Mental Health and Historical Perspectives

Mental Health

Maintenance of successful mental activity, productive activities, fulfilling relationships, and coping ability.

WHO Definition of Mental Health

A state of mental well-being enabling stress-coping, realizing abilities, learning/working well, and community contribution.

Mental Illness

Disruption in a person's ability to function due to symptoms for a significant period.

Causes of Mental Illness

Genetics, environment, and brain disorders.

Horwitz's Cultural Elements of Mental Illness

Incomprehensibility and cultural relativity.

DSM-5

Diagnostic Statistical Manual (5th ed., 2013) by the APA used to classify and diagnose mental disorders.

Stress

State of disequilibrium occurring when demands on an environment exceed the ability to cope.

Freeze Response

A parasympathetic response involving feelings of paralysis or dissociation, even during non-life-threatening events.

Hildegarde Peplau

Considered the mother of psychiatric nursing; developed the four stages of anxiety.

Ego Defense Mechanisms

Psychological strategies like denial, projection, rationalization, and displacement.

Kübler-Ross's Five Stages of Grief

Denial, anger, bargaining, depression, and acceptance.

Grief

Subjective state of emotional, physical, and social responses to the loss of a real or perceived entity.

Coping Skills

Techniques that help promote change in thought processes to combat negative or catastrophic thinking.

Denial

Refusing to accept an unpleasant or painful reality.

Displacement

Taking out anger on a surrogate, such as a restaurant server instead of a brother.

Projection

Attributing one's own unacceptable thoughts or desires to someone else.

Rationalization

Blaming external factors like a professor for a failing grade instead of lack of studying.

Reaction Formation

Acting in a way that is the exact opposite of one's true feelings.

Regression

Demonstrating childlike behavior, such as cuddling a childhood toy, after failing an exam.

Repression

The unconscious suppression of painful memories or thoughts.

Sublimation

Channeling desires, such as revenge, into positive outlets like supporting a charity.

Trephining

Neolithic practice of chipping a hole into the skull to release evil spirits.

Pre-1776 Mental Illness Beliefs

Believed to be supernatural or spiritual in nature.

Dorothea Dix

Primary advocate for humane treatment and asylums during the Moral Treatment era (1790-1900).

Moral Treatment Movement Impact

Institutions became overcrowded.

Metrazol Shock Therapy

Discontinued in the 1940s due to a high incidence of fatality.

Lobotomy

Biological treatment developed during the Institutionalized Period involving the brain's frontal lobes.

National Mental Health Act of 1946

To develop mental health programs outside of state hospitals.

Chlorpromazine

First typical antipsychotic medication that fueled the deinstitutionalization movement in 1955.

John F. Kennedy

US President who passed the Community Mental Health Act in 1963.

Deinstitutionalization Failure

Community resources were insufficient to support discharged patients.

Mental Health Stigma

Negative attitudes or discrimination toward persons with mental illness.

Self-Stigma

Internalization of negative stereotypes by the individual with the illness.

Implicit vs. Explicit Bias

Implicit bias is subconscious, while explicit bias involves awareness of one's prejudices.

Person-First Language

Using 'person with schizophrenia' instead of 'schizophrenic'.

Nonverbal Cues

Typically account for 93% of a message in therapeutic communication.

SOLER ('O')

Observe an open posture.

SOLER ('E')

Establish eye contact.

Empathy vs. Sympathy

Empathy involves experiencing the feelings of another, while sympathy is just understanding suffering.

Open-Ended Questions

Used to foster discussion and encourage the exploration of feelings.

'Why' Questions

Should generally be avoided because they can make the patient feel defensive or judged.

Giving False Reassurance

Non-therapeutic technique exemplified by phrases like 'Everything will be fine'.

Therapeutic Alliance

An interaction where both participants contribute to a climate of healing and growth.

Transference

When a patient unconsciously redirects feelings for a significant person from their past onto the nurse.

Countertransference

The nurse's behavioral and emotional response to a patient based on the nurse's past.

Genuineness

Essential characteristic of being open, honest, and 'human'.

Professional Boundaries

The mutually understood physical, emotional, and social limits of the relationship.

Touch Boundaries

A common professional boundary concern regarding physical interaction.

NCSBN Clinical Judgment Model (Step 2)

Analyze cues after recognizing cues.

NCSBN Clinical Judgment Model (Prioritizing)

Prioritize hypotheses by deciding what matters most.

Nursing Process Assessment Step

Corresponds to 'Recognize Cues' in the Clinical Judgment Model.

Mental Status Examination (MSE) Components

Appearance, behavior, speech, mood/affect, thought, perception, cognition, and insight/judgment.

Cognitive Screen vs. MSE

A cognitive screen focuses specifically on orientation and memory, whereas the MSE is a broader assessment.

Collateral Information Sources

Family, EMS, police, or an outpatient treatment team.

Body Habitus

The patient's physical build, such as thin, average, or obese.

Impulsivity

A behavioral term describing a patient acting without considering consequences.

Akathisia

Motor finding in an MSE characterized by inner restlessness and the need to move.

Waxy Flexibility

A catatonic feature where a patient's limbs stay in the position they are placed by another person.

Pressured Speech

Speech that is rapid, loud, and difficult to interrupt.

Poverty of Speech

The clinical term for a patient who speaks very little or provides minimal information.

Mood vs. Affect

Mood is the patient's internal emotional state; affect is the external expression of that state.

Critical Safety Risks

Suicide, violence, and self-harm.

Weather-Inappropriate Dress in MSE

Belongs to the Appearance category (e.g., wearing a T-shirt and shorts in 28°F weather).

Stereotypy

Repetitive, abnormally frequent, non-goal-directed movements.

SOLER ('R')

Relax.

Unconditional Positive Regard

Viewing health care situations through the patient's eyes with sensitivity and respect.

Response to Stimuli

Documented when a patient laughs or gestures without any external reason.

Latency in Communication

The time delay between a nurse's question and a patient's response.

The Institutionalized Period

Period from 1900-1955 characterized by large asylums and insulin shock therapy.

Joint Commission on Mental Health and Illness (1955)

To identify national mental health needs and recommend improvements in care.

Transaction Model of Communication

Both participants are simultaneously considered communicators.

Belittling Feelings

A non-therapeutic technique involving telling a patient 'You shouldn't feel that way'.

Insight in MSE

Assessing the patient's awareness of their own illness and situation.

What does "milieu" mean?

Surroundings or environment.

What does the French word "milieu" mean?

"Middle."

What is a therapeutic milieu?

An environment manipulated so that all aspects of care for the patient are considered therapeutic.

What is the goal of a therapeutic milieu?

To create an environment where patients can learn and develop coping skills, social skills, illness management, and wellness strategies.

What are four things patients can learn in a therapeutic milieu?

Coping skills, social skills, illness management, and wellness strategies.

When was milieu therapy commonly used in psychiatric inpatient programs?

1960s-1980s.

How has milieu therapy changed today?

Strategies have been modified to meet the needs of shorter inpatient psychiatric stays.

What was nursing's focus in therapeutic milieu care?

Establishing relationships and encouraging patients to be active participants in treatment.

What types of programs continue to use milieu therapy?

Adolescent/children residential programs and substance abuse treatment centers.

Who outlined the basic assumptions of milieu therapy?

Skinner (1979).

What is the first basic assumption of milieu therapy?

The health of each individual is encouraged to grow.

What is the therapeutic importance of each interaction?

Each interaction is an opportunity for a therapeutic intervention.

What does autonomy mean in milieu therapy?

The client has control over his or her environment.

What does it mean that the client "owns" their behavior?

The client takes responsibility for their behavior.

How can peer pressure be used in a therapeutic milieu?

Peer pressure can be a useful and powerful tool.

How should inappropriate behaviors be handled?

They should be dealt with as they occur.

What should be avoided in milieu therapy?

Restrictions and punishment.

What is containment?

Creating a sense of safety and security.

What is structure?

Providing a schedule of activities, group therapy, and information about whom the client should go to for help.

What is involvement?

Encouraging community interaction through things such as common dining areas, small group seating, and community meetings.

What is support?

Being supportive and affirming rather than punitive or rigid; includes empowerment.

What is validation?

Active, empathic listening to the patient's perceptions and concerns.

What is one major responsibility of the nurse in milieu therapy?

Managing the therapeutic milieu and day-to-day activities.

How does the nurse establish therapeutic relationships?

Through one-to-one interactions.

What is the nurse's medication responsibility?

Administering medications or assisting clients with self-medication.

What team does the psychiatric nurse participate in?

The interdisciplinary treatment team.

What educational responsibilities does the nurse have?

Providing client education and teaching group activities.