Psychiatric-Mental Health Nursing

This is formatted in an outline of the chapter.

• Society defines health & illness according to its beliefs & values.
• Culture greatly influences these determinations about health & illness.

• The World Health Organization defines health as "a state of complete physical, mental & social wellbeing, not merely the absence of disease or infirmity."
• Mental health is defined as being able to function comfortably in society & being satisfied with your achievements.
• Menninger defined mental health as "the adjustment of human beings to each other & to the world around them with a maximum of effectiveness & happiness."
• There is no generally accepted definition of mental health.

• Self-governance
• Growth orientation
• Tolerance of uncertainty
• Self-esteem
• Mastery of the environment
• Reality orientation
• Stress management

• Biological, psychological, & sociocultural variables influence mental health.

• In the past viewed as demonic possession, the influence of ancestral spirits, the result of violating a taboo.
• The mentally ill were neglected, banned, persecuted, & deprived of their freedoms.
• In the 19^th century, mental illness was viewed as incurable.
• Until 1820, the mentally ill were exhibited as diversions & entertainment for the public.
• Until 1886, they typically were restrained in iron manacles.
• In the 1950s pharmacotherapy dramatically changed mental health care. These drugs relieved many symptoms & allowed psychotic clients to gain greater benefit from other therapies.

• General criteria for mental disorders include the following:
• Dissatisfaction with one’s characteristics, abilities, & accomplishments.
• Ineffective or unsatisfying interpersonal relationships.
• Dissatisfaction with one’s place in the world.
• Ineffective coping or adaptation to the events in one’s life & a lack of personal growth.

The Diagnostic & Statistical Manual of Mental Disorders, 4^th edition (DSM-IV) provides the diagnostic criteria for mental disorders or illness.

• More than 12% of adults in the United States have a diagnosable menatl illness at any time.
• Between 12% and 20% of children younger than 18 years in the US are believed to have a diagnosable mental disorder.
• 22% of adults will experience a mental disorder needing treatment at some point in life.
• The incidence of suicide is escalating, especially in people 14 to 24 years old, in whom the rate has tripled during the last 30 years.

• Current trends in care
• The decade of the brain
• Primary mental health care
• Consumer advocacy
• Care of the aged
• Persistent mental illness
• Challenges
• Holistic mental health care

• Hans Selye, defined stress as the "nonspecific response of the body to any demand made upon it" & termed the responses the general adaptation syndrome.

• There are three stages or GAS:
• Alarm reaction – the body responds & adjusts to the stressor.
• Stage of resistance – the body continues to resist & initial signs of reaction are no longer evidenced.
• Stage of exhaustion – occurs after lengthy exposure to the same stressor. Death occurs at the stage.

• Damaging stressors.

• Denial
• Regression
• Displacement
• Projection
• Reaction Formation
• Repression
• Suppression
• Identification
• Rationalization
• Fantasy
• Intellectualization

• Is built on the following principles & beliefs:
• Every person is worthy of dignity & respect.
• Every person has the potential to change & grow.
• All people have basic human needs in common with others.
• All behavior is meaningful & can be understood from the person’s perspective.
• People have the right to participate in decisions about their health & their care.

Psychiatric nursing focuses on the care & rehabilitation of those with identifiable emotional disorders.

• Assessment
• Nursing Diagnosis
• Planning
• Intervention
• Evaluation

Standards of care for nursing practice:

Standards I – V-g:

• Assessment
• Diagnosis
• Outcome Identification
• Planning
• Implementation
• Counseling
• Milieu therapy
• Self-care Activities
• Psychobiological Interventions
• Health Teaching
• Case Management
• Health Promotion & Health Maintenance

Standards V0h – VI:

• Psychotherapy
• Prescription of Pharmacological Agents
• Consultation
• Evaluation

I – VIII include:

• Quality of Care
• Performance appraisal
• Education
• Collegiality
• Ethics
• Collaboration
• Research
• Resource Utilization

• Reaction to the behaviors of those with mental disorders is likely to reflect the nurses’ personal experiences and values.

• Nurses with fear or anxiety related to this area of nursing i.e. nursing student’s, may hamper the nurse’s effectiveness in intervention.