Psychiatric-Mental Health Nursing Notes

History of Psychiatric-Mental Health

  • NSG, Theory, Tx modalities & Culture
  • Nsc 392
  • OBJECTIVE 1,2,3,4,5,7,10

Mental Disorders

  • Conditions involving altered thinking, mood, or behavior associated with distress or impaired functioning.
  • Occurrence: In the US, 1 in 5 have a diagnosable illness.
  • Epidemiology:
    • Study of patterns of disease distribution and determinants of health within populations.
    • Examination of associations among possible factors related to an area of investigation, not causes of a disorder.

Stigma "Judgement"

  • Defined as a mark of shame, disgrace, or disapproval resulting in being shunned or rejected by others.
  • Can rob individuals of work, independence, and relationships.
  • Three types of stigma:
    • Public stigma: What the public is saying.
    • Self stigma: Believing everything that is said.
    • Label avoidance: Not wanting to believe a diagnosis.

Components of Recovery

  • Responsibility
  • Respect
  • Peer Support
  • Hope
  • Self-Direction
  • Individualized and Person-Centered
  • Strengths-Based
  • Non-Linear
  • Empowerment
  • Holistic

Rule Out Medical or Substance Abuse First

Key Figures for Change

  • Philippe Pinel (France): Stopped barbaric treatment and placed patients in the care of physicians.
  • William Tuke (England): Advocated for sympathetic care and occupation.
  • Dorothea Dix (United States): Promoted humane treatment and expansion of state hospitals.

Managed Care

  • Efforts to coordinate patient care efficiently and cost-effectively.
  • Services via mostly private health maintenance organizations (HMOs) or preferred provider organizations (PPOs).
  • "Carve-out" mental health services: separated from general medical care packages and reimbursed differently.
  • Managed behavioral health care: Standardized admissions criteria, reduced length of patient stay, and directed patients to the proper level of care while attempting to control cost.
  • Mental Health Parity Act: Eliminated caps but did not include substance abuse.

History of Mental Health Nursing

  • Early Founders:
    • Nightingale: Holistic view for all clients.
    • Linda Richards: Opened a training school in Boston at McLean Hospital (First psychiatric nurse).
    • Effie Taylor: Integrated psychiatric nursing into the curriculum.
    • Harriet Bailey: Wrote the first mental health textbook.

Theories and Practice (TX Modalities)

Interpersonal Theories

  • Harry Stack Sullivan: Focused on interpersonal relationships.
    • 5 life stages (Table 3.4).
    • 3 developmental cognitive modes:
      • Protaxic mode
      • Parataxic mode
      • Syntaxic mode
  • Therapeutic community/milieu: Participant observer.
  • Was one of primary modes of treatment but not practical now.

Treatment Modalities

  • Individual therapy
    • Therapist-client relationship is pivotal.
  • Groups
    • Two or more people developing interactive relationships.
    • Sharing of at least one common goal or issue.
    • More than the sum of its parts.
    • Own personality, patterns of interaction, and rules of behavior.

Leading a Group

  • Determine the purpose.
  • Maintain professional boundaries.
  • Assess suitability for the group:
    • Does the purpose of the group match the needs of potential members?
    • Does the potential member have the social skills to function comfortably in the group?
    • Do other group members accept the new member?
    • What is the potential of the group member to commit to attending group meetings?
  • Will it be open or closed?

Challenging Behaviors

  • Monopolizer
  • “Yes, But…”
  • Disliked member (may become the scapegoat)
  • Silent member
  • Group conflict

Group Development Cont.

  • Termination Stage
    • Review group work/accomplishments.
    • Grieve for loss of group's closeness.
    • Reestablishment of self as an individual.
    • Summary and future plans.

Nursing Intervention Groups

  • Medication groups
  • Symptom management groups
  • Anger management groups
  • Self-care groups
  • Reminiscence groups

Cultural and Spiritual Issues Associated with Mental Health

Terminology

  • Culture: A way of life; basis of some common purpose, need, or similarity of background; totality of learned, socially transmitted beliefs, values, and behaviors from members' interpersonal transactions.
  • Cultural competence: Nursing care that is sensitive to issues related to culture, race, gender, sexual orientation, social class, economic situations, and other factors.
  • Acculturation: How immigrants from a different culture adopt the behaviors and language patterns of the dominant culture.
  • Culture has the most influence on a person's health beliefs and practices as well as influencing concept of disease and illness.

Cultural Patterns and Differences

  • No one size fits all.
  • Knowing general cultural patterns is a start.
  • Individualize care by asking about preferences.
    • How to greet.
    • Communication patterns and tone of voice.
    • Beliefs regarding MI/healing, spirituality, and medical treatment.

Factors in Cultural Assessment

  • Communication
    • Language, both nonverbal and verbal.
    • Physical distance/space.
  • Social organization.
  • Time orientation.
  • Environmental control.
  • Biologic variations.

Poverty

  • Socioeconomic status "drives health disparities more than minority status."
  • Daily needs are the priority, not preventative care.
  • No barriers: Affects all cultural groups.
  • Financial and emotional stress may trigger or exacerbate mental problems.
  • Trapped in a downward economic spiral, thus increasing tension and stress.
  • The homeless population is most at risk of escaping poverty.

Spirituality

  • One's self as a part of a spiritual force.
  • Connection to life; way of interpreting life events.
  • Source of hope, joy, comfort, and guidance on life's journey.

Spiritual Assessment and Intervention

  • Positive association with perception of well-being and health in persons with severe mental illness.
  • Therapeutic relationship and use of self as a therapeutic tool are necessary to carry out spiritual interventions.
  • Spiritual interventions: Meditation, guided imagery, prayer (where appropriate).

Religiousness

  • Participation in a community of people gathering around common ways of worshiping.
  • Religious beliefs often define one's relationship within a family and community.
  • Religious activities have been shown to improve health and a sense of well-being, as well as improve coping with poor health.

Self Awareness

  • The process of understanding one's own values, beliefs, thoughts, feelings, attitudes, motivations, biases, strengths, and limitations, and recognizing how they affect others.

    • Values
    • Beliefs
    • Attitudes

  • Self-examination; a willingness to be introspective.

  • Avoidance of bias if self-examination involves another's perspective.

  • "Know thyself."

Personal Feelings/Beliefs and Changing Behaviors

  • Understand own personal feelings and beliefs and try to avoid projecting them onto patients.
  • Avoid preconceptions.
  • Solicit feedback from colleagues and supervisors about how personal beliefs or thoughts are being projected onto others.
  • Through self-awareness and conscious effort, change learned behaviors to engage effectively in therapeutic relationships (therapeutic use of self).

Carper's Patterns of Knowing (table 5.1)

  • Four patterns of knowing:
    • Empirical knowing (book knowledge)
    • Personal knowing (life experiences)
    • Ethical knowing (Moral knowledge)
    • Aesthetic knowing (art of nursing)
  • Unknowing was added by Munhall in 1993.
    • (Identify an example of each of the above)

Behaviors that Can Diminish the Therapeutic Relationship

  • Inappropriate boundaries
  • Feeling sympathy or encouraging dependency
  • Nonacceptance
  • Avoidance