Mental Health Fall '12

1. Mental Health Nursing

2.  Historical Beliefs
 Demonology requiring exorcism, beating, torture
 Middle Ages associated mental illness with witchery
 Asylums emerged in the 1800s – institutionalized
 Evolution of Nursing
 Linda Richards – First psychiatric nurse
 Est’b psychiatric hospitals and schools of nursing
(asylums)
 Contemporary Approach
 Mid 1900s – shift to community care, psychiatric nursing
added to nursing curricula
 National Mental Health Act – post WWII

3.  American Psychiatric Association
 A state of being that is relative rather than
absolute
 Shown by productive activities, fulfilling
relationships, ability to adapt to change and
cope with adversity
 Lisa Robinson (Psychiatric Nursing Expert)
 Dynamic state in which thought, feeling, and
behavior is age appropriate and congruent with
local and cultural norms

4.  American Psychiatric Association
 A clinically significant behavioral or
psychological pattern, associated with
distress, disability, or risk of suffering
 Not an expected cultural response to an event
 Townsend
 Maladaptive responses to s tre s s o rs , AEB
thoughts, feelings, behaviors that are not
congruent with c ulture and interferes with
functioning

5.  Members of the community define norms
 Relatives typically determine “normalcy”and
define when state has changed
 Class and Education
 Lower - high incidence; low recognition
 Higher - high recognition and self labeling
 Gender
 Women are more likely to recognize symptoms of
MI and seek treatment

6.  Stressor
 Any factor that causes emotional or physical
tension; may be a responsible factor in certain
illnesses
 Stress Response - General Adaptation
Syndrome
 Alarm-Resistance-Exhaustion (review N101
lecture)
 Adaptation – responses preserve integrity and
equilibrium
 Maladaption – responses that result in disruption

7.  Primary  Secondary
 The person asks  The person assesses
themselves is this event: their skills, resources,
▪ Irrelevant – the and knowledge to deal
outcome is with the situation
insignificant  Determines coping
▪ Benign-positive - the strategies available
outcome is  Considers options
pleasurable
▪ Stressful – the
outcome is harmful,
threatening,
challenging

8.  Predisposing Factors
 Genetic influences: temperament, family
history of mental illness, personality
 Past Experiences: learned patterns of coping
due to past experiences
 Existing Conditions: Current health status,
developmental maturity, financial and
educational resources, support system

9.  The use of coping strategies in response to
stress
 Adaptive or Maladaptive
 Specific Strategies
 Awareness - recognition
 Relaxation/Meditation
 Communication – talking it out; support systems
 Problem Solving – view situation objectively,
analyze, act, evaluate
 Alternative Resources
▪ Pets/ music/ dance/ art/ exercise

10.  Anxiety
 Vague apprehension associated with feelings
of uncertainty
 Levels of anxiety
▪ Mild – tension, prepares for action/response
▪ Moderate –heightened tension; cognition impaired
and individual needs assistance
▪ Severe – Difficulty functioning even simple tasks
▪ Panic – terror, desperate, out of touch with reality

11.  Defense Mechanisms
 Protective devices used to alleviate anxiety
▪ Compensation – covering up a weakness by
emphasizing something more desirable
▪ Denial – refusal to acknowledge
▪ Displacement – transfer of feelings from target to
another
▪ Identification – increase self worth by acquiring
attributes of a positive role model
▪ Intellectualization – avoid emotions by focusing on
analysis
▪ Introjection – integration of others values into self
▪ Isolation – separating the event and emotion

12.  Defense Mechanisms con’t
▪ Projection – attributing unacceptable self-feelings to
another
▪ Rationalization – making excuses
▪ Reaction – avoids thoughts, feelings by expressing
opposite
▪ Repression – blocking unpleasant feelings
▪ Sublimation – direct impulses into constructive activities
▪ Suppression – avoiding unpleasant thoughts, feelings
▪ Undoing – symbolically cancels out an unpleasant
experience

13.  Dia g no s tic a nd Sta tis tic a l M nua l o f M nta l
a e
Dis o rd e rs – Fo urth Ed itio n – Te x t Re v is io n
 This is a tool provides guidelines and diagnostics
criteria for mental illness
 It is a multi-axial system
 Axis 1: All psychiatric disorders except personality d/o and
MR
 Axis 2: Personality disorders and MR
 Axis 3: Medical conditions
 Axis 4: Environmental issues or psychosocial problems that
may impede treatment
 Axis 5: Global Functioning Scale – Townsend, page 26