NURS 451 PSYCHOLOGY TEST 1~ NURS 451 LIBERTY UNIVERSITY

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Psych – TEST 1
Chapter 1 & 2: Foundational Concepts of Mental Health Nursing:
 Eugenics:
o VA passed the Eugenical Sterilization Act in 1924  adopted as part of cost-saving strategy to relieve the tax burden in a state where
public facilities for the “sane/feebleminded” had experienced rapid growth
 The law was also written to protect physicians who performed sterilizing operation from the malpractice lawsuit
 Virginia’s law asserted that “heredity plays an important role in the transmission of insanity, idiocy, imbecility, epilepsy, &
crime…” it focused in “defective persons” whose reproduction represented “a mesne to society”
 Carrie Buck, 17 yrs was the first in VA to be sterilized to avoid procreation because they were considered “unfit”

 Social Influences on Mental Health Care:
o Surgeon General’s Report on Mental Health (1999) – MH is fundamental & there are effective treatments
o Recovery Model: (2005) 10 components
 Recovery Emerges from Hope
 Recovery is Person Driven
 Recovery occurs in many pathways
 Recovery is holistic
 Recovery is supported by peers & allies
 Recovery is supported by through relationships & social networks
 Recovery is culturally based & influenced
 Recovery is supported by addressing trauma
 Recovery involves individuals, family, & community strengths, & responsibility
 Recovery is based on respect
o Decade of the Brain (1990-2000) – neuroscience, - how the brain worlds
o Human Genome Project (1990-2003) – role of DNA
o President’s New Freedom Commission on Mental Health (2003) – call for streamlining mental health care
o Institute of Medicine (2005) – highlights effective treatments
o Mental Health Parity Act (2008) – equality
o Affordable Care Act (2010)

 Neuroscience & Mental Health
o Social Dimensions
o Brain Dysfunction
o Neurochemical
o Medication Therapy

 Mental Health & Illness:
o Mental Health:
 When an individual realizes own protection, can cope with normal stresses of life, work productively, & contribute to the
community
o Mental Illness:
 Medical Condition
 Disrupts thinking, feeling, mood, ability to relate to others, & daily functioning
 Psychiatry
 Discipline that encompasses diagnoses & treatment of individuals with mental illness
o Primary symptom are their thoughts
 Prevalence of Mental Illness:
o VERY common for adults to have mental illness
 Includes major depression, schizophrenia, bipolar disorder, OCD
 Only 41% are dx with any mental illness & receive tx
 Ages 15-44
o 45% of those with mental illness meet the criteria for 2 or more disorders, with severity strongly related to morbidity
 No boundaries amount sex, race, ethnicity, or socioeconomic status

 Overview of Psychiatric-Mental Health Nursing:
o HUGE need for psych nursing
o Employment setting include
 General hospitals with inpatient units, psych hospitals, community mental health centers, crisis services, primary care clinics,
nursing homes, substance abuse tx setting, & faith-based settings
o Participation in case management services
o Working with family to fullest extent possible

o ALL registered nurses must:
 Become skilled in providing mental health care
 Understand the vital role of psych-mental health nurses

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Psych – TEST 1


 Psychiatric Nursing Skills:
o Being with the patient more than doing for**
 Development of therapeutic relationship & corresponding therapeutic use of self  a lot comes from communication
 Focus on human emotion & behaviors, treating symptoms
 Differentiate normal human emotions from pathology

o Providing Presence
 Being with & attending to the patient
 Promoting human engagement & interchange in a way that is meaningful to the patient.
 Remain focused on assessing the pt needs to become more comfortable being with the patient.

o Therapeutic Communication:
 Transmission & interpretation of verbal & non-verbal messages
 Nurses listen & facilitates conversation with patient in a goal-direct manner.
 Guides, but does not force.

o Mental Status examination:  how do you respond?
 Asses the pt’s level of functioning
 Patient’s perception
 Both patient report & care provider observation important

 Diagnosing Mental Disorders:
o Diagnostic & Statistical Manual of Mental Disorders (DSM5) - 1 Q
 Categorical Classification System
 Used to dx the psychiatric disorder

o Previous Edition Classification System: (NOT ON TEST)
 Uses Axis System, requiring judgments to be made on each of the five axes, forces diagnostician to consider a broad range of
information
 Axis 1: Mental disorder that is the focus of the tx
o Tends to be more acute than chronic, generally considered resolvable, short term tx, responds to meds,
clear onset & remission
o 300.21 – panic disorder with agoraphobia
 Axis 2:
o Personality disorders & mental retardation (more chronic, generally begins in childhoods
 OCD – 301.4
 Axis 3:
o General medical disorder relevant to mental disorder in Axis 1
 DM – 250.00
 Axis 4:
o Psychosocial & environmental problems
 Frequent absences from work (occupational problems)
 Axis 5:
o Global Assessment of Functioning (GAF)
 55
 Score of 100 = excellent
 Score of 50 – needs hospitalization
 Health assess the patient baseline & some subjectivity

 Wellness domain framework for psych-mental health nursing:

o Biological Domain:
 Basic needs of adequate nutrition/hydration, relaxation/sleep, exercise
 Considerable alteration in the immune, endocrine, neuro, & neurochemical systems
 Focus on education regarding good health practices
 Focus on medications

 Needs ENERGIES:
 Exercise, nutrition, each body system in balance, rest, good health practices, information proves,
endocrine/immune, sensory function
o Exercise is best with anti-depressants
o Play important role of relapse

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Psych – TEST 1




o Psychological Domains:
 Attitudes:
 Sometimes seen as behaviors that express psychological needs
o Attitudes & behaviors can (+/-) interact with regaining wellness

 Worldview:
 Cognitive map that shapes beliefs, feelings about the world
o Life experiences influence an individual’s ability to engage in tx
 Encourage pt to engage in behaviors that help them manage challenges of life
 Active Participation
 EMPOWERS:
o Enjoy life, manage wellness, pain/pleasure, outlook, worthwhile, elect to love, responsible for own
behavior, success take action

 Sociological Domain:
 All aspect of the environment
o Presence of nature, fresh air
o Living & working conditions


 Interpersonal Relationships
o Give & receive needed services
o People patients talk to regular
o Kinship
 SERVICES:
o School/work, enjoy nature, resources/residence, value life skill, interpersonal relations, communication
skills, economics, support
 Cultural Domain:
 Customs, beliefs, values, instructions, & language among those who share commonalities of race, religion,
ethnicity
o Shared beliefs do not always result in similar behaviors
o Language barriers, disparities in care
o Views of stigma, personal weakness

 Use CULTURES
o Customs/actions, understand speech/communication, language, thoughts & beliefs, understood values,
race & religion, ethnicity, & social groupings

 Spiritual Domain:
 Spiritual nature striving for intellectual, moral, spiritual enjoyments
o Faith, hope, charity, values clarification, & seeking truth
 Forgiveness
o Of someone who has done wrong
o Steps towards making it right
o Forgiving one’s self
 PEACEFUL:
o (+) attitude, embrace truth, accept forgiveness, clarify values, express gratitude, friendship with self &
others, understanding the heart, & learn to develop insight
o Level of Wellness:
 Level 1
 Initial onset or relapse
o Return of symptoms after stabilization that can be life-threatening
 Patient unstable with compromised level of functioning
 Level 2:
 Recovery
o Help people realize that it will not always be this way – HOPE
o Symptoms have stabilized

 Level 3:
 Rehabilitation
o Teach skills that will help patient maintain wellness, manage symptoms, & prevent future relapse
 Level 4:
 Actualization

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Psych – TEST 1
o Est. desired life goals & engaging in goal-directed activities
o Takes time to achieve
 Working to accomplish the goals


o From suffering hope:
 Nurses provide better care when they:
 Develop a greater understanding of concepts that affect every patient
 Help pts learn behaviors that alleviate suffering & promote hope
 Gain greater awareness of their own perceptions, thoughts, feelings

Orientation Information:
 What is Milieu?
o Used to describe therapeutic environment
 Involves:
 Safety
 Structure
 Support
 Includes consistency, client rules, limitations & boundaries, & client expectations – including contracts relating to appropriate
behavior
 Focused on a structured environment

 Patient Safety
o Suicidal ideation
 15 minute checks!!
o Pt are treated with respect & dignity & they are searched upon admission
 All items brought in to the pt from family & friends have to be searched, before being given to the pt
 NOT allowed to have ANYTHING they can potentially use to hurt themselves
 NO shoe strings, draw strings, etc,
o ISA – Intensive Supervision Area
o ECO – Emergency Custody of Order – gets them into the hospital
o TDO – Temporary Detaining Order - judicial order

 What to do when working with children?
o DO NOT be in the patients room alone with the door closed
o Do NOT hold or hug children

o If children start to act out – make sure they are safe, then leave
 Do not give the kids an audience. All staff have been certified in MANDT training

o Refrain from talking about religion.
 It is OKAY to answer questions about your faith*

o DO not bring things for the children
o Remember the staff knows these pt well

 Therapeutic communication (12 Q)
o Communication with a purpose
 Your most important nursing intervention
 DO NOT BE SCARED – RELAX
o Communication should be 10% verbal & 90% nonverbal
 If you are scared, do not let it show

 Nonverbal Behaviors:
o Body behavior
o Facial Expression – affect (way the person shows their emotions)
o Eye cast
o Voice related behaviors
o Observable autonomic physiologic – you can prevent anxiety
o Appearance (way they look)
o Physical characteristics

 Confidentiality:
o If any information, including but not limited to, patient ID, dx, or course of tx, physician or other personal activities, hospital procedures,
financial or operating statistics in confidential.