NURSING

PSYCHIATRIC
MCE. DORA LUZ GOMEZ CERVANTES
JUNE 2016
Academic Program Focus
The Bachelor's Degree in Nursing and Midwifery contributes to the
training of professionals with a theoretical-scientific preparation to
intervene in the promotion and dissemination of mental health education
programs, preventive measures to avoid risk factors for behavioral and
behavioral diseases where the student take advantage of the information
by making it your own, linking it with your environment and way of life, and recreating it in
your mind until you build your own knowledge, the teacher creates an environment where
the fundamental characteristic of the content taught is the congruence and validity of the
knowledge of this discipline, with dynamics of knowledge development.
Subject focus
The Psychiatric Nursing subject is based on nursing theories, using the scientific method, maintaining
coherence between theory and professional practice in the care of psychiatric patients, in an outpatient
and hospitalization area.
In accordance with the demands in the care of the mentally ill that have arisen in psychiatric and non-
psychiatric institutions, the aim is to provide detailed specific knowledge of therapeutics and nursing care
in the different psychiatric pathologies and mental health problems, their physical assessment as well as
the patient's care plans involving his or her own family.

Description of the content

The psychiatric nursing subject comprises four units. Unit I Introduction to the subject, Unit II Personality
and its structure, Unit III Role of the Nurse in the Therapeutic Environment, Unit IV, Nursing Care in
Neurosis and Psychosis Unit V, Nursing Participation in Pharmacological and Therapeutic Treatment With
this programmatic content it allows us to have the level of competence for the care of patients with mental
disorders.
 Unit: I INTRODUCTION TO THE SUBJECT.

UNIT OBJECTIVE:
Know and manage the basic concepts of psychiatric nursing.
CONTENTS THEMATIC OBJECTIVES

1 Historical background.
Know the thematic content, the way of organizing the course and
the criteria to evaluate

1.2 Psychiatry Nursing Concept Investigate the historical background of Psychiatric nursing

1.3 Mental Health Concept Research the basics

1.4 Importance of mental health.

Describe the importance of mental health
1.5 Mental Health Programs
Know the Health program that is in place in primary care
1.6 Actions of Nursing in the
Mental Health programs.
Identify nursing actions in mental health programs
 Philosophy
Each discipline has its theory on which the practice is based
Nursing theory • Strives to promote and maintain • The most important therapeutic
psychiatric maintains the highest possible level of well- instrument is the nurse herself and
being and functioning. Psychiatric her relationship with the patient.
that the relationship nursing is a "specialized area of
nurse-patient nursing practice, which uses the
can help heal. wide range of explanatory theories
The infirmary of behavior as its science and
objective.
psychiatric is based on
the relational process and
interpersonal.
 FUNDAMENTALS OF PSYCHIATRIC NURSING

Psychiatric nursing theory is built on the belief that each individual has
inherent value and that everyone has the potential to change and the
ability to become healthier and more self-sufficient.

First, people need to meet their own basic physical needs. Once this
happens, all human beings need to feel safe and loved and to feel that
they belong.

All individuals seek the feeling of self-esteem and self-fulfillment.

Psychiatric nurses help people heal by therapeutically meeting basic
needs that they did not have before. All human behavior has a meaning
and can be understood only from the individual's internal frame of
reference.
Psychiatric nursing is one of the five major disciplines of
mental health. It works alongside psychiatry, psychology,
social work, and marriage and family therapy to address
the mental health needs of the community. It takes place
in different contexts. In addition to traditional psychiatric
hospitals, psychiatric nurses may also work in nursing
homes, social service centers, drug and alcohol treatment
facilities, and outpatient centers. Psychiatric nurses examine and evaluate
patients, provide case management services, and advanced practice nurses
can provide individual, family, and group therapy.
 MENTAL HEALTH CONCEPT

Mental health is defined as a state of well-being in which the individual is aware

of his or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or her
community.

The positive dimension of mental health is highlighted in the definition of health

in the WHO Constitution: "Health is a state of complete physical, mental and
social well-being and not merely the absence of infirmity or disease."
 REST AND SLEEP
FEEDING EDUCATION
CULTURE

STAKE
COMMUNITY
HEALTH FAMILY

MENTAL
RECREATION
AND JOB
SPORT
RELATIONS
SOCIAL
Since its founding in 1946 of the World Health Organization (WHO), mental health has been considered an integral part of
the general definition of health.
Advances in health sciences, particularly in neurosciences, allow us to better understand the relationship between the
components of the state of health, as well as to define anticipatory interventions for the disease. However, the
psychosocial component has not had equal presence in the policies of health institutions.

The better living conditions in most countries have led to a notable change in health and disease indicators, presenting
situations like ours, in which diseases resulting from backwardness coincide with those typical of an accelerated urbanization
process, such as chronic-degenerative diseases where neurological and psychiatric pathologies are located, many of them
associated with the epidemiological change that has been observed in recent years in countries with emerging economies,
such as Mexico.
Health problems have increased drastically in recent decades worldwide and our country is no exception. Data suggest
that mental problems are among the largest contributors to the global burden of disease and disability. Beyond the
impressive figures related to these pathologies, there is a large group of people who live in extremely difficult
conditions or circumstances that put them at risk of being affected by a mental disorder; For example, children and
adolescents with alterations in their development and education, abandoned older adults, working women, street
children, indigenous groups and ethnic groups, communities that leave their homes due to natural disasters or wars, or
to seek better living conditions and of course the population that lives in conditions of extreme poverty. To respond to
a challenge of this magnitude, it is necessary to invest in the psychosocial component of health to increase human
capital.

*MU 1 /
1/% -23
im
• The General
patients in hospital
Assembly of the
institutions be
United Nations, as
reformulated.
well as some of its
• Promoting and
organizations (WHO,
strengthening
UNESCO, UNICEF and
primary mental
ILO), and the
health care as well as
Organization of
promoting greater
American States
presence and
• That mental health participation in
programs be
society, both at the
strengthened and the
individual level and in
predominant vision of
the organization of
caring exclusively for
groups and
disabled psychiatric
associations.
ACTION PLAN ON MENTAL HEALTH
2013-2020
The UNEME-CAPA are units for the prevention, treatment and training of personnel for the control
of addictions, which have the purpose of improving the individual, family and social quality of life of
the population.

The CAPAs offer the population an early intervention model for addictions that includes everything from the
prevention of psychoactive substance use and the promotion of mental health, to brief, outpatient treatment
(outpatient consultation), prioritizing the early detection of people with greater vulnerability and experimental
consumers, to intervene with them and their families in a timely manner, in order to avoid the development of
abuse or dependence and improve the individual, family and social quality of life of the users.
The objective is to reduce drug consumption through early and timely actions in schools, organized groups and
the community in general.
Some of the activities carried out are:
The strategies implemented are:
Prevention:
In schools, with students, parents and civil society organizations.

Primary Care Center for

Addictions
 Some of the activities carried out are:
»»»>
• • Address the determinants associated with the consumption of addictive substances in the community

• Reduce the prevalence of abuse and dependence through preventive activities

• Identify susceptible or vulnerable young people early (screening)

• Intervene early

• Diagnose in bio-psycho-social areas those who suffer from addiction

• Stop the development of the disease in early stages

• Provide the necessary support to the families of experimenters, abusers or dependents

The strategies implemented are:

Prevention:
In schools, with students, parents and civil society organizations.
NURSE PARTICIPATION IN MENTAL HEALTH PROGRAMS

Mental Health nurses play a key and increasingly important role in addressing
the new needs and demands of citizens in relation to Mental Health, as well
as in ensuring the provision of high-quality, accessible, equitable, efficient
health services. and sensitive that ensure continuity of care, guarantee the
rights and satisfy the needs of citizens.
They develop their work with people and human responses derived from
Mental Health alterations, with the affective aspects that human behavior
implies and the potential of these to influence the capacity for social
integration of individuals.
 NURSE-PATIENT THERAPEUTIC RELATIONSHIP

The relationship therapy The willingness to share attitudes,

nurse-patient provides an thoughts and feelings is a
experience emotional main characteristic of the
corrective to the patient. The therapeutic relationship, and the
nurse uses both clinical nurse must be empathetic and
techniques and himself and the emotionally
instruments available so that the patient feels
therapeutics to increase the safe to do so.
patient's insight and healthy
functioning
According to Gail Wisarz Stuart,
an author in the field of
psychiatric nursing, "The key
therapeutic tool of psychiatric
nursing is the use of self." In order
to do this successfully, the nurse
needs to have specific qualities,
such as authenticity, empathy, a
clear sense of self, and a desire to
help others.
• health nursing staff mental knowledge, respect for
this interdisciplinarity, the use of
the method scientific and the
qualified by their training to
design of recording
provide specific care to the
instruments, protocols and
individual, family and intervention programs.
community, promoting,
preventing or addressing • The application of care plans
mental health problems. based on NANDA, NIC and NOC
will allow to the
• He procedure professionals of
Nursing requires, from a nursing manage a common
scientific perspective, to take language, evaluate nursing
into account a series of aspects results in a similar way and
related to the frameworks of reduce the variability of daily
nursing action and the type of care
professionals with whom one
interacts, such as professional
 Unit: II PERSONALITY AND ITS STRUCTURE

UNIT OBJECTIVE:
• Identify the phenomenon of population aging within global parameters (cultural, historical and
social).

CONTENTS THEMATIC OBJECTIVES

2.1 Levels of consciousness.

2.2 Personality structure.

Know the defense mechanisms of the personality
2.3 Adaptation to different stages of life. and the components of the mental examination.

2.4 Personality defense mechanisms.

2.5 Components of the mental examination.

2.5.1 General appearance and behavior.

2.5.2 Language
 LEVELS OF
CONSCIOUSNESS
SIGMUND FREUD
AWARE
Perceptions that come from the
outside world become conscious. Through the senses of sight, smell, taste, motor skills (what you see,
hear, do) it is managed with the principle of reality, in the here and now.

SUBCONSCIOUS feelings, thoughts, fantasies, experiences, etc. that are not present in
Events and processes that come consciousness but that can become present at any moment.
to consciousness with
concentration. There are all the repressed contents, emotions, desires, ideas,
experiences and conflicts that have no place in consciousness, because
UNCONSCIOUS the intensity they have produces displeasure (suffering) to the person
Desires, memories, repressed
desires, because they are
when they remember them, which is why they are repressed and they
unacceptable and painful. remain hidden. at this level.
 PERSONALITY CONCEPT

Personality is the set of ,

physical, genetic and social characteristics that an individual brings together
and that make them different and unique compared to the rest of the
individuals
Personality is made up of two elements: and character, one has a
•
genetic origin and the other social origin, that is, it will be determined by the
environment in which the individual lives, respectively.

PERSONALITY STUDENTS — PSYCHOLOGISTS

Sigmund Freud, Alfred Adler, Carl Gustav Jung, Jean Piaget, among the most recognized.
 PERSONALITY STRUCTURE

Personality structure , 3 functional instances (drivers of

behavior):
•It (id): instincts (sex, aggression), ppiopleasure, immediate satisfaction
Unconscious

•I (ego): rational satisfaction of the desires of the id; reality ppio

•Super-ego (superego): conscience, social morality
- He is the one who represses the “unacceptable” and sends it to the JnconscM
 Sociological adaptation

Human beings have a great capacity to adapt to new

situations. In children, this capacity is much higher
than in adults, since it is this quality that allows them
to learn, as they do not have a prior cultural
relationship that conditions them.
ADAPTATION TO DIFFERENT STAGES OF LIFE.
PERSONALITY DEFENSE MECHANISMS

The development and, in general, the life of the human being

unfolds through successive stages that have very special
characteristics. Each of them gradually melts into the next stage. It
is not possible to say when exactly each stage begins and when it
emotional isolation
Conflict is avoided by separating ideas from emotions, which allows intellectual or
ends, since various individual, social and cultural factors influence
objective aspects to be retained while losing contact with threatening emotions.
development. That is why it is said that each human being has its
An attempt is made to eliminate feelings of guilt through behaviors that actually or
own paceCompensation
of development. symbolically compensate the injured party.

1 .Prenatal
2.Childhood
3 .Childhood
4 .Adolescence
5 .Youth
6 .Adulthood
7 .Old age
Impulsive behavior Conflicts are transformed into actions with little or no intervention (acting out) no reflection on the matter

Conflicts move from one threatening object to another that is less threatening.
Attribution of unrealistic negative qualities to self or others Devaluation others to punish oneself or to reduce
the negative impact of
what has been devalued

. ... Managing conflict by altering the integrity of the

Dissociation . . . , .... , .
consciousness, memory or perception of the external and internal world
GENERAL ASPECT AND CONDUCT

I THINK
LANGUAGE
male name

1 .Human being's own ability to express thoughts and feelings through words.

2 . System of signs that a community uses to communicate orally or in writing.

It is defined as a representation
internal that is built through a
accepted means of communication
 Language functions

Function Function Function

Representative appellative Expressive
Yo
The speaker has The tongue The tongue
ability provides the provides the
reference! either speaker the media speaker to speaker
communicative and to address the means to
can represent others express your
reality feelings and
emotions
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HISTORY

Middle Ages, conceptions

esoteric, the ideas that
arise in the Church, During the Renaissance, the
considered related to mental illness is
diabolical possessions, considered as somatic,
it superstition, attributed to the use
demonology and exorcism deficient in reason, body-
are the tools for mind, as well as the
treat them fundamentals
biological psychology

17th century protect and

protect Reformatory schools are
From the Greeks and Egyptians
ancient, diseases created and
mental disorders have been corrections to educate
described morally to the “crazy”;
as manifestations of the although Connolly
spirits (demonic in their understands
that madness is a
brain disturbance
conditioned by factors

majority), granting them a

 rather magical origin
religious. The figure of
“Shaman” or “sorcerer”
In the 5th century BC. C,
Hippocrates,
states that the cause is
biological
and it depends on the types
of
temperaments that are
based on
the mix of humors
corporal: blood, black bile,
yellow bile and phlegm.
mental patients, from
of his confinement in
different
nursing homes and
hospitals. appear
attempts to treat
humanely to the sick
mental, creating the first
hospitals; the order of Saint
Juan de Dios stands out in
Spain. .
• At the end of the 18th century and psychiatric hospitals. Psychiatric universal classification of mental
the beginning of the 11th, the Nursing emerges, despite the fact disorders.
efforts of Phillipe Pinel (France), that the functions of nursing itself
founder of Psychiatry, proclaimed already existed, for the work of
the acceptance of mentally ill Florence Nighthingale, determining
people as human beings who that patient care must consider
needed medical assistance. psychological, physiological and
• William Tuke (England), calls on the social aspects.
Society of Quakers to revolutionize • AND. Kraepelin, develops a
the care of the mentally ill; fights to systematized descriptive
free the chains of mental patients classification system of psychiatric
and suppress the anguish due to disorders: manic-depressive
the responsibility that treatment psychosis, dementia praecox, to
brings. avoid being left with only the
• At the end of the 19th century and symptomatic set of a given
the beginning of the 20th century, condition by including a new
there is a new trend that is criterion; taking up the conceptual
characterized by the creation and aspects of Wilhelm Wundt's
development of mental or Experimental Psychology for this
 MENTAL HEALTH AND PSYCHIATRY PROGRAM.

Linda Richards promotes better medication, supervising the use of for its treatment; Together with
care for psychiatric patients and hydrotherapy, and physical and Breuer, Freud transformed the
directs the first nursing school in nutritional care. therapeutic methodology into the
the field of mental health and 20th century, the dynamics of method of “free association”, to
psychiatry. illness by Sigmund Freud, arrive at his psychoanalytic theory
At the end of the 19th century, develops his psychoanalytic that was so controversial at the
there were nursing staff in several theory; when studying in Paris the beginning of this century.
mental hospitals who were in manifestations of hysteria and the
charge of administering effects of hypnosis and suggestion
The program describes the set of activities to be carried out in the different establishments for the
promotion of mental health and the prevention, detection, treatment and rehabilitation of mental
disorders.

* For health centers, prevention and promotion measures will be carried out, as well as the detection of psychosocial
problems, in which intervention can be made.
• In the Maternal and Child hospitals, the formation of Mental Health clinics will be carried out, which will have the
purpose of promoting the mother-child relationship, as well as preventing, detecting, and influencing (if necessary),
the problem of the Maternal-Child bond. .

These small actions will have great consequences in the future, since good development will be promoted from the
earliest stages of life, which is the time when the disease develops, therefore these actions will have long-term results.
MENTAL HEALTH AND PSYCHIATRY PROGRAM.
 MENTAL HEALTH PROGRAMS:

Medical Care and Free Home Delivery of Medications

Comprehensive care for older adults

Therapeutic Adherence

Organ, Tissue and Cell Donation Campaign

Vaccination Campaign against Human Papillomavirus

Advance Directive Law

Move and Get in Waist

Network of Mastographers of the Federal District

Health Protection of non-smokers
Comprehensive Care for Non-Communicable Diseases

Free Medical Services and Medications Program

Food Support and Medical Care Program for Seniors

Popular Insurance Program

Addiction Prevention and Care Program

Mental Health Program

Gender Violence Program

 COMPONENTS OF THE MENTAL EXAM

The mental examination is a conditions for both the patient while interviewing the patient.
technique that every clinical and the doctor. We say “as It is also necessary to have
doctor must use, since it will much as possible”, because we sufficient time.
allow him to have a more know that there are many
precise diagnosis of his patient's situations in which
psychiatric syndromes. It is environments (for example
done rooms of
after of to have emergency) do not allow this
obtained enough minimum comfort.
information about the reason It is important that the patient
for consultation and the feels that they are paid
evolution of the symptoms and attention, respected, and
signs presented. treated with dignity. and
It should be carried out, as far confidentiality. It is not
as possible, in comfortable advisable to use the cell phone
 A basic mental exam should contain the following elements:

Appearance and attitude of the patient

Consciousness: if you appear cloudy, drowsy, lethargic, stuporous or in a coma.

Language and Speech: We must ensure that the patient understands us. You may have Aphasia (sensory or comprehension aphasia)

Orientation: Time, place and space

Memory: Memory for recent events, memory for remote events and false memories should be explored.

Attention: It is explored by observing the patient's ability to maintain a coherent conversation with the interviewer.

Thinking: the speed of thought must be evaluated, if it is too fast it is called tachypsychia and if it is too slow it is called bradypsychia.

Perception or Sensoperception: The most frequent are illusions, they consist of the impossibility of perceiving an object, but this disorder
belongs more to the field of neuropsychology.

Affectivity: The patient's appearance, movements, posture, facial expression and general behavior are important indications of his or her
affectivity.
 Before finishing the exam, the knowledge that the person has is explored.
person about their symptoms.

Which is Do you think

Do you see Do you think Are you aware Do you think it
the
attitude of not
them as a you need of your is
patient before treatment? mistakes? has It's about a
disease?
hisalterations? disease Physical
some? problem
 Stages of the therapeutic relationship

Introductory or
Pre-interaction, as it orientation phase,
happens before the establish a
relationship of trust The third phase is
nurse meets the work.
patient. It is a stage with frank
communication and The nurse and patient Completion,
of self-exploration for
the nurse. formulate a contract work to help the which occurs
between patient and patient see his or her when the nurse
For her to be nurse, defines roles, thoughts, feelings, and
therapeutically the objective of the and patient
effective, it is relationship, the evaluate
essential that she The mainand
duration taskdetails
of eo behaviors that progress and

Y
takes into account This phase is still can be translated
her own the creation of share their
as mutually
preconceptions, trust, and the determined feelings and
prejudices and fears contract exists only objectives memories.
before interacting to fulfill that
with the patient. objective.

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 Unit: III ROLE OF A NURSE IN THE THERAPEUTIC ENVIRONMENT

UNIT OBJECTIVE:
Know what role the nurse plays in the therapeutic environment.
CONTENTS THEMATIC OBJECTIVES
Understand and analyze the importance of effective
3.1 Therapeutic communication communication, the characteristics of the
3.2 Therapeutic environment of the psychiatric therapeutic environment and the role of the nurse
hospital in the care of psychiatric patients.
3.3 Description of the psychiatric area
3.4 The role of the nurse in the therapeutic
environment of the psychiatric hospital.
3.5 Attitudes of the nurse towards the psychiatric
patient
 Unit: IV NURSING CARE IN NEUROSES AND PSYCHOSIS

UNIT OBJECTIVE:
Know the different levels of geriatric care in our environment and the current situation of geriatric care. And know
the points of view and perspectives of nursing care.

CONTENTS THEMATIC OBJECTIVES

4.1 Neurosis.
4.1.1 affective neurosis
4.1.2 Depressive neurosis
4.1.3 Anxiety neurosis.
4.1.4 Drug dependence.
4.1.5 Sexual deviations.
4.2 4.2.1 Schizophrenia
4.2.1 Paranoid schizophrenia Psychosis and classification

4.2.2 Euphrenic schizophrenia

4.2.3 simple schizophrenia
4.2.4 Catatonic schizophrenia Undifferentiated schizophrenia
Residual schizophrenia Disorganized schizophrenia Alcoholic
schizophrenia Alcoholic psychosis
Epileptic psychosis
2. The child with mental disorder due to lack of attention
Know the emotional factors that predispose the presence of
neurosis and psychosis, as well as the strategies to provide
specific nursing care.
 Unit: V PARTICIPATION OF THE NURSE IN PHARMACOLOGICAL AND
THERAPEUTIC TREATMENTS.
UNIT OBJECTIVE:
Know the different levels of geriatric care in our environment and the current situation of geriatric
care. And know the points of view and perspectives of nursing care.

CONTENTS THEMATIC OBJECTIVES

1. Administration of psychotropic drugs different therapies
2. Nurse considerations in relation to medications
3. Tranquilizing drugs.

4. Antidepressants
5. Special therapies
6. Occupational therapies
7. Special psychotherapy.
Identify the participation of the nurse in the
administration of psychotropic drugs and the
 Unit: VI NURSING PARTICIPATION IN PATIENTS UNDER
PSYCHIATRIC TREATMENT
UNIT OBJECTIVE:
Identify nursing actions in the management of patients with psychiatric treatment

CONTENTS THEMATIC OBJECTIVES

UNIT VI
Know the reactions that occur in patients with
treatments psychiatric
NURSING PARTICIPATION IN PATIENTS UNDER
specific and emergencies. .
PSYCHIATRIC TREATMENT

6.1.Electroshock treatment.
6.2Observation of the patient's behavior
6.3Non-psychogenic psychiatric emergencies

Mental, neurological and substance abuse disorders are prevalent in all regions of the
world and are important contributing factors to morbidity and premature mortality. 14%
 of the global burden of disease can be attributed to these disorders. Stigma and
violations of the human rights of people suffering from these disorders exacerbate the
problem. Resources provided to address the enormous burden of mental disorders
have been unequally distributed and ineffectively used, resulting in a treatment gap of
more than 75% in many low- and middle-income countries. low.
The Mental Health Gap Action Program provides health planners, policymakers and
donors with a clear and coherent set of activities and programs to expand and improve
care for mental, neurological and substance abuse disorders. coherent substances.
Identifies strategies to increase coverage of key interventions in priority conditions in
resource-limited settings.
• Download the Action Program
Stages of the therapeutic relationship
There are four basic stages of the therapeutic relationship. The first is called the pre phase interaction,
as it happens before the nurse meets the patient. It is a stage of self-exploration for the nurse. For her to
be therapeutically effective, it is essential that she takes into account her own preconceptions,
prejudices and fears before interacting with the patient. The second phase of the therapeutic
relationship is the introductory or orientation phase. The objectives of this phase are to establish a
relationship of trust with frank communication and formulate a contract between patient and nurse, if
the contract is appropriate in the specific context. The contract defines roles, the purpose of the
relationship, the duration and details such as the frequency of meetings. The main task of this phase
remains the creation of trust, and the contract exists only to fulfill that objective. The third phase is the
work phase, in which most of the therapeutic work is done. The nurse and patient work to help the
patient see his or her thoughts, feelings, and behaviors that can be translated into mutually determined
goals. The final phase is termination, which occurs when the nurse and patient evaluate progress and
share their feelings and memories.