Review notes some of the information is not in your psychiatric text book.

Read chapter 2 and 3 (will have question on quiz)

Personality is defined by the DSM-IV-TR as “enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts.”

Life-cycle developmentalists believe that people continue to develop and change throughout life, thereby suggesting the possibility for renewal

and growth in adults.

TheoriesFreud’s theory of psychosexual development

Erikson’s eight development stages

Harry Stack Sullivan’s interpersonal theory

Mahler’s theory of object relations development

Piaget’s cognitive development

Kohlberg’s theory of moral development

Nursing Peplau’s stages

Youtube site Mental Health Videohttp://www.youtube.com/watch?v=7H-joP-QX

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Mental HealthDefined as “The successful adaptation to

stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-

appropriate and congruent with local and cultural

norms.” Stages are identified by age. However,

personality is influenced by temperament (inborn personality characteristics) and the environment.

It is possible for behaviors from an unsuccessfully completed stage to be modified and corrected in a later stage.

Mental IllnessDefined as “Maladaptive responses to stressors

from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational, or physical functioning.”

Horwitz describes cultural influences that affect how individuals view mental illness. These include Incomprehensibility – the inability of the general population to understand the motivation behind the behavior. Cultural relativity – the “normality” of behavior is

determined by the culture.

Psychological Adaptation to Stress

Anxiety and grief have been described as two major, primary psychological response patterns to stress.

A variety of thoughts, feelings, and behaviors are associated with each of these response patterns.

Adaptation is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual’s functioning.

Anxiety

A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness.

Extremely common in our society. Mild anxiety is adaptive and can provide

motivation for survival.

Peplau’s four levels of anxietyMild-

Moderate –

Severe –

Panic –

Behavioral Adaptation Responses to Anxiety

At the mild level, individuals employ various coping mechanisms to deal with stress. A few of these include eating, drinking, sleeping, physical exercise, smoking, crying, laughing, and talking to persons with whom they feel comfortable.

Anxiety at the moderate to severe level that remains unresolved over an extended period of time can

contribute to a number of physiological disorders – for example, migraine headaches, IBS, and cardiac arrhythmias.

Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving – for example, anxiety disorders and somatoform disorders.

Small Group DiscussionDiscuss experiences you have had in clinical

were a patient was very anxious and how this effected you in providing care or educating the patient.

How did you deal with the patient.

GriefThe subjective state of emotional, physical, and

social responses to the loss of a valued entity; the loss may be real or perceived.

Elisabeth Kübler-Ross

(5 Stages of Grief)

Defense MechanismsCompensationDenialDisplacementIdentificationIntellectualizatio

nIntrojectionIsolationProjection

RationalizationReaction

formationRegressionRepressionSublimationSuppressionUndoing

DSM-IV-TR Multiaxial Evaluation SystemAxis I Axis II –Axis III – Axis IV – Axis V –

PsychobiologyThe 101st Congress of the U.S. designated

the 1990s as the “Decade of the Brain,” with the challenge for studying the biological basis of behavior.

In keeping with the neuroscientific revolution, greater emphasis is placed on the study of the organic basis for psychiatric illness.

Youtube site to reviewThe Brain--Emotions, Neurons,

Neurotransmittershttp://www.youtube.com/watch?v=r71RoIkftd

4NEURONS AND NEURO-TRANSMITTERShttp://www.youtube.com/watch?v=DF04XPBj5

ucNeurotransmitter Synapse 3D Animationhttp://www.youtube.com/watch?v=90cj4NX87

YkSynapse animationhttp://www.youtube.com/watch?v=CiZLnbKVI

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Implications for NursingEmphasis in psychiatric nursing is on a

smooth transition from a psychosocial approach to a biopsychosocial focus

Psychiatric nurses must have a specialized knowledge about Neuroanatomy and neurophysiology Neuronal processes Neuroendocrinology Circadian rhythms Genetic influences Psychoimmunology Psychopharmacology Diagnostic technology

Neurotransmitters play an important role in human emotions and behavior and are the target for the mechanism of action in many psychotropic medications.Major categories of neurotransmitters

Circadian rhythmsFollow a near-24-hour cycle in humans and may

influence a variety of regulatory functions, including the

sleep-wake cycle, body temperature regulation, patterns of activity such as eating and drinking, and hormone secretion.

Some mood disorders have been linked to increased secretion of melatonin during darkness hours.

Symptoms that occur in the premenstrual cycle have been linked to disruptions in biological rhythms.

Sleep-wake cycle is one of the most common biological rhythms that demonstrates circadian influence.

Sleep stages 0 – Alpha 1 – Beta2 – Theta 3 – Delta4 – DeltaREM - Beta

Neurochemical influences on sleep-wake cycle

Serotonin and L-tryptophan Norepinephrine and dopamine GABA Acetylcholine

Ethical and Legal Issues in Psychiatric/Mental

Health Nursing

DefinitionsEthics -Bioethics -Values – Moral behavior – Values clarification –

Ethical ConsiderationsTheoretical PerspectivesUtilitarianism – an ethical theory that promotes

actions based on the end results that produce the most good (happiness) for the most people

Kantianism – suggests that decisions and actions are bound by a sense of duty

Christian ethics - do unto others as you would have them do unto

you; alternatively, do not do unto others what you would not have them do unto you.

Natural law theories – do good and avoid evil. Evil acts are never condoned, even if they are intended to advance the noblest of ends.

Ethical egoism – decisions are based on what is best for the

individual making the decision.

Ethical Dilemmas Ethical dilemmas occur when moral appeals

can be made for taking either of two opposing courses of action.

Taking no action is considered an action taken.

Group DiscussionHave you had any ethical dilemmas?How did you deal with them?

Avoiding Liability Respond to the client Educate the client Comply with the standard of care Supervise care Adhere to the nursing process Document carefully Follow up and evaluate Maintain a good interpersonal

relationship with client and family

Ethical PrinciplesAutonomy – This principle emphasizes the status

of persons as autonomous moral agents whose rights to determine their destinies should always be respected.

Beneficence – This refers to one’s duty to benefit or promote the good of others.

Nonmaleficence – abstaining from negative acts toward another; includes acting carefully to avoid harm

Justice – principle based on the notion of a hypothetical social contract between free, equal, and rational persons. The concept of justice reflects a duty to treat all individuals

equally and fairly.Veracity – principle that refers to one’s duty to be truthful

always.

A Model for Making Ethical Decisions

Assessment Problem identification Plan Implementation Evaluation

Ethical Issues in Psychiatric/Mental Health Nursing

The right to refuse medication The right to the least restrictive treatment

alternative

How do you feel about this related to Psy. patient?

Legal Considerations Nurse Practice Act defines the legal parameters of

professional and practical nursing. Types of Laws

Statutory law Common law

Civil Law – protects the private and property rights of individuals and businesses

Tort Contracts

Criminal law – provides protection from conduct deemed injurious to the public welfare

Confidentiality and right to privacy Doctrine of privileged communication

Informed consent Restraints and seclusion

False imprisonment Commitment issues

Voluntary admissions Involuntary commitment Emergency commitment The mentally ill person in need of treatment Involuntary outpatient commitment The gravely disabled client

Malpractice and negligence Types of lawsuits that occur in psychiatric

nursing Breach of confidentiality Defamation of character

Libel Slander

Assault and battery False imprisonment Invasion of privacy

QuestionsTrue or False- A client who is admitted

involuntarily to an acute care mental health facility automatically loses his right to informed consent for medical procedures or treatments.

True or False- An example of the principle of justice is allowing a hospitalized patient to refuse to attend a scheduled counseling session with her clear understanding that she must accept the consequences for not attending.

True or False- A nurse is committing battery against a patient by forcefully holding the patient and insisting that he swallow a pill. The nurse tells the patient that he will be punished if he does not do it.

Which of the following is an example of a patient who requires emergency admission to a mental health facility?

A. A patient with schizophrenia who has frequent hallucinations

B. A patient with symptom of depression who attempted suicide a year ago

C. A patient with psychosis who assaulted a home less man with a metal rod

D. A patient with bipolar disease who paces quicklyl down the sidewalk talking to himself

A patient tells a student nurse. “Don’t tell anyone. But I hid a sharp knife under my mattress in order to protect myself form my roommate, who is always yelling at me and threatening me.” Thinking about the principles of patient confidentiality and veracity, the student makes a correct decision to

A. Keep the patient’s communication confidential but talk to the patient daily, using therapeutic communication to convince him to admit to hiding the knife

B. Keep the patient’s communication confidential, but watch the patient and his roommate closely.

C. Tell the patient that this must be reported to health care staff because it concerns health and safety.

D. Report the incident but do to inform the patient of having the intention to do so

A nurse decides to put a patient with psychosis in scelusion overnight because the nit is very short-staff and the patient fequejntly fights with the other patients. This is an example

A. BeneficenceB. a tortC. A facilityD. justice