Psychiatric Nursing: Advocacy and Caring

• Psychiatric nurses need complex communication skills and critical thinking to address multidimensional problems.
• Psychiatric nurses must help patients with medical and mental health issues, reflecting a holistic approach.
• Workloads have increased in psychiatric settings, similar to other specialties.
• Psychiatric nursing involves clinical practice, not just documentation.
• Psychosocial pain and suffering are as real as physical pain.

Advocacy in Nursing

• Nurses advocate for patients by defending their causes, especially when patients cannot advocate for themselves.
• Advocacy includes helping patients understand their rights and make decisions.
• Community-scale advocacy involves political activity and public speaking to improve the human condition.

Caring in Nursing

• Caring involves empathetic understanding and competence.
• It transforms pain and suffering into a shared experience, reducing isolation.
• Simply asking about preferences or explaining treatment plans is not necessarily caring.

Mental Illness Indicators

• Mood alterations specifically a consistently sad, discouraged, and hopeless mood can indicate mental illness.
• Responding to group norms, performing tasks within abilities, and distinguishing between reality and pretense are signs of mental health

Achieving Mental Health

• A patient who sees themselves as capable of meeting demands and approaching ideals has achieved mentally healthy behavior.

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

• Essential for determining the diagnostic criteria for mental disorders.

Multiaxial Assessment (DSM-IV-TR)

• DSM-IV-TR profiles psychiatric diagnoses on five axes to define specific aspects of the diagnosis.
• Axis I identifies major clinical disorders.
• Axis II details personality and developmental disorders.
• Axis III identifies general medical conditions.
• Axis IV details psychosocial and environmental problems.
• Axis V rates the Global Assessment of Functioning,
• It requires assessment encompassing medical conditions, psychosocial issues, and overall functioning.

Stigma and Mental Illness

• Stigma involves stereotypical, negative beliefs that lead to discrimination.
• Mental illness has multiple causes, including stress, brain changes, and genetics.

NANDA and NIC

• NANDA relates to clinical judgment as NIC relates to nursing actions.

Mental Health Continuum

• Mental health means a person is happy, has an adequate self-concept, is reality oriented, works effectively, and has control over their behavior.
• Mental health does not mean being happy all the time

Nursing Assessment

• It is helpful to refer to Axis IV of the DSM-IV-TR to gain another source of information for the nurse.
• Do not persistently question the patient as it may cause them to withdraw.
• Do not violate patient's privacy rights by asking their roomate.

DSM-5 Classification

• Classifies disorders people have rather than classifying people themselves.
• Refers to individuals "with a disorder," not labeling them.

Prevalence of Mental Disorders

• Alzheimer's disease has a high prevalence, especially in older adults.
• Schizophrenia and bipolar disorder have lower prevalence rates.

Culture and Mental Illness

• Hearing voices may be associated with mental illness, but in some cultures, it is a desirable religious experience.
• Varying cultural norms make accurate diagnosis difficult.

Mental Health and Relationships

• Mentally healthy individuals have stable, satisfying, and socially integrated relationships.

Global Assessment of Functioning (GAF)

• A patient unable to maintain hygiene, oral intake, or verbal communication has a low GAF score.

Culture and Patient Advocacy

• A nurse understanding cultural influences on symptoms can better advocate for patients.

Types of Epidemiology

• Clinical epidemiology studies what happens to people with illnesses seen in clinical care.
• Prevalence refers to numbers of new cases.
• Descriptive epidemiology estimates rates of disorders in a population.
• Experimental epidemiology tests assumptions between risk factors and disorders.

Causes of Mental Disorders

• Many disabling mental disorders have strong biological influences, not just psychological ones.

Self-Concept

• A poorly developed self-concept is evident when a person needs multiple explanations of new tasks and relies on parents for decisions as an adult.
• Interventions can aim to improve this.

Physical Health and Treatment

• Axis III of the DSM indicates relevant general medical conditions that may affect treatment.
• Axis II refers to personality disorders.
• Axis IV reports psychosocial/environmental problems.
• Axis V is the global assessment of functioning.

Differences Between DSM-5 and Nursing Diagnosis

• The medical diagnosis (DSM-5) addresses diseases, causes, and cures.
• Nursing diagnosis focuses on patient responses to stress and interventions.
• Both tools consider culture.
• The DSM-5 diagnosis guides medical treatment, whereas the nursing diagnosis provides a framework for identifying interventions.

Evidence-Based Practice

• Use research, maintain respect, and avoid generalizations.
• Evidence-based practice uses research findings and standards of care.
• Nurses should continuously integrate new research findings and respect each patient as an individual to provide the most effective nursing care.

Psychosocial Factors Influencing Depression

• A person's depression may be influenced by hostility, over involvement, religious influence, and life experiences.
• Family influence: A hostile, overinvolved family is critical of the patient.
• Genetic factors are not psychosocial factors.
• Treatment with antidepressant medication is an example of a biological influence.

Aspects of Mental Health

• The aspects of mental health of greatest concern are the patient's appraisal of and control over behavior.
• Inaccurate appraisal of reality includes auditory hallucinations and delusions.
• Evidence of lacking self-concept includes delusions of grandeur.

Mentally Healthy Perspective

• Taking responsibility is helpful.
• "I will make some changes in my behavior for the good of the family."

The importance of DSM-5

• DSM-5 details the description of diagnostic criteria for anxiety disorders.

How resilience is demonstrated.

• Resilience id demonstrated when the patient takes a temporary job to maintain financial stability after loss of a permanent job.
• Resilience is the ability to adapt and helps people facing tragedy, loss, trauma and severe stress.

Culture-Bound Syndromes

• Are disorders found only in specific cultures.
• Running amok is when a person in certain cultures (particularly Malaysia) suddenly engages in a frenzied, aggressive behavior.

Incidence

• Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of time.

QSEN

• QSEN recognizes that care is centered on the patient.

Cultural Considerations for Mental Health

• An Asian client's cultural view regarding suicide is an important factor to consider for differentiation.

Planning Care for Mentally Ill Clients

• Interventions should be based on the concept that the client has areas of strength on which to build.

Deviant Behavior vs. Mental Illness

• Deviation from social norms does not always indicate mental illness. The assessment data supports that the 14 year old client is displaying deviant behavior.

Assesing Mental Health

• The mental health nurse can assess the patient's appraisal of reality by listening to their frightening and delusional statements.

Clinical Treatment

• Studying outcomes for patients treated with ECT involves clinical branch of epidemiology.

Cross-Cultural Mental Illnesses

• Recognize across cultures include schizophrenia and bipolar disorder.

Prevalence Rate

• The prevalence rate for major depressive disorder is greater than the prevalence rate for generalized anxiety.

Mental Disorders

• Culture can affect symptoms of mental disorders.

Nurses Role in Psychiatric care

• The best way for a paitent to describe what a "Psychiatric Mental Health Nurse is when seeking treatment is, "We have the specialized skills needed to care for those with mental illnesses."

What causes most disabling mental disorders?

• The most disabling mental disorders are most often the result of biological influences.

Description of DSM-5

• DSM-5 is a medical psychiatric assessment system.

Epidemiology Definition

• Epidemiology - Is the quantitative study of the distribution of mental disorders in human populations.

Psychiatric nurses require strong communication and critical thinking skills to handle complex patient needs, addressing both medical and mental health issues holistically. Advocacy in nursing involves defending patient rights and helping them make informed decisions. Caring includes empathy and competence, transforming suffering into shared experiences.