****Intro to Mental Health Nursing

Mental health nursing

Specialized nursing using both the science + art of nursing.

Science of mental health nursing

Evidence-based practice; Recovery Model; trauma-informed care.

Art of mental health nursing

Communication; empathy; connection.

Mental health

Emotional, psychological, and social well-being.

Factors affecting mental health

Genetics; brain chemistry; life experiences/trauma.

Positive mental health

Reaching full potential; coping with stressors; productivity; meaningful connections.

Mental illness

Affects thinking, feelings, mood/behavior; makes relationships and daily functioning difficult.

Mental illness processes

May involve flawed biological, psychological, or social processes.

Mental health continuum

Ranges from ability to function → disability/dysfunction.

Stigma

Negative attitude/discredit toward a person or group labeled as different.

Bias

Unfair stereotyping, prejudice, or discrimination against a group.

Self-stigma

Internalized negative view or shame about one's condition.

Institutional stigma

Policies/organizations limit opportunities for people with mental illness.

Mental illness & violence misconception

Mental health disorders do not automatically mean violent/unpredictable behavior.

Mental illness & personality misconception

Mental illness is not caused by personality weakness/character flaws.

Mental illness & parenting misconception

Mental illness is not caused by bad parenting.

Nursing core values

Trust; inclusiveness; innovation; empowerment.

Cultural humility

Appreciating/respecting another person's culture and its role in life/health practices.

Cultural humility requires

Self-reflection; identify biases; assess client's cultural health beliefs and practices.

Cultural competence

Respectful and responsive care toward diverse health beliefs/practices.

Cultural communication considerations

Loudness; emotional communication; eye contact; touch.

Cultural filters

Nurse's own cultural biases that may affect care.

LGBT cultural consideration

Many have experienced judgment and/or rejection.

Children/adolescents

Child should be a source of information; wide range of normal can make diagnosis difficult.

Older adult considerations

Functional ability; economic/social status; environmental factors.

Social determinants of health

Ways people live/work that shape health outcomes.

Health inequities

Differences that contribute to unequal health outcomes/treatment.

Trauma can affect

Individuals and groups.

Trauma-informed nursing care

Recognize signs/symptoms; screen for trauma; resist re-traumatization.

ACEs

Adverse Childhood Experiences; considered when recognizing signs/symptoms of trauma.

DSM-5-TR

Standard guide used to classify and diagnose mental health disorders.

DSM-5-TR provides

Expected assessment findings and standardized language.

DSM-5-TR helps with

Planning, interventions, and evaluation of care.

DSM-5-TR does NOT provide

Medication lists or client care plans.

NANDA

Basis for nursing diagnoses/interventions.

Normal vs. abnormal

What is considered normal can change over time.

Mental illness characteristics

Cognitive/emotional disturbances; abnormal behaviors; impaired functioning.

Major mental health theories

Psychoanalytic; interpersonal; behavioral; cognitive; biological.

Psychoanalytic theory

Freud; focuses on unconscious thoughts/feelings and past relationships.

Psychoanalysis

Identifies unconscious conflict and works to resolve it.

Psychotherapy

Trusting relationship between therapist and client.

Psychodynamic psychotherapy

Similar to psychoanalysis but focuses on present relationships.

Interpersonal therapy

Improves interpersonal relationships and communication.

Cognitive therapy

Focuses on thoughts and behaviors; thoughts come before feelings/behavior.

Cognitive therapy techniques

Priority restructuring; journaling; assertiveness training; monitoring thoughts.

Behavioral therapy theorists

Pavlov; Watson; Skinner.

Behavioral therapy

Focuses on changing learned behavior and its consequences.

Behavioral therapy techniques

Modeling; operant conditioning; systematic desensitization; aversion therapy.

CBT

Combines cognitive + behavioral therapy.

CBT principle

What the client thinks influences behavior.

Biological theory

Mental illness has a physical cause.

Biological treatments

ECT; medications/psychopharmacology.

Recovery Model

Focuses on adapting to illness rather than cure.

Recovery Model use

Frequently used in substance abuse.

Psychiatric nursing

Promotes/maintains appropriate behavior that improves functioning.

Psychiatric nursing interventions

Listening; communication; teaching; medication assistance/education; symptom management; stress management; self-care groups.

Peplau

"Mother of Psychiatric Nursing."

Peplau's theory

Interpersonal Theory.

Peplau's major nursing goal

Decrease anxiety and improve client interactional skills.

Peplau's focus

Nurse-patient relationship influences patient outcomes.

Peplau & patient care

Patient should feel understood and be viewed holistically.

Peplau communication

Use language the client understands; spend time with client; provide support.

Therapeutic mental health strategies

Counseling; milieu; screening; self-care; psychobiological care; CBT; health promotion; case management.

Psychobiological nursing role

Medication education and monitoring for side effects.

Goal of mental health law/ethics

Balance individual rights with rights of society.

Beneficence

Doing good; act for client benefit and prevent harm.

Autonomy

Client's right to make rational decisions about care.

Justice

Fair and equal care regardless of background/culture.

Nonmaleficence

Do no harm; avoid pain/suffering.

Fidelity

Loyalty to the client.

Veracity

Duty to communicate truthfully.

Confidentiality

Person's constitutional right to privacy.

Confidentiality standard

Supported by ANA Code of Ethics for Nurses.

Duty to warn/protect

Confidentiality may be broken to protect a threatened third party.

Duty to warn steps

Assess danger; identify threatened person; take appropriate protective action.

Abuse reporting

Nurses are legally obligated to report abuse.

Voluntary admission

Client chooses admission.

Involuntary admission

Admission without consent when client threatens harm to self/others.

Long-term involuntary admission

May last 60-180 days or longer.

Temporary emergency admission

Less than 15 days.

Informal admission

Least restrictive; client can leave at any time/AMA.

AMA

Against Medical Advice.

Mental health patient rights

Treatment; least restrictive environment; confidentiality; freedom from restraints/seclusion; consent; refusal of treatment; humane care.

Right to treatment

Mental health clients have a right to receive treatment.

Right to refuse treatment

Clients may refuse treatment.

Least restrictive environment

Care must use the least restrictive setting/intervention possible.

Restraint rule

Least restrictive restraint for shortest duration.

Seclusion

Should not be used unless necessary.

ADA & mental illness history

Prior mental illness cannot be asked about on an employment application.

ADA & stabilized condition

Stabilized mental condition may mean there is no disability.

ADA risk assessment

Based on behavior, not the mental disability itself.

Tort

Civil wrong for which the injured party may collect money damages.

Intentional torts

False imprisonment; assault; battery; invasion of privacy.

Unintentional torts

Negligence; malpractice.

False imprisonment

Intentional tort.

Assault

Intentional tort.

Battery

Intentional tort.

Invasion of privacy

Intentional tort.

Negligence

Unintentional tort.

Malpractice

Unintentional tort.