mental health nursing lecture1class & copy 10

7/25/2019 Mental Health Nursing Lecture1class & Copy 10

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Mental HealthMental Health

NursingNursingElisa A. Mancuso RNC, MS, FNSElisa A. Mancuso RNC, MS, FNS

ProfessorProfessor


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Mental HealthMental Health

Successful adaptation to internal & external stressorsSuccessful adaptation to internal & external stressors age appropriate thoughts, feelings & behaviorsage appropriate thoughts, feelings & behaviors

Adaptive Coping MechanismsAdaptive Coping Mechanisms

+ Self-Estee+ Self-Estee + !elationships+ !elationships

!ealit" oriented!ealit" oriented

E#ective $roble SolverE#ective $roble Solver

%ounicate e#ectivel"%ounicate e#ectivel"

%ontrol eotions%ontrol eotions

!eason ogicall"!eason ogicall"

!is' (a'er!is' (a'er

)"naic and ad*ust $!N)"naic and ad*ust $!N


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Mental llnessMental llness

%linicall" signicant behavioral pattern or%linicall" signicant behavioral pattern orps"chological s"ndroeps"chological s"ndroe

ssociated .ith distress or disabilit"ssociated .ith distress or disabilit" Risk of suffering causing;Risk of suffering causing;

Loss of freedomLoss of freedom

IsolationIsolation

PainPain

DeathDeath


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Mental Health-llnessMental Health-llness

%ontinuu%ontinuu

HealthHealth llnessllness

!ealit" /riented!ealit" /riented HallucinationsHallucinationsMeaningful 0or'Meaningful 0or' )isengaged)isengaged

!esilient!esilient nhedonianhedonia


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)SM 1-(!)SM 1-(!

)iagnostic & Statistical Manual of)iagnostic & Statistical Manual of

Mental )isorders 2Mental )isorders 2thth

ed, (ext !evisioned, (ext !evision(axono" used to describe ental disorders(axono" used to describe ental disorders

according to specic criteria3according to specic criteria3

Multi-axial 4xis -15 classication s"steMulti-axial 4xis -15 classication s"steAxis ! Clinical "isordersAxis ! Clinical "isorders

Axis ! Personalit# "isorders $ MentalAxis ! Personalit# "isorders $ MentalRetardation Retardation

Axis ! %eneral Medical ConditionsAxis ! %eneral Medical Conditions

Axis & ! Ps#chosocial $ EnvironmentalAxis & ! Ps#chosocial $ EnvironmentalPro'lemsPro'lems

Axis & ! %lo'al Assessment Functioning (%AF)Axis & ! %lo'al Assessment Functioning (%AF)

6$s"chological, social & occupational76$s"chological, social & occupational7


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$s"chological (heories$s"chological (heories

Ps#choanal#tic Model! FreudPs#choanal#tic Model! Freud *asic character formed '# age +.*asic character formed '# age +.

Ps#chosexual stages of development.Ps#chosexual stages of development. ral, Anal, Phallic, -atenc# $ %enitalral, Anal, Phallic, -atenc# $ %enital

*ehavior motivated '# su'conscious*ehavior motivated '# su'consciousthoughts $ feelings.thoughts $ feelings.

Ego defense mechanisms.Ego defense mechanisms.

Neurotic s#mptoms are attempts to controlNeurotic s#mptoms are attempts to controlanxiet#.anxiet#.

Change is a process of insight.Change is a process of insight. ncover the repressed feelings to resolvencover the repressed feelings to resolve

con/icts.con/icts.


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$s"choanal"tic Model- 8reud$s"choanal"tic Model- 8reud

cont3cont3 Personalit# Components0Personalit# Components0

d0 Pleasure Principled0 Pleasure Principle

Ego0 Realit# PrincipleEgo0 Realit# Principle

Superego0 Perfection PrincipleSuperego0 Perfection Principle

Conscious!A1are of presentConscious!A1are of present2ere $ No12ere $ No1

Su'conscious ! Not a1areSu'conscious ! Not a1are Repressed feelings, thoughtsRepressed feelings, thoughts


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$s"choanal"tic Model- 8reud$s"choanal"tic Model- 8reud

cont3cont3

3ransference3ransference 8eelings and attitudes patient had originall"8eelings and attitudes patient had originall"

experienced in other relationships, no.experienced in other relationships, no.displaces onto the therapist3displaces onto the therapist3

CountertransferenceCountertransference(herapist displaces onto the patient(herapist displaces onto the patient

attitudes or feelings fro his past3attitudes or feelings fro his past3


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)evelopental Model-)evelopental Model-

Eri'sonEri'son Social processes a4ect speci5c tas6s for each stageSocial processes a4ect speci5c tas6s for each stageand emotional gro1th.and emotional gro1th. ncorporates0ncorporates0

Pro'lem Solving, "ecision Ma6ing, Coping $ CommunicationPro'lem Solving, "ecision Ma6ing, Coping $ Communication

7 Continuous and evolutionar# stages7 Continuous and evolutionar# stages

3rust vs. Mistrust3rust vs. Mistrust Autonom# vs. Shame8"ou'tAutonom# vs. Shame8"ou't nitiative vs. %uiltnitiative vs. %uilt

ndustr# vs. nferiorit#ndustr# vs. nferiorit# dentit# vs. Role "i4usiondentit# vs. Role "i4usion ntimac# vs. solationntimac# vs. solation %enerativit# vs. Self!A'sorption%enerativit# vs. Self!A'sorption Ego ntegrit# vs. "espairEgo ntegrit# vs. "espair


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nterpersonal Model -nterpersonal Model -

SullivanSullivan 9ehavior and personalit" developent are9ehavior and personalit" developent are

direct result of interpersonal relationships3direct result of interpersonal relationships3

9asic fear is re*ection :9asic fear is re*ection : anxiet"anxiet"

3herapeutic Milieu3herapeutic Milieu %ounit" environent .hich facilitates%ounit" environent .hich facilitates

client interactionclient interaction $ractice interpersonal s'ills$ractice interpersonal s'ills

0or' cooperativel" to solve probles30or' cooperativel" to solve probles3


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Huanistic Model- Maslo.Huanistic Model- Maslo.

Hierarch" of basic huan needsHierarch" of basic huan needs9.9. Ph#sicalPh#sical:.:. Safet#8Securit#Safet#8Securit#

;.;. -ove $ *elonging-ove $ *elonging


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Huanistic Model-!ogersHuanistic Model-!ogers

%lient-centered therap"%lient-centered therap"

=nconditioned positive regard for the=nconditioned positive regard for the

clientclient >enuineness & epathetic>enuineness & epathetic

understandingunderstanding

portance of learningportance of learning ?? $otential$otential

?? $ersonal >ro.th$ersonal >ro.th


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9ehavioral Model- S'inner &9ehavioral Model- S'inner &

$avlov$avlov*ehaviorism*ehaviorism Focuses on 'ehaviors and changes, notFocuses on 'ehaviors and changes, not

the mind>s e4ect.the mind>s e4ect. All 'ehavior is learned.All 'ehavior is learned.

*ehavior has conse?uences*ehavior has conse?uences Re1ard or PunishmentRe1ard or Punishment

ReconditioningReconditioning nlearning maladaptive 'ehaviornlearning maladaptive 'ehavior

Treatment ModalitiesTreatment Modalities Behavior ModificationBehavior Modification Token EconomyToken Economy

Systematic DesensitizationSystematic Desensitization


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9ehavioral Model- cont39ehavioral Model- cont3

ReinforcementReinforcement @@ Fre?uenc# of 'ehaviorFre?uenc# of 'ehavior () Reinforcement uses a stimulus() Reinforcement uses a stimulus

Praise for completed 1or6Praise for completed 1or6

(!) Reinforcement removes the stimulus(!) Reinforcement removes the stimulus

No attention for interruptingNo attention for interrupting Continuous ReinforcementContinuous Reinforcement

Fastest 1a# to @ 'ehaviorFastest 1a# to @ 'ehavior

ntermittent Reinforcementntermittent Reinforcement Slo1er, 'ut longer lasting 1a# to @ 'ehaviorSlo1er, 'ut longer lasting 1a# to @ 'ehavior

PunishmentPunishment BB Fre?uenc# of 'ehaviorFre?uenc# of 'ehavior

() Punishment Scolding for inappropriate 'ehavior() Punishment Scolding for inappropriate 'ehavior

(!) Punishment No contact 1ith D1rong cro1d (B(!) Punishment No contact 1ith D1rong cro1d (B

cursing)cursing)


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Medical Model- @raeplinMedical Model- @raeplin

"isease Entit#"isease Entit# Signs $ S#mptomsSigns $ S#mptoms

Ph#siologicalPh#siological s and possi'l# viruses, altereds and possi'l# viruses, alteredimmune s#stemimmune s#stem

PE3 scans G 'rain meta'olismPE3 scans G 'rain meta'olism

C3 scans G lesions, tumorsC3 scans G lesions, tumors Classif# illness via "SM!& 3RClassif# illness via "SM!& 3R

*iochemical*iochemical s in Neurotransmitterss in Neurotransmitters @@ "A hallucinations $ delusions"A hallucinations $ delusions "rug therap# is e4ective"rug therap# is e4ective

%enetic%enetic Speci5c genes predispose toSpeci5c genes predispose to @ ris6 of illness@ ris6 of illness Chromosome H + $ I @ ris6 of schi=ophreniaChromosome H + $ I @ ris6 of schi=ophrenia

31ins +J!K+L ris631ins +J!K+L ris6


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%erebru :%erebru : A Heispheres & 2A Heispheres & 2obesobes - 2emisphere- 2emisphereBB controls ! side of bod"controls ! side of bod" ogical reasoning, reading, .riting, athogical reasoning, reading, .riting, ath

R 2emisphereR 2emisphereBB controls side of bod"controls side of bod" %reative thin'ing, intuition, artistic abilities%reative thin'ing, intuition, artistic abilities

Frontal -o'eFrontal -o'e (hought, eotions, eories, oveent &(hought, eotions, eories, oveent &

oral behaviororal behavior

Parietal -o'eParietal -o'e

(aste, touch , spatial orientation(aste, touch , spatial orientation

3emporal -o'e3emporal -o'e Sell, hearing, eor" & eotional expressionSell, hearing, eor" & eotional expression

ccipital -o'eccipital -o'e

anguage & visual interpretationanguage & visual interpretation


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9rain Ste9rain Ste

Midbrain, $ons & Medulla /blongataMidbrain, $ons & Medulla /blongata

Reticular Activating S#stemReticular Activating S#stem(RAS)(RAS) Motor activit", sleep, consciousness &Motor activit", sleep, consciousness &

a.arenessa.areness

Extrap#ramidal S#stem (EPS)Extrap#ramidal S#stem (EPS) Moveent & coordinationMoveent & coordination


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ibic S"ste : Eotionalibic S"ste : Eotional

9rain9rain 3halamus3halamus ctivit", sensation & eotionctivit", sensation & eotion

2#pothalamus2#pothalamus(ep regulation, appetite control, sexual(ep regulation, appetite control, sexualdrive, & ipulsive behavior 4anger, rage,drive, & ipulsive behavior 4anger, rage,

exciteent5exciteent5

Am#gdala $ 2ippocampusAm#gdala $ 2ippocampus Eotional arousal & eor"Eotional arousal & eor"


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NeurotransittersNeurotransitters

"opamine"opamine4)5 Excites4)5 Excites Complex movements, motivation, cognition,Complex movements, motivation, cognition, Emotional responsesEmotional responses D ! Schizo"hreniaD ! Schizo"hrenia

NorepinephrineNorepinephrine4NE5 Excites4NE5 Excites Mood regulation, attention, learning,Mood regulation, attention, learning,

memor#,memor#, sleep, 1a6efulnesssleep, 1a6efulness

## $E ! de"ression$E ! de"ression

EpinephrineEpinephrine4E5 Excites4E5 Excites Perception Flight or Fight responsePerception Flight or Fight response


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NeurotransittersNeurotransitters

SerotoninSerotonin4C-H(5 nhibits4C-H(5 nhibits Appetite, sleep, arousal, pain perception,Appetite, sleep, arousal, pain perception, -i'ido, regulation of emotions-i'ido, regulation of emotions ## %&'T !Schizo"hrenia( ggression ) s*icide%&'T !Schizo"hrenia( ggression ) s*icide

%amma Amino'ut#ric Acid%amma Amino'ut#ric Acid4>95 nhibits4>95 nhibits Slo1s do1n other neurotransmittersSlo1s do1n other neurotransmitters +B & # D( +( $E( E( ,h+B & # D( +( $E( E( ,h

%lutamate%lutamate4>5 Excites4>5 Excites Acet#lcholineAcet#lcholine4%h5 Excites


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Nursing (heor" -$eplauNursing (heor" -$eplau

nterpersonal 3herapeutic Modelnterpersonal 3herapeutic Model Nurse!Patient Relationship (909)Nurse!Patient Relationship (909) Colla'orative processColla'orative process Nurse>s RoleNurse>s Role

Resource person, teacher, leader, surrogate,Resource person, teacher, leader, surrogate,counselorcounselor3herapeutic Relationship Criteria3herapeutic Relationship Criteria

Patient initiatedPatient initiatedPt accepted unconditionall#Pt accepted unconditionall#Create environment of trustCreate environment of trustRN conve#s genuineness $ empath#RN conve#s genuineness $ empath#Explore feelings, thoughts, 'ehaviors $Explore feelings, thoughts, 'ehaviors $

experiencesexperiencesdentif# alternate methods for pro'lemdentif# alternate methods for pro'lem

solvingsolving


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(herapeutic !elationship(herapeutic !elationship

2 )istinct $hases2 )istinct $hases

9. rientation9. rientation

rientation8ntroductionrientation8ntroduction Esta'lish trust and rapportEsta'lish trust and rapport dentif# purpose, roles anddentif# purpose, roles and

responsi'ilitiesresponsi'ilities

Assess client>s needsAssess client>s needs

Form contractForm contract


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or6ing (denti5cation $ Exploitation)or6ing (denti5cation $ Exploitation)

:. denti5cation:. denti5cation RN facilitates expression of feelingsRN facilitates expression of feelings

Pt participates to identif# pro'lemsPt participates to identif# pro'lems

Pt responds and trusts RNPt responds and trusts RN

;. Exploitation;. Exploitation Promote Pt insights $ perception ofPromote Pt insights $ perception of

realit#realit#

vercome resistant 'ehaviorsvercome resistant 'ehaviors

Pt tests alternate pro'lem solving $Pt tests alternate pro'lem solving $coping s6illscoping s6ills

nitiate action plan $ ne1 goalsnitiate action plan $ ne1 goals from dependentfrom dependent. inde"endent /ehavior. inde"endent /ehavior

s6ills in interpersonal relationshipss6ills in interpersonal relationships


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(herapeutic %ounication(herapeutic %ounication

Active -isteningActive -istening 9e attentive to verbal & non-verbal essages39e attentive to verbal & non-verbal essages3

ssess congruenc" of essagessess congruenc" of essage

RN Non!&er'al S6illsRN Non!&er'al S6illsSS- Sit suarel" facing $t- Sit suarel" facing $t

- /bserve an open posture- /bserve an open posture

--- ean for.ard to.ard the $t3- ean for.ard to.ard the $t3

EE- Establish e"e contact- Establish e"e contact

RR !elaxF !elaxF


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Non-1erbal ssessentNon-1erbal ssessent Ph#sical AssessmentPh#sical Assessment

Clothing $ 2#gieneClothing $ 2#giene

*od# Movement8Posture*od# Movement8Posture Re/ects self!esteem $ statusRe/ects self!esteem $ status

3ouch3ouch Ellict 'oth ( $ !) responsesEllict 'oth ( $ !) responses

Cultural interpretationCultural interpretation Facial ExpressionFacial Expression

Re/ects a4ectRe/ects a4ect

E#e MovementE#e Movement

DDindo1s of the soulindo1s of the soul Direct contact - "ersonal interestDirect contact - "ersonal interest

&ocal Cues&ocal Cues 2o1 a message is ver'ali=ed2o1 a message is ver'ali=ed

Pitch, tone, loudness, rate of spea6ingPitch, tone, loudness, rate of spea6ing


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CommunicationCommunication

3echni?ues3echni?ues cceptancecceptance Non-*udgental attitudeNon-*udgental attitude

%onve" respect%onve" respect

/#ering Self/#ering Self Sense of presenceSense of presence

9eing available9eing available

/pen-ended Guestions/pen-ended Guestions

9road openings allo. $t to select the topics9road openings allo. $t to select the topics

1alidation1alidation %onring .hat the patient has said%onring .hat the patient has said


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%ounication (echniues%ounication (echniues

!eection!eection %ontent & feeling is referred bac' to $t%ontent & feeling is referred bac' to $t

$t recognition & acceptance$t recognition & acceptance

!estateent!estateent $araphrase ain content or eotion$araphrase ain content or eotion

8ocus8ocus

)irect conversation to a single concept)irect conversation to a single concept %larication%larication

Enhance understanding vague orEnhance understanding vague orconfused essageconfused essage


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%onve" nforation%onve" nforation Suppl" data via stateentSuppl" data via stateent

$rovide 8eedbac'$rovide 8eedbac'

Specic constructive inforationSpecic constructive inforation

State /bservationsState /bservations 1erbaliDe .hat is .itnessed or perceived1erbaliDe .hat is .itnessed or perceived

%onnect nforation%onnect nforation dentif" relationships, siilarities ordentif" relationships, siilarities or

di#erences to clarif" behavior< thoughtsdi#erences to clarif" behavior< thoughts


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%onfrontation%onfrontation dentif# discrepancies 'et1eendentif# discrepancies 'et1een

1hat the Pt sa#s $ does1hat the Pt sa#s $ does

SuariDeSuariDe 2ighlight the main themes of2ighlight the main themes ofcontent $ feelings discussedcontent $ feelings discussed

$resent !ealit"$resent !ealit" rient to the presentrient to the present Clarif# misperceptionsClarif# misperceptions

SilenceSilence

nteraction 1ithout 1ordsnteraction 1ithout 1ords


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9loc's to %ounication9loc's to %ounication

8alse !eassurance8alse !eassurance Ma# discourage Pt from disclosing feelingsMa# discourage Pt from disclosing feelings !e*ecting!e*ecting

Refusing to consider the Pt>s ideas orRefusing to consider the Pt>s ideas or

'ehaviors'ehaviors >iving pproval>iving pproval

Passing udgment or Pt Dright or 1rongPassing udgment or Pt Dright or 1rong

>iving dvice>iving dvice

mplies RN 6no1s 1hat is 'est for the Pt.mplies RN 6no1s 1hat is 'est for the Pt.

$robe$robe Pushing for ans1ers the Pt does not 1antPushing for ans1ers the Pt does not 1ant

to discussto discuss


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9loc's to %ounication9loc's to %ounication

)efend)efend mplies Pt has no right to express his o1nmplies Pt has no right to express his o1n

ideasideas

9elittle9elittle Minimi=ing Pt. distressMinimi=ing Pt. distress . Pt0 *nim"ortant. Pt0 *nim"ortant %hange the Sub*ect%hange the Sub*ect

RN ta6es over the direction of theRN ta6es over the direction of theconversationconversation

)enial)enial *loc6s further discussion*loc6s further discussion

I

mental health nursing lecture1class & copy 10

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