CHAPTER 1: FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING

MENTAL HEALTH

state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability.

1. Individual

2. Interpersonal

3. Social/cultural

FACTORS INFLUENCING A PERSON'S MENTAL HEALTH

1. Person's biological makeup (Physical, anything in our human body).

2. Autonomy and independence (choices, decisions, freedom).

3. Self-esteem; ability to find meaning in life.

4. Sense of belonging, reality orientation.

5. Coping or stress management abilities.

INDIVIDUAL OR PERSONAL FACTORS (READ)

1. Effective communication.

2. Ability to help others.

3. Intimacy.

4. Balance of separateness and connectedness.

INTERPERSONAL OR RELATIONSHIP FACTORS (READ)

1. Sense of community, access to adequate resources.

2. Intolerance of violence.

3. Support of diversity among people. (Different background, face, sexual orientation, etc.)

4. Positive, yet realistic, view of one's world.

SOCIOCULTURAL OR ENVIRONMENTAL FACTORS (READ)

Mental illness

These are disorders that affect mood, behavior, and thinking, such as depression, schizophrenia, anxiety disorders, and addictive disorders.

Mental disorders

Disorders that often cause significant distress or impaired functioning or both

DEPRESSIVE DISORDER (Depression)

A common mental disorder.

It involves a depressed mood or loss of pleasure or interest in activities for long periods of time.

ANXIETY DISORDER

A mental disorder that has symptoms like feelings of nervousness, panic and fear.

ADDICTIVE DISORDER

A mental disorder that occurs when the use of a substance (alcohol or drugs) or a behavior (excessive gambling, shopping, gaming) causes significant problems in a person's life.

SCHIZOPHRENIA

A serious mental disorder in which people interpret reality abnormally (Disconnection from reality)

SCHIZOPHRENIA

A mental disorder that may result in some combination of hallucinations, delusions and extremely disordered thinking and behavior that impairs daily functioning and can be disabling.

HALLUCINATION

A mental disorder that involves a false perception of objects or events involving your senses.

AUDITORY (SOUND) HALLUCINATIONS

The most common type of hallucination.

These hallucinations involve hearing sounds that aren't real, like voices, music, footsteps, or doors banging

They may command you to do something that may cause harm to yourself or others.

VISUAL (SIGHT) HALLUCINATIONS

These hallucinations involve seeing things that aren't real, like objects, shapes, people, animals or lights.

TACTILE (TOUCH) HALLUCINATIONS

These hallucinations cause you to feel touch on your body or movement in your body that's not real. They may involve feeling like bugs are crawling on your skin or your internal organs are moving around.

OLFACTORY (SMELL) HALLUCINATIONS

These hallucinations involve experiencing smells that don't exist or that no one else can smell.

GUSTATORY (TASTE) HALLUCINATIONS

These hallucinations cause tastes that are often strange or unpleasant (often with a metallic taste). These are a common symptom for people with epilepsy.

PRESENCE HALLUCINATIONS

These hallucinations make you feel that someone is in the room with you or standing behind you.

PROPRIOCEPTIVE HALLUCINATIONS

These hallucinations make you think that your body is moving, such as flying or floating, when it's not.

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION

DSM-5 stands for?

1. To provide a standardized nomenclature and language for all mental health professionals

2. To present defining characteristics or symptoms that differentiate specific diagnoses

3. To assist in identifying the underlying causes of disorders

The DSM-5 has three purposes: (READ)

1. ANCIENT TIMES

2. ARISTOTLE (382-322 BC)

3. CHRISTIAN TIMES (1-1000 AD)

4. RENAISSANCE (1300-1600)

5. HOSPITAL OF ST. MARY OF BETHLEHEM

HISTORICAL PERSPECTIVES OF THE TREATMENT OF MENTAL ILLNESS (Enumerate)

ANCIENT TIMES

What historical perspective?

● People of ___________ believed that any sickness indicated displeasure of the gods and, in fact, was a punishment for sins and wrongdoing.

● Those with mental disorders were viewed as either divine or demonic, depending on their behavior.

ARISTOTLE (382-322 BC)

What historical perspective?

● He attempted to relate mental disorders to physical disorders and developed his theory that the amounts of blood, water, and yellow and black bile in the body controlled the emotions. These four substances, or humors, corresponded with happiness, calmness, anger, and sadness.

blood, water, and yellow and black bile

Aristotle developed his theory that talks about the four substances or humors, which corresponded with happiness, calmness, anger, and sadness.

What are the 4 substances?

CHRISTIAN TIMES (1-1000 AD)

What historical perspective?

● In early ______________, primitive beliefs and superstitions were strong. All diseases were again blamed on demons, and the mentally ill were viewed as possessed.

● Priests perform exorcisms to rid sufferers of evil spirits. When that failed, they used more severe and brutal measures, such as incarceration in dungeons, flogging, and starving.

1. demons

2. possessed

In early Christian times (1-1000 AD), primitive beliefs and superstitions were strong. All diseases were again blamed on ________, and the mentally ill were viewed as _________.

1. exorcisms

2. incarceration

3. flogging

4. starving

In early Christian times (1-1000 AD), priests perform ________ to rid sufferers of evil spirits. When that failed, they used more severe and brutal measures, such as ________ in dungeons, __________, and _________.

RENAISSANCE (1300-1600)

What historical perspective?

● In England during the _______________, people with mental illness were distinguished from criminals. Those considered harmless were allowed to wander the countryside or live in rural communities, but the more "dangerous lunatics" were thrown in prison, chained, and starved.

criminals

In England during the Renaissance (1300-1600), people with mental illness were distinguished from __________.

HOSPITAL OF ST. MARY OF BETHLEHEM

What historical perspective?

● In 1547, the ____________ was officially declared a hospital for the insane, the first of its kind.

HOSPITAL OF ST. MARY OF BETHLEHEM

What historical perspective?

● By 1775, visitors at the institution were charged a fee for the privilege of viewing and ridiculing the inmates, who were seen as less than human animals.

● During this same period in the colonies (later the United States), the mentally ill were considered evil or possessed and were punished. Witch hunts were conducted, and offenders were burned at the stake.

Witch hunts

By 1775, the mentally ill were considered evil or possessed and were punished. __________ were conducted, and offenders were burned at the stake.

PERIOD OF ENLIGHTENMENT AND CREATION OF MENTAL INSTITUTIONS

What period?

● In the 1790s, a period of enlightenment concerning persons with mental illness began. Philippe Pinel in France and William Tuke in England formulated the concept of asylum as a safe refuge or haven offering protection at institutions where people had been whipped, beaten, and starved because they were mentally ill.

1. Philippe Pinel in France

2. William Tuke in England

In the 1790s...

Who (2) formulated the concept of asylum as a safe refuge or haven offering protection at institutions where people had been whipped, beaten, and starved because they were mentally ill.

DOROTHEA DIX (1802-1887)

Who began a crusade to reform the treatment of mental illness after a visit to Tuke's institution in England.

32 state hospitals

DOROTHEA DIX (1802-1887) was was instrumental in opening HOW MANY state hospitals that offered asylum to the suffering?

Dix believed that society was obligated to those who were mentally ill, she advocated adequate shelter, nutritious food, and warm clothing.

100 years

The period of enlightenment was short-lived. Within _______ years after the establishment of the first asylum, state hospitals were in trouble.

Attendants were accused of abusing the residents, the rural locations of hospitals were viewed as isolating patients from their families and homes, and the phrase insane asylum took on a negative connotation.

1. Sigmund Freud (1856-1939)

2. Emil Kraepelin (1856-1926)

3. Eugen Bleuler (1857-1939)

The period of scientific study and treatment of mental disorders began with? (3)

Sigmund Freud (1856-1939)

Who challenged thew society to view human beings objectively?

Emil Kraepelin (1856-1926)

Who began classifying mental disorders according to their symptoms?

Eugen Bleuler (1857-1939)

Who coined the term schizophrenia?

1950

DEVELOPMENT OF PSYCHOPHARMACOLOGY

When did this happen?

A great leap in the treatment of mental illness began with the development of psychotropic drugs, or drugs used to treat mental illness.

psychotropic drugs

drugs used to treat mental illness.

Chlorpromazine (Thorazine)

The first antipsychotic drug, ___________, was effective in mania.

1. 1963

2. Community Mental Health Centers Construction Act

The movement toward treating those with mental illness in less restrictive environments gained momentum in ______ (year) with the enactment of the __________.

DEINSTITUTIONALIZATION

a term for deliberate shift from institutional care in state hospitals to community facilities, began.

Federal Legislation

1. Supplemental Security Income (SSI)

2. Social Security Disability Income (SSDI)

What was passed to provide an income for disabled persons?

This allowed people with severe and persistent mental illness to be more independent financially and to not rely on family for money

18 TO 25 AGE GROUP

MENTAL ILLNESS IN THE 21st CENTURY

What AGE GROUP had the highest prevalence of mental illness as well as the lowest percent of people receiving treatment?

MENTAL ILLNESS OR SERIOUS EMOTIONAL DISTURBANCES

MENTAL ILLNESS IN THE 21st CENTURY

What impair daily activities for an estimated 15 million adults and 4 million children and adolescents.

REVOLVING DOOR EFFECT

MENTAL ILLNESS IN THE 21st CENTURY

What effect?

Some believe that deinstitutionalization has had negative as well as positive effects. Although deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to those beds correspondingly increased by 90%.

check transes

OBJECTIVES FOR THE FUTURE (READ)

Healthy People 2020 Mental Health Objectives (11)

COMMUNITY SUPPORT SERVICE PROGRAMS

These were developed to meet the needs of persons with mental illness outside the walls of an institution

COMMUNITY-BASED SYSTEM

This did not accurately anticipate the extent of the needs of people with severe and persistent mental illness.

MANAGED CARE

A concept designed to purposely control the balance between the quality of care provided and the cost of that care.

IN THE 1990's

When did a new form of managed care was developed by utilization review firms or managed care organizations to control the expenditure of insurance funds by requiring providers to seek approval before the delivery of care?

1873

What year?

Linda Richards graduated from the New England Hospital for Women and Children in Boston and went on to improve nursing care in psychiatric hospitals and organized educational programs in state mental hospitals in Illinois.

Linda Richards

She is called the first American psychiatric nurse; she believed that "the mentally sick should be at least as well cared for as the physically sick"

1882

What year?

The first training of nurses to work with persons with mental illness at McLean Hospital in Belmont, Massachusetts. The care was primarily custodial and focused on nutrition, hygiene, and activity.

1913

What year?

Johns Hopkins was the first school of nursing to include a course in psychiatric nursing in its curriculum

Johns Hopkins

Who was the first school of nursing to include a course in psychiatric nursing in its curriculum?

1920

What year?

The first psychiatric nursing textbook, Nursing Mental Diseases by Harriet Bailey, was published in _____.

What is the first psychiatric nursing textbook, Nursing Mental Diseases by Harriet Bailey, that was published in 1920?

1950

What year?

accredits nursing programs, required schools to include an experience in psychiatric nursing.

1. HILDEGARD PEPLAU

2. JUNE MELLOW

Two early nursing theorists shaped psychiatric nursing practice

Hildegard Peplau

Who Published Interpersonal Relations in Nursing in 1952 and Interpersonal Techniques: The Crux of Psychiatric Nursing in 1962.

June Mellow

Nursing Therapy, described her approach of focusing on clients' psychosocial needs and strengths.

AMERICAN NURSES ASSOCIATION (ANA)

This develops standards of care, which are revised as needed. Standards of care are authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable.

AMERICAN

This has standards of practice and standards of professional performance. These also outline the areas of practice and phenomena of concern for today's psychiatric-mental health nursing.

THE PHENOMENA OF CONCERN

Describe the 13 areas of concern that mental health nurses focus on when caring for clients.

Self-awareness

The process by which the nurse gains recognition of his or her own feelings, beliefs, and attitudes.

primary focus

In nursing, being aware of one's feelings, thoughts, and values is a ____________.

1. Keep a diary or journal that focuses on experiences and related feelings.

2. Talk with someone you trust about your experiences and feelings.

3. Engage in formal clinical supervision

4. Seek alternative points of view.

5. Do not be critical of yourself (or others) for having certain values or beliefs.

POINTS TO CONSIDER WHEN WORKING ON SELF AWARENESS (read)