Psych Nursing 1

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PSYCHIATRIC NURSING

LECTURE 1


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PSYCHOSOCIAL INTEGRITY

COPING AND ADAPTATION

MENTALLY HEALTHY INDIVIDUAL

ATTITUDE OF SELF ACCEPTANCE

AUTONOMY ABILITY TO ABSTRACT,TRUST ,COPE

WITH STRESS

ACCURATE SELF PERCEPTION

AWARENESS OF SELF


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MENTAL HEALTH balance in a

persons internal life and adaptation

to reality

Mental ILL Health state of imbalancecharacterized by a disturbance in a personsthoughts, feelings and behavior

Poverty and abuses are major risk factors

Psychiatric nursing interpersonal processwhereby the professional nurse practitioner,through the therapeutic use of self(art) andnursing theories (science), assist clients toachieve psychosocial well being.

Core of psych nursing interpersonal processhuman to human relationship(both for mentally

healthy and ill)


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Neurosis

any long term mental or behavioral d/o in which

contact with reality is retained the condition isrecognized by the patient as abnormal.

Essentially features anxiety or behavior

exagerrated designed to avoid anxiety

( anxiety d/o ; hysteria to conversion

d/o,amnesia,fugue,multiple personality and

depersonalization- dissociative d/o

;oc d/o)Result of inappropriate early

programming(psychoanalysis little value)

Benefits from Behavior Therapy


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Psychos is

Mental or behavioral disorder wherein

patient looses contact with realityPresence of delusions,hallucinations,severe thought

disturbances,alteration of mood, poverty ofthought and abnormal behavior

(schizophrenia , major disorder of affect (mania depression), major paranoidstates and organic mental disorder

Benefits from psychoanalysis andantipsychotics


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Mental hygiene measures to promotemental health , prevent mental illness and

suffering and facilitaterehabilitation.(and if necessary findmeaning in these experiences)

Main tool therapeutic use of self

It requires self-awareness

Methods to increase self-awareness:

Introspection

Discussion Experience

Role play


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Mental health concepts

Assessment (psychosocial processes )

Appearance , behavior or mood

Speech , thought content and thought process

Sensorium

Insight and judgement

Family relationships and work habits

Level of growth and development


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Common Behavioral Signs and

Symptoms

1) Disturbances in perception

Illusion- misinterpretation of an actual

external stimuli

Hallucinations false sensory perception in

the absence of external stimuli


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2) Disturbances in thinking and speech

neologism coining of words that people donot understand

Circumstantiality over inclusion ofinappropriate thoughts and details

Word salad incoherent mixture of words andphrases with no logical sequence

Verbigeration meaningless repetition ofwords and phrases

Perseveration persistence of a response to aprevious question

Echolalia pathological repetition of words ofothers

Aphasia speech difficulty and disturbance Expressive , receptive or global


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Flight of ideas- shifting of one topic from

one subject to another in a somewhat

related wayLooseness of association-incoherent

,illogical flow of thoughts(unrelated way)

Clang association sound of word givesdirection to the flow of thought

Delusion persistent false belief,rigidly

heldDelusions of grandeur- special /important in a way

Persecutory-threatened

Ideas of reference-situation/events involve them

Somatic- body reacting in a particular way


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Magical thinking primitive thought

process thoughts alone can change

eventsAutistic thinking regressive thought

process-subjective interpretations not

validated with objective reality


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3) Disturbances of affect

Inappropriate disharmony between the

stimuli and the emotional reaction Blunted affect severe reduction in

emotional reaction

Flat affect absence or near absence of

emotional reaction Apathy dulled emotional tone

Depersonalization feeling of strangenessfrom ones self

Derealization feeling of strangenesstowards environment

Agnosia lack of sensory stimuli integration


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4) Disturbances in motor activity

Echopraxia imitation of posture of others

Waxy flexibility maintaining position for along period of time

Ataxia loss of balance

Akathesia extreme restlessness Dystonia- uncoordinated spastic movements

of the body

Tardive dyskenisia involuntary twitching or

muscle movements

Apraxia involuntary unpurposeful

movements


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5) Disturbances in memory

Confabulation filling of memory gaps

Dj vu 2nd time-like feeling

Jamais vu- not having been to the place

one has been before

Amnesia memory loss (inability to

recall past events)

Retrograde-distant past

Anterograde immediate past

Anomia lack of memory of items


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Dynamics of Human Behavior

Behavior the way an individual reacts to acertain stimulus

Conflict situation arising from the presence oftwo opposing drives

Need - organismic condition that requires acertain activity

Stress life events in which a demandingsituation (warrants a response )taxes a persons

resources( support systems or copingmechanisms/strategiesdistress and eustress

Adaptation process of interacting with theenvironment to maintain homeostatic equilibrium

Maladaptation ineffective coping


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Dynamics of Human Behavior

Personality integration of systems and

habits representing anindividuals

characteristic adjustment to his

environment expressed through behavior

Individualistic, unique, predictable(stability

and consistency)

Determinants: psychological,cultural,

biological ( not inhereted) and familial


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Analysis

Potential support systems or stressors

Potential risk factor

Satisfaction of human needs

Physiological(oxygen , fluids, nutrition,

temp.,elimination,shelter,rest,sex)

Safety and security(physical and psychological)

Love and belongingness

Self esteem

Self -actualization


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3 divisions of the mind

Conscious focussed on awareness

Subconscious recalled at will

Unconscious never recalled / largest part

Learning change in behavior throughinsight , relearning and remotivation


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Theories of personalitydevelopment

Psychosexual

PsychosocialCognitive

Developmental tasks

MoralInterpersonal


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Freuds psychosexual theory

Libido inner drive

Parts of bodyfocus of gratification

Unsuccesful resolution - fixation

Structures of personality

Id pleasure principle-instinct

Ego controls action and perceptionreality principle

Superego moral behavior - conscience


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0-18 m0s ;oral mouth trust and

discriminating

18 mos. 3 years ; anal bowelsholding on or letting go

Negativism and toilet training age

3 -6 years phallic ; genitalsexplorationand discovery ( inc. sexual tension)

Gender identification and genital awareness

Oedipus and Electra complex // Castration anxiety and penis envy


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6-12 yearslatency (quiet stage) sexual

energy diverted to play. Institution of

superegocontrol of instinctual impulses

12 young adult genital ; reawakening

of sexual drivesrelationships

Sexual maturation

Sexual identity ,ability to love and work


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Psychosocial Erickson

developmental milestones/delay

0-12mos; TRUST VS. MISTRUST

1-3y AUTONOMY VS. SHAME AND DOUBT

3-6 INITIATIVE VS. GUILT

6-12 INDUSTRY VS. INFERIORITY12-18 IDENTITY VS. ROLE DIFFUSION

18-25 INTIMACY VS ISOLATION

25-60 GENERATIVITY VS. STAGNATION

60 and above EGO INTEGRITY VS. DESPAIR


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INFANCY

CONSISTENT MATERNALCHILD

INTERACTION TRUST

INNER FEELING OF SELF WORTH

HOPE


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TODDLER

ALLOW EXPLORATION

PROVIDE FOR SAFETY

NO NO NEGATIVISM

OFFER CHOICES / REVERSE PSYCHOLOGYTOILET TRAINING 18 MOS.-BOWELDAYTIME BLADDER -2 Y

NIGHTIME BLADDER 3 Y

REWARD W/ PRAISE AND AFFECTION

INDEPENDENCE


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PRE-SCHOOL

PROVIDE PLAY MATERIALS

SATISFY CURIOSITY

TEACH ANDREINFORCE(HYGIENE,SOCIAL

BEHAVIOR)

SIBLING RIVALRY

WILLPOWER


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SCHOOL AGE

HOW TO DO THINGS WELL-SUPPORT

EFFORTS

CHUMS AND HOBBIES

NEEDS TO EXCEL/ACCOMPLISH

NEED FOR PRIVACY AND PEER

INTERACTION

COMPETENCE


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ADOLESCENCE

MAKE DECISION,EMANCIPATION

FROM PARENTS

BODY IMAGE CHANGES

NEED TO CONFORM BUT KEEP

INDIVIDUALITY

SELF - AWARENESS


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YOUNG ADULT

COMMITMENT AND FIDELITY

RESPONSIBILITY

ACHIEVEMENT OF INDEPENDENCE


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MIDDLE ADULTHOOD

SUPPORT-PERIOD OF ROLE TRANSITIONS

MIDLIFE CRISIS

ADJUSTMENT AND COMPROMISE

MOST PRODUCTIVE AND CREATIVE

ALTRUISM


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LATE ADULTHOOD

SELF ACCEPTANCE

SELF WORTH

WISDOM


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PIAGETS COGNITIVE

THEORY


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0-2 SENSORIMOTOR

REFLEXES

IMITATIVE REPETITIVE BEHAVIOR

SENSE OF OBJECT PERMANENCEAND SELF SEPARATE FROM ENVT.

TRIAL AND ERROR RESULTS IN

PROBLEM SOLVING


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2-7Y PRE-OPERATIONAL

SELF-CENTERED,EGOCENTRIC

CANNOT CONCEPTUALIZE OTHERS VIEW

ANIMISTIC THINKING

IMAGINARY PLAYMATE SYMBOLIC

MENTAL REPRESENTATION CREATIVITY

2-4 PRE-CONCEPTUAL (PRE-LOGICAL)

4-7 INTUITIVE (UNDERSTANDING OF ROLES)


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7-12Y CONCRETE

OPERATIONAL

LOGICAL CONCRETE THOUGHT

INDUCTIVE RESAONING (SPECIFIC TO

GENERAL)

CAN RELATE ,PROBLEM SOLVING

ABILITY

REASONING AND SELF-REGULATION


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12-ABOVE FORMAL

OPERATIONAL THOUGHT

Abstract thinking

Separation of fantasy and fact

Reality orientedDeductive reasoning

Apply scientific method


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HavighurstDevelopmental Tasks


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Early adulthood Career

Selecting a mate

Finding Civic or social responsibility

Middle age Achieving Civic or social responsibility

Adjusting to changes

Satisfactory career performance

Adjusting to aging parents

Adjusting to parental roles

Old age Adjusting to changes

Establishing satisfactory living arrangements andaffiliations


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Baby to early childhood

Right from wrong and Conscience

Late childhood Physical skills,wholesome attitude,social roles

Conscience morality and values

Fundamental skills in academics

Personal independence

Adolescence

Sexual social roles

Relationships Independence and ideology


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Kohlberg MORAL

DEVELOPMENT/

THINKING/ JUDGEMENT


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PRE-CONVENTIONAL (0-6)

PUNISHMENT AND OBEDIENCE

OBEDIENCE TO RULES TO AVOIDPUNISHMENT

CONVENTIONAL ( 6-12 )

MUTUAL INTERPERSONAL

EXPECTATIONS,RELATIONSHIPS ANDCONFORMITY

SOCIAL SYSTEM AND CONSCIENCEMAINTENANCE

BEING GOOD IS IMPORTANT SELFRESPECT OR CONSCIENCE


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POSTCONVENTIONAL (12 18 Y)

PRIOR RIGHT OR SOCIAL CONTRACT

UNIVERSAL ETHICAL PRINCIPLE

ABIDE FOR COMMON GOOD

RATIONAL PERSON-VALIDITY OF

PRINCIPLES-AND BECOMECOMMITTED TO THEM

INNER CONTROL OF BEHAVIOR

UNDERSTANDING THE EQUALITY OFHUMAN RIGHTS AND DIGNITY OFHUMAN BEINGS AS INDIVIDUALS


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SULLIVANSINTERPERSONALTHEORY


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INFANCY

NEED FOR SECURITY-INFANT LEARNS

TO RELY ON OTHERS TO GRATIFY

NEEDS AND SATISFY WISHES,

DEVELOPS A SENSE OF BASIC TRUST,SECURITY AND SELF WORTH WHEN

THIS OCCURS

O OO /


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TODDLERHOOD / EARLY

CHILDHOOD

CHILD LEARNS TO COMMUNICATE

NEEDS THROUGH USE OF WORDS

AND ACCEPTANCE OF DELAYED

GRATIFICATION AND INTERFERENCEOF WISH FULFILLMENT


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PRE-SCHOOL

DEVELOPMENT OF BODY IMAGE AND SELF-

PERCEPTION

ORGANIZES AND USES EXPERIENCES IN

TERMS OF APPROVAL AND DISAPPROVALRECEIVED

BEGINS USING SELCTIVE INATTENTION AND

DISASSOCIATES THOSE EXPERIENCES

THAT CAUSE PHYSICAL OR EMOTIONALDISCOMFORT AND PAIN


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SCHOOL AGE

THE PERIOD OF LEARNING TO FORM

SATISFYING RELATIONSHIPS WITH

PEERS-USES

COMPETITION,COMPROMISE ANDCOOPERATION

THE PRE-ADOLESCENT LEARNS TO

RELATE TO PEERS OF THE SAME SEX


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ADOLESCENCE

LEARNS INDEPENDENCE AND HOW

TO ESTABLISH SATISFACTORY

RELATIONSHIPS WITH MEMBERS OF

THE OPPOSITE SEX


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YOUNG ADULTHOOD

BECOMES ECONOMICALLY,

INTELLECTUALLY AND EMOTIONALLY

SELF SUFICIENT


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LATER ADULTHOOD

LEARNS TO BE INTERDEPENDENT

AND ASSUMES RESPONSIBILITY FOR

OTHERS


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SENESCENCE

DEVELOPS AN ACCEPTANCE OF

RESPONSIBILITY FOR WHAT LIFE IS

AND WAS AND OF ITS PLACE IN THE

FLOW OF HISTORY


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FORMATION OF PERSONALITY

CERTAIN GOALS MUST BEACCOMPLISHED, IF THIS GOALS ARE

NOT ACCOMPLISHED AT A CERTAIN

STAGE,.PERSONALITY WILL BEWEAKENED.FACTORS IN EACH

STAGE PERSISTS AS A PERMANENT

PART OF PERSONALITY.


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EACH STAGE HAS MAJOR

TRAUMAS AND FRUSTRATIONS THAT

MUST BE OVERCOME.SUCCESSFUL RESOLUTION OF

CONFLICTS ASSOCIATED WITH EACH

STAGE IS ESSENTIAL TODEVELOPMENT..UNRESOLVED

CONFLICTS REMAIN IN THE

UNCONSCIOUS AND MAY, AT TIMES,RESULT IN MALADAPTIVE BEHAVIOR

Psych Nursing 1

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