Mental Health Nursing: Chapters 4, 9, 11 & 12

• Study notes for Mental Health Nursing
• Covers Chapters 11 and 12
• Includes Chapter 4 on Stress and Defence Mechanisms
• Includes Chapter 9 on Stress Management

Defence Mechanisms: Adaptive vs Maladaptive Use

• Adaptive defence mechanisms are helpful

• Maladaptive defence mechanisms are unhelpful

• Altruism definition involves helping others to reduce personal anxiety

• A nurse volunteering after losing a family member in a fire exemplifies adaptive altruism

• Altruism is always adaptive, with no maladaptive examples

• Sublimation definition involves replacing unacceptable impulses with acceptable ones

• An example of adaptive sublimation is a person who channels anger into exercise

• Sublimation is always adaptive, with no maladaptive examples

• Suppression is voluntarily pushing away unpleasant thoughts

• Adaptive suppression is a student ignoring a breakup to focus on a test

• Maladaptive suppression is avoiding worrying about losing their job

• Repression is unconsciously forgetting distressing thoughts

• Adaptive repression is a person forgetting about a childhood bullying incident before giving a speech

• Maladaptive repression is continually avoiding going to the dentist due to past trauma

• Regression is returning to childlike behaviors

• Adaptive regression is a child temporarily wetting the bed after losing a pet

• Maladaptive regression is an adult throwing things when upset at work

• Displacement is redirecting emotions toward something else

• Adaptive displacement is a teenager punching a pillow after an argument

• Maladaptive displacement is a parent destroying their child's toy after losing a job

• Reaction Formation is overcompensating by behaving in the opposite way of one's true feelings

• Adaptive reaction formation is a person trying to quit smoking who warns others about its dangers

• Maladaptive reaction formation is a resentful caregiver becoming overprotective of an aging parent

• Undoing is making up for an unacceptable action

• Adaptive undoing is a teenager doing chores after arguing with a parent

• Maladaptive undoing is a partner buying flowers after an abusive incident

• Rationalization is justifying behaviors with logical-sounding reasons

• Adaptive rationalization is a rejected adolescent assuming their crush must be taken

• Maladaptive rationalization is a drunk driver claiming they only drove to avoid inconvenience

• Dissociation is disconnecting from reality to avoid stress

• Adaptive dissociation is a parent who tunes out distractions while driving

• Maladaptive dissociation is a sexual assault victim forgetting who they are

• Denial is refusing to accept reality

• Adaptive denial is when a person reacts with disbelief to a cancer diagnosis

• Maladaptive denial is a grieving parent insisting their deceased child is still alive

• Compensation is strengthening a skill to make up for a weakness

• Acting as a student who struggles academically and excels in sports is an example of adaptive compensation

• A shy person avoids social interactions by focusing on computers; this is maladaptive compensation

• Identification is adopting traits of another person or group

• A sick child pretending to be a nurse for their dolls is adaptive identification

• Maladaptive identification is the abuse of a child of abusive parents bullying

• Intellectualization is using logic instead of emotions to cope

• Adaptive intellectualization is a detective who focuses on facts rather than emotions

• Thinking about a terminally ill person focusing only on finances instead of grief: a maladaptive intellectualization

• Conversion is where stress manifests as physical symptoms

• There are no adaptive examples

• Maladaptive conversion is a person experiencing blindness after receiving bad news

• Splitting is viewing things as entirely good or bad

• There are no adaptive examples for splitting

• An example of maladaptive splitting is where a patient praises a nurse one day and ignores them the next

• Projection is attributing one's own negative thoughts onto others

• There are no adaptive examples of projection

• A cheating spouse accusing their partner of cheating is maladaptive projection

Anxiety Levels and Nursing Interventions

• Mild Anxiety involves a normal anxiety level that enhances perception, mild tension such as fidgeting or lip chewing

• Nursing interventions for mild anxiety feature active listening and asking open-ended questions

• Moderate Anxiety involves reduced perception, increased heart rate, headaches, and urinary urgency

• Nursing interventions for moderate anxiety include staying calm, using clear communication, and encouraging problem-solving

• Severe Anxiety features distorted perception, confusion, rapid speech, and hyperventilation

• Nursing interventions for severe anxiety include providing a quiet environment

• Panic Anxiety involves extreme fright, hallucinations, immobility, and disorganized speech

• Nursing interventions for panic anxiety include staying with the patient, speaking in a calm voice, as well as using simple directions, setting limits, and focusing on reality

Chapter 9 - Stress Management

• Stress is the brain's response to demands

• Fight is facing the stressor head-on as a response type to stress

• Flight is avoiding the stressor as a response type to stress

• Freeze is feeling stuck or unable to act as a response type to stress

• Fawn is submissively trying to please others as a response type to stress

• Acute Stress (short-term) will cause increased heart rate, insomnia, decreased appetite, and suppressed immunity

• Chronic Stress (long-term) will cause anxiety, weight changes, hypertension, fatigue, and increase risk for infections

Nursing Care: Stress Management Techniques

• Nursing care will require stress management techniques

• Cognitive Reframing requires restructuring negative thoughts into positive ones

• Adaptive thinking of a parent might be "I'm a terrible parent" -> "I've made mistakes but learned from them."

• Priority Restructuring involves adjusting priorities to reduce stress

• One can delegate tasks instead of handling everything alone

Primary Techniques

• Meditation focuses the mind for relaxation
• Guided Imagery uses visualization to create a sense of calm
• Breathing Exercises control breathing to lower stress
• Progressive Muscle Relaxation involves tensing and relaxing muscles to reduce tension
• Physical Exercise releases endorphins, reducing anxiety and stress

Additional Techniques

• Biofeedback uses devices to monitor physiological responses to stress
• Mindfulness encourages staying present and aware
• Assertiveness Training helps individuals express needs and set boundaries
• Journal Writing provides a therapeutic way to process stress

Other Individual Stress-Reduction Strategies

• You can engage in hobbies (e.g., music, fishing, pet therapy)
• Prioritize getting enough sleep and massage therapy

Nursing Assessment for Stress

• Protective Factors:
• Strong social support
• Religious/spiritual beliefs
• Optimism and humor
• Standardized Stress Screening Tools:
  • Holmes and Rahe Stress Scale measures life stressors
  • Perceived Stress Scale
  • Lazarus's Cognitive Appraisal assesses coping

Key Takeaways for the Exam

• Defense Mechanisms:
  • Understand which are adaptive
  • Understand which are maladaptive
  • Understand how they function
• Recognize the symptoms of anxiety levels
• Understand the appropriate nursing interventions for mild to panic-level anxiety
• Stress Management:
  • Be aware of various cognitive
  • Be aware of behavioral stress-reduction techniques
• Nursing Interventions:
  • Effective communication
  • Calming techniques provide patient education