NCM 117 Psychiatric Nursing

**NCM 117: PSYCHIATRIC NURSING** A. **CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS IN THE COUNTRY AND THE WORLD** 1. **FACTORS AFFECTING MENTAL HEALTH IN PHILIPPINE SETTING:** I. Cultural Context and Stigma: - Filipino Culture - Religious Belief - Stigma and Discrimination...

**NCM 117: PSYCHIATRIC NURSING** A. **CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS IN THE COUNTRY AND THE WORLD** 1. **FACTORS AFFECTING MENTAL HEALTH IN PHILIPPINE SETTING:** I. Cultural Context and Stigma: - Filipino Culture - Religious Belief - Stigma and Discrimination II. Access to Mental Healthcare : - Limited Resources - Uneven Distribution - Financial Barries III. Recent Development: - Mental Health Act of 2018 - Increased Awareness - Telehealth Services IV. Challenges and Future Directions: - Addressing Stigma - Increasing Resources - Improving Access - Data Collection and Research **ACCESS TO MENTAL HEALTH:** 1. Through your primary Care Physician(GP) 2. Self-Referral 3. Workplace Referrals 4. School or College Referrals 5. Referrals from Trusted Individuals 6. Online Mental Health Support 7. Crisis Hotlines and Emergency Services 8. Community Health Centers and Non-profit Organizations 9. Insurance Coverage 10. Specific Resources **VITAL ROLE OR MENTAL HEALTH CARE DELIVERY SYSTEM & ITS IMPACT IN THE COMMUNITY:** 1. Addressing a Growing Need: - Prevalence of Mental Health Condition - Economic Burden 2. The Mental Health Act: A Framework for Change: - Republic Act No. 11036 - Challenges and Gap 3. Community Impact: Beyond Individual Well- Being: - Family and Social Support - Educational Attainment - Economic Productivity - Social Inclusion 4. Innovative Approaches and Future Directions: - Community-Based Mental Health Programs - Integration with Primary Care - Telehealth and Online Support - Training and Workforce Development B. **PSYCHOBIOLOGIC BASES OF BEHAVIOR NEUROSCIENCE: BIOLOGY AND BEHAVIOR** I. **Neuro-Anatomy and Neurophysiology** - Neurons - Central Nervous System - Memory Repetition and Learning Neurotransmitters **NERVOUS SYSTEM ANATOMY AND PHYSIOLOGY** **Functions of the Nervous System** 1. **Monitoring Changes -** monitor changes occurring both inside and outside the body; these changes are called stimuli, and the gathered information is called sensory input. 2. **Interpretation of Sensory Input -** it processes and interprets the sensory input and decides what should be done at each moment, a process called integration. 3. **Effects Response -** it then effects a response by activating muscles or glands (effectors) via motor output. 4. **Mental Activity -** The brain is the center of mental activity, including consciousness, thinking, and memory. 5. **Homeostasis -** This function depends on the ability of the nervous systems to detect , interpret, and respond to changes in internal and external conditions. It can help stimulate or inhibit the activities of other systems to help maintain a constant internal environment. cns 11  **Structural Classification** - **Central Nervous System (CNS).** The CNS consists of the brain and spinal cord, which occupy the dorsal body cavity and act as the integrating and command centers of the nervous system. - **Peripheral Nervous System (PNS).** The PNS, the part of the nervous system outside the CNS, consists mainly of the nerves that extend from the brain and spinal cord. **Functional Classification** - **Sensory division.** The sensory, or afferent division, consists of nerves (composed of nerve fibers) that convey impulses to the central nervous system from the sensory receptors located in various parts of the body. - **Somatic sensory fibers.** Sensory fibers delivering impulses from the skin, skeletal muscles, and joints are called somatic sensory fibers. - **Visceral sensory fibers.** Those that transmit impulses from the visceral organs are called visceral sensory fibers. - **Motor division.** The motor, or efferent division carries impulses from CNS to the effector organs, the muscles, and glands; the motor division has two subdivisions: the **somatic nervous system** and the **autonomic nervous system**. - **Somatic nervous system.** The somatic nervous system allows us to consciously or **voluntarily**, control our skeletal muscles. - **Autonomic nervous system.** The autonomic nervous system regulates events that are automatic, or **involuntary**; this subdivision, commonly called the involuntary nervous system, has two parts: the **sympathetic** and **parasympatheti**c, which typically bring about opposite effects. While your **sympathetic** nervous system carries signals that put your body's systems on **alert**, your **parasympathetic** carries signals that **relax** those systems. 14e82b99bf1b153ea6e09b6497f66003 **THE BRAIN** b31d845f-fbb6-43bb-8c27-2fa7866d6fbc - **Cerebrum** \- Hemispheres Lobes \- Pineal Body \- Corpus Callosum - **Cerebellum** - **Brain Stem** \- Midbrain \- Pons \- Medulla Oblongata - **Limbic System** \- Thalamus \- Hypothalamus \- Hippocampus \- Amygdala **THE SPINAL CORD** The cylindrical spinal cord is a glistening white continuation of the brain stem. - **Length.** The spinal cord is approximately 17 inches (42cm) long. - **Major function.** The spinal cord provides a two-way conduction pathway to and from the brain, and it is a major reflex center(spinal reflexes are completed ate this level). - **Location.** Enclosed within the vertebral column, the spinal cord extends from the foramen magnum of the skull to the first or second lumbar vertebra, where it ends just below the ribs. **NERVES** A nerve is a bundle of the neuron fibers found outside the CNS. - **Spinal Nerves.** In humans, 31 pairs of spinal nerves arise from the cord and exit from the vertebral column to serve the body area closed by. - **Cranial Nerves.** The 12 pairs of cranial nerve primarily serve the head and the neck.  OIP **NEUROTRANSMITTERS** These are the chemical manufactured in the neuron that aid in the transmission of information throughout the body. **EXCITATORY -** stimulates an action in the cells **INHIBITORY -** inhibit or stop an action of the cell These neurons communicate information with one another by sending electrochemical messages from neuron to neuron **(NEUROTRANSMISSION)**. C. **THERAPEUTIC MODELS AND ITS RELEVANCE TO NURSING PRACTICE** 1. **Psychoanalytic Model -** Sigmund Freud 2. **Developmental Model -** Erik Erikson 3. **Interpersonal Model -** Harry Stack Sullivan/ Hildegard Peplau 4. **Cognitive Model -** a. b. c. 5. **Stress Model** a. b. 1. **PYSCHOANALYTIC MODEL - Sigmund Freud** - It emphasizes man's unconscious processes or psychodynamic factors as the basis for motivation and behavior. - Personality is formed in early childhood and that his personality knowledge of how an individual's drives, instincts, psychic energy or libido, and psychosexual attitude are formed during the first 6 years of life - crucial to an understanding. - **Conciousness** Level of consciousness are central in an understanding of problems of personality and behavior. Consciousness or material within our awareness is only one small part of the mind. - **Unconsciousness** A larger area and consists of memories, conflicts, experiences that have been repressed. It cannot be recalled at will. - **Preconscious** Memories that can be recalled to consciousness. - **Defense Mechanism** These are normal methods that people use to protect the ego and to diminish anxiety. These are primarily unconscious behaviors; however, some are within voluntary control. **Goals of Pyschoanalysis Model** To make the unconscious conscious so that the individual can work through the past and understand his behavior. 2. **DEVELOPMENTAL MODEL - Erik Erikson** It spans the total life cycle from birth to death. Each of the 8 stages of development allowed opportunities for growth up to the acceptance of one's own death. Each stage was described as an emotional crisis involving positive and negative experiences. +-----------------+-----------------+-----------------+-----------------+ | **Stage** | **Age** | **Psychosocial | **Virtue** | | | | crisis** | | +-----------------+-----------------+-----------------+-----------------+ | 1. Trust vs. | Birth to 1 year | Trusting the | Hope | | Mistrust | | world vs. | | | | | Developing | | | | | mistrust | | +-----------------+-----------------+-----------------+-----------------+ | 2. Autonomy | 1-3 years | Developing | Will | | vs. Shame | | independence | | | and Doubt | | vs. Feeling | | | | | shame and doubt | | +-----------------+-----------------+-----------------+-----------------+ | 3. Initiative | 3-5 years | Taking | Purpose | | vs. Guilt | | initiative vs. | | | | | Feeling guilt | | +-----------------+-----------------+-----------------+-----------------+ | 4. Industry | 5-12 | Developing | Competence | | vs. | | competence vs. | | | inferiority | years | Feeling | | | | | inferior | | +-----------------+-----------------+-----------------+-----------------+ | 5. Identity | 12. 18 years | Forming a sense | Fidelity | | vs. Role | | of identity vs. | | | Confusion | | Experiencing | | | | | role confusion | | +-----------------+-----------------+-----------------+-----------------+ | 6. Intimacy | 18-40 years | Developing | Love | | vs. | | intimate | | | isolation | | relationships | | | | | vs. Feeling | | | | | isolated | | +-----------------+-----------------+-----------------+-----------------+ | 7. Generativit | 40-65 years | Contributing to | Care | | y | | society vs. | | | vs. | | Feeling | | | Stagnation | | stagnant | | +-----------------+-----------------+-----------------+-----------------+ | 8. Ego | 65 years and | Accepting one's | Wisdom | | Integrity | older | life vs. | | | vs. Despair | | Feeling despair | | +-----------------+-----------------+-----------------+-----------------+ 3. **INTERPERSONAL MODEL** **Interpersonal Psychotherapy Model (IPT)- Harry Stack Sullivan** Sullivan's key contributions include: - **The Interpersonal Theory of Psychiatry:** this theory emphasizes the role of social interactions and the effects of the environment on mental health. Sullivan believed that individuals develop their personalities and behaviors through interactions with others. - **The Concept of the "Good Me." "Bad Me," and "Not Me":** these represent different aspects of the self that emerge based on social appraisals and the anxiety associated with negative feedback. The "good me" is the part of the self that is accepted and valued by others, while the "bad me" is the part that is rejected or criticized. The "not me" represents the unknown or repressed part of the self. - The Importance of Anxiety: Sullivan believed that anxiety is a fundamental human emotion that arises from interpersonal interactions. He argued that individuals develop security operations to manage anxiety, which can involve various coping mechanisms and defenses. - **The Concept of the Self- System:** This refers to the collection of security operations that an individual uses to defend against anxiety and maintain self-esteem. The self- system is shaped by early interpersonal experiences and plays a crucial role in how individuals perceive and interact with the world. **Interpersonal Relationship in Nursing Practice- Hildegard Peplau** Key Concepts pf Peplau's Theory: - **The Nurse as a Therapeutic Agent:** Peplau viewed the nurse as an active participant in the therapeutic process, responsible for fostering a trusting and supportive relationship with the patient. This relationship is based on mutual respect, empathy, and a shared understanding of the patient's needs. - **The Importance of the Nurse-Patient Relationship:** Peplau believed that the quality of the nurse-patient relationship significantly impacts patient outcomes. She emphasized the need for nurses to be attuned to the patient's emotional state, communication patterns, and individual needs. - **The Patient as a Partner in Crime:** Peplau advocated for patient empowerment, encouraging patients to actively participate in their care and make informed decisions about their treatment. - **The Role of Anxiety:** Peplau recognized that anxiety is a common human experience, particularly in the context of illness. She emphasized the importance of nurses helping patients understand and manage their anxiety, providing support and guidance. 4. **COGNITIVE MODEL** **Cognitive Stage of Development - Jean Piaget**  **Cognitive Therapy (CT) - Aaron Beck** 40a0b4db-ed56-4dcc-a5be-fb1d6e69b31f - **All-or-nothing thinking:** Viewing situations in extreme terms (e.g., "if I don't get a perfect score, I'm a failure"). - **Overgeneralization:** Drawing broad conclusions based on a single event (e.g., " I failed this test, so I'm going to fail all my classes"). - **Jumping to Conclusions:** Making assumptions without sufficient evidence ( e.g., " My boss didn't smile at me, so he must be angry with me"). - **Personalization:** Taking responsibility for event that are outside of one's control (e.g., "It's my fault my team lost the game"). - **Catastrophizing:** Exaggerating the negative consequences of events (e.g., " If don't get this job, my life is over"). - **Mental Filtering:** Focusing only on negative aspects of a situation while ignoring positive ones. - **Disqualifying the positive:** Dismissing positive experiences as insignificant or not counting. - **Should Treatments:** imposing rigid rules and expectations on oneself and others (e.g., " I should be able to do everything perfectly"). - **Labelling:** Assigning labels to oneself or others (e.g., I am a loser"). **Rational Emotive Therapy (RET) - Albert Ellis**  5. **STRESS MODEL** **Selye's Stress Adaption Syndrome - Hans Selye** c9507927-7ab8-42c9-8314-ec6662100dc5  **Lazarus' Interaction Model - Richard Lazarus** 740b6ba5-2d22-4eb3-948e-bd836ee2b0a1 **PSYCHIATRIC NURSING** **Health (WHO)** - It is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. **Mental Hygiene** - The brach od psychiatry that deals with the science and practice of maintaining and restoring mental health, and of preventing mental disorder through education, early treatment, and public health measures. - Science of maintaning mental helath and preventing disorders to help people function at their full mental potential. **6 T ECHNIQUES TO TAKE CARE OF OUR MENTAL HEALTH by: Edward G. Brown** 1. Transcend the environment 2. Cultivate constructive acceptance 3. Visualize the ideal self 4. Use positive affirmation 5. Practice psychological counterpunching 6. Change your internal computer chip **MENTAL HEALTH** - It is a state of emotional, psychological and social wellness evidence by satisfying interpersonal relationships, effective behavior and coping, a positive self-concept and emotional stability. - It is a psychological state of well-being, characterized by continuing personal growth, a sense of purpose in life, self-acceptance, and positive relations with others. - It is the absence of mental illness. - It is the ability to solve problems, fulfill one's capacity for love and work, cope with crisis without assistance beyond the support of family and friends, and maintain a state of well-being by enjoying life's setting goals and realistic limits, and becoming independent, interdependent, or dependent as the need arises without permanently losing one's independence. **Factors influencing mental health** - Inherited characteristics - Nursturing childhood - Life's circumstances **Ways to maintain mental health** - Good interpersonal communication - Ego defense mechanism - Significnat others or support people - Involvement in physical activities **Characteristics of Mental Health** - Accepts self and others - Is able to cope with or tolerate stress - Can return to normal functioning if temporarily disturbed - Is able to form close and lasting relationship - Uses sound judgement to make decisions - Accepts responsibility for actions - Is optimistic - Recognizes limitations (abilities and deficiencies) Can function effectively and independently - Is able to distinguish imagines circumstances from reality - Is able to develop potential talent to fullest extent - Is able to solve problems - Can delay gratification - It reflects a person's approach to life by communicating emotions, giving and receiving, working alone as well as with others, accepting authority, and coping successfully with emotional conflict. **Mental disorders (APA)** - It is a clinically significant behavior or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom. **Characteristics of Mental Illness** - Feels inadequate - Has poor self- concept - Is unable to cope - Exhibits maladaptive behavior - Is unable to establish a menaingful relationship - Displays poor judgement - Is irresponsible or unable to accept responsibility for actions - Is pessimistic - Does not recognize limitations, exhibits dependency needs because of feelings of inadequacy - Is unable to perceive reality - Does not recognize potentials and talents because of poor self-concept - Avoids problems rather than coping with them or attempting to solve them - Desires or demands immediate gratification - It reflects a perosn's inability to cope with stress, resulting in disruption, disorganization, inappropriate reactions, unacceptable behavior, and the inability to respond according to the person's expectations and the demands of society. **Pyschiatry** - It is the science of curing or healing of the psyche - It is the medical specialty that is derived from the study, diagnosis, treatment and prevention of mental disorders. **Psychiatric Nursing** - It is the diagnosis and treatment of human responses to actual and potential mental health problems. - It is a specialized area of nursing practice, employing theories of human behavior as its science and purposeful use of self as its art. (ANA) - It is a interpersonal process that strives to promote and maintain behavior which contributes to integrated functioning. (Gail Stuart) - It is an interpesonal process whereby the professional nurse practitioner assists an individual, family and community to promote health, to prevent or cope with the experience of mental illness and suffering and if necessary to find meaning in these experiences. (Travelbee) **Selected Nursing Interventions that are commonly used in psychiatric nursing** - Active listening - Anger control assistance - Assertiveness training - Behavior management - Body image enhacement - Caregiver support - Communication enhancement - Delusion management - Eating disorders management - Grief work facilitation - Hallucination management - Impulse control training - Milieu therapy - Mood management - Role enhancement \- Sleep enhancement \- Spiritual support \- Substance abuse treatment \- Suicide Prevention \- Teaching **Philosophical beliefs related to the effective practice of Psychiatric Nursing** - The individual had worth and dignity - The goal of the individual is on growth, health, autonomy, and self- actualization. - Every individuals has the potential to change and the desire to pursue personal goals. - The person functions as a holistic being that acts on, interacts with, and reacts to the environment as a whole person. Each part affects the total response. - All people have common, basic, and necessary human needs. - All behavior is meaningful. - Behavior consists of perceptions, thoughts, feelings and actions. - Individual vary in their coping capacities, which depend on genetic endowment, environmental influences, nature and degree of stress and available resources. - Illness can be a growth-producing experience. - All people have a right to equal opportunity for adequate care regardless of gender, race, religion, ethics, sexual orientation, or cultural background. - Mental health is a critical and necessary component of comprehensive health care services. - The individual has the right to participate in decision-making. **USE OF PSYCHIATRIC-MENTAL HEALTH NURSING IN CAREER OPPORTUNITIES** **Obstetric Nursing** - Helping the mother in labor and support person cope with anxiety or stress during labor and delivery. - Providing support to the bereaved parents in the event of fetal demise, inevitable abortion, or the birth of an infant with congenital anomalies. - Providing support to a mother considering whether to keep her child or give the child for adoption. **Forensic Nursing** - Providing services to incarcerated clients - Acting as consultant to medical and legal agencies - Serving as expert witness in a court - Providing support for victims of violent **Oncologic Nursing** - Helping cancer patients or other terminally ill individuals on oncologic units work through the grieving process. - Providing support groups to families of terminally ill patients. **Industrial (Occupational Health) Nursing** - Implementing or participating in industrial substance abuse programs for employees and their families. - Providing crisis intervention during an industrial accident or the acute onset of a physical or mental illness. - Teaching stress management. **Public Health Nursing** - Assessing the person both physically and psychologically (e.g. the newly diagnosed diabetic client may develop a low self- concept, or the recovering stroke client may exhibit symptoms of depression due to slow recovery) **Office Nursing** - Assisting the client by explaining somatic or emotional concerns during the assessment process. - Providing support with the problem-solving process when people call the office and the physician is unavailable. - Acting as a community resource person. **Emergency Room Nurse** - Providing crisis intervention as the need arises (e.g. during natural disasters, accidents or unexpected illnesses causing increased anxiety, stress or immobilization) **ROLES AND FUNCTION OF MENTAL HEALTH AND PSYCHIATRIC NURSE** The mental health and psychiatric nurse provide direct care to patients with mental or emotional disorders, including: - Promoting self-care and independence - Assisting with the problem solving to facilitate activities of daily living. - Aiding communication and interpersonal relations. - Helping the client examine behaviors the test alternatives. - Teaching about disorder. - Administering prescribed medications and treatments. - The nurse is also responsible for constructing and maintaining a therapeutic environment. - Patient and family teaching. - She also coordinates in diverse aspects of care - Acting as an advocate on behalf of the patient and family, she: \- Teaches about rights and responsibilities \- Shares information about self-help groups - Responsibilities associated with primary prevention include: \- Teachings principles of mental health -Teaching how to recognize and reduce stress -Promoting effective family functioning -Participating in community activities related to mental health promotion. **SCHIZOPHRENIA** - Was coined by **Eugen Bleuler -** a swiss psychiatrist - It came from the greek word meaning split personality - which means that there is a disconnection or splitting of the psychic functions. - It encompasses a group of psychotic reactions that affect multiple areas of the individual's functioning, including thinking and communicating, perceiving and interpreting reality, feeling and demonstrating emotion, and behaving in socially acceptable manner. - It is characterized by withdrawal from reality, illogical patterns of thinking, delusions and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. - It is a severe mental disorder characterized by 5 "A's" a. b. c. d. e. - The nodal onset for men is between 18-25; for women, between 25 and mid-30's **CAUSES OF SCHIZOPHRENIA** 1. **Genetic predisposition** - - - - - - 2. **Neuro developmental abnormalities** - Development of minor fetal malformation during early gestation - Factors that can affect nuerodevelopment and that may increase the risk of disease include: a. b. c. 3. **Brain structural abnormalities and chemical imbalances** - Brain imaging techniques, MRI, positron emission tomography have shown abnormalities in the structure of the brain. a. b. c. d. - Excessive production of dopamine in some areas of the brain - Other neurotransmitters like serotonin, nor epinephrine, glutamate and GABA play and important role in the development of schizophrenia. 4. **Psychosocial and environmental factors** - Developmental theories proposed that lack of warm, nurturing attention in the earliest life contributes to the lack of self-identity , reality, misinterpretation and relationship withdrawal. - Families who have highly expressed emotions are emotionally over involved, hostile and critical. - Consistent association with low-socio-economic - Biologically vulnerable individuals who are always exposed to life's stressors may produce symptoms of schizophrenia **SIGNS AND SYMPTOMS OF SCHIZOPHRENIA** 1. **Positive symptoms:** reflect the symptoms of overt psychotic of distorted behavior - - - - a. b. c. d. e. f. g. The person might attempt to contact the object of the delusion, and stalking behavior is not uncommon. - Excitement and agitation - Hostility or aggressive behavior - Suspiciousness - Pressure speech - Possible suicidal tendencies - Loose association a. **Neologism-** creating new words b. **Word salad-** words in a sentence that may seem connected but do not compose coherent thought c. **Echolalia-** senseless repetition of the words of another person d. **Echopraxia-** senseless copying of another person's behavior or action e. **Clang association-** words that rhyme are put together for their sound association without coherent thought f. **Flight of ideas-** continuous flow of verbalization in which the person jumps from one topic to another 2. **Negative symptoms: reflect a diminution or loss of normal function** - **Anergia-** lack of energy - **Anhedonia**- lack of pleasure in activities and things that the individual would normally perceive as pleasure or enjoyable - **Emotional withdrawal** - **Poor eye contact** - **Blunted affect** - **Ambivalence** - **Avolition-** lack of motivation to persistent a goal- oriented activity - **Difficulty to abstract thinking** - **Alogia-** refers to decreased speech pattern or poverty of speech - **Dysfunctional relationship with others**