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Psychiatric Nursing Handout 2009

Psychiatric Nursing Handout 2009

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Published by laninna


Semester, SY 2008 – 2009)

Week 1: FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING The Culture of a Society  Influences values and beliefs  Affects definition of health and illness  “Healthy” people fulfill their roles and have appropriate & adaptive behavior.  “Ill” people are those who fail to fulfill roles and carry out responsibilities, and have inappropriate behavior. WHO Definition of Health  A state of complete physical, mental, & social we


Semester, SY 2008 – 2009)

Week 1: FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING The Culture of a Society  Influences values and beliefs  Affects definition of health and illness  “Healthy” people fulfill their roles and have appropriate & adaptive behavior.  “Ill” people are those who fail to fulfill roles and carry out responsibilities, and have inappropriate behavior. WHO Definition of Health  A state of complete physical, mental, & social we

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Published by: laninna on Jun 15, 2010
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The Culture of a Society

Influences values and beliefs
Affects definition of health and illness
“Healthy” people fulfill their roles and have appropriate & adaptive behavior.
Ill” people are those who fail to fulfill roles and carry out responsibilities, and have inappropriate behavior.

WHO Definition of Health

A state of complete physical, mental, & social wellness, not merely the absence of disease or infirmity
Aposit iv e state ofwe l l- being
People fulfill responsibilities, function effectively, and are satisfied with them-selves and interpersonal relationships

Mental Health
A state of emotional, psychological, & social wellness, evidenced by satisfying interpersonal relationships, effective behavior and coping,
positives e lf - c onc e pt , and emotional stability
Components of Mental Health
1. Autonomy and Independence

2.Maximization of one’s potential 3.Tolerance of life’s uncertainties 4. Self-esteem

5. Mastery of the environment
6. Reality orientation
7. Stress management
APA Definition of Mental Illness
A clinically significantbeha v iora l or psychological syndrome or pattern that occurs in an individual associated with present distress or
disability, or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom
Describes all mental disorders, outlining diagnostic criteria based on clinical experience and research

1. To provide standardized nomenclature and language for all
2. To present defining characteristics that differentiate diagnoses
3. To assist in identifying underlying causes of disorders

DSM-IV-TR Assessment Axes

1.Axis I: Major psychiatric disorders
2.Axis II: Personality Disorders or Developmental Disorders (e.g. Mental Retardation), maladaptive defense mechanisms
3.Axis III: General medical conditions that relate to axes I and II or have a bearing on treatment
4.Axis IV: Psychosocial/environmental stressors affecting client management
5.Axis V: Global assessment of functioning (GAF)

Clinician’s assessment rated on a scale of 0-100 of patient’s current level of functioning; also used to show prior functioning.
Psychosocial Theories

Attempt to explain human behavior, health, and mental illness.
Suggest how normal development occurs based on the theorist’s beliefs, assumptions, and view of the world.
Suggest strategies that the clinician can use to work with clients

Sigmund Freud: The Father of Psychoanalysis
Freud’s Deterministic Theory contends that ―All human behavior is caused and can be explained.‖

Repressed sexual impulses and desires motivate much human behavior.
Symptoms in women with no physiologic basis were considered ―hysterical‖ or neurotic behavior
Problems resulted from childhood trauma or failure to complete tasks of psychosexual development.
Women repressed their unmet needs, sexual feelings and traumatic events.

Freud’s Personality Components:The “Id”
The part of one’s nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses
Seeks instant gratification, causes impulsive unthinking behavior, and has no regard for rules or social convention.
Freud’s Personality Components:The “Superego” and the “Ego”
The superego is the part of a person’s nature that reflects moral and ethical concepts, values, and parental & social expectations;
therefore, it is in direct opposition to the id.
The ego is the mediating force between the id & the superego, and represents mature and adaptive behavior that allows a person to function
successfully in the world
Anxietyresults from the ego’s attempts to balance the impulsive instincts of the id with the stringent rules of the superego.
Freud’s Three Levels of Awareness
Conscious refers to the perceptions, thoughts, and emotions that exist in the person’s awareness
Pr e c o n sc io u sth o u g h ts and emotions are not currently in the person’s awareness, but can recall the m
Theuncons c ious is the realm of thoughts and feelings that motivate a person even though he or she is totally unaware of them.
The Unconscious Realm
Includes most defense mechanisms and some instinctual drives or motivations.
The personre pre s s e s into the unconscious the memory of traumatic events that are too painful to remember.
Freud’s Subconscious Realm
Much of what we do and say is motivated by ours ubconsc ious thoughts or feelings.
“Freudian slip: describes slips of the tongue which are not accidents but rather are indications of subconscious feelings or thoughts that
accidentally emerge in casual day-to-day conversation.
Freud’s Dream Analysis

A person’s dreams reflect his or her subconscious and have significant hidden, symbolic meaning.
Primary method in psychoanalysis which involves discussing a client’s dreams to discover their true meaning and significance
A woman has recurrent frightening dreams about snakes chasing her. How might Freud interpret this?

Freud’s Free Association
Another method used to gain access to subconscious or repressed thoughts or feelings
Uncovers the client’s true thoughts and feelings by saying a word and asking the client to respond quickly with the first thing that comes to mind
Freud’s Ego Defense Mechanisms

Attempt to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events
Most operate at the unconscious level
e.g. A person who was diagnosed with cancer and has 6 months to live refuses to talk about the illness, or a cancer patient exhibits a

continuously cheerful behavior
Freud’s Ego Defense Mechanisms
1.Compensation: Overachievement in one area to offset real or perceived deficiencies in another area
2.Conversion: Expression of an emotional conflict through the development of a physical symptom, usuallys e nsorimot or in nature
3.D enial: Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue,
e.g. a diabetic eating chocolate candy
4.Displacement: Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings , e.g. a child who is
harassed by a bully at school mistreats a younger sibling
5.Dissociation: Dealing with emotional conflict by a temporary alteration in consciousness or identity e.g.a mn e s ia
6.Fixation: Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage
7.Ident ification: Modeling actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or
occupational goal
8.Intellectualiz ation: Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the
9.Introjection: Modeling actions and accepting another person’s attitudes, beliefs, and values as one’s own
10.Project ion: Unconscious blaming of unacceptable inclinations or thoughts on an external object, e.g. Man who has thought about same-
gender sexual relationship, but never had one, beats a man who is gay.

11.R at ionaliz at ion: Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect
12.Reaction Formation: Acting the opposite of what one thinks or feels
13.R egression: Moving back to a previous developmental stage to feel safe or have needs met
14.R epression: Excluding emotionally painful or anxiety-provoking thoughts & feelings from conscious awareness

15.R esist ance:Overt or covert antagonism toward remembering or processing anxiety-producing information e.g. The nurse is too busy with
tasks to spend time talking to a dying patient.

16.Subli mat ion: Substituting a socially acceptable activity for an impulse that is unacceptable
17.Subst it ut ion: Replacing the desired gratification with one that is more readily available
18.Suppression: Conscious exclusion of unacceptable thoughts and feelings from conscious awareness

19. Undoing:Exhibiting acceptable behavior to make up for or negate unacceptable behavior, e.g. a person who cheats on a spouse brings the
spouse a bouquet of roses
Freud’s Five Stages of Psychosexual Development
Based on the theory thatlib ido was the driving force of human behavior
Psychopathology results when a person has difficulty making the transition from one stage to the next or when a person remains stalled at a
particular stage or regresses to an earlier stage
Five Stages of Psychosexual Development:
1.Oral (Birth to 18 months)

Major site of tension and gratification: the mouth, lips, and tongue
The “Id is present at birth and develops by the 6th month; The “Ego develops gradually from rudimentary structure present at birth
Defense Mechanisms:

a.FIXA TION when a person is stuck in a certain developmental stage
b.R EGR ESSION return to an earlier developmental stage
2.Anal (18 to 36 months)

Major source of interest: Anus and surrounding area
Focus: Acquisition of voluntary sphincter control (toilet training)
The “Superegod e v e lop s
If the child had aSTR IC T toilet training (AnalR e t e nt iv e): Clean, Organized, Obedient, OBSESSIVE-COMPULSIVE PD

If the child had aPO O R toilet training (AnalEx puls iv e): Dirty, Disorganized, Disobedient, ANTISOCIAL PD
3.Phallic/Oedipal (3-5 yrs)

Thegenit a ls are the focus of interest, stimulation, and excitement
Thepenis is the organ of interest for both sexes.
Masturbation is common.
Oedipal / Elektra complex (wish to marry opposite-sex parent and be rid of same-sex parent)

C ast rat ionboy fears his dad
Penis Envy envy of little girl towards her dad (wish to possess penis)
Defense Mechanism:Ident if icat ionThe boy associates with the father, and the girl associates with the mother
4.Latency (5-11 or 13 yrs)

Resolution of Oedipal complex
Sexual drive channeled into socially appropriate activities such as school work and sports (Sublimation Defense Mechanism).
Formation of thes uper e go
Final stage of psychosexual development

5.Genital (11 13 years)
Begins withpube rt y and the biologic capacity for orgasm; involves the capacity for true intimacy
Transference vs. Countertransference
Transference occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other
relationships; patterns are automatic & unconscious in the therapeutic relationship
Countertransference occurs when the therapist displaces onto the client attitudes or feelings from his or her past.
Developmental Theories Erik Erikson: Psychosocial Stages of Development
Described eight psychosocial stages of development
In each stage, the person must complete a life task that is essential to his or her well-being and mental health
Developmental Theories – Jean Piaget’s Cognitive Stages of Development
Human intelligence progresses through a series of stages based on age, with the child at each successive stage demonstrating a higher level of
functioning than at previous stages
1.Sensorimotor (Birth to 2 years)
The child develops a sense of self as separate from the environment and the concept of object permanence
He or she begins to form mental images.
2.Preoperational (2 to 6 years)
The child develops the ability to express self with language, understands the meaning of symbolic gestures, and begins to cla ssify objects.
3.Concrete Operations (6 to 12 years0
The child begins to apply logic to thinking, understands spatiality and reversibility
The child is increasingly social and able to apply rules; however, thinking is still concrete
4.Formal Operations (12 to 15 years and beyond)
The child learns to think and reason in abstract terms, further develops logical thinking and reasoning, and achieves cognitive maturity.

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