Mental Health Nursing Vocabulary
GRIEF AND LOSS: CONCEPTS AND DEVELOPMENTAL UNDERSTANDING
Definition of Grief: The emotional process of coping with a loss. While often associated with the death of a loved one (spouse, parent, child, or pet), it applies to the loss of anything significant to an individual.
Loss: Defined as an actual or perceived change in the status of a relationship to a valued object or person. Examples include: * Death of a person or pet. * Separation or divorce. * Loss of a body part or health threat. * Loss of income or home (fire/natural disaster). * Loss of an ideal (e.g., desiring a vaginal delivery but needing a cesarean section). * Academic failure or missing a promotion.
Bereavement: The natural, healthy, and expected reaction of grief and sadness following a significant loss.
Mourning: The outward expression of grief, heavily influenced by personal, familial, and cultural beliefs. Customs determine the length of the mourning period and specific rituals.
Age-Related Understanding of Loss (Table 1.5): * Toddler: Egocentric; they do not understand the concept of loss. They may experience anxiety from separation but usually adapt to a new nurturing figure. * Preschool: Uses Magical Thinking (the belief that thoughts or actions cause real events, e.g., "Grandpa died because I hit my brother"). They do not understand death as permanent and may ask if a deceased person will wake up to play. * School-age: Associated with a growing moral concept of right and wrong. They may feel guilt or responsibility (e.g., for a parent's divorce) but can understand concrete, logical explanations (e.g., death of a pet). * Adolescent: Understands death as finality but struggles to fit loss into their search for identity; often perceives loss as a threat to identity. * Adults: Able to view loss as temporary or permanent and typically grow from the situation.
Types of Grief: * Anticipatory Grief: Seen when a major loss is expected in the near future (e.g., terminal illness). This allows for preparation and closure, often supported by hospice care. * Conventional Grief: Primarily associated with the period immediately following a loss. The duration varies (days, weeks, or years) based on development and coping strategies. * Dysfunctional Grief: Failure to complete the grieving process. The reaction is prolonged and intense, leading to a sense of meaninglessness. * Chronic Sorrow: Grief that resurfaces at specific times but never fully dissipates (e.g., parents of a developmentally disabled child missing milestones). * Unresolved Grief: Use of maladaptive symptoms continuing months after the loss. Signs include worthlessness, suicidal tendencies, hallucinatory images of the deceased, or delusional thinking.
Factors Contributing to Dysfunctional Grief (Box 1.5): * Socially unacceptable death (suicide, homicide). * Missing persons (war, abduction). * Multiple losses in close succession. * Ambivalent feelings toward the lost person. * Survivor's Guilt: Feeling that one should have died instead of the deceased.
Stages of Grief (Theorist: Elisabeth Kübler-Ross): 1. Denial. 2. Anger. 3. Bargaining. 4. Depression. 5. Acceptance.
LAWS, ETHICS, AND CLIENT RIGHTS
Ethics: A set of principles or values guiding behavior and determining right from wrong in healthcare conducted via an ethical review board when values conflict.
Mental Health Patient Bill of Rights (U.S. Code Title 42, Chapter 102): * Right to treatment in the least-restrictive setting. * Right to an individualized written treatment plan and periodic reviews. * Right to refuse treatment (unless court-ordered). * Right to refuse participation in experimental therapy. * Freedom from restraint or seclusion except in emergencies ordered by trained professionals. * Right to confidentiality within legal limits. * Right to access medical records and have private communication (telephone, mail, visitors). * Right to assert grievances.
Informed Consent: Permission granted after full explanation of procedures, risks, and benefits. Clients must be competent unless determined otherwise by a court.
Legal Decision-Making Roles: * Ombudsman/Guardian/Conservator: Terms for court-appointed individuals who make decisions when a client is incapacitated. * Durable Power of Attorney for Health Care: Designates a specific person to make decisions if the client becomes unable.
Confidentiality and Disclosure (Box 2.3): Nurses must protect privacy via the Nurse Practice Act. Disclosure is legally required for: * Intent to commit a crime. * Duty to Warn: Forewarning endangered individuals. * Evidence of child abuse. * Initiation of involuntary hospitalization. * Infection by HIV.
OBRA (Omnibus Budget Reconciliation Act): Protects nursing home residents, prevents unnecessary restraints, and ensures quality care.
DEVELOPMENTAL THEORIES AND CONTRIBUTORS
Sigmund Freud (Psychoanalytic Theory): * Divisions of Psyche: Conscious (present awareness), Preconscious (easily retrieved), and Unconscious (largest part; past experiences/emotions). * Transference: Unconscious transfer of feelings from the past to a person in the present (e.g., client to nurse). * Countertransference: The response elicited in the healthcare provider receiving those transferred feelings. * Personality Components: * Id: Pleasure principle; demands instant gratification; present at birth (hunger, sex, aggression). * Ego: Reality principle; the "peacemaker" between the Id and Superego; develops from 6 months to 2 years. * Superego: The conscience; morality/values; develops at age to ; fully developed by to . * Ego Defense Mechanisms (Table 3.1): * Sublimation: Rechanneling unacceptable impulses into constructive outlets (e.g., aggressive person playing football). * Intellectualization: Using logic to block uncomfortable emotions (e.g., explaining abuse signs while ignoring one's own abuse). * Suppression: Voluntary exclusion of anxiety-producing thoughts (e.g., setting aside a home argument to work). * Denial: Refusal to recognize reality (e.g., setting a table for a deceased spouse). * Displacement: Transferring hostility to a safer object (e.g., arguing with family after a bad day at work). * Fantasy: Using imagination to solve problems. * Repression: Involuntary distancing of painful events into the unconscious. * Regression: Returning to an earlier developmental stage (e.g., a child using a bottle during hospitalization). * Projection: Blaming others for one's own faults (e.g., alcoholic blaming spouse for their drinking). * Reaction Formation: Replacing unacceptable feelings with the opposite (e.g., parent who dislikes a child becoming overprotective). * Conversion: Emotional conflict becomes physical (e.g., migraine to avoid work). * Undoing: Positive action to neutralize a previous negative action. * Rationalization: Substituting false logic for behavior threatening to the ego.
Freud’s Psychosexual Development: 1. Oral Stage ( to years): Sucking/oral gratification. 2. Anal Stage ( to years): Urination/defecation control. 3. Phallic Stage (around age ): Genital stimulation; sexual identity. 4. Latency Stage (middle childhood): Subdued sexual desires. 5. Genital Stage (puberty/adolescence): Relationships formed.
Other Major Theorists: * Jean Piaget: Cognitive development (Sensorimotor, Preoperational, Concrete Operational, Formal Operational). * Erik Erikson: Psychosocial stages (e.g., Trust vs. Mistrust). * Abraham Maslow: Hierarchy of Needs (Physiological, Safety, Love/Belonging, Esteem, Self-Actualization).
Nursing Contributors: * Benjamin Rush: Father of American Psychiatry. * Florence Nightingale: Nursing reform and hygiene.
ABUSE AND VIOLENCE
Cycle of Violence: Begins with an ideal relationship, followed by subtle behavioral changes. 1. Tension-Building: Verbal threats, insults, and blaming. 2. Acute Battering Incident: Physical/sexual assault, property destruction. 3. Honeymoon Phase: Abuser offers gifts, Loving gestures, remorse, and promises to change.
Fiduciary/Financial Abuse: Controlling all money, preventing a partner from working, or coercing a relative to change a will.
Domestic Violence: Can happen to any gender or age. Survivors often return due to fear, guilt, lack of resources, or for children.
Warning Signs of an Abuser (Box 6.4): * Excessive jealousy and possessiveness. * Temper set off by minor inconveniences. * Cruelty to animals. * Monitoring phone calls, car mileage, and controlling dress.
Interventions: * IPV Screening: All pregnant clients should be screened repeatedly. * Safety: Victims are in greatest danger right after separation. * Child Interventions: Use play therapy or drawing to allow expression of feelings.
Suicide Management: Assess plan and intent; remove harmful objects; frequent observation.
Anger Management: Use time-outs, relaxation techniques, and encourage verbal expression.
THERAPEUTIC COMMUNICATION
Definition: Goal-oriented interaction to learn about the client-systematic, planned, and guided by the nurse.
Personal Space: Typically an arm's length, or to feet. Aggressive clients require distance greater than feet.
Effective Verbal Techniques (Table 7.1): * Clarification: "Did I understand you correctly?" * Validation: Verifying perceptions of feelings ("You seem anxious"). * Reflection (Parroting): Paraphrasing content and feelings back to the client. * Restating: Repeating content to lead to further discussion. * Focusing: Directing conversation back to a specific issue. * General Leads: "Go on…" or "And then?" * Giving Information: Increases client involvement.
Nonverbal Aspect (Table 7.2): * Stance: Lateral conversations (both seated at eye level) are best. Standing while a client sits (vertical) is intimidating. * Closed Body: Crossed arms/legs send messages of disinterest. * Intermittent Eye Contact: Shows interest and concentration.
MOOD DISORDERS: DEPRESSION AND BIPOLAR
Bipolar Disorder: Characterized by erratic shifts in mood and energy. * Hypomania: Lasts at least days; high energy, decreased sleep ( to hours); no psychotic symptoms. * Mania: Lasts at least week; severe impairment; may include delusions of grandeur or hallucinations. * Signs/Symptoms: Euphoria, Clang Associations (rhyming words), Flight of Ideas (racing mind), impulsivity (spending sprees), hypersexuality, and neglect of hygiene. * Rapid Cycling: or more episodes of mania or depression within a year. * Labile: Rapid shifts in mood (euphoria to irritability).
Depression Treatments: * SSRIs (e.g., Fluoxetine, Sertraline): First-line; side effects include insomnia and GI upset. * Tricyclic Antidepressants (TCAs): Side effects include sedation and orthostatic hypotension. * Age-Appropriate Interventions: Children (drawing/play), Adults (CBT), Older Adults (reduce isolation).
PSYCHIATRIC MEDICATIONS
Antipsychotics (Neuroleptics): * Typical (Traditional): Block dopamine; better for positive symptoms (hallucinations/delusions). * High Potency (e.g., Haloperidol): Higher risk of EPS. * Low Potency (e.g., Chlorpromazine): Higher risk of anticholinergic effects (dry mouth, blurred vision). * Atypical: Better for negative symptoms (flattened affect, withdrawal). * Side Effects: * EPS (Extrapyramidal Symptoms): Dystonia, Parkinsonism, Akathisia. * Tardive Dyskinesia (TD): Permanent drug-induced movement disorder. * Neuroleptic Malignant Syndrome (NMS): Potential life-threatening crisis (high fever, rigidity). * Smoking/Nicotine: Increases metabolism of antipsychotics; smokers may need higher doses.
MAOIs (Monoamine Oxidase Inhibitors): Risk of Hypertensive Crisis if consuming foods high in Tyramine (aged cheeses, processed meats, wine).
Antianxiety (Benzodiazepines): Lorazepam, Diazepam; risk of dependence and sedation.
PERSONALITY DISORDERS (CHAPTER 12)
Cluster A (Aloof/Eccentric): * Paranoid: Pervasive distrust; interprets actions as harmful; bears grudges; jealous. * Schizoid: "Loners"; emotional indifference; no desire for close relationships; bland expression. * Schizotypal: Magical thinking; ideas of reference; eccentric dress; irrational thinking.
Cluster B (Dramatic/Emotional/Erratic): * Antisocial: Disregard for rights of others/laws; no remorse; charming but deceitful; high prison population. * Borderline: Unstable relationships; Splitting (viewing world as all good or all bad); Self-Mutilation (distraction from emotional pain via endorphin release); Jekyll and Hyde behavior. * Narcissistic: Grandiose self-importance; needs admiration; lacks empathy; sensitive to criticism. * Histrionic: Center of attention-seeking; overdramatic; superficial; provocative dress.
Cluster C (Anxious/Fearful): * Avoidant: Extreme shyness; hypersensitive to rejection; feels inadequate but desires relationships. * Dependent: Helplessness; extreme need to be cared for; cannot make decisions; stays in abusive relationships to avoid being alone. * Obsessive-Compulsive Personality Disorder (OCPD): Perfectionism; rigid control; hoarding; workaholic; not the same as OCD (no specific obsessions/compulsions).
Nursing Care: Establish boundaries; set limits; maintain safety; no-harm contracts.
SUBSTANCE USE AND CHEMICAL DEPENDENCY
Tolerance: Brain/body adapts; need for higher doses to achieve the same effect.
Withdrawal: Occurs as blood/tissue concentration of substance declines; risks seizures/hallucinations.
Codependency/Enabling: People involved with the user take responsibility for their behavior, cover up problems, and allow the addiction to continue.
Alcohol Withdrawal: Symptoms include tremors, anxiety, and Delirium Tremens (DTs). Treated with benzodiazepines and thiamine.
Opioid Withdrawal: Muscle aches, yawning, dilated pupils. Treated with Methadone or Buprenorphine. Naloxone used for overdose.
Phases of Dependency: * Phase 1: Learning the high; temporary escape. * Phase 2: Hangover effects; guilt; building tolerance. * Phase 3: Dependent lifestyle; loss of control; revolving cycle.
EATING DISORDERS
Anorexia Nervosa: * Restricting Type: Weight loss through starvation or excessive exercise. * Binge-Eating/Purging Type: Restricting mostly, but uses purging (vomiting/laxatives) after small intakes. * Physical Findings: BMI low for age; Amenorrhea (absence of periods); Lanugo (fine hair on trunk/face); Russell Sign (calluses on hands from inducing vomiting); bradycardia; sensitivity to cold.
Bulimia Nervosa: Repeated binge-eating followed by compensatory behaviors (purging, exercise). Characterized by dental erosion.
Anatomy of Malnutrition: Low levels of pituitary hormones (FSH and LH) and ovarian estrogen.