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CHAPTER 35 CoDependency

p 712 Application of the Nursing Process to

Addictions
Etiology & Ideas of codependency - aka Enabling, coalcoholic, high
caretakers
Defined: Codependency is progressive - but treatable... That's the good
news characterized by self defeating behaviors, distorted thinking (w/b
explained later), problems expressing FEELINGS, difficulty c
relationships... Hi caretaking behaviors - really to control.
Begins in family of origin. In a codependency family system... may be an
addict - addicted to a substance, legitimate or illegitimate (illegal)
drugs, substances - or addicted behaviorally to gambling, work, food,
sex, spending, etc. etc..) ... one mentally ill, physically ill or
strongly moralistic orientation. Family of origin: rigid, unwritten
rules that encourage dishonesty - much manipulation - prevention of
normal development - show one face to the community --- much diff than
that at home...Many, many SECRETS. We are as sick as our secrets...
Prevents healthy communication and v important TRUST development. Child
sees what is real and what is not real - or the public persona issued
forth. ..Sexual abuse (incest) may occur... Also discourages autonomy
... "Don't embarrass the family", Don't feel - just smile" Role reversal
- child must be caretaker... Ex: alcoholic/drug dependent parent who
needs help - at least cannot care for child...One child becomes
scapegoat, other "hero - or star" - perhaps other as "lost child" -
"symptom bearer" of the family. See Box 35-1 Hi-risk groups for
codependency The rule is "just don't be" BE
Other contributing factors: Abuse - physical, emotional, sexual,
intellectual, spiritual, religious abuse. Physical abuse, or emotional
abuse, or sexual abuse - a secret... Don't let anyone know.. Show a good
face to the community. Read of each of the abuses.... w/discuss again
later in unit: Crisis, violence- violence in the family... Loss of self,
codependency is an addictive process in which the persons identity is not
developed or unkn to the indiv. Abuse pattern, child learns coping to
escape pain thru controlling external factors or controlling others -....
as cannot control self - or self control
Ineffective boundaries: Difficulty negotiating personal boundaries..
Enmeshed family
Cannot say "NO" - personally, professionally, socially, in any way
etc. Person's needs are determined by others. Will stay at work long
hours - to please boss... W/become depressed, discouraged when not
externally praised or rewarded.. Personal boundaries are "fuzzy" -
cannot say no... Socially: W/join groups, w/do all the work for praise.
Moral of the story is: Go to work to do the work, not to
please your boss... In doing your defined job description, you are
pleasing your boss.
Impaired Growth and Development: Children in these families are ruled
by guilt and shame... Toxic shame as John Bradshaw states it. JB in
his book, tapes, seminars: "Going Home" - "Coming Home" He helps people -
by teaching them to heal that inner child - Visits, revisits,
strengthens, encourages, loves, cares for her/him... Very very powerful
stuff. Guilt, shame and fear of abandonment are central themes
Imbalanced Internal Ego state: TA transactional analysis: we are 3
internal ego states; parent, child, adult... Again the inner child, adult
and parent the child is expected to "drive the bus" - Read this part of
the chapter ---- is the latest stuff people pay $$$$ for - for a
weekend seminar
How Codependency Evolved: 1st appeared as a diseased family=>- chemical
dependency field... Found that enablers were as addicted as the addict.
This theory (idea) extended on to mean codependency is a disease that
affects the personality... indiv from dysfunctional family, addictive,
overly religious, or other... Instead of learning to care for self and
others, indiv learns to care for and control others at expense of self
Nurses: at High Risk for codependency: many indivs who aspire to
nursing played a "fixer" role in the family of origin... to survive...
had to control a chaotic environment. They take on the pain of others
and overreact to situations.... Do you see that in each other of your
classmates??? Control and perfectionism dominate. Don't get caught up
in that situation. Self is sacrificed for the client &/or system. The
codep nurse w/get frustrated, angry and resentful if not continually
reinforced. Burnout.... All nurses need acceptance and nurturing
support systems... Read Table 35-1 Codep behavs of Nsg students....p
716
Application of the Nursing Process to Addictions
Assessment Codependency involves control of others proportionate to the
degree other is out of control Just as addictions are denied, client
w/deny the severity of the problem.. As nurses we MUST understand
denial, projection, and other Dms. The spiritual self is unable to be
expressed when FEAR is the motivator
One clue is client is focusing on past & future - not here and now....
Nsg Dx: Many, many - Ineffective indiv coping prob #1, Boundary issues
foremost in the picture... Ineffective family coping R/T enmeshed family
system... etc.
Planning: Recovery can take a lifetime Long term goals Read 1-10 and
Nursing Care Plan 35-1 p. 718.
Intervention: Teach self affirmation - positive self statements for
recovery - see Box 35-2, Use of Journaling for recovery, Sharing
personal experiences, Involving the Client in a Spiritual Recovery
Program- codependency, as in any addictive process entails a loss of
spirituality. Box 33-3 12 steps of Codependents Anon, p. 720 - Helping
client grieve over past losses - unresolved grief - loss We've
discussed - you've read in Depression chapters... Helping the client
(self) create a healthy Inner Child, Teaching cognitive methods to deal
with Shame Attacks.. Very real.. Help the client develop healthy
boundaries...and healthy communication patterns - assertiveness training
- learn to say no - when self is to be sacrificed - Teaching Relaxation
Techniques On all of the above areas where "Client" is listed as
nurses also list SELF
EVALuation: Lifelong - Awareness of this deeply ingrained habit,
personality codepent behavior is probably the first step...Self care
Self nurturing Visit that inner child - Nurturing, caring for, loving
the inner child will help