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• Mental Health Nursing N201 is a part of the Practical Nursing Program in the Winter Semester of 2025.
• The course facilitator is Glenda Manning, who can be reached at 777-8165 or [email protected], and is available by appointment via email for meetings on Brightspace.
• Land Acknowledgement: Respectfully acknowledge the territory as the ancestral homelands of the Beothuk, the island of Newfoundland, the Mi'kmaq, the Inuit of Nunatsiavut and NunatuKavut, and the Innu of Nitassinan, and their ancestors.

Course Description - N201

• This course covers N201 Mental Health.
• The course objectives, outline, and PPT (key points) are available on D2L.
• Lectures are 90 minutes long and held on Mondays, Tuesdays, and Wednesdays.
• Required textbook: Varcarolis's Canadian Psychiatric Mental Health Nursing: A Clinical Approach (3rd Canadian Ed.) by Pollard, C.J. & Jakubec, S.L. (2023).
• There are required readings, and deferred exams for N201.

Course Evaluative Methodologies

• Written Assignment: 20% of the final grade, due February 3, 2025, with the option to select a partner.
• Term Test #1: 25% of the final grade, on February 11, 2025, consisting of 50 multiple-choice questions covering objectives 1-7 & 12.
• Psychotropic Medication Quiz: 15% of the final grade, on March 10, 2025, a 30-minute quiz with 30 multiple-choice questions.
• Final Exam: 40% of the final grade, in April 2025, consisting of 100 multiple-choice questions covering all objectives.
• There is mandatory attendance and classroom etiquette is expected.
• Exam content includes material from lectures, readings (text and required), and clinical practice.
• PPT provides key points of lectures, not a detailed presentation.

Course Overview

• Students will explore theories and models relevant to mental health and mental illness.
• Apply knowledge of contributing factors to mental health/illness and substance misuse.
• Gain an understanding and knowledge of symptoms, treatments, and care for individuals experiencing mental illness and addictions.
• Examine the role of the practical nurse in various MH settings.
• Develop strategies to promote therapeutic, diverse, and caring relationships via collaboration and communication with the health care team in various settings.
• Integrate and discuss the nursing process and gain a greater understanding of the importance of being mentally healthy.

Course Objectives

• Discuss factors relevant to mental health and mental illness.
• Discuss the mental status examination and its relevance to practice.
• Discuss the ethical, legal, and cultural considerations pertaining to the practice of psychiatric mental health nursing.
• Discuss suicide and non-suicidal self-injury.
• Discuss personality disorders.
• Discuss the concepts of stress and crisis.
• Discuss anxiety, anxiety-related disorders, and somatic symptom disorders.
• Discuss depressive and bipolar disorders.
• Discuss schizophrenia spectrum and other psychotic disorders.
• Discuss eating disorders and disordered eating.
• Discuss substance-related disorders and addictions.
• Discuss childhood and adolescent mental health disorders.
• Discuss anger, aggression, violence, abuse, and sexual assault.

Objective 1: Introduction to Mental Health

• Discuss factors relevant to mental health and mental illness.
  • Define the concepts of mental health and mental illness(MI).
  • Discuss attributes of positive mental health.
  • Discuss influences/factors that impact mental health.
• Explain Canada's Mental Health Strategy.
  • Discuss the trends and issues impacting mental health from national and global perspectives.
  • Identify the determinants of health in relation to mental health
• Discuss the development of psychiatric mental health nursing.
• Discuss applicable theories that guide psychiatric mental health nursing.
• Recall factors that foster a therapeutic nurse-client relationship and influence the communication process.
• Explain the continuum of psychiatric mental health approaches.
  • Discuss the value of a collaborative team approach in mental health practice.
• Discuss the concept of recovery and its relevance to mental health care.

Mental Health Defined

• Mental health constitutes a state of well-being where individuals realize potential, cope with normal stresses, work productively, and contribute to the community (World Health Organization, 2016a).
• Everyone possesses mental health, which should be distinguished from mental illness.
• Mental illnesses are proper diagnoses such as anxiety, bipolar disorder, and depression.
• Key aspects of mental health include hope for recovery and the capacity to be responsible, make decisions, problem-solve, and be self-directed.

Attributes of Mental Health

• Maintain a healthy self-concept and self-value.
• Negotiate each developmental task
• Attain self-defined spirituality
• Accurately appraise reality
• Be able to love and experience joy
• Be able to deal with conflicting emotions
• Be able to live without (undue) fear, guilt, or anxiety
• Be able to take responsibility for one's own actions
• Be able to control one's own behaviour
• Relate to others and Form relationships. Have close, loving, adaptive relationships
• Experience empathy toward others
• Manage interpersonal conflict constructively
• Think clearly
• Problem solve
• Use good judgement
• Reason logically
• Reach insightful conclusions
• Be creative

Influences on Mental Health

• Determinants of mental health include environmental and inherited factors, available support systems, family and community influences, health practices and beliefs, and spirituality and religious influences.
• Negative influences encompasses psychosocial stressors, poverty, impaired support, demographic and geographic factors, and cultural and subcultural beliefs influence mental health.

Concepts of Mental Health and Mental Illness

• Involves the Epp Report (1988).
• Continua from Epp Report (See Fig.1-2, p.4).
• Mental Health Strategic Framework—Mental Health Commission of Canada (2017).
• Review Box 1-2—Changing Directions, Changing Lives: The Mental Health Strategy for Canada.

Contributing Factors

• Resilience helps persons recognize stressors and negative emotions, deal with them, and learn from the experience (p.5).
• Culture lacks a standard measure regarding mental health as it is culturally defined and determined by societal norms.
• Varying viewpoints exist globally on mental illness.

Trends and Issues in Mental Health

• Include the effects of pandemics (social isolation, masking, virtual technology).
• Focus on Indigenous MH and well-being, the opioid crisis, and violence and trauma.
• Trends encompass political, social, and economic unrest globally and migration.
• Trends include climate change and Access to services (Increased self harm and suicide rates)
• Include stigma, discrimination and racism.

Mental Illness (Ch.1)

• Alterations in cognition, mood, or behavior are coupled with significant stress and impaired functioning (Pollard & Jakebuc, 2023).
• Impairment in functioning may be due to a social,psychological, genetic, physical/chemical, or biologic disturbance.

Mental Illness/Disorders (MI)

• Classification of MI comes from the Diagnostic and Statistical Manual of Mental Disorders (DSM); 5th ed.
• Includes:
  • Mood Disorders: Depression & bipolar
  • Suicide
  • Anxiety Disorders
  • Schizophrenia (Psychotic disorders)
  • Eating Disorders
  • Substance Misuse/Addictions
  • Child/ Adolescent Mental Disorders

Stigma

• Negative attitudes or behaviors are directed towards an individual or group based on a belief that they possess negative traits.
• These attitudes can motivate the public to fear, reject, avoid, and discriminate against people with a mental illness.
• Stigma in health care towards persons living with a mental illness can lead to inadequate care and services and a failure to understand the person's issues/concerns (Pollard & Jakubec, 2023, p. 589).
• Focus on self-stigma, where a person believes they are weak or unworthy due to their illness.

Impact of Language

• Emphasizes using respectful language when discussing mental health to avoid stigmatizing.
• For instance, use "Person lives with/are experiences depression" instead of "Person suffers with depression".

Psychiatric-Mental Health Nursing (Chapters 2 & 3)

• A specialized area of nursing practice.
• It Involves the care and treatment of human responses to actual or potential mental health problems.
• Employs theories of human behavior as its science
• Follows Canadian Federation of Mental Health Nurses (CFMHN) standards.

Future Challenges and Roles for PMHN

• Topics include the aging population and cultural diversity.
• Also addresses decolonization and expanding technology (virtual health care); and inequities.

Determinants of Health (p.12)

• Determinants include income and social status.
• This also includes employment/working conditions, education and literacy, and childhood experiences.
• Encompasses physical environments, social supports and coping skills, and healthy behaviors.
• Encompasses access to health services, and biology and genetic endowment.
• Encompasses gender and culture.

Theories

• Theories are hypotheses or explanations intended to explain something.
• Various theories are used in MH to provide a means to understand problems and issues.
• Include Psychoanalytical (Freud), Developmental (Piaget, Erickson), Behavioral (Skinner, Pavlov), Humanistic (Maslow), Interpersonal (Peplau, Sullivan), Cognitive (Beck), Biological (Psychopharmacology), and Milieu Therapy.

Defense Mechanisms (p.42)

• The ego develops defense mechanisms that ward off anxiety by preventing conscious awareness of a threat.
• They help preserve emotional stability.
• Overuse can lead to unhealthy behaviors.

Transference & Countertransference (p.43)

• Unconscious transfer of a personal situation to another.
• Example: a client says to a nurse, "Your voice sounds like my mother who abused me".
• Example: a nurse says to a client, "You remind me so much of my son".

Interpersonal Theories and Therapies

• Sullivan -Interpersonal Interactions.
• Peplau (Interpersonal relations)- believed illness offered an opportunity for learning, growth and improved coping skills & nurses play a key role in growth via the nurse-client relationship.
• Peplau's theory forms the foundation for psychiatric mental health nursing, and she is considered the Mother of Psychiatric nursing.

Cognitive Behavior Theory - Beck

• How people feel and behave is related to and greatly influenced by their thinking.
• Actions result from distorted perceptions & thoughts that can be changed.
• Aims to get clients to view their thoughts in a different perspective that impacts their well-being
• Commonly used for people with anxiety or depression

Biological Theories and Therapies

• Involves Psychopharmacology (mainly medications).
• Biological Model focuses on illness and using physical interventions like medications.
• Also employs Milieu therapy (a living, learning, and working environment).

Structure(Brain) Functions and Dysfunctions

• Frontal lobe:
  • Function: Personality, attention, Problem solving, emotional controls, organization, motivation.
  • Dysfunction: Inflexible thinking, personality changes difficulty problem solving, emotional dysregulation.
• Temporal lobe:
  • Function: Hearing, memory, sequencing, learning, emotions.
  • Dysfunction: Difficulty understanding, STM loss,, aggressive, irritable
• Parietal lobe:
  • Function: Attention for learning
  • Dysfunction: Dyslexia, poor coordination, poor reading/writing/math
• Occipital lobe:
  • Function: Vision, visual perception
  • Dysfunction: Hallucinations, visual distortions, problems reading & writing
• Cerebelum:
  • Function: Balance, coordination, posture.
  • Dysfunction: Grasping, poor fine motor skills Brain Stem:
  • Function: -
  • Dysfunction: Sleep/arousal problems, nausea, vertigo, problems with attention

Neurotransmitters and their Roles:

• Serotonin: Regulates mood and impulsivity; decreased in depression, increased in mania.
• Dopamine: Involved in regulating movements, rewards, punishment, pleasure, and energy; Increased in schizophrenia, decreased in Parkinson Dx.
• Norepinephrine: Involved in arousal and alertness, feelings of pleasure; Increased in mania, decreased in depression.
• Gamma aminobutyric Acid (GABA): Inhibits arousal, impulsivity, and judgment; decreased in anxiety disorders.
• Acetylcholine: Inhibits involvement in movement, memory, motivation & sleep; decreased in Alzheimer's dx.

Nurse - Client Relationship

• Nurse -Client Relationship; important components include, Therapeutic use of self, Social relationships.
• Involves therapeutic relationships and professional boundaries.
• Review Nursing Boundary Index Self Check.
• Nursing Process (aligns with Standards of Practice and Code of Ethics).
• Values, beliefs.
• Self- awareness.
• Peplau's Model, and review phases of the nurse -client relationship.

Communication (Ch.10)

• Emphasis on therapeutic communication, verbal and non-verbal communication, and the communication process. Factors influence/affect communication.
• Review therapeutic communication techniques.

Continuum of Care Levels

• The levels (Most acute treatment, intensive outpatient treatment, transitional outpatient treatment, and Ongoing outpatient treatment). are 3 levels of care in the continuum:
  • Primary (provide information & teaching)
  • Secondary (early detection & Rx)
  • Tertiary (Rx of psychiatric symptoms & address residual concerns).
• Implementing Levels of Prevention (Pollard & Jakubec, pp. 376-381) as it applies to substance-related disorders.

Assertive Community Treatment (ACT/FACT) (p.31, p.578)

• Involves intensive case management with creative problem-solving and interventions.
• ACT- Considers that individuals need support and resources after 1700h.
• Team on call 24h daily.
• Inter-professional (Case manager); LPNs play major role.
• The length of Rx- could possibly be years.
• Flexible Assertive Community Treatment (FACT).

Mental Health Treatment Team

• Involves a nursing approach and psychiatrists.
• Includes collaborative approaches with psychology, the medical team, and social work; as well as, pharmacy, occupational therapy, recreational therapy, a dietician, music therapy, and personal care attendants.

Nursing Care (p.36)

• Consists of Establishing rapport, Assessment.
• Other nursing care includes, Milieu management, Group activities.
• Also includes, Med administration, Documentation and Crisis intervention.

Recovery

• Emphasizes a person's capacity to have hope, work, live, participate in a community, and lead a meaningful life.
• Demonstrates there is hope for every person diagnosed with a mental illness to have recovery; a recovery which is unique for every individual.
• Having a positive quality of life is essential to recovery.

Recovery Model (p.573)

• A patient-centered approach, which emphasizes hope, living a productive life, and eventual recovery.
• Health care providers assist and support the patient to achieve the highest quality of life possible.
• It is empowering and hopeful and encourages a great degree of patient independence and self-determination whereby the patient can choose and lead a productive and meaningful life (Sanchez, 2020).

Summary

• Concepts of mental health and mental illness.
• Factors influencing and impacting MH.
• The impact of MI on individuals, families, and communities.
• Psychiatric Mental Health Nursing.
• Theories and therapies relevant to nursing.
• Significance of the nurse client relation and communication.
• Team approach and practice areas.
• Levels of prevention.
• Recovery.
• The Mental Health approach is aimed at community-based care.
• Focus is moving away from the stigmatizing approach of long-term institutionalization.