Define and describe psychiatric and mental health nursing: Psychiatric nursing focuses on care and rehab of people with identifiable mental illness or disorder Mental Health nursing focuses on well and at risk population to prevent mental illness or provide immediate treatment for those with early signs of a disorder. Psychiatric mental health nursing is described by Psychiatric-Mental Health Nursing: Scope and Standard of Practice as committed to promoting mental health through the assessment, diagnosis and treatment of human responses to mental health problems and psychiatric disorders.
Psychiatric mental health nursing uses the study of human behavior as its science and purposeful use of self as its art. It views people holistically, considering their strength, needs, and problems. It is based on physical and social science, designed to meet needs of people with health problems, provided by caring and knowledgeable professionals, relies on problem solving approach to plan, deliver, and evaluate care. 2. Trace the history of psychiatric mental health nursing in the US as it applies to patient centered care: 3.
Identify significant trends in healthcare and their effects on psychiatric nursing 4. Describe the difference between various theories Psychodynamic- psychoanalytic theory derives from Sigmund Freud. Central to analytic theory is the idea of unconscious which contains repressed memories. Although a person is unaware of unconscious material, repressed thoughts seek expression thorugh dreams, fantasies or may lead to irrational or maladaptive behavior. A goal of psychodynamic counseling is to expand awareness on unconscious functioning and its relation to daily living.
To Freud, personality is composed of three subsystem: id, ego , superego. Cognitive- Guides two major schools of thoughts: Albert Ellis’s rational emotive theory and Aaron Beck’s cognitive theory. Both emphasize the role of cognition (thoughts) in how people feel and act Rational emotive therapy (Ellis theory) event do not cause emotional or behavioral consequences directly. Rather, beliefs about these activating events are the most direct and important causes of how people feel and act. Rational emotive therapy (RET) emphasizes the disputation of irrational beliefs.
Cognitive Theory (Becks)- holds that conditions such as depression result primarily from pervasive, negative misinterpretation . Behavioral- States that all behavior are learned, focuses on how environmental conditions result in acquisition, modification, maintenance, and elimination of adaptive and maladaptive behaviors. To a behaviorist, subjective experience did not provide acceptable scientific data, only study of directly observable behavior and the stimuli reinforcing conditions that control it could serve as a basis for formulating scientific principles.
Concepts of behavioral theory are: conditioning, reinforcement, punishment, generalization and discrimination, modeling, shaping. Cognitive behavioral- Learning theorists, such as Donald Meichenbaum enhanced behavior therapy by introducing role of cognitions or mediating processes between a stimulus and response, which led to cognitive behavioral theory or cognitive behavioral management. This type of therapy is active, directive, highly structured, and time limited.
Therapists are seen as teachers or coaches and expect clients to be engaged actively in their treatment, practicing new thoughts and behaviors through homework exercises developed by the therapist. Some cognitive behavioral techniques: Cognitive labeling, systematic rational restructuring, rational problem solving Humanistic- Recognizes the importance of learning and other psychological processes that traditionally have been the focus of research. Such processes include creativity, hope, love, self fulfillment, personal growth, values, and meaning.
Humanists are concerned with the personal growth and potentialities of people. With their positive view of human nature, humanists believe that psychopathology results from the blocking or distortion of personal growth, excessive stress, and unfavorable social conditions. Sociocultural-focuses on role of social and cultural influences on the person. Culture can be thought of as the “glue” that holds certain groups together. It consists of socially acquired and transmitted symbols, beliefs, techniques, institutions, customs, and norms.
Culture has been found to exert a great influence on the birth, development, and death of humans. Biophysical- referred to as medical model. Proposes that psychopathology results from physiologic condition, primary a deviation within the central nervous system. The reasons for these deviations are multifaceted, involving a complex interplay of genetics, temperament, development, brain circuitry, molecular biology, and environment. Interpersonal models- Emphasize the socialization of humans throughout their developmental stages.
Failure to proceed through these stages satisfactorily lays the foundation for later maladaptive behavior. Emphasizes the role of early childhood in shaping self concept. Distorted self concepts can be traced to the person’s family. Two results of distorted self concepts are poor interpersonal functioning and self defeating games people learn to play. Interpersonal therapy is concerned with alleviating anxiety and pathogenic or problem causing relationships. 5.
Discuss the rights of mental health clients and identify how these rights apply in practice: The basic rights of clients receiving psychiatric nursing care include: right to appropriate treatment, right to an individualized, written, treatment or service plan, right to ongoing participation in a manner appropriate to person’s capabilities, the right to be provided reasonable explanation in terms or language that client can understand, right not to receive a mode or course of treatment in the absence of informed, voluntary, written consent to treatment except during emergency, right not to participate in experimentation in the absence of informed, voluntary, written consent, right to freedom from restraint or seclusion, other than as a mode or course of treatment or restraint or seclusion during emergency, right to humane treatment environment that affords reasonable protection from harm and appropriate privacy with regard to personal needs, right to access on request, person’s mental health record, right ( in the case of a person admitted on a residential or inpatient care basis, to converse with others privately, to have convenient and reasonable access to telephone and mails, see visitors, right to be informed promptly and in writing at time of admission of these rights, right to exercise rights without reprisal, right of referral to other providers upon discharge. 6. Identify situations in which the duty to warn should be invoked- The duty to warn should e invoked when there is possibility of harm. As a result of the Tarasoff decision, it is mandatory in most states for healthcare personnel to report any clear threat from clients about intent to harm specific people. Psychiatrists, psychotherapists, and other mental healthcare providers must warn authorities (if specified by law) and potential victims of possible dangerous actions of their clients, even if clients protest.