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SECONDARY
B- behavior - reducing the effects of mental illness
C- communication ex:
a. psychiatric screening/evaluation
Alteration HOMEOSTATIS b. crisis intervention
P- perception c. suicide prevention: suicidal
P- personality ideation
B- behavior d. counseling
E- emotions e. emergency nursing care
T- thought
3. TERTIARY
Affect - minimizing the long term residual
S- self-awareness effects of mental illness
I- interpersonal relationship
R- reality presentation (+ affirmation) ex:
A- activities of daily living a. rehabilitation program
b. vocational training
A. MENTAL HEALTH c. after care support
- ability of the individual, family and community d. partial hospitalization
to respond adaptively to the internal and external
stressors CONCEPTUAL FRAMEWORK of PSYCH
CARE
B. POPULATION is at RISK to DEVELOP - organizing and better understanding of
1. Genetic predisposition the psychiatric care
2. Poor access to health care - helps the nurse to make a rational
3. Poverty systematic approach of the nursing care
4. Misusing substances
5. Undergoing lifestyle changes Classification:
Ex. : early pregnancy 1. PSYCHODYNAMIC FRAMEWORK
6. Victims of violence - focuses on the conflict, anxiety and
7. Elderly people defenses
Ex.: dementia, delirium, alzheimer’s dse. - process that makes the patient
conscious (dream analysis)
C. PSYCHIATRIC NURSING - TRANSFERENCE ANALYSIS
- interpersonal process between the nurse and - focuses on intrapsychic
patient to promote and maintain optimum level process
of functioning a. Psychosexual Stages- Freud
b. 8 Developmental Stages- Erickson
D. CONCEPT of PSYCHIATRIC NURSING c. Personality Dynamics-
Psychiatric Mental Health Nursing psychoanalytic
8 Human Responses: - topography/ iceberg of the
1. activity mind
2. cognitive level - components of personality
3. environment *ID, EGO, SUPEREGO
4. emotions - defense mechanism
5. interpersonal
6. intrapersonal: talking to self; visual imaging 2. BEHAVIORAL FRAMEWORK (Skinner)
7. own perception - focuses on learned behavior
8. physiologic - person is shaped by own environment
- behavior: REWARD and
Levels of Care PUNISHMENT
1. PRIMARY - anxiety, behavioral problems
- altering risk factors to hinder *systematic desensitization
development of mental illness
ex: 3. INTERPERSONAL FRAMEWORK (Sullivan)
a. client and family teaching - personality development
b. stress reduction - result to interaction with significant
c. psychosocial support others
- focus in interpersonal relationship
4. HUMANISTIC/EXISTENTIAL FRAMEWORK
- focuses on human experiences
- human beings are responsible for their - unhappy
own behavior b. WEAK/DEFECTIVE SUPEREGO- guilt feeling
- lack of self-awareness - antisocial behavior;
* GESTALT THERAPY * if superego is dominant, it needs the
- patient is assisted by means of role id
playing to express feeling *disorder: Obsessive-Compulsive Disorder and
5. BIOMEDICAL FRAMEWORK Anorexia Nervosa
- focuses on the disease process or approach AGE FREUD ERICKSON SULLIVAN PIAGET
0-18 mos. - ORAL - TRUST vs. - need for - Sensorimotor
- brought about by STAGE MISTRUST security - gradual
a. Neurotransmitter Theory - gratification - special or increase in the
by means of significant ability to think
- depression: ↓ serotonin’ mania: ↑ serotonin taking person: and use
- dementia: ↓ dementia everything in Mother language
- depression: ↓ epinephrine; mania: ↑ - needs of - tolerates
infants are small doses of
norepinephrine primarily frustration
centered into
the lips,
TOPOGRAPHY of the MIND mouth and
1. CONSCIOUS tongue
- ID is
- awake dominant
- part of the mind that functions during thinking *maternal
- here and now; responds to self or “I” deprivation:
infant is not
- memories or ideas can be recalled without given milk
exerting effort 1 ½- 3 - ANAL - - develop self- - Pre-
yrs. STAGE AUTONOMY esteem operational
- gratification vs. SHAME & - Pre-
2. SUBCONSCIOUS through DOUBT conceptual
elimination - principle of - use of
- stored in the mind but partially forgotten and retention struggling of symbols with
- ideas can be recalled but with exerting effort of feces holding on literal
- tip-of-the-tongue experience - mother: and letting go interpretation
superego - special
- Ambivalence figure:
3. UNCONSCIOUS - toilet PARENTS
training: when
- largest part of the mind present, child
- gives greatest influence in the personality of becomes OC
the person 3-6 yrs. - PHALLIC - INITIATIVE
STAGE vs. GUILT
- serves as storehouse of all the memories - interest is
- can be expressed by means of dreams, slip of focused on
his/her own
the tongue, unexplained behavior, jokes or lapse body
of memories - penis envy
- Oedipus or
Electra
COMPONENTS of PERSONALITY Complex
6-12 yrs.
12-18
1. ID- unconscious part of the person yrs.
- focuses on biologic drives; primitive 18-25
yrs.
- part of the personality in which we are born 25-45
because it was developed during the infancy yrs.
stage of development 45 &
above
- PLEASURE PRINCIPLE
* if id is dominant, it needs superego or “conscience”
* disorders: Mania, Antisocial and Narcissism
THERAPEUTIC COMMUNICATION
- process in which the nurse consciously utilizes
2. EGO- REALITY PRINCIPLE
the principle of communication in a goal-directed
- corresponds to self or “I”
framework
- integrator of the personality
- mediator between the id and superego
Best responses:
- develops during toddlerhood stage
1. here and now events
* disorder: Schizophrenia (ego distortion)
2. more of the “what” than the “why” questions
3. orientation and presentation of reality
3. SUPEREGO
4. description rather than judging
- conscience
5. maintenance of biological integrity
- MORALITY PRINCIPLE
6. actual observation
- with parental directions of censoring force
7. nursing intervention
- develops during PRE-SCHOOL AGE
8. sharing of information exploring alternatives
a. STRICT SUPEREGO- personality is rigid
NURSE-PATIENT REALTIONSHIP - involuntary; automatic; submerging of the
painful experiences
Therapeutic vs. Social Relationship - called UNCONSCIOUS FORGETTING
- usually used by patients with Catatonic
Therapeutic Relationship Schizophrenia
- focuses on personal and emotional needs of B. SUPPRESSION
the client - also called extensional exclusion of forbidden
ideas
Social Relationship - called CONSCIOUS FORGETTING
- focuses on the needs and emotions of both the - ex: a rape victim consciously forgets the
nurse and patient experience
C. RECATION-FORMATION
PHASES of NURSE-PATIENT INTERACTION - assuring the attitude or behavior that one
consciously regrets
1. ORIENTATION PHASE - usually used by manic patients
- introduction and role definition D. RATIONALIZATION
- establishment of trust - attempting to modify or justify the unacceptable
- clarify therapeutic parameters needs
a. Assessment - always use the word “because” to maintain
- must be completed within 24 hours self- respect
- set the contract with the client E. UNDOING
- start the establishment of discharge plan - actual or symbolic attempt
- brief but frequent interactions - erase previous experiences that cause the guilt
feelings
2. WORKING PHASE - repair feelings that created the guilt feelings
- promotes problem-solving approach F. PROJECTION
- discussion between the nurse and patient - attributing ones own unacceptable behavior to
- nurse had established trust from the patient others
- patient is cooperative - blames others
- nurse already teaches patient the new coping - “escape goat”
strategies G. COMPENSATION
- attempting to make-up or off-set deficiencies
3. TERMINATION PHASE by means of developing other personal qualities
- time of evaluation H. INTELLECTUALIZATION
- nurse already start summarizing the - overuse of intellectual concepts to avoid the
accomplishment and regrets real or effective expressions of the feelings
- called SOLIDIFICATION of SEPARATION I. IDENTIFICATION
- nurse says “good bye” - attempting to pattern or resemble the
- patient feels grief and anger towards the nurse personality of the admired person
- circumstance: SUICIDE due to anxiety J. CONVERSION
- transforming an emotional problem into
physical signs and symptoms
c. Looseness of Association
- shifting from one topic to another which has no
meaning
SEXUAL ADDICTION
- characterized by recurrent, compulsive, self-distarctive
behavior
- includes compulsive masturbation
Nursing Diagnoses:
1. Anxiety r/t threat to security and fear
discovery
2. Altered sexual patterns
3. Sexual dysfunction
4. Altered family process
5. Ineffective individual coping
Plan of Care:
1. Accept individual as a person who is in emotional pain
2. Protect individual from others
3. Avoid punitive remarks
4. Set limits on the individual’s sexual acting-out
5. Provide diversional activities
6. Sexual counseling