Introduction to mental health Nursing (part 1)

Objectives 1. Define terms: A.Mental Health B.Mental Illness 2. List factors Influencing a Person’s Mental Health. 3. Discuss History of Concepts. 4. List Mental Health Team. 5. Enumerate rights of Psychiatric/Mental Health Patients. 6. Define Therapeutic Relationships. 7.Types of therapeutic Relationships.

Concerned with the promotion of mental health, prevention of mental disorders, and the nursing care of patients during mental illness and rehabilitation. Introduction

WHO definition: State of complete physical, mental, and social wellness, not merely absence of disease. OR State of emotional, psychological, and social wellness evidenced by: A.Satisfying interpersonal relationships B.Effective behavior and coping C.A positive self-concept. D.Emotional stability. Important Terms What Is Mental Health?

Mental illness defined as: is a disease or condition which either: by the Texas Mental Health Code. – Basically impairs the person’s thought, perception of reality, emotional process. OR – Grossly impairs behavior as manifested by a recent event of disturbed behavior. Important Terms What Is Mental Illness?

1.Individual factors: autonomy, independence, self-esteem, ability to find meaning in life, a sense of belonging. 2.Interpersonal factors: Effective communication, ability to help others. 3.Social/cultural factors: A sense of community, intolerance of violence. Factors Influencing a Person’s Mental Health

History of Concepts  How were mentally ill treated prior to1790’s? – Banishment – Confinement  What were attitudes toward them? – Possessed by the devil – Lacked basic human qualities  Period of Enlightenment begins in 1790’s – Concept of “ Asylum” (sanctuary):  If we treat patients humanely and respectfully, they will improve.

History of Concepts First mental hospitals (“asylums”) in US in 1820’s.  Who was Dorthea Dix? ( ). A nurse who was one of the first major reformers in the United States. Helped develop the concept of an asylum Direct role in opening 32 state hospitals Moral-treatment movement advocating humane care. Freud introduces psychoanalysis in 1890s.

ConfinementBanishment Asylum

Dorthea Dix Asylum in North Carolina Freud Dorthea Dix

Era of Psychotropic Drugs  Anti-psychotic drugs (medications) introduced in mid-1950s. ex. chlorpromazine (Thorazine) for Schizophrenia, Lithium for Mania.  New biological therapies introduced in 1930s. A.Insulin-coma therapy (ICT) B.Electro-shock therapy (ECT) C.Frontal lobotomy

Community Mental Health Movement Response to the overcrowding and bureaucracy of public mental hospitals. – Chronically mentally ill “warehoused” and often abused, neglected.  1963 Community Mental Health Act:- – Concept: Patients can be treated better, cheaper in community. Deinstitutionalization: All State Hospitals closed. Result : Community mental health centers established in 1963.

 Hospitals (2004 and 2006 National Hospital Discharge Survey). A.Mental Disorders accounted for 2.3million hospitalizations (2004). B.Mental disorders increased to 2.4 million hospitalizations (6.9% of total). C.Psychoses was the 3 rd most common reason for hospitalization. Community Mental Health Centers. Out-patient mental health clinics. Nursing homes. Private clinic. Modern Treatment Facilities /Trends

Mental Health Team: 1.Psychiatrists 2.Psychiatric nurses 3.Physicians 4.Therapeutic Recreation 5.Psychologists 6.Social workers 7.Client and family counselors 8.Other: Substance abuse counselor, employment specialist, dietician, etc. Professionals who treat mental disorders

Rights of Psychiatric/Mental Health Patients 1.Right to refuse treatment. 2.Right to informed consent and know about rights. 3.Right to confidentiality. 4.Right to receive visitors and telephone calls. 5.Right to be treated with respect. 6.Right to be treated in the least restrictive environment

Rights of Mentally Ill Patients Concept of least restrictive environment: seclusion is used when the person is a danger to others, and restraint is used when the person is a danger to self. Basic Needs: A.Warmth: clothing a blanket B.Food C.Access to the outdoors Contact with family, legal representative

A Nurse Needs to Know About How to adapt legal principles to mental health settings: – safeguarding nursing practice from charges of negligence, false imprisonment, assault, or battery Duty to warn: – Mental health professionals must warn others of a client’s threat of suicide or of harm to self or others.

The ability to establish therapeutic relationships with clients is one of the most important skills a nurse can develop. Nurse Patient Relationship: – Therapeutic nurse–patient relationship, which includes four phases: orientation, identification, exploitation, and resolution. Therapeutic Relationships

1. Social Relationship: A social relationship is purpose of friendship, socialization, companionship, usually focuses on sharing ideas, feelings, and experiences and meets the basic need for people to interact. 2. Intimate Relationship: A healthy intimate relationship involves two people who are emotionally committed to each other. as well as sharing of mutual goals. 3. Therapeutic Relationship: The therapeutic relationship focuses on the needs, experiences, feelings, and ideas of the client. The nurse uses communication skills, personal strengths, and understanding of human behavior to interact with the client. TYPES OF RELATIONSHIPS

 Therapeutic relationships are focused on the needs, experiences, feelings, and ideas of the client, not the nurse.  The therapeutic relationship consists of three phases: 1. Orientation 2. Working 3. Termination Establishing the Therapeutic Relationship

1. Orientation: The orientation phase begins when the nurse and client meet and ends when the client begins to identify problems to examine. the nurse establishes roles, the purpose of meeting. Nurse task is to: A.Build trust B.Reads background materials available on the client. C.Becomes familiar with any medications the client is taking D.Gathers necessary paperwork E.Arranges for a quiet, private, comfortable setting Therapeutic Relationship

Divided into two sub phases A. Problem identification: the client identifies the issues causing problems Examination of the client’s feelings and responses B. Exploitation (exploration): the nurse guides the client to examine feelings and responses and to develop better coping skills and a more positive self-image; this encourages behavior change and develops independence. Working phase

The specific tasks of the working phase include the following: 1.Maintaining the relationship. 2.Gathering more data. 3.Exploring perceptions of reality. 4.Developing positive coping mechanisms. 5.Promoting a positive self-concept. 6.Encouraging verbalization of feelings. 7.Facilitating behavior change. 8.Working through resistance. 9.Evaluating progress and redefining goals as appropriate. 10.Providing chance for the client to practice new behaviors. 11.Promoting independence. Working phase

A.Begins when the client’s problems are resolved. B.Ends when the relationship is ended. C.Deals with feelings of anger or abandonment that may occur. Termination

 Teacher: the nurse may teach the client new methods of coping and solving problems.  Caregiver: role in mental health settings is the implementation of the therapeutic relationship to build trust, explore feelings, assist the client in problem solving, and help the client meet psychosocial needs.  Advocate: In the advocate role, the nurse informs the client and then supports him or her in whatever decision he or she makes. Therapeutic Roles of the Nurse in a Relationship

Psychotherapeutic Management TOOLS ARE: SELF  DRUGS  ENVIRONMENT  Therapeutic Use of SELF (Nurse-Client Relationship)  DRUGS: Psychopharmacology  ENVIRONMENT: Therapeutic Milieu