Psychiatric Nursing Lecture, Lecture notes of Nursing

Psychiatric Nursing Lecture Complete

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2024/2025

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NCM 117 - Psychiatric Nursing Lecture 1 (Prelims)
1 | P a g e
PSYCHIATRIC NURSING
HEALTH (WHO) – It is a state of complete physical, mental, and social well-
being and not merely the absence of disease and infirmity.
MENTAL HYGIENE
The branch of psychiatry that deals with the science and practice
of maintaining and restoring mental health, and of preventing
mental disorder through education, early treatment, and public
health measures.
Science of maintaining mental health and preventing disorders to
help people function at their full mental potential.
6 Techniques to Take Care of Our Mental Hygiene
by: Edward G. Brown
1. Transcend the environment
2. Cultivate constructive acceptance
3. Visualize the ideal self
4. Use positive affirmation
5. Practice psychological counterpunching
6. Change your internal computer chip
Mental Health
It is a state of emotional, psychological and social wellness
evidence by satisfying interpersonal relationships, effective
behavior and coping, a positive self-concept and emotional
stability.
It is a psychological state of well-being, characterized by
continuing personal growth, a sense of purpose in life, self-
acceptance, and positive relations with others.
It is the absence of mental illness.
It is the ability to solve problems, fulfill one’s capacity for love and
work, cope with crisis without assistance beyond the support of
family and friends, and maintain a state of well-being by enjoying
life’s setting goals and realistic limits, and becoming independent,
interdependent, or dependent as the need arises without
permanently losing one’s independence.
Factors Influencing Mental Health
Inherited characteristics
Nurturing childhood
Life’s circumstances
Ways To Maintain Mental Health
Good interpersonal communication
Ego defense mechanisms
Significant others or support people.
Involvement in physical activities
Characteristics Of Mental Health
Accepts self and others
Is able to cope with or tolerate stress
Can return to normal functioning if temporarily disturbed
Is able to form close and lasting relationship
Uses sound judgment to make decisions.
Accepts responsibility for actions
Is optimistic
Recognizes limitations (abilities and deficiencies)
Can function effectively and independently
Is able to distinguish imagined circumstances from reality
Is able to develop potential talents to fullest extent
Is able to solve problems
Can delay gratification
It reflects a person’s approach to life by communicating emotions,
giving and receiving, working alone as well as with others,
accepting authority, displaying a sense of humor, and coping
successfully with emotional conflict.
MENTAL DISORDER (APA)
It is a clinically significant behavioral or psychological syndrome
or pattern that occurs in an individual and that is associated with
present distress or disability or with a significantly increased risk of
suffering death, pain, disability or an important loss of freedom.
Characteristics of Mental Illness
Feels inadequate
Has poor self- concept
Is unable to cope
Exhibits maladaptive behavior
Is unable to establish a meaningful relationship
Displays poor judgment
Is irresponsible or unable to accept responsibility for actions
Is pessimistic
Does not recognize limitations, exhibits dependency needs
because of feelings of inadequacy.
Is unable to perceive reality
Does not recognize potentials and talents because of poor self-
concept.
Avoids problems rather than coping with them or attempting to
solve them
Desires or demands immediate gratification
It reflects a person’s inability to cope with stress, resulting in
disruption, disorganization, inappropriate reactions, unacceptable
behavior, and the inability to respond according to the person’s
expectations and the demands of society.
PSYCHIATRY
It is the science of curing or healing of the psyche.
It is the medical specialty that is derived from the study, diagnosis,
treatment and prevention of mental disorders.
PSYCHIATRIC NURSING
It is the ‘diagnosis and treatment’ of human responses to actual
and potential mental health problems.
It is a specialized area of nursing practice, employing theories of
human behavior as its science and purposeful use of self as its art.
(ANA).
It is an interpersonal process that strives to promote and maintain
behavior which contributes to integrated functioning. (Gail Stuart).
It is an interpersonal process whereby the professional nurse
practitioner assists an individual, family and community to
promote health, to prevent or cope with the experience of mental
illness and suffering and if necessar y to find meaning in these
experiences. (Travelbee).
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PSYCHIATRIC NURSING

HEALTH (WHO) – It is a state of complete physical, mental, and social well- being and not merely the absence of disease and infirmity. MENTAL HYGIENE ▪ The branch of psychiatry that deals with the science and practice of maintaining and restoring mental health, and of preventing mental disorder through education, early treatment, and public health measures. ▪ Science of maintaining mental health and preventing disorders to help people function at their full mental potential. 6 Techniques to Take Care of Our Mental Hygiene by: Edward G. Brown

  1. Transcend the environment
  2. Cultivate constructive acceptance
  3. Visualize the ideal self
  4. Use positive affirmation
  5. Practice psychological counterpunching
  6. Change your internal computer chip Mental Health ▪ It is a state of emotional, psychological and social wellness evidence by satisfying interpersonal relationships, effective behavior and coping, a positive self-concept and emotional stability. ▪ It is a psychological state of well-being, characterized by continuing personal growth, a sense of purpose in life, self- acceptance, and positive relations with others. ▪ It is the absence of mental illness. ▪ It is the ability to solve problems, fulfill one’s capacity for love and work, cope with crisis without assistance beyond the support of family and friends, and maintain a state of well-being by enjoying life’s setting goals and realistic limits, and becoming independent, interdependent, or dependent as the need arises without permanently losing one’s independence. Factors Influencing Mental Health ✓ Inherited characteristics ✓ Nurturing childhood ✓ Life’s circumstances Ways To Maintain Mental Health ✓ Good interpersonal communication ✓ Ego defense mechanisms ✓ Significant others or support people. ✓ Involvement in physical activities Characteristics Of Mental Health ✓ Accepts self and others ✓ Is able to cope with or tolerate stress ✓ Can return to normal functioning if temporarily disturbed ✓ Is able to form close and lasting relationship ✓ Uses sound judgment to make decisions. ✓ Accepts responsibility for actions ✓ Is optimistic ✓ Recognizes limitations (abilities and deficiencies) ✓ Can function effectively and independently ✓ Is able to distinguish imagined circumstances from reality ✓ Is able to develop potential talents to fullest extent ✓ Is able to solve problems ✓ Can delay gratification ✓ It reflects a person’s approach to life by communicating emotions, giving and receiving, working alone as well as with others, accepting authority, displaying a sense of humor, and coping successfully with emotional conflict. MENTAL DISORDER (APA) ▪ It is a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom. Characteristics of Mental Illness ✓ Feels inadequate ✓ Has poor self- concept ✓ Is unable to cope ✓ Exhibits maladaptive behavior ✓ Is unable to establish a meaningful relationship ✓ Displays poor judgment ✓ Is irresponsible or unable to accept responsibility for actions ✓ Is pessimistic ✓ Does not recognize limitations, exhibits dependency needs because of feelings of inadequacy. ✓ Is unable to perceive reality ✓ Does not recognize potentials and talents because of poor self- concept. ✓ Avoids problems rather than coping with them or attempting to solve them ✓ Desires or demands immediate gratification ✓ It reflects a person’s inability to cope with stress, resulting in disruption, disorganization, inappropriate reactions, unacceptable behavior, and the inability to respond according to the person’s expectations and the demands of society. PSYCHIATRY ▪ It is the science of curing or healing of the psyche. ▪ It is the medical specialty that is derived from the study, diagnosis, treatment and prevention of mental disorders. PSYCHIATRIC NURSING ▪ It is the ‘diagnosis and treatment’ of human responses to actual and potential mental health problems. ▪ It is a specialized area of nursing practice, employing theories of human behavior as its science and purposeful use of self as its art. (ANA). ▪ It is an interpersonal process that strives to promote and maintain behavior which contributes to integrated functioning. (Gail Stuart). ▪ It is an interpersonal process whereby the professional nurse practitioner assists an individual, family and community to promote health, to prevent or cope with the experience of mental illness and suffering and if necessary to find meaning in these experiences. (Travelbee).

SELECTED NURSING INTERVENTIONS THAT ARE COMMONLY USED

IN PSYCHIATRIC NURSING

✓ Active listening ✓ Anger control assistance ✓ Assertiveness training ✓ Behavior management ✓ Body image enhancement ✓ Caregiver support ✓ Communication enhancement ✓ Delusion management ✓ Eating disorders management ✓ Grief work facilitation ✓ Hallucination management ✓ Impulse control training ✓ Milieu therapy ✓ Mood management ✓ Role enhancement ✓ Sleep enhancement ✓ Spiritual support ✓ Substance abuse treatment ✓ Suicide prevention ✓ Teaching PHILOSOPHICAL BELIEFS RELATED TO THE EFFECTIVE PRACTICE OF PSYCHIATRIC NURSING

  • The individual had worth and dignity
  • The goal of the individual is one of growth, health, autonomy, and self- actualization.
  • Every individual has the potential to change and the desire to pursue personal goals.
  • The person functions as a holistic being that act on, interacts with, and reacts to the environment as a whole person. Each part affects the total response.
  • All people have common, basic, and necessary human needs.
  • All behavior is meaningful
  • Behavior consists of perceptions, thoughts, feelings and actions
  • Individuals vary in their coping capacities, which depend on genetic endowment, environmental influences, nature and degree of stress and available resources.
  • Illness can be a growth- producing experience.
  • All people have a right to equal opportunity for adequate care regardless of gender, race, religion, ethics, sexual orientation, or cultural background.
  • Mental health is a critical and necessary component of comprehensive health care services.
  • The individual has the right to participate in decision- making.

USE OF PSYCHIATRIC – MENTAL HEALTH NURSING SKILLS IN CAREER

OPPORTUNITIES

OBSTETRIC NURSING

▪ Helping the mother in labor and support person cope with anxiety or stress during labor and delivery. ▪ Providing support to the bereaved parents in the event of fetal demise, inevitable abortion, or the birth of an infant with congenital anomalies. ▪ Providing support to a mother considering whether to keep her child or give the child for adoption. FORENSIC NURSING ▪ Providing services to incarcerated clients ▪ Acting as consultant to medical and legal agencies ▪ Serving as an expert witness in a court ▪ Providing support for victims of violent crimes. ONCOLOGIC NURSING ▪ Helping cancer patients or other terminally ill individuals on oncologic units work through the grieving process. ▪ Providing support groups to families of terminally ill patients. INDUSTRIAL (OCCUPATIONAL HEALTH) NURSING ▪ Implementing or participating in industrial substance abuse programs for employees and their families. ▪ Providing crisis intervention during an industrial accident or the acute onset of a physical or mental illness ▪ Teaching stress management PUBLIC HEALTH NURSING ▪ Assessing the person both physically and psychologically (e.g. the newly diagnosed diabetic client may develop a low self- concept, or the recovering stroke client may exhibit symptoms of depression due to slow recovery) OFFICE NURSING ▪ Assisting the client by explaining somatic or emotional concerns during the assessment process ▪ Providing support with the problem- solving process when people call the office and the physician is unavailable. ▪ Acting as community resource person EMERGENCY ROOM NURSE ▪ Providing crisis intervention as the need arises (e.g. during natural disasters, accidents, or unexpected illnesses causing increased anxiety, stress or immobilization).

Mental Health – Is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well. What is the state of mental health globally? ▪ According to WHO it was estimated that 1 out of every 4 people will be impacted by mental illness at some point in their lives, 300 million people worldwide suffer from depression. What is the current situation of mental health in the Philippines?

  • In the Philippines the prevalence of mental disorders ranged between 11.3% and 11.6% with an average annual increase of 2.0% increasing from 7.0 to 12.5 million Filipinos diagnosed with a mental disorder between 1990 until 2019 underscoring the mental health agenda in the Phil. What is mental health in today’s world? ▪ Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It has intrinsic and instrumental value and is integral to our well-being. What is the rate of mental health problems in the world? ▪ 970 million people around the world struggle with some mental illness and drug abuse, 1 in every 4 people will be affected by a mental illness at some point in their lives. 14.3% of deaths worldwide or approximately 8 million deaths each year are attributable to mental disorders. What state has the most mental illness? ▪ Montana ▪ Across the US Montana had the highest rate of mental illness with 25.7% reporting any mental illness and 6.75 % reporting having a serious mental illness. MENTAL DISORDERS ACCORDING TO WHO- JUNE 8, 2022 ▪ 1 in every 8 people in the world live with mental disorder, mental disorders involve significant disturbances in thinking, emotional regulation or behavior. Who is at risk from developing a mental disorder? ▪ At any one time, a disease set of individual, family community and structural factors may combine to protect or undermine mental health. ▪ Although most people are resilient, people who are exposed to adverse circumstances including poverty, violence, disability and inequality are at higher risk. protective and risk factors include individual psychological and biological factors, such as emotional skills as well as genetics.

NEURONS

  • are nerve cells that send messages all over your body to allow you to do everything from breathing, talking, eating walking, and thinking.
  • It is also called as nerve cells and is the fundamental units of the brain and the Nervous system.
  • It is a type of cell that receives and send messages from the body to the brain and back to the body.
  • 86 billion of neurons and 100 billion in mature brain.
  • Researchers estimates that the brains hippocampus which plays a key role in learning, memory and emotion makes about thousands new neurons each day throughout adulthood. NEUROTRANSMITTERS
  • are endogenous chemicals that allow neurons to communicate with each other throughout the body.
  • They enable the brain to provide a variety of function through the process of chemical synaptic transmission, these endogenous chemicals are integral with shaping everyday life and function.
  • body’s chemical messenger, they carry messages from one nerve cell across a space to the next nerve, muscle or gland cell.
  • they relay messages- travel between cells- attaching to specific receptors on target cells. TYPES OF NEUROTRANSMITTERS:
  1. Serotonin
  2. Dopamine
  3. Glutamate
  4. Acetylcholine
  5. GABA- gamma aminobutyric acid MEMORY
  • refers to the psychological process of acquiring, storing, retaining, and later retrieving information. 3 major processes involved in memory?
  1. Encoding – initial learning of information
  2. Storage – maintaining information over time
  3. Retrieval – ability to access information when you need it. 3 types of Memory:
  4. Long term memory- unlimited storage of information to be maintained for long periods, even for life (creates long lasting memories)
  5. Short term memory - memory systems in the brain involved in remembering pieces of information for a short period of time, often up to 30 seconds.
  6. Working memory- type of short-term memory that allows a person to temporarily hold a limited amount of information ready for immediate mental use- (problem solving, reasoning, learning) Why memory is important in psychology? ▪ It is an integral part of human cognition since it allows individual to recall and draw upon past events to frame their understanding of the behavior within the present.

REPETITION

  • is a well-documented trigger for memory formation- the more times something is repeated the better it is remembered.
  • set of repeating or doing, saying or writing something again. Repetitive compulsions are repetitive patterns and behavior often stemming from unresolved and deep-rooted emotional pain or past traumas, the compulsion to repeat certain behaviors can also be caused by a mental illness like OCD (Obsessive Compulsive Disorder). OCD ▪ long lasting disorder in which a person experiences uncontrollable and recurring thoughts (obsession), engages in repetitive behaviors (compulsions) or both. ▪ People with OCD have time consuming symptoms that can cause significant distress or interfere with daily life. ▪ is a disorder in which people have recurring unwanted thoughts, ideas and sensations (obsessions) and to get rid of the thoughts they feel driven to do something repetitively (Compulsion) What is repetition of action called in Psychology?
  • Repetition of similar actions in similar circumstances is the definition of habit.
  • Habit is a result of gradual repetition of actions used over a period of time (sleeping, eating, drinking are some examples of habits) CONCEPTS AND PATTERNS OF HUMAN BEHAVIOR FAMILY DYNAMICS ▪ refers to the patterns of interactions among relatives, their role and relationships and the various factors that shape their interactions because family members rely on each other for emotional, physical, and emotional support, they are one of the primary sources of relationship security or stress. ▪ the processes by which family members influences, each other ’s thoughts, feelings, and behavior and the changes in the family relationships that these processes bring. 5 HEALTHY FAMILY DYNAMICS
  1. Cohesiveness
  2. Open communication
  3. Parents leading by example
  4. Conflict management
  5. Setting clear expectations and limits PATTERNS OF BEHAVIOR ▪ Behavior patterns are also described as chains of behavior, which are multifariously linked from simpler, smaller segments. ▪ a complex arrangement of 2 or more responses that occur in a prescribed order. ▪ Behavior – the way in which one acts or conducts oneself especially towards others the way in which a person acts in response to a particular situation or stimulus. Different types of Behavioral patterns:
  6. Passive aggressive tendencies – Indirectly expressing negative feelings instead of openly addressing them.
  7. Hostility – unfriendly, aggressive behavior towards people or ideas.
  8. Quick tempered
  9. Acting on impulse – when you act quickly with no thought to the consequence
  10. Self- sabotage – when people do things that block their success or prevent them from accomplishing their goals (self-medicate with drugs/alcohol, self-injury)
  11. Being attracted to the same sort of person each time. ANXIETY- FEELING OF FEAR, DREAD AND UNEASINESS ▪ Anxiety disorders are conditions in which you have anxiety that does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships. There are several types of anxiety disorders, including:
  12. Generalized anxiety disorder (GAD).
  • People with GAD worry about ordinary issues such as health, money, work, and family. But their worries are excessive, and they have them almost every day for at least 6 months.
  1. Panic Disorder.
  • People with panic disorder have panic attacks. These are sudden, repeated periods of intense fear when there is no danger. The attacks come on quickly and can last several minutes or more.
  1. Phobias.
  • People with phobias have an intense fear of something that poses little or no actual danger. Their fear may be about spiders, flying, going to crowded places, or being in social situations (known as social anxiety). What causes anxiety disorders? o The cause of anxiety is unknown. Factors such as genetics, brain biology and chemistry, stress, and your environment may play a role. Who is at risk for anxiety disorders? o The risk factors for the different types of anxiety disorders can vary. For example, GAD and phobias are more common in women, but social anxiety affects men and women equally. There are some general risk factors for all types of anxiety disorders, including:
  1. Certain personality traits, such as being shy or withdrawn when you are in new situations or meeting new people
  2. Traumatic events in early childhood or adulthood
  3. Family history of anxiety or other mental disorders
  4. Some physical health conditions, such as thyroid problems or arrhythmia.