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Glossary of Ch. 6 & 8 - Mental Health (Models of Mental Health Nursing Practice)

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Created by daisy497

Theoretic Basis/Models of Mental Health Nursing:
- 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:
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:
1. NURSING
2. HEALTH
3. PERSON
4. ENVIRONMENT

** Metaparadigm: profession - worldview








Interpersonal Relationships:
- 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):
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
- 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:
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:
ICRA LINK:
http://www.icra-wholelife.org

(lots of videos related to recovery - good resource for presentations)


ACTIONS necessary:
- 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)



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