PSYCHIATRIC NURSING

LECTURE 1

PSYCHOSOCIAL INTEGRITY

COPING AND ADAPTATION MENTALLY HEALTHY INDIVIDUAL ATTITUDE OF SELF ACCEPTANCE AUTONOMY ABILITY TO ABSTRACT,TRUST ,COPE WITH STRESS ACCURATE SELF PERCEPTION AWARENESS OF SELF

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:
Introspection Discussion Experience Role play

Mental health concepts

Assessment (psychosocial processes )
Appearance , behavior or mood Speech , thought content and thought process Sensorium Insight and judgement Family relationships and work habits Level of growth and development

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

2)

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

3) 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 ones self Derealization feeling of strangeness towards environment Agnosia lack of sensory stimuli integration

4) 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

5) Disturbances in memory
Confabulation filling of memory gaps Dj 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 persons resources( support systems or coping mechanisms/strategiesdistress 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 Individualistic, unique, predictable(stability and consistency) Determinants: psychological,cultural, biological ( not inhereted) and familial

Analysis
Potential support systems or stressors Potential risk factor Satisfaction of human needs
Physiological(oxygen , fluids, nutrition, temp.,elimination,shelter,rest,sex) Safety and security(physical and psychological) Love and belongingness Self esteem Self -actualization

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

Theories of personality development

Psychosexual Psychosocial Cognitive Developmental tasks Moral Interpersonal

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 superegocontrol 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 VS. MISTRUST 1-3y AUTONOMY VS. SHAME AND DOUBT 3-6 INITIATIVE VS. GUILT 6-12 INDUSTRY VS. INFERIORITY 12-18 IDENTITY VS. ROLE DIFFUSION 18-25 INTIMACY VS ISOLATION 25-60 GENERATIVITY VS. STAGNATION 60 and above EGO INTEGRITY VS. DESPAIR

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

PIAGETS 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 OTHERS 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

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

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

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 SELFPERCEPTION 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