to these and
deliberately bring them into the
conscious mind.
Unconscious mind
Largest area
Memories, conflicts, experiences, and
material that have been repressed and
cannot be recalled at will.
Anxieties
Feeling of apprehension, worry,
uneasiness.
Normal reaction to tensions, conflicts or
stress.
Levels of Anxiety
1. Mild anxiety
2. Moderate anxiety
3. Severe anxiety
4. Panic
Mild Anxiety

A sensation that something is different and

warrants special attention.

Increased motivation

Alert

Enlarge perceptual field

Can solve problem

Learning is effective

Restless, GI Butterflies

Sleepless, Irritable

Hypersensitive to noise
Moderate Anxiety

Disturbing feeling that something is definitely

wrong.

Perceptual field is limited to the immediate task.

Can be redirected.

Cannot connect thought or events independently.

Muscle tension

Diaphoresis, pounding pulse

Headache, dry mouth

Increase rate of speed, GI upset

Frequent urination, nervous mannerism

Severe Anxiety

Involves feeling of dread or terror

Distorted perception, scattered details

Difficulty focusing even with assistance.

Cannot solve problem or learn effectively.

Doesnt respond to redirection.

Severe headache

Nausea, vomiting, diarrhea

Vertigo, tachycardia, chest pain, crying

Panic
Panic

Perceptual field reduced to focus on self

Cannot process environmental stimuli.

Distorted perception.

Loss of rational thought

Doesnt recognized danger.

Possibly suicidal.

Delusion or hallucination possible.

Cant communicate verbally

Either cannot sit or is totally mute &

immobile.
Anxiety can be communicated
1. Verbally
2. Non-verbally
Coping with Anxiety
1. Adaptive
2. Palliative
3. Maladaptive
4. Dysfunctional
Adaptive

Solves the problem that is causing

the anxiety, so the anxiety is
decreased

The patient is objective, rational,

and productive
Palliative

Temporarily decreases the anxiety but

does not solve the problem, the
anxiety eventually returns.

Temporary relief allows the patient to

return to problem solving.
Maladaptive

Unsuccessful attempts to decrease

the anxiety without attempting to
solve the problem.

The anxiety remains.

Dysfunctional

Is not successful in reducing

anxiety or solving the problem.

Even minimal functioning

becomes difficult, and new
problems begin to develop.
D
E
F
E
N
S
E
M
E
C
H
A
N
I
S
M
Defense Mechanism
Are cognitive distortions used by a person
to maintain the sense of being control of a
situation, to lessen discomfort, and to deal
with the stressful situation.
Involves self-deception, restricted
awareness of the situation, or less
emotional commitment.
Most arises from the unconscious.
Defense Mechanism

Compensation. Covering up a weakness by stressing

a desirable or strong trait (e.g. a child with a learning
disability becomes an outstanding athlete).

Denial. The refusal to recognize reality (e.g. refusal

to acknowledge a fatal disease).

Displacement. The transferring of an emotion to a

substitute (e.g. yelling at your child instead of your
boss).

Projection. The attributing of your own unwanted

trait onto another person (e.g. He made me do
it).
Defense Mechanism

Rationalization. The justification of behaviors using

reasons other than the real reason (e.g. presenting an
attitude of not caring).

Reaction Formation. Demonstrating a behavior that

is exactly the opposite of what is expected. (e.g. a
messy individual becomes neat).

Regression. Resorting to an earlier behavioral or

developmental level (e.g. In traumatic brain injury
common under high stress situations).

Repression. An inability or refusal to recall

undesirable past thoughts or events.
Therapeutic
Relationship
Components of a therapeutic
relationship
1. Trust
2. Genuine interest
3. Empathy
4. Acceptance
5. Positive regards
Trust
-
Builds when the client is confident
in the caregiver.
-
The caregiver conveys integrity and
reliability.
-
Includes being friendly, caring,
interested, understanding, and
consistent.
-
Conguence ;

occurs when words and action match.

Genuine interest
-
When the caregiver is comfortable with
himself or herself, aware of his or her
strengths & limitation, & clearly focused.
-
Dishonest: asking question& not Waiting for
an answer, talking over the client, or
assuming the client everything will be all
right.
-
Sometimes, truth & honesty alone does NOT
provide the best professional response.
-
Must NOT shift emphasis to caregivers
problem
Empathy
-
The ability of the caregiver to perceive the
meaning & feelings of the client & to
communicate that understanding.
-
Being able to put oneself to clients shoes.
-
Listening
-
Sympathy:

Feeling of concerns or compassion one shows for

another.

Caregiver may project personal concerns to the

client, can inhibit clients expressions of feeling
Acceptance
-
A caregiver who does not become upset
or respond negatively to a clients
outbursts, anger, or acting out conveys
acceptance to the client.
-
Avoiding judgments of the person, no
matter what the behavior.
-
Caregiver must set boundaries.
Positive regards
-
When the caregiver appreciates the
client as unique, worthwhile human
being, can respect the client regardless
of behavior, background, or lifestyle.
-
Calling by name, spending time,
listening & responding openly.
-
Considering the clients ideas &
preferences.
Communication

The process people use to exchange

information
Therapeutic
Communication

An interpersonal interaction between

the caregiver and the client during
which the caregiver focuses on the
clients specific needs to promote an
effective exchange of information.
Therapeutic Communication

Establish the caregiver-client relationship

Identify the most important client

concerns at that moment.

Assess the clients perception of the

problem as it unfolds.

Facilitate the clients expression of

emotion.
Therapeutic Communication

Teach the client and family the necessary

self care skill.

Recognizes the clients needs.

Guide the client towards identifying a plan

of action to a satisfying and socially
acceptable resolutions
Communication

Is the means by which a therapeutic

relationship is initiated, maintained
and terminated.
Therapeutic Use of Self

During therapeutic communication,

therapists use themselves as a therapeutic
tool to establish a therapeutic relationship
with a patient, to help the patient grow,
change and heal.

Using ones humanity---personality,

experiences, values, feelings, intelligence,
needs, coping skills, and perceptions --- to
help a patient grow and change is called the
therapeutic use of self.
Therapeutic Use of Self

Self-awareness means an understanding of

ones personality, emotions, sensitivity,
motivations, ethics, philosophy of life,
physical and social image, and capacities.
The greater the therapists understanding of
his or her own feelings and responses, the
better he or she can communicate with and
understand others.

The therapists personal actions rise out of

conscious and unconscious responses, which
are formed by ones life experiences and
educational, spiritual, and cultural values
Therapeutic Relationship
Therapeutic Communication

Components:
1. Confidentiality
2. Self-Disclosure
3. Privacy & Respect of boundaries
4. Use of touch
5. Active listening and observation
Confidentiality
Confidentiality

Respecting the patients right to keep

private any information about his or
her mental and physical health and
related care.

Allowing only those dealing with the

patients care to have access to the
information divulged by the patient.

The therapist must be alert if a patient

asks him or her to keep a secret,
because this information may relate to
the patients harming himself or
herself or others. Avoid any promises
to keep secrets.
Confidentiality

I am going to jump off the 14

th
floor of
my apartment building tonight, but
please dont tell anyone

I cannot keep such a promise,

especially if it has to do with with your
safety. I sense you are feeling
frightened. The staff and I will help you
to stay safe.
Self-Disclosure
Self-Disclosure

Revealing personal information about

oneself to patients, such as biographical
information and personal ideas, thoughts,
and feelings.

Conventional wisdom held that therapists

should share only their name, marital
status, and number of children, and
perhaps should give a general idea about
their residence. It is now believed that
more self-disclosure can create greater
rapport between the therapist and the
patient.

Self-disclosure can be used to convey

support, educate patients, demonstrate
that a patients anxiety is normal, and
even facilitate emotional healing.
Self-Disclosure

When using self-disclosure, consider

cultural factors. For example, if the
patient is from a culture that is stoic and
non-communicative, self-disclosure may be
deemed inappropriate.

Keep self-disclosure brief and comfortable,

respect the patients privacy by making
sure the discussion takes place out of the
earshot of others, and understand that
each experience is different. The therapist
must monitor his or her own comfort level.
If the therapist has unresolved feelings
about the issue, he or she should not share
personal experiences.
Self-Disclosure

Disclosing personal information can be

harmful and inappropriate for a patient. If
the patient does not seem ready to deal
with the issue, or if the conversation is
purely social, it is not a good time to
disclose information about oneself..
Privacy &
Respecting Boundaries
Proxemics

The study of distance zones between people

during communication.

US, Canada and many Easter European

nations observe four distance zone
Distance Zone

Intimate zone (0 18 inches between people)

Comfortable for parents w/ young children, people who

mutually desire personal contact.

Personal zone (18 36 inches between people)

Between family and friends who are talking.

Social zone (4 12 feet between people)

Acceptable for social, work and business setting.

Public zone (12 25 feet between people)

Between a speaker & audience, small groups & other

informal function.
Distance Zone

When a caregiver must invade the

intimate or personal zone, he or she
should always ask for the clients
permission.

Therapeutic communication is most

comfortable when the caregiver and the
client are 3 to 6 feet apart.
Touch
Touch types of

Functional-Professional

Used in examination or procedures.

Social-polite

Used in greeting, handshakes or air kisses

Guide someone to a correct direction

Friendship-warmth

Involves hug in greeting

Love-intimacy

Involves tight hugs and kisses between lovers or close

relatives

Sexual-arousal

Used by lovers
Active Listening
&
Observation
Active Listening
-
means refraining from other
internal mental activities and
concentrating exclusively on what the
client says.
Active Observation
-
Means watching the speakers non
verbal actions as he or she
communicates.
1. Verbal communication

Consists of words a person uses to

speak to one or more listener.
1. Nonverbal communication

The behavior that accompanies

verbal content.
Verbal Communication
Concrete Messages

The words are explicit and needs no

interpretation.

Uses nouns instead of pronouns

E.x. What health symptoms caused

you to come here today?
Verbal Communication
Abstract Messages

Are unclear patterns of words that

often contains figure of speech that
are difficult to interpret.

E.x. How did you get here?

Nonverbal communication skills
1. Facial expression
2. Body language
3. Vocal cues
4. Eye contact
5. Silence
Facial Expression
1. Expressive face

Portrays the persons moment-by-moment

thoughts, feelings, and needs

When the person does not want to reveal his or

her emotion.
1. Impassive face

Frozen into an emotionless, deadpan

expression similar to a mask.
Facial Expression
3. Confusing facial expression

One that is opposite of what the person wants

to convey.
3. Looking away & yawning

Indicates listener is disinterested

Body Language

Gesture, postures, movements,

and body position.
Body Language

Closed Body position

Crossed legs or arms folded across the chest.

Indicates that the interaction might threaten the

listener who is defensive or not accepting.

Open posture

Sit facing the client with both feet on the floor,

knees parallel, hands at he sides of the body.

Demonstrates positive regards, trusting, caring,

and acceptance.
Body Language

Hand gesture:

A slight lift of the arm from the arm of the chair

strengthens the meaning of the word.

Holding both hands with palms up while

shrugging the shoulder means I dont know.
Body Language

Positioning:

Sitting beside or across the client can put the

client at ease.

Sitting behind a desk increases the formality of

the setting, may decrease the clients willingness
to open up and communicate freely.
Vocal Cues

The voice volume, tone, pitch, intensity,

emphasis, speed, and pauses.

Volume: the loudness of the voice indicates

fear, anger, happiness, or deafness.

Tone: indicates if client is relaxed, agitated,

or bored.

Intensity: the power, severity, and strength

behind the the words.
Vocal Cues

Emphasis: to accent on words or phrases

that highlight the subject or give insight on
the topic.

Pauses: also adds emphasis or feeling.

Vocal Cues

Anxiety:

High-pitched, rapid delivery of a message.

Depression:

Slow, hesitant response, confused and searching

for a correct words.
Eye Contact

Eyes: the mirror of souls

Eye contact: assess the other person & the

environment. Increases during listening nad
decreases during speaking.
Understanding Context
I am Going to kill you!

Gives more information & reduces

the risk of assumptions

gather info. From verbal & non

verbal sources & validates the
findings.
Understanding Context

Assessment focused on:

who was there

What happened

When it occurred

How the event progressed

Why the client believed it happened as it did

Anxiety
Fear
Anxiety Disorder (Anxiety Neurosis)
Anxiety Disorder (Anxiety Neurosis)

Excessive anxiety not associated with

realistic threatening situations.

Fear of going crazy

They are NOT psychotic

Anxiety Disorder (Anxiety Neurosis)
Neurosis

also known as psychoneurosis or

neurotic disorder, is a "catch all" term
that refers to any mental imbalance that
causes distress
Anxiety Disorder (Anxiety Neurosis)
Psychosis

is a generic psychiatric term for a

mental state often described as involving a
"loss of contact with reality".

"a severe mental disorder, with or without

organic damage, characterized by
derangement of personality and loss of
contact with reality and causing
deterioration of normal social functioning."
Anxiety Disorder (Anxiety Neurosis)
A.Panic attacks
+
Acute, intense anxiety or terror
+
May be uncontrollable, accompanied
by sympathetic signs, loss of mental
control, sense of impending death.
Anxiety Disorder (Anxiety Neurosis)
B. Phobias
+
Excessive and unreasonable fear
leads to avoidance behaviors.
Anxiety Disorder (Anxiety Neurosis)
C. Obsessive-compulsive behavior
+
Persistent anxiety is manifested by
repetitive, stereotypic acts
+
Behavior interfere with social
functioning
+
E.g. hand washing, counting,
touching.
Anxiety Disorder (Anxiety Neurosis)
A. Panic attacks
B. Phobias
C. Obsessive-compulsive behavior
Posttraumatic Stress Disorder

Demonstrated by someone who has

experienced a traumatic event.

Was exposed to an event that poses a threat

of death or serious injury and responded
with intense fear, helplessness, or terror.
Posttraumatic Stress Disorder
Symptoms

Re-experiencing the traumatic

event

Psychic numbness with reduce

responsiveness

Detachment from the external

world, and survival guilt.

Exaggerated autonomic arousal,

hyperalertness
Posttraumatic Stress Disorder
Symptoms

Disturbed sleeping

Ongoing irritability

Impaired memory and

concentration
Posttraumatic Stress Disorder

Can be acute (last < 3 months) or chronic (3

months or longer).

Onset can also be delayed

Symptoms should not be ignored

Mental health consultation is indicated

Psychosomatic DO (somatoform DO)
+
Physical sign or disease that are related to
emotional causes
+
Cannot be explained by identifiable disease
process or underlying pathology.
+
Not under voluntary control; provides a
means of coping with anxiety & stress.
+
Frequently indifferent to symptoms.
Psychosomatic DO (somatoform DO)
+
Patient are convinced that they harbor
serious physical problems despite a negative
diagnostic tests.
+
NOTE: the patient really do experience the
symptoms they describe and cannot control
them.
Psychosomatic DO (somatoform DO)
Types
+
Conversion Do (hysterical paralysis)

Loss or altered physical functioning

representing psychosocial conflict or need.

Hemiplegia, paralysis, blindness

+
Hypochondria

Abnormal or heightened concerns about health

or body functions

False beliefs about suffering from some disease

or conditions
Psychosomatic DO (somatoform DO)
MANAGEMENT
+
Physical symptoms are real: treat the patient as you
would any other patient with similar symptoms.
+
Provide supportive environment
+
Identify primary gain (internal conflicts); assist px in
learning new, alternate methods of stress
management
+
Identify secondary gain (additional advantage,
attention, sympathy) do NOT reinforce
+
Provide encouragement & support for the total
person.
Schizophrenia
O
A disease affecting the brain that causes distortion
and bizarre thoughts, perceptions, emotions,
movements, and behavior.
O
Unknown etiology
O
Usually diagnosed in late adolescence and early
adulthood
O
Onset may be abrupt or insidious
Schizophrenia
Schizophrenia
Positive or hard symptoms
O
Delusions, hallucinations, and grossly disorganized
thinking, speech, and behavior
O
Can be controlled by medication
Negative or soft symptoms
O
Flat affect, lack of volitions, social withdrawal or
discomfort
O
Often persist over time
Schizophrenia
Paranoia
O
Characterized by feeling of extreme suspiciousness,
persecution, grandiosity (feeling of power or great
wealth), or jealousy
O
Withdrawal of all emotional contact with others.
Catatonia
O
Characterized by mutism or stupor, unresponsiveness
O
Catatonic posturing (remain fixed, unabl to move,
talk for extended period)
Bipolar DO (manic-depressive illness)

Applied to a cyclic mood changes

demonstrated by a person who has manic
episodes (one pole), period of profound
depression (second pole), and period of
normal behavior in between.
Depression
C
Altered mood characterized by morbid sadness,
dejection, sense of melancholy.
C
Manifestation:
C
Loss of interest in all usually pleasurable outlet
C
Poor appetite, weight loss, or weight gain
C
Insomia or hypersomia; decrease energy
C
Psychomotor imbalance: agitation or excessive
fatigue; irritability
Depression
C
Manifestation:
C
Feeling of worthlessness; self-reproach, guilt,
hopelessness
C
Impaired concentration, ability to think
C
Recurrent thoughts of suicide or death
Depression
MANAGEMENT
C
Pharmacologic: tricyclic antidepressant.
(disturbed balance, postural hypotension, falls
& Fx, increased HR, dysrhythmias, ataxia,
seizure.
C
Cognitive therapy
Depression
P.T. Intervention

Maintain positive attitude, consistently

demonstrate warmth & interest

Acknowledge depression, provide hope

Use positive reinforcement, build in successful

treatment experiences

Involve the px in the treatment decisions

Avoid excessive cheerfulness

Take all suicide thoughts and acts seriously

Perseveration

The continued repetition of a movement,

word, or expression

Often accompanied TBI or stroke

Lesion in premotor or prefrontal cortex

Perseveration
P.T. Interventions

Use of interesting activities to:

help refocus attention.

well-defined sequences of activities to limit

preservation episodes.

Successful completion of a task or sequence of

movements should be positively rewarded.
Grief Process
+
Emotional process by which an individual
deals with loss.
Grieving
The process by which the grief is experience
Mourning
The outward sign of grief, is a way of
integrating loss and grief into the life of the
bereaved
Grief Process
+
Somatic symptoms:

Fatigue, sighing, hyperventilation, anorexia,

insomia
+
Psychological symptoms:

Sorrow, discomfort, regret, guilt, anger,

irritability, depression
+
Resolution may take months or years
Grief Process
Stages
+
Shock and disbelief, inability to comprehend
loss
+
Increased awareness & anguish; crying,
anger are common
+
Mourning
+
Resolution of loss
+
Idealization of lost person or function
Grief Process
MANAGEMENT
+
Provide support and understanding of the
grief process.
+
Encourage expression of feeling, memories
+
Respect privacy, cultural or religious customs
Death and Dying

Physical symptoms: decreasing physical and

mental functioning; gradual loss

Stages (Kubler-Ross)
1. Denial
2. Anger, resentment
3. Bargaining
4. Depression
5. Acceptance
Death and Dying
Denial

Patient insist that they are fine, joke about

themselves, are not motivated to participate
in treatment.
O
Allow denial: its a protective compensatory
mechanism necessary until such time as the
patient is ready to face his illness.
O
Provide opportunities for px to question,
confront illness and impending death.
Death and Dying
Anger, resentment

Patient may become disruptive, blame

others.
O
Be supportive, allow patient to express
anger, frustration, resentment.
O
Encourage focus on coping strategies.
Death and Dying
Bargaining

Patient bargain for time to complete life

task; turn to religion or other individuals,
make promises in return for function.
O
Provide accurate information, honest,
truthful answer.
Death and Dying
Depression

Patient acknowledge impending death,

withdraw from life,

Demonstrate an overwhelming sense of loss,

low motivation.
O
Observe closely for suicide ideation
O
Allay fears & anxieties, especially loneliness
& isolation.
O
Assist in providing for comfort of the patient.
Death and Dying
Acceptance and
Preparation for death

Acceptance of their conditions,

Relate more to their family, makes plans for

the future.
Death and Dying
MANAGEMENT
1. Support patient and family during each
stage.
2. Maintain hope without supporting
unrealistic expectations.
P.T. Goals, Outcomes, &
Interventions

Establish boundaries of the professional

relationship: identify problems, expectations,
purpose, roles & responsibilities.

Provide empathic understanding: the

capacity to understand what your px is
experiencing from that pxs perspective.

Recognize loses, allow oppurtunity to mourn old

self.
P.T. Goals, Outcomes, &
Interventions

Ask open ended questions that reflect what

the px is feeling.
it sounds like you are worried & anxious about your
pain & are trying your best.
dont worry about your pain. youre over-reacting

Sympathy is NOT helpful or therapeutic:

care giver is closely affected by the pxs
behavior.
P.T. Goals, Outcomes, &
Interventions

Set realistic, meaningful goals: involve tha px

& family in the gol setting process, self-
determination is important.

Set realistic timeframes for the rehabilitation

program: recognize symptoms, stages of grief
process or death & dying & adjust accordingly.

Recognize & reinforce healthy, positive,

socially appropriate behaviors; allow px to
experience success.
P.T. Goals, Outcomes, &
Interventions

Provide the environment conducive to the

pxs emotional state, learning & optimal
function.
1. Provide a message of hope tempered with realism
2. Keep px informed
3. Lay adequate groundwork or preparation for
expected changes or discharge
4. Help to re-establish personal dignity & self worth;
acknowledge whole person.
P.T. Goals, Outcomes, &
Interventions

Help px identify feelings, successful coping

strategies, recognize successful conflict
resolution. & rehabilitation gains.
1. Stress ability to overcome major obstacles.
2. Stress that recovery is unoque & highly
individual.