NRSG 220 Exam 1

Mental health - difficult to define, no single universal definition of mental health exists individual factor influencing mental health - or personal factors include a person's biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality interpersonal factors influencing mental health - or relationship factors include effective communication, ability to help others, intimacy, and a balance of separateness and connectedess social/cultural factors influencing mental health - or environmental factors include a sense of community, access to adequate resources, intolerance of violence, support of diversity among people. mastery of the environment, a positive view of ones world Diagnostic and Statistical Manual of Mental Disorders (DSM) - -to provide a standardizes nomenclature and language for all mental health professionals -to present defining characteristics or symptoms that differentiate specific diagnoses -to assist in identifying the underlying causes of disorders *used to diagnose psychiatric disorders the people of ancient times believed what about mental illness? - believed that any sickness indicated displeasure of the gods and was viewed as demonic who formulated the concept of an asylum? - Philippe Pinel and William Tuke asylum - a safe refuge or haven offering protection when was the development of psychotropic drugs? - 1950s what was the result of the use of psychotropic drugs? - reduced agitation, psychotic thinking, and depression. this shortened hospital stays and many people became well enough to go home deinstitutionalization - moving people with psychological or developmental disabilities from highly structured institutions to home- or community-based settings what did deinstitutionalization accomplish? - release of individuals from long-term stays in state institutions, the decrease in admissions to hospitals, and the development of community-based services as an alternative to hospital care what did the federal legislation pass in regards to providing an income for a disabled person? - supplemental security income (SSI) and social security disability income (SSDI). this allowed people with severe and persistent mental illness to be more independent financially and to not rely on family for money what type of economic burden does mental illness describe? - the economic burden of mental illness including both health care costs and lost productivity, exceeds the economic burden caused by cancer revolving door effect - continuous flow of clients being admitted and discharged quickly; not adequate time to maintain the clients needs long term boarding - patients are often boarded or kept in the ED while waiting to see if the crisis deescalates or until and inpatient bed can become available after deinstitutionalization, by 1990, only 1,300 programs provided various types of psychosocial rehab services. what did this do for patients with persistent and severe mental illness? - the patients were either ignored or underserved by the community health centers managed care - control the balance between the quality of care provided and the cost of that care managed care organizations - developed to control the expenditure of insurance funds by requiring providers to seek approval before the delivery of care case management - optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services what in theory is case management, managed care, and managed care organizations designed for? - decreased fragmented care from a variety of sources, eliminate unneeded overlap of services, provide care in the least restrictive environment, and decreased the costs for insurers what did congress pass in 1996? - the mental health parity act, which eliminated annual and lifetime dollar amounts for mental health care for companies over 50 employees. did not cover substance abuse linda richards - first american psychiatric nurse harriet bailey - wrote the first psychiatric nursing textbook, Nursing Mental Diseases in 1920 standards of care - legal requirements for nursing practice that describe minimum acceptable nursing care phenomena of concern - describe 13 areas of concern that mental health nurses focus on when caring for clients what happens when a student says the "wrong thing" talking to a psychiatric patient? - listen carefully, showing genuine interest, and restate it saying "that didn't come out right. what i meant was..." what happens when a student asks "what will I be doing?" during their clinical rotation at a psychiatric unit? - developing therapeutic nurse-client relationships how should a student handle bizarre or inappropriate behavior from a psychiatric patient? - monitor one's facial expressions and emotional responses so the client does not feel rejected or ridiculed, ask for assistance from a nursing instructor or facility staff when a psychiatric client asks a student about a date or displays sexually aggressive or inappropriate behavior, what does the nursing student do? - it is important for the student to clarify to the client boundaries of the professional relationship, protect the clients privacy and dignity, and ask for assistance from the nursing instructor or facility staff self-awareness - is the process by which the nurse gains recognition of his or her own feelings, beliefs, and attitudes what did sigmund freud develop? - psychoanalysis theory psychoanalysis theory - all human behavior is caused and can be explained id - one's nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses. causes impulsive unthinking behavior superego - person's nature that reflects moral and ethical concepts, values, and parental and social expectations ego - balancing force between superego and id, represents mature and adaptive behavior that allows a person to function successfully in the world conscious - refers to the perceptions, thoughts, and emotions that exist in a persons awareness what is an example of conscious personality function? - a personal being aware of happy feelings or thinking about a loved one preconscious - thoughts and emotions are not currently in the persons awareness, but he or she can recall them with some effort what is an example of preconscious personality function? - an adult remembering what he or she did, thought, or felt as a child unconscious - realm of thoughts and feelings that motivates a person even though he or she is totally unaware of them what is an example of unconscious personality funciton? - the person represses the memory of traumatic events that are too painful to remember in the unconscious subconscious - not fully aware; occurring below your level of thinking and awareness free association - in psychoanalysis, a method of exploring the unconscious in which the person relaxes and says whatever comes to mind, no matter how trivial or embarrassing ego defense mechanisms - methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events introjection - accepting another persons attitudes, beliefs, and values as ones own what is an example of introjection? - a person who dislikes guns becomes an avid hunter, just like the best friend or family member projection - unconscious blaming of unacceptable inclinations or thoughts on an external object what is an example of projection? - a mean who has thought about same-gender sexual relationship but has never had one beats a man who is gay rationalization - excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect what is an example of rationalization? - student blames failure on teacher being mean reaction formation - acting the opposite of what one thinks or feels what is an example of reaction formation? - woman who never wanted to have children becomes a supermom, person who despises the boss tells everyone what a great boss she is transference - occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other relationships what is an example of transference? - an adolescent female client working with a nurse who is about the same age as the teen's parents might react to the nurse like she reacts to her parents countertransference - occurs when the therapist displaces onto the clients attitudes or feelings from his or her past what is an example of countertransference? - a female nurse who has a teenage child and who is experiencing extreme frustration with an adolescent client may respond by adopting a parental or chastising tone what did erik erikson develop? - personality development across the life span while focusing on social and psychological development in the life stages what did jean piaget develop? - explored how intelligence and cognitive functioning develop in children prototaxic mode - characteristic of infancy and childhood that involves brief, unconnected experiences that have no relationship to one another parataxic mode - begins in early childhood as the child begins to connect experiences in sequence syntaxic mode - begins to appear in school-aged children and becomes more predominant in preadolescence; the person begins to perceive himself or herself and the world within the context of the environment and can analyze experiences in a variety of settings participant observer - the therapist both participates and observes the progress of the relationship therapeutic community - the interaction among clients is seen as beneficial, and treatment emphasizes the role of this client-to-client interaction milieu therapy - involved clients interactions with one another, including practicing interpersonal relationship skills, giving one another feedback about behavior, and working cooperatively as a group to solve day-to-day problems hildegard peplau developed what? - the concept of therapeutic nurse-patient relationship what are the four phases of therapeutic nurse-patient relationship? - 1. orientation phase 2. identification phase 3. exploitation phase 4. resolution phase orientation phase of therapeutic relationships - directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions identification phase of therapeutic relationships - begins when the patient works interdependently with the nurse, expresses feelings, and begins to feel stronger exploitation phase of therapeutic relationships - the client makes full use of the services offered