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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%ounication (echniues%ounication (echniues
%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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%ounication (echniues%ounication (echniues
%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