Objective 1 Flashcards by Kaitlyn Dominie

Diagnosis and treatment of human responses to actual or potential
mental health problems
* Specialized nursing practice
* Uses theories of human behavior as scientific framework
* Requires purposeful use of self as its art of expression

psychiatric mental health nursing

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state of well-being in which the individual realizes his own
abilities, can cope with the normal stressors of life, can work
productively, and is able to make a contribution to his or her
community

mental health

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what are the traits of mental health?

Ability to:
* Think rationally
* Communicate appropriately
* Learn
* Grow emotionally
* Be resilient
* Have a healthy self-esteem

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what are factors that influence mental health?

Nurturing during childhood
* Life circumstances, those that occur from birth
* The relationship between environment and mental health

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Refers to interaction between the family and child -
affecting the development of mental health

nurturing during childhood

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The ability and capacity to secure resources needed to
support well-being

resilience

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what is resilience characterized by?

optimism
sense of mastery
competence

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what are the characteristics of mental health?

Mentally healthy people who achieve self actualization (to
make something real or make something come about) or
achieve mental health are able to:
* Have positive self concepts
* Relate well to people and their environment
* Form close relationships with others

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distinctive set of:
traits
behavioral styles
The total of a person’s internal and external patterns of
adjustment to life determined in part by genetic makeup and life
experiences

personality

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what are characteristics of a healthy personality?

Positive self concept, body image and sense of self worth
* Well-balanced, cheerful and minimal stress
* Has self-discipline and self-control
* Open and honest with themselves and others
* Have a great ability to understand others and they know well
how to deal with people

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An illness or syndrome with psychological or behavioural
manifestations and/or impairment in functioning due to a social,
psychological, genetic, physical/chemical or biologic disturbance”
* Not limited to relations between people and society
* Characterized by symptoms and/or impairment in functioning

mental illness

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Pre-1900s
* European “asylums” (“Moral care”)
* Canadian “asylums” and history
* “Custodial care”
* Introduction of nurses to asylum work
* Training programs & professionalization of nursing
* Provincial psychiatric hospital

early mental illness care

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Expanded community-based mental health services
development

crisis management
consultation-liaison
primary care psychiatry

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Evolving nursing approaches toward mental health care
with expanded and autonomous roles in:

assessment
consultation
crisis management
therapy

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Evolved from general diploma to university education
countrywide
* Western Canada, registered psychiatric nursing diplomas
have been a long-established educational program
* Degree and graduate programs in psychiatric nursing have
been in place since 1995
* Since 1995 - CNA has offered RN’s certification in
psychiatric mental health nursing

nursing education

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Clinical nurse specialists (CNSs) have practiced in
psychiatric mental health since the 1970s
* Psychiatric nurse practitioners (NPs) are a newer and
expanded consultation role
* Advanced-practice nurses (APNs) are expected to have
expanded roles, particularly in rural areas of Canada

advanced practice

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pharmaceutical discoveries, leading to a gradual shift from provincial institutions

1950s

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integration of psychiatric care into general community hospitals, phase of trans institutionalization

1960s-70s

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change to shorter hospital stay, with community care

1970s-80s

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national advocacy, recovery movement, national mental health strategy

1990s-now

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what are the roles and responsibilities of the Canadian mental health care system?

federal
provincial/territorial
employer
private

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Highlighted importance of issues related to mental health and
mental illness in Canada
* Proposed 7 guiding principles for development of public policies to
support mental health

EPP report (1988)

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Developed a strategy framework for action established in 2017
* Ensures that people with mental health problems and mental
illnesses, are treated with respect and dignity, and have same rights

mental health commission of Canada (2009)

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Framework, changing directions, changing lives

Promotion and Prevention
Recovery and Rights
Access to Services
Disparities and Diversity
First nations, Inuit, and Metis
Leadership and Collaboration

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what are the 4 significant tends that will affect the future of psychiatric mental health nursing in Canada?

the aging population 2. increasing cultural diversity 3. expanding technology 4. an increased awareness of the impact of health determinants on mental illness

what are the 12 determinants of health?

Income and social status 2. Social support networks 3. Education 4. Employment/working conditions 5. Social environments 6. Physical environments 7. Personal health practices and coping skills 8. Healthy child development 9. Biology and genetic endowment 10. Health services 11. Gender 12. Culture

what is mental functioning related to?

developmental biological psychological distrubances

what are the social influences on mental health?

Consumer/recovery movement * Decade of the brain * Media * National Mental Health Framework and Strategy * Provincial Mental Health Legislation * International Conventions and Human Rights

Defined by some as a disorder causing people to: * Display abnormal behaviour more often than most people * Psychopathology(disorder) exhibiting frequent irresponsibility * Inability to cope

mental illness

what can mental illness be caused by?

Chemical imbalances in the brain  Transfer of drugs across the placental barrier  Organic changes within the brain  Inherited characteristics  Poor nurturing during childhood  Negative life circumstances

what are the characteristics of mental illness?

Feeling inadequate * Poor self concept * Inability to cope * Maladaptive behaviour * Unable to establish meaningful relationships * Poor judgement * Irresponsible * Pessimistic * No limitations * Dependency needs * Unable to perceive reality

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition * Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders

DSM-5

The International Classification of Diseases (ICD) sets the global health information standard for mortality and morbidity statistics. * Clinicians and researchers use this classification system to define diseases, study disease patterns, monitor outcomes, and subsequently allocate resources based on the prevalence of disease. The ICD is used globally and has been translated into 43 languages. An eleventh revision was released in 2019 * The Canadian Institute for Health Information developed an enhanced version of the ICD-10, referred to as the ICD-10-CA

ICD

an Austrian neurologist, revolutionized thinking about mental health disorders with his groundbreaking theory of personality structure, levels of awareness, anxiety, the role of defense mechanisms, and the stages of psychosexual development. * Freud came to believe that the vast majority of mental health disorders were caused by unresolved issues that originated in childhood

Sigmund Freud (1856-1939)

what are the levels if awareness?

conscious preconscious unconscious

what are Freud's three major and distinct but interactive components of personality?

Id Ego Superego

Pleasure principle * Reflex action * Primary process

Problem solver * Reality tester

EGO

Moral component

SUPEREGO

Formation of personality * Conscious and unconscious influences * Importance of individual talk sessions * Attentive listening * Transference * Countertransference

Freudian theory and nursing

Eight stages of development * Personality continues to develop through old age

Erikson's ego theory

what are Erikson's 8 stages of developmen?

trust vs. mistrust autonomy vs. shame/doubt initiative vs. guilt industry vs. inferiority identity vs. role confusion intimacy vs. isolation generativity vs. self-absorption integrity vs. despair

0-1.5

trust vs mistrust

1.5-3

autonomy vs shame/doubt

3-6

initiative vs guilt

6-12

industry vs inferiority

12-20

identity vs role confusion

20-35

intimacy vs isolation

35-65

generativity vs self-absorption

65+

integrity vs despair

Purpose of all behaviour is to get needs met through interpersonal interactions and to reduce or avoid anxiety  Anxiety  Security operations

sullivan's interpersonal theory

what was the foundation for Hildegard Peplau's theory??

Participant observer  Mutuality  Respect for the patient  Unconditional acceptance  Empathy

provide care, compassion, and advocacy enhance comfort and well-being

art of nursing

Application of knowledge to: * Understand a broad range of human problems and psychosocial phenomena * Intervene in relieving patients’ suffering and promote growth

science of nursing

influenced by Sullivan's work created the art and science of nursing

Hildegard Peplau's theory of interpersonal relationships in nursing

what are the behavioral theories?

Pavlov’s classical conditioning theory * Watson’s behaviourism theory * Skinner’s operant conditioning theory * Implications for nursing  Modifying or replacing behaviours  Behaviour management

Modelling * Operant conditioning * Systematic desensitization * Aversion therapy * Biofeedback

behavior therapy

Dynamic interplay between individuals and the environment * Thoughts come before feelings and actions * Thoughts about the world and our place in it are based on our own unique perspectives, which may or may not be based on reality

cognitive theory

what are the cognitive theories?

rational-emotive behavior therapy (Ellis) cognitive-behavioral therapy (Beck)

Aims to eradicate irrational beliefs * Recognize thoughts that are not accurate

rational-emotive behavior therapy (Ellis)

Test distorted beliefs and change way of thinking; reduce symptoms

cognitive-behavioral therapy (beck)

Human beings are active participants in life, striving for self- actualization * When lower needs are met, higher needs are able to emerge

maslow's hierarchy of needs

what do biological theories focus on?

neurological chemical biological genetic

how the body and brain interact to create what?

emotions memories perceptual expierences

what do biological theories and nursing focus on?

Qualities of a therapeutic relationship * Understanding patients’ perspective * Communicating to facilitate recovery

Basis of all psychiatric nursing treatment approaches * To establish that the nurse is: * Safe, Confidential, Reliable, & Consistent * Relationship with clear boundaries

concepts of the nurse-pt relationship

Basis of all psychiatric nursing treatment approaches * To establish that the nurse is: * Safe, Confidential, Reliable, & Consistent * Relationship with clear boundaries

therapeutic use of self

nitiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task * Mutual needs are met * Communication to give advice or to give or ask for help * Content of communication superficial

social relationships

Needs of patient identified and explored * Clear boundaries established * Problem-solving approaches taken * New coping skills developed * Behavioural change encouraged

therapeutic relationships

what are the necessary behaviors for nurses?

Accountability * Focus on patient’s needs * Clinical competence * Delaying judgement * Supervision

Physical boundaries * The contract * Personal space

establishing boundaries

When relationships slips into social context * When nurse’s needs are met at expense of patient’s needs

blurring of boundaries

* Patient unconsciously and inappropriately displaces onto nurse feelings and behaviours related to significant figures in patient’s past * Transference intensified in relationships of authority

transference

Nurse displaces feelings related to people in nurse’s past onto patient * Patient’s transference to nurse often results in countertransference in nurse * Common sign of countertransference in nurse is over-identification with the patient

countertransference

what are nurses values and beliefs?

Reflect own culture/subculture * Derived from range of choices * Chosen from a variety of influences and role models

Refers to the ability to recognize the nature of one’s attitudes, emotions, and behaviors

self-awareness

Self-reflection, prior to clinical experience in the psychiatric setting will enhance your personal and professional growth

introspection

what are the factors that help nurse-pt relationships?

Consistency * Pacing * Listening * Initial impressions * Promoting patient comfort & balancing control * Patient factors include trust & active participation

what are the factors the promote pt growth?

Genuineness * Empathy (not sympathy) – (*remember the Brené Brown video) * Positive regard * Attitudes * Actions * Attending * Suspending value judgements * Helping patients develop resources

Employ purposeful use of self * Use nursing, psychosocial, and neurobiological theories and research * Work with people throughout the life span * Educated and registered to practice from a variety of educational and professional associations * Employed in a variety of settings * Utilize therapeutic communication techniques in interactions and interviews with patients * Monitor for side effects of psychotherapeutic medications

psychiatric mental health nurses

what is the nursing process?

assessment nursing diagnosis outcome identification planning interventions implementation evaluation

Screening and assessment tools * Disturbance of cognition * Disturbance of affect * Disturbance of interpersonal functioning * Dysfunctional behavior (lack of impulse control) * Trans-cultural considerations

assessment

Disturbed Thought Processes * Anxiety * Hopelessness * Ineffective Coping * Impaired Social Interaction * Impaired Verbal Communication * Risk for Other-Directed Violence * Disturbed Sleep Pattern * Social Isolation

nursing diagnosis

Members of each discipline are responsible for gathering data and participating in the planning of care * Patient care plans provides a guideline for patients’ care during hospital stay

multidisciplinary treatment team

Surroundings and physical environment * Managing behavioural crises, safety, & suicide risk

therapeutic milieu

what are the components of nursing care?

Admission assessment * Physical health assessment * Milieu management * Structured group activities * Documentation * Medication administration 75 * Crisis management * Discharge management * Medication management * Medical emergencies * Preparation for discharge to community

Participating in community preparedness * Response to immediate needs and crisis management * Recovery to provide mental health first aid and reestablish treatment and initiate opportunities for listening, compassion, treatment, and referral

roles

what are the prevention strategies?

primary prevention secondary prevention tertiary prevention

Adult and youth recreational or cultural centres * Schools and day care centres * Churches, temples, synagogues, mosques * Disaster preparedness teams

primary prevention

Crisis centres, telephone crisis care, and shelters * Correctional community facilities * Youth residential treatment centres * Partial hospitalization programs * Chemical dependency programs * Nursing homes and hospices * Industry/work sites * Early intervention psychosis programs * Street outreach

secondary prevention

Community mental health centres *Psychosocial rehabilitation programs

tertiary prevention

Acute care facilities, including psychiatric hospitals and sub acute units - considered the most restrictive clinical settings- * Medical-psychiatric unit; Transitional care hospital; Psychiatric hospitals; Forsenic hospital * Sub acute care units often located in LTC facilities * Day Treatment Hospitals: Extended outpatient clinic during the day and allows clients to return to families during evening, nights and weekends

inpatient care

24 hour emergency psychiatric care and crisis intervention * Screening for Involuntary admission to mental health facilities * Partial hospitalization and day treatment programs * Case management * Community based residential treatment programs * Aftercare and rehabilitation * Psychiatric home care

community mental health

Average client can be admitted for short term rehabilitation, behavior problems, chronic care issues or respite care

long-term care

what are types of community mental health services?

psychiatric emergency care day treatment programs residential treatment programs psychiatric home care aftercare and rehabilitation

A psychiatrist must certify that the client is homebound The client must have a DSM-5 psychiatric diagnosis that is acute or an acute exacerbation of a chronic illness The client must require the specialized knowledge, skills, and abilities of a psychiatric registered nurse

established by the health care financing admin

what is the foundation for community mental health?

A multidisciplinary team, consisting of psychiatrist, psychologist, social workers, nurses, and mental health counselors * Prevention of mental illness * Early detection and treatment * Comprehensive, multifaceted treatment program * Continuity of care * Group and family therapy * Environmental and social support, and intervention