Mental Health Nursing: Test 1 ALL SOLUTION FALL-2022 LATEST SOLUTION 100% CORRECT GUARANTEED GRADE A+

● Defined by World Health Organization (WHO) ○ “Mental health is 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.” ● Defined by American Psychiatric Nurses Association: ○ “Emotional and psychological wellness; the capacity to interact with others, deal with ordinary stress, and perceive one’s surroundings realistically” ● Mental health is a Continuum ● Trait of Mental Health ○ Ability to: ■ Think rationally ■ Communicate appropriately ■ Learn and be productive ■ Grow emotionally ■ Be resilient ● Ability and capacity to secure the resources needed to support well-being ● Characterized by (more by definition) ○ Optimism ○ Sense of mastery ○ Competence ● Essential to recovery ○ Ex. fail an exam and not fall apart ○ Doing what you have to do to get through what you need to ■ Have a healthy self-esteem ■ Cope effectively ■ Care for self ● Can affect daily activities ■ Have self-control and self-awareness Mental Illness ● Defined by American Psychiatric Nurses Association: ○ Disturbance in thoughts or mood that causes maladaptive behavior, inability to cope with normal stresses, and/or impaired functioning (ANA, 2007) ● Maladaptive behavior ○ Ex- Bipolar: shopping ● Disorders with definable diagnosis; DSM-5 ○ Bible for MD to diagnosis ● “Time and impact” ○ How long ■ Short term ■ Long term ○ How is it impacting my life ■ Social relationships ■ Work ● Significant dysfunction in mental functioning related to ○ Developmental ○ Biological ○ Physiological disturbances ● Culturally defined ○ Some cultures have their own views on why - cant judge those views even if they think they need an exorcism ● Mental health and illness are on a continuum in terms of stress and impairment ○ Mental Health and Well-Being is only OCCASIONAL distress without impairment ○ Mild to moderate can move to marked distress and then to chronic or disabling impairment Causes of Mental Illness ● Bio, Psycho, and Social factors ● Stress Diathesis Model ○ Diathesis – Biological predisposition ○ Stress – Environmental stress or trauma ○ Most accepted explanation for mental illness ○ Combination of genetic vulnerability and negative environmental stressors ○ Nature vs Nurture out of favor ■ Now more about Epigenetics ● Genetic markers more identifiable now Impact of Mental Illness Physical Health: Morbidities ● Diabetes - 56% ● Pulmonary disease - 55% ● CVD - 57% ○ Correlation not exact causation Burden of mental Illness ● Economic and social burden of mental illness in the US is among the highest of all diseases ○ Ex: losing your job, not wanting to go in. ● The National Institute of Mental Health ○ estimates $300 billion/year in lost wages ● Mental health represents ○ 6.2% of all health care expenditures ● Among the most common causes of disability ○ 1 in 4/5 adults in the US have a mental disorder ○ 1 in 17 (13 million) have a serious mental illness ○ 1 in 5 children have a mental illness ● Overdose: 115 daily deaths in U.S. Factors Affecting Severity/Progression ● Risk and Protective Factors (semi overlap) ○ Resiliency & available support ○ Family influences, developmental events ○ Personality ○ Cultural (and subcultural), spiritual, & religious beliefs ○ Perceptions, health practices, & beliefs ○ Social influences ○ Biology, genetics, hormonal influences ○ Psychosocial , socioeconomic, demographics, environment ● Risk: more has to do with things like the environment, social, psychosocial and if it has a negative impact ● Social and Legislative Influences ** she kinda skipped this guessing its not as important??* ○ Consumer/recovery movement ○ 1979: National Alliance on Mental Illness (NAMI) paternalistic relationship was demoralizing, implied clients were not competent ○ 1990: Decade of the brain ○ 1996: Mental Health Parity Act ○ 1999: Surgeon General’s First Report on Mental Health ○ 2003: New Freedom Commission on Mental Health: less fragmentation of care ○ 2010: Mental Health Parity Act : Affordable Care Act ● Cultural Aspects of Illness ○ Important to understand the impact!! ○ Boundaries between normality and pathology vary across cultures for specific behaviors ○ Thresholds of tolerance for specific symptoms or behaviors differ across cultures, social settings and families. ○ Judgment that a given behavior is abnormal and requires clinical attention depends on cultural norms (APA, 2013) ● Cultural Humility ○ lifelong process of self reflection, self-critique and commitment to understanding and respecting different points of view and engaging humbly, authentically and from a place of learning (Tervalon & Murray-Garcia, 1998) ○ Being HUMBLE and ACCEPTING ■ May have to make certain accommodations and valuing their cultures- it might be important in their healing ● Ex: story of pt. Needing to face a certain way or needing a rug ect. Guiding Principles of Recovery ● Self-directed ○ Pt. has to WANT to be better ● Individual & person-centered ● Empowering ● Holistic ● Nonlinear ○ Not just a straight line/process to getting better or sick ● Strength-based ● Peer-supported ● Respect ● Responsibility ● Hope Evolution of the Treatment of Mental Illness **quick review** ● Basically - bad conditions: jail, sanitation, abuse ○ 1840’s: Dorothea Dix lobbies for more humane care of the mentally ill and establishes 32 state hospitals for the mentally ill. ○ Late 1800’s: State mental hospitals become over-crowded and custodial care supersedes humane treatment. ○ Early 1900’s: Clifford Beers publishes his autobiography, A Mind That Found Itself ○ 1950’s: Chlorpromazine (Thorazine, CPZ) developed helps control psychotic symptoms ○ 1960’s: Some deinstitutionalization is possible because of anti-psychotic drugs, many people left untreated become homeless. ○ 1963: Mental Retardation Facilities and Community Mental Health Centers Act (deinstitutionalization) ○ 1979: National Association on Mental Illness ○ 1980 Community Mental Health Systems Act (funding terminated in 1984) ○ 1990: The Decade of the Brain, designated by President G.H.W. Bush to advance the worldwide growth of scientific research ○ 1999: The Surgeon General’s Report of Mental Health: ○ : Human Genome Project, biologic and genetic explanation for psychiatric disorders ○ 2005: IOM’s Improving the Quality of HealthCare for Mental and Substance-Use Conditions ● Changes to deinstitutionalized ○ BUT there was a call for SUPPORT that isn’t always addressed ○ No meds or care :( ○ Still not always an understanding - not being in rehab center or guided to help Classification of Mental Disorders: ● DSM-5: The Diagnostic and Statistical Manual of Mental Disorders, 5th edition ○ Classifications of DISORDERS NOT PEOPLE ■ People WITH ** insert disorder** - this language is important!! ○ Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders ○ Organizes diagnoses on a developmental hierarchy ○ Classifies disorders, not people! ○ Other classifications: ICD-10-CM (WHO 2016) ■ More for coding and billing ■ And meeting a criteria ● NANDA ○ The North American Nursing Diagnosis Association International ○ (NANDA-I) describes a nursing diagnosis as a clinical judgment about individual, family, or community responses to actual or potential health problems and life processes; identifies appropriate interventions ○ Medical Care: reductionist, looks at a piece of the system, rather than the whole Psychiatric/Mental Health Nursing ● Definition ○ Nursing practice committed to promoting mental health through the assessment, diagnosis, and treatment of human responses (NOT illness) to mental health problems and psychiatric disorders ○ Employs a purposeful use of self as its art and a wide range of nursing ■ You are the tool - use self and ability to listen, show respect and non judgment to make pt. Comfortable ■ psychosocial and neurobiological theories and research evidence as its science ● History of Psychiatric Nursing **kinda skipped** ○ First training school for PMHN was The Boston City Hospital Training School for Nurses at McLean Hospital 1882 ○ 1950: NLN requires all nursing schools to have clinical experience in psychiatry in order to receive accreditation ● Hildegard Peplau: Mother of Psychiatric Nursing ○ The Essence of Healing is in the Interpersonal Relationship ■ Foundation of nursing Delivery of Care ● Hospital based care ● State hospital systems ● Community Mental Health Centers ● PACT (Program of Assertive Community Treatment) ○ Team goes to them ○ At home checks ○ Emergency calls ● Day-Evening Treatment/Partial Hospitalization Programs ● Intensive outpatient programs ● Community Residential Facilities, i.e. group homes ● Psychiatric Home Health Care ● Telepsychiatry Quality and Safety Education for Nurses (QSEN) ● Key areas of care: ○ Patient-centered care : guided by patient’s values, preferences, & needs ○ Teamwork and collaboration: open communication, shared decisions ○ Evidence-based practice: integrating best evidence with patient values ○ Quality improvement: nurses monitor outcomes, test changes ○ Safety: minimization of harm via system & individual performances ○ Informatics: communicate, manage knowledge, mitigate error, support clinical decision-making ● Goal of QSEN Project: to meet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare system within which they work. Levels of Psychiatric Nursing ● Basic Level ● Advanced Practice ● Each has clearly defined roles ● Psychiatric-Mental Health Nursing: Scope and Standards of Practice - See more at: ● The Nurse as a Member of the PMH Team -Team work makes the dream work ● Multidisciplinary, coordinated, integrated care ● Members of the Team include: ○ Client/patient ○ Psychiatrist/Psychiatric Nurse Practitioner ○ Psychiatric Nurse ○ Clinical Psychologist ○ Psychiatric Social Worker ○ Therapist: Occupational, Creative Arts, Leisure/Recreational, Vocational ○ Mental Health Worker or Psychiatric Aide Building a Therapeutic Relationship ● Essential conditions: ○ Rapport ○ Trust – confidentiality ○ Respect ○ Genuineness ○ Empathy ● Phases of a Therapeutic Relationship **HALLMARK ** ○ Pre-interaction phase: preparation for the first encounter with the client, explore self-perceptions ○ Orientation phase: establish trust and formulate contract for intervention begin to address termination ○ Working phase: promote client change ○ Termination: Evaluate goal attainment and ensure therapeutic closure Community Mental Health Nursing ● Public Health Model **HALLMARK** ○ Primary prevention: reducing the incidence (# of new cases) of mental disorders within the population ■ Examples of Primary Prevention: - get in ahead of time before it progresses (help them secure the bag) - ● Helping people avoid stressors or cope with them more adaptively ● Stress management classes for nursing students ● Parenting skills to prospective parents, ● Drug Abuse Resistance Education (DARE) ○ Secondary prevention: decreasing the prevalence (# of existing cases) of mental disorders ■ Examples of Secondary Prevention ● Early case finding ● Screening ● Prompt and effective treatment ● EXAMPLE: ○ Telephone hotlines ○ Crisis intervention ○ Disaster responses ○ Tertiary prevention: reducing the severity or disability associated with a mental disorder ■ Examples of Tertiary Prevention ● Rehabilitative services ● Avoidance or postponement of complications ● EXAMPLE: ○ Day treatment programs ○ Case management for physical, housing, or vocational needs ○ Social skills training Adverse Childhood Experience (ACE) Study - direct correlation - ● Collaboration between Kaiser Permanente and CDC ● Participants answered questionnaires about adverse childhood events; recruited from ● 8,667 completed the questionnaire ● Mental health problems were correlated with ACE’s ● Higher ACE scores correlated with depression, alcohol abuse, suicide, smoking ● Childhood abuse and neglect: Higher risk for heart, lung and liver diseases, obesity, cancer, high blood pressure, and high cholesterol ● The Current Picture in America **JUST A PICTURE FOR REFERENCE** ● Nearly 1 in 5 Americans experience a mental illness ● Nearly 1 in 25 (10 million) adults in America live with a serious MI ● ½ of all chronic mi begins by age 14; ¾ begins by age 24 ● 18.1% (42 million) of American adults live with anxiety disorders ● 6.9% (16 million) of American adults live with major depression ● 26% of America’s homeless in shelters have a serious mi ● 24% of state prisoners - recent history of a mental health condition ● Serious mental illness costs America $193 billion in lost earnings ● 90% of those who die by suicide have an underlying mental illness Implications for Nursing ● Mental Health education to emphasize the humanistic approach: ○ “…to treat every patient with the highest possible regard.” Irwin Yalom, MD ● To ensure all nursing students receive quality instruction in caring for persons with mental illness: patients with mental illness will be in all areas of medical facilities ● To secure a generalist nurse base in education, then focus on specialty nursing ● To maintain competence through continuing education on advancements in treatment of patients with mental illness ● To encourage activism/advocacy for persons with mental illness ● Our job is to destigmatize ! Future Challenges and Roles ● Education ○ demand for psychiatric nurses; ANCC certification; BSN ● Aging population ○ increased # clients with dementia: inpatient, home care, assisted living, retirement communities ● Patient advocacy ○ reduce stigma ● Legislative involvement ○ review local and national policies; APNA; nurses are the LARGEST contingent of mental health care providers ● Changing environment in mental healthcare ○ Outpatient treatment facilities, etc. ● Can the ADN-prepared RN meet the challenge of a specialty such as psychiatry/mental health: Yes! ● Aging workforce ● Declining inpatient population ○ less opportunity for nursing education ● Patient acuity ○ more serious illness ● Cultural diversity ● Science and Technology ● Electronic Healthcare ● Integrated, coordinated treatment of co-occurring substance use and mental health disorders. ● Education ○ need for qualified nursing educators ● Nursing research in Mental Health Future Opportunities ● Equine Therapy – ○ PTSD ● Walk and talk therapy – ○ Anxiety/Depression ● LED treatment for TBI/PTSD ● Expanding technology: ○ integrating EMRs, confidentiality, genomic testing, tele-psychiatry, internet-based psychotherapies ● Alternative /complementary treatments ● Alternatives in use of technology: ○ deep brain stimulation for PTSD Relevant Theories and Therapies for Nursing Practice ● Help us to explain theories to explain theories ● We need to be aware of abnormal behaviors Theories ● Sigmund Freud - psychoanalysis ○ Unconscious mental activity ○ Role of childhood experiences ○ 3 levels of awareness ■ Conscious ■ Preconscious ■ Unconscious ○ Levels of Awareness ■ Transference - the unconscious tendency to assign to other’s feelings and attitudes associated with a significant person to the therapist ● Positive/ negative ○ Ex. remind me of my mom ■ Countertransference - the therapist’s emotional involvement with a client ● As nurse how they make you feel