NURm2488mMentalmHealthmNursin
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FinalmExammK
eymConcepts
Introduction min mPsychiatric mNursing
BasicmBrain mAnatomy-mwhatmdo mthemdifferentmpartmof mbrain mcontrol?
Hypothalamus? mNeurons/msynapse-mpg.m51
Hypothalamus:mRegulatesmtemperature,mblood mpressure,mperspiration,mlibido,mhunger,mthirst,mand mcircadi
an mrhythms,msuchmasmsleepmandmwakefulness. mHypothalamic mneurohormones,moften mcalled mreleasingmhor
mones,mdirectmthemsecretion mof mhormonesmfrommthemanteriormpituitary mgland.
Neurons:mThembrainmismcomposedmofmamvastmnetworkmofmmoremthanm100 mbillionminterconnectedmnervemcell
sm(neurons)mand mthemsupportingmcellsmthatmsurroundmthesemneurons.mAnmessentialmfeaturemofmneuronsmismthe
irmability mto minitiatemsignalsmand mconductmanmelectricalmimpulsemfrommonemendmofmthemcellmto mthemothermcall
ed mneurotransmission.
Synapse:mThismtransmittermthenmdiffusesmacrossmamnarrowmspace,mormsynapse,mto man madjacentmpostsynapticm
neuron,mwheremitmattachesmto mspecializedmreceptorsmonmthemcellmsurfacemandmeitherminhibitsmormexcitesmthem
postsynaptic mneuron.
Understand mmilieu mtherapy-mcan myou mdescribe mitmin mamclinicalmsetting?
Milieumtherapy:mgroup mtherapy mwith msimilarmillnessesminvolved.mPromotesmproductivemactivity,mself-
respect,mand mindividualmresponsibility.mUsesmtotalmenvironmentmto mtreat.mEnforcesmboundaries.mInpatientmr
ehab.
Describe mthemdifference mbetween mmentalmhealth mand mmentalmillness
MentalmHealth:mAmsuccessfulmperformancemofmmentalmfunctions,mresultingmin mthemabilitymto mengageminmpro
ductivemactivities,menjoy mfulfillingmrelationships, mand madaptmto mchangemand mcopemwith madversity.
MentalmIllness:mAremmedicalmconditionsmthatmaffectmamperson’smthinking,mfeeling,mmood,mability mtomrelatem
to mothers,mandmdaily mfunctioning.mBasically,mmentalmillnessmcan mbemseenmasmthemresultmofmamchainmofmevent
smthatminclude mflawed mbiological,mpsychological, msocial,mand mculturalmprocesses.
Maslow’smHierarchy mof mneedsm(pgm31)
, NURm2488mMentalmHealthmNursin
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FinalmExammK
eymConcepts
• Physiologicalmneeds.m Themmostm basicm needsm arem them physiological mdrives,m i
ncludingmthemneedmfor mfood,moxygen,mwater,msleep,msex,mandmamconstantmbod
ymtemperature.mIfmallm themneedsmweremdeprived,m thismlevelmwouldm takemprior
ity.
• Safetymneeds.m Oncem physiological mneedsm arem met,mthemsafetymneedsm emerge.m T
heymincludemsecurity,mprotection,mfreedommfrommfear/anxiety/chaos,mandmthem n
eedmfor mlaw,morder,mandm limits.
• Belongingness mandmlove mneeds.m Peoplem havem am needm for m anm intimatem rela
tionship,mlove,maffection,mandmbelongingm andmwillmseekm tom overcomem fe
elingsmofmlonelinessmandmalienation.mMaslowmstressesmthemimportancemof
m havingm am familym andm am homem andm beingm partm ofm identifiable m groups.
• Esteemmneeds.m Peoplem needm tom havem am highm self-
regardm andmhavem itmreflectedmtomthemmfrommothers.mIfmself-
esteemmneedsmaremmet,mwemfeelmconfident,mvalued,mandmvaluable.mWhenmself-
esteemmismcompromised,mwemfeelminferior,mworthless,mandm helpless.
• Self-
actualization.mWemarempresetmtomstrivemtom bem everythingmthatm wem arem capabl
emofmbecoming.mMaslowm said,m“Whatmammanmcanmbe,m hem mustmbe.”m What
, NURm2488mMentalmHealthmNursin
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FinalmExammK
eymConcepts
wem aremcapablemofmbecomingmismhighlymindividual—
anm artistmmustmpaint,mamwriter mmustmwrite,mandmamhealer mmustmheal.mThemdriv
emtomsatisfymthismneedmismfeltmasmamsortmofm restlessness,m amsensemthatm somethi
ngm ismmissing.mItm ismupmtomeachmpersonmtomchoosemampathmthatm willmresultminmin
ner mpeacemandmfulfillment.
Peplau’smTheory mof mInterpersonalmRelations
Peplau’smTheory mofmInterpersonalmRelations:memphasizedmthatmthemnaturemofmthemnursemtompatientmrelati
onship mstrongly minfluenced mthemoutcome mformthempatient.
Freud-mwhatmdid mhemcontribute mto mpsychiatric msetting?
SigmundmFreudm(1856mto m1939),man mAustrianmneurologist,mismconsideredmthem“fathermofmpsychiatry.”mHis
mwork mwas mbasedmon mpsychoanalyticmtheory,min mwhichmFreudmclaims mthatmmostmpsychologicalmdisturbance
smaremthemresultmofmearlymtraumamormincidentsmthatmaremoften mnotmrememberedmormrecognized.mFreudm(1961
)midentifiedmthreemlayersmofmmentalmactivity:mthemconscious,mthempreconscious,mand mthemunconsciousmmin
d.
Onemof mFreud'smlatermandmwidelymknown mconstructsmconcernsmthemintrapsychicmstrugglemthatmoccursmwithi
n mthembrain mamongmthemid,mthemego,mand mthemsuperego.
Reviewmtablem3-2 m(pgm28)
TABLEm 3-
2mDEVELOPM EN T mOF mPERSON ALI TYm ACCO RDING m TO mFREU D, mSU LLIVAN, m AN Dm ERIKSON ∗
FREUD SULLIVAN ERIKSON
Oral—birth mto m1½myears Infancy— Infancy—birth mto m1½myears
birth mto m1½myearsmMotheringmobject
relievesmtension
m
, NURm2488mMentalmHealthmNursin
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FREUD SULLIVAN ERIKSON
Pleasure-painmprinciple through mempathicmintervention mand m
tenderness,mleadingmto mdecreased man
Id,mtheminstinctivemand mprimitivemmind,mis xiety mand mincreased msatisfaction man
mdominant d msecurity; mmothermbecomesmsymbo Trust m vs.m mistrust
lized m“good mmother”
Demanding,mimpulsive,mirrational,masocial Egocentric
,mselfish,mtrustful,momnipotent,mand mdepen Goalmismbiologicalmsatisfaction ma
dent nd mpsychologicalmsecurity Danger—
duringmsecond mhalf mof mfirstmyear,man
Primary mthought mprocesses Denialmof mtension mrelief mcreatesmanx mabrupt mand mprolonged mseparationmm
iety,mand mmothermbecomesmsymboli ay mintensify mthemnaturalmsensemof mlos
smand mmay mlead mto ma msensemof mmistr
Unconsciousminstincts—source-energy- zed masm“bad mmother”
ust mthat mmay mlast mthroughout mlife
maim-object
Anxiety min mmothermyieldsmanxiety
mand mfearmin mchild mvia mempathy
Task—
Mouth—primary msourcemof mpleasure
develop ma mbasicmsensemof mtrust mthatml
eadsmto mhopeTrust mrequiresma mfeelin
Immediatemreleasemof mtension/anxiety mand Thesemstatesmaremexperienced mby mthe gmof mphysicalmcomfort mand ma mminim
mchild min mdiffuse-
mimmediate mgratification mthrough moralmgr
almexperiencemof mfearmormuncertainty
atification undifferentiated mmanner
; mif mthismoccurs,mthemchild mwillmexten
d mtrust mto mthemworld mand mself
Task— Task—
develop ma msensemof mtrust mthat mneedsmwillm learn mto mcount mon mothersmformsatisfac
bemmet tion mand msecurity mto mtrust
Anal—1½mto m3 myears Childhood—1½mto m6 myears Early mchildhood—1½mto m3 myears
Realitym principle— Muscularmmaturation mand mlearningmt Autonomym vs.m shame/doubt
postponemimmediatemdischargemof menergy o mcommunicate mverbally
mand mseek mactualmobject mto msatisfy mneeds Develop mconfidence min mphysicalmand
Learningmsocialmskillsmthrough mcons mmentalmabilitiesmthat mleadsmto mthemd
Learningmto mdefermpleasure ensualmvalidation evelopment mof man mautonomousmwill
Gainingmsatisfaction mfrom mtoleratingmsom Beginningmto mdevelop mself- Danger—
emtension-masteringmimpulses esteem mvia mreflected mappraisals: development mof mamdeep msensemofmsh
ame/doubt mif mchild mismdeprived mof mt
Focusmon mtoilet mtraining— Good mm hemopportunity mto mrebel; mlearnsmto me
retaining/lettingmgo;mpowermstruggle xpect mdefeat min many mbattlemof mwillsm
emBad mm with mthosemwho marembiggermand mstr
Ego m development— onger
functionsmof mthemego mincludemproblem- emNot mm
solvingmskills,mperception,mability mto mmed Task—gain mself-
iatemid mimpulses controlmof mand mindependence mwithin
e mthe menvironment
Task—delay mimmediatemgratification Levelsmof mawareness
Awareness
g
FinalmExammK
eymConcepts
Introduction min mPsychiatric mNursing
BasicmBrain mAnatomy-mwhatmdo mthemdifferentmpartmof mbrain mcontrol?
Hypothalamus? mNeurons/msynapse-mpg.m51
Hypothalamus:mRegulatesmtemperature,mblood mpressure,mperspiration,mlibido,mhunger,mthirst,mand mcircadi
an mrhythms,msuchmasmsleepmandmwakefulness. mHypothalamic mneurohormones,moften mcalled mreleasingmhor
mones,mdirectmthemsecretion mof mhormonesmfrommthemanteriormpituitary mgland.
Neurons:mThembrainmismcomposedmofmamvastmnetworkmofmmoremthanm100 mbillionminterconnectedmnervemcell
sm(neurons)mand mthemsupportingmcellsmthatmsurroundmthesemneurons.mAnmessentialmfeaturemofmneuronsmismthe
irmability mto minitiatemsignalsmand mconductmanmelectricalmimpulsemfrommonemendmofmthemcellmto mthemothermcall
ed mneurotransmission.
Synapse:mThismtransmittermthenmdiffusesmacrossmamnarrowmspace,mormsynapse,mto man madjacentmpostsynapticm
neuron,mwheremitmattachesmto mspecializedmreceptorsmonmthemcellmsurfacemandmeitherminhibitsmormexcitesmthem
postsynaptic mneuron.
Understand mmilieu mtherapy-mcan myou mdescribe mitmin mamclinicalmsetting?
Milieumtherapy:mgroup mtherapy mwith msimilarmillnessesminvolved.mPromotesmproductivemactivity,mself-
respect,mand mindividualmresponsibility.mUsesmtotalmenvironmentmto mtreat.mEnforcesmboundaries.mInpatientmr
ehab.
Describe mthemdifference mbetween mmentalmhealth mand mmentalmillness
MentalmHealth:mAmsuccessfulmperformancemofmmentalmfunctions,mresultingmin mthemabilitymto mengageminmpro
ductivemactivities,menjoy mfulfillingmrelationships, mand madaptmto mchangemand mcopemwith madversity.
MentalmIllness:mAremmedicalmconditionsmthatmaffectmamperson’smthinking,mfeeling,mmood,mability mtomrelatem
to mothers,mandmdaily mfunctioning.mBasically,mmentalmillnessmcan mbemseenmasmthemresultmofmamchainmofmevent
smthatminclude mflawed mbiological,mpsychological, msocial,mand mculturalmprocesses.
Maslow’smHierarchy mof mneedsm(pgm31)
, NURm2488mMentalmHealthmNursin
g
FinalmExammK
eymConcepts
• Physiologicalmneeds.m Themmostm basicm needsm arem them physiological mdrives,m i
ncludingmthemneedmfor mfood,moxygen,mwater,msleep,msex,mandmamconstantmbod
ymtemperature.mIfmallm themneedsmweremdeprived,m thismlevelmwouldm takemprior
ity.
• Safetymneeds.m Oncem physiological mneedsm arem met,mthemsafetymneedsm emerge.m T
heymincludemsecurity,mprotection,mfreedommfrommfear/anxiety/chaos,mandmthem n
eedmfor mlaw,morder,mandm limits.
• Belongingness mandmlove mneeds.m Peoplem havem am needm for m anm intimatem rela
tionship,mlove,maffection,mandmbelongingm andmwillmseekm tom overcomem fe
elingsmofmlonelinessmandmalienation.mMaslowmstressesmthemimportancemof
m havingm am familym andm am homem andm beingm partm ofm identifiable m groups.
• Esteemmneeds.m Peoplem needm tom havem am highm self-
regardm andmhavem itmreflectedmtomthemmfrommothers.mIfmself-
esteemmneedsmaremmet,mwemfeelmconfident,mvalued,mandmvaluable.mWhenmself-
esteemmismcompromised,mwemfeelminferior,mworthless,mandm helpless.
• Self-
actualization.mWemarempresetmtomstrivemtom bem everythingmthatm wem arem capabl
emofmbecoming.mMaslowm said,m“Whatmammanmcanmbe,m hem mustmbe.”m What
, NURm2488mMentalmHealthmNursin
g
FinalmExammK
eymConcepts
wem aremcapablemofmbecomingmismhighlymindividual—
anm artistmmustmpaint,mamwriter mmustmwrite,mandmamhealer mmustmheal.mThemdriv
emtomsatisfymthismneedmismfeltmasmamsortmofm restlessness,m amsensemthatm somethi
ngm ismmissing.mItm ismupmtomeachmpersonmtomchoosemampathmthatm willmresultminmin
ner mpeacemandmfulfillment.
Peplau’smTheory mof mInterpersonalmRelations
Peplau’smTheory mofmInterpersonalmRelations:memphasizedmthatmthemnaturemofmthemnursemtompatientmrelati
onship mstrongly minfluenced mthemoutcome mformthempatient.
Freud-mwhatmdid mhemcontribute mto mpsychiatric msetting?
SigmundmFreudm(1856mto m1939),man mAustrianmneurologist,mismconsideredmthem“fathermofmpsychiatry.”mHis
mwork mwas mbasedmon mpsychoanalyticmtheory,min mwhichmFreudmclaims mthatmmostmpsychologicalmdisturbance
smaremthemresultmofmearlymtraumamormincidentsmthatmaremoften mnotmrememberedmormrecognized.mFreudm(1961
)midentifiedmthreemlayersmofmmentalmactivity:mthemconscious,mthempreconscious,mand mthemunconsciousmmin
d.
Onemof mFreud'smlatermandmwidelymknown mconstructsmconcernsmthemintrapsychicmstrugglemthatmoccursmwithi
n mthembrain mamongmthemid,mthemego,mand mthemsuperego.
Reviewmtablem3-2 m(pgm28)
TABLEm 3-
2mDEVELOPM EN T mOF mPERSON ALI TYm ACCO RDING m TO mFREU D, mSU LLIVAN, m AN Dm ERIKSON ∗
FREUD SULLIVAN ERIKSON
Oral—birth mto m1½myears Infancy— Infancy—birth mto m1½myears
birth mto m1½myearsmMotheringmobject
relievesmtension
m
, NURm2488mMentalmHealthmNursin
g
FinalmExammK
eymConcepts
FREUD SULLIVAN ERIKSON
Pleasure-painmprinciple through mempathicmintervention mand m
tenderness,mleadingmto mdecreased man
Id,mtheminstinctivemand mprimitivemmind,mis xiety mand mincreased msatisfaction man
mdominant d msecurity; mmothermbecomesmsymbo Trust m vs.m mistrust
lized m“good mmother”
Demanding,mimpulsive,mirrational,masocial Egocentric
,mselfish,mtrustful,momnipotent,mand mdepen Goalmismbiologicalmsatisfaction ma
dent nd mpsychologicalmsecurity Danger—
duringmsecond mhalf mof mfirstmyear,man
Primary mthought mprocesses Denialmof mtension mrelief mcreatesmanx mabrupt mand mprolonged mseparationmm
iety,mand mmothermbecomesmsymboli ay mintensify mthemnaturalmsensemof mlos
smand mmay mlead mto ma msensemof mmistr
Unconsciousminstincts—source-energy- zed masm“bad mmother”
ust mthat mmay mlast mthroughout mlife
maim-object
Anxiety min mmothermyieldsmanxiety
mand mfearmin mchild mvia mempathy
Task—
Mouth—primary msourcemof mpleasure
develop ma mbasicmsensemof mtrust mthatml
eadsmto mhopeTrust mrequiresma mfeelin
Immediatemreleasemof mtension/anxiety mand Thesemstatesmaremexperienced mby mthe gmof mphysicalmcomfort mand ma mminim
mchild min mdiffuse-
mimmediate mgratification mthrough moralmgr
almexperiencemof mfearmormuncertainty
atification undifferentiated mmanner
; mif mthismoccurs,mthemchild mwillmexten
d mtrust mto mthemworld mand mself
Task— Task—
develop ma msensemof mtrust mthat mneedsmwillm learn mto mcount mon mothersmformsatisfac
bemmet tion mand msecurity mto mtrust
Anal—1½mto m3 myears Childhood—1½mto m6 myears Early mchildhood—1½mto m3 myears
Realitym principle— Muscularmmaturation mand mlearningmt Autonomym vs.m shame/doubt
postponemimmediatemdischargemof menergy o mcommunicate mverbally
mand mseek mactualmobject mto msatisfy mneeds Develop mconfidence min mphysicalmand
Learningmsocialmskillsmthrough mcons mmentalmabilitiesmthat mleadsmto mthemd
Learningmto mdefermpleasure ensualmvalidation evelopment mof man mautonomousmwill
Gainingmsatisfaction mfrom mtoleratingmsom Beginningmto mdevelop mself- Danger—
emtension-masteringmimpulses esteem mvia mreflected mappraisals: development mof mamdeep msensemofmsh
ame/doubt mif mchild mismdeprived mof mt
Focusmon mtoilet mtraining— Good mm hemopportunity mto mrebel; mlearnsmto me
retaining/lettingmgo;mpowermstruggle xpect mdefeat min many mbattlemof mwillsm
emBad mm with mthosemwho marembiggermand mstr
Ego m development— onger
functionsmof mthemego mincludemproblem- emNot mm
solvingmskills,mperception,mability mto mmed Task—gain mself-
iatemid mimpulses controlmof mand mindependence mwithin
e mthe menvironment
Task—delay mimmediatemgratification Levelsmof mawareness
Awareness
