MODULE 1
➔ Continuum of mental health/mental illness
◆ On one end of the continuum is mental health
● Mental health: a state of well-being in which each individual is able to realize his
or her own potential, cope with the normal stresses of life, work productively,
and make a contribution to the community
● Well-being is characterized by adequate to high-level functioning
● No serious impairments in daily functioning - may experience stress and
discomfort
◆ On the other end of the continuum is mental illness
● Mental illness: all psychiatric disorders that have definable diagnoses and
manifested in significant dysfunction that may be related to developmental,
biological, or psychological disturbances in mental functioning
● Individual may experience alt thinking, mood or behavior resulting in chronic
impairment or disability
● Emotional problems or concerns and experience mild to moderate discomfort and
distress
● Causing marked distress and moderate to disabling or chronic impairment
● Anything with a definable diagnosis
● Causes a significant dysfunction that may be developmental, biological, or
psychological disturbances
● Impairs the ability to think clearly at all times
● May cause behavioral alterations
➔ Risk and protective factors for developing mental health conditions
◆ Risk factors: Individual attributes and behaviors, genetics, biological, social & economic
circumstances, environmental
◆ Protective factors: resilience ( ability and capacity for people to secure resources to
promote well being) cultural and religious beliefs
➔ Define the Diathesis stress model: Nature vs. Nurture
◆ Suggests that both play a role individuals have biological predisposition and experience
environmental stress.
➔ DSM5 medical diagnosis vs. nursing diagnosis
◆ DSM5
● The actual, medical, diagnosis of the mental condition
● Provides criteria to diagnose psychiatric disorders
● Classification system
○ Realizes that symptoms vary culture to culture
● Organized on a developmental hierarchy
● System that allows us to diagnose someone
◆ Nursing diagnosis
● Clinical judgment concerning the patient’s response to their condition
● Assessment, diagnosis, planning, implementation, evaluation
● Provides framework for identifying appropriate nursing interventions
● A clinical judgment about actual or potential responses to health problems
● A way to guide treatment and care from a nursing perspective
➔ Terms
◆ Comorbid condition: the simultaneous existence of two or more disorders
◆ Incidence: the number of new cases of mental disorders in a healthy population within a
given period of time
◆ Prevalence: the total number of cases, new and existing, in a given population during a
specific period of time
, ◆ Parity: The equality of services given to mental health in relation to normal medical
conditions.
● Parity Act was passed in ‘96 requiring insurance companies to cover mental
health the same way they covered regular health. It didn’t work though, 87% of
companies enacted new rules that basically skirted the system. The Wellstone-
Domenici act of 2008 was for group plans with more than 50 employees.
Required everything for mental health to be identical to normal health in respect
to co-pays, coinsurance, out of pocket etc..
◆ Stigma: the belief that the overall person is flawed, characterized by social shunning,
disgrace, and shame
◆ Resilience: the ability and capacity for people to secure the resources they need to
support their well-being
➔ Psychiatric mental health nursing ROLE OF A NURSE
◆ Psychiatric-mental health RN (PMH-RN): a nursing graduate who possesses a diploma,
an associate degree, or a baccalaureate degree and chooses to work in the specialty of
psychiatric-mental health nursing
● Focus: promoting mental health through the assessment, diagnosis, and treatment
of human responses to mental health problems and psychiatric disorders
◆ Dedicated to promoting mental health through the assessment, diagnosis, and treatment
of behavioral problems, mental disorders, and comorbid conditions across the lifespan
◆ Assist people who are in crisis or who are experiencing life problems, as well as those
with long-term mental illness
◆ Phenomena of concern - human experiences and responses for psychiatric mental health
nurses
➔ Mental health nursing basic practice to advanced practice
◆ Psychiatric-mental health advanced practice RN (PMH-APRN): a licensed RN with a
Master of Science in Nursing (MSN) or Doctor or Nursing Practice (DNP) in psychiatric
nursing
● Coordination of care
● Health-teaching and health maintenance
● Milieu therapy
● Pharmacological, biological, and integrative therapies
● Medication prescription and treatment
● Psychotherapy
● Consultation
➔ What does a psychiatric mental health nurse do?
◆ Purposeful use of self
● Goal-directed and planned
◆ Identify and treat problems/responses to illness
◆ Assess and develop holistic plan of care that is grounded in theory and based on sound
research evidence
◆ Basic levels of intervention
● Coordination of care
● Health-teaching and health maintenance
● Milieu therapy
● Pharmacological, biological, and integrative therapies
➔ Therapeutic milieu
◆ What is milieu?
● Surrounding and physical environment
● In therapeutic content milieu refers to the overall environment interactions within
that environment
, ◆ What factor constitutes a therapeutic milieu?
● The setting, the people (patients and staff), the structure, and the emotional
climate
● Structured aspects - activities, rules, reality orientation practices, environment
➔ Continuum of care
◆ Provides patients with a wide range of treatment options
● Total freedom to total hospitalization
◆ Facilitates effective/appropriate care
◆ Standardized decision-making process
➔ Mental status exam
◆ Important in determining brain function
◆ Important in evaluating cog & Behavior for current function and diagnosis
◆ One time “snap shot” of the patient’s thoughts feelings and behavior
◆ More through than the mini mental status.
◆ There are 10 components to the exam
● Appearance
● Emotion - how pt is feeling, affect
● Thought process - logical?tangent
● Thought content - reality? Delusional ( persecuity, grandiose, somatic)vague?
● Perceptual distribution - sensory (seeing, hearing, tasting, smelling)
● Safety - duty to warn others break confidence
● Intellectual function - current events? Memory?
● Judgement - good, fair, poor?
● Insight - do they recognize they have a problem
● Motivation for treatment
➔ Stats on mental health
◆ 46.4% of all Americans will meet the criteria for a psychiatric disorder in their lifetime
◆ 44 million adults in the US experienced a diagnosable mental illness in 2013
MODULE 2: NURSE PT RELATIONSHIP & THERAPEUTIC COMMUNICATION
Chapter 8 - THERAPEUTIC RELATIONSHIP
➔ Terms:
◆ Therapeutic use of self (p. 125): use of distinct gifts/personality traits to promote healing
in others
◆ Psychotherapy (p. 125): “formalized approach to talk therapy that is based on theoretical
models”
● Who’s allowed to use psychotherapy: HCPs w/ advanced degrees and specialized
knowledge, psych-mental health RNs/NPs, psychologists
◆ Counseling (p. 125): “supportive, face-to-face process that help individuals problem-
solve, resolve personal conflicts and feel supported”
➔ Social v Therapeutic Relationship v. intimate
◆ Differences:
● Intimate: mutual needs are met with emotional commitment
● Social: intended for the purpose of friendship, socialization and enjoyment
○ Mutual needs are met
○ Communication may include giving advice and giving dependency
needs; communication is often superficial
● Therapeutic: nurse enhances the conversation to enhance pt’s growth
○ Nurse addresses pt issues and ID areas that need exploration and nurse
should periodically evaluate the degree of progress of the pt
○ Conversation/ relationship should be completely focused on the pt’s
➔ Continuum of mental health/mental illness
◆ On one end of the continuum is mental health
● Mental health: a state of well-being in which each individual is able to realize his
or her own potential, cope with the normal stresses of life, work productively,
and make a contribution to the community
● Well-being is characterized by adequate to high-level functioning
● No serious impairments in daily functioning - may experience stress and
discomfort
◆ On the other end of the continuum is mental illness
● Mental illness: all psychiatric disorders that have definable diagnoses and
manifested in significant dysfunction that may be related to developmental,
biological, or psychological disturbances in mental functioning
● Individual may experience alt thinking, mood or behavior resulting in chronic
impairment or disability
● Emotional problems or concerns and experience mild to moderate discomfort and
distress
● Causing marked distress and moderate to disabling or chronic impairment
● Anything with a definable diagnosis
● Causes a significant dysfunction that may be developmental, biological, or
psychological disturbances
● Impairs the ability to think clearly at all times
● May cause behavioral alterations
➔ Risk and protective factors for developing mental health conditions
◆ Risk factors: Individual attributes and behaviors, genetics, biological, social & economic
circumstances, environmental
◆ Protective factors: resilience ( ability and capacity for people to secure resources to
promote well being) cultural and religious beliefs
➔ Define the Diathesis stress model: Nature vs. Nurture
◆ Suggests that both play a role individuals have biological predisposition and experience
environmental stress.
➔ DSM5 medical diagnosis vs. nursing diagnosis
◆ DSM5
● The actual, medical, diagnosis of the mental condition
● Provides criteria to diagnose psychiatric disorders
● Classification system
○ Realizes that symptoms vary culture to culture
● Organized on a developmental hierarchy
● System that allows us to diagnose someone
◆ Nursing diagnosis
● Clinical judgment concerning the patient’s response to their condition
● Assessment, diagnosis, planning, implementation, evaluation
● Provides framework for identifying appropriate nursing interventions
● A clinical judgment about actual or potential responses to health problems
● A way to guide treatment and care from a nursing perspective
➔ Terms
◆ Comorbid condition: the simultaneous existence of two or more disorders
◆ Incidence: the number of new cases of mental disorders in a healthy population within a
given period of time
◆ Prevalence: the total number of cases, new and existing, in a given population during a
specific period of time
, ◆ Parity: The equality of services given to mental health in relation to normal medical
conditions.
● Parity Act was passed in ‘96 requiring insurance companies to cover mental
health the same way they covered regular health. It didn’t work though, 87% of
companies enacted new rules that basically skirted the system. The Wellstone-
Domenici act of 2008 was for group plans with more than 50 employees.
Required everything for mental health to be identical to normal health in respect
to co-pays, coinsurance, out of pocket etc..
◆ Stigma: the belief that the overall person is flawed, characterized by social shunning,
disgrace, and shame
◆ Resilience: the ability and capacity for people to secure the resources they need to
support their well-being
➔ Psychiatric mental health nursing ROLE OF A NURSE
◆ Psychiatric-mental health RN (PMH-RN): a nursing graduate who possesses a diploma,
an associate degree, or a baccalaureate degree and chooses to work in the specialty of
psychiatric-mental health nursing
● Focus: promoting mental health through the assessment, diagnosis, and treatment
of human responses to mental health problems and psychiatric disorders
◆ Dedicated to promoting mental health through the assessment, diagnosis, and treatment
of behavioral problems, mental disorders, and comorbid conditions across the lifespan
◆ Assist people who are in crisis or who are experiencing life problems, as well as those
with long-term mental illness
◆ Phenomena of concern - human experiences and responses for psychiatric mental health
nurses
➔ Mental health nursing basic practice to advanced practice
◆ Psychiatric-mental health advanced practice RN (PMH-APRN): a licensed RN with a
Master of Science in Nursing (MSN) or Doctor or Nursing Practice (DNP) in psychiatric
nursing
● Coordination of care
● Health-teaching and health maintenance
● Milieu therapy
● Pharmacological, biological, and integrative therapies
● Medication prescription and treatment
● Psychotherapy
● Consultation
➔ What does a psychiatric mental health nurse do?
◆ Purposeful use of self
● Goal-directed and planned
◆ Identify and treat problems/responses to illness
◆ Assess and develop holistic plan of care that is grounded in theory and based on sound
research evidence
◆ Basic levels of intervention
● Coordination of care
● Health-teaching and health maintenance
● Milieu therapy
● Pharmacological, biological, and integrative therapies
➔ Therapeutic milieu
◆ What is milieu?
● Surrounding and physical environment
● In therapeutic content milieu refers to the overall environment interactions within
that environment
, ◆ What factor constitutes a therapeutic milieu?
● The setting, the people (patients and staff), the structure, and the emotional
climate
● Structured aspects - activities, rules, reality orientation practices, environment
➔ Continuum of care
◆ Provides patients with a wide range of treatment options
● Total freedom to total hospitalization
◆ Facilitates effective/appropriate care
◆ Standardized decision-making process
➔ Mental status exam
◆ Important in determining brain function
◆ Important in evaluating cog & Behavior for current function and diagnosis
◆ One time “snap shot” of the patient’s thoughts feelings and behavior
◆ More through than the mini mental status.
◆ There are 10 components to the exam
● Appearance
● Emotion - how pt is feeling, affect
● Thought process - logical?tangent
● Thought content - reality? Delusional ( persecuity, grandiose, somatic)vague?
● Perceptual distribution - sensory (seeing, hearing, tasting, smelling)
● Safety - duty to warn others break confidence
● Intellectual function - current events? Memory?
● Judgement - good, fair, poor?
● Insight - do they recognize they have a problem
● Motivation for treatment
➔ Stats on mental health
◆ 46.4% of all Americans will meet the criteria for a psychiatric disorder in their lifetime
◆ 44 million adults in the US experienced a diagnosable mental illness in 2013
MODULE 2: NURSE PT RELATIONSHIP & THERAPEUTIC COMMUNICATION
Chapter 8 - THERAPEUTIC RELATIONSHIP
➔ Terms:
◆ Therapeutic use of self (p. 125): use of distinct gifts/personality traits to promote healing
in others
◆ Psychotherapy (p. 125): “formalized approach to talk therapy that is based on theoretical
models”
● Who’s allowed to use psychotherapy: HCPs w/ advanced degrees and specialized
knowledge, psych-mental health RNs/NPs, psychologists
◆ Counseling (p. 125): “supportive, face-to-face process that help individuals problem-
solve, resolve personal conflicts and feel supported”
➔ Social v Therapeutic Relationship v. intimate
◆ Differences:
● Intimate: mutual needs are met with emotional commitment
● Social: intended for the purpose of friendship, socialization and enjoyment
○ Mutual needs are met
○ Communication may include giving advice and giving dependency
needs; communication is often superficial
● Therapeutic: nurse enhances the conversation to enhance pt’s growth
○ Nurse addresses pt issues and ID areas that need exploration and nurse
should periodically evaluate the degree of progress of the pt
○ Conversation/ relationship should be completely focused on the pt’s
