Académique Documents
Professionnel Documents
Culture Documents
Mentally Healthy
A person is mentally healthy when a person possesses knowledge of oneself; meets
one’s basic needs; assumes responsibility for one’s behavior and for self-growth; has
learned to integrate thoughts, feelings, and actions; and can resolve conflicts successfully.
Mentally Ill
The mentally ill show deficits in functioning; it is usually these deficits that bring them
to the facilities where you will encounter them.
Mental illness occurs when an individual is not able to view oneself clearly or has a
distorted view of self, is unable to maintain satisfying personal relationships, and is
unable to adapt to one’s environment.
In 1846, the term psychiatry was introduced by physicians and they published their
Asylums were built for the treatment and cure of the insane.
Nineteenth Century
Conditions in the asylums became unbearable.
There was a called for reform.
Dorothea Lynde Dix became a leader for reform. She advocated for humane
treatment as well as safe and comfortable environments for the patient. Through
her efforts, care was improved in the U.S., Canada, and Scotland.
Nursing Education
Eighteenth and Nineteenth Centuries
In 1882, the McLean Asylum in Somerville, Massachusetts, opened the first training
school in the world for mental health nurses.
Edward Cowles, the physician superintendent of McLean, believed that the presence of
a “nurse” indicated not only that the patient was ill but also that there was a hope
of recovery.
The year 1893 marked the first meeting of organized nursing in the U. S.
Twentieth Century
The American Psychiatric Association established a committee on Training Schools for
Nurses.
Johns Hopkins Hospital School included psychiatric nursing in the training of general
nurses. This was the first time a hospital program offered training in psychiatric
care to all students.
By 1920, the first psychiatric nursing textbook was publish, Nursing Mental Disease by
Harriet Bailey.
In the 1930s, somatic therapies emerged.
In 1946, the U.S. Congress passed the National Mental Health Act, which established
the National Institutes of Mental Health.
See Table 2-2 for additional important events and trends in psychiatric nursing history.
Hildegard Peplau
Described nursing as a therapeutic interpersonal relationship that provides a growth
opportunity for both the nurse and the patient.
Described a four distinct phases of a interpersonal relationship: Orientation,
identification, exploitation, and resolution.
In1997, Peplau combined identification exploitation into the working phase, and
renamed resolution, termination.
Orientation
Working
Termination
Jean Watson
Differentiatedbetween nursing and medicine by stating that curing is the domain of
medicine and caring is the domain of nursing.
Proposed 10 carative factors that are involved in forming a humanistic, altruistic
system of values; instilling faith-hope; cultivating sensitivity to one’s self and to
others; developing helping-trust relationships; expressing positive and negative
feelings; using scientific problem-solving methods for decision making;
promoting interpersonal teaching-learning; providing an environment that
supports, protects, and corrects mental, physical, sociocultural, and spiritual
aspects; assisting with the gratification of human needs; and allowing for
existential-phenomentological forces (see p. 30)
Dorothea Orem
Proposed a general self-care deficit theory of nursing.
Has three constitute theories –self-care, self-care deficit, and nursing systems which
are based on six central and one peripheral concept.
Self-care
Self-care agency
Therapeutic self-care demand
Self-care deficit
Nursing agency
Nursing system
Initiate and regulate the basic drives: hunger, thirst, sex, aggressive self-protection
Conscious sensation
Memory
Mood (affect)
Thought
Regulate sleep cycle
Language
Neurotransmitters
Dopamine
Fine muscle movement
Integration of emotions and thoughts
Involved with decision making
Stimulates hypothalmus to release hormones (sex, thyroid, adrenals)
Thought disorders such schizophrenia is associated dopamine. This may be due either
to excess release of transmitter or to increased receptor responsiveness.
Norepinephrine
Level in brain affects mood
Stimulates sympathetic branch of ANS for “fight or flight”
Serotonin (5-HT)
Playsa role in sleep regulation, hunger, mood states, and pain perception
Playsa role in aggression and sexual behavior
The most commonly group is the selective Serotonin Reuptake Inhibitors.
GABA seems to exert an inhibitory effect on neurons in many parts of the brain. Drugs
that can enhance this effect exert a sedative-hypnotic action of brain function
Many drugs with this type of effect tend to reduce anxiety and some are actually used
as antianxiety agents. The most commonly used drugs of this group are the
benzodiazepines (Dalmane, Halcion, Ativan, Xanax)
Histamine
Alertness
Inflammatory response
Stimulates gastric secretion
The Diencephalon
The Cortex
Four Lobes
Frontal
Temporal – strongly involved with emotion and memory
Parietal
occipital
Deep in the temporal lobe is a complex set of structure known as the limbic system.
ICD-9
Consists of a comprehensive listing of clinical diagnoses, each associated with a unique
numerical code.
Permits computerized data entry and tracking.
Are commonly three-digit numbers followed by a decimal point and a single digit (e.g.,
296.2 for Major Depressive Disorder – single episode)
Used in epidemiological analysis and insurance companies
DSM-IV-TR
Includes explicit criteria for making psychiatric diagnoses, and these criteria have been
increasingly validated by careful epidemiological study.
Has a multiaxial system that allows developmental and other disorders to be considered
along with psychiatric diagnoses of more recent onset.
Therapeutic communication is the purposeful use of dialog to bring about the client’s
insight, control of symptoms, and/or healing.
To accomplish therapeutic communication, the nurse needs to understanding
communication theory and how to build a positive nurse-client relationship.
Nonverbal Communication
Refers to all of the messages sent by others than verbal or written.
Includes behaviors, cues, and presence (such as proximity) that sends a message.
Physical Space
Denotes a sense of relationship between two people.
Has meaning in communication.
Public space = approximately 12 feet
Social space = 9 to 12 feet
Personal space = 18 inches to about 4 feet
Intimate space = closer than 18 inches
Actions or Kinetics
Refer to movements, expressions, question, and posture that accompany interactions
and influence communications.
NOTE: They are almost always culture-bound.
Paralinguistic Cues
Provide the context in which the words are delivered, and they influence meaning
directly.
Include tone, pitch, emotions expressed verbally (such as anxiety or anger or fear),
sounds of hesitation, nervous laughter, and nervous coughing.
Must be interpreted within the context of the client’s cultural and social/familial norms.
Touch
Is a form of communication used almost daily by nurses providing direct physical care
and support to clients.
Can convey warmth, positive regard, support during silence, and reassurance that the
nurse if fully present and caring.
Has many meanings (appropriate and inappropriate touching).
Verbal Communication
Is the use of words, written and spoken, to send messages to another.
For communication to be most therapeutic, it must convey a respectful attitude, one that
supports the individuality and self-esteem of both the client and the nurse.
Defense Mechanisms
Are unconscious responses used by persons to protect themselves from internal
conflicts and external stressors.
Symbolization – Use of an object, idea, or act to express emotion that is not expressed
directly
Cultural Sensitivity
The Process of Cultural Competence in the Delivery of Healthcare Services
(Campinha-Bacote, 1998, 2003)
Five elements
Cultural desire
Cultural awareness
Cultural knowledge
Cultural skill
Cultural encounter
Cultural blindness is the attempt to treat all people fairly by ignoring differences and
acting as though the differences do not exist.
Can be perceived as insensitivity just as readily as are stereotyping and ethnocentrism.
Cultural Assessment
Giger and Davidhizar (2003) p. 108
Andrews and Boyle (2003) p. 108
Normal vs. Abnormal Behavior
What is normal in one culture may not be normal in another.
Eye contact
Proxemics (Space and Distance)
Touch
Silence
Social Behavior
Time orientation
Positive attitude
Give up the victim consciousness
Be alert and empowered
Taking care of your body, mind and spirit