Mental Health Nursing

Historical Beliefs Demonology requiring exorcism, beating, torture Middle Ages associated mental illness with

witchery Asylums emerged in the 1800s – institutionalized

Evolution of Nursing Linda Richards – First psychiatric nurse Est’b psychiatric hospitals and schools of nursing

(asylums)

Contemporary Approach Mid 1900s – shift to community care, psychiatric

nursing added to nursing curricula National Mental Health Act – post WWII

American Psychiatric Association A state of being that is relative rather than

absolute Shown by productive activities, fulfilling

relationships, ability to adapt to change and cope with adversity

Lisa Robinson (Psychiatric Nursing Expert) Dynamic state in which thought, feeling, and

behavior is age appropriate and congruent with local and cultural norms

American Psychiatric Association A clinically significant behavioral or

psychological pattern, associated with distress, disability, or risk of suffering

Not an expected cultural response to an event

Townsend Maladaptive responses to stressors, AEB

thoughts, feelings, behaviors that are not congruent with culture and interferes with functioning

Members of the community define norms Relatives typically determine

“normalcy”and define when state has changed

Class and Education Lower - high incidence; low recognition Higher - high recognition and self labeling

Gender Women are more likely to recognize symptoms

of MI and seek treatment

Stressor Any factor that causes emotional or physical

tension; may be a responsible factor in certain illnesses

Stress Response - General Adaptation Syndrome Alarm-Resistance-Exhaustion (review N101 lecture) Adaptation – responses preserve integrity and

equilibrium Maladaption – responses that result in disruption of

integrity and disequilibrium

Primary The person asks

themselves is this event:▪ Irrelevant – the

outcome is insignificant▪ Benign-positive - the

outcome is pleasurable▪ Stressful – the outcome

is harmful, threatening, challenging

▪ Stressful conclusion leads to secondary appraisal

Secondary The person assesses

their skills, resources, and knowledge to deal with the situation

Determines coping strategies available

Considers options

Predisposing Factors Genetic influences: temperament, family

history of mental illness, personality Past Experiences: learned patterns of

coping due to past experiences Existing Conditions: Current health

status, developmental maturity, financial and educational resources, support system

The use of coping strategies in response to stress Adaptive or Maladaptive

Specific Strategies Awareness - recognition Relaxation/Meditation Communication – talking it out; support systems Problem Solving – view situation objectively,

analyze, act, evaluate Alternative Resources▪ Pets/ music/ dance/ art/ exercise

Anxiety Vague apprehension associated with

feelings of uncertainty

Levels of anxiety▪ Mild – tension, prepares for action/response▪ Moderate –heightened tension; cognition

impaired and individual needs assistance▪ Severe – Difficulty functioning even simple tasks▪ Panic – terror, desperate, out of touch with

reality

Defense Mechanisms Protective devices used to alleviate anxiety▪ Compensation – covering up a weakness by

emphasizing something more desirable▪ Denial – refusal to acknowledge▪ Displacement – transfer of feelings from target to

another▪ Identification – increase self worth by acquiring

attributes of a positive role model▪ Intellectualization – avoid emotions by focusing

on analysis▪ Introjection – integration of others values into self▪ Isolation – separating the event and emotion

Defense Mechanisms con’t▪ Projection – attributing unacceptable self-feelings to

another▪ Rationalization – making excuses▪ Reaction – avoids thoughts, feelings by expressing

opposite▪ Repression – blocking unpleasant feelings▪ Sublimation – direct impulses into constructive

activities▪ Suppression – avoiding unpleasant thoughts, feelings▪ Undoing – symbolically cancels out an unpleasant

experience

Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition – Text Revision

This is a tool provides guidelines and diagnostics criteria for mental illness

It is a multi-axial system Axis 1: All psychiatric disorders except personality

d/o and MR Axis 2: Personality disorders and MR Axis 3: Medical conditions Axis 4: Environmental issues or psychosocial

problems that may impede treatment Axis 5: Global Functioning Scale – Townsend, page

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