Mental Health Nursing N201 PDF

Mental Health Nursing N201 Practical Nursing Program Winter Semester 2025 1 Course Facilitator Glenda Manning Office: 224 Telephone: 777-816...

Mental Health Nursing N201 Practical Nursing Program Winter Semester 2025 1 Course Facilitator Glenda Manning Office: 224 Telephone: 777-8165 [email protected] Office Hours: By appointment Please send me an email to arrange meeting on Brightspace 2 Land Acknowledgement We respectfully acknowledge the territory in which we gather as the ancestral homelands of the Beothuk, and the island of Newfoundland as the ancestral homelands of the Mi’kmaq and Beothuk. We would also like to recognize the Inuit of Nunatsiavut and NunatuKavut and the Innu of Nitassinan, and their ancestors, as the original people of Labrador. We strive for respectful relationships with all the peoples of this province as we search for collective healing and true reconciliation and honor this beautiful land together. 3 1  Course Description-N201 N201 Mental Health Course Objectives/Outline & PPT (key points)- D2L 90 min. Lectures : Monday, Tuesdays & Wednesday ** Required textbook: Pollard, C.J. & Jakubec, S.L. (2023).Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. (3rd Canadian Ed.).Elsevier Required readings* (Deferred Exam-N201)* 4 Course Evaluative Methodologies Method of Value Date Format evaluation Written 20% February Written assignment 3,2025 Assignment (Select your partner) Term Test#1 25% Feb. 11, 50 multiple choice 2025 Questions feb Objectives 1-7 12 Psychotropic 15% March 10, 30 multiple choice Medication Quiz 2025 -30 min. Final Exam 40% April , 2025 100 multiple All objectives choice questions 5 N201 Attendance Classroom etiquette Exam content (lectures, readings,(text and required) and clinical practice. Please note: PPT provides key points of lectures, not a detailed presentation. 6 2  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. Gain a greater understanding of the im[poertance of being mentally healthy. 7 Course Objectives 1. Discus factors relevant to mental health and mental illness. 2. Discuss the mental status examination and its relevance to practice. 3. Discuss the ethical, legal, and cultural considerations pertaining to the practice of psychiatric mental health nursing. 4. Discuss suicide and non-suicidal self-injury. 5. Discuss personality disorders. 6. Discuss the concepts of stress and crisis. 7. Discuss anxiety, anxiety related disorders and somatic symptom disorders. 8. Discuss depressive and bipolar disorders. 9. Discuss schizophrenia spectrum and other psychotic disorders. 10.Discuss eating disorders and disordered eating. 11.Discuss substance related disorders and addictions. 12.Discuss childhood and adolescent mental health disorders. 13.Discuss anger, aggression, violence, abuse, and sexual assault. 8 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 which guide psychiatric mental health nursing.  Recall factors which 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. Chapters 1,2,3,4,6, 9,10, 29 ,30 9 3  everyone has a mental health as mental illness is different. Mental Health ****** A state of well being in which each mental illness is a proper diagnosis such as anxiety, bipolar, individual is able to realize his or her own potential, cope with normal depression, stresses of life, work productively and fruitfully and make a contribution to *you have to have hope in order to recover* the community” (World Health Organization, 2016a) *mental health also entails our ability to be responsible able to make decisions, problem solve, and be 10 self directed* Attributes of MH 11 Influences on Mental Health 12 4  Concepts of Mental Health and Mental Illness 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 https://www.mentalhealthcommission.ca/wp- content/uploads/drupal/FNIM_Toward_Recovery_and_Well_Being_ENG_0_1.pdf 13 Contributing factors Resilience – a characteristic of Mental health that helps persons recognize stressors and negative emotions, deal with them and learn from the experience. (p.5) Culture –there is no standard measure for mental health (culturally defined and determined by societal norms) Varying viewpoints globally on mental illness 14 Trends and Issues in Mental Health Pandemic (social isolation, masking, virtual technology) Indigenous MH and well- being Opioid Crisis Violence and trauma Political, social and economic unrest globally Migration Climate change Access to services (Increased self harm and suicide rates) Stigma, discrimination and racism ( CFMHN, 2023) How do the issues/trends impact the MH of Canadians? What may be potential outcomes in relation to the issues/trends ? 15 5  Mental Illness (Ch.1) Alterations in cognition, mood, or behavior which 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 Ch.1 16 Mental Illness/Disorders (MI) Classification of MI Diagnostic and Statistical Manual of Mental Disorders (DSM); 5th ed. (Text, p.9) read!! Mood Disorders: Depression & bipolar Suicide Anxiety Disorders Schizophrenia (Psychotic disorders) Eating Disorders Substance Misuse/Addictions Child/ Adolescent Mental Disorders 17 focus on self stigma Stigma and Mental Illness Negative attitudes or behaviors towards an self stigma: a person believes they are weak or unworthy individual or group based on a belief that they possess negative traits. due to their illness Such 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) 18 6  Impact of Language Stigmatizing Respectful Person suffers with depression Person lives with/are experiences depression Substance abuse Substance use Committed suicide Died by suicide Used to be an addict They are in recovery https://t.co/yiGGBgFYjR (CMHA, 2021) 19 Psychiatric-Mental Health Nursing Chapters 2 & 3 Specialized area of nursing practice Involves the care and treatment of human responses to actual or potential mental health problems Employs theories of human behavior as its science Canadian Federation of Mental Health Nurses (CFMHN) https://www.cfmhn.ca/professional-practice 20 Future Challenges and Roles for PMHN Aging population Cultural diversity Decolonization Expanding technology (virtual health care) Inequities Are there others? 21 7  Determinants of Health p.12 without these determinants, it can impact your mental Income and social status Employment /working conditions health Education and literacy Childhood experiences Physical environments Social supports and coping skills Healthy behaviors Access to health services Biology and genetic endowment t Gender Culture Why are DOH importance in care and practice? https://www.canada.ca/en/public-health/services/health-promotion/population- health/what-determines-health.html. 22 Theories Theories are hypothesis or explanations intended to explain something. Various theories are used in MH to provide a means to understand problems and issues. Recall theories from N101 and N103  Psychoanalytical (Freud) Levels of awareness,(Fig.4.1) personality structure, Defense mechanisms & Psychosexual Development (Table 4.1)  Developmental (Piaget (See Table 4-6) Erickson (See Table 4-2)  Behavioral (Skinner, Pavlov,pp.48-49)  Humanistic (Maslow, p. 53) ******  Interpersonal (Peplau, Sullivan)  Cognitive (Beck)  Biological (Psychopharmacology)  ( Milieu Therapy p.54) 23 Defense Mechanisms p.42 The ego develops defense mechanisms Defense mechanism ward off anxiety by preventing conscious awareness of a threat. They help preserve emotional stability If overused, can lead to unhealthy behaviors (Further discussed in Ch. 12, Table 12.2) 24 8  unconscious transfer of a personal situation to another Transference & Countertransference p.43 example: client says to nurse your voice sounds like my Nurse Client - Transference mother who abused me Nurse Client - Countertransference example: nurse says to client “you remind me so much of my son 25 Interpersonal Theories and Therapies 2 theories are very important for psychiatry 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 is foundation to psychiatric mental health nursing. She is considered the Mother of Psychiatric nursing. 26 Cognitive Behavior Theory- Beck used a lot in psychiatry, get them to view their thoughts How people feel and behave is related to and greatly influenced by their thinking. in a different perspective that impacts their well being Actions result from distorted perceptions & thoughts that can be changed. 27 9  psychopharmacology: mainly medications Biological Theories and Therapies Psychopharmacology biological model: used a lot in the western world Biological Model – focuses on the illness and using physical interventions such as medications Other: Milieu therapy-a living, learning and working environment 28 Structure( Brain) Functions Dysfunctions Frontal lobe Personality, attention Inflexible thinking, Problem solving , emotional controls, personality changes organization , motivation difficulty problem solving, emotional dysregulation Temporal lobe Hearing , memory, sequencing , Difficulty understanding, learning , emotions STM loss,, aggressive, irritable Parietal lobe Attention for learning Dyslexia, poor coordination, poor reading /writing /math Occipital lobe Vision, visual perception Hallucinations, visual distortions, problems reading & writing Cerebelum Balance, coordination, posture Grasping , poor fine motor skills Brain stem Sleep/arousal problems, nausea, vertigo, problems with attention 29 Neurotransmitters and their Roles Serotonin Regulates mood and impulsivity Decreased in depression; Increased in mania Dopamine Involved in regulation of movements, (Increased in schizophrenia rewards, punishment, pleasure, and Decreased in Parkinson Dx) energy Norepinephrine Involved in arousal and alertness, feelings (Increased in mania; of pleasure decreased in depression) Gamma aminobutyric Acid (GABA) Inhibits arousal, impulsivity and (Decreased in anxiety disorders) judgement Acetylcholine Inhibits involvement in movement , (Decreased in Alzheimer’s dx) memory, motivation & sleep 30 10  Nurse –Client Relationship Therapeutic use of self Social relationships Therapeutic relationships Professional Boundaries ( Review Jakubec,2022, Table 9-1, p.125) Review Nursing Boundary Index Self Check (Fig.9-1, p. 128) Nursing Process (aligns with Standards of Practice and Code of Ethics) 31 Nurse – Client Relationship Values, beliefs  Self- awareness -(Pollard & Jakubec, p.126) Peplau’s Model The phases of the nurse –client relationship (Pollard & Jakubec, pp.126-132) As a PN student, who can help you develop greater self awareness in practice? What does Fitness to Practice mean and how does it impact relationships? 32 Communication (Ch.10) Therapeutic Communication Verbal and non- verbal communication  Communication Process (Pollard & Jakubec, p.137 Factors that influence/affect communication (See Fig.10.1) Therapeutic Communication Techniques (See Table 10.2) 33 11  Continuum of Psychiatric Mental Health Treatment (Fig3.1) 34 Continuum of Care-3 levels know the difference between 3 levels Primary-provide information & teaching Secondary – early detection & Rx Tertiary –Rx of psychiatric symptoms & address residual concerns (See Box 3-1)-p.26 Implementing Levels of Prevention (Pollard & Jakubec, pp. 376-381) as it applies to substance related disorders 35 Assertive Community Treatment(ACT/ FACT) p.31, p.578 Intensive case management Hallmarks – creative problem solving and interventions ACT concept-Considers that individuals need support and resources after 1700h Team on call 24h daily Inter-professional (Case manager); LPNs play major role Length of Rx- could possibly be years Flexible Assertive Community Treatment (FACT) 36 12  Mental Health Treatment Team Collaborative approach Nursing Psychiatrist  Psychology Medical team  Social work Pharmacy  Occupational therapy  Recreational therapy  Dietician, music therapy  Personal Care Attendants (Pollard & Jakubec, Box 3-3) 37 Nursing Care p. 36 Establishing rapport Assessment Milieu management Group activities Med administration Documentation Crisis intervention 38 hope is a key component for recovery Recovery Emphasizes a person’s capacity to have hope , work , live, participate in a community and lead a meaningful life Demonstrates that 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. (Pollard & Jakubec, p. 27,573) 39 be familiar with this slide for exam purposes 13  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) https://www.youtube.com/watch?v=nOqbTHl7b1M *know slide for exam* 40 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 41 Study Note Mental Health approach is aimed at community based care. We are moving away from the stigmatizing approach of long term institutionalization. 42 14