Mental Health Unit 1

Mental health

Successful performances of mental functions; Resulting in the ability to engage in productive activities, enjoy fulfilling relationships, and change/cope with adversity.

Involves our emotional, psychological and social wellbeing

-can be affected by genetics, brain chemistry & life experiences

Mental disorders with biological influences

Schizophrenia, Bipolar disorder, Major depression, OCD & panic disorders, PTSD, Autism, anorexia nervosa, and attention deficit/hyperactivity disorder

Define Mental Illness

Clinically significant behavior or psychological syndrome experienced by a person and marked by distress, disability or the risk of suffering disability/loss of freedom

Resiliency

Ability to “bounce back”, recover from or adjust to misfortunate change

Resilient people tend to

recognize feelings, deal with feelings, and learn from experiences

Factors of resiliency

Past experiences, age, thinking patterns

What is the benefit of clinical epidemiology for mental helath

Can help to identify high risk groups

What are the 7 signs of Positive mental health, or someone that is “mentally healthy”

Happiness,

Controlled behavior,

Appraisal of reality (accurate perception),

Effectiveness in work,

Healthy Self-esteem,

Satisfying relationships,

Effective coping strategies

Factors that can affect the severity and progression of mental illness

Support system present, family influence, developmental events, cultural beliefs and values, health practices, and negative influences.

Things to think about regarding factors affecting severity and progression of mental illness

Does the family or support system understand the disease?

Does the family enable them?

Are they supportive?

Did the patient endure abuse or trauma as a child?

DSM-5

Guidebook for categorizing and diagnosing psychiatric mental disorders in the US

Axis 1 of the DSM 5

The mental disorder

Axis 2 of DSM 5

The personality disorder

Axis 3 of DSM 5

General medical conditions that are relevant

Axis of DSM 5

Psychosocial and environmental problems.

What has led to this hospitalization? What was the trigger?

Axis 5 of DSM 5

Global Assessment of Functioning (GAF) Score (1-100)

Culture and assessment of the mental health patient

is what they are experiencing or displaying normal in their culture or spirituality

Culture bound sydromes

Appear only in particular cultures and do not appear globally in all societies or parts of the world.

Stigma

Negative view or stereotypical view of someone with mental illness, can cause health care disparities

Transference

patient projects intense feelings onto the therapist related to unfinished work from previous relationships

Countertransference

Circumstances in which a psychoanalyst develops personal feelings about a clint because of perceived similarity of the client to significant people in the therapists life.

Ethics

The study of philosophical beliefs about what is considered right or wrong in a society.

Beneficence

Duty to do good /act as a benefit

Autonomy

Respecting rights to others to make their own decisions.

Justice

Duty to distribute resources equally

Fidelity or nonmaleficence

maintaining loyalty and commitment to a patient

Veracity

Duty to communicate truthfully

Voluntary admission

Admission is sought out by patient. Has the right to demand and obtain release; but may require a written release notice - usually 3 days

Involuntary Admission

committed without the patients consent- necessary when the patient is a harm to self, to others, or not meeting their own basic needs as a result of a psychiatric condition

Who can petition an incoluntary admission

Police officers, the court, or healthcare professionals when a patient is a harm to self, others, or cannot meet their own basic needs.

How long is involuntary admissions?

Usually 7-10 days, but can vary depending on the psychiatrist evaluation

Long term/ formal commitment

extended care and Tx of mentally ill - usually 60-180 days

Involuntary outpatient commitment

Often court ordered and is used as a preventative measure for inpatient Tx while still mandating Tx.

Which person with mental illness may need involuntary hospitalization?

An individual with bipolar disorder, manic phase, who has not eaten in four days

Conditional Release

Discharge with requirement of outpatient Tx for a specified period- Court ordered

Unconditional release

Termination of patient - institution relationship

When should consent be obtained

Before doing anything with the patient

What type of questions should you never ask the patient when interviewing / talking with the patient

“Why” questions

Who decides if a patient is competent or not to make decisions?

The courts

If a patient is deemed incompetent, who is responsible for signing consents?

The Legal guardian

What should be the first question when restraints are possible needed for a patient?

Can we first verbally deescalate the situation?

Order of utilizing restraints

Start first with the least restrictive then proceed to more as needed.

What is needed for seclusion or restraints

Dr. Orders.

Following all checks and protocol,

Documentation of the situation and checks.

What is an exception of patient confidentiality?

Duty to warn third parties- in reguards to threats.

What is negligence or malpractice?

Failure to complete or provide care correctly that breaches the duty of the nurse.

Steps of the Mental health Nursing process

Assessment,

Diagnosis,

Outcome identification,

Planning,

Implementation,

and Evaluation

What is often referred to as the 7th step of the nursing process

Documentation

What is the primary assessment data

Information from the patient

What is the secondary assessment data

Information from anyone other than the patient (family, friends, police, and other healthcare workers)

Hallucinations are based on

The 5 senses,

Seeing or feeling things that are not there.

Ex: reporting hearing numerous voices, saying they smell their insides rotting, or screaming that bugs are crawling under their skin.

Delusions are

False fixed beliefs that cannot be correct by reasoning, even with evidence to the contrary.

Ex: believes the secret service was planning to kill them by poisoning their food, therefore they would not eat food unless they knew for certain it was safe.

Illusions are

Misinterpretations of objects in the environment

Ex: thinking an object is something else - thinking the spots on the wallpaper are blood sucking ants.

Age is an important consideration when

Assessing and how you interact with the patient.

Your approach may differ.

What is an important fact to state when working with teens in the mental health setting.

Confidentiality will not be breached, unless you are a harm to yourself, others, or illegal drug use is occurring.

What is an important consideration when assessing children

Their developmental age

What is important to identify when assessing older adults/ the elderly

Any physical or sensory deficits, physical illnesses, and any previous losses (Widow?)

Labile

Mood changes / going between moods.

May see happy, then sad, then happy

What is the mental status exam (MSE)

Evaluates the individuals cognitive process

What consists of the mental status exam (MSE)

Personal information/demographics,

General appearance,

Mood and Affect,

Thought process and content,

Perception,

Cognition/LOC,

Insight and judgement

In regards to insight and judgement, what does this consider

Is the person aware of their illness or deficits?

Do they understand why they are here?

What do we first want to do when treating mental illness, especially with the elderly?

First rule out any medical issues that may be contributing to their psychiatric symptoms

What are the 3 components of diagnosis for mental health

What is the problem, what is the cause, and what is the supporting data / the signs and symptoms

What is the nursing diagnosis mainly based off of

The signs and symptoms / the supporting data

What are the outcomes identification?

Setting goals with / for the patient

Goals must be

Measurable and attainable / realistic

What is planning?

How the goal will be met

Elements of planning in the nursing process

Must be safe, appropriate, patient centered, and evidence based.

Implementation

The action phase / working on meeting the goal

Main component of implementation

Involve the patient and provide education and encouragement

Evaluation in the nursing process

Reassess, was the goal met?

If not… Replan/ rewrite the goal

What is therapeutic communication?

Communication that is focused on the patients needs and well-being.

Components of therapeutic communication

Active listening, genuine respect, goal directed, patient centered, observing the patient, developing goals, and developing rapport

Goal of building rapport with the patient

We want the patient to feel safe to open up and find the root of the problem

Why can silence be effective in communication

allows time for reflection and processing

Something the nurse does not do in therapeutic communication

Advise, ask why questions, interrogate the patient, or give approval/ disapproval

What should the nurse do when preparing for therapeutic communication / practiving self awareness

Be honest with yourself and your opinions, identify your biases and set them aside for the wellbeing of the patient / the patient outcome

Why dont we want social / casual relationships with the patient as the nurse

They may think we are friends and this can blur boundaries. The patient is the focus.

Transference

When the patient projects past issues or ideas onto the nurse

Countertransference

When the nurse projects past issues or ideas onto the patient

What is the pre-orientation phase

The nurse mentally prepares self for upcoming interaction

What should the nurse do when a patient makes suicide threats

Immediately report

What is the orientation phase

The nurse meets the patient, interviews, clarifies roles and responsibilities,

prepares patient of the setting, sets boundaries, reminds of confidentiality and when termination of the relationship will occur

What is the working phase

Setting and working on goals, having realistic expectations, keeping the patient busy, working on improvement

What are the possible defense mechanisms the patient may use during the working phase

Acting out, withdrawal, intellectualization, manipulation, denial

What is the termination phase

End of Treatment/ Discharge,

Reflecting and reminiscing

Factors that enhance the relationship between the nurse and the patient

Consistency, Allowing the patient to set the pace, privacy, listening, positive initial impression (approach), promoting patient comfort, encouragement, and balancing control.

Psychoanalytic Therory

Expresses the importance of early life trauma showing up later in mental health disorders.

The 3 layers of mental activity focused on the psychoanalytic theory

Conscious, unconscious, and preconscious

The 3 parts of personality in psychoanalytic theory

ID, Ego, Superego

Methods of psychoanalytic therapy

Free association and dream analysis

Psychoanalytic therapy goal

To know and understand what is happening at the unconscious level in order to uncover the truth

Interpersonal theroy

Focuses on what occurs between people and relationships; feels social interaction is the main source of anxiety.

Healthy relationships are necessary for a healthy personality.

Interpersonal therapy

Emphasis on building and maintaining relationships.

Work on awareness of dysfunctional patterns in order to fix focus on the here and now

Behavioral Therapy

Goal is to correct or eliminate behaviors or responses by rewarding/reinforcing good behavior.

Cognitive behavioral therapy

Modifying negative thoughts, feelings, and behaviors.

Reframing thinking patterns.

Theory of Cognitive development

A progression from primitive awareness to complex thought and responses

Cognitive development importance for nursing

Important to tailor care to suit the cognitive level of the patient (patient focused)

Theory of psychosocial development

Tasks/Stages for each age group, meeting these stages tasks help in growing, shaping and moving forward onto the next stage- task completion brings out confidence.

Theory of object relations

Emphasis on past relationships in influencing a persons sense of self as well as the nature and quality of relationships in the present.

Theories of Moral development

Context dependent process on decision making for right and wrong- How there is no black and white to this- Focuses on personal development and changes in self.