Psychiatric Mental

Health Nursing
Related Learning
Experience
FELIPE NAVAL ESCANO,R.N.,M.D.
Application of the Basic Concepts of
Psychiatric Mental Health Nursing

“It takes so much more skill to

understand the human mind and
emotions than it does to give a
shot.”
 FUNDERBURK, 2001
Student Issues and Concerns
 Frequently Asked Questions by Student Nurses
 PMHN may occur in many different settings each provides a unique
experience.
 Will the client know that I am a student nurse?
 How do I introduce myself?
 What I do wear?
 What if I say the wrong thing?
 Will I be left alone with client?
 What if the client becomes violent?
 Student Nurses Comments Responses

 Avoid making assumptions about any client’s medical or psychiatric history.

 Don’t hesitate to approach your clinical instructor or a staff member with questions about your assigned client’s needs
or plan of care.

 Feel free to discuss with your instructor any feelings that you have about your clinical rotation or your assigned client.

 Take time to adjust to a slower pace.

 Don’t become frustrated with client who refuses to speak to you.

 Be patient with a client who requires repeated prompting to complete a task.

 Recognize that listening, observing, and self awareness are important tools that you possess when providing care.
 CAVITE CENTER FOR MENTAL HEALTH

Community Mental Health

 Services provided in the community may include

 emergency psychiatric care and crisis intervention,

 partial hospitalization and day treatment programs,

 aftercare and rehabilitation

 consultation and support

CAVITE CENTER FOR MENTAL HEALTH

 the primary goal of community mental health is to deliver comprehensive care by a

professional multidisciplinary team using innovative treatment approaches.

1. Involvement and concern with the total community population

2. Emphasis on primary prevention
3. Orientation toward social treatment goals
4. Comprehensive continuity of care
5. Belief that community mental health should involve total citizen participation in need
determination, policy establishment, service delivery, and evaluation programs
OCULAR SURVEY OF THE HOSPITAL
SELF AWARENESS

 Self Awareness refers to the ability to

recognize the nature of one’s own attitude,
emotions and behavior. It can be an
effective tool when interacting with clients
who are exhibiting anxiety and other
psychiatric disorders.
SELF AWARENESS ACTIVITY

1. Describe at least two personality traits in yourself that could affect

your ability to interact with clients in the clinical setting.
2. Articulate how self awareness can be an effective tool in the
clinical setting
3. Determine whether your personal issues and concerns about your
psychiatric nursing clinical experience have been resolved.
APPLICATION OF SELF AWARENESS IN
CLINICAL SETTING

 The Myers-Brigss Type Indicator to identify your personality traits or distinguishing

characterisitics of your personality the test identifies whether you are extrovert or introvert

 Accdg to the test individuals referred to as sensors, thinkers, judgemental.

 Selfawareness exercise gives you the opportunity to stuimulate your introspection or self
reflection prior to clinical experience in the psychiatric setting.

 The examples also should help you to understand attitudes and behaviors displayed by clients.

 After you resolve basic issues and concerns about this clinical experience, self confidence in
your ability to interact with clients in a variety of settings will grow.
CAVITE CENTER FOR MENTAL
HEALTH
MINDFULNESS
DURING THE
PANDEMIC:
A MENTAL HEALTH
GUIDE
12-11-2020
FELIPE NAVAL ESCANO,RN,M.D.
objectives
To educate ourselves to find
happiness
To find inner peace…
To learn how we treat
ourselves well and others…..
 To learn how to focus of the
here and now…
Mental wellness to illness spectrum
 mind·ful·ness
 /ˈmīn(d)f(ə)lnəs/
 noun
 1.the quality or state of being conscious or
aware of something.

 2.a mental state achieved by focusing one's

awareness on the present moment, while
calmly acknowledging and accepting one's
feelings, thoughts, and bodily sensations, used
as a therapeutic technique.

 Definitions from Oxford Languages

Everyday mindfulness
Mindfulness is the basic
human ability to be fully
present, aware of where
we are and what we’re
doing, and not overly
reactive or overwhelmed
by what’s going on
around us.
 The Types of Mindfulness Practice
 While mindfulness is innate, it can
be cultivated through proven techniques.
Here are some examples:
1. Seated, walking, standing,
and moving meditation (it’s also
possible lying down but often leads to
sleep);
2. Short pauses we insert into everyday life;
3. Merging meditation practice with other
activities, such as yoga or sports.
Mindfulness integration in daily life
The Benefits of Mindfulness Practice:
 When we’re mindful
 we reduce stress
 enhance performance
 gain insight
 awareness through observing our own mind
 and increase our attention to others’ well-being.
 Mindfulness meditation gives us a time in our lives when we can
suspend judgment
 unleash our natural curiosity about the workings of the mind
 approaching our experience with warmth and kindness—to
ourselves and others.




Everyday
So much more with meditation
mindfulness
It is an approach in everyday life to be enjoyable and less stressful
 It is a choice that we can make in any moment that we can better understand
how we feel in the moment and what we are experiencing around us.
 It is being aware of the present instead of playing the past and worrying the
future.
 It is being aware with kindness, engage in everyday life, choosing to be nice to
yourself and others.
 Open awareness to all moments, whether pleasant, neutral or unpleasant.
Bringing that awareness to some curiosity and kindness instead of judgement
and criticism
 Not meditating but just paying attention on purpose with little friendliness this
can help you with stress, anxiety and sadness.
 It helps you focus on what is happening right now, because worrying about the
future and past all the time is exhausting…
 Practicing paying attention in a kind way to little things can help the mind to
developed more care across in our lives.
5 minutes breathing exercise
 Doing What Matters in Times of
Stress:

 ACTINGON YOUR VALUES,

ENGAGING,HANDLING THOUGHTS,
AND GROUNDING.
 CARING FOR
YOURSELF,
 CARING FOR
OTHERS.
“ITS OK NOT TO
BE OK”
EMOTIONAL


 Thoughts on giving up
 That it is all too hard
 Blame others (Denial)
 Make harsh judgment
 Perceived yourself as weak
 Here are some tips to handle the difficult thoughts.
 1. LEARN ON HOW TO FOCUS ON values
 2. LEARN ON HOW TO BE aware and engage.
 3. LEARN ON HOW TO manage difficult thoughts.
 4. IDENTIFY YOUR OWN ground.
 END PRODUCT: WE ARE MINDful of what WE are doing

 “MINDFULLNESS IS A
WAY OF LIVING”
  FOCUS ON YOUR VALUES

 WHAT ARE VALUES?

Values are your

deepest desire for
the sort of person you
want to be.
simple Engaging exercise
 The Awareness of
Drinking a cup of
coffee

 Handling Difficult Thoughts
 First,
NOTICE how you are feeling and what
you are thinking.
 Then, SLOW DOWN and CONNECT with your
body. Slowly breathe out.
 Slowly stretch.
 Slowly push your feet into the floor.
 Now Now REFOCUS on the world around you.
 Pay attention with curiosity to what you can …

 SEE… HEAR…TASTE…SMELL…TOUCH…
 
 Grounding Exercise
 The first step in grounding is to REFOCUS on
the world around you.
 Notice where you are.
 What are five things you can see?
 What are three or four things you can hear?
 Breathe the air.
 What can you smell?
 Touch your knees,
 or the surface beneath you,
 or any object you can reach.
 Notice what it feels like under your fingers.


 The purpose of the grounding

exercises is to help you ”engage” in life.
For example, to help you give your full
attention to family and friends.

 It is also to help you move towards

your values; to help you behave more
like the kind of person you want to be.
 When we engage in life, pay attention to
others, focus on what we’re doing and live
by our values, we manage stress much
better.
 It is like building your muscles to run
faster or to lift heavier loads. With
practice, your muscles get bigger!
 Engaging, focusing and grounding.

 Like any new skill,
 it requires practice.
And the more we
exercise…
…the better we GET!
 You could do some shorter
practices that last for one or two
minutes.
and some longer practices that
last for five to ten minutes.
 Then SLOW down.
Slowly breathe out.
Slowly stretch.
Slowly push your feet into the
floor.
 MIND your MIND

Maria Victoria V. Briguela, MD

THANK YOU
FOR SHARING
YOUR SLIDES….
 THE END
THANK YOU FOR YOUR KIND
ATTENTION

HAVE A STRESS FREE LIVING!

BE KIND TO YOUR MIND….

FELIPE NAVAL ESCANO, RN, M.D.

CCMH MEDICAL OFFICER 111
Clinical context of Mental Health and Mental
Illness Concept in the Setting.

Factors influencing MH

a. Inherited characteristics
b. Nurturing during childhood
c. Life circumstances
Characteristic of MH

 Abraham Maslow (1970) identified a hierarchy of needs to describe an individual’s

motivation to experience self actualization, or mental health. According to Maslow,
mentally healthy individual who achieve self actualization are able to:

 Have positive self concepts and relate well to people and their environment.

 Form close relationships with others.

Characters of Mental Health

 Be optimistic and appreciate and enjoy life.

 Be independent or autonomous in thought and action, relying on personal standards of

behavior and values.

 Be creative, using a variety of approaches as they perform tasks or solve problems.

 Self-actualized individuals display behavior that is consistent as they appreciate and respect
the rights of others.

 They also display a willingness to listen and learn from others, and show reverence for the
uniqueness of and difference in others.

 Insert figure of Maslow’s hierarchy of needs.

Factors affecting MH maintenance

1. Interpersonal communication

2. Use of ego defense
mechanism
3. Significant others or support
people
Factors affecting MH maintenance

1. Interpersonal Communication- Powell 1969, discusses 5 levels of communication that

affect and individual’s personal growth and maturity during interpersonal encounters:
 Level 5 cliché’ conversation, indicating superficial conversation in which no
emotions are shared. No sharing of onself occurs during this interaction.
Statements such as “how are you doing? “And talk to you later” are superficial. No
personal growth can occur at this level.
Factors affecting MH maintenance

 Level 4 reporting of facts , reveals very little about onself and minimal or no
interaction is expected from others, no personal interaction occurs at this level
 Level 3 revelation of ideas and judgements: such communication occurs under
strict censorship by the speaker, who is watching the listeners response for an
indication of acceptance or approval. If the speaker is unable to read the reactions
of the listener, the speaker may revert to safer topics rather than face disapproval
or rejection
Factors affecting MH maintenance

 Level 2: spontaneous here and now emotions: revealing one’s feelings or emotion
takes courage because one faces the possibility of rejection by the listener. Powell
1969, states that if one reveals the contents of the mind and heart, one may fear
that such emotional honesty will not be tolerated by another. As a result, the
speaker may resort to dishonesty and superficial conversation.
 Level 1: open, honest communication: when this type of communication occurs,
two people share emotions. Open communication may not occur until people
relate to each other over a period of time, getting to know and trust each other.
Factors affecting MH maintenance

 2. Use of Ego Defense Mechanisms- Freud, 1946 also referred to us as a defense

mechanisms, are considered unconscious, protective barriers used to manage instinct
and affect in stressful situations. They may be used to resolve a mental conflict, to reduce
anxiety or fear, to protect oneself esteem, or to protect one’s sense of security.
Depending upon their use, they can be therapeutic or pathologic, because all defense
mechanisms include a distortion of reality, some degree of self deception, and what
appears to be irrational behavior. DM in action by 10 years of age.
Factors affecting MH maintenance

a. Significant Others and Support People- people may also reach out to individuals or groups for support
during periods of increased stress and anxiety that may occur during the labor and delivery process as well
as during the postpartum recovery period.
 Harry Stack Sullivan, states that people mistakenly believe that they can solve their own problems and
maintain control of their lives without assistance from anyone or anything (Sullivan, 1953). Sullivan
believed that those who attempt to solve problems by themselves may become consumed by their
problems and suffer some types of mental disorder or mental illness. MH, in part, is a determined by
relationships between those who either love or refuse to love one another.
 Support people or significant people can be anyone with whom the person feels comfortable, trusts, and
respects.
 A support person can act as a sounding board, simply listening while one vents various feelings or
emotions, or he or she may interact as the need arises.
Personal strategies for MH maintenance

 Cellphones, e-mail, fax machines, you tube, FB, and the

use of computer games have increased personal stress
because people feel like they are working 24/7
 Such technology even impacts vacations because
individuals take their portable offices with them.
Personal strategies for MH maintenance

 Personal strategies for Reducing stress and Enhancing well being

1. Aerobic exercise
2. Aromatherapy
3. Martial arts
4. Massage
5. Meditation
6. Progressive relaxation techniques
7. Self- hypnosis
8. Walking
9. Yoga
CHARACTERISITICS OF MH and MI
Accepts self and others
Can return to normal functioning if
temporarily disturbed
Is able to form a close and lasting
relationship
Uses sound judgement to make decisions
Is able to cope with or tolerate stress
Accepts responsibility for actions
Is optimistic
Recognizes limitations (abilities and
deficiencies)
Is able to solve problems
Can function effectively and
independently
Is able to distinguish imagined
circumstances from reality
Is able to develop potential and talents to
fullest extent
Can delay gratification
Mental health reflects a person’s
approach to life by communicating
emotions, giving and receiving, working
alone as well as with others, accepting
authority, displaying a sense of humor,
and coping successfully with emotional
conflict.
Feels inadequate
Has a poor self-concept
Exhibits maladaptive behavior
Displays poor judgement
Is unable to cope
Is irresponsible or unable to accept
responsibility for actions
Is pessimistic
Does not recognize limitations (abilities
and deficiencies)
Avoids problems rather than coping with
them or attempting to solve them
Exhibits dependency needs because of
feelings of inadequacy
Is unable to perceive reality
Does not recognize potential and talents
because of poor self concept
Desires or demands immediate
gratification
Mental illness reflects a perosn’s inability
to cope with stress, resulting in disruption,
disorganization, inappropriate reactions,
unacceptable behavior, and the inability
to respond according to the persons
expectations and the demands of
society.
 HUMANISTIC MODEL (MASLOW)

 In the humanistic model, understanding human behavior requires familiarity with a hierarchy that has six levels of need.
• Level 1: physiologic survival (food, oxygen, and rest)
• Level 2: safety, security and self preservation)
• Level 3: love and belonging (developing fulfilling relationships)
• Level 4: esteem and recognition (feeling like a worthwhile), contributing member of society, appreciating one’s own uniqueness)
• Level 5: self-actualization (self-fulfilment)
• Level 6: truth, harmony, beauty, and spiritually

 Nursing draws from the humanistic model by striving to meet patient’s lower-level needs before higher-level ones. By performing
a needs assessment, the nurse determines appropriate intervention strategies to help patients meet their needs.
 COMMUNICATING WITH PATIENTS

 Effective communication is key to psychiatric nursing

 Communication involves both sending and receiving messages, it

can be verbal or non verbal
 Usually, people send verbal and nonverbal messages
simultaneously
 Verbal communication
 Influences

 Patient’s and nurse’s past experience, background, and feelings

 Native languages

 Culture or nationality

 Sexual orientation or gender

 Age and developmental considerations

 Influences
Roles and responsibilities

Social background or status

Space and territoriality

Physical, mental, and emotional state

Values
Obstacles

 Requires nurse self-awareness and knowledge of and

sensitivity to patient’s experiences, beliefs and
background
 Can be especially challenging
 May be useful to use interpreter or communication aids
 Nonverbal communications- Also known as
body language
 Types
 Eye contact
 Facial expression
 Posture
 Gait
 Gestures
 Touch
Nonverbal

Physical appearance or attributes

Dress or grooming
Affect
Silence
 Types of communication barriers

Language difficulties or differences

Impaired hearing

Inappropriate responses

Thought disorders
Types of communication barriers

 Paranoid thinking

 Hallucinations

 Delusions

 Delirium

 Dementia
LEGAL AND ETHICAL ISSUES

 Legal and ethical issues help shape the role of the psychiatric nurse

 Psychiatric nurses are held to the same standards of reasonable and prudent
behavior expected of other professionals with the same education in similar
circumstance

 Must provide care that meets professional standards established by the DOH

 Must know and abide by statutory provisions concerning patient admissions

into psychiatric care
 Nurses and other healthcare providers must never
violate the rights of mentally ill or developmentally
disabled patients who, although dependent, have all of
the same basic rights can have serious legal
consequences
 Mentally ill are further protected by laws to ensure the
right to fair and ethical treatment
Rights of mentally ill patients

 Right to treatment
 Right to refuse treatment
 Rights of minors
 Right to informed consent
 Right to privacy
 Reproductive and Sexual rights
 Right to privacy

 Circumstances for disclosure of confidential information

 Suspected child abuse

 Criminal cases

 Government requests

 When public has a right to know

 If patient is imminent risk to himself or others

Reproductive and sexual rights

 Right to marry

 Right to have children

 Right to use contraception, sterilization

 Right to follow lifestyle of their own choosing

 How treatment must be given:

 By adequate staff

 In least restrictive setting

 In privacy

 In facility that provides comfortable bed, adequate diet, and recreational facilities

 With patients informed consent before unusual treatment

 With payment for work done in facility, outside of program activities

 According to individual treatment plan

Criteria for court ordered treatment

 Need has been clearly established

 Patient poses danger to himself or others

 Physician and treatment team demonstrate

need for continued inpatient treatment
 Evaluating informed consent

 Can consent for treatment or special procedure be obtained the same way it is from another patient/

 Does patient fully understand procedure he’s to undergo, including risks and alternatives?

 Does patient have authority to give his own consent, or must someone else give it?

 Consent to medical research

 Guidelines are complicated and raise unresolved questions.

 Potential risks must be weighed against potential benefits.

 Govt regulations guide methods for treatment.

 Guardianship criteria

 For a minor: may be parents, legal or court appointed guardian, or state

 For an adult: may be parents or spouse

 Patient requests

 Maybe challenged to authority

 May be oppositional behavior treatment team should be consulted

Criteria for involuntary admission

 Patient at risk for taking own life

 Patient poses threat to another person’s life

or property
 Mental illness alone not sufficient legal basis
Restraints and Seclusion

Maybe used only to prevent patient from seriously

injuring himself or others
 Maybe used only when all other physical and
psychological means have failed
 If required, only amount of restraint necessary to protect
patient and staff is used
Criteria for using restraints

 Examination of patient by physician to determine need

 Written physician’s order that’s placed in patient’s
medical record before restraints are applied
 Application of restraints for specified duration (must
follow and facility regulations)