1. Mental Health and Mental Illness
Chapter 1
Mental Health and Mental Illness

2. Introduction
The concepts of mental health and mental illness are culturally defined
Individuals experience both physical and psychological responses to stress

3. Mental Health Maslow identified A “hierarchy of needs”
Self-actualization as fulfillment of one’s highest potential

4. Mental Health (cont.)
Defined as “the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms”

5. Mental Illness
Defined as “maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational, or physical functioning”

6. Mental Illness (cont.)
Horwitz described cultural influences that affect how individuals view mental illness, including
Incomprehensibility: the inability of the general population to understand the motivation behind the behavior
Cultural relativity: the “normality” of behavior is determined by the culture

7. PHYSICAL AND PSYCHOLOGIAL RESPONSES TO STRESS

8. Physical Responses
Hans Selye defined stress as “the state manifested by a specific syndrome which consists of all the nonspecifically induced changes within a biologic system”
“Fight-or-flight” syndrome
Immediate stress response
Sustained stress response

9. Psychological Responses (cont.)
Anxiety
A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness
Extremely common in our society
Mild anxiety is adaptive and can provide motivation for survival

10. Psychological Responses (cont.)
Behavioral adaptation
responses to anxiety
At the mild level, individuals employ various coping mechanisms to deal with stress, including
Eating
Drinking
Sleeping
Physical exercise
Smoking
Crying
Laughing
Talking to persons with whom they feel comfortable

11. Psychological Responses (cont.)
At the mild to moderate level, the ego calls on defense mechanisms for protection, such as
Compensation
Denial
Displacement
Identification
Intellectualization
Introjection
Isolation
Projection
Rationalization
Reaction formation
Regression
Repression
Sublimation
Suppression
Undoing

12. Psychological Responses (cont.)
Anxiety at the moderate to severe level that remains unresolved over an extended period can contribute to a number of physiological disorders—for example, migraine headaches, irritable bowel syndrome, and cardiac arrhythmias.
Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving—for example, anxiety and somatoform disorders.

13. Psychological Responses (cont.)
Extended periods of functioning at the panic level of anxiety may result in psychotic behavior—for example, schizophrenic, schizoaffective, and delusional disorders.

14. Psychological Responses (cont.)
Grief: the subjective state of emotional, physical, and social responses to the loss of a valued entity; the loss may be real or perceived.
Elisabeth Kübler-Ross
Five stages of grief
Denial
Anger
Bargaining
Depression
Acceptance

15. Psychological Responses (cont.)
Anticipatory grief: The experiencing of the grief process before the actual loss occurs.
Thought to shorten the grieving process
Resolution: Length of the grief process is entirely individual. It can last from a few weeks to years and it is influenced by a number of factors.

16. Psychological Responses (cont.)
Resolution of the grief response is thought to occur when an individual can look back on the relationship with the lost entity and accept both the pleasures and the disappointments of the association.

17. Psychological Responses (cont.)
Maladaptive grief responses
Prolonged response
Delayed/inhibited response
Distorted response

18. DSM-IV-TR Multiaxial Evaluation System**
Axis I: Clinical disorders and other conditions that may be a focus of clinical attention (Can be treated with meds)
Axis II: Personality disorders and mental retardation (No medication tx)
Axis III: General medical conditions (Physiological)
Axis IV: Psychosocial and environmental problems
Axis V: The measurement of an individual’s psychological, social, and occupational functioning on the Global Assessment of Functioning Scale (GAF)

19. Example of a Psychiatric Diagnosis
Axis I: Dysthymic Disorder
Axis II: Dependent Personality Disorder
Axis III: Hypothyroidism
Axis IV: Unemployed
Axis V: GAF = 65 (current)

20. Ethical and Legal Issues
Chapter 4
Ethical and Legal Issues

21. Introduction
Nurses are constantly faced with the challenge of making difficult decisions regarding good and evil or life and death
Legislation determines what is “right” or “good” within a society

22. Definitions
Ethics: the science that deals with the rightness and wrongness of actions
Bioethics: term applied to ethics within the concept of medicine, nursing, and allied health

23. Definitions (cont.)
Moral behavior: conduct that results from serious critical thinking about how individuals ought to treat others
Values: ideals or concepts that give meaning to an individual’s life
Values clarification: a process of self-exploration through which individuals identify and rank their own personal values

24. Definitions (cont.)
Legal right: a right on which the society has agreed and formalized into law
Right: a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service
Absolute right: when there is no restriction whatsoever on the individual’s entitlement

25. Ethical Considerations
Theoretical perspectives
Utilitarianism: an ethical theory that promotes actions based on the end results that produce the most good (happiness) for the most people
Kantianism: suggests that decisions and actions are bound by a sense of duty

26. Ethical Considerations (cont.)
Christian ethics: do unto others as you would have them do unto you; alternatively, do not do unto others what you would not have them do unto you
Natural law theories: do good and avoid evil; evil acts are never condoned, even if they are intended to advance the noblest of ends
Ethical egoism: decisions are based on what is best for the individual making the decision

27. Ethical Dilemmas
Ethical dilemmas occur when moral appeals can be made for taking either of two opposing courses of action
Taking no action is considered an action taken

28. Ethical Principles
Autonomy: emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected
Beneficence: refers to one’s duty to benefit or promote the good of others

29. Ethical Principles (cont.)
Nonmaleficence: abstaining from negative acts toward another; includes acting carefully to avoid harm
Justice: based on the notion of a hypothetical social contract between free, equal, and rational persons; concept of justice reflects a duty to treat all individuals equally and fairly
Veracity: refers to one’s duty to be truthful always

30. A Model for Making Ethical Decisions
Assessment
Problem identification
Plan
Implementation
Evaluation

31. Ethical Issues in Psychiatric/Mental Health Nursing
The right to refuse medication
The right to the least restrictive
treatment alternative

32. Legal Considerations
Nurse Practice Act defines the legal parameters of professional and practical nursing
Types of laws
Statutory law
Common law

33. Classifications Within Statutory and Common Law
Civil law: protects the private and property rights of individuals and businesses
Torts
Contracts
Criminal law: provides protection from conduct deemed injurious to the public welfare

34. Legal Issues in Psychiatric/Mental Health Nursing
Confidentiality and right to privacy
Hippa
Doctrine of privileged communication
Exception: duty to warn
Informed consent
Restraints and seclusion
False imprisonment

35. Legal Issues in Psychiatric/Mental Health Nursing (cont.)
Commitment issues
Voluntary admissions
Involuntary commitments
Emergency commitment
The “mentally ill” person in need of treatment
Involuntary outpatient commitment
The gravely disabled client

36. Legal Issues in Psychiatric/Mental Health Nursing (cont.)
Malpractice and negligence
Types of lawsuits that occur in psychiatric nursing
Breach of confidentiality
Defamation of character
Libel
Slander

37. Legal Issues in Psychiatric/Mental Health Nursing (cont.)
Types of lawsuits that occur in psychiatric nursing (cont.)
Invasion of privacy
Assault and battery
False imprisonment

38. Nursing Actions to Avoid Liability
Respond to the patient
Educate the patient
Comply with the standard of care
Supervise care
Adhere to the nursing process
Document care
Follow-up and evaluate
Maintain a good interpersonal relationship with the client and family