FOUNDATIONS OF MENTAL HEALTH
AND PSYCHIATRIC NURSING
Lecture 1
BASIC CONCEPTS IN PSYCHIATRIC
NURSING
MENTAL HEALTH
Is a state of emotional, psychological, and social
wellness evidenced by satisfying personal
relationships, effective behavior and coping, a
positive self concept, and emotional stability.
COMPONENTS OF MENTAL HEALTH
(Johnson, 1997)
 Autonomy and Independence
 Maximizing One’s Potential
 Tolerating Life’s Uncertainties
 Self-esteem
 Mastering the Environment
 Reality Orientation
 Stress Management
AUTONOMY AND INDEPENDENCE
The individual can look within for guiding
values and rules to live by.
The opinions and wishes of others are
considered but do not dictate the person’s
decisions and behavior.
The person can work independently or
cooperatively with others without losing his or
her autonomy
MAXIMIZING ONE’S POTENTIAL
The person has an orientation toward growth and
self-actualization.
He or she is not content with the status quo and
continually and continually strives to grow as a
person.
TOLERATING LIFE’S UNCERTAINTIES
The person can face the challenges of life’s day-
to-day living with hope and a positive outlook,
despite not knowing what lies ahead.
SELF-ESTEEM
The person has realistic awareness of his or her
abilities and limitations.
MASTERING THE ENVIRONMENT
The person can deal with and influence the
environment in a capable, competent, and
creative manner.
REALITY ORIENTATION
The person can distinguish the real world from a
dream, fact from fantasy, and act accordingly.
STRESS MANAGEMENT
The person can tolerate life stresses, experience
feelings of anxiety or grief appropriately, and
experience failure without devastation.
He or she uses support from family and friends
to cope with crises, knowing that the stress will
not last forever.
MENTAL ILL HEALTH
A state of imbalance characterized by
disturbance in a person’s thoughts, feelings and
behavior.
MENTAL DISORDER (AMERICAN
PSYCHIATRIC ASSOCIATION, 1994)
Is a clinically significant behavioral or
psychological syndrome or pattern that occurs in
an individual and that is associated with present
distress (i.e., painful symptom) or disability (i.e.,
impairment in one or more important areas of
functioning) or with a significantly increased
risk of suffering death, pain, disability, or an
important loss of freedom.
PSYCHIATRIC NURSING
Interpersonal process whereby the professional
nurse practitioner through the therapeutic use of
self assists a family, group, or community to
promote mental health, to prevent mental illness
and suffering, to participate in the treatment and
rehabilitation of the mentally ill, and if
necessary to find meaning in these experiences.
It is both a science and an art.
THE SCIENCE
IN PSYCHIATRIC NURSING
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The use of different theories in the practice of C) Political turmoil
nursing serves as the science of Psychiatric
Nursing D) Genetics

THE ART ANSWER

IN PSYCHIATRIC NURSING Letter B
The therapeutic use of self is considered as the Rationale: Poverty and domestic abuses are
art of Psychiatric Nursing. some of the most common causes of mental
THE CORE illness at home
OF PSYCHIATRIC NURSING 3. The science which deals with the measures to
The interpersonal process, that is, the human-to- promote mental health and reduce incidence of
human relationship, is the core of Psychiatric mental illness is known as?
Nursing. A) Psychiatric Nursing
THE CLIENTS B) Psychology
IN PSYCHIATRIC NURSING
C) Psychiatry
The individual, the family, and the community,
both mentally healthy and mentally ill, are D) Mental Hygiene
considered as the clientele in Psychiatric
Nursing. ANSWER

MENTAL HYGIENE Letter D

It is the science that deals with measures to
promote mental health, prevent mental illness
and suffering and facilitate rehabilitation.
Rationale: Mental Hygiene is the science that
deals with measures to promote mental health.
Psychiatric Nursing is the interpersonal process
whereby the nurse assists the patient to attain a
state of mental health.

PRACTICE QUESTIONS: 4. Nursing as an interpersonal process is?

1. Which of the following is a generally A) The science of nursing

accepted component of mental health?
B) The art of nursing
A) Autonomy
C) The core of nursing
B) Absence of anxiety
D) The clientele of nursing
C) Ability to control others
ANSWER
D) Happiness
Letter C
ANSWER
Rationale: The core of Psychiatric Nursing is the
Letter A human-to-human relationship or the
interpersonal process.
Rationale: According to Johnson, 1997,
autonomy and independence is one of the 5. Mental illness is?
components of mental health.
A) Always hereditary in nature
2. A major predisposing factor of mental illness
in the home is? B) Is manageable but is never treatable

A) Urbanization C) A behavioral pattern associated with

a significantly increased risk of suffering death,
B) Poverty pain, disability, or an important loss of freedom.

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 D) A state of emotional balance
ANSWER
Letter C
Rationale: Mental Illness is a clinically
significant behavioral or psychological
syndrome or pattern that occurs in an individual
and that is associated with present distress (i.e.,
painful symptom) or disability (i.e., impairment
in one or more important areas of functioning)
or with a significantly increased risk of suffering
death, pain, disability, or an important loss of
freedom.
THERAPEUTIC USE OF SELF
During therapeutic communication, nurses use
themselves as a therapeutic tool to establish a
therapeutic relationship with the client, to help
the client grow, change, and heal.
It is the main tool used by the nurse in the
practice of Psychiatric Nursing.
THERAPEUTIC USE OF SELF
*Using one’s humanity – personality,
experiences, values, feelings, intelligence, needs,
coping skills, and perceptions – to help the client
grow and change is called THERAPEUTIC USE
OF ONE’S SELF (Northouse & Northouse,
1998).
It is the main tool used by the nurse in the
practice of Psychiatric Nursing.
It is the positive use of one’s self in the process
of therapy
*Hildegaard Peplau (1952), who described this
therapeutic use of self in the nurse-client
relationship, believed that nurses must have a
clear understanding of themselves to promote
their clients’ growth and to avoid limiting
clients’ choices to those valued by the nurse.
Therapeutic use of self requires SELF-
AWARENESS!!!
SELF-AWARENESS
Self-awareness means an understanding of one’s
personality, emotions, sensitivity, motivation,
ethics, philosophy of life, physical and social
image, and capacities (Campbell, 1980).
It is the process by which the nurse gains
recognition of his or her own feelings, beliefs,
and attitudes.
The nurse needs to discover himself and what he
believes before trying to help others with
different views.
Most of the time, the nurse’s values and beliefs
will conflict with those of the client, the nurse
must learn to accept these differences among
people and view each client as a worthwhile
person regardless of the client’s opinions and
lifestyle.
Therefore, understand YOURSELF before
understanding OTHERS!
The greater the nurse’s understanding of his or
her own feelings and responses, the better he or
she can communicate with and understand
others.
One tool that is useful in learning more about
oneself is the JOHARI WINDOW (Luft, 1970),
which creates a “word portrait” of a person in
four areas and indicates how well a person
knows himself or herself and communicates
with others.
FOUR QUADRANTS OF THE
JOHARI WINDOW
QUADRANT I
Open Public Self
Qualities one knows about oneself and others
also know
QUADRANT II
Blind / Unaware Self
Qualities known only to others
QUADRANT III
Hidden / Private Self
Qualities known only to oneself
QUADRANT IV
Unknown
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An empty quadrant to symbolize qualities as yet
undiscovered by oneself or others
CREATING A JOHARI WINDOW
The goal is to work toward moving qualities
from Quadrants II, III and IV into Quadrant I
(qualities known to oneself and others), which
indicates the person is gaining self-knowledge
and self-awareness.

First Step
METHODS USED TO INCREASE
Appraise one’s own qualities by creating a list of
SELF-AWARENESS
those qualities:
ROLE PLAY
One’s values
Putting yourself in the client’s situation allows
Attitudes
you to think about his or her thoughts, feelings
Feelings and actions.

Strengths INTROSPECTION

Behaviors Self-awareness can be accomplished through

reflection, spending time consciously focusing
Accomplishments on how one feels and what one values or
believes.
Needs
Keep a diary that focuses on experiences and
Desires
related feelings.
Sad thoughts
DISCUSSION
Second Step
Talk with others about your own experiences
Find out how others perceive you by and feelings and how they feel about similar
interviewing others and asking them to identify experiences.
qualities they see in you, both positive and
Try to seek alternative points of view.
negative.
ENLARGING ONE’S EXPERIENCE
Third Step
Being involved in new situations and
Compare lists and assign qualities to the
experiences will uncover qualities in yourself
appropriate quadrants.
you might have not seen before.
FOUR QUADRANTS OF THE
JOHARI WINDOW
CORE CONCEPTS ON THE CARE OF
If Quadrant I is the longest list, this indicates the
THE PSYCHOTIC PATIENT
person is open to others; a small Quadrant I
means the person shares little about himself or COMMON BEHAVIORAL SIGNS AND
herself with others SYMPTOMS
FOUR QUADRANTS OF THE  Disturbances in Perception
JOHARI WINDOW  Disturbances in Thinking
If Quadrants I and III are both small, the person  Disturbances in Affect
demonstrates little insight.  Disturbances in Motor Activity
 Disturbances in Memory

FOUR QUADRANTS OF THE DISTURBANCES IN PERCEPTION

JOHARI WINDOW
ILLUSION

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Misperception of an actual external stimuli Example:

Example “Corn, potatoes, jump up, play games, grass,

cupboard.”
An electrical cord on the floor may appear to be
a snake! VERBIGERATION

HALLUCINATION Meaningless repetition of words and phrases.

False sensory perception in the absence of an Example:

external stimuli
“I want to go home, go home, go home, go
Perceptual experiences that do not exist in home.”
reality

Example PERSEVERATION

A person may see “angels” hovering above
when nothing is there
A person may hear voices in a room wherein he
is alone
Persistence of a response to a previous question.
Example:
Nurse: “How have you been sleeping lately?”

Client: “I think people have been following me.”

DISTURBANCES IN THINKING Nurse: “Where do you live?”

NEOLOGISM Client: “At my place people have been following

me.”
Pathological coining of new word
Nurse: “What do you like to do in your free
These are words invented by the client time?”

Example: Client: “Nothing because people are following

me.”
“I am afraid of grittiz. If there are any grittiz
here, I will have to leave. Are you a grittiz?”
ECHOLALIA
CIRCUMSTANTIALITY
Pathological repetition of words of others.
Over inclusion of details.
Example:
Example:
Nurse: “Can you tell me how you are feeling?”
Nurse: “How have you been sleeping lately?”
Client: “Can you tell me how you are feeling?
Client: “Oh, I go to bed early, so I can get plenty how you are feeling?”
of rest. I like to listen to music or read before
bed. Right now I am reading a good mystery.
Maybe I will write a mystery someday. But is it FLIGHT OF IDEAS
isn’t helping, reading I mean. I have been
getting only 2 or 3 hours of sleep at night.” Shifting of one topic from one subject to another
in a somewhat related way.

WORD SALAD Excessive amount and rate of speech composed

of fragmented or unrelated ideas.
Incoherent mixture of words and phrases.

This is a combination of jumbled words and

phrases that are disconnected or incoherent and LOOSENESS OF ASSOCIATION
make no sense to the listener.

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Shifting of a topic from one subject to another in
a completely unrelated way.
Example:
Nurse: ”Do you have enough money to buy that
candy bar?”
Patient: “I have a real yen for chocolate. The
Japanese have all the yen and have taken all of
our money and marked it. You know, you have
to be careful of the Marxists because they are
friends with the Swiss and they have all the
cheese and all the watches and that means they
have taken all the time. The worst thing about
Swiss cheese is all the holes. People have to be
careful about falling into holes.”
Delusion of inflated worth, power, knowledge,
identity, or special relationship to a famous
person.
Jealous Type
Delusion that the individual's sexual partner is
unfaithful
Persecutory Type
Delusion that the person (or someone to whom
the person is close) is being malevolently
treated in some way.
Somatic Type
Delusions that the person has some physical
defect or general medical condition.

CLANG ASSOCIATION Mixed Type

The sound of the word gives direction to the Delusions with characteristics of more than one
flow of thought. of the above types but with no one theme
predominating.
Examples:

“I will take a pill if I go up to the hill but not if

my name is Jill, I don’t want to kill.” DISTURBANCES IN AFFECT

“I want to sing ping pong that song wong kong

long today, hey way.” INAPPROPRIATE AFFECT

Disharmony between the stimulus and the

DELUSION emotional reaction.

False belief which is inconsistent with one’s

knowledge and culture BLUNTED AFFECT

Examples: Severe reduction in emotional reaction.

The client may claim to be engaged to a famous Restricted range of emotional feeling, tone, or
movie star or related to some public figure such mood
as claiming to be the daughter of the President
of the Philippines FLAT AFFECT

May claim he or she has found a cure for cancer Absence or near absence of emotional reaction

Absence of any facial expression that would

indicate emotions or mood
The Diagnostic and Statistical Manual of
Mental Disorders (DSM) enumerates six types
of DELUSION: APATHY

Erotomanic Type (erotomania) Dulled emotional tone

Delusion that another person is in love with Feelings of indifference toward people,
the individual. activities, and events

Grandiose Type AMBIVALENCE

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Presence of two opposing feelings.
Holding seemingly contradictory beliefs of
feelings about the same person, event or
situation
DEPERSONALIZATION
Feeling of strangeness towards oneself
Clients feel detached from their behavior
Although client can state his name correctly, he
feels as if his body belongs to someone else, or
that his spirit is detached from his body.
He may feel that his limbs are detached or that
the size of his body parts is changed, or he is
unable to tell where his body leaves off and the
rest of the world begins
Patient describes the feeling of having stepped
outside their bodies and are observing
themselves as detached and foreign objects.
DEREALIZATION
Feeling of strangeness towards the environment
Environmental objects become smaller or larger,
or seem unfamiliar.
Individual feels that the outside world has
changed:
Buildings may appear to be leaning
Everything may seem gray and dull
DISTURBANCES IN MOTOR ACTIVITY
ECHOPRAXIA
The pathological imitation of posture or action
of others.
Imitation of the movements and gestures of
another person whom the client is observing.
WAXY FLEXIBILITY
Maintaining the desired position for long periods
of time without discomfort even when it is
awkward or uncomfortable.
DISTURBANCES IN MEMORY
CONFABULATION
Filling in of memory gaps to save face in an
embarrassing situation.
It is a confused person’s tendency to make up a
response to a question when he cannot
remember the answer
Example:
Nurse: “Do you know Gemma? (referring to one
of the residents at the patient’s home)
Patient: “Yes, I know her. I used to play cards
with her husband.”
Actually, Gemma’s husband had been dead for
many years and the patient had never met him
AMNESIA
Inability to recall past events.
ANTEROGRADE AMNESIA
Loss of memory of the immediate past.
RETROGRADE AMNESIA
Loss of memory of the distant past.
DEJA VU
Feeling of having been to a place which one has
not yet visited.
JAMAIS VU
Feeling of NOT having been to a place which
one HAS VISITED.
PRACTICE QUESTIONS:
1. A patient changes topics quickly while
relating his past psychiatric history. However,
the nurse is able to follow his thoughts. The
patient’s pattern of thinking is called?
A) Looseness of association
B) Flight of ideas
C) Clang association
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 D) Confabulation Letter A

ANSWER Rationale: The patient misperceived an actual

external stimulus.
Letter B
5. All of the following are disturbances in
Rationale: Flight of ideas is the shifting of a thinking, EXCEPT?
topic from one subject to another in a somewhat
related way. Looseness of association is the A) Looseness of association
shifting of a topic from one subject to another in
a completely unrelated way. B) Hallucination

2. A patient states, “The sun is shining. Where C) Delusion

is my sun? I love Lucy. Let us play ball.” The D) Clang association
patient is displaying?
ANSWER
A) Clang association
Letter B
B) Flight of ideas
Rationale: Hallucination is a disturbance in
C) Derealization perception.
D) Neologism

ANSWER

Letter B

Rationale: The patient is manifesting flight of

ideas

3. The main function confabulation serves in

patients with dementia, is to?

A) Lessen isolation

B) Protect their self-esteem

C) Control others

D) Enhance memory recall

ANSWER

Letter B

Rationale: Confabulation is the filling in of

memory gaps and it serves to protect the
patient’s self-esteem

4. A patient has mistakenly perceived a coiled

piece of wire as a snake. This is an example of?

A) Illusion

B) Hallucination

C) Delusion
JDC/2010
D) Confabulation

ANSWER