Mental Health Nursing Principles

Mental Health Concepts

• Mental health is dynamic and fluctuates along a continuum, and mentally healthy individuals are able to enjoy life's activities, adapt to changes, set realistic goals, and maintain interpersonal relationships.
• Factors affecting mental health include inherited characteristics, childhood nurturing, and life's circumstances, which can have positive or negative influences on an individual's response to daily stressors.
• Mental illness or disorder is a manifestation of dysfunction (behavioral, psychological, and biological), and changes in society and the economy have altered the status and situation of many individuals.

History of Mental Health Care

• In ancient times, people believed that mental illness was caused by evil spirits, and shamans or medicine men used magical treatments to remove these spirits.
• In the Greco-Roman era, the Greeks introduced the idea of explaining mental illness through observation of behavior, and Hippocrates viewed mental illness as an imbalance of humors.
• During medieval times, the church believed that mental illness was punishment for sins, and treatments included exorcisms, physical punishment, and imprisonment.
• In the 16th century, the first English institution for the mentally ill was founded, and the term "bedlam" originated from the hospital's nickname.
• During the Renaissance and the Reformation, little changed in the treatment of mental illness, but in the 17th and 18th centuries, psychiatry became a separate branch of medicine, and Dr. Philippe Pinel and Dr. William Tukes introduced humane care and classification of illnesses.
• In the United States, Dr. Benjamin Rush established the Pennsylvania Hospital for the treatment of the mentally ill, and Dorothea Dix advocated for the care of the mentally ill and led to the establishment of mental hospitals.

Development of Mental Health Care

• In the 20th century, the reform of mental health care began, and the Committee for Mental Hygiene was formed to focus on prevention and removal of the stigma of mental illness.
• Sigmund Freud introduced his theories and treatment for mental illnesses, and psychotherapeutic drugs were introduced in the 1950s.
• The government started the movement of deinstitutionalization, and community treatment became a goal, with the aim of returning individuals to their home environment and providing a support system.
• In the 1970s and 1980s, legislatures brought about further changes in mental health treatment, and the President's Commission on Mental Health was established to assess mental health care needs.

Basic Concepts Related to Mental Health

• Nursing is a person-oriented profession, and every interaction with a patient affords an opportunity for assessment of the patient's emotional state.
• The nurse has the power and responsibility to create an environment that allows the patient to have a positive experience.
• Most people have an innate ability to heal themselves, and the nurse can help the patient use this inner healing capacity through nursing interventions.

Mental Health Continuum

• Mental health and mental illness are the opposite ends of a mental health continuum, and functioning is normal on the healthy end of the continuum.
• The midpoint on the continuum represents normal mental health, and the influences of daily stressors, although affecting the mentally healthy individual, do not normally disrupt mental health.
• Loss of contact with reality can result when an individual is at the illness end of the continuum.

Personality and Self-Concept

• Personality refers to the relatively consistent set of attitudes and behaviors particular to an individual, and it consists of unique patterns of mental, emotional, and behavioral traits.
• Personality development comes under the influence of genetics and interactions with the environment, and it may be viewed as the total of internal and external patterns of adjustment to life.
• Erik Erikson provided a framework for understanding personality development in terms of task mastery, and Sigmund Freud described personality development as having three parts: id, ego, and superego.### Self-Esteem and Self-Concept
• Self-esteem is an individual's assessment of their personal worth, comprising thoughts and feelings about themselves.
• Self-concept is a broader term, encompassing all perceptions, values, behaviors, and interactions, and serving as a frame of reference for all experiences.

Stress

• Stress is a nonspecific response to any demand made on the body, which can be pleasant or unpleasant.
• Stressors can be physical, social, economic, chemical, spiritual, or developmental, and can be combinations of these.
• An individual's response to stress is often a learned or conditioned behavior.
• Stress is highly subjective and can have both positive and negative effects.

Anxiety

• Anxiety is a vague feeling of apprehension that results from a perceived threat to the self.
• Anxiety is a universal emotion and a response to stressful events.
• Anxiety can be described in terms of levels, with higher levels immobilizing coping skills and resulting in emotional chaos.
• Signs of higher levels of anxiety include vocal changes, rapid speech, increased pulse, respirations, and blood pressure, tremors, restlessness, and others.

Motivation

• Motivation is the inner drive to complete a task or reach a goal, generated by anticipation of reward or punishment.
• Motivation is an important aspect in treating emotional problems, and can help patients through the stages of recovery.

Frustration

• Frustration is the emotional response to anything that interferes with goal-directed activity.
• Frustration can lead to anxiety when adaptive behavior fails.

Conflict

• Conflict is a struggle, usually mental, resulting from the simultaneous presence of opposing or incompatible thoughts, ideas, goals, or emotional forces.
• Conflict can lead to anxiety and can be resolved easily or lead to serious levels of anxiety.

Adaptation and Coping

• Adaptation refers to the ability to adjust to changing life situations using various strategies.
• Coping responses are used to reduce anxiety brought on by stress, and can include conscious and unconscious behaviors.
• Defense mechanisms are unconscious, intrapsychic reactions that offer protection to the self from stressful situations.

Illness and Mental Health

• Illness can affect mental health by reducing control and creating instability, leading to anxiety.
• Hospitalization can exchange familiarity with unfamiliarity, leading to anxiety and emotional upheaval.
• Nurses play a crucial role in addressing the mental health needs of patients, including providing effective patient education and support.

Crisis

• A crisis is an unstable period in a person's life, characterized by an inability to adapt to change from a precipitating event.

• Successful management of a crisis period is needed to prevent disorganization within the individual or family unit.

• Cultural and ethnic backgrounds affect the patient's and family's behavior during illness.### Crisis and Illness

• Family members may withdraw from an ill person or the ill person may isolate themselves from the family, presenting an opportunity for personal growth and strength.

• Phases of crisis are similar to stages in grief and dying, including:

  • Initial phase: confusion, disbelief, and high anxiety
  • Denial phase: grasping of the conviction that everything will be all right
  • Reality phase: expression of anger and remorse
  • Sadness and crying phase: acknowledgment and expression of loss
  • Reconciliation phase: acceptance of the new reality and adaptation

Nursing Intervention in Crisis

• Help individuals or families get through a crisis by providing accurate information and empathic gestures.
• Identify family supports and adequate coping mechanisms to recognize family communication patterns.
• Active listening, restating facts, and using therapeutic communication techniques can help address problems constructively.
• Offer flexibility in visiting hours to reduce frustration of separation.
• Crisis often resolves over a 4-6 week period, resulting in the development of coping mechanisms and redefinition of goals and roles in life.

Crisis Intervention

• Goals:
  • Decrease emotional stress and protect the victim
  • Assist the victim in organizing and mobilizing resources
  • Return to pre-crisis status or a higher functional level
• Steps:
  1. Assess the situation and individual involved in the crisis
  2. Determine possible interventions with input from relevant parties
  3. Implement the intervention plan

Assessment of Emotional Status

• General appearance: dress, makeup, and hygiene
• General behavior: activity level, posture, gait, and response to examination
• Speech pattern: rate, tone, loudness, and quantity content
• Content of thought: reality-oriented, delusional, hallucinations, or non-reality-based thinking
• Mood and affect: overall feeling state and affect
• Sensorial function: orientation, memory, attention, and abstract thinking ability
• Insight and judgment: understanding of the situation and willingness to take action
• Potential for danger: potential for violence or self-harm, degree of impulse control, and history of violence or aggression