Intro to Mental Health Nursing condensed

Mental health nursing

Specialized nursing using 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, relationships, and daily functioning.

Mental illness processes

Biological, psychological, or social processes.

Mental health continuum

Ability to function → disability/dysfunction.

Stigma

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

Bias

Unfair stereotyping, prejudice, or discrimination.

Self-stigma

Internalized negative view/shame about one's condition.

Institutional stigma

Policies/organizations that limit opportunities for people with mental illness.

Mental illness misconceptions

Not automatically violent/unpredictable; not caused by personality weakness, character flaws, or bad parenting.

Nursing core values

Trust; inclusiveness; innovation; empowerment.

Cultural humility

Respect another person's culture and its role in life/health practices; use self-reflection, identify biases, assess cultural beliefs/practices.

Cultural competence

Respectful, 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 contributing to unequal health outcomes/treatment.

Trauma-informed nursing care

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

Trauma can affect

Individuals and groups.

DSM-5-TR

Standard guide used to classify/diagnose mental disorders; provides expected findings and standardized language; assists planning, interventions, and evaluation.

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, conflicts, 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/behaviors; thoughts come before feelings and behavior.

Cognitive therapy techniques

Priority restructuring; journaling; assertiveness training; monitoring thoughts.

Behavioral therapy

Pavlov/Watson/Skinner; changes learned behavior and its consequences.

Behavioral therapy techniques

Modeling; operant conditioning; systematic desensitization; aversion therapy.

CBT

Combines cognitive + behavioral therapy; 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; 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"; developed Interpersonal Theory.

Peplau's major nursing goal

Decrease anxiety and improve client interactional skills.

Peplau's focus

Nurse-patient relationship influences outcomes; client 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; benefit client and prevent harm.

Autonomy

Client's right to make rational care decisions.

Justice

Fair/equal care regardless of background or culture.

Nonmaleficence

Do no harm; avoid pain/suffering.

Fidelity

Loyalty to the client.

Veracity

Communicate truthfully.

Confidentiality

Constitutional right to privacy; supported by ANA Code of Ethics.

Duty to warn/protect

Confidentiality may be broken to protect a threatened third party; assess danger, identify threatened person, take 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

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.

Restraint rule

Least restrictive restraint for shortest duration.

Seclusion

Should not be used unless necessary.

ADA & mental illness

Prior mental illness cannot be asked about on employment application; stabilized condition may mean no disability; risk assessment is based on behavior, not disability.

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.

Duty to report includes

Abuse; patient safety concerns; bullying; neglect; impaired coworker; boundary violations.

Mental health documentation

Client behavior; staff response; time provider was notified.

Medical records

May be used as legal evidence.

Therapeutic communication

Professional; goal-directed; scientifically based; structured around client needs; safe, confidential, reliable, consistent.

Key therapeutic attitude

Genuine respect + compassionate, empathetic listening.

Therapeutic nurse-client focus

Client's ideas, experiences, feelings, needs, and problems.

Nurse's therapeutic role

Discuss alternatives; develop strengths/coping skills; encourage positive behavior; promote autonomy/self-resilience.

Therapeutic nurse qualities

Genuine; positive; empathetic; nonjudgmental.

Empathy vs. sympathy

Therapeutic relationships use empathy, not sympathy.

Therapeutic relationship components

Time; active listening; caring attitude; honesty; trust; nonjudgmental attitude.

Active listening

Eye contact; body language; verbal tracking.

Therapeutic communication techniques

Silence; active listening; questions; clarification; restating; reflecting; paraphrasing; exploring.

Open-ended questions

Encourage expanded responses.

Closed-ended questions

Produce brief/specific responses.

Projective questions

"What if?" questions.

Restating

Repeat client's main idea.

Reflecting

Direct thoughts/feelings back to client.

Paraphrasing

Restate client's message in different words.

Exploring

Encourage further discussion.

Communication barriers

Excessive questions; approval/disapproval; advising; "why" questions.

Communication & culture

Always consider cultural differences.

Orientation phase

First meeting; establish rapport.

Working phase

Trust/comfort established; work toward goals.

Termination phase

Goals met; summarize progress, review coping strategies, and evaluate relationship.