Unit 1 Mental Health (study guide)

Core concepts of stress

1. Adaptation

2. Maladaptation

3. Stressor

Adaptive respone

Behavior that maintains the integrity of the individual. Positive and healthy

Maladaptive Response

When behavior disrupts the integrity of the individual. Negative, harmful, unhealthy

Stressor

A biological, psychological, social, or chemical factor that causes physical or emotional tension.

Selye’s general adaptation syndrome - Stages of stress reaction?

1. Alarm reaction

2. Stage of resistance

3. Stage of exhaustion

Alarm reaction stage

Fight or flight syndrome

Stage of resistance

Uses physiological responses of first stage as a defense in attempt to adapt to the stressor

Stage of exhaustion

The body responds to prolonged exposure to a stressor. Diseases of adaptation (e.g., headaches, mental disorders, coronary artery disease, ulcers, colitis) may occur. Without intervention for reversal, exhaustion and even death can occur.

What are some examples of biological responses to stress?

Increased HR, BP, and RR; dilated pupils; increased blood glucose; suppression of digestion/immune system

What are psychological response to stress?

Anxiety, anger, depression, denial, withdrawal, poor concentration,

What are primary appraisals in stress?

Evaluating if event is:

1. Irrelevant (no significance)

2. Benign (pleasure)

3. Stressful (harm/loss)

Secondary appraisals

An assessment of skills, resources, and knowledge that the person possesses to deal with the situation

Common coping strategies

Awareness, relaxation, meditation, interpersonal communication, problem-solving, pets, music

Problem-solving/decision making model

Assessing the facts of the situation

Formulating goals for resolution of stressful situation

Studying the alternatives for dealing with the situation

Determining the risks and benefits of each alternative

Select an alternative

Implementing the alternative selected

Evaluating the outcome

If first choice is ineffective, selecting second option to implement

Stress management

The use of coping strategies in response to stressful situations

• Awareness

• Relaxation

• Meditation

• Interpersonal communication

• Problem solving

Kubler-Ross’s five stages of grief response

1. Denial - “No it can’t be true”

2. Anger - “Why me?/“Its not fair”

3. Bargaining - Made with God

4. Depression - Intense sadness

5. Acceptance - peace

Mental Health

Successful adaptation to stressors with thoughts, feelings, and behaviors that are age-appropriate and culturally congruent

Mental illness

Maladaptive responses to stressors that interfere with functioning and are congruent with cultural norms

6 indicators of mental health

1. Positive self-attitude

2. Growth/self-actualization

3. Integration

4. Autonomy

5. Reality perception

6. Environmental mastery

Freuds 6 Ego Defense Mechanisms

1. Repression

2. Denial

3. Projection

4. Displacement

5. Regression

6. Sublimation

Repression

An unconscious mechanism emplyed by the ego to keep disturbing or threatening thoughts from becoming conscious

Ex: During Oedipus complex aggressive thoughts about the same sex parents are repressed

Denial

Blocking external events from awareness. If some situation is just too much to handle, the person refuses to experience it

Ex: Smokers may refuse to admit to themselves that smoking is bad for their health

Projection

This involves individuals attributing their own unacceptable thoughts, feeling and motives to another person

Ex: You might hate someone, but your superego tells you that such hatred is unacceptabe. You can solve the problem by believing they hate you.

Displacement

Satisfying an impulse with a substitute object

Ex: Someone who is frustrated by his or her boss at work may go home and kick the dog

Regression

This is a movement back in psychological time when one is faced with stress

Ex: A child may begin to suck their thumb again or wet the bed when they need to spend some time in the hospital

Sublimation

Satisfying an impulse with a substitute object. In a socially acceptable way.

Ex: Sport is an example of putting our emotions into something constructive

Maslows Hierarchy of Needs

1. Physiological needs - food, water, warmth, rest

2. Safety needs - security

3. Belongingness and love - intimate relationships

4. Esteem needs - prestige and feeling of accomplishment

5. Self-actualization - Achieving one’s full potential, including creative activities

Ethical Dilemmas

A situation that requires the nurse to make a choice between two equally unfavorable alternatives

Taking no action is considered an action taken

How to proceed should an ethical question or dilemma arise

Nurses can improve their critical thinking and clinical judgement skills by identifying such issues and seeking clarification through collaborative exploration with others and through ethic committee involvement.

5 ethical principles

Autonomy, beneficence, nonmaleficence, veracity, and justice

Autonomy

Individuals are always capable of making independent choices

Beneficence

One’s duty to benefit or promote the good of others

Nonmaleficence

Is the requirement that healthcare provides do not harm to their clients, either intentionally or unintentionally

Justice

Treat all individuals equally and fairly

Veracity

Always be truthful

The Nurse Practice Act

Definese the legal parameters of professional and practical nursing

What are patients rights in psychiatric care?

Right to refuse treatment, right to treatment, right to least restrictive alternative

Informed Consent

Patients right to automony in deciding treatment; must be voluntary, informed and competent

Negligence

Failure to act reasonably

Malpractice

Professional negligence causing harm

Nursing liability/Common lawsuits in pyschiatric nursing

Breach of confidentiality, defamation (libel(written)/slander(oral)), invasion of privacy, assault, battery, false imprisonment

Assault

Threatening harm

Battery

Nonconsensual touching/harm

Clinical Pearl

Always put the clients rights and welfare first; develop and maintain a good interpersonal relationship with each client and his or her family

Voluntary commitments

Individual makes direct application to the institution for services and may stay as long as treatment is deemed necessary

Involuntary Commitments

This type of hospitalization results in substantial restrictions of the rights of an individual, the admission process is subject to the guarantee of the 14th amendment to the US constitution that provides citizens with protection against loss of liberty and esures due process rights.

Emergency commitment

Short-term (72 hours) used when a person is imminently dangerous to self or others. Court hearing required to extend

Involuntary outpatient commitment

Court-ordered treatment in the community; used for people with history of decompensation, noncompliance, or risk of relapse

Mentally ill person in need of treatment

Longer-term; applioes whne a person cannot make informed decisions, is likely to harm self/others or cannot meet basic needs

Gravely disabled client

When a person cannot provide basic needs (food, shelter, safety, medical care) due to mental illness

Characterisitics of therapeutic relationships

Trust, respect, empathy, genuineness, professional boundaries

Examples of therapeutic communication

Using silence, accepting, giving recognition, offering self, giving broad openings, offering general leads, placing event in time or sequence, making observations, encouraging description of perceptions, encouraging compassion, restating, reflecting

Examples of non-therapeutic communication

Giving advice, false reassurance, “why” questions, changing subject, judgemental responses.