NR 326 Week 1

Student Name

Chamberlain University

NR-326: Mental Health Nursing

Prof. Name

Date

Mental Health and Mental Illness

The concepts of mental health and mental illness are influenced by cultural definitions. Psychological adaptation to stress can be explained through two primary responses: anxiety and grief.

Mental health is defined as “the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms.” Maslow emphasized that individuals are motivated in a continuous quest for self-actualization, described through the hierarchy of needs: physiological/safety, love and belonging, self-esteem, and self-actualization.

Mental illness, on the other hand, refers to “maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and that interfere with the individual’s social, occupational, and/or physical functioning.” This is consistent with the transactional model of stress and adaptation.

Levels of Anxiety

Anxiety is a diffuse, vague apprehension often associated with feelings of uncertainty and helplessness. It becomes problematic when the individual can no longer control it. The four recognized levels of anxiety are presented below:

NR 326 Week 1

Level	Description	Common Symptoms
Mild	Seldom a problem; anxiety has a clear cause	Fidgeting, lip chewing, foot/finger tapping, mild apprehension
Moderate	Perceptual field narrows; thinking ability is diminished	Headache, backache, urinary urgency/frequency, insomnia, difficulty concentrating
Severe	Greatly diminished perceptual field; learning and problem-solving do not occur; limited connection with reality	Confusion, feelings of impending doom, hyperventilation, tachycardia, loud/rapid speech
Panic	Most intense form; individual loses touch with reality	Severe hyperactivity, flight/immobility, disorganized speech, delusions, hallucinations

Stages of Grief

Grief is a subjective state resulting from a perceived loss, expressed through mourning. According to Kübler-Ross, there are five stages of grief:

Stage	Description
Denial	Shock and disbelief regarding the loss
Anger	Envy and resentment toward those unaffected by the loss
Bargaining	Attempt to negotiate with a higher power to delay or reverse the loss
Depression	Intense sadness and despair over the loss
Acceptance	A sense of peace regarding the loss

Legal and Ethical Issues

Ethics involves determining what is right or wrong based on moral values, while bioethics applies these principles within medical contexts. A legal right is one established by law, such as freedom of speech. Ethical perspectives include:

Perspective	Core Principle
Utilitarianism	Greatest good for the greatest number
Kantianism	Actions are judged by duty and intention, not outcomes
Christian Ethics	Follows the Golden Rule
Natural Law	Humans inherently know right from wrong
Ethical Egoism	Decisions are based on self-interest

An ethical dilemma occurs when a choice must be made between two equally unfavorable outcomes, such as end-of-life decisions for a patient on life support.

Key Legal and Ethical Terms

Term	Meaning
Beneficence	Promoting good for others
Nonmaleficence	Doing no harm
Justice	Ensuring fairness
Veracity	Being truthful
Autonomy	Supporting patient’s right to decide
Confidentiality	Protecting patient privacy (HIPAA)
Consent	Must be competent, voluntary, and informed
Negligence	Failure to meet standard care
Malpractice	Professional negligence causing harm

Restraints and Seclusion should only be used as a last resort. Orders for restraint use vary by age: 4 hours for adults, 2 hours for children over 8, and 1 hour for children under 8.

Avoiding liability includes effective communication (iBAR, SBAR, AIDET), accurate documentation, compliance with standards of care, understanding the client’s background, and practicing within one’s scope and competence.

Relationship Development

The nurse–client relationship is central to mental health care, fostering healing, growth, and illness prevention. It should be patient-centered, goal-oriented, and mutually established.

Phases of the Therapeutic Relationship

Phase	Description
Pre-interaction	Review client information; self-reflection on biases
Orientation	Introduce, gather data, establish goals, set boundaries
Working	Maintain trust, implement and evaluate action plans
Termination	Transition client to next level of care

Transference occurs when the patient redirects feelings toward the nurse, while countertransference refers to the nurse’s personal emotional reaction to the patient.

Therapeutic Communication

Therapeutic communication is a purposeful interaction focusing solely on the patient’s needs. It differs from personal communication because the nurse has no self-interest.Examples of Therapeutic Techniques

Technique	Definition	Example
Silence	Allows client to gather thoughts	Nurse remains quiet after client pauses
Accepting	Shows positive regard	“Yes, I understand what you said.”
Offering self	Making oneself available	“I’ll remain with you for a while.”
Broad openings	Allows client to direct conversation	“What would you like to talk about today?”
Making observations	Verbalizing perceived behaviors	“I noticed you are pacing.”
Restating	Repeating main idea	“You are having trouble concentrating.”
Reflecting	Referring questions back to client	“What do you think you should do?”
Focusing	Directing attention to key topics	“Let us discuss how you are feeling.”
Exploring	Encouraging deeper discussion	“Tell me more about this relationship.”
Presenting reality	Correcting misperceptions	“I understand you hear voices, but I do not hear them.”
Voicing doubt	Expressing uncertainty	“I have trouble believing the FBI is after you.”

Nontherapeutic Techniques

Technique	Definition	Example
Giving reassurance	Minimizes patient’s feelings	“Everything will be fine.”
Approving/disapproving	Passing judgment	“That was a bad decision.”
Agreeing/disagreeing	Taking sides	“I think the right thing is to tell your wife.”
Giving advice	Directing patient’s actions	“I think you should…”
Probing	Forcing uncomfortable discussion	“You must tell me more about that breakup.”
Defending	Protecting someone from criticism	“Your doctor knows what he’s doing.”
Requesting explanation	Asking “Why” questions	“Why do you feel this way?”

References

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

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396.

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American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA.

HIPAA, Pub. L. No. 104–191, 110 Stat. 1936 (1996).