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 fruitfully, and make a contribution to the community.

Mental health provides people with the capacity for:

(components of mental health)

rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem.

a clinically significant behavioral or psychological syndrome marked by the patient's distress, disability, or the risk of suffering disability or loss of freedom.

marked distress or suffer from impairment or inability to function in our everyday lives

mental health and mental illness can be conceptualized as points along a ____ _______ ______.

adequate to highlevel functioning in response to routine stress and resultant anxiety or distress.

cultural and ethnic factors.

closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress.

occur in specific sociocultural contexts and are easily recognized by people in those cultures.

For example, one syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behavior.

—  Predisposing characteristics that, if present for a person, make it more likely that he or she will develop a disorder

◦       Biological, psychosocial, environmental

—  Coping resources and coping mechanisms that can improve a person’s response to stress, resulting in adaptive behavior

What is the Diathesis-Stress Model?

—  Diathesis – biological predisposition

—  Stress – environmental stress or trauma

— 

Most accepted explanation for mental illness

—  Combination of genetic vulnerability and negative environmental stressors

What theorists are credited for the 

Psychoanalytic theory?

(Freud/Erikson)

ego develops defenses, or defense mechanisms.

What are they?

ward off anxiety by preventing conscious awareness of threatening feelings.

operate on an unconscious level

they deny, falsify, or distort reality to make it less threatening.

Erikson's Eight Stages of Development

Trust vs. mistrust occures between what ages?

Early childhood

(1.5-3 years)

Late childhood

3-6 years

School age

(6-12 yr)

Erikson's Eight Stages of Development

Identity vs. role confusion occures between what ages?

Adolescence

(12-20 yr)

Early adulthood

20-35 years

Middle adulthood

(35-65 yr)

Later years

(65 yr to death)

◦       Participant observer- theripist are involved 

◦       Self-awareness- on steffs part inorder to be effective

◦       Experiential learning- give pt a chance to practice new skills

who was involved is deleloping the Behavioral theory?

observations of behaviors in dogs

Classical conditioning (involuntary)

narula reflex

What is Operant conditioning?

receiving a reward

causes a behavior to occur more frequently

such as the removal of an objectionable or aversive stimulus

(walking freely through a park once the vicious dog is picked up by the dogcatcher).

◦       Thoughts come before actions

◦       Negative thoughts basis for problems

◦       Cognitive Behavioral Therapy – CBT- was developed as a result. 

◦       Focus is on “Here and Now”- don't talk about child hood. what can we do now to fix it?

What is the —  Biological (psychotropics)?

◦       Problems are a result of neurological, chemical, or genetic issues

Medication is a common treatment

Mental disorders are considered a manifestation of a ______, ______, or _______ a dysfunction of the individual.

–   Behavioral

–   Psychological or

–   Biological

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) is used to:

classify diagnostic categories for psychiatric disorders

Multiaxial System

What is Axis I:

Mental disorder that is the focus of treatment

Personality disorders and mental retardation

General medical disorder relevant to the mental disorder in axis I

Psychosocial and environmental problems

Global Assessment of Functioning (GAF)

1-100

1-40 low

80-norm

The North American Nursing Diagnosis Association (NANDA) describes a nursing diagnosis as a:

clinical judgment about individual, family, or community responses to actual or potential health problems and life processes.

What can a Basic Level Nurse do in a psych setting?

Counseling, Milieu therapy, Self-care activities, Psychobiological intervention, Health teaching, Case management, Health promotion and maintenance

How does a nurse creat a Therapeutic Milieu?

Maintain an atmosphere of healing and growth . Monitor emotional climate and level of tension. Communicate behavioral limits and rules. Monitor that boundaries are consistently enforced. Hold all clients and staff responsible for their own behavior. Involve clients in some decision making. Direct staff to frequently interact therapeutically with clients 

What is the criteria to justify involuntary admissions?

Danger to self or others

True

if they are not a harm to them selfs or others

Right to treatment/refuse

Right to informed consent

Rights r/t restraints= least restictive for shortest amount of time as possible

Right to confidentuality

type of voluntary admission that is similar to any general hospital admission in which there is no formal or written application

the patient is free to stay or leave, even against medical advice.

sought by the patient or the patient's guardian through a written application to the facility.

states require that a patient submit a written release notice to the facility staff, who reevaluate the patient's condition for possible conversion to involuntary admission

 used (1) for people who are so confused or demented they cannot make decisions on their own or (2) for people who are so ill they need emergency admission.

generally patients can be held no more than 15 days under the temporary procedure.

admission to a facility without the patient's consent.

presents a danger to self or others, or is unable to meet his or her own basic needs.

Chemical interventions (i.e., med¬ ications) are usually considered less restrictive than physical/mechanical interventions (i.e., restraints and seclusion).

True or Fales?

True

but they can have a greater impact on the patient's ability to relate to the environment

When the particular behavior is physically harmful to the patient or a third party 

• When alternative or less restrictive measures are insufficient to protect the patient or others from harm 

• When a decrease in sensory overstimulation (seclusion only) is needed 

• When the patient anticipates that a controlled environment would be helpful and requests seclusion

• On the written order of a physician

• When orders are confined to specific time-limited    periods (e.g., 2 to 4 hours) 

• When the patient's condition is reviewed and documented regularly (e.g., every 15 minutes) 

• When the original order is extended after review and reauthorization (e.g., every 24 hours) and specifies the type of restraint

willful or intentional acts that violate another person's rights or property.

Some examples of intentional torts include assault, battery, and false imprisonment

What is Cognitive restructuring?

Cognitive Behavioral Treatment

Monitoring thoughts and feelings, questioning the evidence, examining alternatives, decatastrophizing, reframing, thought stopping

What type of theripy is Problem focused, goal oriented, and deals with here-and-now issues?

Cognitive Therapy

Types of group therapy:

Closed group - no one new once the group has formed  

Open group - like AA all are welcome any time

Heterogeneous group - verity of problems  

Homogeneous- same types of problems 

Subgroup-group within a group, can be negitive

What are the advantages of Group Work?

Cost effective

Client feels less isolated

Clients receive peer feedback

Teach different problem-solving approaches

Therapeutic Factors in Groups:

Instillation of hope, Universality, Imparting of information, Altruism, Corrective recapitulation of the primary family group, Development of socializing techniques, Imitative behavior, Interpersonal learning, Group cohesiveness, Catharsis, Existential resolution

Phases of Group Development:
Roles of Leader and Group

Initial phase (forming)

Leader: Set up an atmosphere of respect, confidentiality, and trust

Group: Get to know one another

Phases of Group Development: 
Roles of Leader and Group

Working phase (storming)

Leader: Encourage members to cooperate with each other and handle conflict

Group: Issues of power and control

Phases of Group Development: 
Roles of Leader and Group

Mature phase (norming)

Leader: Keep group focused on therapeutic goals of individual members

Group: Develops functional norms and a sense of group identity

Phases of Group Development: 
Roles of Leader and Group

Termination (performing)

Leader: Acknowledge the contributions of each member and the experience as a whole

Group: Prepare for the separation and for the future

What are Patterns of Problematic Behaviors in Group Members?

¨  Monopolizes group

¨  Complains but continues to reject help

¨  Demoralizes others

¨  Silent person

Basic Level Registered Nurse 

Able to assume responsibility for the following groups: 

Medication education,  Sexuality ,  Dual-diagnosis,  Multifamily,  Symptom management,   Stress management,  Community ,  Self-care

Functions of a Healthy Family

Management 

The adults agree how these functions are to be performed

Functions of a Healthy Family

Clear; help define roles and allow for differences

Functions of a Healthy Family

Clear and direct messages about wants and needs

Functions of a Healthy Family

Emotional-supportive

Feeling of affection dominate family pattern; members’ emotional needs are met

Functions of a Healthy Family

Socialization

Members flexible in adapting to new roles within the family

What is the purpose  of a  Therapeutic Relationships?

—  Needs of patient identified and explored

—  Clear boundaries established

—  Problem-solving approaches taken

—  New coping skills developed

     Behavioral change encouraged

What is the purpose  of a Social Relationships?

—  Initiated for the purpose of friendship or meeting a goal

—  Mutual needs are met

—  Communication can be to give advice, give or ask for help

—  Content of communication can be superficial 

What must a  nurse be in order to establish a therapeutic relationship with a pt ?

To establish that the nurse is

◦       Safe

◦       Confidential

◦       Reliable

◦       Consistent

What are 4  Therapeutic Relationships Goals?

—  Facilitate communication of distressing thoughts and feelings

—  Assist patient with problem solving

—  Help patient examine self-defeating behaviors and test alternatives

—  Promote self-care and independence

What is the Blurring of Boundaries in the nurse pt realationship?

—  When relationship slips into social context

—  When nurse’s needs are met at expense of patient’s needs

Sings of a Detrimental Nurse-Client Relationship

Nurse tries to get his or her own needs met.

Nurse needs to be needed.

Nurse tries to solve the client's problems.

Nurse sets unrealistic goals for client.

Nurse takes the role of a friend or family member of the client.

Difficulty terminating the nurse-client relationship.

Lack of boundaries in the relationship

Peplau’s Model of Nurse-Patient Relationship

What are the three phases?

—  Orientation phase

—  Working phase

—  Termination phase

What is the —  Orientation phase?

—  Establishing rapport

—  Parameters of the relationship

—  Formal or informal contract

—  Confidentiality

—  Terms of termination

—   

What is the —  Working phase?

—  Maintain relationship

—  Gather further data

—  Promote patients:  problem-solving skills, self-esteem, use of language

—  Facilitate behavioral change

—  Overcome resistant behaviors

—  Evaluate problems and goals

◦       Redefine them as necessary

—  Promote practice and expression
of alternative adaptive behaviors

What is the Termination phase?

—  Summarize goals and objectives achieved

—  Discuss ways for patient to incorporate new coping strategies learned

—  Review situations of relationship

—  Exchange memories

What are Factors That May Help Nurse-Patient Relationship?

—  Consistency

—  Pacing

—  Listening

—  Initial impressions

—  Promoting patient comfort and balancing control

What Are Factors That Encourage and 

Promote Patient Growth?

—  Genuineness

—  Empathy (not sympathy)

—  Positive Regard (attitudes, actions)

—  Suspending value judgments

—  Helping patients develop resources

What are some Clarifying Techniques?

—  Paraphrasing

—  Restating

—  Reflecting

—  Exploring

What are some Nontherapeutic Communication Techniques?

—  Excessive questioning

—  Giving approval or disapproval

—  Giving advice

—  Asking “why” questions

—  Double or mixed messages

D) A distinction cannot be made

D) a normal response to a perceived threat.

D) vulnerability.

D) reciprocal closeness.

D) "If you fine comfort in prayer, I'd encourage you to pray."