MENTAL DEFENSE MECHANISMS

MENTAL DEFENSE MECHANISMS (ADAPTIVE COPING PROCESSES)

Defense Mechanisms or Coping Mechanism
-are unconscious, intrapsychic adaptive processes to cope with anxiety and resolve emotional confict
-are acquired during the development of the personality as an attempt to defend itself, establish compromises between conflicting impulses and allay inner tensions.

Characteristics of Defense Mechanism
(1) it is automatic
(2) it is not defense mechanism that is pathological but it is the frequency of its use
(3) used by both mentally healthy and mentally ill individuals

Types of Defense Mechanisms
• Compensation- overachievement in one area to offset real or perceived deficiencies in another area
-covering up for a weakness by overemphasizing
-“making-up”
Example: a homely school girl attempts to impress her peers by making straight A’s

• Conversion- unconscious expression
-turning psychological/emotional conflicts into physical symptoms
Example: a husband suddenly develops impotence after his wife discovers he is having an affair with his secretary

• Denial- unconscious refusal to face reality
Example: “I am not an addict”

• Displacement- unconsciously transfer of unacceptable feeling, emotion or reaction, to less threatening object or person
Example: a person who is mad at the boss yells at his or her spouse

• Dissociation- unconscious separation of painful feelings or emotions from an unacceptable idea, situation or object
Example: Amnesia that prevents recall of yesterday’s auto accident

• Fixation- stuck in a certain stage of development
Example: lack of clear sense of identity as an adult

• Fantasy- conscious distortion of unconscious feeling or wishes
- is likened to make-believe and daydreams. Wishes and desires are imagined as fulfilled

• Identification- a conscious or unconscious attempt to model oneself after a respected person
Example: nursing student becoming a critical care nurse because this s the specialty of an instructor she admires

• Introjection- accepting another person’s attitudes, beliefs and values as one’s own
Example: college student follows his parents’ instruction to abstain from casual sex

• Intellectualization- using only logical explanations without feelings or an affective component to justify unacceptable behavior or feelings
Example: person shows no emotion expression when discussing serious car accident

• Isolation- cutting of or blunting of an unacceptable aspect of a total experience

• Projection- unconscious blaming of unacceptable inclinations or thoughts on an external object
- blames other for wrong doing; looks for scapegoat
Example: a student was late and blames the alarm clock for failing to alarm

• Rationalization- excusing own behavior to avoid guilt, responsibility, conflict, anxiety or loss of self respect
-attempts to make or prove that one’s feeling or behavior is justifiable
Example: man says he beats his wife because she doesn’t listen to him

• Reaction Formation- a conscious behavior that is exact opposite of an unconscious feeling
Example: person who despises the boss tells everyone what a great boss he is

• Regression- returning to an earlier level of development in the face of stress
Example: man pouts like a four year old if he is not the center of his girlfriend’s attention

• Repression- unconscious forgetting of painful ideas, events and conflicts
Example: a woman has no memory of the mugging she suffered yesterday

• Resistance- overt or covert antagonism toward remembering or processing anxiety-producing information
Example: person attends court ordered treatment for alcoholism but refuses to participate

• Suppression- conscious forgetting unacceptable thought but able to recall at will
Example: a woman tells a friend she cannot think about her son’s death right now

• Substitution- replacing the desired gratification with one that is more readily available
Example: woman who would like to have her own children opens a day care center

• Sublimation- channeling instinctual drives into acceptable activities
Example: person goes for a 15 minute walk when attempted to eat junk foods

• Symbolization- less threatening objects is used to represent another

• Undoing- feeling guilty for doing something—showing true feeling but regret after
Example: after spanking her sn,a mother bakes his favorite cookies

NURSING CORE COMPETENCIES FOR QUALITY LEVEL

NURSING CORE COMPETENCIES FOR QUALITY LEVEL

Core Competencies
-conceptualized by members of Board of Nursing
-basic for nursing practice
-unifying framework for nursing education
-the phrase "core competencies in nursing" refers to a standard set of performance "domains" in which it is necessary to demonstrate proficiency to enter into professional practice.

Legal Basis
Article 3 Sec.9 (c) of R.A. 9173/ “Philippine Nursing Act 2002”
-Board shall monitor & enforce quality standards of nursing practice necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation.

Significance of Core Competencies Standard
• Guide in developing curriculum in nursing
• Framework in developing test syllabus for entrants to the nursing profession
• Tools for performance evaluation among nurses
• Basis for advanced practice and specialization
• Protect the public from incompetent practitioners
• Framework for developing a training curriculum for nurses
• Yardstick for unethical and unprofessional practice of nursing

Key Areas of Responsibilities
(1) Patient Care Competencies
• Safe and quality nursing care
• Communication
• Collaboration and teamwork
(2) Empowering
• Legal responsibility
• Ethics
(3) Ethico-moral responsibility
• Personal and professional development
(4) Enhancing
• Record management
• Management of resources and environment
(5) Enabling
• Quality improvement
• Research

Eleven (11) Core Competencies

I. SAFE AND QUALITY NURSING CARE
• Demonstrates knowledge based on the health/illness/status of individuals or groups
-identifies the health needs of the patients/groups
-explains the health status of the patients/groups
• Provide sound decision in making in the care of individuals/groups considering their beliefs and values
-identifies the problem
-gather data related to the problem
-analyzes the data gathered
-selects appropriate action
-monitors the progress of the action taken
• Promotes safety and comfort and privacy of patients
-performs age-specific safety measures in all aspects of patient care
-performs age age-specific comfort measures in all aspects of patient care
-perform age-specific measures to ensure privacy in all aspects of patient care
• Sets priorities in nursing care based on patients’ needs
-identifies the priority needs of patients
-analyzes the needs of patients
-determines appropriate nursing care to be provided
• Ensures continuity of care
-refers identified problem to appropriate individuals / agencies
-establishes means of providing continuous patient care
• Administers medications and health therapeutics
-conforms to the 10 golden rules in medication administration and health therapeutics
• Utilizes the nursing process as framework for nursing
a. Performs comprehensive and systematic nursing assessment
-obtains consent
-completes appropriate assessment forms
-performs effective assessment techniques
-obtains comprehensive client information
-maintains privacy and confidentiality
-identifies health needs
b. Formulates a plan of care in collaboration with patients and other members of the health team
-includes patient and his family in care planning
-states expected outcomes of nursing intervention
-develops comprehensive patient care plan
-accomplishes patient centered discharge plan
c. implements planned nursing care to achieve identified outcomes
-explain interventions to patient, family before carrying them out
-implement safe, comfortable nursing interventions
-acts according to client’s health conditions and needs
-performs nursing interventions effectively and in timely manner
d. evaluates progress toward expected outcomes
-monitors effectiveness of nursing interventions
-revises care plan when necessary
• Responds to urgency of patient’s condition
-identifies sudden changes in patient’s health conditions
-implements immediate, appropriate interventions

II. MANAGEMENT OF RESOURCES AND ENVIRONMENT
• Organizes workload to facilitate patient care
-identifies task or activities that need to be accomplished
-plans the performance of task or activities based on priority
-finishes work assignment on time
• Utilizes resources to support patient care
-determines the resources needed to deliver patient care
-control the use of equipment and supplies
• Ensures the functioning of resources
-check proper functioning of the equipment
-refers malfunctioning equipment to appropriate unit
• Check the proper functioning of the equipment
-establishes mechanism to ensure proper functioning of equipments
-determines the task and procedures that can be safely assigned to the other members of the team
-verifies the competence of the staff prior to delegating tasks
• Maintains a safe environment
-observe proper disposal of waste
-adheres to policies, procedures and protocols on prevention and control of infection
-defines steps to follow incase of fire, earthquake and other emergency situation

III. HEALTH EDUCATION
• Assesses the learning needs of the patient and the family
-obtains learning information through interview, observation and validation
-defines relevant information
-completes assessment records appropriately
-identify priority needs
• Develops Health Education plan based on assessed and anticipated needs.
-considers nature of the learner in relation to social, cultural, political, economic, educational, and religious factor
• Develops learning material for health education
-involves the patient, family and significant others and other resources
-formulates a comprehensive health educational plan with the following components: objectives, content and time allotment, teaching-learning resources and evaluation parameters
-provides for feedback to finalize plan
• Implements the health education plan
-provides for conducive learning situation in terms of timer and place
-considers client and family preparedness
-utilize appropriate strategies
-provides reassuring presence through active listening, touch and facial expression and gestures
-monitors client and family’s responses to health education
• Evaluates the outcome of health education
-utilizes evaluation parameters
-documents outcome of care
-revises health education plan when necessary

IV. LEGAL RESPONSIBILITY
• Adheres to practices in accordance with the nursing law and other relevant legislation including contract and informed consent.
-fulfill legal requirements in nursing practice
-holds current professional license
-acts in accordance with the terms of contract of employment and other rules and regulation
-complies with the required continuing professional education
-confirms information given by the doctor for informed consent
-secures waiver of responsibility for refusal to undergo treatment or procedures
-check the completeness of informed consent and other legal forms
• Adheres to organizational policies and procedures, local and national
-articulates the vision and mission of the institution where one belongs
-acts in accordance with the established norms and conduct of the institution/ organization
• Document care rendered to patients.
-utilizes appropriate patient care records and reports
-accomplish accurate documentation in all matters concerning patient care in accordance with the standard of nursing practice.

V. ETHICO-MORAL RESPONSIBILITY
• Respects the rights of individual/ groups
-renders nursing care consistent with the patient’s bill of rights
• Accepts responsibility & accountability for own decisions and actions
-meets nursing accountability requirements as embodied in the job description
-justifies basis for nursing actions and judgments
-projects a positive image of the profession
• Adheres to the national and international code of ethics for nurses
-adheres to the Code of Ethics for Nurses and abides by its provisions
-reports unethical and immoral incidents to proper authorities

VI. PERSONAL AND PROFESSIONAL DEVELOPMENT
• Identifies own learning needs
-verbalizes strengths, weaknesses, limitations.
-determines personal and professional goals and aspirations.
• Pursues continuing education
-participates in formal and non-formal education.
-applies learned information for the improvement of care.
• Gets involved in professional organizations and civic activities
-participates actively in professional, social, civic and religious activities
-maintain membership to professional organizations
-support activities related to nursing and health issues
• Projects a professional image of nurse
-demonstrate good manners and right conduct at all times
-dresses appropriately
-demonstrates congruence of words and actions.
-behaves appropriately at all times.
• Possesses positive attitude towards change and criticism
-listens to suggestions and recommendations
-tries new strategies or approaches
-adapts to changes willingly.
• Performs function according to professional standards
-assesses own performance against standards of practice
-sets attainable objectives to enhance nursing knowledge and skills
-explains current nursing practices, when situations call for it

VII. QUALITY IMPROVEMENT
• Gathers data for quality improvement
-demonstrates knowledge of method appropriate for the clinical problems identified
-detects variation in the vital signs of the patient from day to day
-reports necessary elements at the bedside to improve patient stay at hospital
-solicits feedback from patient and significant others regarding care rendered
• Participates in nursing audits and rounds
-contributes relevant information about patient condition as well as unit condition and patient current reactions
-shares with the team current information regarding particular patients condition
-encourages the patient to speak about what is relevant to his condition
-documents and records all nursing care and actions
-performs daily check of patient records/condition
-completes patients records
-actively contributes relevant information of patients during rounds thru readings and sharing with others
• Identifies and reports variances
-documents observed variance regarding patient care and submit to appropriate group within 24 hours
-identifies actual and potential variance to patient care
-reports actual and potential variance to patient care
-submits report to appropriate groups within 24 hours
• Recommends solutions to identified problems
-gives appropriate suggestions on corrective and preventive measures
-communicates and discusses with appropriate groups
-gives and objective and accurate report on what was observed rather than an interpretation of the event

VIII. REASEARCH
• Gathers data using different methodologies
-identifies researchable problems regarding patient care and community health
-identifies appropriate methods of research for a particular patient/community problem
-combines quantitative and qualitative nursing design thru simple explanation on the phenomena observed
-analyzes data gathered
• Recommends actions for implementation
-based on the analysis of data gathered, recommends practical solutions appropriate for the problem
• Disseminates results of research findings
-communicates results of findings to colleagues/patients/family and to others
-endeavors to publish research
-submits research findings to own agencies and others as appropriate
• Applies research findings in nursing practice
-utilizes and findings in research in the provision of nursing care to individuals/groups/communities
-makes use of evidence-based nursing to ameliorate nursing practice

IX. RECORDS MANAGEMENT
• Maintains accurate and updated documentation of patient care
-completes updated documentation of patient care
• Records outcome of patient care
-utilizes a record system (kardex or Hospital Information System)
• Observes legal imperatives in recording keeping
-observes confidentially and privacy of patient’s records
-maintains an organized system of filing and keeping patient’s records in a designated area
-refrains from releasing records and other information without proper authority

X. COMMUNICATION
• Establishes rapport with patients, significant others and members of the health team.
-creates trust and confidence
-listens attentively to client’s queries and requests
-spends time with the client to facilitate conversation that allows client to express concern.
• Identifies verbal and non-verbal cues
-interprets and validates client’s body language and facial expression
• Utilizes formal and informal channels
-makes use of available visual aids
• Responds to needs of individuals, family, group and community
-provides re- assurance through therapeutic, touch, warmth and comforting words of encouragement
-readily smiles
• Uses appropriate information technology to facilitate communication
-utilizes telephone, mobile phone, email and internet, and informatics
-identifies a significant other so that follow up care can be obtained
-provides “holding” or emergency numbers of services

XI. COLLABORATION AND TEAMWORK