LESSON 4: PSYCHOSOCIAL INTEGRITY

I. Concepts of Mental Health and Mental Illness

A. BIOCHEMICAL RESEARCH
Study of the brain and its functioning has helped
researchers understand which parts of the brain are
involved in each mental illness
Medications are now more effective as a result of a
better understanding of neurotransmitters and their
functioning
Major neurotransmitters include: norepinephrine,
dopamine, serotonin, and gamma-aminobutyric acid
(GABA)
Neuroimaging through positron emission tomography
(PET scan) or the computed tomography (CT scan) and
magnetic resonance imaging (MRI scan) allow
researchers and diagnosticians to study the brain
without surgery
B. GENETIC RESEARCH
Currently, no type of genetic testing can tell whether a
person will develop mental illnesses; not enough is
known about which gene variations contribute to them
or the degree to which other factors contribute
Familial and genetic factors are part of many major
psychiatric illnesses, including bipolar disorder and
schizophrenia
C. PSYCHOLOGICAL THEORIES
1. Psychoanalytic theory
Developed by Sigmund Freud
Introduced concept of the mind as a structure
incorporating the id, ego and superego
Part of each persona's mental functioning is conscious
and part unconscious
Treatment includes helping make the unconscious
conscious

Defense mechanisms are used to defend the ego from

conflicts between the id and superego

2. Interpersonal theory
Originally developed by Harry Stack Sullivan
Personality develops according to the client's
perception of how others view them
A healthy personality is the result of healthy
relationships
Hildegard Peplau, who is considered to be the "mother
of psychiatric nursing," was influenced by this theory
i.
She wrote Interpersonal Relations in Nursing, which
became the foundation for the nurse-client
relationship
ii.
According to Peplau, the nurse-client relationship is
one in which
the client receives unconditional acceptance
the relationship between nurse and client is
client-centered
the relationship is developed according to the
client's perceived readiness
3. Psychosocial developmental theory
Developed by Erik Erikson
Describes eight psychosocial stages of development in
the human life cycle
Development is successful if the person is able to
resolve the conflict that arises during each stage
If the person does not effectively resolve the conflict,
then development is arrested at that stage
4. Cognitive behavioral theory (CBT)
Focuses on the premise that a person's thoughts
control their behavior
If a client is feeling or behaving in an unwanted way,
then it is important to identify the thoughts that are
causing these feelings or behaviors

The treatment
thoughts with
outcome
CBT is used to
illness and live

is for the client to replace the current

ones that produce a more desirable
help clients manage symptoms of their
a fuller life

5. Behavioral theory
Symptoms of mental illness are the result of learned
behavior
Through
the
use
of
positive
and
negative
reinforcement unacceptable learned behavior can be
replaced by a more desired behavior
Symptoms of phobias, sexual dysfunction, and eating
disorders are some of the mental illnesses currently
treated using behavioral therapy
Assertiveness training and desensitization
are
commonly used behavioral techniques
D. RELIGIOUS AND SPIRITUAL INFLUENCES
1. Develop cultural self-awareness - respect the beliefs that
are different from those of the nurse
Religion - an organized system of beliefs about a
higher power
Spirituality - beliefs about the essence of being
2. Be familiar with common practices of common religions
including value systems, diet, beliefs surrounding death
Catholic
Protestant
Jewish
Muslim
Hindu
Buddhist
Mormon
Christian Scientist

Jehovah Witness

3. Seek personal spiritual support for clients who are in

distress
Chaplain service
Consider HIPAA and client's wishes
4. Recognize that research supports the importance of
spiritual support; several studies indicate that prayer
improves health status

E. CULTURAL AWARENESS AND CULTURAL COMPETENCE

1.
Develop cultural self-awareness and respect cultural
differences of others
Consider culture as different from race or ethnicity
alone
Determine the cultural beliefs of the client especially
related to health practices
2. Be

familiar with various cultural practices

Folk healing of rural populations
Native American practices
Integration of Eastern healing or complementary and
alternative therapies

3. Determine any healing practices the client uses,

prescribed or unprescribed
Use non-judgmental approach
Observe for positive or negative interactions of
traditional (allopathic) therapy with complementary
alternative therapies (CAT)
Document all practices and therapies

3.
4.
5.
6.
F. GRIEF & LOSS
1. Loss
A universal phenomenon, occurring across the lifespan
Types of loss
loss of external objects
loss of significant others through death or divorce
loss of environment by relocating, accepting a new
job, hospitalization
loss of an aspect of self, which may include a body
part (amputation of a limb), physiologic, or
psychologic function
perceived loss - felt by the person but intangible to
others, e.g., youth
situational loss - the result of an unpredictable
event, e.g., natural disaster
Response to loss depends on
personality
culture
previous experience with loss
one's values
perceived value of loss
support system
2. Types of grief

Anticipatory grief: person learns of impending loss and

responds with processes of mourning, coping,
interaction, planning, and psychosocial reorganization
Disenfranchised grief: person experiences a loss that is
not or cannot be openly acknowledged, publicly
mourned, or socially supported
Complicated grief: a result of a sudden loss

Mourning: process used to resolve grief

Bereavement: a state of grieving
Models (or theories) of grief
Nursing interventions in grief
Support client's effective coping mechanisms
Don't take client's responses personally
Listen attentively
Support client with problem-solving and decisionmaking as indicated
Encourage the client and/or significant others to
express their feelings and concerns
Utilize therapeutic touch as appropriate
Assist in discussions of future plans as appropriate