PRINCIPAL & CONCEPT OF MENTAL HEALTH NURSING.pptx

principles and concept of mental health nursing Conceptual models and Role of nurse

1. Principles & Concept of Mental Health Nursing Amritanshu Chanchal Nursing Tutor SLMGNC

2. Psychiatric Nursing A specialized field of nursing practice that involves the care of individuals with a mental health disorder to help them recover and improve their quality of life.

3. Mental Illness The American Psychiatric Association defines mental illness as a health condition that involves “changes in emotion, thinking, or behavior—or a combination of these.” 1 It is important to note that mental health and mental illness are different. Mental health refers to your ability to function effectively in your daily life, including having healthy relationships, engaging in daily activities, and coping with the problems you face effectively. By contrast, mental illness refers to diagnosable mental health conditions that create significant changes in how you think, feel, and act. These changes make it difficult to function and create significant distress.

4. Alteration of biological function Sleep: Insomnia, Excessive sleep ( Hypersomnia ), Drowsiness, Somnolence, Insufficient night time sleep. Appetite: Bullimia Nervosa, Pica etc Sexual Desire: Loss of libido, Erectile Dysfunction, Ejaculatory disturbance and pain are presenting symptoms in psycho-sexual disorder.

5. Disorders of Consciousness Clouding of consciousness Drowsiness Qualitative change in consciousness Fugue and dissociation Stupor

6. Disorder of Attention & Concentration Disorders to ones own identity (failing to recognize ones own name and identity) Distraction is the inability to shut of irrelevant stimuli so that any stimulus so that any stimulus I the environment takes away the attention. Attention is impaired in anxiety, mania, depression, schizophrenia and organic states. Fatigue and substance abuse disrupts attention and concentration.

7. Volitional disturbances Volition is the willful initiation and control of one’s behavior. Volitional disturbances are seen in organic and functional disorder. Lesion of the midbrain, the area of the brain where the centre of the biological needs are located cause volitional disturbance by reducing drives.

8. Disorders of motor activity Hyperactivity, restlessness, agitation, accelerated speech, motor activity and hyper-vigilance. Decreased activity level in depression and in some types of schizophrenia. Akinesia (lack of body movement), mutism and non responsiveness to environment. Stupor is common in depression, schizophrenia and also in certain organic conditions. Tics are sudden involuntary twitching of small groups of muscles. They are brief, repetitive and stereotypic and may be single or multiple. Sniffing, Throat clearing, tongue darting or shoulder shrugging etc.

9. Disturbance of posture and expression Waxy flexibility (some patient lie on the bed with head raised a few inches above the bed and maintain this posture for very long period. (Psychological pillow). Disturbance of motor speech: Echolalia is repetition of words or sentence uttered by another person. Palilalia is a variant of echolalia where only the last word or syllable are repeated.

10. Disorders of perception Sensory distortion: Hyperesthesia (Sound becomes louder, color brighter and pain unbearable. Sensory deception (false perception) Auditory hallucination, Visual Hallucination, Olfactory Hallucination , Gustatory hallucination and tactile hallucination Perceptual disturbance of time and space: macropsia and micropsia Perceptual disturbance of body image: In organic lesion there are disturbances of bodily experiences such as right left dis -orientation.

11. Disorders of mood Abnormal presence: Fear, Anxiety, Depression, Elation and anger are examples. Abnormality in depth and duration: Blunted or flattened affect, apathy and Anhedonia. Inappropriateness is when it is not proper to the occasion and incongruent. In schizophrenia incongruent affect is very common.

12. Disorders of memory Amnesia: Partial or total failure to recall past Hyperamnesia: Extreme degree of retention and recall of event Paraamnesia: Paraamnesia are distorted or falsified recall of events. Confabulation and deja -vu. Ganser syndrome: Syndrome of approximate answer.

13. Disorder of thought Disorder of form: Incoherence, illogical thinking, over inclusion and neologism. Disorder of progression: Logorrhea, poverty of speech, pressure of speech ad crowding of thoughts. Disorders of tempo: Flight of ideas, Incoherence. In thought block there is sudden break in flow of thought or speech and the patient feels that his mind has gone blank. Disorder of direction: Derailment of thought ( tangentiality ). Disorder of content: Delusion

14. Classification of mental disorder F00-F09 Organic including symptomatic mental disorder F10-F19 Mental & behavior disorder due to psychoactive substance use F20-29 Schizophrenia, schizotypal and delusional disorder F30-39 Mood disorder F40-49 Neurotic stress related and somatoform disorder F50-59 Behavioral syndrome associated with physiological disturbances & physical factor F60-69 Disorder of adult personality and behavior F70-79 Mental retardation F80-89 Disorders of psychological development F90-98 Behavioral & emotional disorders with onset usually occurring in childhood & adolescence F99 Unspecified mental disorder

15. Classification of mental disorder Psychosis Neurosis Special disorder Functional Anxiety Neurosis Childhood Disorder Schizophrenia Depressive Neurosis Personality disorder Simple Schizophrenia Hysterical Neurosis Substance abuse Hebephrenic Schizophrenia OCD Psycho-physiological disorder Catatonic schizophrenia Phobic neurosis Mental Retardation Paranoid schizophrenia Affective Mania Depression Organic Acute & Chronic

16. Factors influencing personality Biological Factors Environmental Factors Heredity Family Endocrine glands School Physique Teacher Nervous system Peer group Sibling relation Mass media Culture

17. Freud stages of personality development

18. Erikson stages of psychosocial development

19. Maslow’s Hierarchy

20. Classical conditioning

21. Operant conditioning

22. Defense mechanism Example Repression Forgetting a loved one’s birthday after a fight Denial Patient denies of any mental disorder Displacement Husband yells at wife for bad day at work Reaction Formation A jealous friend may show extra affection Rationalization Student blames teacher for failing Sublimation Aggressiveness may be transformed into competitiveness Compensation Students poor in studies may be good in studies Projection A senior nurse may blame junior nurse for mistakes Undoing Giving a treat to child for who was punished for wrong doing Conversion A student may complain of ailment before exam

23. Psychopathology of mental disorder Mental Illness Biological Factors Psychological factors Social factors Heredity Strained interpersonal relationship Poverty Disturbance in neurotransmitters Stress and frustration Alcoholism Brain damage Pathological personalities Urbanization Physiological changes Childhood insecurities Family instability Physical illness Unemployment

24. Neurons

25. Neurotransmitters Neurotransmitters Function Acetylcholine Sleep arousal pain movement memory Nor-Epinephrine Mood Cognition Perception Locomotion Sleep Arousal Dopamine Movement Co-ordination Emotions Judgment Serotonin Sleep Arousal Libido Appetite Mood Aggression Pain Co-ordination & Judgment Histamine Control of gastric secretion smooth muscles control cardiac stimulation & Alertness

26. Principles of mental health nursing Accept the Patient Exactly as He is Acceptance conveys the feeling of being loved and cared. It gives a nonthreatening experience. No matter whether psychiatric patients appear to be dirty, or display maladaptive behavior, they have to be treated and provided nursing care with respect as individual human beings.

27. Be Non- judgemental and Non-punitive You should not judge the patients' behavior as right or wrong, good or bad, You should not punish the patient for his/her undesirable behavior, either directly or indirectly. Chaining, restraining. putting him in a separate room are some of the direct punishments. Ignoring his presence or withdrawing his importance are a few ways of giving indirect punishments.

28. Recognize and Reflect on Feeling which the Patient may Express You need to identify the feelings actually expressed by the patient. For example, when a patient says '1 would like to break someone's neck', you try to interpret that he is angry at somebody. You give more importance to analyzing the feeling behind the patient's conversation, then to the content.

29. Talk with a Purpose As a nurse, while you are talking to a patient, your conversation should be directed towards achieving the nursing goals or therapeutic goals. It should bring out the wants need and interests of the patients. More than you, the patient must get a benefit out of the talk.

30. Listen You need to listen attentively to what the patient is saying. Listening is an active process. Your ears are required to listen to what the patient says to you, but you may require the 'third ear to understand what the patient is saying to you non-verbally.

31. Permit the Patient to Express Strongly Held Feelings Strong emotions, bottled up, are potentially explosive and dangerous. It is better to permit the patient to express his/her strong feelings without the fear of disapproval or punishment. At times, the patient may show his/her feelings of anxiety, fear, hospitality, hatred or anger to the nurse. You need to tolerate these and allow their further expression. But also let the patient know about the expressed behaviour towards the nurse.

32. Use Self-understanding as the Therapeutic Tool Use Consistent Behavior to Increase the Patient's Emotional Security Give Reassurance to the Patients in a Subtle and Acceptable Manner Change the Patients' Behavior through Emotional Experience and Not by Rational Interpretation Avoid Unnecessary Increase in Patient's Anxiety

33. Demonstrate Objective Observation to Understand and Interpret the Meaning of the Patient's Behavior Maintain Realistic Nurse-patient Relationship Avoid Physical and Verbal Force as Much as Possible Provide Nursing Care to the Patient as a Person and not Merely to Control Symptoms of the Disease/Symptoms that Patient has

34. Explain Routines and Procedures at the Patient's Level of Understanding Maintain the Basic Nursing Principles While Following any Procedures

35. Qualitie s of psychiatric nurse Self awareness Self acceptance Acceptance of patient Being sincerely interested in patient care Being available Empathizing with the patient Reliability Professionalism Accountability The ability to think critically

36. Psychiatric nursing skill Care values & Attitude Counseling skills Behavioral skills Self awareness Unconditional positive regards To increase adaptive behavior Respecting the persons right Empathy Positive reinforcement Listening Warmth & Genuineness Timeout Responding with care & respect Confidentiality Token economy Reassuring with explanation and honesty Non verbal sensitivity Modeling Physically nursing the helpless with compassion Paraphrasing, reflecting, Clarifying & Summarizing Cueing Working within personal and ethical boundaries Restraining

37. Conceptual model & Role of a nurse Existential model The existential approach considers human nature to be open-ended, flexible and capable of an enormous range of experience. The person is in a constant process of becoming. I create myself as I exist. There is no essential, solid self, no given definition of one's personality and abilities.

38. Psychoanalytical model According to Freud's psychoanalytic theory, all psychic energy is generated by libido. Freud suggested that our mental states were influenced by two competing forces: cathexis and anticathexis . Anticathexis involves the ego blocking the socially unacceptable needs of the id.

39. Behavioral model The behavioral model says that people learn behavior patterns. Behaviorists see learned behaviors as the cause of psychological issues. This model was built on the theories of psychologists, like Ivan Pavlov and B.F. Skinner, who noticed that animals learned to associate one thing with another . Therapeutic approaches: Systematic desensitization, Token Reinforcement, Shaping, Chaining, Prompting, Flooding, Aversion Therapy, Assertiveness & Social skill training.

40. Peplau’s theory Peplau's theory is one of the early Nursing theories, published in 1952. The nurse-patient relationship consists of four steps (orientation, identification, development and conclusion). In these steps nurse could have the role of foreign, reliable person, teacher, guide in nursing care, substitute and consultant .

41. Orem’s theory Orem's self-care deficit theory suggests patients are better able to recover when they maintain some independence over their own self-care. This theory, which is applied often in the field of nursing, is studied in Doctor of Nursing Practice (DNP) programs .

42. Rogers theory Martha Rogers' nursing theory, known as the Science of Unitary Human Beings, upholds four core principles: energy fields, openness, pattern, and pan-dimensionality. These principles emphasize the holistic, dynamic and individualistic nature of human beings and their continuous interaction with the environment.

43. Roy’s theory The Roy Adaptation Model sees the person as a bio-psychosocial being in continuous interaction with a changing environment. The environment includes focal, contextual and residual stimuli. A focal stimulus is the confrontation with one's internal and external environment .

44. Holistic model Holistic nursing is a way of treating and taking care of the patient as a whole body, which involves physical, social, environmental, psychological, cultural and religious factors.