Chapter 1 Foundations of Psychiatric--Mental Health Nursing Flashcards
Mental Health
A state of emotional, psychological, & social wellness evidenced by satisfying relationships, effective behavior and coping, positive self-concept, & emotional stability
WHO Definition of Health & Impact on Emotional & Mental Well-Being
The World Health Organization defines health as: “A state of complete physical, mental, and social wellness.”
- Not just absence of disease or infirmity
Emphasizes health as a positive state of well-being
Fulfill life responsibilities
Function effectively in daily life
Satisfied w/ their interpersonal relationships & themselves
A person’s mental health is…
…a dynamic or ever-changing state
(T/F) True or False: A single universal definition of mental health exists.
FALSE: There are many influencing factors that make mental health a dynamic and ever-changing state, each person has a different view/interpretation of health makes determining a person’s mental health difficult
What is the significance of a person’s behavior in the terms of mental health?
A person’s behavior can help clue into a person’s mental health
- Each person has a different view/ interpretation of behavior based on their cultural values and belief which, can make the determination of mental health difficult
What generally serves as evidence for a person’s mental health?
Satisfying interpersonal relationships
Effective behavior & coping
Positive self-concept
Emotional Stability
What are the three categories of factors that influence a person’s mental health?
Individual (personal), interpersonal (relationship), & social determinants
Factors that Influence A Person’s Mental Health: Individual (Personal)
Biological Makeup
Autonomy & independence
Self-esteem
Capacity for growth
Vitality
Ability to find meaning in life
Emotional resilience (hardiness)
Sense of belonging
Reality Orientation
Coping/ Stress Management Abilities
Factors that Influence a Person’s Mental Health: Interpersonal/ Relationship
Effective Communication
Ability to help others
Intimacy
Balance of separateness & connectedness
Factors that Influence a Person’s Mental Health: Social Determinants
Nonmedical factors that influence health, such as a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of environment, education, employment, income and social protection, & food security
Mental Illness
A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual & is associated w/ present distress or disability or w/ a significantly increased risk of death, pain, disability, or an important loss of freedom
Mental illness includes…
…disorders that affect mood, behavior, and thinking, such as depression, schizophrenia, anxiety disorders, and addictive disorders
Why are both concepts of mental illness and mental health difficult to precisely define?
People carry out roles in society:
- Those whose behavior is appropriate & adaptive are deemed “healthy”
- Those who fail to fulfill roles & carry out responsibilities or whose behavior is inappropriate are deemed “ill”
Culture of any society strongly influences its values & beliefs-> affects how society defines health & illness
What generally serves as evidence of mental illness?
Significant Distress
Impaired functioning
Dissatisfaction w/ self & relationships
Ineffective coping
Daily life can seem overwhelming or unbearable
Individuals may believe that their situation is hopeless
Factors that Influence A Person’s Mental Illness: Individual (Personal)
Biomedical makeup
Intolerable/unrealistic fears or worries
Inability to distinguish reality from fantasy
Intolerance of life’s uncertainties
Sense of disharmony in their life
Loss of meaning in one’s life
Factors that Influence a Person’s Mental Illness: Interpersonal/ Relationship
Ineffective communication
Excessive dependency on or withdrawal from relationships
No sense of belonging
Inadequate social support
Loss of emotional control
Factors that Influence a Person’s Mental Illness: Social Determinants
Lack of resources
Violence
Homelessness
Poverty
Unwarranted negative view of the world
Discrimination such as stigma, racism, classism, ageism, and sexism
Social/Cultural Influence on Mental Illness
Can result in isolation, feelings of alienation, & maladaptive, violent, or criminal behavior
This may support a diagnosis of a personality disorder but not necessarily a mental illness w/ symptoms amenable to treatment w/ medication
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
A taxonomy published by the American Psychiatric Association (APA) that describes all mental disorders, outlining specific diagnostic criteria for each based on clinical experience & research
- ALL Mental Health clinicians who diagnose psychiatric disorders use this book
The three purposes of the DSM-5-TR
1) To provide a standardized nomenclature & language for all mental health professionals
2) To present defining characteristics or symptoms that differentiate specific diagnoses
3) To assist in identifying the underlying cause of disorders
The Clinical Significance of the Classification System
Allows the practitioner to identify all factors that relate to a person’s condition:
1) All major psychiatric disorders such as depression, schizophrenia, anxiety, & substance-related disorders
2) Medical conditions that are potentially relevant to understanding or managing the person’s mental disorder as well as medical conditions that might contribute to understanding the person
3) Psychosocial & environmental problems that may affect the diagnosis, treatment, & prognosis of mental disorders Included: Problems w/ primary support group, the social environment, education, occupation, housing, economics, access to health care, & legal system
Ancient Times Mental Health Treatment
People believed that any sickness indicated the displeasure of the gods-> punishment for sins & wrongdoing
Those w/mental illnesses were either seen as divine or demonic depending on their behavior
- Divine: Worshipped & adored
- Demonic: Ostracized, punished, sometimes burnt at the stake
Later, Aristotle attempted to relate mental health disorders w/physical disorders -> developed theory that amounts of blood, water, yellow & black bile in the body controlled these emotions
- These 4 substances/humors corresponded w/ happiness, anger, calmness, & sadness
- Imbalance of these was believed to cause mental illness-> restore balance via bloodletting, starving, & purging
Aristotle’s practices were continued until the 19th century
Early Christian Period Mental Health Treatments (1-1000 A.D.)
Mental ill were viewed as evil or possessed by demons and being punished for sin and wrongdoing
Priests would perform exorcisms to rid sufferers of evil spirits
- Treatment if exorcisms didn’t work: Incarcerated in dungeons, beaten, starved
Period of Enlightenment (1790s) Era Mental Health Treatment
Philippe Pinel & William Tuke formulated the concept of asylums
Evidence developed that “insanity” was an illness; creation of asylums as a safe refuge offering protection, shelter, nutrition, and warm clothing
- Response: State hospitals were created and care was mandated for mentally ill
->Confinement in state hospitals for long periods
Period was short-lived: <100 years later, issues were prevalent in asylums and state hospital
- Attendants were accused of abusing the residents
- Rural locations of hospitals were seen as isolating patients from their families
- Phrase “insane asylum” took on a negative connontation
Asylum
A safe refuge/ haven offering protection at institutions where people have been whipped, beaten & starved due to being mentally ill
Late 1800s Mental Health Treatment
For the first time, study of the mind, its disorders, and their treatment began
Sigmund Freud was on the rise
1950s Mental Health Treatment
Development of psychotropic drugs began
- Greatly reduced agitation, psychotic thinking, and depression
- Hospital stays shortened and people became well enough to go home
Institutions were found to contribute to mental illness
Psychotropic Drugs
Drugs used to treat mental illness
- Developed in 1950
Drugs actually reduced agitation, psychotic thinking, & depression
Hospital stays were shortened
- Many people became able to return home
Level of noise, chaos, & violence greatly diminished in the hospital setting
1st Psychotropic Drugs to be Introduced
Chlorpromazine (Thorazine): Antipsychotic drug
Lithium: Antimanic drug
Deinstitutionalization
The deliberate shift from institutional care in state
hospitals to community facilities, which served a variety of needs for the mentally ill
- Began in the 1960s
Community health centers served smaller geographic catchment or service areas that provided less restrictive treatment located closer to individual’s home, family, & friends
Provided:
- Emergency care
- Inpatient care
- Outpatient care
- Partial hospitalization
- Screening services
- Education
The Effect of Deinstitutionalization on the Mental Health Care Field
Decreased hospital admissions and long-term institutional stays
Social security funds helped people with severe and persistent mental illness to be more independent financially
In the 1970s, commitment laws changed decreasing the number of people committed for mental health treatment against their will
Consequently, deinstitutionalization increased the mentally ill homeless population
- In many cases, community assimilation never occurred
- Contributing factors: Lack of resources and difficulty re-integrating into society
(T/F) True or False: Deinstitutionalization decreased the mentally ill homeless population
FALSE
Mental Illness Today
51.5 million adults in the U.S. in 2019 were living with mental illness
23 million adults in the U.S. received treatment in the last year
The economic burden of mental illness in the U.S. (including both healthcare costs & lost productivity), exceeds the economic burden caused by all types of cancer
Mental disorders are the leading cause of disability in the U.S. & Canada for people between 15-44 years old
Revolving Door Effect
People w/ severe, persistent mental illness have shorter hospital stays, but are admitted to hospitals more frequently
- Continuous flow of clients being admitted & discharged quickly overwhelms general hospital psychiatric units
Lack of Adequate Community Resources
Cost containment, managed care, lack of funding, insufficient resources to meet the volume of clients
Homelessness
Increasing since the COVID-19 pandemic
- 33% have severe persistent mental health illness
- 67% have primary SUD
Boarding
Shortened hospital stays where clients are not fully stabilized (may show signs of improvement but, not ready)
- Result: People w/ severe mental illness are discharged into the community w/out being able to cope w/ community living
Community-Based Care Concerns
The volume of community mental health centers never materialized
- Insufficient community mental health centers to provide services
- Inaccurate anticipation of extent of people’s needs
- Availability & quality of mental health services varies greatly
- Those w/ severe mental health illness are more likely to be ignored, while those w/mild cases are more likely to receive treatment
Managed Care
Concept designed to purposely control the balance between the quality of care provided & the cost of the care
People receive care based on need rather than request
Utilized Review Firms
Developed to control the expenditure of insurance funds by requiring providers to seek approval before the delivery of care
Case Management
Management of care on a case-by-case basis, representing an effort to provide necessary services while containing costs
Include:
- Accessing medical & psychiatric services
- Providing assistance w/ tasks of daily living (financial management, transportation, & buying groceries)
Stigma
A mark of disgrace associated with a particular circumstance, quality, or person
Self-Stigma
Negative stereotypes internalized by people with mental illness
Public Stigma
Negative stereotypes by others after a person is
marked as mentally ill
Label Avoidance
Avoiding treatment in order to not be marked as mentally ill
Healthy People 2030 Goals
1) Reduce the suicide rate
2) Increase the proportion of adults w/mental health disorders who receive treatment
3) Increase depression screening by primary care providers
4) Increase the number of homeless adults who receive mental health services
Linda Richards
1st American Psychiatric Nurse
Believed that “the mentally sick should be at least as well cared for as the physically sick”
McLean Hospital
First training of nurses to work with persons with mental illness (1882)
Care was primarily custodial
Primarily focused on: nutrition, hygiene, & activity
Adapted med-surg principles to psychiatric patients & treated them w/ kindness & tolerance
Role of psychiatric nurses expanded as somatic therapies were developed
- Insulin shock therapy, psychosurgery, & electroconvulsive therapy req nurses to extensivelly use their med-surg skills
John Hopkins Hospital
First school of nursing to include a psychiatric nursing course (1913)
Harriet Bailey
Published the first psychiatric nursing textbook, called “Nursing Mental Disease” (1920)
National League of Nursing (NLN)
Required all nursing schools to include an experience in psychiatric nursing (1950)
Hildeguard Peplau
Published “Interpersonal Relations in Nursing” (1952) & “Interpersonal Techniques: The Crux of Psychiatric Nursing” (1962)
Nursing theorist who focused on the therapeutic nurse-client relationship w/phases, as well as anxiety
Significance: Her interpersonal dimension theory forms the foundations of practice today
June Mellow
Published “Nursing Therapy” in 1968
Focused on clients’ psychosocial needs and strengths
Believed that the nurse, as a therapist, is particularly suited to working w/ those w/sever mental illnesses in the context of ADLs, and focusing on the here & now to meet each person’s psychosocial needs
ANA Standards of Care
Authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable
Not legally binding, unless they are incorporated into the state Nurse Practice Act or state board rules & regulations
When lawsuits arise, they are used to determine safe & acceptable practices & assess quality of care
PMH Nursing (Phenomena of Concern)
Standards of practice and professional performance written by the American Psychiatric Nurses Association
Describe the 13 areas of concern that mental
health nurses focus on when caring for clients
The 13 Areas of Concern
1) Promotion of optimal mental & physical health & well-being & prevention of mental illness
2) Impaired ability to function related to psychiatric, emotional, & physiological distress
3) Alterations in thinking, perceiving & communicating due to psychiatric disorders/mental illness
4) Behaviors & mental states that indicate harm to self or others
5) Emotional stress related to illness, pain, disability & loss
6) Symptom management, side-effects, or toxicities associated w/ self-admin drugs, psychopharmacological interventions, & other treatment modalities
7) Barriers to treatment efficacy & recovery posed by alcohol & substance abuse & dependence
8) Self-concept & body image changes, developmental issues, life process changes, & end-of-life issues
9) Physical symptoms that occur along w/ altered mental status
10) Psychological symptoms that occur along w/ altered physiological status
11) Interpersonal, organizational, sociocultural, spiritual, or environmental circumstances or events that have an effect on the mental and emotional well-being of the individual and family or community
12) Elements of recovery, including the ability to maintain housing, employment, and social support, that help individuals reengage in seeking meaningful lives
13)Societal factors such as violence, poverty, and substance abuse
Basic-Level Functions of a Psychiatric Nurse (BSN-RN)
Counseling
- Interventions & comm techniques
- Problem-solving
- Crisis intervention
- Stress management
- Behavior modification
Milieu Therapy
- Maintain therapeutic environment
- Teach skills
- Encourage communication between client & others
- Promote growth via role-modeling
Self-Care Activities
- Encourage independence
- Increase self-esteem
- Improve function & health
Psychobiologic (Meds) Interventions
- Admin meds
- Teach
- Observe
Health Teaching
Case Management
Health Promotion and Maintenance
Milieu Therapy
A safe, structured group treatment method for mental health issues
Advanced-Level Functions of a Psychiatric Nurse (BSN-RN)
Psychotherapy
Prescriptive Authority for Drugs
Consultation and Liaison
Evaluation
Program Development and Management
Clinical Supervision
Common Student Concerns in Mental Health Clinical
What if I say the wrong thing?
What will I be doing?
What if no one will talk to me?
Am I prying when asking personal questions?
How will I handle bizarre or inappropriate behavior?
What happens if a client is sexually inappropriate?
Am I physically safe?
What if I encounter someone I know?
What if I share similar problems or backgrounds?
Self-Awareness
The process by which the nurse gains recognition of their own feelings, beliefs, & attitudes
Why is having the ability of self-awareness critical for being a nurse in the mental health field?
At times a nurse’s values & beliefs will conflict w/ those of the client or the client’s behavior
- The nurse must accept these differences; however, they do not need to condone the beliefs or behavior
- The key is to NOT let the nurse’s beliefs INTERFERE w/ the client’s care
