Objective 1 Flashcards
Diagnosis and treatment of human responses to actual or potential
mental health problems
* Specialized nursing practice
* Uses theories of human behavior as scientific framework
* Requires purposeful use of self as its art of expression
psychiatric mental health nursing
state of well-being in which the individual realizes his own
abilities, can cope with the normal stressors of life, can work
productively, and is able to make a contribution to his or her
community
mental health
what are the traits of mental health?
Ability to:
* Think rationally
* Communicate appropriately
* Learn
* Grow emotionally
* Be resilient
* Have a healthy self-esteem
what are factors that influence mental health?
Nurturing during childhood
* Life circumstances, those that occur from birth
* The relationship between environment and mental health
Refers to interaction between the family and child -
affecting the development of mental health
nurturing during childhood
The ability and capacity to secure resources needed to
support well-being
resilience
what is resilience characterized by?
optimism
sense of mastery
competence
what are the characteristics of mental health?
Mentally healthy people who achieve self actualization (to
make something real or make something come about) or
achieve mental health are able to:
* Have positive self concepts
* Relate well to people and their environment
* Form close relationships with others
distinctive set of:
traits
behavioral styles
The total of a person’s internal and external patterns of
adjustment to life determined in part by genetic makeup and life
experiences
personality
what are characteristics of a healthy personality?
Positive self concept, body image and sense of self worth
* Well-balanced, cheerful and minimal stress
* Has self-discipline and self-control
* Open and honest with themselves and others
* Have a great ability to understand others and they know well
how to deal with people
An illness or syndrome with psychological or behavioural
manifestations and/or impairment in functioning due to a social,
psychological, genetic, physical/chemical or biologic disturbance”
* Not limited to relations between people and society
* Characterized by symptoms and/or impairment in functioning
mental illness
Pre-1900s
* European “asylums” (“Moral care”)
* Canadian “asylums” and history
* “Custodial care”
* Introduction of nurses to asylum work
* Training programs & professionalization of nursing
* Provincial psychiatric hospital
early mental illness care
Expanded community-based mental health services
development
crisis management
consultation-liaison
primary care psychiatry
Evolving nursing approaches toward mental health care
with expanded and autonomous roles in:
assessment
consultation
crisis management
therapy
Evolved from general diploma to university education
countrywide
* Western Canada, registered psychiatric nursing diplomas
have been a long-established educational program
* Degree and graduate programs in psychiatric nursing have
been in place since 1995
* Since 1995 - CNA has offered RN’s certification in
psychiatric mental health nursing
nursing education
Clinical nurse specialists (CNSs) have practiced in
psychiatric mental health since the 1970s
* Psychiatric nurse practitioners (NPs) are a newer and
expanded consultation role
* Advanced-practice nurses (APNs) are expected to have
expanded roles, particularly in rural areas of Canada
advanced practice
pharmaceutical discoveries, leading to a gradual shift from provincial institutions
1950s
integration of psychiatric care into general community hospitals, phase of trans institutionalization
1960s-70s
change to shorter hospital stay, with community care
1970s-80s
national advocacy, recovery movement, national mental health strategy
1990s-now
what are the roles and responsibilities of the Canadian mental health care system?
federal
provincial/territorial
employer
private
Highlighted importance of issues related to mental health and
mental illness in Canada
* Proposed 7 guiding principles for development of public policies to
support mental health
EPP report (1988)
Developed a strategy framework for action established in 2017
* Ensures that people with mental health problems and mental
illnesses, are treated with respect and dignity, and have same rights
mental health commission of Canada (2009)
Framework, changing directions, changing lives
- Promotion and Prevention
- Recovery and Rights
- Access to Services
- Disparities and Diversity
- First nations, Inuit, and Metis
- Leadership and Collaboration
what are the 4 significant tends that will affect the future of psychiatric mental health nursing in Canada?
the aging population
2. increasing cultural diversity
3. expanding technology
4. an increased awareness of the impact of health determinants on
mental illness
what are the 12 determinants of health?
Income and social status
2. Social support networks
3. Education
4. Employment/working conditions
5. Social environments
6. Physical environments
7. Personal health practices and
coping skills
8. Healthy child development
9. Biology and genetic endowment
10. Health services
11. Gender
12. Culture
what is mental functioning related to?
developmental
biological
psychological distrubances
what are the social influences on mental health?
Consumer/recovery movement
* Decade of the brain
* Media
* National Mental Health Framework and Strategy
* Provincial Mental Health Legislation
* International Conventions and Human Rights
Defined by some as a disorder causing people to:
* Display abnormal behaviour more often than most people
* Psychopathology(disorder) exhibiting frequent
irresponsibility
* Inability to cope
mental illness
what can mental illness be caused by?
Chemical imbalances in the brain
Transfer of drugs across the placental barrier
Organic changes within the brain
Inherited characteristics
Poor nurturing during childhood
Negative life circumstances
what are the characteristics of mental illness?
Feeling inadequate
* Poor self concept
* Inability to cope
* Maladaptive behaviour
* Unable to establish meaningful relationships
* Poor judgement
* Irresponsible
* Pessimistic
* No limitations
* Dependency needs
* Unable to perceive reality
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition
* Official medical guidelines of the American Psychiatric Association for
diagnosing psychiatric disorders
DSM-5
The International Classification of Diseases (ICD) sets the global health
information standard for mortality and morbidity statistics.
* Clinicians and researchers use this classification system to define diseases,
study disease patterns, monitor outcomes, and subsequently allocate
resources based on the prevalence of disease. The ICD is used globally and
has been translated into 43 languages. An eleventh revision was released in
2019
* The Canadian Institute for Health Information developed an enhanced version
of the ICD-10, referred to as the ICD-10-CA
ICD
an Austrian neurologist,
revolutionized thinking about mental health disorders with his
groundbreaking theory of personality structure, levels of awareness,
anxiety, the role of defense mechanisms, and the stages of
psychosexual development.
* Freud came to believe that the vast majority of mental health
disorders were caused by unresolved issues that originated in
childhood
Sigmund Freud (1856-1939)
what are the levels if awareness?
conscious
preconscious
unconscious
what are Freud’s three major and distinct but interactive components of personality?
Id
Ego
Superego
Pleasure principle
* Reflex action
* Primary process
ID
Problem solver
* Reality tester
EGO
Moral component
SUPEREGO
Formation of personality
* Conscious and unconscious influences
* Importance of individual talk sessions
* Attentive listening
* Transference
* Countertransference
Freudian theory and nursing
Eight stages of development
* Personality continues to develop through old age
Erikson’s ego theory
what are Erikson’s 8 stages of developmen?
trust vs. mistrust
autonomy vs. shame/doubt
initiative vs. guilt
industry vs. inferiority
identity vs. role confusion
intimacy vs. isolation
generativity vs. self-absorption
integrity vs. despair
0-1.5
trust vs mistrust
1.5-3
autonomy vs shame/doubt
3-6
initiative vs guilt
6-12
industry vs inferiority
12-20
identity vs role confusion
20-35
intimacy vs isolation
35-65
generativity vs self-absorption
65+
integrity vs despair
Purpose of all behaviour is to get needs met through interpersonal
interactions and to reduce or avoid anxiety
Anxiety
Security operations
sullivan’s interpersonal theory
what was the foundation for Hildegard Peplau’s theory??
Participant observer
Mutuality
Respect for the patient
Unconditional acceptance
Empathy
provide care, compassion, and advocacy
enhance comfort and well-being
art of nursing
Application of knowledge to:
* Understand a broad range of human problems and psychosocial phenomena
* Intervene in relieving patients’ suffering and promote growth
science of nursing
influenced by Sullivan’s work
created the art and science of nursing
Hildegard Peplau’s theory of interpersonal relationships in nursing
what are the behavioral theories?
Pavlov’s classical conditioning theory
* Watson’s behaviourism theory
* Skinner’s operant conditioning theory
* Implications for nursing
Modifying or replacing behaviours
Behaviour management
Modelling
* Operant conditioning
* Systematic desensitization
* Aversion therapy
* Biofeedback
behavior therapy
Dynamic interplay between individuals and the environment
* Thoughts come before feelings and actions
* Thoughts about the world and our place in it are based on our own
unique perspectives, which may or may not be based on reality
cognitive theory
what are the cognitive theories?
rational-emotive behavior therapy (Ellis)
cognitive-behavioral therapy (Beck)
Aims to eradicate irrational beliefs
* Recognize thoughts that are not accurate
rational-emotive behavior therapy (Ellis)
Test distorted beliefs and change way of thinking; reduce
symptoms
cognitive-behavioral therapy (beck)
Human beings are active participants in life, striving for self-
actualization
* When lower needs are met, higher needs are able to emerge
maslow’s hierarchy of needs
what do biological theories focus on?
neurological
chemical
biological
genetic
how the body and brain interact to create what?
emotions
memories
perceptual expierences
what do biological theories and nursing focus on?
Qualities of a therapeutic relationship
* Understanding patients’ perspective
* Communicating to facilitate recovery
Basis of all psychiatric nursing treatment approaches
* To establish that the nurse is:
* Safe, Confidential, Reliable, & Consistent
* Relationship with clear boundaries
concepts of the nurse-pt relationship
Basis of all psychiatric nursing treatment approaches
* To establish that the nurse is:
* Safe, Confidential, Reliable, & Consistent
* Relationship with clear boundaries
therapeutic use of self
nitiated for the purpose of friendship, socialization,
enjoyment, or accomplishment of a task
* Mutual needs are met
* Communication to give advice or to give or ask for
help
* Content of communication superficial
social relationships
Needs of patient identified and explored
* Clear boundaries established
* Problem-solving approaches taken
* New coping skills developed
* Behavioural change encouraged
therapeutic relationships
what are the necessary behaviors for nurses?
Accountability
* Focus on patient’s needs
* Clinical competence
* Delaying judgement
* Supervision
Physical boundaries
* The contract
* Personal space
establishing boundaries
When relationships slips into social context
* When nurse’s needs are met at expense of patient’s needs
blurring of boundaries
- Patient unconsciously and inappropriately displaces onto nurse
feelings and behaviours related to significant figures in patient’s past - Transference intensified in relationships of authority
transference
Nurse displaces feelings related to people in nurse’s past onto
patient
* Patient’s transference to nurse often results in countertransference
in nurse
* Common sign of countertransference in nurse is over-identification
with the patient
countertransference
what are nurses values and beliefs?
Reflect own culture/subculture
* Derived from range of choices
* Chosen from a variety of influences and role models
Refers to the ability to recognize the nature of one’s
attitudes, emotions, and behaviors
self-awareness
Self-reflection, prior to clinical experience in the psychiatric
setting will enhance your personal and professional growth
introspection
what are the factors that help nurse-pt relationships?
Consistency
* Pacing
* Listening
* Initial impressions
* Promoting patient comfort & balancing control
* Patient factors include trust & active participation
what are the factors the promote pt growth?
Genuineness
* Empathy (not sympathy) – (*remember the Brené
Brown video)
* Positive regard
* Attitudes
* Actions
* Attending
* Suspending value judgements
* Helping patients develop resources
Employ purposeful use of self
* Use nursing, psychosocial, and neurobiological theories and
research
* Work with people throughout the life span
* Educated and registered to practice from a variety of
educational and professional associations
* Employed in a variety of settings
* Utilize therapeutic communication techniques in interactions
and interviews with patients
* Monitor for side effects of psychotherapeutic medications
psychiatric mental health nurses
what is the nursing process?
assessment
nursing diagnosis
outcome identification
planning interventions
implementation
evaluation
Screening and assessment tools
* Disturbance of cognition
* Disturbance of affect
* Disturbance of interpersonal functioning
* Dysfunctional behavior (lack of impulse control)
* Trans-cultural considerations
assessment
Disturbed Thought
Processes
* Anxiety
* Hopelessness
* Ineffective Coping
* Impaired Social Interaction
* Impaired Verbal
Communication
* Risk for Other-Directed
Violence
* Disturbed Sleep Pattern
* Social Isolation
nursing diagnosis
Members of each discipline are responsible for gathering
data and participating in the planning of care
* Patient care plans provides a guideline for patients’ care
during hospital stay
multidisciplinary treatment team
Surroundings and physical environment
* Managing behavioural crises, safety, & suicide risk
therapeutic milieu
what are the components of nursing care?
Admission assessment
* Physical health assessment
* Milieu management
* Structured group activities
* Documentation
* Medication administration
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* Crisis management
* Discharge management
* Medication management
* Medical emergencies
* Preparation for discharge
to community
Participating in community preparedness
* Response to immediate needs and crisis management
* Recovery to provide mental health first aid and reestablish
treatment and initiate opportunities for listening,
compassion, treatment, and referral
roles
what are the prevention strategies?
primary prevention
secondary prevention
tertiary prevention
Adult and youth recreational or cultural centres
* Schools and day care centres
* Churches, temples, synagogues, mosques
* Disaster preparedness teams
primary prevention
Crisis centres, telephone crisis care, and shelters
* Correctional community facilities
* Youth residential treatment centres
* Partial hospitalization programs
* Chemical dependency programs
* Nursing homes and hospices
* Industry/work sites
* Early intervention psychosis programs
* Street outreach
secondary prevention
Community mental health centres
*Psychosocial rehabilitation programs
tertiary prevention
Acute care facilities, including psychiatric hospitals and sub
acute units - considered the most restrictive clinical settings-
* Medical-psychiatric unit; Transitional care hospital; Psychiatric
hospitals; Forsenic hospital
* Sub acute care units often located in LTC facilities
* Day Treatment Hospitals: Extended outpatient clinic during the
day and allows clients to return to families during evening,
nights and weekends
inpatient care
24 hour emergency psychiatric care and crisis intervention
* Screening for Involuntary admission to mental health facilities
* Partial hospitalization and day treatment programs
* Case management
* Community based residential treatment programs
* Aftercare and rehabilitation
* Psychiatric home care
community mental health
Average client can be admitted for short term rehabilitation,
behavior problems, chronic care issues or respite care
long-term care
what are types of community mental health services?
psychiatric emergency care
day treatment programs
residential treatment programs
psychiatric home care
aftercare and rehabilitation
A psychiatrist must certify that the client is homebound
The client must have a DSM-5 psychiatric diagnosis that is acute or
an acute exacerbation of a chronic illness
The client must require the specialized knowledge, skills, and
abilities of a psychiatric registered nurse
established by the health care financing admin
what is the foundation for community mental health?
A multidisciplinary team, consisting of psychiatrist,
psychologist, social workers, nurses, and mental health
counselors
* Prevention of mental illness
* Early detection and treatment
* Comprehensive, multifaceted treatment program
* Continuity of care
* Group and family therapy
* Environmental and social support, and intervention
