Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Third Edition
Mental Health
WHO definition: state of complete physical, mental, and social wellness, not merely absence of disease or infirmity
State of emotional, psychological, and social wellness evidenced by: satisfying interpersonal relationships effective behavior and coping a positive self-concept emotional stability
Interpersonal factors:
effective communication, ability to help others, intimacy, and a balance of separateness and connectedness
Social/cultural factors:
a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic, view of ones world
Mental Illness
Historically viewed as possession by demons, punishment for religious or social transgressions, weakness of will or spirit, and violation of social norms Today seen as a medical problem, although some stigma from previous beliefs remains
Mental Illness (contd) Mental disorder is a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom (American Psychological Association [APA])
Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision
Axis I: all major psychiatric disorders except mental retardation and personality disorders Axis II: mental retardation, personality disorders, maladaptive personality features, and defense mechanisms Axis III: current medical conditions
Axis IV: psychosocial and environmental problems, including problems with primary support group, social environment, education, occupation, housing, economics, access to health care, legal system
Axis V: Global Assessment of Functioning (GAF) score
Historical Perspective Ancient times: sickness represented displeasure of the gods, punishment for wrongdoing; treatments included starving, urging, bloodletting Period of Enlightenment (1790s) saw the creation of asylums or safe havens to offer protection Sigmund Freud and others studied mental disorders scientifically by the 1900s
Mental Illness in the 21st Century 56 million Americans have a mental illness (DHHS, 2002)
Homeless population of persons with mental illness, including substance abuse, is growing Most health care dollars still spent on inpatient psychiatric care; community services not adequately funded Healthy People 2010 mental health objectives strive to improve care of mentally ill persons
Community-based care includes community support services, housing, case management, residential services outside the hospital (see Chap. 4) Cost containment efforts include utilization review, HMOs, managed care, case management
Cultural considerations: diversity increasing in U.S. in terms of ethnicity and changing family structures
Standards of Psychiatric-Mental Health Clinical Nursing Practice developed in 1973, revised in 1982, 1994, 2000 Psychiatric Mental Health Nursing Phenomena of Concern: 12 areas of concern that mental health nurses focus on when caring for clients
Student Concerns
Saying the wrong thing
Self-Awareness Issues
Everyone has values, beliefs, ideas; nurses need to know what theirs are, not to change them, but to prevent unknown or undue influence on their nursing practice
Hints to increase self-awareness: keep a journal, talk to trusted coworkers, examine points of view other than ones own