Glossary

GLOSSARY

Abduction: also referred to as kidnapping; taking or detaining an individual against his or her will Abuse: an act of commission in which intentional physical, mental, or emotional harm is inflicted on a child or adult by other persons Acculturation: adoption of the cultural traits or patterns of another group Acquired immunodeficiency syndrome (AIDS): a viral infection caused by the HIV that attacks an individuals immune system resulting in an extremely painful, debilitating, and devastating physical condition and psychosocial effects Activities of daily living: terminology used to describe the ability to feed, bath, dress, and toilet oneself ACT model: an acronym for Assertive Community Treatment, a team treatment approach designed to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness who often have co-existing problems such as homelessness or substance abuse problems, or are involved with the judicial system Actual nursing diagnosis: nursing diagnosis based on the clinical judgment of the nurse on review of validated data Acute dyskinesia: any disturbance in movement due to the neuromuscular or neurologic adverse effects associated with the use of antipsychotics

Glossary Acute dystonic reaction: characterized by irregular, involuntary spastic muscle movements;

wryneck; facial grimacing; and abnormal eye movements or backward rolling of the eyes in the sockets; may occur after the first dose of an antipsychotic drug Acute (or primary) insomnia: characterized by the inability to fall asleep due to emotional or physical discomfort such as chronic stress, hyperarousal (eg, awakens easily), poor sleep hygiene (eg, drinking coffee just prior to sleep), environmental noise, or jet lag. It is not due to the direct physiologic effects of a substance or a general medical condition. Acute stress disorder: characterized by symptoms that occur during or immediately after trauma, last for at least 2 days, and either resolve within 4 weeks after the conclusion of the event or the diagnosis is changed to PTSD Addiction: an illness characterized by compulsion, loss of control, and continued patterns of abuse despite perceived negative consequences; obsession with a dysfunctional habit Addictions nursing: an area of specialty practice concerned with care related to dysfunctional patterns of human response that have one or more of the following key characteristics: some loss of self-control capacity, episodic or continuous maladaptive behavior or abuse of some substance, and development of dependence patterns of a physical and/or psychological nature Addictive personality: characterized by the search for immediate gratification of needs or ways to escape tension by using alcohol or drugs to experience euphoria or oblivion; clinical symptoms include low self-esteem, feelings of dependency, low tolerance for frustration and anxiety, antisocial behavior, and fear Advance care planning: thoughtful, facilitated discussion that encompasses a lifetime of values, beliefs, and goals for the client and family

Glossary Advance directive: a legal document in which an individual states his or her end of life preferences regarding health care Adverse effect or reaction: untoward medication side effect that may have serious physiologic consequences Affect: outward manifestation of a persons feelings, tone, or mood Affective disorders: an alternative term for mood disorders Affective disturbance: inability to show appropriate emotional responses Aggression: any behavior or attitude that reflects anger, rage, or hostility and the potential for physical or verbal abuse or destructiveness Aging: a process in which there is a gradual decline in the functioning of all the bodys systems (eg, cardiovascular, endocrine, genitourinary, etc.) Agnosia: failure to recognize or identify objects despite intact sensory function Agoraphobia: the fear of being alone in public places from which the person thinks escape would be difficult or help unavailable if he or she were incapacitated AIDS-related complex (ARC): a syndrome caused by the AIDS virus characterized by chronically swollen lymph nodes and persistent fever, cough, weight loss, debilitating fatigue, diarrhea, night sweats, and pain Akathisia: motor restlessness such as fidgeting, rocking, or pacing due to the neuromuscular or neurologic adverse effects associated with the use of antipsychotics Akinesia: motor retardation or reduced voluntary motor movement Alcohol intoxication: alcohol-induced disorder that occurs after the recent ingestion of alcohol, characterized by behavioral changes such as impaired social or occupational functioning, fighting, or impaired judgment

Glossary

Alcoholism: the inability to stop drinking that seriously alters a normal living pattern. Cessation of drinking or a reduction in intake results in withdrawal symptoms. Alcohol withdrawal: alcohol-induced disorder that can occur within several hours to a few days after the cessation or reduction of heavy and prolonged alcohol consumption; clinical symptoms may include autonomic hyperactivity; increased hand tremor; sleep disturbances, insomnia, or nightmares; nausea or vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety; and grand mal seizures Alexithymia: the inability to understand ones feelings or to describe ones feelings to others Alogia: lack of spontaneity in speech and diminished flow of conversation Altruistic suicide: suicide by persons who have excessive integration into a group and hope to draw attention to a specific cause (eg, suicide bombers in the Middle East) Ambiguous genitalia: characterized by the presence of a penis and a small vaginal opening Ambivalence: contradictory or opposing emotions, attitudes, ideas, or desires for the same person, thing, or situation Amnesia: loss of memory that may be organic or emotional in origin Anaclitic depression: failure of infants to thrive when separated from their mothers Anergia: sluggishness or listlessness Anger: an affective state in which a person experiences a sense of power to warn, intimidate, or attack those who are perceived as challenging or intimidating Anhedonia: the inability to experience pleasure while engaged in activities that normally produce pleasurable feelings Anomic suicide: suicide that occurs when an individual has difficulty relating to others, adapting to a world of overwhelming stressors, or adjusting to expected normal social behavior (eg, a

Glossary college student, who was popular in high school, has difficulty adjusting to college life, feels socially unaccepted on campus, and commits suicide) Anorexia nervosa: an eating disorder characterized by an aversion to food, intense fear of

becoming obese, and distorted body image, which may result in death due to serious malnutrition Anterograde amnesia: the inability to recall events of long ago but have normal recall of recent events Anticipatory grief: refers to the reactions that occur when an individual, family, significant other, or friends are expecting a loss or death to occur. It includes all of the thinking, feeling, cultural, and social reactions that occur regarding a loss or death. Anticipatory grief allows the individual and others to get used to the reality of the loss or death and to complete unfinished business. Anxiety: feelings of uncertainty, uneasiness, apprehension, or tension that a person experiences in response to an unknown object or situation Anxiety disorder due to a medical condition: characterized by prominent anxiety, panic attacks, or obsessions or compulsions that are judged to be due to the direct physiologic effects of a medical condition Anxiety state: the result of a stressful situation in which the person loses control of her or his emotions Anxiety trait: a component of personality that has been present over a long period and is measurable by observing the persons physiologic, emotional, and cognitive behavior Apathy: indifference Aphasia: loss of ability to use or understand words Apraxia: inability to execute motor activities despite intact comprehension and motor function

Glossary Aromatherapy: the controlled, therapeutic use of essential oils for specific measurable outcomes Aspergers disorder: considered to be a mild form of autism, this developmental disorder is characterized by the presence of normal or higher intelligence, pedantic speech by age 5 years, clumsiness, poor handwriting, and autistic-type behavior such as hand flapping or pacing when excited or upset Assault: an act that puts another person in apprehension of being touched or of bodily harm without consent Assertiveness training: the act of teaching clients how to appropriately relate to others using frank, honest, and direct expressions, whether these are positive or negative in nature

Associative disturbance or looseness: an inability to think logically; ideas expressed have little, if any connection and shift from one subject to another Asterixis: abnormal movement in which the client exhibits a peculiar flapping movement of hyperextended hands Asthenia: profound fatigue with loss of motivation and short-term memory problems Attachment theory: states that normal attachment in infancy is crucial to a persons healthy development. Attachment occurs when there is a warm, intimate and continuous relationship with the mother in which both the infant and mother find satisfaction and enjoyment. Attachment is also referred to as the emotional tone between children and their caregivers and is evidenced by the childs clinging to the caregiver. Attempted rape: an assault on an individual in which oral, vaginal, or anal penetration is intended but does not occur

Glossary

Attention-deficit hyperactivity disorder: a childhood developmental disorder characterized by short attention span, impulsivity, and distractibility; may also be characterized by stubbornness, negativism, temper tantrums, obstinacy, inability to tolerate frustration, deficit in judgment, poor self-image, and aggressiveness Atypical antipsychotics: also referred to as new-generation antipsychotics, they block the activity of both serotonin and dopamine; they are used to treat both the positive and negative symptoms of disorders such as schizophrenia Autistic disorder: characterized by qualitative impairment in social interaction, qualitative impairments in communication, and restricted repetitive and stereotyped patterns of behavior, interest, and activities Autistic thinking: a thought process in which the individual is unable to relate to others or to the environment Autocratic group leader: a group leader who generally does not encourage active participation or interaction among group members. Such leaders maintain authority and control over group members. Aversion therapy: a form of therapy that uses unpleasant or noxious stimuli such as emetine (an extract of the ipecac root) to change inappropriate behavior such as alcohol abuse Avolition: lack of initiative or inability to complete projects, work, or assignments Awakening phenomena: a phenomena experienced by clients who initially respond to psychotropic medication; clinical symptoms are stabilized and painful reactions are manifested as inner emotions and real losses are recognized Awareness syndrome: another term for awakening phenomena Barbiturates: drugs that depress the central nervous system and are used for sedative effects

Glossary Battery: unlawful touching of another without consent

Behavioral nursing theory: a theory by Orem that focuses on self-care deficit and proposes that the recipients of nursing care are persons who are incapable of continuous self-care or independent care because of health-related or health-derived limitations Behavior therapy: a mode of treatment that focuses on modifying observable and, at least in principle, quantifiable behavior by means of systematic manipulation of the environment and variables thought to be functionally related to the behavior Behavioral dependence: a form of behavior displayed by individuals who use substances characterized by substance-seeking activities and pathological use patterns Bereavement: feelings of sadness, insomnia, poor appetite, deprivation, and desolation during the grief process Bestiality: sexual contact with animals to produce sexual excitement Bill of Rights for Registered Nurses: developed by the ANA, this bill clearly defines the rights of registered nurses (eg, safe work environment and to advocate freely on behalf of themselves and their clients) Binge eating: characterized by a rapid consumption of a large amount of food in less than 2 hours Binge eating disorder: an eating disorder characterized by recurrent episodes of binge eating in the absence of purging. Individuals with this disorder admit to a lack of control over eating and relate a history of repeated attempts to lose or stabilize their weight. Binswangers disease: a type of vascular dementia that is characterized by the presence of many small infarctions affecting the white matter of the brain that spare the cortical regions

Glossary Bipolar I disorder: a mood disorder characterized by one or more manic or mixed episodes in which the individual experiences rapidly alternating moods accompanied by symptoms of a manic mood and a major depressive episode

Bipolar II disorder: a mood disorder characterized by recurrent major depressive episodes with hypomanic (a mood between euphoria and excessive elation) episodes Blocking: impaired communication in which there is a sudden stoppage in the spontaneous flow or stream of thinking or speaking for no apparent external or environmental reason Body dysmorphic disorder (BDD): an anxiety-related disorder characterized by a pervasive subjective feeling of ugliness and preoccupation with an imagined defect in physical appearance accompanied by fears that one is unattractive or even repulsive Body mass index: an indicator of physical fitness that identifies whether a person is overweight or underweight based on height in relation to weight; a healthy BMI range is 20 to 25 Brief cognitive therapy: a form of individual therapy in which the therapist uses a time-limited, goal-oriented, problem-solving, here-and-now approach Brief couples therapy: a form of couple therapy based on understanding each partners belief systems and how these systems interlock to govern their lives and relationships Brief interpersonal psychotherapy: a semi-structured, psychodynamically time-limited model of psychotherapy adapted from the interpersonal models used by Peplau, Horney, Fromm, and Sullivan, designed for use in a 3- to 4-month framework Brief psychotic disorder: a psychotic disorder characterized by the sudden onset of at least one of the positive symptoms of psychosis (ie, hallucinations, delusions, disorganized speech, or grossly disorganized or catatonic behavior) which last for at least 1 day but less than 1 month, as the individual eventually exhibits a full recovery or return to former level of functioning

Glossary Bulimia nervosa: an eating disorder characterized by binge eating in which the individual is aware that the behavior is abnormal, fears the inability to stop eating voluntarily, is self-critical, and may experience depression after each episode Burnout (also referred to as compassionate fatigue): fatigue that occurs when one provides care for others at work and home but loses the ability to take care of ones self Cachexia: characterized by skeletal-like appearance and low body mass index; may occur in anorexia nervosa or failure to thrive CAMI: acronym for chemically abusing and mentally ill; implies that the primary diagnosis is chemical abuse and the secondary diagnosis is mental illness Case management: the coordination of a clients health care by a case manager who makes a determination of the providers of the care of a particular condition, such as depression; case management continues as the client transitions through different levels of care

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Catatonic schizophrenia: a subtype of schizophrenia characterized by the presence of abnormal motor activity such as immobility, extreme agitation, stupor, or posturing Cellopathy: a term used in alternative therapy to describe restoration of body function; reflects the medical model of care Child abuse: terminology used to include the physical, emotional, or sexual abuse or neglect of a child Chromosomes: carriers of genetic programming information Circumstantiality: impaired communication in which much unnecessary detail delays meeting a goal or stating a point Civil commitment: a process by which a person believed to be mentally ill is court-ordered to remain in a facility for a specified period

Glossary Clang association: a type of thinking in which the sound of a word (eg, punning or rhyming) substitutes for logic during communication Clearance: the amount of a drug excreted from the body in a specific period of time Client confidentiality: refers to the nondisclosure of private information related by one individual to another, such as from client to nurse. (See Confidentiality.) Client privacy: the right to be left alone and free from intrusion or control by the public or, in this situation, health care providers. (See Privacy.)

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Clinical efficacy: the maximum clinical response achievable by the administration of a specific drug Clinical pathways: daily flow charts that track the clients clinical symptoms, nursing diagnoses, nursing interventions as well as interventions by members of the multidisciplinary treatment team, and nursing outcomes Clinical psychopharmacology: the study of drug effects in clients and the expert use of drugs in the treatment of psychiatric conditions Clitoridectomy: considered to be an invasive surgical procedure in which there was a removal of part of the clitoris of female clients who exhibited inappropriate or aggressive sexual behavior; also referred to as a form of female sterilization Closed groups: a form of group therapy that consists of a set number of clients and establishes a specific time frame, or both of these components. Specific membership may address the needs of a particular kind of client. Clubhouse program: a voluntary, participatory group of clients who work together to secure and sustain employment, locate and maintain appropriate housing, and participate in recreational and social activities

Glossary Code of Ethics for Nurses: a code to guide nurses to employ certain principles when faced with ethical challenges

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Codependency: terminology used to describe a dysfunctional relationship between a substance abuser and family member or significant other in which the loss of self and boundary distortions occur; refers to all the behavioral patterns of family members who have been significantly affected by another family members substance use or abuse Cognator: an internal coping mechanism, identified in Roys Theory of Adaptation, that enables an individual to adapt to external stimuli; pertains to perceptual, social, and informationprocessing functions Cognition: refers to the various modes of knowing and reasoning (eg, comprehension, judgment, memory) Cognitive behavior therapy: combines the individual goals of cognitive therapy and behavioral therapy; uses confrontation to identify both thoughts and behaviors that are causing distress and to change those thoughts in order to readjust the behavior Cognitive disorder: a clinically significant deficit in cognition from a previous level of functioning Comfort zones: personal comfort level that encompasses the way we dress, what we can and cannot do, and have a direct effect on the way we deal with people Communication: the giving and receiving of information; includes three elements: the sender, the message, and the receiver Community-based health care: delivery of services (continuum of care) designed to meet the biopsychosocial needs of a client at any given time

Glossary Community mental health: an ideology or a perspective that promotes early, comprehensive treatment in the community, accessible to all, including children and adolescents

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Community Mental Health Centers Act of 1963: this act mandated that the community make the necessary provisions for psychiatric emergency care Compensation: the act of making up for a real or imagined inability or deficiency with a specific behavior to maintain self-respect or self-esteem Complementary and alternative medicine (CAM): refers to various disease-treating and disease-preventing practices or therapies that are not considered to be conventional medicine taught in medical schools, not typically used in hospitals, and not generally reimbursed by insurance companies Compulsions: insistent, repetitive, intrusive, and unwanted urges to perform an act contrary to ones ordinary wishes or standards; the performance of a repetitious, uncontrollable, but seemingly purposeful act to prevent some future event or situation Conceptual framework: a group of concepts linked together to describe a specific viewpoint developed by theorists Conduct disorder: a disruptive behavior disorder that is characterized by a pattern of behavior that violates the basic rights of others or major age-appropriate societal norms or rules Confabulation: the filling in of memory gaps with false but sometimes plausible content to conceal the memory deficit Confidentiality: nondisclosure of private information related by one individual to another, such as from client to nurse Conjugal paranoia: also referred to as delusional jealousy; a form of paranoia in which an individual is convinced that his or her mate or significant other is unfaithful

Glossary Content-specific delusions (CSDs): a term that describes complex delusions present in an identifiable neurologic disease in which cerebral cortical functioning is intact (eg, focal lesions

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of the frontal lobes or right hemispheres of the brain); clients insist that their delusions are true, but also admit to puzzlement or bemusement regarding aspects of the delusion. Types of CSDs include delusions of place, delusions of person, sexual delusions, and somatic delusions. Contextual therapy: a form of couple therapy that focuses on issues such as the impaired development as a couple, parental conflict, child abuse, or spouse infidelity Continuum of care: a complete range of programs and services that treat the whole person from wellness to illness to recovery within the community Conventional antipsychotics: an alternative term for neuroleptic agents or typical antipsychotics (eg, haloperidol [Haldol]) Conversion: the transference of a mental conflict into a physical symptom to release tension or anxiety Conversion disorder: a somatoform disorder that involves motor or sensory problems that would suggest a neurologic condition Counseling: a form of supportive psychotherapy in which the nurse offers guidance or assists the client in viewing options to problems that are discussed by the client in the context of the nurse client relationship Countertransference: reactions to a client by the nurse based on the nurses unconscious needs or conflicts related to past experiences Couple therapy: therapy involving a married, nonmarried, homosexual, or heterosexual pair to resolve tension or conflict in a relationship

Glossary

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Creutzfeldt-Jakob disease: a rare neurologic disorder that presents with nonspecific neurologic symptoms; relentlessly progresses as dysphasia dementia, visual, emotional, and behavioral disturbances occur; and culminates in mutism, akinesia, and death within 6 months Crisis: an extreme state of emotional turmoil or disequilibrium (eg, loss of control of feelings and thoughts) that occurs as a result of undue stress Crisis forensics: assessment of the dangerousness of a clients behavior toward self or others. The word forensics is used because the clinician has a responsibility toward society, the liberty interest of the client, and the legal regulation of psychiatry, all operating in a crisis mode. Crisis intervention: an active, but temporary, attempt to resolve a crisis when an individuals, familys or groups life goals are obstructed and usual problem-solving methods fails Crisis response teams: groups of trained professionals, typically including mental health specialists, victim advocates, public safety individuals, and members of the clergy, among others, who volunteer their services on call to provide immediate, short-term, on-scene crisis intervention, emotional support, and referrals to families, neighbors, witnesses and/or survivors who have been traumatized by experiences such as a death, a serious injury, or a violent crime Crisis situations: situations that threaten the safety, integrity, or reputation of the community Critical pathways: another name for clinical pathways Cues: facts collected during the assessment process Culture: a broad term referring to a set of shared beliefs, values, behavioral norms, and practices that are common to a group of people sharing a common identity and language Culture-bound syndrome: denotes recurrent locality-specific patterns of aberrant behavior and troubling experiences

Glossary Cultural care accommodation/negotiation: the nurse adapts nursing care to accommodate the clients beliefs or negotiate aspects of care that would require the client to change certain practices Cultural care preservation/maintenance: the nurse assists the client in maintaining health practices that are derived from membership in a certain ethnic group

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Cultural care repatterning/restructuring: the nurse educates the client to change practices that are not conducive to health Curing: the alleviation of symptoms or the suppression or termination of a disease process through surgical, chemical, or mechanical intervention Cybertherapy: the use of the Internet as a practice extender Cyclothymic disorder: a mood disorder in which the clinical symptoms are similar to those of bipolar II disorder, except that they are generally less severe Decision trees: a set of clinical features that guides the clinician through a series of questions to rule out or rule in various disorders. These questions are not meant to replace actual diagnostic criteria, but rather to assist in the decision-making process. Defamation: injury to a persons reputation or character through oral or written communications to a third party Deinstitutionalization: the movement of chronically mentally ill clients from the state psychiatric hospitals back to their homes or to community-supervised facilities; the process by which large numbers of psychiatric clients were discharged from public psychiatric facilities over the past 40 years Dj vu: a French term used to describe the act of seeing what one has seen in the past

Glossary Delirium: a transient cognitive impairment disorder, usually acute or subacute in onset,

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presenting as a reversible global dysfunction in cerebral metabolism; usually due to a disturbance of brain pathology by a medical disorder or an ingested substance. Symptoms include clouding of the consciousness, disorientation, memory impairment, and decreased ability to sustain attention to environmental stimuli. Delirium tremens (DTs): an alcohol-induced disorder that may occur 2472 hours after the clients last drink; clinical symptoms include elevation of vital signs, restlessness, tremulousness, agitation, and hyperalertness Delusions: fixed false beliefs not true to fact and not ordinarily accepted by other members of the persons culture; based on an incorrect inference about external reality and firmly sustained despite clear evidence to the contrary Dementia: a syndrome (eg, a group of signs and symptoms that cluster together) of global or diffuse brain dysfunction characterized by a gradual, progressive, chronic deterioration of intellectual function; clinical symptoms may include impaired judgment, orientation, memory, cognition, and attention that are affected either by a pattern of simple, gradual deterioration or by rapid, complicated deterioration Dementia praecox: a syndrome, identified by Emil Kraepelin, characterized by hallucinations and delusions Dementia syndrome of depression: a syndrome in which clients have mistakenly been diagnosed with dementia because the clinical symptoms of depression resemble the clinical symptoms of dementia Dementia with Lewy bodies (DLB): a condition due to neurohistologic changes (spherical protein deposits in nerve cells) in the cerebral cortex and other areas of the brain. Their presence

Glossary

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in the brain disrupts the brains normal functioning, interrupting the action of important chemical messengers, including acetylcholine and dopamine. When lesions collect in the substantia nigra of the brain stem, they cause Parkinsons disease. Democratic group leader: a group leader who encourages active participation, values the input and feedback of group members, and promotes cohesiveness among the group members as they develop problem-solving and decision-making skills Denial: unconscious refusal to face thoughts, feelings, wishes, needs, or reality factors that are consciously intolerable Depersonalization: a feeling of unreality or strangeness concerning self, the environment, or both Depersonalization disorder: an anxiety-related disorder characterized by a strange alteration in the perception or experience of the self, often associated with a sense of unreality. This temporary loss of ones own reality includes feelings of being in a dreamlike state, out of the body, mechanical, or bizarre in appearance. Depression: a mood state characterized by a feeling of sadness, dejection, despair, discouragement, or hopelessness Detoxification: medical intervention to relieve withdrawal symptoms while clients adjust to a drug-free state Developmental obesity: obesity that begins in childhood due to overeating Dialectic behavioral therapy (DBT): developed by Linehan for chronically suicidal individuals suffering from borderline personality disorders; a comprehensive psychosocial treatment modality that blends together the most effective interventions in behavior therapy and balances them with treatment strategies that focus on acceptance and validation

Glossary Diminished capacity: a term used to describe the mental capabilities of a defendant who,

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because of a mental impairment, could not form the specific mental state required for a particular offense, such as first-degree murder Disaster: traumatic event that occurs suddenly, causes great damage, and generally precipitates a crisis situation Disaster mental health nursing: the application of the nursing process to meet the biopsychosocial needs of victims and communities as they experience the recovery process following a disaster. The recovery process generally involves four transitional periods and may last for several years. Disaster response team: trained professional individuals who provide a combination of physical, psychological, and emotional support for victims of natural or man-made disasters Discharge planner: coordinates all the facets of a clients admission and discharge. The discharge planner reviews the clients current response to treatment, past medical history, and assesses what family or friend support is available once the client is ready to be discharged. Discipline: a purposeful action to restrain or correct a childs behavior to teach, not to punish Discontinuation (withdrawal) syndrome: a transient emergence of mild clinical symptoms due to the discontinuation or reduction in the dosage of a psychotropic drug Disorganized schizophrenia: considered to be the most severe subtype of schizophrenia, characterized by the disintegration of personality, withdrawal, incoherent speech, uninhibited behavior, and lack of attention to personal hygiene and grooming Disorganized symptoms: the presence of confused thinking, incoherent or disorganized speech, and disorganized behavior such as the repetition of rhythmic gestures

Glossary Disorientation: a level of consciousness in which a person is unaware of the position of self in relation to time, surroundings, or other persons Displacement: the transference of feelings such as frustration, hostility, or anxiety from one idea, person, or object to another Dissociation: the act of separating and detaching a strong emotionally charged conflict from ones consciousness

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Dissociative amnesia: characterized by the inability to recall an extensive amount of important personal information because of physical or psychological trauma Dissociative disorders: characterized by a disruption of integrated functions of consciousness, memory, identity, or perception of the environment. Onset may be sudden, gradual, transient, or chronic. Dissociative fugue: differs from dissociative amnesia in that the person suddenly and unexpectedly leaves home or work, is unable to recall the past, assumes a new partial or complete identity, and is unable to recall his or her previous identity Dissociative identity disorder: formerly known as multiple personality disorder in which a person is dominated by at least one of two or more definitive personalities at one time; characterized by the emergence of various personalities, or alters, that occurs suddenly and is often associated with psychosocial stress and conflict Disturbances in executive functioning: impaired cognitive abilities such as the inability to plan, organize, sequence, or abstract; may be seen in dementia Doctrine of Charitable Immunity: also known as the Good Samaritan Act, this doctrine made hospitals, churches, and schools immune from prosecution in the early 1900s

Glossary Domestic violence: a pattern of coercive behaviors that may include repeated battering and injury, psychological abuse, sexual assault, progressive social isolation, deprivation, and intimidation Dopamine hypothesis: the hypothesis that an excessive amount of the neurotransmitter,

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dopamine, allows nerve impulses to bombard the part of the brain normally involved in arousal and motivation known as the mesolimbic pathway. Normal cell communication is disrupted, resulting in the development of hallucinations and delusions, symptoms of schizophrenia. Double-bind situation: conflicting demands placed upon an individual, referred to as a no-win experience, in which there is no correct choice Drug dependence: characterized by habituation to, abuse of, and/or addiction to a chemical substance mostly due to psychological craving for the substance Drug half-life: the amount of time it takes for metabolism and excretion to reduce the plasma concentration of a specific drug by half Drug polymorphism: the pharmacodynamic and pharmacokinetic variations that occur based on several factors such as a clients age, gender, size, and body composition DSM-IV-TR: the multiaxial psychiatric diagnostic and statistical manual of psychiatric disorders used by clinicians and researchers of many different orientations in various settings; a necessary tool for collecting and communicating accurate public health statistics Dual diagnosis: term used to designate mentally ill clients who show a comorbid substance dependency or abuse Durable health care power of attorney: an advance directive that permits an individual to name a health care decision maker or surrogate to make medical decisions in the event the individual is unable to make medical decisions or give informed consent

Glossary Dying declaration exception to hearsay: a unique form of advance directive that allows as admissible the statements made by a person who is nearing death and who is aware of the imminence of it, including statements regarding the circumstances of his mortal injury, such as who inflicted it Dying Persons Bill of Rights: a list of rights for dying persons created in the 1970s at a workshop on the care of terminally ill clients

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Dysfunctional families: families in which communication is not open, direct, or honest causing individuals be isolated from one another and where one individual may try to control others in the family Dysfunctional grief: a grief process in which the individual experiences distress or denial of the loss; changes in eating and sleeping habits; mood disturbances, such as anger, hostility, or crying; and alterations in activity levels, including libido or sex drive Dysgraphia: the impaired ability to write Dysmorphobia: another term for body dysmorphic disorder Dysnomia: the inability to name objects Dysthymia: a term used to describe clinical symptoms of moderate depression Dysthymic disorder: characterized by clinical symptoms similar to those of major depressive disorder or severe depression; however, they are not as severe and do not include symptoms such as delusions, hallucinations, impaired communication, or incoherence Echolalia: the parrot-like repetition of overheard words or phrases. Individuals with a developmental disorder, neurologic disorder, or schizophrenia may exhibit echolalia in a mocking or mumbling manner or with staccato intonation. Echopraxia: pathologic repetition or imitation of observed movements

Glossary

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Eclectic approach: an individualized style of therapy in which a therapist may specialize in one particular conceptual model or combine aspects of different ones. The therapist realizes there is no one way to deal with all of lifes stresses or problems of living and is open to new ideas and approaches as the need arises. Ego: the part of the personality that meets and interacts with the outside world as an integrator or mediator and serves as the executive function of the personality operating at all three levels of consciousness Egocentrism: seeing things from ones own point of view with the inability to comprehend the ideas of others if they differ from ones own Ego defense mechanisms: unconscious, protective barriers that are used to manage instinct and affect in the presence of stressful situations (also referred to as defense mechanisms) Egoistic suicide: suicide by individuals who are not strongly integrated into any social group (eg, a divorced male, who has no children and who lives alone, commits suicide) Ego preoccupation: the act of resigning oneself to the aging process, becoming inactive, feeling that there is no future, and waiting to die. Such individuals do not feel their lives have any significant meaning to themselves or others as they disengage themselves from society. Ego transcendence: the act of finding meaning in life as aging persons talk about past life experiences and realize that they have the wisdom and knowledge to serve as resource persons Elation: a state of extreme happiness, delight, or excitability Electroconvulsive therapy (ECT): the use of electric currents to induce convulsive seizures to correct the biochemical abnormalities of peptides and neurotransmitters (eg, serotonin and dopamine) that occur during the transmission of nerve impulses between synapses

Glossary Electronarcosis: a type of ECT that produces a sleep-like state without the presence of convulsions due to the use of anesthetics and muscle relaxants Emotional abuse: behavior such as provoking fear with verbal assaults or threats, sending double messages, or communicating confusing or demeaning messages Emotional neglect: failure to provide an emotional climate that fosters feelings of love, belonging, recognition, and enhanced self-esteem Empowerment Model of Recovery: describes mental illness as a combination of severe emotional distress and an interruption of a persons place in the community and social role; emphasizes that emotional distress is a temporary disruption in life Enabling: perpetuating the substance users dependence by shifting the blame for his or her behavior onto other family members Encopresis: characterized by fecal soiling or the passage of feces into inappropriate places End-of-life care: refers to the nursing care given during final weeks of life when death is imminent Endogenous depression: depression that occurs or originates internally due to genetic or biological factors Enuresis: repeated urination, day or night, into bed or clothes E-practice: use of electronic technology in the delivery of health care Erotomanic delusion: the delusion that one is loved by another person

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Essential oils: volatile, organic constituents of aromatic plant matter that trigger different nerve centers in the brain to produce particular neurochemicals and promote relaxation E-therapy: online psychotherapy that serves as a viable alternative source of help when traditional psychotherapy is not accessible

Glossary Ethics: a branch of philosophy that refers to the study of values or values-laden decisions that conform to moral standards of a group or a profession

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Ethnicity: refers to the beliefs, values, customs, traits, and means of communication held by a group of people with a common origin Ethnic group: refers to people in a larger social system whose members have common ancestral, racial, physical, or national characteristics, and who share cultural symbols such as language, lifestyles, and religion Ethnocentrism: the tendency to believe that ones own way of thinking, believing, and behaving is superior to that of others Ethnopharmacology: the study of how ethnicity affects drug metabolism Euphoria: an exaggerated feeling of physical and emotional well-being Euthanasia: the deliberate act of causing a persons death by administering a lethal dose of medication or other agent Exhibitionism: the practice of obtaining sexual gratification by repeatedly exposing the genitals to unsuspecting strangers who are involuntary observers Exogenous depression: depression that occurs as a result of the environment (eg, dysfunctional relationship with spouse) or external forces (eg, intoxication) Expected outcomes: measurable client-oriented goals that are realistic in relation to the clients present and potential capabilities Extrapyramidal side effects (EPS): neuromuscular or neurologic adverse effects associated with the use of antipsychotics that occur during the early phase of drug therapy Extrovert: an individual who relates better to the outside world of people and things Facilitate: to proceed further or make easier

Glossary Factitious disorder: the consciously motivated production or feigning of physical or psychological symptoms to assume the sick role

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Failure of duty to warn: a form of malpractice in which a health care professional fails to warn an individual that his or her life may be in danger Failure to thrive: a syndrome comprised of unexplained weight loss, deterioration in mental status and functioning ability, and social isolation False imprisonment: intentional and unjustifiable detention of a person against his or her will Families: an integral part of society bound together by intense and long-lasting ties of past experience, social roles, mutual support, and expectations Family therapy: a method of treatment in which family members gain insight into problems, improve communication, and improve functioning of individual members as well as the family as a whole Family violence: another term for domestic violence Fantasy: imagined events or fabricated series of mental pictures such as daydreams; used to express unconscious conflicts, gratify unconscious wishes, or prepare for anticipated future events Fear: the bodys physiologic and emotional response to a known or recognized danger Fetishism: sexual contact with an inanimate article such as a piece of clothing (fetish), resulting in sexual gratification First pass effects: the initial metabolism of an orally administered drug within portal circulation of the liver and the fraction of the absorbed drug that reaches systemic circulation unmetabolized Flight of ideas: impaired communication characterized by continuous talk in which the individual verbally skips from one idea to another

Glossary

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Flooding: repeated exposure to intense forms of anxiety producers in ones imagination or real life Folie deux: a delusion that involves two individuals who have a close relationship and share the same delusion. The inducer or primary case usually has a chronic psychotic disorder with prominent delusions that the other individual, the secondary case or follower, begins to believe. Forensic nurses Code of Ethics: a brief description of the responsibilities and obligations of the forensic nurse including the health and welfare of clients and the community at large Forensic nursing education: preparation through a synthesis of education and experience in nursing, forensic science and law enforcement. This specialized education develops a clinician qualified to respond to the challenge health care faces in the protection of the legal, civil, and human rights of victims and perpetrators of violent crimes Forensic nursing practice: a specialty in which nurses provide care for clients by focusing on advocacy for and ministration to offenders and victims of violent crime and the families of both. Forensic nurses provide a vital link in the multidisciplinary treatment of victims, perpetrators, survivors, or individuals falsely accused of abuse and violence. Forensic psychiatry: a psychiatric specialty in which mental health professionals work with the legal system to provide assistance and consultation regarding a wide range of civil, criminal, and administrative proceedings Free-floating anxiety: anxiety that is always present and accompanied by a feeling of dread Fugue: rare occurrence in which a person suddenly and unexpectedly leaves home or work and is unable to recall the past or his or her identity. Assumption of a new identity usually occurs after relocation to another geographic area.

Glossary Gender identity: a persons sense of maleness or femaleness

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General Adaptation Syndrome (GAS): a syndrome in which an individual who copes with the demands of stress experiences a fight-or-flight reaction that occurs in three stages: alarm reaction, resistance, and exhaustion. Genetic testing: the laboratory analysis of cells for gene products (eg, proteins, enzymes, metabolites) or DNA analysis (eg, chromosomal analysis) to identify diseases and possible cures for the diseases Genomic health care: a highly individualized plan of care that utilizes information related to phenotype responses and gene functions Geriatric nursing: meeting the disease-created needs of older people Gerontological nursing: the assessment of the health care needs of older people, including planning and implementing health care and evaluating the effectiveness of such care. An effort is made to promote independence, prevent illness, promote health, and maintain life with dignity and comfort. Grandiose delusion: also referred to as megalomania; characterized by the belief that one possesses unrecognized talent or insight, such as that of a religious leader, and seeks a position of power Grief: a normal, appropriate emotional response to an external and consciously recognized loss which is usually time-limited and subsides gradually Grief process: a process that is all-consuming; having a physical, social, spiritual, and psychological impact on an individual; and which may impair daily functioning Group therapy: a method of therapeutic intervention based on the exploration and analysis of both individual and intrapsychic structures and the group process

Glossary Guilty but mentally ill: a plea used when a criminal act is committed, and although the client

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has a mental illness, the client is responsible for his or her behavior (eg, a substance abuser robs a store to obtain money to purchase drugs) Habituation: also referred to as psychological dependence; implies an emotional dependence on a drug or a desire or compulsion to continue taking a drug Half-life: refers to the time required for plasma concentrations of a drug to be reduced by 50% Hallucinations: sensory perceptions that occur in the absence of an actual external stimulus; may be auditory, visual, olfactory, gustatory, or tactile in nature Hate crime: a crime (eg, violent crime, hate speech, vandalism) that is motivated by feelings of hostility against any identifiable group of people within a society; a crime in which the defendant intentionally selects a victim or the victims property because of the victims race, color, or national origin Healing: terminology used in alternative therapy to describe a gradual or spontaneous awakening that originates within a person and results in a deeper sense of self, effecting profound change Health care directive: an advance directive regarding ones desires regarding health care in the event of serious or terminal illness; also referred to as a living will Health care proxy: an individual appointed by the court (eg, spouse, guardian, or parent) to act on behalf of a client who has not completed a durable health care power of attorney or is unable to communicate his or her wishes Healthy functioning families: families in which there is a respect for the individuation of other family members and their points of view and opinions, even if the differences lead to confrontation or altercation

Glossary

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Hermaphrodism: a rare occurrence characterized by the presence of testicular tissue containing semeniferous tubules and spermatozoa and ovarian tissue containing follicles in the same person Holism: terminology used to describe a way of viewing health care in terms of patterns and processes instead of medication, technology, and surgery Holistic nursing: a nursing specialty that focuses on searching for patterns and causes of illness, not symptoms; viewing pain and disease as processes that are a part of healing; treating the person as a whole, autonomous client rather than a fragmented, dependent individual; emphasizing the achievement of maximum health and wellness; equating prevention with wholeness; and the use of body-mind, spiritual, energetic, and ethical healing Homeopathic remedies: terminology used to describe a form of homeopathic therapy used to effect healing; also referred to as herbal medicine or natural remedies (eg, valerian or melatonin) Homeopathy: a specific healing therapy started in the 1700s by Samuel Hahnemann, a German physician and chemist, who formulated the theory that the body possesses the power (a vital force) to heal itself Homophobia: the unreasonable fear or hatred of homosexuals or homosexuality Homosexuality: a primary erotic attraction to others of the same sex Hospice care: a program that supports the client and family through the dying process and the surviving family members through the process of bereavement Human immunodeficiency virus (HIV): virus that causes AIDS Huntingtons disease: a rare hereditary and progressive degenerative disease of the central nervous system in which the person exhibits involuntary movements of the face, hands, and shoulders; progressive dementia generally parallels the movement disorder

Glossary Hyperkinesis: an attention deficit disorder characterized by restlessness, short attention span, distractibility, overactivity, difficulty in learning, and difficulty with perceptual motor function Hypnotic: any drug or agent that induces sleep Hypochondriasis: a somatoform disorder in which a client presents with unrealistic or exaggerated physical complaints Hypomania: a psychopathological state and abnormality of mood falling somewhere between normal euphoria and mania characterized by unrealistic optimism, pressure of speech and activity, and a decreased need for sleep Id: the part of the personality that is an unconscious reservoir of primitive drives and instincts dominated by thinking and the pleasure principle Ideas of reference: self-centered thoughts, in which everything is taken personally Ideational compulsion: an urge to carry out an act within ones mind Identification: a defense mechanism by which a person attempts to be like someone or to resemble the personality and traits of another to preserve his or her ego Illusion: a term used to describe the misperception of a real external stimulus such as noise or shadows Impaired nurse: term used to describe nurses who suffer from substance abuse or dependence

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and resist any offer of support or help. Others, aware of their shortcomings, go to great efforts to mask their addictions. Implosive therapy: the opposite of systematic desensitization; a therapy in which persons are exposed to intense forms of anxiety producers, either in imagination or in real life, until the stimuli no longer produce disabling anxiety.

Glossary Impulse control disorders: psychiatricmental health disorders characterized by a persons failure to resist an impulse, thus not preventing ones self from performing an act that will be

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harmful to self or others; impulse control problems may be related to functions in specific parts of the brain, due to hormonal imbalance, or due to abnormal transmission of nerve impulses Incest: sexual intercourse between family members who are so closely related as to be legally prohibited from marrying one another (blood relatives) Incompetent: incapable of giving informed consent Individual psychotherapy: a confidential relationship between client and therapist that may occur in the therapists office, outpatient clinics, or mental hospital Inferences: judgments that the nurse makes about cues during the assessment process Informed consent: permission granted by a client to the treating clinician for a procedure to be performed based on the clients understanding of the nature of the procedure, the risks involved, the consequences of withholding permission, and alternative procedures available Insight: defined as self-understanding, or the extent of ones understanding about the origin, nature, and mechanisms of ones attitudes and behavior Insomnia: disturbance in sleep pattern such as difficulty falling asleep or staying asleep Insulin shock therapy: the use of large doses of insulin to stabilize the hyperactivity of clients with a psychiatric diagnosis Integrated Model Program (IMPACT): based on Assertive Community Treatment, it allows clients to have access to whatever level of treatment they need (eg, day treatment, partial hospitalization, outpatient care). The goal of the program is to reduce clients hospital admissions and criminal involvement, improve their quality of life, and prepare them to become employed.

Glossary Intellectualization: a defense mechanism by which a person transfers emotional concerns in the sphere of the intellect; reasoning is used as a means of avoiding confrontation with unconscious conflicts and their stressful emotions

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Intentional tort: willful or wanton conduct to do a wrongful act with disregard of the interests of others Interaction-oriented approach: an approach used by nurses who view themselves as a therapeutic tool as they counsel, guide, and teach clients International Association of Forensic Nurses (IAFN): a diverse body of nurses who apply concepts and strategies to provide intervention to victims of crime or perpetrators of criminal acts Interpersonal theory: a theory by Peplau that incorporates communication and relationship concepts and focuses primarily on the nurseclient relationship in which problem-solving skills are developed during the phases of orientation, identification, exploitation, and resolution Intimate partner violence: another term for domestic or family violence Introjection: a defense mechanism by which a person attributes the good qualities of others to self; symbolically taking on the character traits of another person by ingesting the persons philosophy, ideas, etc. Introspection: self-reflection Introvert: an individual who relates better to the inner world of ideas, thoughts, and feelings Involuntary admission: the admission and detention, for at least 72 hours, of a client who poses a threat to self or others

Glossary Isolation: a defense mechanism by which a person separates an unacceptable feeling, idea, or impulse from his or her thoughts

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Judgmental: arriving at an opinion based on ones own values without enough facts or enough regard for what other people may think Klinefelters syndrome: a syndrome that occurs in males as the result of an XXY chromosome grouping (an extra X chromosome). The male appears normal until adolescence, when low levels of testosterone result in small testes, infertility, and a low level of sexual interest. Korsakoffs psychosis: a form of amnesia characterized by a loss of short-term memory and the inability to learn new skills. Clinical symptoms include disorientation and the use of confabulation. Degenerative changes in the thalamus occur because of a deficiency of Bcomplex vitamins, especially thiamine and B12. La belle indifference: an inappropriate lack of concern; indifference Labile: exhibiting unstable, rapidly shifting emotions; moody Laissez-faire group leader: a group leader who allows much freedom in the group setting Libel: printed slander, defamation, or malicious falsehood Libido: emotional energy; psychic drive (often referred to as psychosexual energy) Life review process: the use of recall and memory to review or analyze ones life and make peace with it Limit setting: a form of behavior therapy used to reduce anxiety, minimize manipulation, provide a framework for the client to function in, and enable a client to learn to make requests Living will: a document filled out by the client with specific instructions that address issues of cardiopulmonary resuscitation (CPR); life support system such as the use of a ventilator or

Glossary intubation; tube feedings or artificial nutrition and hydration; and emergency measures such as surgery, blood transfusion or antibiotics to treat end-stage diseases

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Lobotomy: a type of psychosurgery or surgical intervention that originated in 1936 in an attempt to modify or alter severe disturbances of behavior, thought content or mood in clients with a psychiatric diagnosis. This invasive surgery severs fibers connecting one part of the brain with another, or removes or destroys brain tissue. Looseness of association: synonymous with the term derailment; a disturbance of thinking shown by speech in which ideas shift from one unrelated, or minimally related, subject to another. The individual speaks in complete sentences, but the relationship between sentences does not make sense. Loss: a condition whereby an individual experiences deprivation of, or complete lack of, something that was previously present Magnetic seizure therapy (MST): a novel convulsive therapy for depression conducted in an ECT suite where clients are anesthetized in a similar fashion to ECT. High-intensity repetitive transcranial magnetic stimulation (rTMS) is used to induce focal seizures. Major depressive disorder: a mood disorder characterized by a significant lowering of the mood tone and loss of interest or pleasure in daily activities accompanied by clinical symptoms such as significant weight change, insomnia, feelings of worthlessness, etc. Male pseudohermaphrodites: terminology used to describe individuals with an inherited deficiency of the enzyme 5 x-reductase that are born with male genes and male internal organs but lack external male genitalia Malingering: the production of false or grossly exaggerated physical or psychological symptoms that are consciously motivated by external incentives to avoid an unpleasant situation

Glossary Malpractice: negligence defined by law that only applies to professionals, such as licensed nurses Managed care: the approval or certification by an insurance company granting a health care provider a specific amount of time to provide health care; recertification may be granted if the provider requests additional time to treat the client Managed care nursing: the development and implementation of health-wellness, illnessprevention, and disease-management programs Mania: behavior and mood characterized by excessive elation, inflated self-esteem, and grandiosity Marital-relations therapy: a form of couple therapy in which the therapist addresses issues such as the couples inability to communicate, conflicts, and sexual dysfunction

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Masochistic behavior: the act of experiencing pleasure or sexual arousal as a result of emotional or physical pain inflicted by oneself or by others Maturational crisis: an experience, such as puberty, adolescence, young adulthood, marriage, or the aging process, in which ones lifestyle is continually subject to change Median effective dose: the dosage of a given drug at which 50% of clients experience a specific therapeutic effect Median toxic dose: the dosage of a given drug at which 50% of clients experience a specific toxic effect Memory: the ability to recall past experiences Mental disorder or mental illness: an illness or syndrome with psychological or behavioral manifestations and/or impairment in functioning due to a social, psychological, genetic, physical/chemical, or biologic disturbance

Glossary Mental health: a positive state in which one is responsible, displays self-awareness, is selfdirective, is reasonably worry free, and can cope with usual daily tensions Mental retardation: terminology used to describe individuals who exhibit subaverage

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intelligence as measured by a standardized IQ test and deficits in adaptive functions (ie, activities of daily living) Mercy bookings: terminology used to describe arrests by police who are trying to protect individuals with serious and persistent mental illnesses Metabolic syndrome: the presence of hyperglycemia, dyslipidemia, and abdominal obesity in clients who take antipsychotic drugs Methadone: a synthetic narcotic used as a substitute substance for heroin during detoxification or withdrawal from heroin MICA: a shortened version of the acronym for mentally ill and chemically abusing, and addicted behavior MICAA: an acronym for mentally ill, chemically abusing, and addicted, which implies that the primary diagnosis is severe mental illness and the secondary diagnosis is chemical abuse or addiction Milieu therapy: an environment designed to assist clients in controlling problematic emotions and behaviors and to promote personal growth Miranda warning: a process by which an arrested person is informed of his or her legal rights Mood disorders: previously referred to as affective disorders, a large group of disorders in which pathologic mood and related disturbances occur; divided into two main categories: depression disorders and bipolar disorders

Glossary

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Mourning: a term used to describe an individuals outward expression of grief regarding the loss of a love object or person Munchausens syndrome by proxy: a well-known phenomenon in which the parent, almost invariably the mother, fabricates illness in her child or deliberately causes an illness or injury in order to assume the sick persons role by proxy Mutism: impaired communication characterized by the refusal to speak even though the person may give indications of being aware of the environment National Mental Health Act: passed in 1946, this act provided funding for states to develop mental health programs outside of state psychiatric hospitals as well as funding for the establishment of the National Institute of Mental Health (NIMH) in 1949 Needs-oriented approach: an approach used by nurses who problem solve, perform physiologic and psychosocial activities for the client, supplement knowledge, and may become temporary self-care agents for clients with self-care deficits Negative symptoms: terminology used to describe the diminution or loss of normal functions, such as affect, motivation, or the ability to enjoy activities. These symptoms are thought to be due to an inadequate amount of dopamine, cerebral atrophy, or other organic functional changes in the brain. Neglect: an act of omission that refers to a parents or other persons failure to meet a dependents basic needs such as proper food, clothing, shelter, medical care, schooling, or attention; provide safe living conditions; provide physical or emotional care; or provide supervision, thus leaving the dependent unattended or abandoning him or her Negligence: conduct that falls below the standard of care established by law for the protection of others and involves an unreasonable risk of harm to a client

Glossary Neologism: impaired communication characterized by the use of a new word or combination of several words coined or self-invented by a person and not readily understood by others Neuroleptics: antipsychotic agents that produce significant neurologic adverse effects. The terms conventional or typical antipsychotics are also used to describe neuroleptic agents Neuroleptic malignant syndrome (NMS): a potentially fatal complication of neuroleptic treatment that may develop within hours of the first dose or after years of continued drug exposure. Symptoms include, but are not limited to, severe muscular rigidity, hyperthermia, deterioration in level of consciousness, and fluctuations in blood pressure

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Neuropsychiatric syndromes: syndromes developed in clients who have tested positive for the AIDS virus (eg, HIV-associated dementia and HIV encephalopathy) Neurovegetative changes: terminology used to describe a depressed clients complaints of insomnia or hypersomnia, loss of appetite or increased appetite, loss of energy, decreased libido, and constipation Nihilism: a viewpoint that existence is senseless and useless Nonbizarre delusions: a term used to describe delusions about situations that could occur in real life; they usually have to do with phenomena that, although not real, are possible Nonverbal communication: communication that occurs though the use of vocal cues, gestures, physical appearance, distance or spatial territory, position or posture, touch, and facial expressions Not guilty by reason of insanity: a plea entered in the presence of a mental disease, such as delusional disorder, at the time of the commission of an alleged criminal act Nurse case manager: coordinates the clients continuum of care and determines the providers of care for a particular conditionsuch as depressionduring the transition process. The nurse

Glossary case manager may assume three different roles: utilization review nurse/manager, quality assurance nurse/manager, and discharge nurse/planner.

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Nurse Practice Act: a state legislative act that defines nursing and regulates standards of nursing care Nursing diagnosis: a statement of an existing problem or a potential health problem that a nurse is both competent and licensed to treat Nursing informatics: a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice Obesity: an excess in body fat; a physical condition resulting from a medical condition, diet, side effect of medications such as steroids, or compulsive eating that is psychogenic in origin Object-relations therapy: a form of couple therapy that addresses issues such as poor self esteem, recurrent dissatisfaction with spouse or partner, escalating interactions and emotional patterns, or complaints by a child or adolescent Obsessions: insistent thoughts, recognized as arising from the self, usually regarded by the client as absurd and relatively meaningless, yet persistent despite his or her endeavors to be rid of them; persistent, painful, intrusive thoughts, emotions, or urges that one is unable to suppress or ignore Obsessivecompulsive disorder (OCD): characterized by recurrent obsessions or compulsions (or a combination of both) that interfere with normal life Occupational therapy: the use of creative techniques and purposeful activities, as well as a therapeutic relationship, to alter the course of an illness; focuses on vocational skills and activities of daily living to raise self-esteem and promote independence

Glossary Omnibus Reconciliation Act: an act passed in 1987 that states that a long-term care facility must not admit, on or after January 1, 1989, any new resident needing active treatment for mental illness or mental retardation. A screening document called the Preadmission Screening and Annual Resident Review (PSARR) determines whether the client needs active psychiatric treatment. Open groups: a form of group therapy in which there are no established boundaries; members may join and leave the group at different times Open-minded: an attitude displayed by individuals who do not make decisions until they are aware of all the facts pertaining to a certain situation Oppositional defiant disorder: a conduct disorder characterized by the inability to develop skills such as flexibility, adaptability, and frustration tolerance. Clinical symptoms include negativistic, hostile, defiant behavior; loss of temper; anger; resentment; and vindictiveness. Outcome-oriented approach: an approach used by nurses who focus on maintaining and promoting energy and harmony between the client and the environment Pain disorder: characterized by the presence of significant pain without physical basis or with pain that greatly exceeds what is expected on the basis of injury Palliative care: the active total care of clients whose disease is not responsive to curative treatment Panic disorder: an anxiety disorder characterized by recurrent, sudden, overwhelming anxiety or panic attacks followed by persistent concern about having panic attacks Paradigm of balancing factors: factors which can effect a return from crisis to equilibrium

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including a realistic perception of an event, adequate situational support, and adequate defense or coping mechanisms to help resolve a problem

Glossary

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Paradoxical conduct: delusional phenomenon in which the client interprets all denials of love, no matter how clear the denial, as secret affirmations of love Paranoia: a rare condition characterized by a delusional system that develops gradually, becomes fixed, and is based on the misinterpretation of an actual event; thought process appears clear and orderly; reality testing is intact; affects remains appropriate; sociability is maintained; and delusions are persecutory or grandiose in content Paranoid: terminology used to describe a wide range of behaviors, from aloof, suspicious, and nonpsychotic behaviors to well-systematized and psychotic symptoms Paranoid schizophrenia: a subtype of schizophrenia in which clients experience persecutory or grandiose delusions and auditory hallucinations, and may exhibit behavioral changes such as anger, hostility, or violent behavior. Clinical symptoms may pose a threat to the safety of self or others. Paraphilia: a disorder in which unusual or bizarre sexual acts or imagery are enacted to achieve sexual excitement; involving recurrent intense sexual urges and sexually arousing fantasies generally involving nonhuman objects Parasuicide: self-injury (eg, self-inflicted wounds) by individuals who usually do not wish to die but rather is often a coping method used to deal with disturbing thoughts or emotions or to relieve tension Parataxis: the presence of distorted perception or judgment exhibited by the client during therapy thought to be the result of earlier experiences in interpersonal relationships; also referred to as parataxic distortion or transference Parataxic distortion: an inaccurate perception in interpersonal relations based on earlier life experiences; also referred to as parataxis or transference

Glossary

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Parish nursing: a nursing specialty that promotes health and wellness of body, mind, and spirit Parkinsons disease: a degenerative disorder of the basal ganglia characterized by rhythmical muscular tremors, rigidity of movement, festination, droopy posture, and a masklike face Parkinsonism: neuromuscular or neurologic adverse effects associated with the use of antipsychotics that can occur after the first week of drug therapy characterized by motor retardation or akinesia, a masklike face, rigidity, tremors, pill rolling and salivation Paternalism: behavior demonstrated by nurses who impose their own methods for care and treatment decisions on clients because think that they know what is best for them Patient Self-Determination Act: passed in 1990, this act states that every competent individual has the right to make decisions about his or her health care Pavlovs theory of conditioning: a behavior modification theory that states that a stimulus elicits a response Peak plasma concentration: refers to the quantity of psychotropic drug present in the plasma following metabolism and prior to excretion Pedophilia: the use of prepubertal children to achieve sexual gratification Persecutory delusions: delusions characterized by a belief that one is being conspired against, spied on, poisoned or drugged, cheated, harassed, maliciously maligned, or obstructed in some way Perseveration: the inappropriate continuation or repetition of a behavior such as giving the same details over and over even when told one is doing so; impaired communication characterized by repetitive expression of a single idea in response to various questions Personality: the total of a persons internal and external patterns of adjustment to life, determined in part by genetically transmitted organic endowment and by life experiences

Glossary Personality disorder: a pervasive pattern of experience and behavior that is abnormal with respect to thinking, mood, personal relations, and the control of impulses Personality traits: distinguishing characteristics of ones personality Persuasion: a phase of the Stages of Change Model in the treatment of clients with dualdiagnosis that focuses on helping clients recognize the need to address problematic behaviors and symptoms and to identify methods to activate change Pharmacodynamics: the study of the biochemical and physiologic effects of drugs and the mechanisms by which the effects are produced (basically, the effects of a drug on the body) Pharmacogenomics: prescribing drugs based on the clients complete DNA structure

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Pharmacokinetics: the study of the movement of drugs and their metabolites through the body from absorption to excretion (basically, what the body does to the drug) Phobia: an irrational fear of an object, activity, or situation that is out of proportion to the stimulus and results in avoidance of the identified object, activity, or situation Physiological dependence: physical symptoms experienced by a client following the need to repeatedly use a substance as evidenced by tolerance or withdrawal Physiotherapy: the application of hydrotherapy and massages to induce relaxation in clients Pica: an eating abnormality characterized by eating non-nutritive substances such as paper or clay Picks disease: a rare type of cerebrodegenerative disease manifested primarily as dementia in which there is a striking atrophy of the frontal and temporal lobes Polypharmacy: the use of several over-the-counter drugs, prescription drugs, or a combination of both to treat various symptoms without the supervision of a health care provider

Glossary

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Positive symptoms: the presence of overt psychotic or distorted behavior, such as hallucinations, delusions, or suspiciousness, possibly due to an increased amount of dopamine affecting the cortical areas of the brain Postictal agitation: a phenomenon that occurs as a client emerges from anesthesia following ECT characterized by clinical symptoms of marked motor restlessness, agitation, incoherence, disorientation, and a fluctuating level of consciousness Post-traumatic stress disorder (PTSD): a syndrome that develops after an individual sees, is involved in, or hears about a traumatic experience Postvention: a therapeutic program for bereaved survivors of a suicide that allows family members or other survivors to vent their feelings Potency: the relative dosage of a drug that is required to achieve a desired effect Poverty of speech content: terminology used to describe the content of a clients answer that is vague or obscure Pre-admission Screening and Resident Review (PASRR): a screening test used to determine the presence or absence of a serious mental illness in clients prior to the admission to a long-term care facility Prejudice: feelings of intolerance or unfavorable opinions about race, religion, or people Premenstrual dysphoric disorder (PDD): a recurring and severe form of premenstrual syndrome (PMS) that causes impaired social and occupational functioning and affects interpersonal relationships with family and friends Premorbid: refers to period of time or state before the onset of a disorder

Glossary Primary aging: also referred to as intrinsic aging, primary aging occurs as a result of biologic and physiologic changes influenced by ones gender; ethnicity and race; intelligence and personality; familial longevity patterns; and genetic disease Primary effects: changes in emotions, behavior, and cognition that occur as a drug is synthesized, released, and metabolized, and acts on the receptor sites of a neurotransmitter system Primary gain: allows relief from anxiety by keeping an internal need or conflict out of ones awareness Primary prevention: the intervention of identifying and eliminating factors that cause or contribute to the development of an illness or disorder that could lead to suicide Privacy: the right to be left alone and free from intrusion or control by the public or, in this situation, health care providers

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Privileging process: a privilege granted to certain licensed health care providers (eg, physicians and nurse practitioners) to provide care for hospitalized clients, clients admitted to long-term care facilities, and clients admitted to subacute care facilities Process recording; a tool used to analyze nurseclient interactions that are seen in various formats. It is used to teach communication skills to student nurses in the clinical setting and focuses on verbal and nonverbal communications. Professional boundaries: limits that protect the space between the professional nurses power and the clients vulnerability in a therapeutic relationship Programs for Assertive Community Treatment (PACT): an integrated program with the goal to help clients with schizophrenia and related disorders, such as depression or substance abuse, stay out of psychiatric hospitals and live independently. Available 24 hours a day, 7 days a week, it

Glossary provides professional staff to meet clients where they live and provide at-home support at whatever level is needed to solve any problem.

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Projection: a defense mechanism in which a person rejects unwanted characteristics of self and assigns them to others Projective identification: the ability to project uncomfortable or aggressive aspects of ones own personality onto external objects Prospective payment system (PPS): a form of managed care that governs payment for psychiatric treatment by setting forth specific criteria. The per diem rate covers all costs related to services provided and is based on client need and resources used. Protective nursing care: providing observation and care so that the client does not injure himself or herself, injure others, or become injured when around other clients Pseudoneurologic manifestation: sensory/motor loss that does not follow neurologic function but rather comes and goes with stress or a functional need Psychalgia: psychogenic pain disorder in which severe, prolonged pain is due to psychological factors Psychiatric nursing: the diagnosis and treatment of human responses to actual or potential mental health problems. It is a specialized area of nursing practice that uses theories of human behavior as its scientific framework and requires the purposeful use of self as its art of expression. It is concerned with promoting optimum health for society. Psychoanalysis: a lengthy method of psychotherapy in which the client talks in an uncontrolled, spontaneous manner termed free association; exploration of repressed anxieties, fears, and childhood images occurs by the interpretation of dreams, emotions, and behaviors

Glossary

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Psychodrama: a form of group therapy by which persons use dramatization to express their own or assigned emotional problems Psychogenic polydipsia: characterized by the compulsive behavior of drinking 3 liters or more of fluid per day Psychological autopsy: a process used to examine what clues, if any, were missed following a successful suicide by a client so that staff members can learn from the evaluation of a particular situation. This process also provides staff with an opportunity to self-assess their behavior and responses and discuss their concerns with peers. Psychological dependence: characterized by continuous or intermittent craving for a substance to avoid a dysphoric or unpleasant mood state Psychological factors (anxiety) affecting medical condition: characterized by the presence of one or more specific psychological or behavioral factors such as anxiety (or depression) that adversely affect a general medical condition. The factors may influence the course of the general medical condition, precipitate or exacerbate symptoms of the general medical condition, and constitute an additional health risk. Psychomotor agitation: excessive motor activity associated with a feeling of inner tension Psychomotor retardation: a generalized slowing of physical and emotional reactions Psychopharmacology: the study of the mediation and modulation of emotions, behavior, and cognition through the interactions of endogenous or internal signaling substances or chemicals such as dopamine, glutamate, or serotonin and drugs Psychosis: a mental disorder in which a person experiences an impairment of the ability to remember, think, communicate, respond emotionally, interpret reality, and behave appropriately

Glossary

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Psychosurgery: a collective term used for surgical interventions such as lobotomy that originated in 1936 Psychotherapy: a process by which a person who wishes to relieve symptoms, resolve problems in living, or seek personal growth enters into a contract with a psychotherapist to interact in a prescribed way Psychotic disorder due to a general medical condition: characterized by the presence of prominent hallucinations or delusions judged to be due to the direct physiologic effects of a specific medical condition Psychotropic drugs or agents: chemicals that alter feelings, emotions, and consciousness in various ways; used therapeutically in the practice of psychiatry to treat a broad range of mental and emotional disorders Purging: attempts to eliminate the body of excess calories by induced vomiting; abuse of laxatives, enemas, diuretics, diet pills, or stimulants; excessive exercise; or a refusal to eat Quality assurance nurse: accountable for the overall quality of care being delivered and often serves as a member of the risk management team, investigating any legal issues that may develop during the clients hospitalization Rape: the act of using force, threat, intimidation, or duress to engage in vaginal, oral, or anal penetration with a nonconsenting adult or child victim Rape-trauma syndrome: a nursing diagnosis used to describe a victims response to rape, including an acute phase of disorganization and a longer phase of reorganization in the victims life Rapid-cycling: a state characterized by the occurrence of four or more mood episodes during the previous 12 months; a course modifier for the differential diagnosis of BPD

Glossary Rationalization: the act of justifying ideas, actions, or feelings with acceptable reasons or explanations

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Reaction-formation: the act of displaying the exact opposite behavior, attitude, or feeling of that which one would normally show in a given situation Reactive obesity: obesity that occurs in later life, when compulsive eating is used to cope with stress Regression: reversion to past levels of behaviors to reduce anxiety and allow one to become dependent on others Regulator: an internal coping mechanism, identified in Roys Theory of Adaptation, that regulates an individuals physiologic response to stress Religion: a specific manifestation of ones spiritual drive to create meaning in the world and to develop a relationship with God Reminiscence: a therapeutic process in which an individual client or group of clients consciously seek and share memories of past significant experiences and events Repression: the inability to recall painful or unpleasant thoughts or feelings, since they are automatically and involuntarily pushed into ones unconsciousness Residual schizophrenia: a subtype of schizophrenia characterized by the presence of negative symptoms following at least one acute episode of schizophrenia. Clinical symptoms may persist over time, or the client may experience a complete remission. Residual symptoms: phase of an illness that occurs after the remission of the initial clinical symptoms

Glossary Resistance: the conscious or unconscious psychological defense against bringing repressed thoughts into conscious awareness; may also occur and interfere with the clients ability to benefit from psychotherapy

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Respite care for the homeless: a form of continuum of care that is currently available for clients with SPMI, offering recuperative services for clients who are too sick to be on the street or in shelters, but who are not sick enough to need acute inpatient beds Restitution or undoing: the negation of a previous consciously intolerable action or experience to reduce or alleviate feelings of guilt Retrograde amnesia: the loss of memory of events occurring before a particular time in a persons life Retts disorder: an X-linked progressive neurodevelopmental disorder considered to be one of the most common causes of mental retardation in girls Risk management: a systematic approach to the prevention of financial loss that evolved in the mid-1970s to decrease liability exposures, integrate risk reduction strategies, and ultimately create a risk-free environment Risk nursing diagnosis: nursing diagnosis based on a clinical judgment of the clients degree of vulnerability to the development of a specific problem Russells sign: callus formation on finger due to self-induced purging Sadistic behavior: the act of achieving sexual excitement from the psychological or physical suffering of another Scapegoat: a term used to describe the role within a family of a person who is the object of the angry, hostile, frustrated, or ambivalent emotions experienced by various family members

Glossary Schemata: methods of assimilating and accommodating incoming information described as looking schema, hearing schema, and sucking schema

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Schizoaffective disorder: a schizophrenic-like disorder characterized by an uninterrupted period of illness during which, at some time, there is a major depressive, manic, or mixed episode concurrent with the negative symptoms of schizophrenia Schizophrenia: a psychotic disorder characterized by positive (eg, hallucinations, delusions) and negative symptoms (eg, flat affect, inability to experience pleasure) associated with disturbance in one or more major areas of functioning Schizophreniform disorder: a schizophrenic-like disorder characterized by features of schizophrenia for more than 1 month but less than 6 months; impaired social or occupational functioning does not necessarily occur Scope of forensic nursing practice: encompasses application of the nursing-related sciences, including biopsychosocial education, to public or legal proceedings; application of the forensic aspects of health care in scientific investigation; and treatment of trauma or death victims and perpetrators (or alleged perpetrators) of abuse, violence, criminal activity, and traumatic accidents Seasonal affective disorder (SAD): a pattern of major depressive episodes in which the clinical symptoms occur at characteristic times of the year Secondary aging: also referred to as extrinsic aging, secondary aging occurs as the result of external factors such as employment, economic level, education, health practices and related diseases, and societal attitude Secondary effects: changes in emotions, behavior, or cognition that occur due to druginfluenced interactions among the neurotransmitters, neuropeptides, and hormones in the brain

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Secondary gain: other than relief from anxiety, any benefit or support from the environment that a person obtains as a result of being sick Secondary infectious diseases: the term used to describe infectious diseases that occur in individuals infected with AIDS (eg, Pneumocystis carinii pneumonia and Kaposis sarcoma, a rare form of skin cancer) Secondary insomnia: insomnia related to a psychiatric disorder such as depression, anxiety, or schizophrenia; general medical or neurologic disorders; pain; or substance abuse Secondary prevention: the intervention of attempting to identify and treat physical or mental health disorders in the early stages before they become disturbing to an individual Secondary traumatization: a phenomenon in which nurses who provide direct or indirect care to clients during a traumatic event experience an occupational acute stress disorder characterized by recurrent images or nightmares about the traumatic event Sedative-hypnotic: an agent used to induce a state of natural sleep, reduce periods of involuntary awakening during the night, and increase total sleep time Self-actualization: a state of mental health in which an individual has a positive self-concept, relates well to people and the environment, is able to form close relationships with others, makes decisions pertaining to reality rather than fantasy, is optimistic and able to appreciate and enjoy life; self-fulfillment that occurs only after the lower needs of survival, safety and security, love and belonging, and a positive sense of self-esteem have been met Self-awareness: the ability to recognize the nature of ones own attitude, emotions, and behavior Self-medication hypothesis: a hypothesis based on the assumption that individuals with a psychiatric disorder use drugs to help them feel calmer or to alleviate clinical symptoms to achieve emotional homeostasis

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Serious and persistent mental illness (SPMI): also referred to as severe and persistent mental illness, SPMI is the currently accepted term for a variety of mental health problems that lead to tremendous disability Sex: one of four primary drives of human beings that also include thirst, hunger, and avoidance of pain Sexual abuse: also referred to as sexual assault, includes the acts of sexual harassment, stalking, sexual coercion, and rape Sexual acts: behaviors that involve the genitalia and erogenous zones Sexual addiction: the act of engaging in obsessivecompulsive sexual behavior that causes severe stress to addicted individuals and their families Sexual assault nurse examiners (SANE): nurse examiners trained to collect forensic evidence from sexual assault survivors Sexual behavior: how one responds to sexual impulses and desires Sexual coercion: behavior in which one person forces or compels another person to engage in a sexual act Sexual dysfunction disorder: involve an impairment of the sexual physiologic response Sexual harassment: any unwelcome sexual advance or conduct on the job that creates an intimidating or offensive working environment Sexual identity: the pattern of a persons biological sexual characteristics including chromosomes, external genitalia, internal genitalia, hormonal composition, gonads, and secondary sex characteristics Sexuality: the result of biologic, psychological, social, and experiential factors that mold an individuals sexual development, self-concept, body image, and behavior

Glossary Sexual misuse of a child: sexual activity that is inappropriate because of the childs age, development, and role within the family unit. Examples of sexual misuse of a child include fondling, genital manipulation, voyeurism, pornography, or exhibitionism.

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Sexual orientation: the object of an individuals sexual impulses (ie, heterosexual, homosexual, or bisexual) Shaken baby syndrome: physical findings caused by violently shaking a baby include bruising and major head injury such as subdural hecatomb or cerebral edema. Nonfatal consequences include blindness due to retinal hemorrhage, cerebral palsy, and cognitive impairment Shared psychotic disorder: another term for folie deux; occurs more frequently in women who are isolated by language, culture, or geography Signal anxiety: the activation of a defensive response to an anticipated anxiety-producing event to avoid the feeling of being overwhelmed Significant others: support persons Silent rape syndrome: a maladaptive stress reaction in which a victim fails to disclose information about rape to anyone, is unable to resolve feelings about the sexual assault, experiences increased anxiety, and may develop a sudden phobic reaction. Behavioral changes may include depression, suicidal behavior, somatization, and acting-out. Situational crisis: an extraordinarily stressful event such as a plane crash or divorce that affects an individual or a family regardless of age group, socioeconomic status, or sociocultural status Skinners Theory of Operant Conditioning: a behavior modification theory which states that the results of a persons behavior determine whether the behavior will recur in the future Slander: a false statement, misrepresentation, or malicious fabrication

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Sleep pattern disturbance: a disruption in ones normal sleep pattern resulting in the inability to fall asleep, stay asleep, or sleeping too much Social anxiety disorder (SAD): a compelling desire to avoid situations in which others may criticize a person Social communication: interaction that occurs daily between the nurse and client; often referred to as small talk Social phobia: another term for social anxiety disorder Sodomy: the legal term for male rape Somatic delusions: delusions which are fixed, unarguable, and presented intensely, because the client is convinced that a medical problem exists Somatic therapy: the biologic treatment of mental disorders such as electroconvulsive therapy, clinical psychopharmacology, and physiotherapy Somatization (Briquets) disorder: a free-floating anxiety-related disorder in which a client expresses emotional turmoil or conflict through a physical system, usually with a loss or alteration of physical functioning Somatoform disorder: an anxiety-related disorder that differs from psychological factors affecting medical condition in that somatoform disorders are reflected in disordered physiologic complaints or symptoms, are not under voluntary control, and do not demonstrate organic findings Specific phobia: excessive fear of an object, an activity, or a situation that leads a person to avoid the cause of that fear

Glossary Spiritual distress: the state in which an individual or group experiences or is at risk of experiencing a disturbance in the belief or value system that provides strength, hope, and meaning to life

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Spirituality: a feeling that refers to a persons belief in, or example of, a power apart from his or her own existence; a personal quality that strives for inspiration, reverence, awe, meaning, and purpose in life Splitting: the inability to integrate and accept both positive and negative feelings at the same moment Split-treatment psychotherapy: also referred to as dual treatment, triangulated treatment, or medication backup, this therapy involves a protocol between a nurse therapist who provides psychotherapy and a psychiatrist or nurse practitioner who provides pharmacotherapy for the client Stages of Change Model: developed by Prochaska and DiClemente (1982); based on scientific investigation of change in humans; conceptualizes change is difficult and several stages (precontemplation, contemplation, preparation, determination, action, maintenance, and relapse) are experienced as an individual attempts to modify a habit Stalking: a pattern of harassing or menacing behavior coupled with a threat to do harm Standardized nursing care plans: care plans developed and used in the clinical setting for specific nursing diagnoses such as Anxiety and Fear Standards of practice: authoritative statements used by the nursing profession to describe the responsibilities for which nurses are accountable. They provide direction for professional nursing practice and a framework for the evaluation of practice. They also define the nursing

Glossary professions accountability to the public and the client outcomes for which nurses are responsible. Standards of Professional Performance: describes a competent level of behavior by the forensic nurse, including activities related to quality of services, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization

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Statutory rape: the act of sexual intercourse with an individual younger than the age of consent (usually 16 years) Stereotype: to categorize or express an opinion lacking in originality Stereotyping: assuming that all members of a particular group are alike Sterilization: an invasive surgical procedure (eg, ligation of the fallopian tubes in a woman and excision of part of the vas deferens in a man) performed on clients who exhibited inappropriate or aggressive sexual behavior Stigmatization: the act of setting a mark of disgrace or shame upon an individual Stimulant: an agent that directly stimulates the central nervous system and creates a feeling of alertness and self-confidence in the user Subacute care unit: units that provide time-limited, goal-oriented care for clients who do not meet the criteria for continued hospitalization Subculture: a smaller group that exists within a larger culture. Members of a subculture may have in common such things as age, gender, race, ethnicity, socioeconomic status, religious and spiritual beliefs, sexual orientation, occupation, and even health status. Sublimation: the rechanneling of consciously intolerable or socially unacceptable impulses or behaviors into activities that are personally or socially acceptable

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Substance use: the ingestion of a chemically active agent such as over-the-counter medication, a prescribed drug, or illicit drug, alcohol, or nicotine Substitution: the act of finding another goal when one is blocked Suffering: a process or state of severe distress associated with injury or events that threaten the composure, integrity, and fulfillment of our intentions. Manifestations of suffering may be behavioral (eg, withdrawal or avoidance of contact with family or caregiver), emotional (eg, anger or depression), physical (eg, impaired sleep or fatigue), or spiritual (eg, a sense of alienation or emptiness) Sundown syndrome: characterized by increased confusion, restlessness, agitation, wandering, or combative behavior in the late afternoon and evening hours; may be seen in clients with dementia Superego: the part of the personality that acts as the censoring force or conscience of the personality, it is composed of morals, mores, values, and ethics largely derived from ones parents, and operates at all three levels of consciousness Suppression: the act of willfully or consciously putting a thought or feeling out of ones mind, with the ability to recall the thought or feeling at will Symbolization: an object, idea, or act represents another through some common aspect and carries the emotional feeling that is associated with the other Syndrome nursing diagnosis: refers to a cluster of actual or high-risk diagnoses that are predicted to be present because of a certain event or situation Systematic desensitization: behavior therapy used to eliminate a clients fears or anxieties by stressing relaxation techniques that inhibit anxious responses

Glossary Systems-oriented theory: theory, developed by Rogers, which considers the individual to be part of the family system, states that stress in one part of the system (eg, family) affects other parts of the system, and postulates that changes in family structure contribute to changes in the behavior of individuals Tangentiality: response to a question with a reply that is appropriate to the general topic but does not specifically answer the question Tarasoff decision: the duty to warn a potential victim of threats of bodily harm made by a specific person takes precedence over the duty to protect the identity or confidentiality of the person making threats Tardive dyskinesia (TD): terminology used to describe the most frequent neuromuscular or neurologic adverse effects associated with the use of antipsychotics that occur during disrupt termination of the drug, during reduction in dosage, or after long-term high-dose therapy. Characterized by involuntary, rhythmic, stereotyped movements; protrusion of the tongue; puffing of the cheeks; and chewing movements Telehealth: the act of providing nursing assessment, consultation, and education by telephone

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Tertiary effects: final changes in clinical symptoms induced by a drug, such as the stabilization of anxiety or depression Tertiary prevention: an intervention to reduce residual disability after an illness Theory: a branch of science that deals with conceptual principles that describe, explain, and predict a class of phenomena; an organized, coherent, and systematic articulation of a set of statements related to significant questions in a discipline that are communicated in a meaningful whole. It is a symbolic depiction of aspects of reality that are discovered or invented to describe, explain, predict, or prescribe responses, events, situations, conditions, or relationships.

Glossary Theory of Adaptation: theory by Roy that states that human beings use two major internal coping mechanisms, the regulator and cognator, to adapt to both internal and external stimuli Theory of Human Becoming: theory by Parse that states the role of the nurse is to guide the

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client or simply be with him or her to bear witness to the clients experiences. Three themes are noted: meaning, rhythmicity, and transcendence. Theory of Self: according to theorists, the internal view of personal existence, referred to as the self, tries to maximize its own self-esteem, seeks pleasure, and avoids pain. The maintenance, protection, and enhancement of the self may be the basic motive for behavior. The self takes precedence over the physical body as individuals often sacrifice physical comfort and safety for psychological satisfaction. Therapeutic communication: an interaction in which the nurse helps or encourages the client to communicate perceptions, fears, anxieties, frustrations, expectations, and increased dependency needs Therapeutic index: the ratio of the median effective dose to the median toxic dose; also referred to as the therapeutic window Therapeutic lifestyle change counseling (TLC): an important behavior modification tool used in clinical practice. Similar to the Stages of Change Model, TLC counseling utilizes motivational behavioral techniques to implement necessary lifestyle changes of clients with chronic conditions or illnesses; indicated as secondary prevention and management for many medical and psychiatric diagnoses such as substance abuse, nicotine abuse, and obesity due to overeating or sedentary lifestyle.

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Therapeutic milieu: an environment created to help clients develop a sense of self-esteem and personal worth, feel secure, establish trust, improve their ability to relate to others, and return to the community Therapeutic relationship: a planned and goal-directed interaction between a nurse and a client for the purpose of providing care to the client and the clients family or significant others Therapeutic window: another term for therapeutic index Tic: a rapid, largely involuntary movement or noise Tolerance: the need for markedly increased amounts of a specific drug over time to achieve a desired effect Tourettes syndrome: also known as Gilles de la Tourettes syndrome, characterized by a combination of motor tics and involuntary vocal and verbal utterances that often are obscene (coprolalia). Repeating ones own sounds or words (palilalia); repeating the last-heard sound, word, or phrase (echolalia); and imitating someone elses movements (echokinesis) may be present. Transference: the unconscious assignment to others of feelings and attitudes that were originally associated with important figures (eg, parents, siblings, or teachers) in ones early life; also referred to as parataxic distortion Transgender: an umbrella term to describe transsexuals, transvestites, and hermaphrodites Transinstitutionalization: the process of transferring state hospital clients to other facilities. Nursing home placement and incarceration remain a significant component of transinstitutionalization. Transcranial magnetic stimulation (TMS): an investigational technique that was first developed in 1985 and now used in the treatment of clients with clinical symptoms of major

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depression, auditory hallucinations, and other psychiatric and neurologic disorders. TMS uses a specialized electromagnet placed on the clients scalp to generate short magnet pulses, similar to the strength of an MRI scanners magnetic field but much more focused. These pulses stimulate the underlying cerebral cortex. Transsexual: individuals whose sexual identities are entirely with the opposite sex Transvestite: cross-dressers who derive sexual pleasure from dressing or masquerading in the clothing of the opposite sex Trichotillomania: compulsive hair pulling Turners syndrome: seen in females, occurs as the result of a missing sex chromosome (XO grouping instead of XX combination). The female appears short in stature and lacks functioning gonads. During puberty, breasts do not develop and menses does not occur. Typical antipsychotics: another term for neuroleptics or conventional antipsychotics Undifferentiated schizophrenia: a subtype of schizophrenia characterized by atypical symptoms that do not meet the criteria for the subtypes of paranoid, catatonic, or disorganized schizophrenia. The client may exhibit both positive and negative symptoms. Odd behavior, delusions, hallucinations, and incoherence may occur. Undoing: see Restitution Unresolved grief: also referred to as dysfunctional grief, characteristics include expressions of distress or denial of the loss; changes in eating and sleeping habits; mood disturbances, such as anger, hostility, or crying; and alterations in activity levels, including libido or sex drive Utilization review nurse: terminology used to describe a nurse who has been trained to monitor the care of clients with different diagnoses to be certain that the care is appropriate and given in a timely manner

Glossary Vagus nerve stimulation (VNS): used in the treatment of depression; a thin, round pulse generator or battery is implanted under the skin to conduct impulses of electrical energy to stimulate the vagus nerve that originates in the brain

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Verbal communication: the process of speaking to a receiver or listener, who then decodes the verbal message and may verbally respond or provide feedback to the initiator of the message Verbigeration: impaired communication characterized by the meaningless repetition of incoherent words or sentences Voluntariness hearing: a process in which an objective professional, such as the registered nurse, asks the minor in a private interview if he or she has voluntarily agreed to obtain psychiatric care or if coercion has occurred Voyeurism: the achievement of sexual pleasure by looking at unsuspecting persons who are naked, undressing, or engaged in sexual activity Vulnerability model: based on the assumption that drug use causes a mental disorder Ward Atmosphere Scale: an instrument used to evaluate the effectiveness of a therapeutic milieu or environment Waxy flexibility: describes the posturing behavior of the catatonic person who maintains the position in which he or she has been placed Welcome Home Ministries: a faith-based community program in California that supports women who have recently been released from prison Wellness nursing diagnosis: a nursing diagnosis that focuses on clinical judgment about an individual, group, or community transitioning from a specific level to a higher level of wellness Wernickes encephalopathy: an inflammatory hemorrhagic, degenerative condition of the brain caused by a thiamine deficiency. Lesions occur in the hypothalamus, mammillary bodies, and

Glossary tissues surrounding ventricles and aqueducts. Clinical symptoms include double vision, involuntary and rapid eye movements, lack of muscular coordination, and decreased mental function, which may be mild or severe.

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Word salad: a disturbance in form of thought. The clients speech contains a mixture of words and phrases that lack comprehensive meaning or logical coherence. Workplace violence: terminology used to describe any physical assault, threatening behaviors, verbal abuse (eg, obscene phone calls, intimidation, or harassment), stalking, and psychological trauma that takes place in the work environment Writ of habeas corpus: a legal term used to describe a probable cause hearing within 3 court days of admission to secure a speedy recovery from involuntary detention if a client is found sane in a court of law Yin-yang: a Chinese term that regulates health, yin represents female, cold, and darkness; yang represents male, hot, and light Zones of distance awareness: zones used to describe spatial territory assumed by adults during communication or interaction with other adults; referred to as intimate, personal, social, and public zones