Psych Unit One

What is a mental illness

Difficulty with thinking, mood changes, and behavioral changes. All psychiatric disorders that have a definable diagnosis. manifest in significant dysfunctions.

mood changes in mental illness

anxiety, sad, irritable, lose the sense of pleasure

behavioral changes in mental illness

Difficulties eating, sleeping, personal hygiene, life functioning is impacted in most mental illnesses

Difficulty with thinking in mental illness

memory, concentrating, problem solving, paranoid, delusional content

Parts of the mental health continuum

Healthy, Reacting, Injured, Ill

Healthy on the mental health continuum

Normal mood fluctuations, taking things in stride, consistent performance normal sleep patterns, physically and socially active. Usual self confidence, comfortable with others

Reacting on the mental health continuum

common and reversible distress. Irritable/impatient, nervousness, sadness, increased worrying, procrastination, forgetfulness, trouble sleeping, lowered energy, difficulty in relaxing, intrusive thoughts, decreased social activity

Injured on the mental health continuum

Significant Functional impairment, anger and anxiety, sadness, tear-fullness, hopelessness, worthlessness, preoccupation, decreased performance in academics or at work. Significantly disturbed sleep, avoidance of social situations, withdrawal

Ill on the mental health continuum

clinical disorder, severe persistent functional impairment, significant difficulty with emotions, thinking high level of anxiety, panic attacks, depressed mood, feeling overwhelmed, constant fatigue, suicidal thoughts and behavior

Diathesis-Stress Model

Theory about what causes mental illness, includes both biological and environmental factors. Most accepted explenation for what causes mental illness

Resilience in mental illness

Ability and capacity to secure resources needed to support well being. Ability to adapt and cope which helps people face tragedies, loss, trauma, and severe stress

Characteristics of resilience

ability to secure needed resources, capacity for regulating ones own emotions and overcoming negative, self defeating thoughts, essential to recovery

Six domains of resilience

Collaboration, Tenacity, Health, Compare, Reasoning, Purpose(goals and congruence)

Social and economic factors of mental illness

Family, schools and peer groups, socioeconomic status, educational advancement

Environmental factors of mental illness

Political climate and cultural considerations, social and economic policies

Psychiatric nursing

specialized area of nursing practice, employing theories of human behavior as its science and purposeful use of “self” as its art

What do PMH nurses do?

Focus on assessment, communication, safety, and education

Psychiatric Registered Nurse Role

across the lifespan; coordination of care, health teaching and maintenance, milieu therapy, pharmacological, biological, and integrative therapies,

Psychiatric NP role

psychotherapy, prescribing medication, consultation, diagnostic tests, admission privileges

Hospital admission criteria

A person much be a risk to themselves or a risk to others due to mental illness, or unable to function or care for themselves due to the severity of their symptoms.

Additional reason for hospital admission

Treatment cannot be safely started on an outpatient basis, such as tapering on/off medications or ECT

Voluntary Admission to a Psych Unit

When a patient meets inpatient criteria needs and signs into the hospital voluntarily, Once they are admitted they cannot leave and will need to be discharged by the medical team

Involuntary Admission

Happens when a person needs inpatient treatment and is unwilling to sign themselves in. Patient does not want admission and may not be aware that they are ill, but is too much of a danger to be released

Application of emergency certification

initiates psychiatric evaluation in the ER if pt is concerning, provides legal authority to keep a patient for a psychiatric assessment. Once admitted the person has the right to sign in voluntarily however if they are deems a risk of harm they can be held involuntarily for 10 days

involuntary admission > 10 days requires…

civil court certification

Rights of patient in psychiatric unit

patients in the psychiatric unit have the right to retain their rights as citizens, including right to refuse treatment and informed consent, right to confidentiality, and right to legal representation

Therapeutic Milieu

a structured environment that creates a safe, secure place for psychiatric patients. Promotes comfortable unit design

Aspects of the therapeutic Milieu

surroundings and physical environment, managing behavioral crisis, safety, unit design

Goals of unit design

Promote and environment of safety and empower patients to partner with clinical staff and take ownership of their own health and safety

Psychoanalytic theory

Developed by freud, first theory used to develop stages of development, psychosexual stages that claimed development ended at puberty

Transference

a phenomenon that occurs when people redirect emotions or feelings about one person to an entirely separate individual, often a medical professional such as a therapist

Countertransference

Phenomenon that occurs when medical professionals such as therapists redirect their emotions and feelings about other people onto their patient

Three levels of consciousness according to Freud

Ego, Id, Superego

Id

Basic impulses(sex and aggression) seeking immediate gratification; irrational and impulsive, operates at the unconscious level

Superego

Ideals and morals striving for perfection, incorporated from parents, becoming a persons conscience and operates mostly at the preconscious level

Ego

Executive mediating between the superego and the Id, rational and operating and conscience and pre conscience level

Psychoanalysis

analysis of dreams, feelings, etc in order to examine the subconscience

Brief dynamic psychotherapy

brief therapy that is used in order to interpret behavior(lasts \~15 weeks)

Eriksons theory of psychosocial development

Every person is a product of society as well as genetics, emphasized by ego development through stage-by-stage growth, derived from male norms from freud

Stages of eriksons development

8 stages that continue through old age

First stage of development(0-1)

trust vs mistrust

Second stage of development(1-3 years)

Autonomy vs shame

Third stage of development(3-6 years)

Initiative vs guilt

Fourth stage of development(6-12 years)

industry vs inferiority

Fifth stage of development(12-19 years)

identity vs role confusion

Sixth stage of development(20-25 years)

intimacy vs isolation

seventh stage of development(26-64)

generativity vs stagnation

Last stage of development (>65)

Integrity vs despair

Cognitive therapy and theory

believes that thoughts about the world and out place in it are based on our own unique perspectives which may or may not be based in reality. Dynamic interplay between individuals and the environment, believes that thoughts come before feelings an actions

Distortions in thinking are…

an error in logic, mistake in reasoning, individual view of the world that does not reflect reality,

all or nothing distortion

Black and white view of the world. Causes thinking in extremes such as success vs failure or only good vs only bad

Overgeneralization cognitive distortion

Type of distortion where a person applies something that occurred during one event to another event. Example: I got into a car accident once, therefore I will get into an accident every time I drive

Mind reading cognitive distortion

Inferring negative thoughts, responses, and motivations of others Often thinking that is directed towards them. Example: A person who believes that every time the enter a gym everyone is judging them

Labeling Cognitive Distortion

A characteristic or event becomes definitive and results in an overly harsh label for self or others. Example: failing one exam makes you a failure

Mental filter cognitive distortion

Focusing on a negative detail or bad event and allowing it to taint everything else. Example: being given a few critiques on an essay makes a person ignore all of the complements on it

Disqualifying the positive cognitive distortion

Maintaining a negative view by rejecting information that supports a positive view as being irrelevant, inaccurate, or accidental. Example: “i only got the job because no one else applied”

Jumping to conclusions distortion

making a negative interpretation despite the fact that there is little to no supporting evidence example: “my boyfriend hasn’t texted me in two hours, he must not love me anymore”

Fortune Telling Distortion

Anticipating that things will turn out badly as an established fact. Example: assuming that if you invite your friends to dinner they will all have a bad time

Magnification or minimization

Exaggerating or reducing the importance of something. Example: if i do not go to the party tonight my fiends will always hate me for it

Catastrophizing

An extreme form of magnification in which the very worst is assumed to be a probable outcome

Emotional Reasoning

drawing a conclusion based on an emotional state. Example: I’m nervous about the exam so I must not be prepared. If I was prepared I wouldn’t be nervous

“Should” and “must” statements

Rigid self-directives that presume an unrealistic amount of control over external events Example: “I must be a bad friend because everyone is too busy to see me today”

Personalization

Assuming responsibility for an external event or situation that was likely outside personal control. Example: “people at this party aren’t having fun because I’m here”

Implications of behavioral theories on nursing

Behavioral modification, modeling, systemic desensitization

Behavior modification

behaviors can be changes through reinforcement of other behaviors. Operant conditioning is the basis for behavior modification

Modeling

Therapist provides a role model for specific identified behaviors, and the patient learns through imitation. Example: people overcoming a snake phobia by watching a therapist hold a snake and trying it themselves

Pavlovs classical conditioning theory

Association of two things that are not related can cause a behavior not normally associated with the stimulus

Skinners operant conditioning theory

Positive reinforcement will increase desired behaviors, modifying those behaviors Example: a child gets candy every time they clean their room, eventually their room stays clean

Systematic Desensitization

Similar to exposure and response prevention, but incorperates the incremental exposure along with relaxation techniques Example: to overcome a spider phobia first see the spider in a cage, then out of the cage, then holding it

Cognitive behavioral therapy

mutual definition of problems, focusing on the here and now. Based on the assumption that dysfunctional behavior is linked to maladaptive learning and thinking

What does CBT do?

identify and test distorted beliefs and change the way of thinking; reduce symptoms. Emphasis on identifying unwanted behavior, learning new skills

Strategies related to CBT

Anxiety reduction, cognitive reconstructing, learning new behaviors

Dialectical behavioral therapy

CBT blended with mindfulness. Integration of opposites help the patient give up extreme positions.

Who is DBT for

developed for individuals with intractable behavioral disorders involving emotional dysregulation

Skill development in DBT focuses on

mindfulness, distress tolerance, interpersonal effectiveness, emotional regulation

Motivational therapy

often employed with CBT, based on five motivational principles. Goal is to empower patients to want to improve and change their behaviors

Five motivational principles

Express empathy, acknowledge disparity between thoughts and reality, avoid argumentation, roll with resistance, support self empathy

Biological model

locates the illness or disease in the body-usually in the limbic system of the brain and synapse receptor sites of the CNS

the brain and mental illness

our biology has a strong influence on our mental health. Psych is never just nature OR nurture and medications often need to be combined with therapy to work best

Neurotransmitters

Chemical signals that are sent through the nervous system. Often psych patients have deficiencies in neurotransmitters

Pharmacotherapy

use of medication to treat psychiatric illness

Agonists

mimic the effects of neurotransmitters, amplify effects

antagonists

block neurotransmitter in the brain, decreases effects

brain stimulation therapies

Electroconvulsive therapy, vagus nerve stimulation, deep brain stimulation

DSM-5

defines diagnostic criteria for various diagnoses, identifies broad categories with related disorders

Humanistic theories

asserts that psychology must go beyond experiences of hate, pain, misery, and conflict to include love, compassion, happiness, and well being

Maslows hierarchy of needs

believes that human beings are active participants in life, striving for self-actualization, when lower needs are met higher needs can emerge

levels of hierarchy of needs

physiological, safety, belongingness and love, esteem, self actualization

Sullivans interpersonal theory

states that major life problems are results of interpersonal relationships with a social context.

Purpose of all behavior according to the interpersonal theory

get needs met through interpersonal interactions and to avoid or reduce anxiety, protecting self will increase self worth and self esteem. focuses on interpersonal growth

Hildegard peplau

leader in psychiatric nursing care, believed that self awareness in nursing will help keep focus on patient, applied sullivans theory to nursing practice.

Social relationship

initiated for the purpose of friendship, socialization, enjoyment of accomplishment of task. Mutual needs are met, communication to give advice, give and ask for help

Therapeutic relationship

needs of patient identified and explored, clear boundaries established, problem solving approaches taken focused only on the patient, behavioral change encouraged

peplaurs theoretical framework

basis of interpersonal processes in nursing, introduced the importance of interpersonal relationships and communication

the art of nursing

provide care, compassion, and advocacy

the science of nursing

application of knowledge to understand a broad range of human problems and psychosocial phenomena, intervene in reliving patients suffering and promote growth

concepts of nurse patient relationship

basis of all psychiatric nursing treatment approaches,

how to establish nurse patient relationship

be safe, confidential, reliable, and consistent. have a relationship with clear boundaries

bounderies

the expected and accepted legal, ethical, and professional standards that separate nurses from patients, provide a safe space for the patient

over involvement increases the risk of

boundary crossing, boundary violations, professional sexual misconduct, blurring of roles