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PsychiatricPsychiatric

Mental HealthMental HealthNursingNursing

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PSYCHIATRIC MENTALPSYCHIATRIC MENTAL

HEALTH NURSINGHEALTH NURSINGMental Health: a state of emotional,Mental Health: a state of emotional,

psychological and social wellness as evidencedpsychological and social wellness as evidenced

by satisfying interpersonal relationships,by satisfying interpersonal relationships,effective behavior and coping, positive selfeffective behavior and coping, positive self--

concept and emotional stabilityconcept and emotional stability

: a dynamic ever changing state: a dynamic ever changing state

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Factors influencing MentalFactors influencing Mental

Health/IllnessHealth/Illness Individual factors: persons biologic makeIndividual factors: persons biologic make--

up, sense of harmony in life, hardiness,up, sense of harmony in life, hardiness,

spirituality, ability to find meaning in life.spirituality, ability to find meaning in life. interpersonal: effective communication,interpersonal: effective communication,

ability to help others, a balance ofability to help others, a balance ofseparateness and connection.separateness and connection.

social/cultural factors: sense ofsocial/cultural factors: sense ofcommunity, access to adequatecommunity, access to adequateresources, intolerance of violence.resources, intolerance of violence.

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Characteristics of Mental HealthCharacteristics of Mental Health

and Mental Illnessand Mental Illness1.accepts self and others1.accepts self and others 1.Feels inadequate Has poor self1.Feels inadequate Has poor selfconceptconcept

2. able to cope with or tolerate stress2. able to cope with or tolerate stress 2.Is unable to cope2.Is unable to cope

3.can return to normal functioning if3.can return to normal functioning if

temporarily disturbedtemporarily disturbed

3.Exhibits maladaptive behaviors3.Exhibits maladaptive behaviors

4.able to form close and lasting4.able to form close and lasting

relationshipsrelationships

4.Unable to establish a meaningful4.Unable to establish a meaningful

relationshipsrelationships

5.uses sound judgment to make5.uses sound judgment to make

decisionsdecisions

5.Has poor judgment5.Has poor judgment

6.accepts responsibility for actions6.accepts responsibility for actions 6.Is irresponsible or unable to accept6.Is irresponsible or unable to acceptresponsibility for actionsresponsibility for actions

7.is optimistic7.is optimistic 7.Is pessimistic7.Is pessimistic

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8.recognizes limitations8.recognizes limitations 8.Unable to recognize limitations8.Unable to recognize limitations

9.can function effectively and9.can function effectively and

independentlyindependently

9.Exhibits dependency needs because9.Exhibits dependency needs because

of feelings of inadequacyof feelings of inadequacy

10. is able to distinguish imagined10. is able to distinguish imagined

circumstances from realitycircumstances from reality

10.Unable to perceive reality10.Unable to perceive reality

11.is able to develop potential and11.is able to develop potential and

talents to the fullest extenttalents to the fullest extent

11.Doesnt recognize potential and11.Doesnt recognize potential and

talents because of poor self concepttalents because of poor self concept

12.is able to solve problems12.is able to solve problems 12.Avoids problems rather than coping12.Avoids problems rather than coping

with them or attempting to solve themwith them or attempting to solve them

13.can delay gratification13.can delay gratification 13.Desires or demands immediate13.Desires or demands immediate

gratificationgratification

14.14. mental health reflects a personsmental health reflects a persons

approach to life by communicatingapproach to life by communicating

emotions, giving and receiving, workingemotions, giving and receiving, workingalone as well as with others, acceptingalone as well as with others, accepting

authority, displaying a sense of humorauthority, displaying a sense of humor

and coping successfully with emotionaland coping successfully with emotional

conflictconflict

14.Mental illness reflects a persons14.Mental illness reflects a persons

inability to cope with stress resulting ininability to cope with stress resulting in

disruption, disorganization, indisruption, disorganization, inappropriate reactions, unacceptableappropriate reactions, unacceptable

behavior and the inability to respondbehavior and the inability to respond

according to the persons expectationaccording to the persons expectation

and the demands of the societyand the demands of the society

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Mental Illness/DisorderMental Illness/Disorder

Mental Illness/Disorder:Mental Illness/Disorder: clinically significantclinically significantbehavioral/psychological syndrome or pattern thatbehavioral/psychological syndrome or pattern thatoccurs in an individual and is associated withoccurs in an individual and is associated with

present distress or disability.present distress or disability.: Dissatisfaction with ones characteristics,: Dissatisfaction with ones characteristics,

abilities and accomplishments, ineffective or nonabilities and accomplishments, ineffective or non--satisfying relationships, dissatisfaction with onessatisfying relationships, dissatisfaction with ones

place in the world, ineffective coping with lifeplace in the world, ineffective coping with lifeevents.events.

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Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental Disorders

(DSM(DSM--IVIV--TR):TR):

Describes all mental disorders,Describes all mental disorders,

outlining specific diagnosticoutlining specific diagnostic

criteria for each based on clinicalcriteria for each based on clinical

experience and research. Itexperience and research. It

serves as basis for diagnosingserves as basis for diagnosingpsychological disorderspsychological disorders..

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Three Main PurposesThree Main Purposes::

provide standardized nomenclature andprovide standardized nomenclature and

language for all mental healthlanguage for all mental health

professionalsprofessionals present defining characteristics orpresent defining characteristics or

symptoms that differentiate specificsymptoms that differentiate specific

diagnosisdiagnosis assist in identifying underlying causes ofassist in identifying underlying causes of

disordersdisorders

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Multi Axial Classification SystemMulti Axial Classification System

Axis I: for identifying all major psychiatricAxis I: for identifying all major psychiatricdisorders except mental retardation anddisorders except mental retardation andpersonality disorders (e.g. depression,personality disorders (e.g. depression,

schizophrenia, anxiety and substance abuse)schizophrenia, anxiety and substance abuse)

Axis II: for reporting mental retardation andAxis II: for reporting mental retardation andpersonality disorders as well as promisingpersonality disorders as well as promisingmaladaptive personality features and defensemaladaptive personality features and defense

mechanism.mechanism.

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Axis III: for reporting current medical conditionsAxis III: for reporting current medical conditionsthat are potentially relevant to understanding orthat are potentially relevant to understanding or

managing persons mental disorders as well asmanaging persons mental disorders as well asmedical conditions that might contribute tomedical conditions that might contribute tounderstanding the personunderstanding the person

Axis IV: for reporting psychosocial andAxis IV: for reporting psychosocial andenvironmental problems that may affect theenvironmental problems that may affect thediagnosis, treatment and prognosis of mentaldiagnosis, treatment and prognosis of mentaldisorders. Included are problems with primarydisorders. Included are problems with primarysupport group, social environment, education,support group, social environment, education,occupation, housing, economics, access to healthoccupation, housing, economics, access to healthare and legal system.are and legal system.

Axis V: presents global assessment of functioning,Axis V: presents global assessment of functioning,rates the person overall psychological functioningrates the person overall psychological functioningon a scale of1on a scale of1--10.10.

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Standards of CareStandards of Care

Standard I: assessmentStandard I: assessment

Standard II: diagnosisStandard II: diagnosis

Standard III: outcome identificationStandard III: outcome identification

Standard IV: PlanningStandard IV: Planning

Standard V: implementationStandard V: implementation Standard VStandard V

a. counselinga. counseling

b. milieu Therapyb. milieu Therapy

c. Self care Activitiesc. Self care Activities

d. psychobiologic interventionsd. psychobiologic interventions

e. health teachinge. health teaching f. case managementf. case management

g. health promotion and maintenanceg. health promotion and maintenance

Standard VI: evaluationStandard VI: evaluation

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Standard of ProfessionalStandard of Professional

PerformancePerformance quality carequality care

performance appraisalperformance appraisal

educationeducation collegialitycollegiality

ethicsethics

collaborationcollaboration

researchresearch resource utilizationresource utilization

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Theories Related to Mental HealthTheories Related to Mental Health

NursingNursingPsychoanalytic Theory:Psychoanalytic Theory:

Developed by Sigmund Freud, all humanDeveloped by Sigmund Freud, all human

behavior is caused and can be explained.behavior is caused and can be explained.

Repressed sexual impulses and desiresRepressed sexual impulses and desires

motivate much human behavior. A problem wasmotivate much human behavior. A problem was

the result of childhood trauma or failure tothe result of childhood trauma or failure to

complete tasks of psychosexual theories thuscomplete tasks of psychosexual theories thus

resulting in unresolved crisis.resulting in unresolved crisis.

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Personality componentsPersonality components

Id: basic or innate desires; pleasure seekingId: basic or innate desires; pleasure seekingbehaviors, aggression and sexual impulses,behaviors, aggression and sexual impulses,

seeks instant gratification no regards for rules orseeks instant gratification no regards for rules or

social connection.social connection.

Superego: reflects moral and ethical concepts,S

uperego: reflects moral and ethical concepts,values and parental and social expectations,values and parental and social expectations,

otherwise known as the total opposite of the Id.otherwise known as the total opposite of the Id.

Ego: balancing or mediate force between Id andEgo: balancing or mediate force between Id and

Superego represents mature and adaptiveSuperego represents mature and adaptive

behavior that allows person to functionbehavior that allows person to functionsuccessfully in the world.successfully in the world.

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Behavior Motivated by Subconscious Thoughts and FeelingsBehavior Motivated by Subconscious Thoughts and Feelings

Conscious:Conscious: refers to perception, thoughts and emotionsrefers to perception, thoughts and emotionsthat exist in the persons awareness.(e.g. being happy,that exist in the persons awareness.(e.g. being happy,

thinking of loved one)thinking of loved one) PrePre--conscious:conscious: thoughts and emotions are not currentlythoughts and emotions are not currently

in the persons awareness buts can recall them with somein the persons awareness buts can recall them with someeffect (e.g. adult remembering what he/she felt, thoughteffect (e.g. adult remembering what he/she felt, thoughtand did during childhood)and did during childhood)

Unconscious:Unconscious: realm of thoughts and feelings thatrealm of thoughts and feelings that

motivate a person, even though he/she totally unaware ofmotivate a person, even though he/she totally unaware ofthem includes defense mechanism. It is where a personthem includes defense mechanism. It is where a personrepresses his/her traumatic events that are painful torepresses his/her traumatic events that are painful toremember.remember.

Much of what we do and say is motivated byMuch of what we do and say is motivated bysubconscious thought and feelings.subconscious thought and feelings.

Freudian slip:Freudian slip: term used to describe slip of theterm used to describe slip of the

tongue, with Freud it is believed to be not antongue, with Freud it is believed to be not anaccident or coincidence rather than indication ofaccident or coincidence rather than indication ofsubconscious feelings or thought that accidentallysubconscious feelings or thought that accidentallyemerged in casual dayemerged in casual day--toto--day conversation.day conversation.

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Methods Used to gain Access inMethods Used to gain Access in

Subconscious MindSubconscious Mind Dream analysis:Dream analysis: primary methodprimary method

used in psychoanalysis, involvesused in psychoanalysis, involves

discussing a clients dream anddiscussing a clients dream andsignificance.significance.

Free association:Free association: the therapist triesthe therapist tries

to uncover thoughts by saying ato uncover thoughts by saying a

word and asking the client toword and asking the client torespond quickly with the first thingrespond quickly with the first thing

that comes into his mind.that comes into his mind.

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Transference and Countertransference:Transference and Countertransference:

Transference:Transference: occurs when the clientoccurs when the clientdisplaces onto the therapist attitudes anddisplaces onto the therapist attitudes and

feelings that the client originallyfeelings that the client originally

experienced in other relationship. Theexperienced in other relationship. The

patterns are automatic and unconsciouspatterns are automatic and unconsciousin the therapeutic relationship (client toin the therapeutic relationship (client to

nurse)nurse)

CountertransferenceCountertransference:: occurs when theoccurs when the

therapist displaces onto the clienttherapist displaces onto the client

attitudes or feelings form his or her past.attitudes or feelings form his or her past.

(nurse to client)(nurse to client)