mental health nursing Flashcards
Mental Health:
State of well-being in which individuals reach their potential, cope with normal stresses of life, work productivity, and contribute to the community
World Health Organization (2019) defines health is:
“a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Traits of positive mental health
rational thinking
communication skills
learning
emotional growth
resilience
self esteem
Mental Illness
Psychiatric disorders with definable diagnoses
Significant dysfunction in mental functioning related to:
1) Developmental
2) Biological
3) Physiological disturbances
Culturally defined & always changing
Mental health vs mental illness
A real middle ground exists: stress discomft from everyday life
Conceptualized as points along a mental health continuum
Resilience
how you bounce back
ability and capacity to secure resources needed to support well-being
characterized by:
1) ability to secure needed resources
2) capacity for regulating one’s own emotions and overcoming negative, self-defeating thoughts
Essential to recovery
Social and Economic circumstances
Family
Schools and peer groups
Socioeconomic status
Educational advancement
Environmental factors
Political climate & cultural considerations
Social & economic policies
Stigma
Refers to the discrediting, devaluing, and shaming of a person because of a person because of characteristics or attributes that they possess
Stigma involves 3 elements
A lack of knowledge (ignorance)
Negative attitudes (prejudice)
People behaving in ways that disadvantage the stigmatized person (discrimination)
Five themes of stigma in mental health nursing;
Four themes are patient-related
Personal/patients stigma
Public/social stigma
Family stigma
Employment stigma
The fifth theme is related to stigma toward healthcare professionals working with patients with mental illnesses:
- Professional stigma
How do we reduce stigma about the mental health population?
Self-reflection & education
A ‘bottom up’ approach
General public campaigns
Target the media to try and ensure more balanced and accurate coverage of mental health issues
Anti-discrimination policy and legislation
Perceptions of Mental Health & Mental Illness
Mental illness versus physical illness:
Root of most mental disorders lies in intercellular abnormalities
Nature versus nurture:
Diathesis-stress model (most accepted explanation for mental illness)
Diathesis-Stress Model
Diathesis- biological predisposition
Stress - environmental stress or trauma
Most accepted explanation for mental illness
Combination of genetic vulnerability and negative environmental stressors
Assertion:
Most psychiatric disorders result from a combination of genetic vulnerability and negative environmental stressors
Psychiatric Mental Health Nursing
Promoting mental health through assessment, diagnosis, and treatment of behavioral and mental disorders
The nurse develops a nursing diagnosis and plan of care, implements the nursing process, and evaluates it for effectiveness
Use nursing, psychosocial, neurobiological theories, and research
Work with people throughout the lifespan
Employed in a variety of settings and among varied populations
Registered nurses work with individuals, families, groups, and communities, assessing their mental health needs
Assessing and providing a therapeutic environment or milieu as a treatment and management modality
Trends affecting the future
Educational challenges
Demand for mental health professionals
Aging population
Cultural diversity
Science, technology, electronic healthcare
Advocacy & legislative involvement
Classical Psychoanalysis
Purpose is to uncover unconscious conflicts
Seldom used today
Intrapsychic conflict ( at an early age) no longer considered to be the cause of all mental illness:
Free association - freely share whatever thoughts/ words come to mind to access the unconscious
Dream analysis
Defense mechanism recognition
Valid tools & concepts:
Transference
Countertransference
Transference
refers to unconscious feelings that the patient has toward a healthcare worker that were originally felt in childhood for a significant other
Countertransference
refers to unconscious feelings that the healthcare worker has toward the patient
Interpersonal therapy is most effective in treating
Grief & loss
Interpersonal disputes
Role transition
Maslow’s Hierarchy of Needs
Human beings are active participants in life, striving for self-actualization
When lowers needs are met, higher needs are able to emerge
Physiological needs
Safety
Belonging & love needs
Esteem needs
Self-actualization
Implications for nursing
Emphasis on human potential & the patient’s strengths
Prioritizing
establishes what is most important in the sequencing of nursing actions
Theory of psychosocial development (Erikson)
Eight stages of development
Personality continues to develop through old age
Primary prevention
Occurs before any problem appears
Seeks to reduce rate of new cases
Secondary prevention
Early identification of problems, screening, and prompt, and effective treatment
While it does not stop the actual disorder from beginning, it is intended to delay or avert progression
Tertiary prevention
Treatment with a focus on preventing progression to a severe course, disability, or even death
Closely related to rehabilitation
Inpatient Care Settings
Crisis Stabilization/Observational Units
General Hospitals & Private Hospitals
State Psychiatric Hospitals
Entry to Acute Inpatient Care
Direct admission on referral
Emergency department or crisis service
Voluntary or involuntary
Voluntary: you want to be a in psych inpatient unit
Involuntary: you do NOT want to be in a psych inpatient unit
Therapeutic Milieu
“Middle place”
Surroundings and physical environment
- Managing behavioral crisis
- Safety
- Unit design
Goals of unit design
- Promote an environment of safety and empower patients to partner with clinical staff and take ownership of their own health and safety
Enculturation
transmission of culture’s worldview, beliefs, values, and practices to its members
-Deviance from cultural expectations can be defined as illness by other members of the group
Ethnocentrism
The universal tendency of humans to think their way of thinking and behaving is the only correct and natural way.
Cultural awareness
Examine beliefs, values, and practices of own culture
Recognize that during a cultural encounter, three cultures are intersecting:
Culture of the patient, nurse, and setting
Bioethics
used in relation to ethical dilemmas surrounding health care
Ethics
The study of philosophical beliefs about what is considered right or wrong in a society
Ethical dilemma
conflict between two or more courses of action, each with favorable and unfavorable consequences
Autonomy
right to make their own decision
Beneficence
benefit to the patient
Nonmaleficence
do no harm
Justice
fairness, equally
Fiedely
being faithful
Veracity
being truthful
Seclusion
involuntary confinement of a patient alone in a room from which the patient is physically prevented from leaving
used for self-destructive or violent behavior
Physical Restraint
purposely limiting or obstructing the freedom of a person’s bodily movement
Mechanical Restraint
restraint of a person by the application of a device to the person’s body, or a limb of a person, to restrict the person movement
Chemical Restraint
the intentional use of any medications to subdue, sedate, or restrain an individual
Patients Rights Under the Law
Right to treatment
Right to refuse treatment
Right to informed consent
Patient is informed of risks, benefits, and alternatives
Person must voluntarily accept treatment
Implied Consent
Capacity & competency
Rights regarding psychiatric advance directives
Rights regarding restraint and seclusion:
-Orders and documentation
-In an emergency, a nurse may place a patient in seclusion or restraint but obtains a written or verbal order as soon as possible thereafter
-Orders for restraint or seclusion are never written as an as needed or as a standing order
Involuntary commitment
Emergency commitment. ( temporary admission)
Person confused or demented; emergency admission
Used for observation, diagnosis and treatment
Generally for 24 to 96 hours
Court hearing before discharge or next admission
Mental Status Examination(MSE)
A component of all medical exams and may be viewed as a psychological equivalent of the physical exam, it is important in neurological and psychiatric evaluations
Nursing Process
ADPIE
SAD PERSONS scale for assessing the risk for suicide:
Sex
Age
Depression
Previous Attempt
Ethanol Abuse
Rational Thinking loss
Social Supports Lacking
Organized plan
No spouse
Sickness
