Essential of Pyschiatric Mental health nursing

  1. Edidemiology of Mental Disorders
    According to healthy people 20/20 mental illness is the 11th leading cause of death in people 25-34

    1 in 4 americans have been dx w/a mental illness

    WHO says about 14% of the world's population is impacted by mental illness, however 75% of those impacted are in a lower economic status and have less access to tx
  2. Intro
    Mental health (towsend)
    is defined as "the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural.
  3. Cultural/spiritual concepts
    • Culture bound syndromes are unique patterns of behavior and troubling experiences that occur in various parts of the world, whose description does not fit into Western conventional diagnostic categories
    • ex- Pibloktoq found in eskimo cultures knows as Arctic hysteria- period of extreme excitement and bizarre behavior (such as stripping naked and rolling in the snow until you get hypothermia), followed by a seizure or coma and then ammensia to the event
  4. cultural/spiritual concepts
    always be aware during initial assessment
    • Communication: Language, dialect, rate, quality. roots are in culture, norms and customs. may look like mental illness, but in culture accepted behaviors
    • Space: (eye contact, touch), re: territory, density and distance. western culture defines interpersonal space as 0-18" intimate, 18"-3 ft personal zone, 3-6ft social
    • time: (past, oriented) some cultures scornful of clocks, difficulty scheduling appts
  5. Cultural/spirtual concepts
    always be aware during initial assessment
    environmental, biological
    • environmental control: (cultural health practices) perception of control, becomes important when environment is used to great optimal health
    • Biological variations: (body, skin, genetics and susceptibility to disease) factual knowledge about variations allow for cultural competency
  6. Spiritual concepts
    • refers to human quality that gives meaning and sense of purpose to an individual's existence
    • exist within in each individual regardless of belief system and serves as a force for the interconnectedness between the self and others, the environment, and a higher power
    • spiritualism gives people lives meaning and purpose
    • faith provides for hope, love and forgiviness
  7. spiritual concepts
    research studies
    • research has shown people who attend religious events/mass regularly and practice a faith have an inc chance of survival following serious illness, less depression and other mental illness, longer life, overall better physical and mental health
    • they also have lower suicide rates, lowers drug use and abuse, less juvenile delinquency, lower divorce rates, improved mental illness outcomes
    • may be correlated with strong support network found in religious organizations
  8. cultural/spiritual concepts pertaining to the nurse
    • knowledge of culture, ethnicity, and spiritualism is sessential for the nurse to understand to be able to interpret and respond to clients effectively and without stereotyping
    • caution must be taken not to assume that all individuals who share a culture, religion or ethnic group are the same. this constitutes stereotyping and must be avoided. all individuals must be appreciated for their
  9. Etiology of mental illness
    • is define as maladapative responses to stressors from internal or external environment, evidence by thoughts, feelings and behaviors that are incongruent with the local and cultural norms and interfere with the individual's social occupational or physical functioning
    • where does mental health come from
  10. coping mechanism
    • behavioral, physical, and psychological ways one adapts to deal with stressors
    • ability to adapt to a stressor
    • affected by culture religion and individual belief
    • affected by one's personal choice
    • can be accessed in a variety of mediums:
    • ex
    • Heathly: excerise, music, reading, playing games, sports, gardening, biking, praying, express self
    • unhealthy: smoking, drinking, gambling, drug use, overeating, isolate, excessive sleeping or shopping
  11. defense mechanism
    • are mental pressure valves
    • are learned
    • are considered to be unconscious
    • give the illusion of being helpful, when in reality they mask the stress and may actually increase it
    • when used in small doses may be helpful for short term relief
    • people tend to have their own repertoire of mechanisms
    • when used excess, becomes ineffective and may lead to breakdown of personality
  12. etiology of mental illness
    risk factors
    • Psychological: emotional developmental level, intelligence, interaction skill, attitude, creativity
    • sociocultural: neglect/abuse, poverty (resource), child rearing patterns, parents with MI/substance abuse, religion values and belief
    • environmental: exposure to toxins, drugs pollution, exposure to ear/terrorism and domestic violence (media)
  13. etiology of MI protective factors
    • some people have internal protection such as resillence, high stress tolerance, and positive attitude
    • some people have external protection such as caring family, supportive friends, adequate income and resources, recreation/hobbies for stress reduction (coping skills)
    • some people rely on culturally bound supports or spiritual beliefs to get though emotional stressors
  14. Various theories
    stress related theories
    • Hans Selve's (GAS)
    • - defined stress as the state manifested by a specific syndrome which consists of all the nonspecifically induced changes within a biologic system flight or fight syndrome ie fressing in extreme cases
    • Stress/Diathesis theory
    • - are we predetermine by genetics or biology to develop a mental illness and the onset of traumas or stress bring it forward? (initial use to describe the onset of schizo)
  15. Physiological responses to stress
    sustain stress
    • promotes susceptibility to many diseases
    • anxiety often lies at the very base of every mental health illness originates from our primal survival and is expressed through throught/perceptions, emotions and behavior
    • Levels of anxiety
    • - mild- seldom problem
    • - moderate- perceptual field diminishes
    • - severe- perceptual field is so diminish that concentration centers on one detail only or on many extraneus details
    • - panic- the most intense state
  16. various theories
    • identifies mental health on a continuum of individual quest thru heirarchy of needs with self actualization as fulfillment of one's highest potential
    • he believed behind everything we do is a needs that wants to be satisfied
    • there is a reason for every behavior we exhibit. we have instincts that keep us alive and continue our species. buth there are other needs that go beyond our body's instincts.
  17. various theories
    personality development concept
    • as nurses we need to have an understanding of human growth and development in order to under and tx pts with mental illness
    • disruption in the development of core personality features are consider one etiological explanation for psychiatric illness
  18. various theories
    personality defines
    • the characteristic way in which a person thinks, feels, and behaves, the ingrained pattern of behavior that each person evolves, both consciously and unconsciously, as his or her style of life or way of thinking
    • this is neither good or bad,
  19. Various theories
    life cycle developmentalist
    • believe that people continue to develop and change throughout life, possibility for renewal and growth in adults
    • stages are identified by age. however, personality is influenced by temperment (inborn personality characteristics) and the environmental
    • it is possible for behaviors from a unsuccessfully completed stage to be modified and corrected in a later stage
  20. Various theories
    life cycle developmentalist 2
    • stages overlap and individuals may be working on tasks from more than one stage at a time
    • individuals may become fixed in a certain stage and remain developmentally delayed
    • developmental theories are generalizations, tendacies, and guidelines not strict rules- individuals grow and develop at their our pace
  21. psychoanalyst theories
    • freud believed that basic character was formed by age 5. he organized the structure of personality into 3 major components: ID (pleasure principle), Ego (reality principle), superego (perfection principle)
    • oral stage (0-18 mths)
    • anal stage 18 mons- 3yrs
    • phallic stage 3-6
    • latency 6-12
    • genital stage 13-20
  22. pyschoanalyst and relevance to nursing practice
    • being able to recognize behaviors associated with ID, ego, and superego will assist in assessment of clients developmental level
    • understanding the use of ego-defense mechanisms is important in making determinations about maladaptove behaviors and in planning care for clients to assist in creating change
  23. interpersonal theory
    • Henry Stack Sullivan (1953)
    • based on the belief that individual behavior and personality development are the direct result of interpersonal relationships
    • sullivan's stages of development:
    • - infancy 0-18
    • - childhood 18 mons-6 yrs
    • - juvenile 6-9
    • - preadolescense- 9-12
    • - adolescents 12-14
    • - late adolescents 14-21
  24. interpersonal theory and relevance to nursing
    • relationship development is a major psychiatric nursing intervention
    • knowledge about the behaviors associated with all levels of anxiety and methods for alleviating anxiety help nurses assist clients in achieving interpersonal sercurity and a sense of well being
  25. theory of psychosocial development
    • erickson 1963
    • based on the influence of social processes on the development of the personality
    • erikson identified eight stages of development and the major tasks associated with each
  26. erickson stages
    • trust v mistrust birth -18 mons
    • automy v shame and doubt 18- 3yrs
    • initiative v guilt 3-6
    • industry v inferiority 6-12
    • identity v role confusion 12-20
    • intimacy v isolation 20-30
    • generativy v stagnation 30 65
    • ego integrity v despair 65 till death
  27. theory of psychosocial development and relevance to nursing practice
    many indiv with mental health problems are still struggling to complete tasks from a number of developmental stages. nurses can plan care to assist these indiv to fulfill these tasks and move on to a higher developmental level
  28. Psychodynamic nursing theory- Peplau
    • applies interpersonal theory to nurse-client relationship development 1991 and revolutionized PMH nursing
    • views interpersonal experiences as learning situations for nurses to facilitate forward movement in the development of health personality
    • peplau identifies seven nursing roles in which nurses function to assist indivi in need of health services: stranger, counselor, teacher, leader, technical expert and surrogate
  29. 4 phases of nurse-pt relationship (overlapping roles)
    • orientation: work together to clarify problem
    • identification: patterns- by observing pt responds to nurse. with with, against or in isolation of the nurse to establish goals and trust
    • exploitation: pt takes advantages of help, becomes more comfortable and may even exploit the services. needs limit setting akin to parenting
    • resolution: pt separates from the nurse and gathers strength to assume independence if all three previous stages are met
  30. Peplau stages
    • peplau's correlates the stages of personality development in childhood to stages thru which clients advance during the progression of a mental illness. as you observe and assess your patients in a clinical setting be keenly aware of these following stages and behaviors
    • a. learn to count on others
    • b. learn to delay gratification
    • c. identifying oneself
    • d. develop skill in participation
  31. psychodynamic nursing theory- peplau
    in relevance to nursing practice
    • peplau's model provides nurses with a framework to interact with pts, many of whom are fixed in or bc of illness have regressed to an earlier level of development
    • using nursing role suggested by peplau may facilitate pt learning that was not achieved in earlier experiences
  32. psychobiology
    • psychiatric nursing care has evolved over the yrs from solely psychsocial focus to bio-psychosocial focus
    • research on brain functioning are continually advancing and neuro anatomy research showing the pathology of numerous disease processes linked to risk factors of mental illnesses
    • the key to understanding tx stragtegies for psych disorders is to recognize the role neurotransmitters play in neural communications
    • psych disorders are brain based illnesses with either an anatomical or physiological compotents
  33. psychobiology influences
    • brain abnormalities (concussion)
    • neuroendo (hormonal affects on NT)
    • neuroanatomy (ventricle, limbic system)
    • neurotransmitter (excess or deficient)

    excessive trauma or stress can be so over stimulating to the brain that is depletes of the neurotransmitter and can lead to slower cognitive functioning, emotional deregulations. this makes it more difficult for current psychotropic medication to work effectively
  34. ex psychobiological influences
    • new research shows abnormalities in orbital cortex area for moral decisions and ethical behavior
    • too much serotonin during fetal development
    • born without natual calming factors and then exposed to violence
    • excessive exposure or actual trauma experiences result in extreme propensity to violence
    • these are found in most serial killers
  35. dx test
    • electroencephalography (brain waves)
    • EEG mapping- region mapping
    • CT scan- transverse image
    • MRI- magnetic field image
    • PET- radioactive substance brain activity
    • single photon emmission CT- like PET but stronger with different detectors
  36. what to know about psychopharm
    • most psychotropic meds work at the neuronal synaptic hap and either produce changes, inc or reduce the amt of NT
    • they are futher influenced by hormonal input, and stressors though the efferent nervous system response
    • in many cases pts are tx with more than one med, thus inc the chances of drug interaction and adverse outcomes
    • psychiarist often use meds 'off label' to address symptomatology
  37. cause of concern
    • political/economic crisis impact mental health funding leaving inadequate care/providers and services
    • mental health laws not clearly enacted and often exist to protect rights at the cost of care. lots of co-mingling of ethical/legal dilemmas in psych nursing
    • resources are limited and 41%v of the world have no mental health policies and over 40% no tx
  38. cause for hope
    • new science and technology started to be incorporated into nursing practice, education and research/ possibilities for expanding role in psych nursing
    • many advanced in brain research and the development of more effective pyschotropic meds
    • inc social campaihns to raise awareness of mental health issues
    • advancement of alternative somatic/holistic tx. recovery is possible. pt centered empowerment, shifting
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Essential of Pyschiatric Mental health nursing