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1. Milieu Therapy: Milieu refers to the environment in which holistic treatment occurs and includes all members of the
treatment team in a positive physical setting, with interactions among those who are hospitalized and activities that promote
recovery.
The psychiatric mental health registered nurse provides, structures, and maintains safe, therapeutic, recovery oriented
environment collaboration with health care consumers, families, and other health care clinicians.
Among other things milieu management includes orienting patients to their rights and responsibilities. Milieu management also
includes informing patients in a culturally competent manner about the need for structure, maintenance of a safe environment,
and limits set on the unit.
The nurse selects activities (both individual and group) that meets the patient's physical and mental health needs. The patient
should always be maintained in the least restrictive environment.
2. Mental health: Successful performance of mental functions, resulting in the ability to engage in productive activities,
enjoy fulfilling relationships, adapt to change, and cope with adversity.
Mental health is the foundation of thinking, communication skills, learning, emotional growth, resilience, and self-esteem
throughout the life span.
It is a STATE OF WELL-BEING in which individuals are able to realize their abilities as well as contribute to their community within
the context of life stressors.
3. Mental illness: Actual diagnoses, gets in the way of obtaining mental health.
Medical conditions that affect a person's thinking, feeling, mood, ability to relate to others, and daily functioning. Basically, menta
illness can be seen as the result of flawed biological, psychological, or social processes.
Fortunately mental illnesses are treatable, and individuals can experience symptom relief, and complete cure in some cases, with
treatment and support.
4. Maslow's hierarchy of needs: Needs are placed conceptually on a pyramid, with the most basic and important
needs on the lower level.
The higher levels, the more distinctly human needs, occupy the top sections of the pyramid. According to Maslow, when lower leve
needs are met, higher level needs are able to emerge.
**Physiological needs first, safety second
5. Physiological needs: Food, water, oxygen, elimination, rest, and sex
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6. Safety needs: Security, protection, stability, structure, order, and limits.
7. Love and belonging needs: Affiliation, affectionate relationships, and love 8. Esteem needs: Self-esteem related to
competency, achievement, and esteem from others.
9. Self-actualization needs: Becoming everything one is capable of.
10. Self-transcendence: When a person experiences a sense of identity that transcends or extends beyond the personal self.
11. The Id: The primitive, pleasure-seeking part of our personalities that lurks in the unconscious mind.
12. The Ego: Our sense of self. (Also unconscious mind)
Acts as an intermediary between the id and the world by using ego defense mechanisms, such as repression, denial, and
rationalization
13. The Superego: Conscious mind.
Our conscience (our sense of what is right or wrong) and is greatly influenced by our parents' or caregivers' moral and ethical
stances.
14. Freud's contribution to mental health: Freud believed that personality development is based on stages. During these
stages, the id focuses on an erogenous zone of the body. These zones are oral, anal, and phallic. Fixation through
overindulgence or frustration results in pathologic conditions and personality disorders. Freud's work has been criticized for
a variety of reasons. One of the harshest criticism stems from the concept of penis envy in which females suffer from
feelings of inferiority for not having male genitalia.
15. Freud - Oral—birth to 1½ years: Pleasure-pain principle
Id, the instinctive and primitive mind, is dominant
Demanding, impulsive, irrational, asocial, selfish, trustful, omnipotent, and dependent
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Primary thought processes
Unconscious instincts—source-energy-aim-object
Mouth—primary source of pleasure
Immediate release of tension/anxiety and immediate gratification through oral gratification
Task—develop a sense of trust that needs will be met
16. Freud - Anal—1½ to 3 years: Reality principle—postpone immediate discharge of energy and seek actual object to
satisfy needs
Learning to defer pleasure
Gaining satisfaction from tolerating some tension-mastering impulses
Focus on toilet training—retaining/letting go; power struggle
Ego development—functions of the ego include problem-solving skills, perception, ability to mediate id impulses
Task—delay immediate gratification
17. Freud - Phallic—3 to 7 years: Superego develops via incorporating moral values, ideals, and judgments of right and
wrong that are held by parents; superego is primarily unconscious and functions on the reward and punishment principle
(sexual identity attained via resolving oedipal conflict)
Conflict differs for boy and girl masturbatory activity
Task—develop sexual identity through identification with same-sex parent
18. Freud - Latency—7 to 12 years: Desexualization; libido diffused
Involved in learning social skills, exploring, building, collecting, accomplishing, and hero worship
Peer group loyalty begins Gang and scout
behavior
Growing independence from family
Task—sexuality is repressed during this time; learn to form close relationship(s) with same-sex peers
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19. Freud - Genital phase (adolescence)—13 to 20 years: Fluctuation regarding emotion stability and physical
maturation
Very ambivalent and labile, seeking life goals and emancipation from parents
Dependence vs. independence
Reappraisal of parents and self; intense peer loyalty
Task—form close relationships with members of the opposite sex based on genuine caring and pleasure in the interaction
20. Verbal communication: Words we speak, clear, honest, convey interest and understanding
21. Non-verbal communication: The tone and pitch of a person's voice and the manner in which a person paces speech
Body language
Physical appearance
Facial expressions
Body posture
Amount of eye contact
Eye cast (emotion expressed in the eyes)
Hand gestures
Sighs
Fidgeting
Yawning
22. Use of silence: When used properly, the use of silence can be an effective tool in encouraging individuals to open up.
Silence is not the absence of communication; it is a specific channel for transmitting and receiving messages.