Karen G. Pounds PhD, APRN, BC Northeastern University Bouve College School of Nursing Boston, Massachusetts

Transcription

1 Karen G. Pounds PhD, APRN, BC Northeastern University Bouve College School of Nursing Boston, Massachusetts

2 1. Identify one feature of social dysfunction for the client with schizophrenia. 2. Verbalize understanding of the impact of social dysfunction on the development of the nurse client relationship. 3. Identify one potential nursing intervention for use with clients with social cognitive deficits.

3 A set of cognitive processes applied to the recognition, adaptive processing, and effective use of social cues in real-world situations (Brothers, 1990) Social Cognition may be a mediator between neurocognitive functioning and social outcomes in the real world (Anselmetti et al 2009)

4 Executive functioning Memory Attention

5 Cognitive or thinking processes that allow one to: Problem solve Set priorities Sequence activities (i.e. steps involved in ADL s) Organize thoughts

6 Ability to store information and draw upon it for later interactions Memory of voice inflections Body language Facial expressions

7 Ability to focus and concentrate on one object or encounter Cognitive Flexibility ability to shift attention between various components of verbal and nonverbal behavior (also necessary for executive functioning) Important for memory

8 Facial emotion recognition Vocal affect recognition Theory of Mind Attributional Biases (causal understanding of behaviors of others)

9 Multiple negative symptoms of the disorder Delusional despite medication Makes sporadic eye contact with the nurse Stares straight ahead during the session Interacts / Reacts only when the RN uses exaggerated facial features and voice inflection Able to use humor in positive connection with nurse

10 Auditory and visual hallucinations despite medication Wore sunglasses throughout the sessions Head and body directed toward the nurse Use of Humor

11 Ability to understand emotions of others by reading facial expressions Process involved in facial emotion is different than recognition of objects Example

12 Emotions conveyed by speech Tone of voice Important for perception of emotional state and intentions of others Reading between the lines of sentences of others

13 Perspective Taking Ability to read mental states of others from facial and vocal cues and nonverbal behavior Example:

14 Determines how individuals infer the causes of particular positive or negative behaviors of others Verbal Behavior External, Situational or Internal Locus of Control

15 How do we understand the symptoms displayed by Gary and Jane? What is it like to interact with him/her? What pieces of the interaction are missing?

16 What are we already doing? Social skills training CBT strategies Social Cognition and Interaction Training (SCIT)

17 Practice Purposive use of Verbal & Nonverbal Behavior Therapeutic Value of Humor Critical Reflective Inquiry Use of Cognitive Behavioral Therapy principles Group therapy, Social skills practice, journaling

18 Education A more accurate world view of the individual with schizophrenia Practice of attention to verbal & nonverbal behaviors of patients Skill set of interventions for patients with severe and persistent mental illnesses

19 Policy Incorporation of knowledge into policy of care of clients with schizophrenia (ISPN, ANA, APNA, 2005) Update the standards of psychiatric nursing practice

20 Novice versus Expert Nurse Long term versus short term relationships how do we help clients improve social cognition via social skills? How do nurses utilize knowledge of social cognitive deficits in care of clients with schizophrenia?

21 Are there differences in techniques used with male versus female clients? Cultural influences? Inpatient / acute phase versus maintenance / outpatient phase: similarities and differences

22 Introduction to Social Cognition, as it applies to schizophrenia Influence of components of social cognition on patient s interactional style /connection with others Nurse s application of knowledge about social cognition and its influence on social competency in schizophrenia What cues do you notice in clients with schizophrenia? What are your individualized approaches to these patients?

23 Karen G. Pounds PhD, APRN, BC Northeastern University Bouve College School of Nursing Boston, Massachusetts 1

24 A set of cognitive processes applied to the recognition, adaptive processing, and effective use of social cues in real-world situations (Brothers, 1990) Social Cognition may be a mediator between neurocognitive functioning and social outcomes in the real world (Anselmetti et al 2009) 2

25 Executive functioning Memory Attention 3

26 Facial emotion recognition Vocal affect recognition Theory of Mind Attributional Biases (causal understanding of behaviors of others) 4

27 Multiple negative symptoms of the disorder Delusional despite medication Makes sporadic eye contact with the nurse Stares straight ahead during the session Interacts / Reacts only when the RN uses exaggerated facial features and voice inflection Able to use humor in positive connection with nurse 5

28 Ability to understand emotions of others by reading facial expressions Process involved in facial emotion is different than recognition of objects Example 6

29 Emotions conveyed by speech Tone of voice Important for perception of emotional state and intentions of others Reading between the lines of sentences of others 7

30 Perspective Taking Ability to read mental states of others from facial and vocal cues and nonverbal behavior Example: 8

31 Determines how individuals infer the causes of particular positive or negative behaviors of others Verbal Behavior External, Situational or Internal Locus of Control 9

32 How do we understand the symptoms displayed by Gary? What is it like to interact with him? What pieces of the interaction are missing? 10

33 What are we already doing? Social skills training CBT strategies Social Cognition and Interaction Training (SCIT) 11

34 Practice Purposive use of Verbal & Nonverbal Behavior Therapeutic Value of Humor Critical Reflective Inquiry Use of Cognitive Behavioral Therapy principles Importance of Group therapy 12

35 Education A more accurate world view of the individual with schizophrenia Practice of attention to verbal & nonverbal behaviors of patients Skill set of interventions for patients with severe and persistent mental illnesses 13

36 Policy Incorporation of knowledge into policy of care of clients with severe and persistent mental illnesses Update the standards of psychiatric nursing practice 14

37 Novice versus Expert Nurse vis a vie the therapeutic relationship Long term versus short term relationships how do we help clients improve social cognition via social skills? How do nurses utilize knowledge of social cognitive deficits in care of clients with schizophrenia? 15

38 Are there differences in techniques used with male versus female clients? Cultural influences? Inpatient / acute phase versus maintenance / outpatient phase: similarities and differences 16

39 Introduction to Social Cognition, as it applies to schizophrenia Influence of components of social cognition on patient s interactional style /connection with others Nurse s application of knowledge about social cognition and its influence on social competency in schizophrenia What cues do you notice in clients with schizophrenia? What are your individualized approaches to these patients? 17