Mental health: week 1

Incidence

conveys information about the risk of contracting a disease.

Prevalence

describes the total number of cases, new and existing, in a given population during a specific period of time, regardless of when they became ill.

Psychiatric-mental health nursing

is the nursing specialty that is dedicated to promoting mental health through the assessment, diagnosis, and treatment of behavioral problems, mental disorders, and comorbid conditions across the lifespan

Epidemiology

, as it applies to psychiatric-mental health, is the quantitative study of the distribution of mental disorders in human populations.

emergency psychiatric care can be categorized into three major models:

1. Comprehensive emergency service model is often affiliated with a full-service emergency department (ED) in a hospital or medical center setting. Typically, there is dedicated clinical space with specialty staffing. Psychiatric-mental health nurses, psychiatric technicians, mental health specialists, social workers, mental health counselors, and psychiatrists generally make up the multidisciplinary workforce. The concepts of triage and stabilization are incorporated into the individualized care plan for each patient. 2. Hospital-based consultant model utilizes the concepts of the comprehensive model by incorporating triage and stabilization. However, there is generally no dedicated clinical space or comprehensive separate staffing. Psychiatric clinical staff members are assigned to a specific hospital and are on-site or on-call, serving as part of the emergency department staff. Psychiatric clinicians manage emergency psychiatric evaluations as requested. Clinicians complete a "level of care" assessment, attempt to stabilize patients, and arrange for discharge or transfer. The emergency department staff maintain responsibility for all immediate care needs. 3. Mobile crisis team model is considered for stabilization in the field.

Key areas of interest of QSEN

1. Patient-centered care: Care should be given in an atmosphere of respect and responsiveness, and the patient's values, preferences, and needs should guide care. 2. Teamwork and collaboration: Nurses and interprofessional teams need to maintain open communication, respect, and shared decision making. 3. Evidence-based practice: Optimal healthcare is the result of integrating the best current evidence while considering the patient/family values and preferences. 4. Quality improvement: Nurses should be involved in monitoring the outcomes of the care that they give. They should also be care designers and test changes that will result in quality improvement. 5. Safety: The care provided should not add further injury (e.g., nosocomial infections). Harm to patients and providers are minimized through both system effectiveness and individual performance. 6. Informatics: Information and technology are used to communicate, manage knowledge, mitigate error, and support decision making.

extinction

Absence of reinforcement, or extinction, also decreases behavior by withholding a reward that has become habitual.

negative reinforcement.

Another rat was placed in the cage with an electrical charge on the grid under his feet. If he accidentally pressed the lever, the charge would turn off. He learned to go straight to the lever to eliminate the shock. This removal of an objectionable or averse stimulus is negative reinforcement.

Id

At birth we are all id. The id is totally unconscious and impulsive. It is the source of all drives, instincts, reflexes, and needs.

Aversion therapy

Aversion therapy is the pairing of a negative stimulus with a specific target behavior, thereby suppressing the behavior.

cognitive-behavioral therapy (CBT)

Beck created an active, directive, time-limited, structured approach. This evidence-based therapy is used to treat a variety of psychiatric disorders such as depression, anxiety, phobias, and pain. It is based on the underlying theoretical principle that feelings and behaviors are largely determined by the way people think about the world and their place in it (Beck, 1967). Their cognitions (verbal or pictorial events in their streams of consciousness) are based on attitudes or assumptions developed from previous experiences. These cognitions may be fairly accurate or distorted.

Behavioral therapy

Behavioral therapy is based on the assumption that changes in maladaptive behavior can occur without insight into the underlying cause. effective in treating people with phobias, alcoholism, schizophrenia, and many other conditions. Four types of behavioral therapy are discussed here: modeling, operant conditioning, systematic desensitization, and aversion therapy.

Behavioral Theories and Therapies

Behaviorists have no concern with inner conflicts but argue that personality simply consists of learned behaviors. Consequently, personality becomes synonymous with behavior—if behavior changes, so does the personality. Behaviorists believe that behavior can be influenced through a process referred to as conditioning. Conditioning involves pairing a behavior with a condition that reinforces or diminishes the behavior's occurrence. Pavlov

Countertransference

Countertransference refers to unconscious feelings that the healthcare worker has toward the patient. For instance, if the patient reminds you of someone you do not like, you may unconsciously react as if the patient were that individual. Strong negative or positive feelings toward the patient could be a red flag for countertransference. Such responses underscore the importance of maintaining self-awareness and seeking supervisory guidance as therapeutic relationships progress. refers to unconscious feelings that the healthcare worker has toward the patient. For instance, if the patient reminds you of someone you do not like, you may unconsciously react as if the patient were that individual. Strong negative or positive feelings toward the patient could be a red flag for countertransference. Such responses underscore the importance of maintaining self-awareness and seeking supervisory guidance as therapeutic relationships progress.

The Diagnostic and Statistical Manual (DSM) is a publication of the American Psychiatric Association (APA). First published in 1952, the latest 2013 edition describes criteria for 157 disorders.

DSM-5 is the dominant method of categorizing and diagnosing mental illness in the United States

Theory of Psychosocial Development

Erikson emphasized the role of culture and society on personality development. According to Erikson, personality was not set in stone at age 5, as Freud suggested, but continued to evolve throughout the life span. Erikson described development as occurring in eight predetermined and consecutive life stages (psychosocial crises), each of which results in a positive or negative outcome. The successful or unsuccessful completion of each stage will affect the individual's progression to the next

Interpersonal Theory

Harry Stack Sullivan (1892-1949), believed that human beings are driven by the need for interaction. Indeed, he viewed loneliness as the most painful human condition. Interpersonal therapy is an effective short-term therapy. The assumption is that psychiatric disorders are influenced by interpersonal interactions and the social context. The goal of interpersonal therapy is to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships.

Hildegard Peplau

Hildegard Peplau, a nursing theorist, developed an interpersonal theoretical framework that has become the foundation of psychiatric mental health nursing practice.

comorbid condition

Individuals may have more than one mental disorder or another medical disorder. The simultaneous existence of two or more disorders is known as a comorbid condition. For example, schizophrenia is frequently comorbid with diabetes.

Humanistic Theories

Maslow believed that human beings are motivated by unmet needs. Maslow (1968) focused on human need fulfillment, which he categorized into six incremental stages, beginning with physiological survival needs and ending with self-transcendent needs. The hierarchy of needs is conceptualized as a pyramid with the strongest, most fundamental needs placed on the lower levels. The higher levels—the more distinctly human needs—occupy the top sections of the pyramid. When lower-level needs are met, higher needs are able to emerge.

Psychiatric Home Care

Medicare requires that four elements be met in order for these services to be reimbursed: (1) homebound status of the patient, (2) presence of a psychiatric diagnosis, (3) need for the skills of a psychiatric registered nurse, and (4) development of a plan of care under orders of a physician or advanced practice registered nurse

mental health continuum

On one end of the continuum is mental health. Well-being describes the general condition of people in this category and is characterized by adequate to high-level functioning. At the opposite end of the continuum is mental illness. Individuals may have emotional problems or concerns and experience mild to moderate discomfort and distress. Mild impairment in functioning such as insomnia, lack of concentration, or loss of appetite may be felt. Problems in this category tend to be temporary, but individuals with mild depression, generalized anxiety disorder, and attention-deficit disorder may fit into this group. The most severely affected individuals fall into the mental illness portion of the continuum. At this point, individuals experience altered thinking, mood, and behavior. It may include relatively common disorders such as depression and anxiety, as well as major disorders such as schizophrenia. The distinguishing factor in mental illness is typically chronic or long-term impairments that range from moderate to disabling.

Peplau's Theory of Interpersonal Relationships

Peplau was the first nurse to identify psychiatric-mental health nursing both as an essential element of general nursing and as a specialty area that embraces specific governing principles. She was also the first nurse theorist to describe the nurse-patient relationship as the foundation of nursing practice. She also shifted the focus from what nurses do to patients to what nurses do with patients. Her theory is mainly concerned with the processes by which the nurse helps patients make positive changes in their healthcare status and well-being. She described the effects of different levels of anxiety (mild, moderate, severe, and panic) on perception and learning. She promoted interventions to lower anxiety with the aim of improving patients' abilities to think and function at more satisfactory levels.

Psychodynamic therapy

Psychodynamic therapy follows the psychoanalytic model by using many of the tools of psychoanalysis such as free association, dream analysis, transference, and countertransference. However, the therapist has increased involvement and interacts with the patient more freely than in traditional psychoanalysis. The therapy is oriented toward the here and now and makes less of an attempt to reconstruct the developmental origins of conflicts. Psychodynamic therapy tends to last longer than other common therapeutic modalities and may extend for more than 20 sessions, which insurance companies often reject.

Psychoanalytic Theory

Sigmund Freud (1856-1939), an Austrian neurologist, revolutionized thinking about mental health disorders. He introduced a groundbreaking theory of personality structure, levels of awareness, anxiety, the role of defense mechanisms, and the stages of psychosexual development.

Operant Conditioning Theory

Skinner (1987) researched operant conditioning, a method of learning that occurs through rewards and punishment for voluntary behavior. Behavioral responses are elicited through reinforcement, which causes a behavior to occur more frequently.

defense mechanisms

The ego develops defenses, or defense mechanisms, to ward off anxiety by preventing conscious awareness of threatening feelings. Defense mechanisms share two common features: (1) they all (except suppression) operate on an unconscious level and (2) they deny, falsify, or distort reality to make it less threatening. Although we cannot survive without defense mechanisms, it is possible for our defense mechanisms to distort reality to such a degree that we experience difficulty with healthy adjustment and personal growth.

superego

The superego, which develops between the ages of 3 and 5, represents the moral component of personality. The superego resides in the conscious, preconscious, and unconscious levels of awareness. The superego consists of the conscience (all the "should nots" internalized from parents and society) and the ego ideal (all the "shoulds" internalized from parents and society). When behavior falls short of ideal, the superego may induce guilt. Likewise, when behavior is ideal, the superego may allow a sense of pride.

positive reinforcement

To cause behavior more frequently, Skinner used two methods. When a hungry rat pressed the lever, it would receive a food pellet. He learned to go straight to the lever for food. This is positive reinforcement of the behavior.

Transference

Two concepts from classic psychoanalysis that are important for nurses to know are transference and countertransference (Freud, 1969). Transference refers to unconscious feelings that the patient has toward a healthcare worker that were originally felt in childhood for a significant other. The patient may say something like, "You remind me exactly of my sister." The transference may be positive (affectionate) or negative (hostile). Psychoanalysis actually encourages transference as a way to understand original relationships. Such exploration helps the patient to better understand certain feelings and behaviors.

Ego

Within the first few years of life as the child begins to interact with others, the ego develops. The ego resides in the conscious, preconscious, and unconscious levels of awareness. The problem solver and reality tester, the ego attempts to navigate the outside world. It is able to differentiate subjective experiences, memory images, and objective reality.

Clinical epidemiology is

a broad field that examines health and illness at the population level. Studies use traditional epidemiological methods and are conducted in groups usually defined by the illness or symptoms or by the diagnostic procedures or treatments given for the illness or symptoms.

Recovery

a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential

Mental health is

a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community.

Therapeutic Milieu

all-inclusive term that recognizes the people (patients and staff), the setting, the structure, and the emotional climate as important to healing. A well-managed milieu offers patients a sense of security and promotes healing. Structured aspects of the milieu include activities, rules, reality orientation practices, and environment.

Assertive community treatment (ACT)

an intensive type of case management developed in the 1970s. This treatment was in response to the hard-to-engage, community-living needs of people with serious, persistent psychiatric symptoms. Due to the severity of their symptoms, they are often unable or unwilling to participate in traditional forms of treatment

Resilience

is the ability and capacity for people to secure the resources they need to support their well-being.

Freud's Psychosexual Stages of Development

old (oral) age (anal) pensioners (phallic) love (latent) grapes (genital)

Mental illness

refers to all psychiatric disorders that have definable diagnoses. These disorders are manifested in significant dysfunctions that may be related to developmental, biological, or psychological disturbances in mental functioning. The ability to think may be impaired—as in Alzheimer's disease. Emotions may be affected—as in major depression. Behavioral alterations may be apparent—as in schizophrenia. Or the patient may display some combination of the three alterations.

Patient-centered medical homes (PCMHs) or primary care medical homes received strong support from the Affordable Care Act

these homes have five key characteristics: 1. Patient-centered—Care is relationship-based with the patient and takes into account the unique needs of the whole person. The patient is a core member of the team. 2. Comprehensive care—All levels (preventive, acute, and chronic) of mental and physical care are addressed. Physicians or advanced practice nurses lead teams that include nurses, physician assistants, pharmacists, nutritionists, social workers, educators, and care coordinators. 3. Coordination of care—Care is coordinated with the broader health system such as hospitals, specialty care, and home health. 4. Improved access—Patients are not limited to Monday through Friday from 9 a.m. to 5 p.m. to get the care they need. In addition to extended hours of service, these homes provide e-mail and phone support. 5. Systems approach—Evidence-based care is provided with a continuous feedback loop of evaluation and quality improvement. The treatment of psychiatric disorders and mental health alterations can be addressed as part of a comprehensive approach to care. Electronic communication (e.g., follow-up e-mails and reminders) and record keeping are viewed as essential aspects of this process.

operant conditioning

uses positive reinforcement to increase desired behaviors. For example, when desired goals are achieved or behaviors are performed, patients might be rewarded with tokens

Typical Items Included in Hospital Statements of Patients' Rights

• Right to be treated with dignity • Right to be involved in treatment planning and decisions • Right to refuse treatment, including medications • Right to request to leave the hospital, even against medical advice • Right to be protected against harming oneself or others • Right to a timely evaluation in the event of involuntary hospitalization • Right to legal counsel • Right to vote • Right to communicate privately by telephone and in person • Right to informed consent • Right to confidentiality regarding one's disorder and treatment • Right to choose or refuse visitors • Right to be informed of research and to refuse to participate • Right to the least restrictive means of treatment • Right to send and receive mail and to be present during any inspection of packages received • Right to keep personal belongings unless they are dangerous • Right to lodge a complaint through a plainly publicized procedure • Right to participate in religious worship