Intro to Psychiatric Mental Health

1
Intro to Psychiatric Mental Health

• Class 53
• NURS1228
• Spring 2003

2
Terms Familiarize Yourself

• Autodiagnosis
• Subjectivity
• Objectivity
• Prevention
• Primary
• Secondary
• Tertiary
• Therapeutic alliance
• Content Prevalence

• Stereotype
• Epigenesis
• Stigma
• Incidence
• Process
• Nomenclature
• Protective Defenses

3
What IS Psychiatric and/or Mental Health Nursing,
Anyway??

• Help!! This is NOT something I want to do!
• I did NOT go into nursing to baby-sit crazies
• Its ridiculous to spend my day just passing out
  pills to keep these people quiet!
• What good does it do, ANYWAY??!
• Well

4
We are so glad you asked!!

• First of all WHAT do psychiatric nurses do,
  anyway?? Isnt it a cushie job??! (Noooo,
  not really)
• You need to know how to interact therapeutically
• You need to have skill interpersonally
• You need to know how medications work
• You need to think on your feet sometimes pretty
  fast. Not to perform a physical skill,
  necessarily. But your words have never been so
  important as they will be in this area of
  nursing.
• AND you need to keep current on your Medical,
  Surgical, Pediatric, and OB skills. Why??

5
What skills does a MH RN need?

• Quick Answer Them all.
• And this is the reason. People in psych areas
  and institutions ALSO have physical problems.
  AND people in regular hospital areas ALSO have
  Mental Health problems. So. Whether you have
  decided to specialize in psych/MH, or whether you
  work ICU or Peds, get ready. You will need all
  the mental health background you can get.

6
So what kinds of skills? (Basic)

• Know how to use and apply the nursing process
• Develop counseling skills and interventions
• Utilize milieu therapy (all the time!)
• Be willing and able to teach and role-model self
  care.
• Be able to recognize psychobiologic interventions
  and use them in collaboration
• Be a good teacher!
• Be a good organizer. You may be case managing.

7
Advanced Practice Psych Nurses

• Do psychotherapy
• Prescribe
• Consult
• Evaluate

8
So What is Mental Health??

• Viewed most easily on a continuum
• See also text p. 8, Box 1-1 for components of
  Mental Health.

• Mental disorder

• Mental health

9
Or in a dynamic coreSee text p. 7

• With internal and external factors surrounding it

• Mental disorder

• Influencing factors

• Mental Health

10
Influencing Factors

• Inherited
• Psychoneuroimmunologic factors!!
• Family
• Development
• Culture
• Values
• Demographic/geographic locations

• Perception of self
• Cognitive abilities
• Support systems
• Positive influences
• Negative influences
• Mental disorders
• Crime
• Drugs
• Psychosocial stressors
• Poverty
• Etc., etc

11
Epigenesis (Erikson)

• Influences of development
• Genetics
• Environmental experience
• Begin with conception
• Continue throughout life
• All determine personality and healthy or
  destructive responses to the world.
• Should be successful in dealing with each
  developmental stage

12
Protective Defenses

• Ways to manage negative aspects of life
• Automatic mechanisms
• Planned strategies

13
Mental Disorder

• DSM-IV (and newer DSM-IV TR) editions attempt to
  define each mental disorder.
• http//www.psychologynet.org/dsm.html
• Anything that is a clinically significant
  behavioral or psychological syndrome that causes
  an individual distress or disability (APA)

14
Defense Mechanisms

• See text p. 10 Some examples
• Repression, denial, rationalization, projection,
  displacement, reaction formation,
  intellectualization, undoing, compensation,
  identification, sublimation, regression,
  suppression, humor, splitting, self-observation,
  self-assertion, altruism, affiliation,
  anticipation, help-rejecting complaining,
  passive-aggression, omnipotence, isolation of
  affect, fantasy, acting out.

15
Conscious Measures

• Exercising, talking to someone, going out,
  crying, eating, reading, volunteering time,
  journaling, sleeping, relaxation, church or
  community meetings, writing letters, involvement
  in purposeful work
• First importance is to support positive (basic)
• Second, confront and challenge defenses

16
Decade of the Brain

• Biologic causes of mental disorders
• Epidemiology
• Prevalence
• Incidence

17
Get rid of that stereotype!!

• RNs are patient advocates for the reduction of
  stereotyping, judgmentalism, disrespectful
  labeling, and dealing with the stigma associated
  with mental disorders.
• Patient behaviors and responses are a product of
  the disorder. The patient is not the disorder.
  It is imperative that the individual is respected
  regardless of the condition or situation. We
  must deal with the behavior.
• Public education is important. Consider the
  NIMBY syndrome.

18
What Good can RNs do??

• Enlighten and Advocate help those who need it
  to obtain
• Access to Education
• Job opportunities
• Health insurance coverage
• Adequate treatment
• Adequate housing
• Research
• Appropriate personal and human contact.

19
Review How Psych Diagnoses Come To Be and Why

• Provides for
• Communication
• Treatment
• Prognosis
• Funding!
• Can be described by DSM and NANDA
• In association with the Multi-axial system

20
Nurse and Therapist

• Empathetic
• Warm
• Genuine
• Respectful
• Concrete
• Immediate
• Confrontive
• Able to disclose self appropriately.

21
The Nurse-Client (Patient) Relationship

• The art of caring the therapeutic alliance
• The ultimate purpose?? Wellness!
• The concept of helping. The ultimate goal is
  eventual patient self-sufficiency.
• Self searching
• Self help
• The RN must know what his/her own interests are
  in helping people.
• What are yours? the process of autodiagnosis!

22
The Process of Helping

• Outcomes. Assisting another person to
• Help him/herself
• Choose a direction in life
• Find purpose for existing
• Solve problems
• Survive Crises
• Share life with others in work, play and love
• The RN also needs to know how to help. This
  involves the science of nursing/helping.

23
The Key to Therapeutic Relationship is Healthy
Boundaries

• Know what the role focus - of the RN is
• Know what the role focus- of the patient should
  be
• Therapeutic vs. social
• Patient focused
• Goal directed
• Objective (empathy vs. sympathy)
• Time limited

24
Stages of the (Time Limited) Nurse-Patient
Relationship

• Preorientation phase
• Orientation phase
• Contract formal or informal
• Working phase
• Termination phase

25
The Team

• Collaborative!
• Interdisciplinary
• Roles of the MH team Members include RN, LPN,
  SW, Psych tech, Psychiatrist, Psychologist,
  Marriage, family, child counselor, case managers,
  etc.
• Treatment is a team effort. They and their
  families are a part of the team.
• Treatment modalities see next class. Most
  professionals are comfortable with an eclectic
  approach, but may have areas of comfort or
  specialties.

26
Prevention of Mental DisordersLevels

• Primary Prevention
• Secondary Prevention
• Tertiary Prevention

27
The Future is Here

• Managed Care and care management
• Defragment care
• Avoiding the Revolving Door Syndrome.
• Cost containment
• Psychobiology and Medical Technology
• Psychopharmacology
• Critical Thinking An acquired skill that
  evolves with knowledge, experience, intent, and
  practice. (Fortinash, p. 23)