Varcarolis’ Foundations of Psychiatric and Mental Health Nursing: Key Points Chapter 1-5

Varcarolis’ Foundations of Psychiatric and Mental Health Nursing: Key Points Chapter 1-5 Chapter 1: Mental Health and Mental Illness 1. Overall health is not possible without good mental health 2. Mental Health vs Mental Illness a. There is a mental health and mental illness continuum that can demonstrate how functioning changes over time; MI and MH are endpoints on the continuum. b. Mental health: i. Able to recognize own potential ii. Cope with normal stress/ Adaptive healthy behavior iii. Work productively iv. Make contribution to community v. is able to differentiate reality from fantasy; reality oriented vi. Adequate self -concept vii. control over own behavior viii. Sees self as capable of achieving ideals and meeting demands ix. Fulfilling stable relationships x. Traits( Mental health provides people with these traits) 1. Ability to Think rationally 2. Communicate appropriately 3. Learn 4. Grow emotionally 5. Be resilient (Characterized by Optimism (positive outlook on life), Sense of mastery, Competence a. Don’t take other’s moods of words personally; let them own it b. Calm down before you express you point of view; communication with respect always can open doors of understanding. 6. Have a healthy self-esteem; adequate self- concept 7. Realistic goals and reasonable function within the individual’s role c. Mental Illness: all psychiatric disorders with definable diagnoses that cause significant dysfunction in development, biological and psychological disturbances. i. unable to differentiate reality from fantasy; consistently abnormal moods, as sadness elation, hopelessness, helplessness ii. behaves without considering the consequences of personal actions iii. aggressively meets own needs without considering rights of others iv. unfulfilling relationships that are intense and unstable; may idealize one minute then devalue leading to feelings of emptiness and in some BPD( borderlines) to suicidality d. Compromised mental health of greatest concern for nurse is patients appraisal of reality, control over impulse and faulty self- concept. e. Mental illness changes with culture, time in history, political systems and groups defining it 1 Downloaded by denis munene () lOMoARcPSD| 3. Psychiatric disorders a. WHO ( World health organization describes health as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity; i. There is a strong relationship between physical and mental health ii. Poor physical health can lead to mental distress and mental distress can lead to poor physical health b. Mental Illness is brain based and is therefore a physical illness c. Psychiatric disorders are generally the result of nature and nurture d. A diathesis-stress model-in which diathesis represent biological predisposition and stress represent environmental stress or trauma is the most accepted explanation for mental illness 4. Risk Factors that increase risk of mental health outcomes a. Inborn vulnerability b. poor social environment c. Economic hardship d. Poor health policy 5. Protective factors as resiliency improve a persons ability to respond to stress, trauma and loss. a. Individual attributes, social and economic, environmental factors. b. Resilience is closely related to process of adapting; it is the ability and capacity for people to secure the resource they need to support their well being. i. helps people facing tragedies, loss, trauma and severe stress 6. Recovery a. The recovery movement has shifted the focus of decision making from a paternalistic system where compliance is emphasized to a focus on self -determination and selfdirection. 7. DSM-V a. DSM-V Classifies disorders people have. i. Details the diagnostic criteria for psychiatric clinical conditions ii. Official guideline for diagnosing psychiatric disorders iii. Gives criteria used to establish a diagnosis b. DSM-V diagnosis guides medical treatment (this differs with nursing diagnosis which is a framework for identifying interventions for pts human responses 8. International Classification of Diseases, 10e a. Clinical descriptions of mental and behavior disorders b. 2 broad classifications c. Subclassifications 9. Psychiatric Nursing 2 Downloaded by denis munene () lOMoARcPSD| a. Promoting mental health through assessment, diagnosis, and treatment of behavioral and mental disorders b. Use nursing, psychosocial, cultural neurobiological theories and research c. Work with people throughout the life span d. Employed in a variety of settings and among varied populations 10. Levels of Psychiatric Nursing a. Basic Level i. Psychiatric mental health registered nurse (PMH-RN) 1. 2 years full-time work, 2000 clinical hours, 30 hours continuing education, followed by certification exam to add “BC” to the RN title (RN-BC) 2. Perform mental health assessments, establish relationship and provide individualized care planning; teach coping skills b. Advanced Practice i. Psychiatric mental health advanced practice registered nurse (PMH-APRN) ii. Master of Science or Doctorate iii. Advanced Practice Psychiatric nurse/Masters prepared nurse practitioners and clinical nurse specialist who have taken special course on prescribing medications. 1. All of the above plus 2. Psychotherapy 3. prescribe psychotropic medications 11. Practice of psychiatric nursing a. Requires different set of skills than medical surgical nursing, although there is overlap. b. Psychiatric nurses must be able to help patients with medical as well as mental health problems, reflecting the holistic perspective c. Psych nursing used complex communication skills as well as critical thinking to solve multidimensional problems d. Teach others that the patient is not the disease but has the disease; the patient has schizophrenic symptoms, don’t say the patient is schizophrenic e. Psych nursing deal with pain and suffering on emotional level, f. Avoid labeling patients g. Recognize cultural bias and work on it h. They do not use high technology, equipment or intravenous therapy; they use “ self” called therapeutic use of self. i. Focuses on relationships (family, partner, etc) as mental health includes rational thinking, communication skills, learning, emotional growth, resilience and self esteem i. Encourages patients and significant others (family) to communicate and compromise for the good of the family unit; avoid blaming and avoidance. j. Serve as patient advocates (defends or assets another’s caused when person lacks ability to do that for self. i. Community: and may engage politically in person or in writing opposing legislation that defunds care of the mental illness 3 Downloaded by denis munene () lOMoARcPSD| 1. Public speaking and publication in interest of improving human condition. ii. Individual advocacy: helping pts understand their rights or make decisions iii. Knowing and respecting that culture matters and Advocating that symptoms must be understood in terms of a person cultural background k. Promotion/prevention: provide regular depression screening for adolescent and teenage students/ risk suicidality l. The interplay of social, cultural, scientific and political factors impact current and future challenges and possibilities for psychiatric mental health nurse. m. Future challenges and roles i. Education ii. Aging population iii. Cultural diversity iv. Science, technology, and electronic health care v. Patient advocacy vi. Legislative involvement n. New research findings should be integrated continuously in a nurse’ practice to provide the most effective care. i. Evidence based practice involves using research findings and standards of care to provide the most effective nursing care o. Never lose sign of patients’ individuality; this will compromise the integrity of practice 12. Nursing Process a. Assessment, diagnosis, planning, implementation, evaluation b. Standardized Nursing Classification Systems are used to form and communicate patient problems, outcomes, and interventions specific to nursing care. i. NANDA , the North American Nursing Diagnosis Association, identifies diagnostic statements regarding human responses to actual or potential health problems; these represent clinical judgments ii. NIC( Nursing Interventions Classification) identifies actins provided by nurses that enhance patient outcomes. iii. NOC: Nursing Outcomes Classification