Psychiatric-Mental Health Nursing Katherine Conlu-Bengan, RN.
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Transcript of Psychiatric-Mental Health Nursing Katherine Conlu-Bengan, RN.
Psychiatric-Mental Health Nursing
Katherine Conlu-Bengan, RN
UNIT I. FOUNDATIONS OF PSYCHIATRIC-MENTAL
HEALTH NURSING
Entering Psychiatric Nursing
How will I handle bizarre or
inappropriate behavior?
Am I prying when I ask personal
questions?
What will I be doing?
Is my physical safety in
jeopardy?
What happens if a client asks me for a date or
displays sexually aggressive or
inappropriate behavior?
What if I say something
wrong?
What if no one will talk
to me?
What if I encounter
someone I know being treated on
the unit?
Difference Between Psychiatric and Medical-Surgical Nursing
Physical efforts prove to students that they are working and accomplishing something. In psychiatric nursing one has to be psychologically active, but physically passive much of the time.
It takes some time to realize that LISTENING to what aches in the hearts of patients may touch them more profoundly than back rub.
DEFINITION OF HEALTH
“a state of complete physical, mental
and social well-being
without the absence of disease or infirmity”
WORLD HEALTH ORGANIZATION
DEFINITION OF MENTAL HEALTH
“the successful performance of mental function,
resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity”
(USDHHS, 1999)
DEFINITION OF MENTAL HEALTH
I probably have the
most sanest
mind..hehe
A state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior, and coping, positive self-concept, and emotional stability.
ELEMENTS OF MENTAL HEALTH
• Self-governance• Progress toward growth or self-
realization• Tolerance of uncertainty• Self-esteem• Reality orientation• Mastery of environment• Stress management
INFLUENCES ON MENTAL HEALTH
kcbengan/SACRNursing/2004
Biological factors Biologic makeup Sense of harmony in life Emotional resilience/hardiness Spirituality Positive identity
kcbengan/SACRNursing/2004
Social and Cultural factors Sense of community Access to adequate resources Intolerance of violence Support of diversity among people
kcbengan/SACRNursing/2004
Interpersonal factors Effective
communication Ability to help
others Intimacy Balance of
separateness and connection
DEFINITION OF MENTAL ILLNESS
“a clinically significant behavioral or
psychological syndrome experienced by a
person, marked by distress, disability, or the
risk of suffering, disability, or loss of
freedom”
(American Psychiatric Association)
Psychopathology
• Psychopathology examines the nature and development of abnormal – Behavior, Thoughts, Feelings
• Definitions of abnormality vary widely and may not capture all aspects of psychopathology– Psychopathological aspect (causes,
mechanisms)– Clinical aspect (assessment, treatment)
Ch 1.1
Early Views of Psychopathology
• Demonology (Supernaturalism) is the view that abnormal mental function is due the occupation by an evil being of the mind of a person – Treatment requires exorcism
• Somatogenesis is the view that disturbed body function produces mental abnormality
• Psychogenesis is the belief that mental disturbance has psychological origins
Demonology During the Dark Ages• The Dark ages were marked by a decline
in Greek and Roman civilizations and by an increase of influence of churches
• Church authorities came to view witchcraft as an explanation of abnormality – Witches were in the league with the Devil– Torture was required to elicit “confessions”
of witchcraft; death by fire was required to drive out supposed demons
Ch 1.5
Asylums• Asylums were created in the 15th century
for the care/treatment of the mentally ill. – Asylums were meant to be a place of refuge– Care and treatment within an asylum was not
always humane or effective
• Pinel (1793) advocated for humane treatment of patients in asylums (“moral treatment”)– Removed shackles, improved diet, better
treatment
Ch 1.6
Modern Approaches to Mental Illness
• Systems of classification were developed which argued that mental illness has a biological cause– Kraepelin suggested that clusters of
symptoms form a syndrome– Each syndrome has its own unique
cause, course, symptoms, treatment, and outcome
Ch 1.7
TREPHINATION
TRANQUILIZER CHAIR
O'HALLORAN'S SWING
HYDROTHERAPY
LUNATIC BOX
HOLLOW WHEELRESTRAINT CAGE
Benjamin Rush Clifford Beers
Sigmund FreudEmil Kraepelin
Hildegard Peplau
THERAPEUTIC COMMUNICATIONTHERAPEUTIC COMMUNICATION
One-Dimensional ModelsOne-Dimensional Models
ONE CAUSEONE CAUSE DISORDERDISORDER
Multidimensional ModelsMultidimensional Models
MANY CAUSESMANY CAUSES
BiologicalBiological
InfluencesInfluences
BehavioralBehavioral
InfluencesInfluences
SocialSocial
InfluencesInfluences
Cognitive & EmotionalCognitive & Emotional
InfluencesInfluences
PROBLEMS IN TREATING MENTAL ILLNESS
• Cost-related issues
• Stigma• Revolving door
treatment• Lack of parity• Limited access to
services
METHODS OF ACHIEVING OPTIMAL CARE FOR MENTAL
ILLNESS• Beyond response to recovery
• Reintegration into society
• Mental health parity
• Culturally competent care
• Medication adherence
PSYCHIATRIC-MENTAL HEALTH NURSING
“the diagnosis and treatment
of human responses to
actual or potential mental
health problems”
(ANA, APNA, & ISPN, 2000)
Psychiatric-Mental Health Nursing
• Nursing Process and Standards of Care
• Levels of Practice
• Guiding Principles
• Role of the Psychiatric Nurse as a Team Member
PERSONAL PHILOSOPHY ISSUES• Self-Awareness
The NURSE gains recognition of his/her own feelings, beliefs, and attitudes.
• Awareness of Environment
Includes recognition of client needs, belief systems, and behaviors; identification of the factors that contribute to health and illness in the client; and assessment of resources available to the client.
• Awareness Of Interactions With The Environment
NURSES identify their:> specific feelings and thoughts about clients (including feelings of acceptance or rejection)> evaluate the consequences of their actions toward clients> learn to effectively differentiate between their own needs and client needs.
An interpersonal process Employing theories of human behavior
as its science and purposeful use of self as its art.
The major therapeutic goal is the prevention, detection, and rehabilitation of psychiatric disorders.
Emphasis on the “interpersonal process and relationships”
Most fundamental goals : To help the patient accept himself, to improve his relationship with other people and to learn to function independently on a
realistic basis.
Psychiatric Nursing Paradigm
Human behavior
Communicationskill
Process Nursing
Therapeutic Use of self
Other Terms Used For Psychiatric Nursing:
Psychosocial Nursing
Institutional Nursing
Mental Health Nursing
Self as a Therapeutic
Tool
Nurse uses herself in order to affect positive changes in the patients’ behavior.
Principles and Perspectives of the Psychiatric-Mental Health Nurse
Principles of Psychiatric Nursing• View the client as a holistic being
• Focus on the client’s strengths and assets, not on his weakness and liabilities
• Accept the client as a human being who has value and worth
• View the client’s behavior as designed to meet a need or to communicate a message
• Potential for establishing relationship with clients
• Quality of the interaction • View the client’s behavior as the best possible
adaptation
N U R S I N G R O L E S
Ward Manager Social Agent Counselor
Teacher Mother Surrogate Technical Role
Essential Qualities of the Psychiatric-Mental Health Nurse
• Therapeutic Use of Self• Genuineness and Warmth• Empathy• Acceptance• Maturity and Self-Awareness
The Mental Health Team
• Nurse• Social Worker• Clinical Psychologist• Psychiatrist• Physician• Occupational Therapist• Recreational Therapist• Psychiatric Aide/Clinical Assistant
MULTI-AXIAL SYSTEM OF DIAGNOSIS
• AXIS I: Clinical Disorders• AXIS II: Personality Disorders and Mental Retardation• AXIS III: General Medical Conditions• AXIS IV: Psychosocial and Environmental Problems• AXIS V: Global Assessment of Functioning (GAF); 0-100
(APA, 2000)