Mental Health Nursing II NURS 2310

1. Mental Health Nursing IINURS 2310 Unit II Growth and Development in Mental Health

2. Objective 1 Reviewing Maslow’s Hierarchy of Needs

4. Objective 2 Exploring the concepts and theories associated with personality development

5. Personality = The combination of character, behavioral, temperamental, emotional, and mental traits that is unique to each specific individual. Temperament = Inborn personality characteristics that influence an individual’s manner of reacting to the environment, and ultimately his or her developmental progression.

6. Psychoanalytic Theory Freud believed an individual’s basic character is formed by the age of 5, and includes these components: • Id • Instinctual drives • Ego • Mediator • Superego • Ego Ideal • internalized value system • Consciousness

7. Theory of Psychosocial Development • Erikson studied the influence of social processes on the development of the personality • Individuals struggle with developmental crises throughout the life cycle • Specific tasks in each stage must be completed for emotional growth to occur

8. Objective 3 Reviewing Erikson’s Stages of Development

9. Stage 1Trust vs. Mistrust • Age: Birth to 18 months • Major Task: Develop a sense of trust in others • Mastery: Trust in people and the environment • Characteristics: Social attachment • Concerns: Emotional dissatisfaction, suspiciousness, difficulty with interpersonal relationships

10. Stage 2Autonomy vs. Shame and Doubt • Age: 18 months to 3 years • Major Task: Learn self-control • Mastery: Pride in self • Characteristics: Self-control, language development, fantasy play • Concerns: Lack of self-confidence, lack of pride in the ability to perform, a sense of being controlled by others, rage against self

11. Stage 3Initiative vs. Guilt • Age: 3 to 6 years • Major Task: Initiate spontaneous activities • Mastery: Able to initiate activities and enjoy learning • Characteristics: Early moral development, self-esteem, group play, egocentrism • Concerns: Feelings of inadequacy and guilt, accepting of liability in situations for which individual is not responsible

12. Stage 4Industry vs. Inferiority • Age: 6 to 12 years • Major Task: Develop necessary social skills • Mastery: Acquire skills for, and develop competence in, work • Characteristics: Friendship, skill learning, self-evaluation, team play • Concerns: Difficulty in interpersonal relationships caused by feelings of inadequacy

13. Stage 5Identity vs. Role Confusion • Age: 12 to 20 years • Major Task: Integrate childhood experiences into a personal identity • Mastery: Strong group identity, readiness to plan for the future • Characteristics: Physical maturation, sexual relationships, membership in peer group • Concerns: Self-consciousness, doubt, and confusion about one’s role in life

14. Stage 6Intimacy vs. Isolation • Age: 20 to 30 years • Major Task: Develop commitments to others and to a career • Mastery: Form close relationships and share with others • Characteristics: Stable relationships, childbearing, work • Concerns: Withdrawal, social isolation, inability to form lasting relationships

15. Stage 7Generativity vs. Stagnation • Age: 30 to 65 years • Major Task: Establish a family and become productive • Mastery: Nurturing children or helping the next generation in other ways • Characteristics: Nurturing of close relationships, managing career/household • Concerns: Lack of concern for the welfare of others, total preoccupation with self

16. Stage 8Integrity vs. Despair • Age: 65 years and older • Major Task: View one’s life as meaningful and fulfilling • Mastery: Sense of fulfillment about life, sense of unity with self and others • Characteristics: Promote intellectual vigor, redirect energy to new roles and activities • Concerns: Self-contempt and disgust with how life has progressed

17. Objective 4 Recalling the major functions controlled by various areas of the brain

18. Cerebrum • Frontal lobes • voluntary body movement • movements that control speaking, thinking, and judgment formation • Parietal lobes • perception & interpretation of most sensory information • touch, pain, taste, and body position • Temporal lobes • auditory functions • short-term memory • Occipital lobes • visual reception and interpretation

19. Diencephalon • Thalamus • integrates all sensory input except smell • Hypothalamus • regulates the pituitary gland • regulates appetite and temperature • Limbic system • associated with fear, anxiety, anger, aggression, love, joy, hope, sexuality, and social behavior

20. Mesencephalon – integration of reflexes (visual, auditory, righting) Pons – respiration – skeletal muscle tone Medulla – regulates heart rate, blood pressure, and respiration – swallowing, sneezing, coughing, vomiting reflexes

21. Cerebellum – involuntary movement, such as the coordination/maintenance of posture Neurotransmitters – essential functions of human emotion and behavior – many psychotropics work here – categories of neurotransmitters include cholinergics, monoamines, amino acids, and neuropeptides

22. Neurotransmitters (cont’d) Cholinergics • Acetylcholine • 1st chemical to be identified as neurotransmitter • involved in disorders of motor behavior and memory Monoamines • Norepinephrine • fight-or-flight syndrome • Dopamine • physical activation of the body • Serotonin • levels dictate heightened or lowered sense of arousal

23. Neurotransmitters (cont’d) Amino Acids • Gamma-aminobutyric acid (GABA) • decreased levels in anxiety and movement disorders • Huntington’s disease, epilepsy • Glutamate • decreased receptor activity can induce psychotic behavior Neuropeptides • Somatostatin • low concentrations in Alzheimer’s disease

24. Autonomic Nervous System • Sympathetic nervous system • dominant during stressful situations • fight-or-flight response • increases cardiac and respiratory activity, and decreases GI functioning • involves acetylcholine and norephinephrine • Parasympathetic nervous system • dominant in the nonstressful or relaxed state • promotes efficient GI functioning • maintains heart and respirations at resting rate • involves acetylcholine

25. Objective 5 Reviewing diagnostic procedures used to detect altered brain function

26. Electroencephalography (EEG) • measures brain electrical activity • detects dysrhythmias, asymmetries, and suppression of brain rhythms • epilepsy, metabolic disorder, degenerative disease • Computed tomographic (CT) scan • measures accuracy of brain structure • identifies anatomical differences • schizophrenia, organic mental disorders, bipolar disorder

27. Magnetic resonance imaging (MRI) • measures anatomical and biochemical status of various segments of the brain • detects changes in myelination • schizophrenia • Positron emission tomography (PET) • measures specific brain activity and functioning • identifies problems with blood flow, oxygen utilization, glucose metabolism, and neurotransmitter/receptor interaction

28. Objective 6 Discussing commonly used physiological and psychological tests utilized in evaluating the function of the brain

29. Physiological Tests • Basic Metabolic Profile (BMP) • electrolytes • glucose • Complete Blood Chemistry (CBC) • Thyroid Panel • Urinalysis

30. Mental Status Examination (MSE) Describes all areas of mental functioning: • Appearance • Mood and affect • Speech and language • Thought content • Perceptual disturbances • Insight and judgment • Sensorium • Memory and attention • General intellectual level

31. Objective 7 Reviewing the steps of the nursing process in the psychiatric/mental health setting

32. The Nursing Process: • Provides a systematic framework for the delivery of nursing care • Consists of six steps • Uses a problem-solving approach • Accepted as nursing’s scientific methodology

33. Assessment = a systematic, dynamic process by which the nurse, through interaction with the client, significant others, and health care providers, collects and analyzes data about the client. Data may include the following dimensions: -- Physical -- Psychological -- Sociocultural -- Spiritual -- Functional Abilities -- Cognitive -- Developmental -- Economic -- Lifestyle

34. Diagnosis = clinical judgments about individual, family, or community responses to actual or potential health problems and/or life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable. Outcome Identification = measurable, expected, patient-focused goals that translate into observable behaviors.

35. Planning = developed by the nurse and negotiated among the patient, nurse, family, and health care team; prescribes evidence-based interventions to attain expected outcomes. Implementation = putting in place interventions identified in the plan of care. Evaluation = the process of determining both the client’s progress toward the attainment of expected outcomes and the effectiveness of nursing care.

36. In the psychiatric/mental health setting – • Nursing care is always goal-directed • Nursing diagnoses are prioritized according to life-threatening potential • Maslow’s Hierarchy of Needs • Concept mapping • Documentation • SOAP notes • SBAR charting • DAR (data/action/response)

37. Objective 8 Describing the nurse’s role in psychiatric evaluation

38. Assessment • Observation • Thought processes • Behaviors • 1:1 • Mood scale • Subjective data Diagnosis (NANDA) Evaluation • Documentation • Treatment planning

39. Objective 9 Examining documentation practices of the psychiatric/mental health nurse

40. Problem-oriented recording (SOAPIE): • Subjective data = information gathered from what the client, family, or other source has said or reported • Objective data = information gathered by direct observation • Assessment = nurse’s interpretation of the subjective and objective data • Plan = actions/treatment to be carried out • Intervention = nursing actions actually carried out • Evaluation = assessment of the problem following nursing interventions

41. Focus charting (DAR and AIR): • Data = information that supports the focus or describes pertinent observations • Action = nursing actions that address the focus • Response = description of client’s response to any part of the medical or nursing care _____________________________________ • Assessment = observations about the client • Intervention = nursing actions that address the observations • Response = client’s response to actions

42. Objective 10 Defining the DSM-IV-TR and identifying its relevance to psychiatric nursing practice

43. Defining the DSM-V • The DSM-V is a handbook for mental health professionals that lists different categories of mental disorders and the criteria for diagnosing them • The manual has been revised six times since its inception • Organizes each psychiatric diagnosis according to different aspects of a specific disorder or disability

44. Relevance to Nursing Practice • Provides uniformity and consistency in psychiatric diagnoses • Groups diagnoses by characteristics according to specific criteria • Allows health care team to provide treatment based on diagnostic classification • Used by the nurse to organize patient care and determine appropriate priority psychiatric nursing diagnosis