Ch. 6 & 8 - Mental Health (Models of Mental Health Nursing Practice)
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- Theoretic Basis/Models of Mental Health Nursing:
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- means of thinking about people and the world
- no one theory adequately accounts for human behaviour/psychiatric disorders
- all theories cannot be used for everyone; components of different theories can be used (need individualized care)
- Psychiatry dominator: BIOMEDICAL model (focused on SYMPTOMS and symptom MANAGEMENT - ex. DSM-IV)
- mental health professionals rely on theoretical models for understanding/treating mental health issues/psychiatric alterations
- many identified in Chapter 8 (psychiatric care) - Major Theories:
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1. JEAN WATSON: CARING (sensitivity to self & others)
2. BETTY NEWMAN: SYSTEMS MODEL
3. DOROTHEA OREM: SELF-CARE/SELF-CARE DEFICIT (patients with mental illnesses can have self-care deficits)
4. CALLISTRA ROY: ADAPTATION (4 Adaptive Modes) - 4 concepts that comprise any nursing theory:
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1. NURSING
2. HEALTH
3. PERSON
4. ENVIRONMENT
** Metaparadigm: profession - worldview
- Interpersonal Relationships:
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- HILDEGARD PEPLAU (Sullivan): introduced NURSE-PATIENT RELATIONSHIP (need to build trust and have self-awareness
- emphasized the importance of ENVIRONMENT (external)
- EMPATHETIC LINKAGE: ability to feel experiences of another -
Clinical Example:
The nurse recognizes that a patient experiences increased anxiety whenever he is beginning a relationship with a women. The patient complains about not knowing what to say or do when he is alone with her (lack of interpersonal skills) -
1. EMPATHETIC
2. CARING
3. Developing THERAPEUTIC RELATIONSHIP
4. ROLE PLAY certain scenarios for meeting someone for the 1st time -
TIDAL MODEL
(PERSON-CENTERED approach & RECOVERY focus) -
- developed by BARKER in 1990's
- RECOVERY focus
- HOLISTIC approach: lived experience of the person (everything that interacts with the person)
- Model focus on SYSTEMIC/SOLUTION oriented approaches
- EMPHASIS on CARE CONTINUUM (3 discrete forms of care):
1. CRITICAL STATE (suicidal with a plan - needs to be death with right away)
2. TRANSITIONAL STATE (work, social)
3. DEVELOPMENTAL LEVEL (which stage? ex. Piaget; Erikson's)
Solution:
- emphasize person's resources (empowers them)
- personhood (WORLD, SELF & OTHERS)
- World (focus person's need to understand)
- Self (Security - plan)
- Others: support/services
*Identify that nurses need to get close - understand the patient's experience -
PSYCHOANALYTIC
(SIGMUND FREUD) -
- psychological disturbances are the result of early trauma/incidents
- CONSTRUCTS: id, ego, superego
- goal to learn UNCONSCIOUS thoughts
- DEFENSE MECHANISMS (ex. DENIAL): things become REPRESSED as life goes on; REGRESSION is going back to stages earlier in life
- PSYCHOSEXUAL STAGES OF DEVELOPMENT (Oral, Anal, etc.): if you get fixated at one of these stages, you can develop mental issues
- CAUSE of mental health issues is PSYCHOANALYTICAL -
COGNITIVE THEORY
(AARON BECK) -
- Aaron Beck developed COGNITIVE BEHAVIOURAL THERAPY
- TENETS (belief): NEGATIVE/SELF-CRITICAL thinking causes DEPRESSION
- THERAPEUTIC model: identify NEGATIVE thoughts/REPLACE them - BIOLOGICAL THEORIES (many):
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Tenets (Beliefs): psychiatric disorders/illness are the result of PHYSICAL (brain) ALTERATIONS
- recent disorders in genetics: EARLY STAGES
- NATURE/NURTURE
- these theories have been challenged
- MODEL: NEUROCHEMICAL IMBALANCES (Treatment: TALK therapy/MEDICATION) - BEHAVIOURAL THEORY
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- Ways: People ACT/LEARN thought CONDITIONING
- PAVLOV: EARLY stimulus response theories
- WATSON: BEHAVIOURISM in the US
- SKINNER: very influential BEHAVIOURISTS
- Behavioural MODIFICATION (giving a TOKEN or REWARD to MODIFY behaviour) - STRESS MODELS:
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1. SELYE'S (STRESS-ADAPATION model) - physiologic responses to stress
2. GENERAL ADAPTATION SYNDROME
- these theories provide a FRAMEWORK for nurses to assess effects of stress on patients/coping processes
- medical ILLNESSES can develop from STRESS; HORMONE levels are also impacted
- people with mental ILLNESSES usually DO NOT RESPOND to stress EFFECTIVELY - have POOR COPING SKILLS -
RECOVERY MODEL
(SUPPLEMENTS the TIDAL MODEL) -
- focus in psychiatry: pathology
- RECOVERY MODEL: "PERSON-CENTERED" - how does one learn to live with mental illness (should focus on RECOVERY rather than PATHOLOGY)
- CORE ELEMENTS:
1. HOPE
2. SECURITY
3. SELF
- there is ALWAYS hope for people
- Kirby (2006) - Out of the Shadows At Last stated: "recovery must be at the CENTRE of mental health reform" p.5
- Self is impacted by illness
- What is needed to RECOVER SELF? It is more than medication and pathology, it is a combination of everything
- a person with a mental illness needs a more POSITIVE sense of self
- people DO NOT recover in ISOLATION (need SOCIAL SUPPORT) - INTERNATIONAL CENTRE FOR RECOVERY ACTION:
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ICRA LINK:
http://www.icra-wholelife.org
(lots of videos related to recovery - good resource for presentations) - ACTIONS necessary:
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- provide EDUCATION & INSPIRATION of HOPE (patient and family)
- view the LIFE EXPERIENCE as an ASSET (understanding their life experiences & how their experiences can help them improve their CURRENT situation)
- develop ALTERNATIVES to hospitalization
- promote CHOICE & CONTROL (just because someone is INVOLUNTARY doesn't mean they can't make a DECISION)
- establish SELF-HELP & CONSUMER (run services)