NURS 353 Intro to Psych Nursing

Mental Health

state of well being in which the individual realizes their own abilities, can cope with life’s normal stressors, works productively, and makes a contribution to society

productivity, fulfilling relationships, adapting to change, coping with adversity

the successful performance of the following functions

rational thinking, learning, emotional growth, resilience, self-esteem

What does mental health provide the capacity for?

self-governance ability, progress toward growth, tolerance of unknown, self-esteem, reality orientation, mastery of environment, stress management

elements of mental health

biological, psychological, sociocultural

Influences on mental health

prenatal events, physical health status, nutrition Hx of injuries, physiology

biological influences on mental health

interactions with others, intelligence quotient, self-concept, skills, creativity, emotional development

psychological influences on mental health

family stability, ethnicity, housing, child-rearing patterns, economic level, religion, values/beliefs

Sociocultural influences on mental health

Mental disorders

Clinically significant disturbances in cognition, emotion, or behavior that reflects dysfunction in physiological, biological, or developmental processes underlying mental dysfunction

Distress or impaired functioning

What are mental disorders usually associated with

Physical level, personal level, interpersonal level, societal level

Mental Health continuum

1 in 4 adults

incidence of mental health

25% have schizophrenia or bipolar

prevalance of mental health in homeless

Depression

what mental illness is often mis/underidagnosed in the older population

individuals older than 65

in what group do we see some of the highest suicide rates

complex interactions of genetics and environmental factors

what does the etiology of mental illness involve

ICD and DSM

2 main classifications of mental illness

ICD

WHO’s classification of mental and behavioral disorders

International diagnostic standard for health management purposes

DSM

groups disorders by symptom clusters and differentiates between normality and psychopathology

duration and severity of symptoms

what does the DSM base their groupings on

put mental and physical health on the same playing field, more unified approach

What did the DSM V do

ICD codes

calls out contributing stressors that allows providers to identify other problems

WHO’s Disability Assessment Schedule

brings the DSM tool into better alignment with other medical disciplines

Disorders and their associated disabilities are shown as conceptually distinct and assessed separately

categories are descriptions not explanations

Divides normal and abnormal

inflexibility of duration

cultural discrepancies

utilized for adults and children, doesn’t consider differences

clients with same disorder/manifestations can have different personal experiences

Limits of DSM

health promotion

attention to underserved pop

managed care in behavioral health

quality management

expanded practice (PNP)

community based primary care

involve pt family

prevention and treatment of mental illness

2/3

how many people fail to seek treatment for mental illness

increased expenses, increase in criminal justice system and social service

what does failure to seek treatment lead to

lack of parity

inequality of coverage
what is most effective treatment vs what is received

stigma, revolving door treatment, decreased length of stay, deinstitutionalization, lack of community supports

issues related to treatment of mental illness

increase mental health professionals (children)

expand mental health services

cultural understanding

improve overall understanding

redesign rehab services

integration and collaboration in services

improve coverage

medication adherence

goals for improving care

work with individuals who have psychiatric problems to:

provide interventions based on individual needs

develop nursing care plans to ensure positive outcomes

crisis intervention and counseling

improve coping abilities

enhance therapeutic environment

assist with self-care activities

monitor treatment regimens

Role of psychiatric nurse

therapeutic use of self

forms a trusting relationship that provides comfort, safety, and acceptance

Genuineness and warmth

openness, realness, lack of defenses

Empathy

able to walk a mile in client’s shoes

Leadership

ability to empower, direct, and manage client care

Acceptance

suggests neither approval nor disapproval but tolerance and appreciation of client

Maturity and self-awareness

nurse’s ability to tolerate differences

never be alone in isolated spot

always have an exit plan

don’t put back to closed in area

avoid provocative clothing/having too much skin showing

avoid necklaces/loop earrings

ensuring safety

religious, political, sexual

what topics should you avoid with the pt

communication skills, consideration of developmental stage, culture, spirituality, religion

components of effective data collection and assessment

ROS

diagnostic testing

vital signs

neuro status

changes in sleep pattern, appetite, libido, concentration

Elimination

Activity and exercise

Hydration

Self-care

Physical exam of pt

general appearance

orientation

mood and affect

quality of speech

thought process

cognitive intellectual performance

insight and judgement

mental status exam

recent stressors

strengths

current meds

Hx of psych treatment

substance abuse Hx

quality of support systems

family definition of problem

psychosocial components

growth and development

family dynamics

parenting styles

considerations for children and adolescents

avoid ageism

determine how to address

considerations for older adults

analyze assessment data

how to determine diagnosis

individualized and measurable

What should expected outcomes be

safety needs

what is often a priority in plan of care

advocate

teacher

socializing agent

role model

What does the psychiatric nurse assume the role of in the plan of care

promote self-care

encourage physical activity

sleep intervention

encourage proper nutrition

relaxation techniques

medication management

biologic interventions

cognitive interventions

counseling

conflict resolution

bibliotherapy

reminiscence

behavior therapy

Psychoeducation

psychological intervnetions

milieu therapy

containment

validation

structured interventions

open communication

patient safety

social interventions

Biologic, psychological, social

types of interventions

evaluation

a dynamic process that changes as clients condition changes

subjective and objective data

writing is clear and legible

avoid inferences and judgments

use of concrete and specific terms

components of documentation