Module U- Mental Health and Mental Illness

Mental health

* a resident’s ability to cope with and adjust to everyday stresses in ways that society accepts

Mental illness

A disturbance in the ability to cope or adjust to stress; behavior and function are impaired;

Mental disorder, emotional illness, psychiatric disorder

De-escalate

To (cause to) become less dangerous or difficult

Mental Health and Mental Illness- importance

* great day-to-day relationships are to the heart of de-escalation
* The nurse aide can come to know what is normal for particular resident and what signs resident may have that he or she is becoming agitated

Causes of Mental Illness

* physical factors (illness, disability, aging, substance abuse, chemical imbalances)
* Environmental factors such as weak interpersonal or family relationships
* Traumatic past experiences, such as abuse
* Inherited traits
* Ability to cope with stress

Anxiety disorders

* generalized anxiety disorder
* Obsessive- compulsive disorder
* PTSD
* phobia

Phobia

An intense, irrational fear of an object, place or situation, such as flying

Mood disorders- depression

* may cause a loss of interest in activities once enjoyed, such as eating, sleeping and work


* The individual way suffer intense emotional and physical pain. If left untreated, depression may lead to suicide, especially in older adults

Mood disorders - bipolar disorder

A condition in which an individual has mood swings and changes in energy levels including the ability to function. The mood swings can alternate from extreme activity (a manic episode) to periods of deep depression (depressive episode)

Mood disorders- Schizophrenia

Interferes with an individual’s ability to interact with others, make decisions, think normally, and communicate clearly. Individuals who experience hallucinations may see someone or something that is not really present or a hear a conversation that is not real.

Individuals who experience delusions may believe that other people are controlling their thoughts

Mental Health and Mental Illness- Treatment

* medication
* Psychotherapy
* Cognitive behavioral therapy

Mental Health and Mental Illness- Nurse Aide’s Role

* important to recognize appropriate and inappropriate behavior and function so nurse aide can
* report inappropriate or different behavior and/or function to the nurse immediately
* De-escalate behaviors
* Has many chances to observe snd get to know resident

De-escalation of a resident who is agitated while keeping self and others safe- important

First and only objective in de-escalation is to reduce level and intensity of resident behavior so that discussion becomes possible

De-escalation of a resident who is agitated while keeping self and others safe

Behavior- appear calm, centered and self- assured even if that is not the vase

Anxiety can make resident feel anxious and unsafe which can escalate aggression

Posture- de-escalation

* Always be at the same eye level- encourage client to be seated, but if he/she needs to stand, stand up also keep relaxed and alert posture
* Stand up straight with feet about shoulder width apart and weight evenly balanced
* Avoid aggressive stances
* Position self for safety
* never talk burn for any reason
* Maintain distance of at least 2 arms lengths between self and agitated party

Body movement and language- de-escalation

* body movements indicate anxiety and will tend to increase agitation
* Minimize body movements such as excessive gesturing, pacing, fidgeting or weight shifting
* Refrain from any touching

Facial expression- de-escalation

* Maintain neutral facial expression
* A calm, attentive expression reduces hostility

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Eye contact- de-escalation

* maintain limited eye contact
* Loss of eye contact may be interpreted as expression of fear, lack of interest or regard, or rejection
* Excessive eye contact may be interpreted as a threat or challenge, do not stare down resident

Attitude

* Refrain from becoming defensive even if comments or insults are directed at nurse aide; comments are not about nurse aide; the nurse aide should not defend self or anyone else from insults, curses or misconceptions about roles or behaviors
* be respectful even when firmly setting limits or calling for help; individual who is agitated is sensitive to feeling shamed and disrespected;

Tone

* Use low monotonous tone of voice
* refrain from getting loud or trying to yell over screaming person, wait