1,2,3,4 Psych

how Freud’s work affected interventions in psych

• Psychoanalytic movement – Freud – early 1900s – 1970s;

  • Personality theory – based on unconscious motivations for behaviors – drives; Three stages – oral, anal, and genital

• Believed mental illness were psychological and result of disturbed personality and faulty parenting. Mental illness categorized as

  • Psychosis (severe)

    • Breaks reality

  • neurosis (less severe)

    • distressed about their problems

• Psychoanalysis remains a treatment option for select group of patients

how psychopharmacology has impacted patients with psychiatric disorders

Initially used barbiturates in 1930s to trat mental illness. Phenothiazines were used in 1950s to help reduce symptoms which it did. But with calmer patients the negative effects of living in a restrictive and coercive institutional environment became evident

deinstitutionalization

The release of those confined to institutions for long periods of time into community for treatment, rehab, support, and became a national movement

• People though asylums contributed to illness, and thought people should return to normal communities and believed that they would get better.

• No evidence that majority of people benefited from community health centers

• By 1990 deinstitutionalization was considered a failure

Recognize the role and definition of recovery for mental health disorders

• MOST important goal for people with mental disorders

• recovery in persons with serious mental illness is influenced by their social and environmental circumstances as well as their symptoms.

• Recovery-oriented treatment is based on the belief that mental illnesses and emotional disturbances are treatable and that recovery is an expectation.

•  In recovery-oriented care, the person with a mental health problem develops a partnership with a clinician to manage the illness, strengthen coping abilities, and build resilience for life’s challenges

recovery in mental health nursing

• process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential

• Worldwide goal

• involved government agency officials, experts, consumers, family members, advocates, researchers, managed care representatives, and others.

• Four dimensions that support recovery: health, home, purpose, and community

• Partnership with health workers

Prevalence

Total number of people who have a disorder within a population at a specified time regardless of how long ago the disorder started

Point prevalence

Proportions of individuals of the population who have the disorder at a specified point in time

Rate

Proportion of cases in population compared with total population

1.     Rate= case in population/ Total population (cases and non-cases)

Incidence

 Rate that includes only new cases that occurred within defined period of time usually 1 year.

Epidemiology

study patterns of the mental health status of population groups, or aggregates, and associated factors

stigma

a.      Dynamic social/interactional process where a person is labeled as different and linked to negative stereotypes

Types:

• Public

• Self-stigma

• Label avoidance

Public stigma

 After being publicly marked as mentally ill. Wether they say odd things they are at risk of being subjected to prejudice and discrimination.

• Stereotyped as dangerous, weak, or immoral

• Can be combated with interactions with effected groups

Self-Stigma

Aware of negative stereotypes, internalize them, and agree with publics perceptions

1.     Low self-esteem

Label avoidance

Avoiding treatment to avoid being labeled as mentally ill. They don’t seek help.

Define culture

a way of life for people who identify or associate with one another on the basis of some common purpose, need, or similarity of background but also the totality of learned, socially transmitted beliefs, values, and behaviors that emerge from its members’ interpersonal transactions that can be used to define them as a collective.

o   A community large enough to be self-sustianing an dproduce new generations of members without relying on outside people

Define cultural identity

o   Identification and perceived acceptance with one group with shared values

a set of cultural beliefs with which one looks for standards of behavior.

Acculturation

socialization process by which underrepresented groups learn and adopt selective aspects of the dominant culture.

Cultural competence

ability to interact effectively with people of different cultures, involves a set of academic and interpersonal skills that are respectful of and responsive to the health beliefs, health care practices, and cultural and linguistic needs of diverse patients to bring about positive health care outcomes

Linguistic competence

• the capacity to communicate effectively and convey information that is easily understood by diverse audiences, is an important part of cultural competence

• appropriate use of words, grammar, and syntax, but also to the practical aspects such as choice of discussion topics, taking turns, use of metaphors, and the “hidden rules” of interactions

Define the components of culturally appropriate care

Understanding each patients cultural background and identity to avoid miscommunication and knowledge barriers

Spirituality

• Develops over time, is dynamic, conscious process.

• Meaning (involves making sense of life), belief (coping, hoping), connecting (with higher power, friends, fam), self-transcendence (appreciation beyond self), and value (objects that have value to self)

Religiousness

• Participation in community of people who gather around

• Often define an individual’s relationship within a family and community

  Recognize the difference between spirituality and religion

Spirituality is more individualized, Religion is more organized and institutionalized

self-determination

is based on a person’s fundamental right to autonomy. Exercising this right, patients may choose to “accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or prejudice”

Components

• Autonomy

  • self governence

• Competence

  • degree to which the patient can understand and appreciate the information given during the consent process, refers to a patient’s cognitive ability to process information at a specific time

• Relatedness

advance care documents

a.      Advance care directives

a.      Power of attorney

a.      Living will

Living will

Specifies what treatment should be omitted or refused in event that person cant make those decisions

Power of attorney

• legally binding document that names someone to act as your attorney-in-fact or your agent

• Living wils and appointment dirrectives

Advance care directives

written instructions for health care when individuals are incapacitated

Recognize and define the 4 criteria for competence

a.      Communicate choices

b.     Understand relevant information

c.      Appreciate the situation & its consequences

d.     Use a logical though process to compare the risks & benefits of treatment options

Voluntary admission

• If hospitalization is required and the patient enters treatment facility, participates in treatment planning process, and follows through treatment.

• They maintain all civil rights and are free to leave at any time eve if its against medical advice

Involuntary admission

• Mandated treatment without persons consent, but with court order

• There should be evidence that the individual is (1) mentally disordered, (2) dangerous to self or others, or (3) unable to provide for basic needs (i.e., gravely disabled).

• Can refuse meds, but can be forced to do so with legal provisions

Voluntary commitment

In both instances, full legal rights are retained

Define HIPAA and maintain HIPAA

• The Health Insurance Portability and Accountability Act of 1996

• protects working Americans from losing existing health care coverage when changing jobs and increases opportunities for purchasing health care.

• Regulates control of patient information, requires patient consent to release info with the exception that required treatment, payment and healthcare administrative operations

• Protects medical workers and hospitals legally