NCM 117 Lec

• Health according to WHO is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity
• Mental hygiene is the branch of psychiatry that deals with maintaining and restoring mental health, preventing mental disorder through education, early treatment, and public health measures
• 6 techniques for mental hygiene by Edward G. Brown:

  • Transcend the environment
  • Cultivate constructive acceptance
  • Visualize the ideal self
  • Use positive affirmation
  • Practice psychological counterpunching
  • Change your internal computer chip
• Mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, a positive self-concept, and emotional stability
• Factors influencing mental health:

  • Inherited characteristics
  • Nurturing childhood
  • Life’s circumstances
• Ways to maintain mental health:

  • Good interpersonal communication
  • Ego defense mechanisms
  • Significant others or support people
  • Involvement in physical activities
• Characteristics of Mental Health:

  • Accepts self and others
  • Is able to cope with or tolerate stress
  • Can return to normal functioning if temporarily disturbed
  • Is able to form close and lasting relationships
  • Uses sound judgment to make decisions
  • Accepts responsibility for actions
  • Is optimistic
  • Recognizes limitations (abilities and deficiencies)
  • Can function effectively and independently
  • Is able to distinguish imagined circumstances from reality
  • Is able to develop potential talents to fullest extent
  • Is able to solve problems
  • Can delay gratification
• Mental disorder according to APA is a clinically significant behavioral or psychological syndrome or pattern associated with present distress or disability
• Characteristics of Mental Illness:

  • Feels inadequate
  • Has poor self-concept
  • Is unable to cope
  • Exhibits maladaptive behavior
  • Is unable to establish meaningful relationships
  • Displays poor judgment
  • Is irresponsible or unable to accept responsibility for actions
  • Is pessimistic
  • Does not recognize limitations
  • Is unable to perceive reality
  • Does not recognize potentials and talents
  • Avoids problems rather than coping with them
  • Desires or demands immediate gratification
• Psychiatry is the science of curing or healing of the psyche
• Psychiatric Nursing is the diagnosis and treatment of human responses to actual and potential mental health problems
• Selected nursing interventions in psychiatric nursing:

  • Active listening
  • Anger control assistance
  • Assertiveness training
  • Behavior management
  • Body image enhancement
  • Caregiver support
  • Communication enhancement
  • Delusion management
  • Eating disorders management
  • Grief work facilitation
  • Hallucination management
  • Impulse control training
  • Milieu therapy
  • Mood management
  • Role enhancement
  • Sleep enhancement
  • Spiritual support
  • Substance abuse treatment
  • Suicide prevention
  • Teaching
• Philosophical beliefs related to effective practice of Psychiatric Nursing:

  • The individual has worth and dignity
  • Every individual has the potential to change and pursue personal goals
  • Mental health is a critical component of comprehensive health care services
  • The individual has the right to participate in decision-making
• Use of Psychiatric-Mental Health Nursing Skills in Career Opportunities:

  • Obstetric Nursing
  • Forensic Nursing
  • Oncologic Nursing
  • Industrial (Occupational Health) Nursing
  • Public Health Nursing
  • Office Nursing
  • Emergency Room Nurse
• Roles and functions of mental health and psychiatric nurse:

  • Providing direct care to patients with mental or emotional disorders
  • Constructing and maintaining a therapeutic environment
  • Patient and family teaching
  • Coordinating diverse aspects of care
  • Acting as an advocate on behalf of the patient and family
  • Responsibilities associated with primary prevention
• DSM 5:

  • Listing of officially recognized mental disorders
  • Intended to guide treatment of mental health issues
  • 7 Biggest Changes from DSM IV-TR to DSM 5
• Basic concepts of personality development:

  • Personality is early established behavior patterns related to how one thinks, feels, and relates to the environment and others
  • Factors influencing personality: heredity, environment, training
• Theories of personality development:

  • Freud, Erikson, Sullivan, and Piaget contribute to the theoretical foundation in nursing and medicine
• Sigmund Freud:

  • Austrian psychiatrist and founder of psychoanalysis
  • Stressed the importance of early childhood experiences in personality development
  • 4 major components of personality development:
  • Levels of awareness
  • Personality structure
  • Concept of anxiety and defense mechanism
  • Psychosexual stages of development
• Levels of awareness according to Freud:

  • Conscious
  • Preconscious/subconscious
  • Unconscious
• Components/structure of personality according to Freud:

  • ID
  • Ego
  • Superego
• Freud's Psychoanalytic Theory:

  • Id: serves as the reservoir of primitive and biologic drives and urges (libido-sexual drives)
  • Primitive, demands immediate satisfaction
  • Functions according to pleasure principle
  • Ego: known as the integrator of personality, operates on reality principles, mediates between id drives and demands of reality, evaluates and judges external world, uses defense mechanisms to protect self
  • Super-ego: internal representative of the values, ideals, and moral standards of society, develops at 3 to 5 years, has 2 sub-systems (conscience and ego-ideal)
• • Theory of psychosexual development:
  • Oral stage (0 to 1 1/2 years old): erogenous zone is the mouth, primary conflict is weaning
  • Anal stage (1 1/2 to 3 years old): erogenous zone is the anus, primary conflict is toilet training
  • Phallic stage (3 to 6 years old): erogenous zone is the genital region, major conflict is Oedipus/Electra complex
  • Latency stage (6-12 years old): marked by expanding peer relationships
  • Genital stage (13 to 20 years old): period of sexual pleasure through genitals
• Psychosocial Stages of Development by Erik Erikson:

  • Trust vs. mistrust (0 to 18 months)
  • Autonomy vs. shame and doubt (18 months to 3 years old)
  • Initiative vs. guilt (3-5 years)
  • Industry vs. inferiority (5-13 years old)
  • Identity vs. role diffusion (13 -21 years)
  • Intimacy vs. isolation (21 to 39 years)
  • Generativity vs. stagnation (40-65 years)
  • Integrity vs. despair (65 years old to end of life)
• Harry Stack Sullivan's Interpersonal Model:

  • Infancy (0-18 months): others satisfy needs, solitary play
  • Toddlerhood (1 1/2 - 3 years): headstrong, negativistic, parallel play
  • Pre-schooler: later childhood, love to watch adults, associative or cooperative play
  • Schooler: juvenile era (6-10 years) and pre-adolescence (11-12 years)
  • Adolescence (12-18 years): establish relationship with opposite sex
  • Young adulthood or late adolescence: incorporation of lust in heterosexual relationship
• Jean Piaget's Theory of Cognitive Development:

  • Sensorimotor period (0-2 years old)
  • Pre-operational period (2-7 years old)
  • Period of Concrete Operations (7-11 years old)
  • Period of Formal Operations (11 years through adulthood)
• Intellectual Development Disability:

  • Disorders affecting physical, intellectual, and emotional development
  • Characterized by problems with intellectual functioning and adaptive behavior
  • Severity classified as mild, moderate, severe, and profound
  • Etiology includes genetic conditions, problems during pregnancy, problems at birth, health problems, environmental factors
  • Severity levels based on ability to perform day-to-day life skills and activities
  • Mild, Moderate, Severe levels described with IQ ranges and characteristics
• Severe intellectual disability:

  • I.Q. 25 to 35
  • Poor motor development and minimal speech
  • Unable to learn academic skills but may learn to talk and be trained in elementary hygiene skills or activities of daily living
  • Require complete supervision in a controlled environment
  • Can achieve a mental age of 0 to 2 years old
  • 3% to 4% of all persons with IDD
  • May learn to perform simple work tasks
• Profound intellectual disability:

  • I.Q. below 20 or 25
  • Minimal capacity for sensorimotor functioning
  • Require total nursing care and highly structured environment with supervision due to self-care deficit
  • 1% to 2% of all persons with IDD
  • "custodial" - requires total care
  • May attain a mental age of young infant
  • Does not relate with peers; more secure with adults
  • Comforted by physical touch
  • May repeat words
  • Short attention span but usually attracted to music
• Signs of IDD:

  • Sit up, crawl, or walk later than other children
  • Learn to talk later, or have trouble speaking
  • Find it hard to remember things
  • Not understand how to pay for things
  • Have trouble understanding social rules
  • Have trouble seeing the consequences of their actions
  • Have trouble solving problems
• How to diagnose intellectual disability:

  Three things factor into the diagnosis of intellectual disability:

  • Interviews with the parents
  • Observation of the child
  • Testing of intelligence and adaptive behaviors
• A child is considered intellectually disabled if they have deficits in both IQ and adaptive behaviors. If only one or the other is present, the child is not considered intellectually disabled.

  After a diagnosis of intellectual disability is made, a team of professionals will assess the child’s particular strengths and weaknesses. This helps them determine how much and what kind of support the child will need to succeed at home, in school, and in the community
• Skills that could be taught:

  • Communicating with others
  • Taking care of personal needs (dressing, bathing, going to the bathroom)
  • Health and safety
  • Home living (helping to set the table, cleaning the house, or cooking dinner)
  • Social skills (manners, knowing the rules of conversation, getting along in a group, playing a game)
  • Reading, writing and basic math
  • As they get older, skills that will help them in the workplace
• Steps to help intellectually disabled child:

  • Learn everything you about intellectual disabilities
  • Encourage the child’s independence
  • Get the child involved in group activities
  • Stay involved
  • Get to know other parents of intellectually disabled children
• Autism spectrum disorder:

  • Is a condition related to brain development that impacts how a person perceives and socializes with others, causing problems in social interaction and communication
  • Includes limited and repetitive patterns of behavior
  • Begins in early childhood and eventually causes problems functioning in society — socially, in school and at work
  • Often children show symptoms of autism within the first year
• • A small number of children appear to develop normally in the first year, and then go through a period of regression between 18 and 24 months of age when they develop autism symptoms
• Predisposing factors for autism spectrum disorder:

  • Psychodynamic theory: Fixed in the pre-symbiotic phase of development, does not achieve a symbiotic relationship with nor differentiate self from mother, ego development is delayed, the child does not communicate or form relationships
  • Biologic theories: genetics/chromosomal abnormality, neurotransmitter abnormality, brain structure abnormality, prenatal infections, peri-natal insults, metabolic disorders
• Risk factors for autism spectrum disorder:

  • Sex: Boys are about four times more likely to develop autism spectrum disorder than girls are
  • Family history: Families who have one child with autism spectrum disorder have an increased risk of having another child with the disorder
  • Other disorders: Children with certain medical conditions have a higher-than-normal risk of autism spectrum disorder or autism-like symptoms
• Complications of autism spectrum disorder:

  • Problems in school and with successful learning
  • Employment problems
  • Inability to live independently
  • Social isolation
  • Stress within the family
  • Victimization and being bullied
• Symptoms of autism spectrum disorder:

  • Some children show signs of autism spectrum disorder in early infancy, such as reduced eye contact, lack of response to their name or indifference to caregivers
  • Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they've already acquired
  • Signs usually are seen by age 2 years
  • Each child with autism spectrum disorder is likely to have a unique pattern of behavior and level of severity — from low functioning to high functioning