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NR 326 Week 1

NR 326 Week 1

Student Name

Chamberlain University

NR-326: Mental Health Nursing

Prof. Name:

Date

Unit 1 Mental Health Nursing

Mental Health and Mental Illness

The understanding of mental health and mental illness has evolved throughout history and is significantly shaped by cultural context. Mental health can be defined as the ability to manage stressors effectively, resulting in behaviors, thoughts, and emotions that are age-appropriate and consistent with societal and cultural expectations. Conversely, mental illness is characterized by maladaptive responses to these stressors, resulting in significant impairment in social, occupational, or physical functioning (Townsend & Morgan, 2018).

Maslow’s hierarchy of needs is a foundational theory in understanding human motivation. According to Maslow, individuals are motivated to fulfill basic needs before moving on to higher-level psychological needs and self-actualization. These needs are organized in the following order:

  1. Physiological needs
  2. Safety needs
  3. Love and belonging
  4. Esteem
  5. Self-actualization

Two primary psychological responses to stress are anxiety and grief. Anxiety is a vague, diffuse feeling of apprehension often linked to uncertainty or helplessness. When left unmanaged, anxiety can escalate and interfere with daily functioning. Grief, on the other hand, is a deeply personal and emotional response to loss and involves a range of emotional stages as proposed by Elisabeth Kübler-Ross.

Levels of Anxiety
LevelCharacteristicsSymptoms
Mild AnxietyNormal experience; often motivatingFidgeting, nail biting, slight discomfort
Moderate AnxietyPerceptual field begins to narrowHeadache, urinary urgency, insomnia, concentration difficulty
Severe AnxietyPerception is significantly reduced; learning is impairedConfusion, sense of doom, rapid speech, hyperventilation
Panic AnxietyComplete disruption of cognitive processing and connection with realityHallucinations, immobility or flight, incoherent speech, delusions
Stages of Grief (Kübler-Ross)
  1. Denial – Shock and disbelief
  2. Anger – Resentment towards unaffected individuals
  3. Bargaining – Attempt to postpone the loss through negotiation with a higher power
  4. Depression – Intense sadness and realization of the loss
  5. Acceptance – Peaceful acknowledgment of the loss

Ethical issues in mental health nursing are primarily centered on the concepts of right and wrong, which are often influenced by personal, cultural, and societal values. The American Nurses Association (ANA) Code of Ethics serves as a guideline for professional conduct. Bioethics, specifically in healthcare, addresses ethical questions in medical practice.

Ethical Frameworks
PerspectiveDescription
UtilitarianismPrioritizes outcomes that yield the greatest benefit for the majority
KantianismFocuses on duties and moral rules rather than consequences
Christian EthicsGuided by the Golden Rule: treat others as you would like to be treated
Natural LawSuggests that humans inherently know right from wrong
Ethical EgoismDecisions are based on self-interest

An ethical dilemma arises when a decision involves two or more unfavorable outcomes. These require collaborative decision-making, often involving the care team, patient, and family.

TermDefinition
BeneficenceDoing good and promoting well-being
NonmaleficenceAvoiding harm to the patient
JusticeEnsuring fairness and equitable care
VeracityTruthfulness in communication
AutonomyRespecting the patient’s right to make their own decisions
ConfidentialityProtecting patient information (e.g., HIPAA regulations)
ConsentVoluntary agreement after being fully informed

Restraints should be used only when necessary for safety and must follow legal guidelines. A physician must evaluate the patient face-to-face within an hour of applying restraints. Orders are time-limited: 4 hours for adults, 2 hours for children over 8, and 1 hour for children under 8. Legal liabilities can be avoided through effective communication (e.g., SBAR, AIDET), proper documentation, adherence to care standards, and staying within the scope of practice.

Relationship Development

The therapeutic relationship between a nurse and a client is central to psychiatric care. It is built on mutual trust, respect, and a shared goal of healing. The relationship progresses through distinct phases:

  1. Pre-interaction Phase: The nurse prepares by gathering information and self-reflecting on biases.
  2. Orientation Phase: Initial meeting; rapport is established and goals are set collaboratively.
  3. Working Phase: Focused on therapeutic interventions, trust-building, and active problem-solving.
  4. Termination Phase: The relationship concludes, often as the patient transitions to another level of care.

Key psychological phenomena include:

  • Transference: The patient projects feelings from past relationships onto the nurse.
  • Countertransference: The nurse develops personal emotional responses to the patient.

Therapeutic Communication

Therapeutic communication involves deliberate techniques to foster healing and emotional growth. It focuses solely on the client’s well-being, distinguishing it from social or personal conversations.

Therapeutic Techniques
TechniqueDefinitionExample
SilenceAllows clients time to collect thoughtsNurse remains quietly present
AcceptingShows openness and respect“Yes, I understand what you said.”
Offering selfEnhances the client’s sense of worth“I’ll stay with you for a while.”
Broad openingsEncourages client to take initiative“What would you like to discuss today?”
Making observationsDescribes client behavior“You appear anxious today.”
RestatingClarifies the client’s message“You’re struggling to focus, is that correct?”
ReflectingRedirects the question back to the client“What do you think is the best course of action?”
FocusingKeeps conversation on a significant topic“Let’s go back to your earlier comment about feeling down.”
ExploringDelves deeper into specific areas“Tell me more about what happened.”
Presenting realityClarifies misconceptions“I do not hear the voices you mention.”
Voicing doubtExpresses skepticism when delusions are present“That seems unlikely based on what I know.”
Nontherapeutic Techniques
TechniqueDefinitionExample
ReassuranceMinimizes client’s feelings“Don’t worry, everything will be fine.”
Approving/DisapprovingJudging client’s behavior“That wasn’t a good choice.”
Agreeing/DisagreeingImposes the nurse’s viewpoint“You should tell your wife.”
Giving adviceReduces client autonomy“You need to stop doing that.”
ProbingPushes the client into discomfort“Why won’t you talk about your past?”
DefendingProtects authority figures rather than focusing on client’s experience“Your doctor knows best.”
Requesting explanationDemands justification“Why did you do that?”

References

Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F.A. Davis.

American Nurses Association (ANA). (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/coe-view-only

NR 326 Week 1

Joint Commission. (2022). Comprehensive accreditation manual for hospitals: The official handbook.

Kübler-Ross, E. (1969). On death and dying. Macmillan.

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