Introduction to Mental Health

Question 1

Describe the characteristics of mental health and mental illness identifying important historical landmarks in psychiatric care.

Answer 1

Mental illness was viewed as demonic possession, sin, or weakness, and individuals were punished accordingly.

Today, mental illness is seen as a medical problem with symptoms causing dissatisfaction with one’s characteristics, abilities, and accomplishments.

In the early 1950’s, the development of psychotropic drugs was a significant advance in treating individuals with mental illness.

1960s- Shift from institutional care to care in the community. Allowed for many individuals to leave institutions for the first time in years. This led to repetitive hospital admission without adequate community follow-up.

Question 2

Discuss the significance of the DSM and its relevance to mental health nursing, current trends in treatment, and the American Nurses Association standards of practice for psychiatric-mental health nursing.

Answer 2

The DSM has three purposes:

• To provide a standardized nomenclature and language for all mental health professionals.
• To present defining characteristics or symptoms that differentiate specific diagnoses
• To assist in identifying the underlying causes of disorders

Community-based programs focus on rehabilitation, vocational needs, education, socialization, management of symptoms, and medication.
Currently using managed care in a effort to contain costs. This has resulted in withholding of services or approval of less expensive alternatives for mental health care.

Standards of Care are authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable.

Question 3

Compare and contrast the purpose, focus, communication styles, and goals for: social relationships, intimate relationships, therapeutic relationships, being certain to differentiate between the various stages of nurse-client relationship.

Answer 3

Social Relationships:

• -Initiated for friendship
• -Mutual needs are met
• -Communication:
  
  • -To give/get advice
  • -To ask for help
  • -Often content with superficial

Intimate Relationships

• -Individuals have an emotional commitment
• -Mutual needs are met
• -Mutual goals are set
• -Personal/intimate info is shared

Therapeutic Relationships

• -Patient centered
• -Goal directed
• -Theory based
• -Proceeds through stages
• -Roles & responsibilities clearly defined
• -Confidently and appropriately maintained
• -Open to observation and supervision by peers or others

Question 4

Describe the importance of self-awareness and therapeutic use of self in the nurse-client relationship and self-awareness issues and negative behaviors that can enhance or hinder the nurse-client relationship.

Answer 4

Self awareness-
Understanding one’s own values, beliefs, thoughts, feelings, attitudes, motivations, prejudice, strengths, and limitations and how these qualities effect others.

Therapeutic use of self-
Can incorporate self-awareness in caring for client’s with mental illness and in establishing relationships.

Question 5

Explain the various possible roles of the nurse in the nurse-client relationship.

Answer 5

Teacher
Caregiver
Advocate–Acting on the client’s behalf when he or she cannot do so
Parent Surrogate–Parent-child communication between client and nurse

Be clear, firm, and set limits

Question 6

Demonstrate the ability to utilize therapeutic communication, differentiating between therapeutic and non-therapeutic verbal & non-verbal communication.

Answer 6

Effective Verbal Communication
Observe patient & self
Verbal comments
Tone of conversation
Other auditory utterances
Active listening
Congruency- Verbal and non-verbal communication should match.
Use “effective” communication techniques
Use of techniques that encourage reflection
Avoid communication techniques that result in barriers
Avoid asking “why” or telling patients to “do this”

Effective Non-Verbal Communication
The majority of “ communication “is non-verbal.
Observer patient and yourself
Consider:
--Facial expression
--Eye contact
--Body position/posture – include hands/arms, feet/legs
--Proximity to each other
--Vocal cues
--Silence

Broad openings
Giving recognitions
Encouragement
Offering of self
Accepting statements
Making observations
Exploring
Clarify
Placing events in sequence or time
Focusing
Encouraging the formulation of a plan
Suggesting collaboration
Restatement
Reflection
Summarizing
Validating Perceptions
Assertive communication