PSYCHIATRIC NURSING

terminologies

General Knowledge
Peter Glen L. Reyes
 MENTAL HEALTH – balance in a
persons internal life and adaptation
to reality
Mental ILL Health – state of imbalance
characterized by a disturbance in a persons
thoughts, feelings and behavior
Poverty and abuses are major risk factors
Psychiatric nursing – interpersonal process
whereby the professional nurse practitioner
,through the therapeutic use of self(art) and
nursing theories (science), assist clients to
achieve psychosocial well being.
Core of psych nursing – interpersonal process –
human to human relationship(both for mentally
healthy and ill)
 Neurosis
any long term mental or behavioral d/o in which
contact with reality is retained the condition is
recognized by the patient as abnormal.
Essentially features anxiety or behavior
exagerrated designed to avoid anxiety
( anxiety d/o ; hysteria to conversion
d/o,amnesia,fugue,multiple personality and
depersonalization- dissociative d/o
;oc d/o)
Result of inappropriate early
programming(psychoanalysis little value)
Benefits from Behavior Therapy
 Psychosis
Mental or behavioral disorder wherein
patient looses contact with reality
Presence of delusions,
hallucinations,severe thought
disturbances,alteration of mood, poverty of
thought and abnormal behavior
(schizophrenia , major disorder of affect
( mania – depression), major paranoid
states and organic mental disorder
Benefits from psychoanalysis and
antipsychotics
Mental hygiene – measures to promote
mental health , prevent mental illness and
suffering and facilitate rehabilitation…….
(and if necessary find meaning in these
experiences)
Main tool – therapeutic use of self
It requires self-awareness
Methods to increase self-awareness:
– Discussion
– Experience
– Role play
 Common Behavioral Signs and
Symptoms
1) Disturbances in perception
 Illusion- misinterpretation of an actual
external stimuli
 Hallucinations – false sensory perception in
the absence of external stimuli
1) Disturbances in thinking and speech
 neologism – coining of words that people do
not understand
 Circumstantiality – over inclusion of
inappropriate thoughts and details
 Word salad – incoherent mixture of words and
phrases with no logical sequence
 Verbigeration – meaningless repetition of
words and phrases
 Perseveration – persistence of a response to a
previous question
 Echolalia – pathological repetition of words of
others
 Aphasia – speech difficulty and disturbance
 Expressive , receptive or global
 Flight of ideas- shifting of one topic from
one subject to another in a somewhat
related way
 Looseness of association-incoherent
,illogical flow of thoughts(unrelated way)
 Clang association – sound of word gives
direction to the flow of thought
 Delusion – persistent false belief,rigidly
held
Delusions of grandeur- special /important in a way
Persecutory-threatened
Ideas of reference-situation/events involve them
Somatic- body reacting in a particular way
 Magical thinking – primitive thought
process thoughts alone can change
events
 Autistic thinking – regressive thought
process-subjective interpretations not
validated with objective reality
1) Disturbances of affect
 Inappropriate – disharmony between the
stimuli and the emotional reaction
 Blunted affect – severe reduction in
emotional reaction
 Flat affect – absence or near absence of
emotional reaction
 Apathy – dulled emotional tone
 Depersonalization – feeling of strangeness
from one’s self
 Derealization – feeling of strangeness
towards environment
 Agnosia – lack of sensory stimuli integration
1) Disturbances in motor activity
 Echopraxia – imitation of posture of others
 Waxy flexibility – maintaining position for a
long period of time
 Ataxia – loss of balance
 Akathesia – extreme restlessness
 Dystonia- uncoordinated spastic movements
of the body
 Tardive dyskenisia – involuntary twitching or
muscle movements
 Apraxia – involuntary unpurposeful
movements
1) Disturbances in memory
Confabulation – filling of memory gaps
Déjà vu – 2nd time-like feeling
Jamais vu- not having been to the place
one has been before
Amnesia – memory loss (inability to
recall past events)
 Retrograde-distant past
 Anterograde – immediate past
 Anomia – lack of memory of items
Dynamics of Human Behavior
Behavior – the way an individual reacts to a
certain stimulus
Conflict – situation arising from the presence of
two opposing drives
Need - organismic condition that requires a
certain activity
Stress – life events in which a demanding
situation (warrants a response )taxes a person’s
resources( support systems or coping
mechanisms/strategies…distress and eustress
Adaptation – process of interacting with the
environment to maintain homeostatic equilibrium
Maladaptation – ineffective coping
Dynamics of Human Behavior
Personality – integration of systems and
habits representing anindividuals
characteristic adjustment to his
environment expressed through behavior
 3 divisions of the mind
Conscious – focussed on awareness

Subconscious – recalled at will

Unconscious – never recalled / largest

part

Learning – change in behavior through –

insight , relearning and remotivation
 Freuds psychosexual theory
Libido – inner drive
Parts of body –focus of gratification
Unsuccesful resolution - fixation
Structures of personality

– Id – pleasure principle-instinct

– Ego – controls action and perception –reality principle

– Superego – moral behavior - conscience

0-18 m0s ;oral – mouth – trust and
discriminating
18 mos. – 3 years ; anal – bowels –
holding on or letting go
– Negativism and toilet training age
3 -6 years phallic ; genitals –exploration
and discovery ( inc. sexual tension)
– Gender identification and genital awareness
– Oedipus and Electra complex //
– Castration anxiety and penis envy
6-12 years –latency (quiet stage) sexual
energy diverted to play. Institution of
superego…control of instinctual impulses
12 – young adult – genital ; reawakening
of sexual drives –relationships
– Sexual maturation
– Sexual identity ,ability to love and work
 Psychosocial – Erickson
developmental milestones //delay
0-12mos; TRUST
1-3y AUTONOMY
3-6 INITIATIVE
6-12 INDUSTRY
12-18 IDENTITY
18-25 INTIMACY
25-60 GENERATIVITY
60 and above EGO INTEGRITY
 INFANCY
CONSISTENT MATERNAL –CHILD
INTERACTION – TRUST
INNER FEELING OF SELF WORTH

HOPE
 TODDLER
ALLOW EXPLORATION
PROVIDE FOR SAFETY

NO NO – NEGATIVISM
OFFER CHOICES / REVERSE PSYCHOLOGY
TOILET TRAINING – 18 MOS.-BOWEL
DAYTIME BLADDER -2 Y
NIGHTIME BLADDER 3 Y
REWARD W/ PRAISE AND AFFECTION

INDEPENDENCE
 PRE-SCHOOL
PROVIDE PLAY MATERIALS
SATISFY CURIOSITY
TEACH AND
REINFORCE(HYGIENE,SOCIAL
BEHAVIOR)
SIBLING RIVALRY

WILLPOWER
 SCHOOL AGE
HOW TO DO THINGS WELL-SUPPORT
EFFORTS
CHUMS AND HOBBIES

NEEDS TO EXCEL/ACCOMPLISH
NEED FOR PRIVACY AND PEER
INTERACTION
COMPETENCE
 ADOLESCENCE
MAKE DECISION,EMANCIPATION
FROM PARENTS
BODY IMAGE CHANGES

NEED TO CONFORM BUT KEEP

INDIVIDUALITY

SELF - AWARENESS
 YOUNG ADULT

COMMITMENT AND FIDELITY

RESPONSIBILITY

ACHIEVEMENT OF INDEPENDENCE
 MIDDLE ADULTHOOD
SUPPORT-PERIOD OF ROLE TRANSITIONS
MIDLIFE CRISIS

ADJUSTMENT AND COMPROMISE

MOST PRODUCTIVE AND CREATIVE

ALTRUISM
 LATE ADULTHOOD
SELF ACCEPTANCE

SELF WORTH

WISDOM
PIAGET’S COGNITIVE
THEORY
 0-2 SENSORIMOTOR
REFLEXES
IMITATIVE REPETITIVE BEHAVIOR
SENSE OF OBJECT PERMANENCE
AND SELF SEPARATE FROM ENVT.
TRIAL AND ERROR RESULTS IN
PROBLEM SOLVING
 2-7Y PRE-OPERATIONAL
SELF-CENTERED,EGOCENTRIC
CANNOT CONCEPTUALIZE OTHER’S VIEW
ANIMISTIC THINKING
IMAGINARY PLAYMATE – SYMBOLIC
MENTAL REPRESENTATION – CREATIVITY
2-4 PRE-CONCEPTUAL (PRE-LOGICAL)
4-7 INTUITIVE (UNDERSTANDING OF ROLES)
 7-12Y CONCRETE
OPERATIONAL
LOGICAL CONCRETE THOUGHT
INDUCTIVE RESAONING (SPECIFIC TO
GENERAL)
CAN RELATE ,PROBLEM SOLVING
ABILITY
REASONING AND SELF-REGULATION
 12-ABOVE FORMAL
OPERATIONAL THOUGHT
Abstract thinking
Separation of fantasy and fact
Reality oriented
Deductive reasoning
Apply scientific method
 Havighurst
Developmental Tasks
Baby to early childhood
– Right from wrong and Conscience
Late childhood
– Physical skills,wholesome attitude,social roles
– Conscience morality and values
– Fundamental skills in academics
– Personal independence
Adolescence
– Sexual social roles
– Relationships
– Independence and ideology
Early adulthood
– Career
– Selecting a mate
– Finding Civic or social responsibility
Middle age
– Achieving Civic or social responsibility
– Adjusting to changes
– Satisfactory career performance
– Adjusting to aging parents
– Adjusting to parental roles
Old age
– Adjusting to changes
– Establishing satisfactory living arrangements and
affiliations
 Kohlberg – MORAL
DEVELOPMENT/
THINKING/ JUDGEMENT
PRE-CONVENTIONAL (0-6)
– PUNISHMENT AND OBEDIENCE
– OBEDIENCE TO RULES TO AVOID
PUNISHMENT
CONVENTIONAL ( 6-12 )
– MUTUAL INTERPERSONAL
EXPECTATIONS,RELATIONSHIPS AND
CONFORMITY
– SOCIAL SYSTEM AND CONSCIENCE
MAINTENANCE
– BEING GOOD IS IMPORTANT SELF
RESPECT OR CONSCIENCE
POST –CONVENTIONAL (12 – 18 Y)
PRIOR RIGHT OR SOCIAL CONTRACT
UNIVERSAL ETHICAL PRINCIPLE
ABIDE FOR COMMON GOOD
RATIONAL PERSON-VALIDITY OF
PRINCIPLES-AND BECOME
COMMITTED TO THEM
INNER CONTROL OF BEHAVIOR
UNDERSTANDING THE EQUALITY OF
HUMAN RIGHTS AND DIGNITY OF
HUMAN BEINGS AS INDIVIDUALS
 SULLIVANS
INTERPERSONAL
THEORY
 INFANCY
NEED FOR SECURITY-INFANT LEARNS
TO RELY ON OTHERS TO GRATIFY
NEEDS AND SATISFY WISHES,
DEVELOPS A SENSE OF BASIC TRUST,
SECURITY AND SELF WORTH WHEN
THIS OCCURS
 TODDLERHOOD / EARLY
CHILDHOOD
CHILD LEARNS TO COMMUNICATE
NEEDS THROUGH USE OF WORDS
AND ACCEPTANCE OF DELAYED
GRATIFICATION AND INTERFERENCE
OF WISH FULFILLMENT
 PRE-SCHOOL
DEVELOPMENT OF BODY IMAGE AND SELF-
PERCEPTION
ORGANIZES AND USES EXPERIENCES IN
TERMS OF APPROVAL AND DISAPPROVAL
RECEIVED
BEGINS USING SELCTIVE INATTENTION AND
DISASSOCIATES THOSE EXPERIENCES
THAT CAUSE PHYSICAL OR EMOTIONAL
DISCOMFORT AND PAIN
 SCHOOL AGE
THE PERIOD OF LEARNING TO FORM
SATISFYING RELATIONSHIPS WITH
PEERS-USES
COMPETITION,COMPROMISE AND
COOPERATION
THE PRE-ADOLESCENT LEARNS TO
RELATE TO PEERS OF THE SAME SEX
 ADOLESCENCE
LEARNS INDEPENDENCE AND HOW
TO ESTABLISH SATISFACTORY
RELATIONSHIPS WITH MEMBERS OF
THE OPPOSITE SEX
 YOUNG ADULTHOOD
BECOMES ECONOMICALLY,
INTELLECTUALLY AND EMOTIONALLY
SELF SUFICIENT
 LATER ADULTHOOD
LEARNS TO BE INTERDEPENDENT
AND ASSUMES RESPONSIBILITY FOR
OTHERS
 SENESCENCE
DEVELOPS AN ACCEPTANCE OF
RESPONSIBILITY FOR WHAT LIFE IS
AND WAS AND OF ITS PLACE IN THE
FLOW OF HISTORY
FORMATION OF PERSONALITY

CERTAIN GOALS MUST BE

ACCOMPLISHED, IF THIS GOALS ARE
NOT ACCOMPLISHED AT A CERTAIN
STAGE,….PERSONALITY WILL BE
WEAKENED….FACTORS IN EACH
STAGE PERSISTS AS A PERMANENT
PART OF PERSONALITY….
 EACH STAGE HAS MAJOR
TRAUMAS AND FRUSTRATIONS THAT
MUST BE OVERCOME
…….SUCCESSFUL RESOLUTION OF
CONFLICTS ASSOCIATED WITH EACH
STAGE IS ESSENTIAL TO
DEVELOPMENT…..UNRESOLVED
CONFLICTS REMAIN IN THE
UNCONSCIOUS AND MAY, AT TIMES,
RESULT IN MALADAPTIVE BEHAVIOR
PROMOTING PSYCHOSOCIAL
HEALTH
 SELF- AWARENESS
SELF CONCEPT – COLLECTION OF
FEELING BELIEFS ABOUT ONE’S SELF
SELF ESTEEM – CONFIDENCE IN
ONE’S ABILITIES AND JUDGEMENT

ASSERTIVENESS

+ SELF - EVALUATION
 STRESS
GAS – ALARM-RESISTANCE-EXHAUSTION
COPING AND STRESS MANAGEMENT

ANXIETY-
– MILD – SLIGHT AROUSAL AND INCREASED
PERCEPTION
– MODERATE-INC. TENSION AND SELECTIVE
INATT.
– SEVERE – DEC. PERCEPTION AND FOCUSSED
ENERGY
– PANIC – OVERPOWERING AND LOSS OF
CONTROL
GRIEF AND LOSS
Loss is a universal experience that occurs throughout life span
Grief is a form of sorrow involving feelings, thoughts, and behaviors
caused by bereavement
Responses to loss are strongly influenced by one’s cultural
background
The grief process involves a sequence of affective, cognitive, and
psychological states as a person responds to, and finally accepts a
loss.
Responses to loss and patterns of coping with loss are developed
early in life.
Stages of Grieving (Kubler-Ross)
Denial- refuses to believe that the loss has occurred
Anger- the individual resists the loss and may “act out” feelings.
Bargaining- the individual attempts to make a deal in an attempt to
postpone the reality of loss.
Depression- overwhelming feeling of loneliness and withdrawal from
others
Acceptance- the individual comes to terms with loss, or impending
loss, psychological reactions to loss to the loss cease, and the
interaction to other people resumed.
LOSS ,GRIEVING AND DEATH
DEATH CONCEPTS
– 1-5Y.O – IMMOBILITY AND INACTIVITY
Wishes and unrelated action responsible for
action
– 5-10 – final but can be avoided
– 9-12 – understands own mortality and fears
death
– 12 – 18 – fears and fantasizes avoidance
– 18-45 – increased attitude awareness
– 45-65 – accepts mortality
– Above 65 – multiple meanings, encounters and
fears
KUBLER ROSS – STAGES OF
GRIEF
D – SUPPORTIVE

A- PROVIDE STRUCTURE AND CONTINUITY

B – LISTEN AND ENCOURAGE

D- ALLOW EXPRESSION AND PROVIDE FOR

SAFETY

A- ENCOURAGE PARTICIPATION
 CONCEPTS
6 MOS – 2 YEARS
PROVISION OF DIGNIFIED PAIN FREE
DEATH( QUEST. ANSWERED AND EMT.
SUPPORT)
DNR- COMFORT AND HYGIENE NEEDS
ON-GOING
 CURE GOALS ----- COMFORT GOALS