1. Psychiatric Mental Health Nursing, 5th Edition Mental Health and Illness Continuum

2. Psychiatric Mental Health Nursing, 5th Edition Mental Health  Defined as “The successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age- appropriate and congruent with local and cultural norms.”

3. Psychiatric Mental Health Nursing, 5th Edition Holism: Five Dimensions of the Person  The person at a development stage  1. Physical - basic needs, healing capacity  2. Intellectual – memory, learning  3. Emotional – feelings, self image  4. Spiritual – relatedness, beliefs  5. Sociocultural – culture, relationships  Another way to define Health is the ability to integrate all dimensions.

4. Psychiatric Mental Health Nursing, 5th Edition Mental Health  Freud – “To work and to love”  - Occupational functioning  role as mother, wife  work outside home roles  meet requirements and expectations  - relationships  intimate  satisfying and have reciprocity

5. Psychiatric Mental Health Nursing, 5th Edition Continued:  Can meet basic needs  Able to cope with daily stress  Can resolve conflict successfully  Positive self concept/positive way of dealing with self: talk, cry, sports.  Capacity for empathy and social sensitivity

6. Psychiatric Mental Health Nursing, 5th Edition Mental Illness  Defined as “Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational, or physical functioning.”

7. Psychiatric Mental Health Nursing, 5th Edition Illness  Symptoms get in the way of effective occupational, role and relationship functioning  - paranoia – “People I work with are out to make me look like a fool or for me to fail.”  - hallucinations – The voices tell the person to jump out of the window  - low self-esteem – “I am unlovable”.

8. Psychiatric Mental Health Nursing, 5th Edition Continued:  Suicidal thinking  Extreme anger or hostility  Delusions, hallucinations  Abuse of alcohol and drugs  Denial of problems  Inability to cope with daily activities

9. Psychiatric Mental Health Nursing, 5th Edition Continued:  Marked personality change  Confused thinking  Prolonged mood disturbance  Excessive anxiety, fear, suspiciousness  Withdrawal from society  Abnormal self-centeredness

10. Psychiatric Mental Health Nursing, 5th Edition Mental Health and Illness Continuum  *_____________________________________*  Mental Degrees Mental  Health of Illness  Functioning  Exacerbations/acute episodes

11. Psychiatric Mental Health Nursing, 5th Edition Myths about Mental Illness  To be mentally ill is to be different and odd  To be healthy, a person must be logical and rational  - All of us dream “irrational” dreams every night  - “irrational” emotions are not only a universal experience but necessary for a fulfilling life  There are people who show extremely abnormal behavior and are mentally ill who are far more like the rest of us than different from us

12. Psychiatric Mental Health Nursing, 5th Edition Remember  Mental health and illness  - Exist on a continuum  All people move back and forth  Not all mental illnesses are equal  It can happen to anyone

13. Psychiatric Mental Health Nursing, 5th Edition Reasons for impaired function 1. Stressors such as  -Developmental phases/Life events  - Job security  - Poverty/Economic pressures  - Crime 2. Inability to cope with stressors, life changes – Adaptation 3. Genetics

14. Psychiatric Mental Health Nursing, 5th Edition Psychological Adaptation to Stress Anxiety  Behavioral adaptation responses to anxiety  At the mild level, individuals employ various coping mechanisms to deal with stress. A few of these include eating, drinking, sleeping, physical exercise, smoking, crying, laughing, and talking to persons with whom they feel comfortable.

15. Psychiatric Mental Health Nursing, 5th Edition Psychological Adaptation to Stress Anxiety – caused by stress. We all have it.  A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness.  Extremely common in our society.  Mild anxiety is adaptive and can provide motivation for survival.

16. Psychiatric Mental Health Nursing, 5th Edition Psychological Adaptation to Stress Anxiety  Peplau’s four levels of anxiety – Mild – seldom a problem – Moderate – perceptual field diminishes – Severe – perceptual field is so diminished that concentration centers on one detail only or on many extraneous details – Panic – the most intense state

17. Psychiatric Mental Health Nursing, 5th Edition Psychological Adaptation to Stress Anxiety  Anxiety at the moderate to severe level that remains unresolved over an extended period of time can contribute to a number of physiological disorders – for example, migraine headaches, IBS, and cardiac arrhythmias.  Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving – for example, anxiety disorders and somatoform disorders.

18. Psychiatric Mental Health Nursing, 5th Edition Psychological Adaptation to Stress Anxiety  Extended periods of functioning at the panic level of anxiety may result in psychotic behavior; for example, schizophrenic, schizoaffective, and delusional disorders.

19. Psychiatric Mental Health Nursing, 5th Edition Psychological Adaptation to Stress Anxiety  At the mild to moderate level, the ego calls on defense mechanisms for protection, such as –Denial –Displacement –Identification –Intellectualization –Projection –Regression –Repression –Sublimation –Suppression –Undoing

20. Psychiatric Mental Health Nursing, 5th Edition Summary  MH – Successful adaptation (and coping) to stressors from the internal and external environment  MI – Maladaptive responses to stressors from the internal and external environment, evidenced by thoughts, feelings and behaviors that are incongruent with local cultural norms  Interfere with functioning

21. Psychiatric Mental Health Nursing, 5th Edition Case  Lois is a 23 year-old college student who wrote about herself, “Most of the time I’m happy and feel pretty good about myself. I’ve learned that what I get out of something is often proportional to the effort I put into it. My grades are OK.”  Where is Lois on the Health/Illness Continuum?

22. Psychiatric Mental Health Nursing, 5th Edition Role of the Psychiatric Nurse  Advocacy  Teaching  Therapeutic relationship –the tool for nursing care  Using the nursing process  Performing mental status assessment  Maintaining a therapeutic milieu (environment)  Cultural assessment –does the patient believe in a folk healer?

23. Psychiatric Mental Health Nursing, 5th Edition Continued:  Maintaining the least restrictive environment  legal requirement  related to seclusion  related to restraints  types of restraints: environmental (room), chemical, mechanical

24. Psychiatric Mental Health Nursing, 5th Edition Health Promotion and Maintenance - Education programs - Stress management - Crisis intervention  Do in out-patient/community mental health centers/schools

25. Psychiatric Mental Health Nursing, 5th Edition Health Restoration  In-patient care  The patient is a danger to self or others  Suicidal, homicidal or cognitively impaired and cannot meet basic need – impaired safety  Voluntary  Involuntary admission – court ordered, time limited, 72 hours and then a court hearing to determine need for further care

26. Psychiatric Mental Health Nursing, 5th Edition Addition nursing roles  Administer meds and monitor compliance  Assist with problem solving  Teach new coping skills

27. Psychiatric Mental Health Nursing, 5th Edition Community Resources  Day hospital (Partial Hospitalization)  Community Mental Health Centers  Preserves the family, keep the patient function at the highest level possible, minimizes stigma or in-patient hospitalization, lowers costs  Medication centers  Alternative Living  Group homes, foster care, cooperative apartments, shelters

28. Psychiatric Mental Health Nursing, 5th Edition Conclusion  Mental Illness is everywhere  You will care for patients with mental illnesses in any setting you will practice  Non-acute vs acute  Healthy people can become mentally ill due to stressors; in addition to the causes and stressors previously covered, it can be due a serious diagnosis, lose of a body part.