Varcarolis: Foundations of Psychiatric Mental Health Nursing, 6th
Edition
Chapter 01: Mental Health and Mental Illness
Instructor’s Manual
Thoughts About Teaching the Topic
The instructor will probably devote an hour or less to this material and will probably
emphasize (1) the mental health–mental illness continuum; (2) the mental health assessment,
using both the factors that influence mental health and the five criteria of mental health; and (3)
the importance of becoming conversant with the DSM-IV-TR.
The learning activities found on the Evolve website will assist students to operationalize this
general knowledge. Activities can be used in class or assigned as independent work.
Key Terms and Concepts
advanced practice registered nurse–psychiatric mental health (APRN-PMH)
basic level registered nurse
biologically based mental illnesses
clinical epidemiology
comorbid condition
Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR)
electronic health care
epidemiology
evidence-based practice
incidence
mental health
mental health continuum
mental illness
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
phenomena of concern
prevalence
psychiatric mental health nursing
psychiatry’s definition of mental health
registered nurse–psychiatric mental health (RN-PMH)
resilience
Objectives
,1. Discuss some dynamic factors (including social climate, politics, myths, and biases) that
contribute to making a clear-cut definition of mental health elusive.
2. Explain how epidemiological studies can improve medical and nursing care.
3. Demonstrate how the DSM-IV-TR multiaxial system can influence a clinician to consider a
broad range of information before making a DSM-IV-TR diagnosis.
4. Compare and contrast a DSM-IV-TR diagnosis with a nursing diagnosis.
5. Give examples of how personal norms and other cultural influences can affect making an
accurate DSM-IV-TR diagnosis.
6. Define psychiatric mental health nursing, and discuss the patient population served by the
psychiatric nurse.
7. Explain the reasons for using standardized classification systems (e.g., North American
Nursing Diagnosis Association International [NANDA-I], Nursing Interventions Classification
[NIC], and Nursing Outcomes Classification [NOC]) in psychiatric nursing practice.
8. Compare and contrast the nursing actions of the basic level psychiatric mental health nurse
with those of the advanced level psychiatric mental health nurse.
9. Describe recent developments that have increased the biological emphasis in psychiatric
mental health nursing.
10. Explore emerging and future roles for psychiatric mental health nursing related to scientific
and social trends.
,Chapter Outline Teaching Strategies
Mental Health and The validity of several concepts is explored, beginning with
Mental Illness the idea that mental illness is what a culture regards as
unacceptable and that mentally ill individuals are those
who violate social norms. This is shown to be an inadequate
definition by pointing out that political dissidents are not
necessarily mentally ill. Another misconception to be
discussed is that a healthy person must be logical and
rational, with the point being made that each of us has
irrational dreams and experiences irrational emotions. All
human behavior lies somewhere along a continuum of
mental health and mental illness. Mentally healthy persons
are those who are in harmony with themselves and their
environment. Such individuals may possess medical
deviation or disease, as long as this does not impair
reasoning, judgment, intellectual capacity, and the ability to
make harmonious personal and social adaptations. Instead
of a definition of mental health, traits possessed by the
mentally healthy are identified as happiness, control over
behavior, appraisal of reality, effectiveness in work, and a
healthy self-concept. The misconception that mental illness
is incurable or treatment is unsuccessful is refuted by
contrasting people with cardiovascular disease with people
with mental illness.
Resilience Resilience is closely associated with the process of adapting
and helps people face tragedies, loss, trauma, and severe
stress (APA, 2004). It means that rather than falling victim
to negative emotions, resilient people recognize their
feelings, readily deal with them, and learn from experience.
Culture In determining the mental health or mental illness of an
individual, we must consider the norms and influence of
culture. Cultures differ in their views of mental illness and
the behavior categorized as mental illness. Although some
disorders such as bipolar disorder and schizophrenia are
found throughout the world, other syndromes are culture
bound (e.g., running amok, pibloktoq, and anorexia
nervosa). The DSM-IV-TR provides information about
cultural variations for each of the clinical disorders, a
description of culture-bound syndromes, and an outline of
cultural formulations for evaluating and reporting the
impact of the individual’s cultural context.
Perceptions of
Mental Health and
Mental Illness
Mental Illness versus A distinction between mental and physical illnesses is often
, Physical Illness made. It frequently implies that psychiatric disorders are all
“in the head,” whereas the majority of physical illnesses are
considered to be beyond personal responsibility.
Nature versus The most prevalent and disabling mental disorders have
Nurture strong biological influences. Examples are schizophrenia,
bipolar disorder, major depression, obsessive-compulsive
and panic disorders, posttraumatic stress disorder, and
autism. Nurses are cautioned to remember that we do not
treat diseases; rather we care holistically for people.
Factors that affect a person’s mental health include support
systems, family influences, developmental events, cultural
or subcultural beliefs and values, health practices, and
negative influences impinging upon one’s life. Each must be
evaluated and factored into a plan of care. Figure 1-3
identifies some influences that can affect a person’s mental
health. Currently, the diathesis-stress model, in which
diathesis represents biological predisposition, and stress
representing the environmental aspect is the most accepted
explanation for mental illness.
Social Influences on
Mental Health Care
Consumer Movement Groups of people with mental illnesses—mental health
and Mental Health consumers—advocate for their rights and the rights of
Recovery others with mental illness; they fight stigma,
discrimination, and forced treatment. There are 10
components of the recovery process per the Substance
Abuse and Mental Health Services Administration (2005):
self-directed, person centered, empowering, holistic,
nonlinear, strengths-based, peer support, respect,
responsibility, hope.
Decade of the Brain The last decade of the 1900s was designated as the “decade
of the brain” by President George W. Bush. The goal was to
make legislators and the general public aware of the
advances that had been made in neuroscience and brain
research (Tandon, 2000).
Surgeon General’s The most important messages from this report, made in
Report on Mental 1999, were that mental health is fundamental to overall
Health health and there are effective treatments for mental health.
Human Genome This project lasted from 1990-2003 and strengthened
Project biological and genetic explanations for psychiatric
conditions (Cohen, 2000).
Edition
Chapter 01: Mental Health and Mental Illness
Instructor’s Manual
Thoughts About Teaching the Topic
The instructor will probably devote an hour or less to this material and will probably
emphasize (1) the mental health–mental illness continuum; (2) the mental health assessment,
using both the factors that influence mental health and the five criteria of mental health; and (3)
the importance of becoming conversant with the DSM-IV-TR.
The learning activities found on the Evolve website will assist students to operationalize this
general knowledge. Activities can be used in class or assigned as independent work.
Key Terms and Concepts
advanced practice registered nurse–psychiatric mental health (APRN-PMH)
basic level registered nurse
biologically based mental illnesses
clinical epidemiology
comorbid condition
Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR)
electronic health care
epidemiology
evidence-based practice
incidence
mental health
mental health continuum
mental illness
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
phenomena of concern
prevalence
psychiatric mental health nursing
psychiatry’s definition of mental health
registered nurse–psychiatric mental health (RN-PMH)
resilience
Objectives
,1. Discuss some dynamic factors (including social climate, politics, myths, and biases) that
contribute to making a clear-cut definition of mental health elusive.
2. Explain how epidemiological studies can improve medical and nursing care.
3. Demonstrate how the DSM-IV-TR multiaxial system can influence a clinician to consider a
broad range of information before making a DSM-IV-TR diagnosis.
4. Compare and contrast a DSM-IV-TR diagnosis with a nursing diagnosis.
5. Give examples of how personal norms and other cultural influences can affect making an
accurate DSM-IV-TR diagnosis.
6. Define psychiatric mental health nursing, and discuss the patient population served by the
psychiatric nurse.
7. Explain the reasons for using standardized classification systems (e.g., North American
Nursing Diagnosis Association International [NANDA-I], Nursing Interventions Classification
[NIC], and Nursing Outcomes Classification [NOC]) in psychiatric nursing practice.
8. Compare and contrast the nursing actions of the basic level psychiatric mental health nurse
with those of the advanced level psychiatric mental health nurse.
9. Describe recent developments that have increased the biological emphasis in psychiatric
mental health nursing.
10. Explore emerging and future roles for psychiatric mental health nursing related to scientific
and social trends.
,Chapter Outline Teaching Strategies
Mental Health and The validity of several concepts is explored, beginning with
Mental Illness the idea that mental illness is what a culture regards as
unacceptable and that mentally ill individuals are those
who violate social norms. This is shown to be an inadequate
definition by pointing out that political dissidents are not
necessarily mentally ill. Another misconception to be
discussed is that a healthy person must be logical and
rational, with the point being made that each of us has
irrational dreams and experiences irrational emotions. All
human behavior lies somewhere along a continuum of
mental health and mental illness. Mentally healthy persons
are those who are in harmony with themselves and their
environment. Such individuals may possess medical
deviation or disease, as long as this does not impair
reasoning, judgment, intellectual capacity, and the ability to
make harmonious personal and social adaptations. Instead
of a definition of mental health, traits possessed by the
mentally healthy are identified as happiness, control over
behavior, appraisal of reality, effectiveness in work, and a
healthy self-concept. The misconception that mental illness
is incurable or treatment is unsuccessful is refuted by
contrasting people with cardiovascular disease with people
with mental illness.
Resilience Resilience is closely associated with the process of adapting
and helps people face tragedies, loss, trauma, and severe
stress (APA, 2004). It means that rather than falling victim
to negative emotions, resilient people recognize their
feelings, readily deal with them, and learn from experience.
Culture In determining the mental health or mental illness of an
individual, we must consider the norms and influence of
culture. Cultures differ in their views of mental illness and
the behavior categorized as mental illness. Although some
disorders such as bipolar disorder and schizophrenia are
found throughout the world, other syndromes are culture
bound (e.g., running amok, pibloktoq, and anorexia
nervosa). The DSM-IV-TR provides information about
cultural variations for each of the clinical disorders, a
description of culture-bound syndromes, and an outline of
cultural formulations for evaluating and reporting the
impact of the individual’s cultural context.
Perceptions of
Mental Health and
Mental Illness
Mental Illness versus A distinction between mental and physical illnesses is often
, Physical Illness made. It frequently implies that psychiatric disorders are all
“in the head,” whereas the majority of physical illnesses are
considered to be beyond personal responsibility.
Nature versus The most prevalent and disabling mental disorders have
Nurture strong biological influences. Examples are schizophrenia,
bipolar disorder, major depression, obsessive-compulsive
and panic disorders, posttraumatic stress disorder, and
autism. Nurses are cautioned to remember that we do not
treat diseases; rather we care holistically for people.
Factors that affect a person’s mental health include support
systems, family influences, developmental events, cultural
or subcultural beliefs and values, health practices, and
negative influences impinging upon one’s life. Each must be
evaluated and factored into a plan of care. Figure 1-3
identifies some influences that can affect a person’s mental
health. Currently, the diathesis-stress model, in which
diathesis represents biological predisposition, and stress
representing the environmental aspect is the most accepted
explanation for mental illness.
Social Influences on
Mental Health Care
Consumer Movement Groups of people with mental illnesses—mental health
and Mental Health consumers—advocate for their rights and the rights of
Recovery others with mental illness; they fight stigma,
discrimination, and forced treatment. There are 10
components of the recovery process per the Substance
Abuse and Mental Health Services Administration (2005):
self-directed, person centered, empowering, holistic,
nonlinear, strengths-based, peer support, respect,
responsibility, hope.
Decade of the Brain The last decade of the 1900s was designated as the “decade
of the brain” by President George W. Bush. The goal was to
make legislators and the general public aware of the
advances that had been made in neuroscience and brain
research (Tandon, 2000).
Surgeon General’s The most important messages from this report, made in
Report on Mental 1999, were that mental health is fundamental to overall
Health health and there are effective treatments for mental health.
Human Genome This project lasted from 1990-2003 and strengthened
Project biological and genetic explanations for psychiatric
conditions (Cohen, 2000).
