Nursing 212

Health Differences Across the Lifespan 2 Study Guide

Communication Blocks to verbal communication: giving advice, preaching, admonishing, patronizing, giving false reassurance, changing the subject, overanalyzing, over-interpretation, demanding, asking probing or “why” type questions, using unfamiliar language, stereotyped responses, inappropriate use of humor, or making statements that focus on oneself Blocks to nonverbal communication: lack of eye contact, distancing from the patient, facial expressions (sneer, frown, disapproval), signs of boredom, irritation, or distracting habits During communication, the patient may display the following: • Defense mechanisms: automatic, psychological processes, caused by internal or external perceived dangers or stressors, which threaten self-esteem and disrupt ego function; may be conscious, but usually takes place at the unconscious level • Projection: placing blame for difficulties on others; predominant in paranoia; paranoid patients project hate for others by saying that others are out to get the them • Displacement: discharging pent-up feelings from one object to a less dangerous object; fairly common; for example, your supervisor yells at you, so you yell at your husband, transferring your anger to a less threatening substitute • Reaction formation: prevention of dangerous feelings and desires from being expressed by exaggerating the opposite attitude (a kind of denial); an overly neat, polite individual may unconsciously desire to be untidy and carefree; behavior is pathological when it interferes with tasks or produces anxiety or frustration • Denial: refusal to face reality; the ego protects itself from unpleasant pain or conflict by rejecting reality; denial of illness is common • Sublimation: mechanism by which primitive or unacceptable tendencies are redirected into socially constructive channels; usually artistic and cultural achievements, such as painting and poetry 1.4 Personality Disorders Personality disorders are diagnosed when personality patterns or traits are inflexible, enduring, pervasive, maladaptive, and cause significant functional impairment or subjective distress. Patients frequently experience their personality patterns as natural or comfortable (ego syntonic), rather than painful or uncomfortable (ego dystonic). Personality disorders are classified in three diagnostic clusters: • Cluster A disorders: characterized by off or eccentric behavior (paranoid, schizoid, and schizotypal); approach the patient in a gentle, interested, but nonintrusive manner; respect patient’s needs for distance and privacy; be mindful of own nonverbal communication because a patient may perceive others as threatening; gradually encourage interaction with others, if appropriate

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