Contemporary Psychiatric-Mental Health Nursing, 3rd Edition

Mental Health, Mental Disorder, and PsychiatricMental Health Clients Who Are They Learning Outcome 1 Define and explain mental disorder. Concepts for Lecture Facing the unknown in a psychiatricmental health setting invites a variety of feelings, concerns, and questions. Expectations related to caring for psychiatricmental health clients are influenced by a number of factors including personal culture, upbringing, previous experiences, and media. Psychiatricmental health clients are everyday, ordinary people. Given the right circumstances, anyone can experience a mental health problem ranging from mild and temporary to severe and persistent. Concepts of mental disorder and mental health are interactional and derive their meaning not only from changes in brain structure and biochemistry but also from how we define certain behavior and social conditions. Mental disorder is a psychological group of symptoms in which the individual experiences distress (a painful symptom), disability (impairment in one or more important areas of functioning), or a significantly increased risk of suffering, pain, loss of freedom, or death. Signs and symptoms of mental disorder are known as psychopathology. Mental disorders are identified, standardized, and categorized in the Diagnostic and Statistical Manual of Mental DisordersIV-TR published by the American Psychiatric Association (APA). Suggestions for Classroom Activities View and discuss the animation Psychological Disorders and Treatment found on the Online Student Resources. Using concept mapping, construct a map of characteristics associated with the concepts of mental illness. Complete the WebLink application assignment that accompanies this chapter. Have students describe various clinical locations where they may encounter individuals with a mental disorder. Discuss common fears and concerns related to contact with individuals who are experiencing a mental disorder. Suggestions for Clinical Activities Using the Diagnostic and Statistical Manual of Mental DisordersIV-TR, compare defining characteristics of several common mental disorders with the components of the general definition(s) of mental disorder. Encourage students to assess client behaviors that give examples of the characteristics within the definition of a mental disorder. Lead a discussion comparing rational and irrational fears and concerns related to the psychiatricmental health clinical setting. Ask students to develop a list of questions for data collection that would be helpful in the determination of a possible mental disorder. Ask students to keep a journal during the psychiatricmental health clinical rotation documenting their perceptions, beliefs, and feelings related to caring for clients with mental illness. Ask them to compare the perceptions, beliefs, and feelings at the beginning of the clinical rotation with the perceptions, beliefs, and feelings at the end of the clinical rotation. Learning Outcome 2 Analyze why the term deviant behavior lacks a definition that covers all situations. Concepts for Lecture The concept of mental disorder lacks a definition that covers all situations. A sociologic definition of deviance is behavior outside the social norm of a specific group and in its social context, deviant does not mean bad. Behavior that is considered bizarre or unreasonable in one cultural context may be considered desirable in another. The appropriateness of behavior depends on whether it is judged plausible or not according to a set of social, ethical, and legal rules that define the limits of appropriate behavior and reality. Deviant political, religious, or sexual behavior or conflicts primarily between an individual and society are not labeled as mental disorders unless the deviance or conflict is a symptom of dysfunction in the individual. Suggestions for Classroom Activities Lead a discussion examining how culture and society influence views of mental health and mental disorder. Ask students to research different cultures and relate two behaviors or beliefs that are valued in the culture being researched but would be labeled as bizarre in contemporary western culture. Ask students to compare social norms and appropriate behaviors and beliefs among various groups comprising modern-day western society. Role-play Dress in a bizarre manner and encourage students to ask assessment questions in order to determine if a mental disorder exists in the character that you portray. Open the class with an example of a current event in the media that reports behavior and beliefs that are considered bizarre in western culture, but are the norm for another culture. Suggestions for Clinical Activities Ask students to develop a list of questions that would be helpful in the determination of culturally and socially appropriate behavior and beliefs versus symptoms of a mental disorder. Ask students to develop a list of questions they should ask themselves in order to increase self-awareness of personal bias and to maximize their therapeutic potential with clients exhibiting deviant behaviors. Learning Outcome 3 Compare and contrast the essential characteristics of mental health with mental disorder. Concepts for Lecture There are many essential qualities of mentally healthy people. Some are reality oriented to people, places, time, and events and have a basic knowledge of their strength and weakness, and the ability to problem solve and maximize the potential to grow. They are able to grow as they interact collaboratively with others. In these collaborative relationships, they not only accept their own strengths and weaknesses, but they also accept the strength and weaknesses of others. Their emotional and psychological states, and values and behavior are consistent. These qualities move the person along the way to hardiness and resilience in his or her life experiences. In general, mentally healthy people relate to others and have a self-concept that is based in reality. They are independent and autonomous and accept the challenges of life. To meet the challenges of life, they utilize problem solving consistent with the norms of their culture. Problem solving may mean seeking assistance from someone and during such time they seek appropriate sources for help. As they work through problems, they develop more resilience. Their behavior, emotions, and values are adaptable to many growth experiences. Mentally healthy people are on a lifelong growth process toward ones potential. Suggestions for Classroom Activities Using concept mapping, construct a map of characteristics associated with a mentally healthy person. List some factors that promote the development the development of mental health. Suggestions for Clinical Activities Ask students to develop a short presentation they could present to high school students on mental health and what they can do to maintain health. Develop a nursing care plan to teach a client problem-solving skills. Learning Outcome 4 Name the five mental disorders that rank among the top ten causes of disability worldwide. Concepts for Lecture How common are mental disorders Researchers have found high incidence of mental disorder in clients seen for physical illnesses in primary health care settings in the United States. Mental disorders are responsible for only 1 of all deaths, but account for 47 of all disability in economically developed countries such as the United States and Canada and 28 of all disability worldwide. Depression is the leading cause of disability among people ages 15 years and older and produce the greatest decrement in health when compared with the chronic illnesses of angina, arthritis, asthma, and diabetes. Major studies Epidemiologic Catchment Area (ECA) study determined that mental disorders are experienced by many people at some point in their lives. Global Burden of Disease (WHO) demonstrated that 5 of the top 10 causes of disability worldwide were psychiatric disordersdepression (1), alcohol use (4), bipolar disorder (6), schizophrenia (9), and obsessivecompulsive disorders (10). U.S. Surgeon Generals report on mental health and mental illness underscored the importance of understanding that mental disorders are real illnesses. People should be educated to seek help and there is an obligation to provide safe and effective treatment. Healthy People 2010 (U.S. Department of Health and Human Services, 2002) identified major public health/mental health problems in the United States and determined specific mental health objectives to be achieved by the end of this decade. Suggestions for Classroom Activities Lead a discussion of the prevalence rates for various mental disorders, referring to Table 1-1 in the textbook. Have students define each of the 5 psychiatric disorders that are found in the top 10 causes of disability worldwide. Discuss possible reasons that psychiatric disorders contribute to high percentages of disability in economically developed countries such as the United States. Suggestions for Clinical Activities Assist students to develop a clinical tool to be used with all clients that would facilitate initial screening for the mental disorders that rank among the top 10 causes of disability. Role-play a brief interview with a client who is being seen for repeated multiple physical complaints that would screen for the five psychiatric disorders causing disability. Reference National Institute of Mental Health. Prevalence rates and demographics of mental illness. Retrieved from HYPERLINK http//www.nimh.nih.govhttp//www.nimh.nih.gov Learning Outcome 5 Describe how societal attitudes, philosophical viewpoints, and definitions of mental disorder have shifted throughout history. Concepts for Lecture Most terms that society uses to describe aberrant behavior have a convoluted history and have changed over timeberserk, crazy, nervous breakdown, insane, lunacy, melancholy. People who have been mentally ill have been with us throughout history. Dominant social attitudes and philosophic viewpoints have influenced the understanding and approach to madness throughout history. Ideas that may be considered contemporary at one time often have roots in earlier centuries. The modern medical concept of madness as an illness is open to the same scrutiny as interpretations of the past examples include witchcraft or mysticism. Historical approaches to the mentally ill include Era of MagicoReligious Explanations Attributing factors were superhuman forces, spirits, violation of taboos, neglect of ritual obligations, loss of the soul, and witchcraft. Treatment centered on dealing with spirits and the forces inflicting pain and suffering. Era of Organic Explanations Hippocrates (4th century bce) proposed imbalances in body humors. Treatment centered on use of words (talking, interpreting dreams) and purging, bloodletting, and ritual purification. Era of Alienation (400 ceapproximately 1600 ce) The insane were driven out and excluded from society. Theologic and magical explanations still prevailed. Treatment included ritualized social exclusion, imprisonment, and ships of fools to search for reason and spiritual reintegration. The exception was in the Arab world where the insane were believed to be divinely inspired and consequently treated kindly. The first asylum was built in Fez, Morocco early in the 8th century. During the Middle Ages (400 ce) to the Renaissance (13001600 ce), troubled minds were thought to be influenced by the moon (lunacy). Era of Confinement The insane were fed, but were morally constrained and physically confined and were frequently publicly beaten and tortured. Enormous asylums arose to confine the insane to maintain social order. These included Hpital Gnral in Paris and St. Mary of Bethlehem (Bedlam) in London. Era of Moral Treatment (18th and early 19th centuries) Treatment continued to be inhumane based on unsatisfactory explanations of mental illness, the belief that mental disorders were incurable, and the idea that mad persons were dangerous. However, there was an emergence of reform and humanitarianism across Western Europe and the United States, which resulted in more humane treatment. Reformers included William Cullen, Philippe Pinel, the Quakers under William Tuke, Benjamin Franklin, and Benjamin Rush (father of American psychiatry). Benjamin Rush explained mental illness as excitement of the brain and used somatic treatments such as bleeding, purging, and developed the tranquilizing chair to quiet the insane. Era of Psychoanalysis (late 19th and early 20th centuries) There was an increase in the number of mental hospitals. Insanity was linked to faulty life habits and treated with physical and somatic therapies. Sigmund Freud explained human behavior in psychological terms. Contemporary developments Increased emphasis on the social dimension, brain dysfunction, neurochemical etiologies, and drug therapy. Research into the 21st century will focus on the bases of mental disorders, psychotropic medications, and the roles of nutrients, biology, and genetics. Suggestions for Classroom Activities Have students choose one historical era and develop a poster presentation of the beliefs about mental disorder that were characteristic of that particular era. Assemble all posters and have students learn by attending the poster session. Develop a game in which students either individually or in small groups compete for small prizes by answering questions regarding how definitions, beliefs, and treatment have shifted throughout history. Suggestions for Clinical Activities Ask students to reflect on their own life experiences and share their observations on how beliefs and attitudes toward individuals with mental illness have shifted in recent history. Ask students to research films, books, articles, and the Internet to find examples of the beliefs and treatment of the mentally ill throughout history. Learning Outcome 6 Explore the meaning of stigma for clients, families, friends, communities, and mental health caregivers and agencies. Concepts for Lecture A diagnosis of mental illness not only means the client must work to regain his or her mental health, it also means the client must learn to cope with the stigma of mental illness. The pain of facing mental illness is compounded with the negative social perception that mentally ill people are a danger to society or lacking in intelligence, and the incoherence that sometime accompanies mental illness will cause some people to become afraid of them, ignore them, be rude to them, or treat them as children. Interactions of this type are painful and disrespectful. It interrupts getting help or utilizing help. The display of covert or overt negative behavior by the public must be addressed with education. In the professional settings, education and supervision are needed. Effort is being made to decrease the stigma attached to mental illness by public figures sharing with the public their diagnosis of mental illness. Many times, a person may not be fully aware of the negative message he or she is giving to the client. Stigma still hurts and impedes the recovery process. No one wants to see a friend or family member being treated poorly or given less-than-adequate care because of prejudice and discrimination. When care is negatively impacted, it is likely to increase the length of treatment. Stigma undermines the confidence that quality care will be provided and it also decreases the clients self-esteem. Suggestions for Classroom Activities Examine the prevalence and factors contributing to the stigma of having a mental disorder. Using concept mapping, construct a map of characteristics associated with the concepts of stigma. Describe an event that you have observed in the media or in public that have overtones of stigma. Suggestions for Clinical Activities Ask students to listen and observe for subtle or overt practice of stigma in the clinical setting. Ask a small group of students to develop a poster to teach others how stigma hurts the mentally ill. Ask a small group of students to develop a corrective plan for stigma and present it to their clinical group. Kneisl 3/e IRM Ch01 PAGE MERGEFORMAT 7 2013 by Education, Inc.Kneisl/Trigoboff, Instructors Resource Manual for Contemporary PsychiatricMental Health Nursing, 3rd Edition J s