NUR173T: Mental Health
Ch 1: Mental Health & Mental Illness
Mental Health
★ Adaptation to stressors from the internal or external environment as evidenced by
thoughts, feelings, and behaviors that are appropriate to cultural norms
Mental Illness
★ Maladaptive responses to internal or external environment as evidenced by thoughts,
feelings, and behaviors that are incongruent to cultural norms
Stressors
★ A stressor triggers a response from pt (any type of stress is valid)
Physical response → fight or flight response
Psychological response
➔ Anxiety (problematic when pt cannot stop escalation to a level that interferes with the
ability to meet basic needs)
◆ Mild → severe anxiety
◆ Panic anxiety → can lead to psychosis
● Significant thought disturbance, impaired reality → delusions,
hallucinations, anosognosia (unaware of psychological problems)
➔ Ego defense mechanisms - Table 1-1
◆ Protective devices used either consciously or unconsciously as protective
devices for the ego in an effort to relieve mild to moderate anxiety
◆ Does not indicate mental illness
◆ Compensation: focusing on strengths to make up for weaknesses
◆ Denial: refusing to accept the reality of a situation
◆
➔ Grief
◆ Response to the loss of a valued entity
◆ Normal mourning → sadness, guilt, anger, helplessness, hopelessness, and
despair
● Maladaptive responses to grief → depression/mental illness
Chapter 5: Relationship Development and Therapeutic Communication
The Therapeutic Nurse-Patient Relationship
★ Foundation on which psychiatric nursing is established
Conditions essential to form a therapeutic relationship:
, ➔ Rapport- Nonjudgemental, friendliness, acceptance, sense of trust
➔ Trust- One must feel confidence in that person’s presence, reliability, integrity,
veracity, and desire to provide assistance when requested
➔ Respect- believe in dignity and worth of an individual regardless of unacceptable
behavior; respect is unconditional, unjudgemental
➔ Genuineness- ability to be open, honest, aware of what one is experiencing
➔ Empathy- ability to see beyond behavior and understand situation from the patient’s
point of view.
Four Phases of Therapeutic Relationship
1. Preinteraction phase
- Obtain information about patient
- Examine one’s own feelings, fears, concerns, anxieties of working with particular pt
2. Orientation (introduction) phase
- Create environment of trust and rapport
- Gather assessment data
- Establish interventions with details of expectations and responsibilities for both
- Identify pt strengths and limitations
- Make a nursing diagnosis
- Set goals, Develop plan of action
- Explore feelings of pt and nurse
3. Working phase
- Maintain trust and rapport
- Promoting insight and perception of reality
- Problem solving
- Overcoming resistance behaviors
- Continually evaluating progress
- Transference and countertransference may affect relationship negatively (boundary
breaking)
- Transference
- Patient transfers feelings to nurse because nurse remind them of someone
- Countertransference
- Nurse transfers feelings to pt because pt reminds them of someone
4. Termination phase (goals were reached, discharge, end of shift)
- Progress made towards goals
- Plan of care for stressful situations
- Recognize and explore feelings of termination
Boundaries
Pt and nurse must respect boundaries (limits)
- Material, social, personal boundaries
- Professional boundaries
, - Self-disclosure: sharing from nurse must be appropriate and beneficial to pt
- Gift giving: may accept token gifts, but significant gifts must be returned
- Touch: may be therapeutic but nurse be aware of cultural beliefs and caution
with pt with trauma, psychosis, etc
- friendship/romantic association: nurse must move from personal to
professional. If they can’t, remove from pt team. Do not develop a relationship
beyond professional with pt
Interpersonal Communication
★ Interpersonal communication is a transaction between sender and receiver (percieve
each other, listen, mutually involved in creating meaning in relationship)
Impact of pre-existing conditions
➔ Preexisting conditions from each person influence communication
◆ Values, attitudes, beliefs
◆ Culture and religion
◆ Social status
◆ Age, gender
◆ Environment of where convo is taking place
Nonverbal communication
➔ Physical appearance → coneys self esteem, gender identity, status, warmth/coldness
➔ Body movement and posture → self esteem and power
➔ Touch → negative or positive reaction, is it appropriate?
➔ Facial expressions → emotional states
➔ Eye behavior→ reveleaing; eye contact
➔ Vocal cues or paralanguage → pitch, tone, loudness, rate of speaking, pauses, emphasis
on words
Therapeutic Communication - Table 5-3
➔ Using silence → allows for pt to organize thoughts and put them to words
➔ Acceptance → attitude of understanding and willingness to interact
➔ Giving recognition → acknowledging and indicating awareness of pt actions
➔ Offering self → willingness to spend time with pt, show interest
➔ Giving broad openings → allows pt to direct focus
➔ Offering general leads → encouragement pt to continue
➔ Placing the event in time or sequence → organzie sequence of events
➔ Making observations → observations of pt behavior makes them aware of how they
are perceived and allows exploration of behaviors
➔ Encouraging description of perceptions → awareness and clarification
➔ Encouraging comparison → recognize life experiences and things that can change
➔ Restating → allows for clarification
Ch 1: Mental Health & Mental Illness
Mental Health
★ Adaptation to stressors from the internal or external environment as evidenced by
thoughts, feelings, and behaviors that are appropriate to cultural norms
Mental Illness
★ Maladaptive responses to internal or external environment as evidenced by thoughts,
feelings, and behaviors that are incongruent to cultural norms
Stressors
★ A stressor triggers a response from pt (any type of stress is valid)
Physical response → fight or flight response
Psychological response
➔ Anxiety (problematic when pt cannot stop escalation to a level that interferes with the
ability to meet basic needs)
◆ Mild → severe anxiety
◆ Panic anxiety → can lead to psychosis
● Significant thought disturbance, impaired reality → delusions,
hallucinations, anosognosia (unaware of psychological problems)
➔ Ego defense mechanisms - Table 1-1
◆ Protective devices used either consciously or unconsciously as protective
devices for the ego in an effort to relieve mild to moderate anxiety
◆ Does not indicate mental illness
◆ Compensation: focusing on strengths to make up for weaknesses
◆ Denial: refusing to accept the reality of a situation
◆
➔ Grief
◆ Response to the loss of a valued entity
◆ Normal mourning → sadness, guilt, anger, helplessness, hopelessness, and
despair
● Maladaptive responses to grief → depression/mental illness
Chapter 5: Relationship Development and Therapeutic Communication
The Therapeutic Nurse-Patient Relationship
★ Foundation on which psychiatric nursing is established
Conditions essential to form a therapeutic relationship:
, ➔ Rapport- Nonjudgemental, friendliness, acceptance, sense of trust
➔ Trust- One must feel confidence in that person’s presence, reliability, integrity,
veracity, and desire to provide assistance when requested
➔ Respect- believe in dignity and worth of an individual regardless of unacceptable
behavior; respect is unconditional, unjudgemental
➔ Genuineness- ability to be open, honest, aware of what one is experiencing
➔ Empathy- ability to see beyond behavior and understand situation from the patient’s
point of view.
Four Phases of Therapeutic Relationship
1. Preinteraction phase
- Obtain information about patient
- Examine one’s own feelings, fears, concerns, anxieties of working with particular pt
2. Orientation (introduction) phase
- Create environment of trust and rapport
- Gather assessment data
- Establish interventions with details of expectations and responsibilities for both
- Identify pt strengths and limitations
- Make a nursing diagnosis
- Set goals, Develop plan of action
- Explore feelings of pt and nurse
3. Working phase
- Maintain trust and rapport
- Promoting insight and perception of reality
- Problem solving
- Overcoming resistance behaviors
- Continually evaluating progress
- Transference and countertransference may affect relationship negatively (boundary
breaking)
- Transference
- Patient transfers feelings to nurse because nurse remind them of someone
- Countertransference
- Nurse transfers feelings to pt because pt reminds them of someone
4. Termination phase (goals were reached, discharge, end of shift)
- Progress made towards goals
- Plan of care for stressful situations
- Recognize and explore feelings of termination
Boundaries
Pt and nurse must respect boundaries (limits)
- Material, social, personal boundaries
- Professional boundaries
, - Self-disclosure: sharing from nurse must be appropriate and beneficial to pt
- Gift giving: may accept token gifts, but significant gifts must be returned
- Touch: may be therapeutic but nurse be aware of cultural beliefs and caution
with pt with trauma, psychosis, etc
- friendship/romantic association: nurse must move from personal to
professional. If they can’t, remove from pt team. Do not develop a relationship
beyond professional with pt
Interpersonal Communication
★ Interpersonal communication is a transaction between sender and receiver (percieve
each other, listen, mutually involved in creating meaning in relationship)
Impact of pre-existing conditions
➔ Preexisting conditions from each person influence communication
◆ Values, attitudes, beliefs
◆ Culture and religion
◆ Social status
◆ Age, gender
◆ Environment of where convo is taking place
Nonverbal communication
➔ Physical appearance → coneys self esteem, gender identity, status, warmth/coldness
➔ Body movement and posture → self esteem and power
➔ Touch → negative or positive reaction, is it appropriate?
➔ Facial expressions → emotional states
➔ Eye behavior→ reveleaing; eye contact
➔ Vocal cues or paralanguage → pitch, tone, loudness, rate of speaking, pauses, emphasis
on words
Therapeutic Communication - Table 5-3
➔ Using silence → allows for pt to organize thoughts and put them to words
➔ Acceptance → attitude of understanding and willingness to interact
➔ Giving recognition → acknowledging and indicating awareness of pt actions
➔ Offering self → willingness to spend time with pt, show interest
➔ Giving broad openings → allows pt to direct focus
➔ Offering general leads → encouragement pt to continue
➔ Placing the event in time or sequence → organzie sequence of events
➔ Making observations → observations of pt behavior makes them aware of how they
are perceived and allows exploration of behaviors
➔ Encouraging description of perceptions → awareness and clarification
➔ Encouraging comparison → recognize life experiences and things that can change
➔ Restating → allows for clarification
