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NURS3314 Mental Health Nursing > Chapter 1 Foundations of Psychiatric--Mental Health Nursing > Flashcards

Chapter 1 Foundations of Psychiatric--Mental Health Nursing Flashcards

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1
Q

Mental Health

A

A state of emotional, psychological, & social wellness evidenced by satisfying relationships, effective behavior and coping, positive self-concept, & emotional stability

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2
Q

WHO Definition of Health & Impact on Emotional & Mental Well-Being

A

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

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3
Q

A person’s mental health is…

A

…a dynamic or ever-changing state

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4
Q

(T/F) True or False: A single universal definition of mental health exists.

A

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

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5
Q

What is the significance of a person’s behavior in the terms of mental health?

A

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

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6
Q

What generally serves as evidence for a person’s mental health?

A

Satisfying interpersonal relationships

Effective behavior & coping

Positive self-concept

Emotional Stability

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7
Q

What are the three categories of factors that influence a person’s mental health?

A

Individual (personal), interpersonal (relationship), & social determinants

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8
Q

Factors that Influence A Person’s Mental Health: Individual (Personal)

A

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

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9
Q

Factors that Influence a Person’s Mental Health: Interpersonal/ Relationship

A

Effective Communication

Ability to help others

Intimacy

Balance of separateness & connectedness

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10
Q

Factors that Influence a Person’s Mental Health: Social Determinants

A

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

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11
Q

Mental Illness

A

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

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12
Q

Mental illness includes…

A

…disorders that affect mood, behavior, and thinking, such as depression, schizophrenia, anxiety disorders, and addictive disorders

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13
Q

Why are both concepts of mental illness and mental health difficult to precisely define?

A

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

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14
Q

What generally serves as evidence of mental illness?

A

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

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15
Q

Factors that Influence A Person’s Mental Illness: Individual (Personal)

A

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

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16
Q

Factors that Influence a Person’s Mental Illness: Interpersonal/ Relationship

A

Ineffective communication

Excessive dependency on or withdrawal from relationships

No sense of belonging

Inadequate social support

Loss of emotional control

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17
Q

Factors that Influence a Person’s Mental Illness: Social Determinants

A

Lack of resources

Violence

Homelessness

Poverty

Unwarranted negative view of the world

Discrimination such as stigma, racism, classism, ageism, and sexism

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18
Q

Social/Cultural Influence on Mental Illness

A

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

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19
Q

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)

A

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

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20
Q

The three purposes of the DSM-5-TR

A

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

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21
Q

The Clinical Significance of the Classification System

A

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
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22
Q

Ancient Times Mental Health Treatment

A

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

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23
Q

Early Christian Period Mental Health Treatments (1-1000 A.D.)

A

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

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24
Q

Period of Enlightenment (1790s) Era Mental Health Treatment

A

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

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25
Q

Asylum

A

A safe refuge/ haven offering protection at institutions where people have been whipped, beaten & starved due to being mentally ill

26
Q

Late 1800s Mental Health Treatment

A

For the first time, study of the mind, its disorders, and their treatment began

Sigmund Freud was on the rise

27
Q

1950s Mental Health Treatment

A

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

28
Q

Psychotropic Drugs

A

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

29
Q

1st Psychotropic Drugs to be Introduced

A

Chlorpromazine (Thorazine): Antipsychotic drug

Lithium: Antimanic drug

30
Q

Deinstitutionalization

A

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

31
Q

The Effect of Deinstitutionalization on the Mental Health Care Field

A

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

32
Q

(T/F) True or False: Deinstitutionalization decreased the mentally ill homeless population

A

FALSE

33
Q

Mental Illness Today

A

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

34
Q

Revolving Door Effect

A

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

35
Q

Lack of Adequate Community Resources

A

Cost containment, managed care, lack of funding, insufficient resources to meet the volume of clients

36
Q

Homelessness

A

Increasing since the COVID-19 pandemic
- 33% have severe persistent mental health illness
- 67% have primary SUD

37
Q

Boarding

A

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

38
Q

Community-Based Care Concerns

A

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
39
Q

Managed Care

A

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

40
Q

Utilized Review Firms

A

Developed to control the expenditure of insurance funds by requiring providers to seek approval before the delivery of care

41
Q

Case Management

A

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)

42
Q

Stigma

A

A mark of disgrace associated with a particular circumstance, quality, or person

43
Q

Self-Stigma

A

Negative stereotypes internalized by people with mental illness

44
Q

Public Stigma

A

Negative stereotypes by others after a person is
marked as mentally ill

45
Q

Label Avoidance

A

Avoiding treatment in order to not be marked as mentally ill

46
Q

Healthy People 2030 Goals

A

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

47
Q

Linda Richards

A

1st American Psychiatric Nurse

Believed that “the mentally sick should be at least as well cared for as the physically sick”

48
Q

McLean Hospital

A

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

49
Q

John Hopkins Hospital

A

First school of nursing to include a psychiatric nursing course (1913)

50
Q

Harriet Bailey

A

Published the first psychiatric nursing textbook, called “Nursing Mental Disease” (1920)

51
Q

National League of Nursing (NLN)

A

Required all nursing schools to include an experience in psychiatric nursing (1950)

52
Q

Hildeguard Peplau

A

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

53
Q

June Mellow

A

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

54
Q

ANA Standards of Care

A

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

55
Q

PMH Nursing (Phenomena of Concern)

A

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

56
Q

The 13 Areas of Concern

A

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

57
Q

Basic-Level Functions of a Psychiatric Nurse (BSN-RN)

A

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

58
Q

Milieu Therapy

A

A safe, structured group treatment method for mental health issues

59
Q

Advanced-Level Functions of a Psychiatric Nurse (BSN-RN)

A

Psychotherapy

Prescriptive Authority for Drugs

Consultation and Liaison

Evaluation

Program Development and Management

Clinical Supervision

60
Q

Common Student Concerns in Mental Health Clinical

A

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?

61
Q

Self-Awareness

A

The process by which the nurse gains recognition of their own feelings, beliefs, & attitudes

62
Q

Why is having the ability of self-awareness critical for being a nurse in the mental health field?

A

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

NURS3314 Mental Health Nursing (30 decks)

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