Psychiatry Nursing

Interpersonal process – major core

Required therapeutic self of nurse – major tool

Task: Self awareness

SELF – AWARENESS – Recognition of one’s own feelings, thoughts, attitude and beliefs.
Nurse: Foundation of therapeutic relationship
- Prevent counter-transference – the feeling and attitude of a nurse toward another person are
transferred to the client
TRANSFERENCE
is the unconscious transfer of special feelings from a client to the nurse or therapist.
COUNTERTRANSFERENCE
Is the projection of the therapist’s feelings about a significant other to the patient during therapy;
Points:
 Keep a diary or journal
 Talk with someone you trust
 Engage in formal clinical supervision
 Seek alternative view of points
 DO NOT BE CRITICAL OF YOURSELF OR OTHERS
Johari’s Window

I Public self/open area – You know and other know

II Semi-public self/Blind spot – Others know but you don’t
III Private self/Hidden area – You know but others don’t
IV Unknown – Not know to self or others

 The following three principles help explain how the self-functions:

1. A change in any one quadrant affects all other quadrants.

1. The smaller quadrant 1, the poorer the communication.
1. When quadrant 1 is larger and other quadrants are smaller, “interpersonal learning is
significantly present.”

STEP 1
 The goal of increasing self-awareness is “to enlarge the area of quadrant 1 while reducing the size
of the other three quadrants.”
 To increase self-knowledge, it is necessary to listen to the self;
 The individual allows genuine emotions to be experienced, and identifies and accepts personal
needs;
STEP 2

 Reduce the size of quadrant 2 by LISTENING TO AND LEARNING FROM OTHERS;

 As we relate to others, we broaden our SELF-PERCEPTIONS;
 Requires active listening and openness to the feedback others provide;

STEP 3
 Reduce the size of quadrant 3 by self-disclosing or revealing to others important aspects of the
self;
 SELF-DISCLOSURE is both a sign of personality health and a means of achieving healthy
personality;
Mental health
 Ability to adjust with stress
 State of well being
 Cope effectively
 Contribute to society
 Realize potential
 Work Productively

Criteria: Acceptance

Factors Affecting Mental Health:

 Individual Factors
 Interpersonal Factors
 Socio-cultural Factors
o sense of community
o access to adequate resources
o intolerance of violence
o support of diversity among people
o mastery of the environment
o a positive & realistic view of one’s world

MENTAL ILLNESS

 Disturbance of thought, feelings, Behavior

 A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and
is associated with present distress, disability or with a significantly increased risk of suffering death,
pain, disability, or an important loss of freedom (APA, 2000)

Factors Affecting Mental Illness:

 Individual Factors
 Interpersonal Factors
 Socio-cultural Factors
o Lack of resources
o Violence, homelessness & poverty
o Unwarranted negative view of the world
o Discrimination
o Hereditary

Diagnostic & Statistical Manual of Mental Disorder (DSM-IV-TR)

Describes all mental disorders, outlining specific diagnostic criteria for each based on clinical experience and
research
3 purposes:
To provide a standardized nomenclature 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

Components
Axis I
Identifying all major psychiatric disorders
Axis II
Reporting mental retardation and personality disorders
Axis III
Reporting current medical conditions
Axis IV
Reporting psychosocial and environmental problems
Axis V
Presents a Global Assessment of Functioning

PSYCHOSOCIAL THEORIES
PSYCHOANALYTICAL MODEL
(or Psychodynamic Theory)
 By Sigmund Freud;
 It supports the notion that all human behavior is caused and can be explained;
 Believed that repressed sexual impulses and desires motivate much human behavior;
Three Components:
1. Id – present at birth; wants to experience only pleasure (pleasure principle)
 Uses fantasies and images to seek pleasure;
 Compulsive and acts without morals;
 Ex. “I want to eat… sleep…... drink…
2. Superego – human conscience that directs and controls thoughts and feelings;
 Concerned with right and wrong;

 “Small voice of GOD within us”

 Provides the ego with an inner control to help cope with the id;

 Delays pleasure from id;

3. Ego – controls id impulses and mediates between id and reality;
 Focuses on reality principle;

 Maintains contact with reality;

 Strives to meet the demands of the id while maintaining the well-being of the individual;

 Altered in client with anti-social PD;

5 PSYCHOSEXUAL DEVELOPMENT
A. Oral Stage (birth – 18 months)
 Oral gratification;
 Child learns to handle anxiety by using the oral cavity (biting and sucking activities).
 Infants explore the environment or assess an object using their oral cavity.
B. Anal Stage (18 – 36 months)
 Child learns to control muscles, especially those that control urination and defecation;
 Develops awareness of fullness of the rectum;
  Takes pleasure in retaining or eliminating feces;
 Acquisition of voluntary sphincter control (TOILET TRAINING)
 Bowel Control – 18 months.
 Daytime Bladder Control – 30 months.
 Nocturnal Bladder Control – 36 months.
 Clues for Toilet Training:
 stand alone.
 walk steadily.
 be dry of at least 2 hours.
 demonstrate awareness of defecating and voiding.
 use words and gestures regarding toilet need and training.
 please the PCG.

C. Phallic or Oedipal Stage (3 – 5 years old)

 Child takes pleasure in exploring and manipulating the genitalia;
 Penis is the organ of interest for both sexes;
 Penis envy for girls;
 Fear of castration for boys due to oedipal feeling to the mother;
 Attracted and wants to marry the opposite-sex parent (Oedipal complex)
 Physiologic homosexuality may also be seen in this stage.
D. Latency Stage (6 – 12 years old)
 Sexual development and energy are quiescent;
 Resolution of the oedipal complex;
 Sexual drive is channeled into socially appropriate activities such as school work or sports;
 Formation of superego

E. Genital Stage (12 – 13 years old)

 Sexual interest emerges as the person strives to develop satisfactory relationships with potential
sex partners (intimacy)
 Corresponding with genital maturation which result to sexual awakenings;

PSYCHOSOCIAL STAGES OF DEVELOPMENT

 Established by Erik Erickson from Freud’s psychoanalytical model;

 Spans the total life cycle from birth to death;
 Each stage of development is an emotional crisis involving positive and negative experiences;
Life Stages
I. Trust vs Mistrust (0 – 18 months of age)
 Child develops sense of trust or mistrust of others;
 Shares openly and relates to others;
 Interpersonal skills start to develop;
II. Autonomy vs Shame and Doubt
 18 months – 3 y/o;
 Child learns self-control or becomes very conscious and full of doubt;
 Negativistic attitude;
 Exhibits motor self-control and independence thru negativism;
 Parallel play is the social skill.
II. Initiative vs Guilt (3 – 5 y/o)
 Child initiates spontaneous activities or develops fear of wrongdoing;
 Shows appropriate social behaviors;
 Curiosity and exploration;
 Social Skill: Cooperative Play
IV. Industry vs Inferiority (6 – 12 y/o)
 Child develops the social and physical skills necessary to negotiate and compete in life;
 Acquisition of competence;
 Ability to cooperate and compromise;
 Identification with admired others (teachers, parents)

V. Identity vs Role Confusion (12 – 18 y/o)

 Teenager either integrates childhood experiences into a personal identity;
 May develop self-doubts about sexual or occupational roles;
 Establish relationship with the opposite sex;
 Fidelity with friends;
 Also, value importance of beauty or self-image;
VI. Intimacy vs Isolation (18 – 25 or 30 y/o)
 The person develops commitment to work and to other people;
 Ability to give and receive love;
 Responsible sexual behaviors;
VII. Generativity vs Stagnation (30 – 65 y/o)
 Productive, constructive, and creative activities;
 Personal and professional growth;
 Parental and societal responsibilities;
 Ability to care;
VIII. Integrity vs Despair (65 years old to death)
 The person reviews life for meaning, fulfillment, and contributions made to the next generations;
 Sense of dignity and worth;
 Explores the philosophy of life;
 Have period of reminiscence;
 May result to regression and withdrawn;
Therapeutic Community or Milieu
 Goal: To establish a satisfying interpersonal relationship
 participant observer
 Involved clients’ interactions with one another, including practicing interpersonal relationship skills,
giving one another feedback about behavior, and working cooperatively as a group to solve day-to-day
problems
Therapeutic Nurse–Patient Relationship
By Hildegard Peplau
 Orientation phase
 engaging the client in treatment, providing explanations and information, and answering questions
 Identification phase
 Begins when the client works interdependently with the nurse, expresses feelings, and begins to feel
stronger
 Exploitation phase
 The client makes full use of the services offered

 Resolution phase
 The client no longer needs professional services and gives up dependent behavior
 The relationship ends

Roles of the Nurse in the Therapeutic Relationship

 Caregiver – Provide direct care to client e.g. v/s. assisting with bathing/eating
 Technician – Maintain therapeutic environment, provision of technical care e.g. administration of
medication
 Teacher – Providing information
 Leader
 Surrogate – Temporary replacement of significant other.
 Counselor – Encourage verbalization of feelings
Maslow’s Hierarchy of Needs
 This theory helps nurses understand how clients’ motivations and behaviors change during life crises

A. Physiologic Needs
 The most basic;
 Food, water, sleep, shelter, sexual expression, and freedom from pain;
B. Safety and Security Needs
 Includes protection, security, and freedom from harm or threatened deprivation;
C. Love and Belongingness
 Includes enduring intimacy, friendship, and acceptance;
D. Self-esteem Needs
 The need for self-respect and esteem from others;
E. Self-Actualization
 The need for beauty, truth, justice, and to meet his highest potential;
 Few people ever become fully self-actualized;

Cognitive Stages of Development

 By Piaget;
A. SENSORIMOTOR STAGE (birth – 18 months)
 The child learns by IMITATION;
 Also, by object permanence;
B. PREOPERATIONAL STAGE (2 – 7 years old)
 Preconceptional Phase (2- 4 y/o)
 Learns using mental images and develops symbolic language and play (symbolism)
 Intuitive Phase (4 – 7 y/o)
 The child learns by separating disparate objects and events and also expands expressive language;
 Can give reason for belief and reactions but still pre-logical;
C. CONCRETE OPERATIONS (8 – 12 years old)
 Child can systemically organize thoughts and facts about the environment;
 Can apply rules to things that are seen and heard;
 Child begins abstract thinking;
D. FORMAL OPERATIONS (12 – adulthood)
 The person can think using conceptual, abstract operations, and CAN HYPOTHESIZE and evaluate
solutions to the problems;