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Mental Health Nursing
Historical Beliefs Demonology requiring exorcism, beating, torture Middle Ages associated mental illness with
witchery Asylums emerged in the 1800s – institutionalized
Evolution of Nursing Linda Richards – First psychiatric nurse Est’b psychiatric hospitals and schools of nursing
(asylums)
Contemporary Approach Mid 1900s – shift to community care, psychiatric
nursing added to nursing curricula National Mental Health Act – post WWII
American Psychiatric Association A state of being that is relative rather than
absolute Shown by productive activities, fulfilling
relationships, ability to adapt to change and cope with adversity
Lisa Robinson (Psychiatric Nursing Expert) Dynamic state in which thought, feeling, and
behavior is age appropriate and congruent with local and cultural norms
American Psychiatric Association A clinically significant behavioral or
psychological pattern, associated with distress, disability, or risk of suffering
Not an expected cultural response to an event
Townsend Maladaptive responses to stressors, AEB
thoughts, feelings, behaviors that are not congruent with culture and interferes with functioning
Members of the community define norms Relatives typically determine
“normalcy”and define when state has changed
Class and Education Lower - high incidence; low recognition Higher - high recognition and self labeling
Gender Women are more likely to recognize symptoms
of MI and seek treatment
Stressor Any factor that causes emotional or physical
tension; may be a responsible factor in certain illnesses
Stress Response - General Adaptation Syndrome Alarm-Resistance-Exhaustion (review N101 lecture) Adaptation – responses preserve integrity and
equilibrium Maladaption – responses that result in disruption of
integrity and disequilibrium
Primary The person asks
themselves is this event:▪ Irrelevant – the
outcome is insignificant▪ Benign-positive - the
outcome is pleasurable▪ Stressful – the outcome
is harmful, threatening, challenging
▪ Stressful conclusion leads to secondary appraisal
Secondary The person assesses
their skills, resources, and knowledge to deal with the situation
Determines coping strategies available
Considers options
Predisposing Factors Genetic influences: temperament, family
history of mental illness, personality Past Experiences: learned patterns of
coping due to past experiences Existing Conditions: Current health
status, developmental maturity, financial and educational resources, support system
The use of coping strategies in response to stress Adaptive or Maladaptive
Specific Strategies Awareness - recognition Relaxation/Meditation Communication – talking it out; support systems Problem Solving – view situation objectively,
analyze, act, evaluate Alternative Resources▪ Pets/ music/ dance/ art/ exercise
Anxiety Vague apprehension associated with
feelings of uncertainty
Levels of anxiety▪ Mild – tension, prepares for action/response▪ Moderate –heightened tension; cognition
impaired and individual needs assistance▪ Severe – Difficulty functioning even simple tasks▪ Panic – terror, desperate, out of touch with
reality
Defense Mechanisms Protective devices used to alleviate anxiety▪ Compensation – covering up a weakness by
emphasizing something more desirable▪ Denial – refusal to acknowledge▪ Displacement – transfer of feelings from target to
another▪ Identification – increase self worth by acquiring
attributes of a positive role model▪ Intellectualization – avoid emotions by focusing
on analysis▪ Introjection – integration of others values into self▪ Isolation – separating the event and emotion
Defense Mechanisms con’t▪ Projection – attributing unacceptable self-feelings to
another▪ Rationalization – making excuses▪ Reaction – avoids thoughts, feelings by expressing
opposite▪ Repression – blocking unpleasant feelings▪ Sublimation – direct impulses into constructive
activities▪ Suppression – avoiding unpleasant thoughts, feelings▪ Undoing – symbolically cancels out an unpleasant
experience
Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition – Text Revision
This is a tool provides guidelines and diagnostics criteria for mental illness
It is a multi-axial system Axis 1: All psychiatric disorders except personality
d/o and MR Axis 2: Personality disorders and MR Axis 3: Medical conditions Axis 4: Environmental issues or psychosocial
problems that may impede treatment Axis 5: Global Functioning Scale – Townsend, page
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