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Erikson's stages for growth and development

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Trust v. Mistrust (birth-1 year) Autonomy v. Shame/Doubt (1-3 years) Initiative v. Guilt (3-6 years) Industry v. Inferiority (6 years-puberty) Identity v. Role Confusion (adolescence) Intimacy v. Isolation (young adulthood) Generativity v. Stagnation (middle adulthood) Ego Integrity v. Dispair (older adulthood-senior citizens)

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Sigmund Freud

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"Father of Psychiatry"-developed theories of id, ego, and superego.

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Freud's "id"

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The most primitive part of our psyche; we are born with it and it resides in our subconscious. Driven by primitive instincts of sexual and aggressive impulses. Believes purpose is to maximize pleasure while minimizing discomfort.

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Freud's "ego"

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The 2nd part of our psyche to develop, this refers to our identity and sense of self. Derives from the "id" and gratifies it in accordance of reality. Operates on 3 levels of awareness: preconscious, conscious, and unconscious.

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Freud's "superego"

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Operates according to morality principle; seeks what is good/moral above all else. Functions on all levels of awareness.

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Anxiety

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Vague feeling of apprehension that results from a perceived threat to self.

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Stress

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Nonspecific response of the body to any demand made on it.

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Stressor

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Stimulation, activity, or an event that produces stress.

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Self-Concept

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More than the total of 4 parts of self (personal identity, body image, role, self-esteem) this is the frame of reference individuals use for all that they know and experience.

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Mental Health-Mental Illness Continuum

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Each occupies a specific end. For placement, several components of mental health are assessed, including: positive self-concept, adaptability to change, effective communication, and others. Midpoint is considered normal mental health. On the illness side the individual is rarely in touch with reality.

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Communication

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Use of words and behaviors to send/receive both verbal and non-verbal messages.

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Verbal Therapeutic Communication

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This fosters a positive nurse and patient relationship by asking open-ended questions, focusing, clarifying, paraphrasing, restating, reflecting, summarizing, and offering the client information.

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Non-therapeutic Communication

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Advising, Disapproving, Disagreeing, Challenging, Testing, Defending, Generalizing, Stereotyping, Promising, Belittling, etc.

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Self

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A complex concept comprising 4 distinct parts: personal identity, body image, role, and set-esteem.

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Common Behaviors Seen with Illness

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Denial, Anxiety, Shock, Anger, Withdrawal.

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Defense Mechanisms

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Behavioral patterns that protect the individual against a real or perceived threat where the conscious awareness is blocked against threatening feelings.

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Commonly Used Defense Mechanisms

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Compensation, conversion, denial, displacement, dissociation, identification, introjection, projection, rationalization, reaction formation, regression, repression, sublimation, and suppression.

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Compensation

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Making up for a "deficiency" in one area by excelling or emphasizing another area.

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Conversion

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Emotional conflicts are turned into a physical symptom, providing the individual with some sort of benefit.

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Denial

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Reality is denied; it does not exist.

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Displacement

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Emotions are expressed toward someone or something other than the source of the emotion.

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Dissociation

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Separation and detachment of emotional significance and affect from an idea or situation.

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Identification

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Individual incorporates a characteristic of another individual or group; the individual does not give up personal identity.

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Introjection

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A quality or attribute of another is internalized and becomes part of the individual.

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Projection

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Attributing to other characteristics that the other person does not want to admit possessing; blaming personal shortcomings on someone else.

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Rationalization

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A process of constructing plausible reasons to explain or justify one's behavior.

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Reaction Formation

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The conscious behavior is completely opposite to the unconscious process.

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Regression

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Behavior, thought, or feelings used at an earlier stage of development are exhibited.

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Repression

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The barring from conscious thought of painful, disagreeable thoughts, experiences, and/or impulses.

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Sublimation

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Sexual or aggressive energy/impulses are discharged in a socially acceptable way.

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Suppression

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An intentional exclusion of painful thoughts, experiences, or impulses.

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Voluntary Admission/Hospitalization

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Clients are willing to seek treatment and agree to be hospitalized if needed. The client also has the right to leave freely unless they are a danger to themselves or others.

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Involuntary Admission/Hospitalization

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Clients who are a danger to themselves or others can be committed for psychiatric care until they no longer are a threat. Each state has specific laws governing the civil commitment process but all are very similar. The client can be detained in a psychiatric facility 48-72 hours on an emergency basis until a hearing can be conducted.

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Involuntary Admission Conditions

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1. Reason to believe individual is mentally ill and has refused voluntary examination or is unable to determine for himself where exam may be necessary. 2. Without treatment, the individual is likely to suffer from neglect or refuse to self care or there is a substantial likelihood that in the near future the individual will inflict serious bodily harm on self or another.

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Voluntary Admission Rights

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The client has the right to leave the hospital if they are a voluntary admission, signs out AMA, or is discharged if they are no longer seen as a threat.

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Dangerous Voluntary Client Rights

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If this individual is dangerous yet insists on leaving the facility, the Psychiatrist can file for a civil commitment to detain the client against their will until a hearing can occur.

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Legal Rights of Minors

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A minor who has not been court-ordered to receive treatment is able to have a voluntary admission hearing where an objective professional asks the minor privately if they agree to obtain psychiatric care voluntarily or if coercion has occurred.

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Basic Client Rights

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-Right to treatment in the least restrictive environment appropriate to meet their needs -Client does not have to be hospitalized if they can be treated in an outpatient facility -Client has the right to be free from restraints and seclusion -Patient Bill of Rights applies to all clients

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Restraints

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Direct application of physical force to a person without his or her permission to restrict freedom of movement. May also be chemical, human, or mechanical as well as a combination of each.

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Panic

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An attack of acute, intense, and overwhelming anxiety accompanied by a degree of personality disorganization where the individual cannot think clearly.

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Nursing Interventions for Mental Health

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-Support for the client -Education of techniques to relieve stress -Removal of any distracting stimuli

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Alternative Therapies for Anxiety

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-St. John's Wart -Kava -Ginkgo and Ginseng -Aromatherapy

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Mental Health

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One's ability to cope with and adjust to the recurrent stresses of everyday living.

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Mental Illness

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Evidenced by a pattern of behaviors that is conspicuous, threatening, and disruptive of relationships or that deviates significantly from behavior that is considered socially and culturally acceptable; it is a manifestation of dysfunction.

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Crisis

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Time of change or turning point in life when patterns of living must be modified to prevent disorganization of person or family.

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Community Mental Health Movement

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Along with the holistic health movement, this has brought awareness to the public that all individuals, sick or healthy, have needs to be met. Mental health care is now practiced in many settings including public health, home health, acute care facilities, and hospitals.

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Nonverbal Therapeutic Communication Techniques

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-Active Listening -Passive Listening -Silence -Touch -Conveying Acceptance

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Phases of Crisis

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1. Confusion, disbelief, and high anxiety. 2. Denial. 3. Anger and remorse. 4. Sadness and crying. 5. Reconciliation.

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Seclusion

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Involuntary confinement of a person in a specially constructed, locked room equipped with security windows or cameras for monitoring.

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Maslow's Hierarchy of Needs

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1. Physiological 2. Safety 3. Love and Belonging 4. Esteem 5. Self-actualization

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Diagnostic and Statistical Manual of Psych Disorders

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Published by the American Psychological Association, this is a multiaxial system that classifies mental disorders and outlines various disorders and descriptive references. Used by most health care professionals to facilitate medical diagnosis and to provide a guide to clinical practice.

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Humoral Theory

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Used by Hippocrates to classify mental illness; this view tied basic elements to corresponding body fluids and was considered an imbalance of humors.

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Linda Richards

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Considered the first psychiatric nurse; practiced during 1880's.

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NANDA Nursing Diagnosis for Psych/Mental Health

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-Impaired adjustment -Anxiety -Disturbed body image -Impaired verbal communication -Ineffective coping -Decisional conflict -Ineffective denial -Interrupted family processes -Fear -Grieving -Hopelessness -Disturbed personal identity -Ineffective role performance

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Mental Health Confidentiality

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This can sometimes be a dilemma, as therapeutic effectiveness often depends on the patient's willingness to discuss feelings/thoughts. The patient must be aware of all members of their healthcare team, and likewise, each employee must offer full disclosure to one another regarding patient behavior and disposition to prevent manipulation, harm, or injury.

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