Introduction to Mental Health Nursing MENTAL HEALTHAND MENTAL ILLNESS Mental health and mental illness are difficult to define precisely. People who can carry out their roles in society and whose behavior is appropriate and adaptive are viewed as healthy. Conversely those who fail to fulfill roles and carry out responsibilities or whose behavior is inappropriate are viewed as ill. The culture of any society strongly influences its values and beliefs, and this in turn affects how that society defines health and illness. What one society may view as acceptable and appropriate, another society may see as maladaptive or inappropriate.
MENTAL HEALTHAND MENTAL ILLNESS . DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-IV-TR) The Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-IV-TR), now in its fourth edition, is a taxonomy published by the APA. The DSM-IV-TR describes all mental disorders, outlining specific diagnostic criteria for each based on clinical experience and research. All mental health clinicians who diagnose psychiatric disorders use the DSM-IV-TR.
MENTAL HEALTHAND MENTAL ILLNESS . DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-IV-TR) The DSM-IV-TR has three purposes: To provide a standardized and language for all mental health professionals • To present defining characteristics or symptoms that differentiate specific diagnoses • To assist in identifying the underlying causes of disorders
STANDARDS OF PSYCHIATRIC-MENTAL HEALTH CLINICAL NURSING PRACTICE STANDARDS OF CARE: Standard I. Assessment The psychiatric-mental health nurse collects client health data. Standard II. Diagnosis The psychiatric-mental health nurse analyzes the data in determining diagnoses. Standard III. Outcome Identification The psychiatric-mental health nurse identifies expected outcomes individualized to the client. Standard IV. Planning The psychiatric-mental health nurse develops a plan of care that prescribes interventions to attain expected outcomes. Standard V. Implementation The psychiatric-mental health nurse implements the interventions identified in the plan of care. Standard Va. Counseling The psychiatric-mental health nurse uses counseling interventions to assist clients in improving or regaining their previous coping abilities, fostering mental health, and preventing mental illness and disability. Standard Vb. Milieu Therapy The psychiatric-mental health nurse provides, structures, and maintains a therapeutic environment in collaboration with the client and other health care providers.
:Actual or potential mental health problems pertaining to• The maintenance of optimal health and well-being and the prevention of psychobiologic illness• Self-care limitations or impaired functioning related to mental and emotional distress• Deficits in the functioning of significant biologic, emotional, and cognitive symptoms• Emotional stress or crisis components of illness, pain, and disability• Self-concept changes, developmental issues, and life process changes• Problems related to emotions such as anxiety, anger, sadness, loneliness, and grief• Physical symptoms that occur along with altered psychological functioning• Alterations in thinking, perceiving, symbolizing, communicating, and decision-making• Difficulties relating to others• Behaviors and mental states that indicate the client is a danger to self or others or has a severe disability• Interpersonal, systemic, sococultural, spiritual, or environmental circumstances or events that affect the mental or emotional well-being of the individual, family, or community• Symptom management, side effects/toxicities associated with psychopharmacologic intervention, and other aspects of the treatment regimen PSYCHIATRIC MENTAL HEALTH NURSING PHENOMENA OF CONCERN
: PSYCHIATRIC NURSING PRACTICEIn 1873, Linda Richards graduated from the NewEngland Hospital for Women and Children in Boston.She went on to improve nursing care in psychiatrichospitals and organized educational programs in statemental hospitals in Illinois. Richards is called thefirst American psychiatric nurse; she believed that“the mentally sick should be at least as well cared foras the physically sick” (Doona, 1984).The first training of nurses to work with personswith mental illness was in 1882 at McLean Hospitalin Waverly, Mass. The care was primarily custodialand focused on nutrition, hygiene, and activity.
AREAS OF PRACTICEBASIC-LEVEL FUNCTIONS• CounselingInterventions and communication techniquesProblem solvingCrisis interventionStress managementBehavior modification• Milieu therapyMaintain therapeutic environmentTeach skillsEncourage communication between clients andothersPromote growth through role-modeling• Self-care activitiesEncourage independenceIncrease self-esteemImprove function and health• Psychobiologic interventionsAdminister medicationsTeachingObservations• Health teaching• Case management• Health promotion and maintenanceADVANCED-LEVEL FUNCTIONS• Psychotherapy• Prescriptive authority for drugs (in many states)• Consultation• Evaluation
Critical Thinking Questions1. In your own words, describe mental health.Describe the characteristics, behavior, and .abilities of someone who is mentally healthy2. When you think of mental illness, what imagesor ideas come to mind? Where do theseideas come from—movies, television, personalexperience?.3. What personal characteristics do you havethat indicate good mental health?