Understanding Mental Health & Mental Health Nursing

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Mental Health

• Mental health involves realizing one's abilities, coping with stress, working productively, and contributing to the community, according to the WHO in 2020.
• Mental health is a state of emotional, psychological, and conceptual stability, with social wellness shown by satisfying relationships, coping, and self-concept.

Mental Health Nursing

• This specialized field focuses on caring for individuals with mental health disorders.
• Mental health nurses aim to help patients recover and improve Quality of Life.

Factors affecting mental health

• Individual factors include biologic makeup, autonomy, self-esteem, growth capacity, emotional resilience, reality orientation, belonging, coping, and stress management
• Interpersonal factors include effective communication, the ability to help others, intimacy, connectedness, and separateness.
• Social-cultural factors include a sense of community, access to resources, intolerance to violence, support for diversity, and a positive view of the world. Poverty negatively impacts social-cultural mental health.

Mental Illness

• Mental illness is defined as a health condition that alters thinking, feelings, or behavior causing distress and functional difficulty.
• The American Psychiatric Association defines mental illness as a clinically significant syndrome or pattern associated with present distress, disability, or risk of suffering, death, pain, or loss of freedom.

DSM(Diagnostic and Statistical Manual of Mental Disorders), 5th Edition

• A diagnostic tool used internationally by the APA that contains specific diagnostic criteria based on clinical experience and research.
• New additions include Internet Gaming Disorder

Roles of the Mental Health Nurse

• Stranger: Initially, the nurse and patient are strangers.
• Resource Person: Provides health information.
• Teacher: Facilitates patient growth and learning.
• Leader: Promotes patient participation.
• Surrogate: Assumes roles based on patient's transference.
• Counselor: Helps patients integrate feelings related to illness.
• Patient Advocate: Protects patient rights and responsibilities.
• Case Manager: Coordinates patient care.
• Researcher: Conducts studies related to mental health.

Functions of Mental Health Nurse

• Counseling: Utilizes interventions and communication, addresses problem-solving, stress management, and behavior modification.
• Milieu Therapy: Focuses on maintaining the therapeutic environment, teaching skills, promoting client communication, and role modeling.
• Self-Care Activities: Encourage independence, increase self-esteem, and improve functional health.
• Psychologic Interventions: Medication administration, teaching, and client observation.
• Health Teaching: Education about health.
• Case Management: Implementation and evaluation of client care plans.
• Health Promotion and Maintenance: Focuses on promoting and maintaining overall wellness.

Historical perspectives on treating mental illness - Ancient times

• Sickness was seen as displeasure of gods as punishment for wrongdoing
• Mental disorders were considered either demonic or divine with treatments reflecting this belief
• Trepanning, which drilled a hole allowing the spirit to escape was used.
• Aristotle said that water, blood, yellow bile and black bile controlled one's emotions and imbalances between the 4 caused mental illness
• In early Christian times those with mental illness were blamed on demons and priests performed exorcisms and if not effective those with mental illness were starved, imprisoned or whipped
• During the Renaissance, harmless mentally ill persons were left to wander while violent ones were imprisoned
• The Hospital of St. Mary of Bethlehem, was declared the first hospital for the insane in 1547.
• During those same times, those with mental illness were considered possessed and were punished or burned stakes

Historical perspectives on treating mental illness - Enlightenment Era

• Benjamin Rush theorized mental disease was caused by irritation of blood vessels in the brain and he was an advocator for bleeding, purging hot and cold water baths and mercury as treatment. He invented a tranquilizer chair and gyrator for psychiatric patients.
• Phillippe Pinel and William Tuke came up with the concept of asylum, in 1790's which sparked movement for moral treatment for those with mental illness
• Dorothea Dix, campaigned to reform the treatment for the insane, opening 32 state hospitals.

Historical perspectives on treating mental illness - Freud

• Sigmund Freud, Emil Kraepelin and Eugene Blueler pioneered the study of psychiatry starting in the 1800's
• Kraepelin categorized mental disorders based on symptoms.
• Bleuler coined the term Schizophrenia
• Freud viewed people in an objective way and believed the mind could be studied

Historical perspectives on treating mental illness - Psychopharmacology

• Chloropromazine (Thorazine), lithium developed in the 1950s and monoamine oxidase inhibitors (antidepressants) haloperidol (antipsychotic), tricyclic antidepressants and benzodiazepines (antianxiety) were introduced
• With drugs, agitation was reduced, psychotic thinking and depression was reduced and hospital stays shortened.

Historical perspectives on treating mental illness - Community Mental Health

• Shift from state hospitals to community facilities began in 1963, called denstitutionalization
• These centers offered emergency care, inpatient, screening and education.

Historical perspectives on treating mental illness - 21st Century

• There is a focus on more aggressive patients, and a cycle of quick release to community.
• Dual diagnosis is common and use of alcohol worsens symptoms.
• Many homeless people have a mental illness or drug abuse issues

Development of psychiatric nursing practice.

• Linda Richards regarded as first psychiatric nurse, advocating as good care for the mentally as the physically sick.
• Nurses first trained to care for the mentally ill at McLean Hospital in 1882, focusing on activity diet and hygiene.
• "A Mind That Found Itself" was printed by Clifford Beers in 1908 which sparked healthcare reform towards client advocacy
• Nursing Mental Disease, a psychiatric textbook, was written by Harriet Bailey in 1920.
• Medical-surgical skills became important for nurses due to insulin shock therapy, psychosurgery ECT treatments.
• Hildegard Peplau spoke of nurse-client relationships in 1952, and wrote on anxiety.
• In 1968, Nursing Therapy by Mellow focused on client-centered strengths and needs of those with mental illness.
• Standards for psychiatric nursing came from the ANA in 1973.

Sigmund Freud's Psychosexual Theory

• Human behavior is motivated by sexual impulses/desires.
• Childhood trauma causes unusual behaviour
• Freud proposed the concept of ID(Pleasure/Impulses), EGO(Adaptive) and SUPEREGO(Moral).
• Anxiety results from tension from balancing ego and superego.
• Human personality consists of: Conscious, Preconscious, Unconscious.
• Main context of the theory is libido driving human behavior
• Each stage focuses on an erogenous zone and developmental milestones such as Id, toilet training and supereg
  • Oral - Sucking and biting Id development
  • Anal - Toilet training, Voluntary Sphicter
  • Phallic Oedipal Complex, Penis Envy
  • Latency-Resolution of Oedipal Development
  • Genital - Puberty and Orgasm

Erickson's Psychosocial stages of development

• Includes eight stages, with a completion of a life task, for well being and mental health by achieving life's virtues.
• Trust vs Mistrust: Viewing the world as safe and reliable, relationships as stable, nurturing and dependable
• Autonomy vs Shame and Doubt: Achieving a sense of control and free will
• Initiative vs Guilt: Beginning development of a conscience, learning to manage conflicts and anxiety
• Industry vs Inferiority: Emerging confidence in own abilities, taking pleasure in accomplishments
• Identity vs Role Confusion: Formulating a sense of self and belonging
• Intimacy vs Isolation: Forming adult loving relationship and meaningful attachments to others
• Generativity vs Stagnation: Being creative and productive, establishing the next generation
• Ego Integrity vs Despair: Accepting responsibility for one's actions done throughout life

John Piaget's Cognitive Stages of Development

• Human intelligence rises through stages, and each stage has a higher functions than the previous stages
• Biologic changes can result in cognitive development
• Aides nurses working with children to better understand them.
• Each stage focuses on : Senses, language, logic and the the achievement of cognitive maturity
  • Sensorimotor, Preoperational, Concrete Operations, Formal Operations

Abraham Maslow's Hierarchy of needs

• A pyramid that describes the basic needs people have
• Basic needs must be met in order to progress upwards
• Physiological: Needs like air , water, food, and clothing
• Safety: Security, protection, freedom from fear
• Social: Love , affection , belongingness
• Esteem: Self Worth, Accomplishment, and Confidence
• Self Actualization: Fulfilling Potential

Therapeutic Use of Self

• Therapeutic use of self involves planned insight, and judgment as part of the therapeutic process.
• Begins with developing self-awareness to promote growth change and healing
• Nurses must understand themselves with key self awareness, forgetting their values and culture.
• Respond to the way a client needs and not in the way nurses think she needs it.

Professional Boundaries in Nursing

• Nurse take responsibility for meeting clients therapeutic needs.
• Nurses maintains these bounaderies regardless of the clients requests

Key trust builders in Components of a Therapeutic Relationship

• Trust builds when the client is confident in the nurse
• Congruence where when the nurses or clients match what they say with their actions and behaviours.

Empathy

• Empathy includes listening, and sensing when a client share is feelings, instead of sympathy

Positive Regard:

• Nurse appreciate the client as a unique, and worthwhile human being
• Positive Regard includes: giving full attention, and full respect and communication.

Therapeutic Use of self - Starting points

• The process of understanding ones own thoughts, values and feelings
• Abstract standards that give person sense of right and wrong.
• Beliefs including having positive or negative attitudes around which a person organizes knowledge of the world.

Therapeutic Communication Techniques

• Nurse/patient relationship should be planned to meet the needs of patients.
• Therapeutic comms is effective for the exchange of information

Establish goals of therapeutic communication.

• Identify the most important client concerns, and provide therapeutic nurse-client relationship
• Asses the clients perceptions of their problems, and provide self care skills
• Guide the client toward having and implement interventions and socially acceptable resolutions

Ensure effective therapeutic communication.

• Give the patient space and privacy (3-6 ft).
• Show touch and observe if the patient enjoys this.
• Concentrate on the patient by refraining refraining from mental activities, being active, and have active observation and watch speaker's nonverbal

Accept in therapeutic communication.

• Accept that you recognize the nurse has heard and followed a chain of thought
• Broad openings are for people who are hesitant about talking

Technique-related therapeutic communication

• A search for understanding, and meanings of the words to have a consensus
• Comparing experiences, and relationships, and remembering and recalling
• Help relieve tension by describing a perspective
• Have a plan to provide the client can what will do about similar situations

Explore technique-related therapeutic communication

• Help them examine more fully.
• General leads which are listening without talking away from the interaction
• Helps build trust by informing which are facts, while acting as a resource

Offer Self

• Can offer presence and interest and desire to understand