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 and societal norms. Mental health reflects an individual’s ability to adapt effectively to stressors from both internal and external environments. This adaptation is evidenced through thoughts, feelings, and behaviors that are age-appropriate and culturally consistent. According to Maslow (1943), individuals continuously strive toward self-actualization, which is represented in the hierarchy of needs. These needs include physiological and safety requirements, love and belonging, self-esteem, and self-actualization, all of which contribute to a balanced state of mental health.

Conversely, mental illness involves maladaptive responses to stressors, resulting in thoughts, feelings, and behaviors that deviate from cultural norms and interfere with social, occupational, or physical functioning. This perspective aligns with the transactional model of stress and adaptation, which views mental illness as a disruption in the balance between the individual and environmental demands.

Levels of Anxiety

Anxiety is a diffuse and often vague apprehension, typically associated with uncertainty and a sense of helplessness. While some anxiety is a normal response to stress, it becomes problematic when it is excessive or uncontrollable. Anxiety is categorized into four levels, each associated with specific symptoms and impacts on perception and cognition:

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 diminishes	Headache, backache, urinary urgency/frequency, insomnia, difficulty concentrating
Severe	Perceptual field greatly reduced; learning impaired	Confusion, feelings of impending doom, hyperventilation, tachycardia, loud/rapid speech
Panic	Most intense form; reality is distorted	Severe hyperactivity, flight/immobility, disorganized speech, delusions, hallucinations

Stages of Grief

Grief is an emotional response to perceived loss, often expressed through mourning. Kübler-Ross (1969) described five stages of grief, which provide a framework for understanding emotional adaptation:

Stage	Description
Denial	Shock and disbelief regarding the loss
Anger	Feelings of envy and resentment toward unaffected individuals
Bargaining	Attempts to negotiate with a higher power to reverse or delay loss
Depression	Deep sadness and despair over the loss
Acceptance	Achieving a sense of peace regarding the loss

Legal and Ethical Issues

Ethics is concerned with discerning right from wrong, while bioethics applies ethical principles in medical contexts. Legal rights are established through legislation, such as the right to freedom of speech.

Ethical Perspectives

Perspective	Core Principle
Utilitarianism	Actions aim for the 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 have an inherent knowledge of right and wrong
Ethical Egoism	Decisions are guided by self-interest

An ethical dilemma arises when a decision must be made between two equally undesirable outcomes, such as determining end-of-life care for patients on life support.

Key Legal and Ethical Terms

Term	Meaning
Beneficence	Promoting good for others
Nonmaleficence	Avoiding harm
Justice	Ensuring fairness
Veracity	Being truthful
Autonomy	Supporting patient’s right to make decisions
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 are measures of last resort, with legal limits based on age: adults (4 hours), children over 8 (2 hours), and children under 8 (1 hour). Nurses reduce liability by practicing effective communication (iBAR, SBAR, AIDET), maintaining accurate documentation, adhering to standards of care, respecting patient background, and staying within professional scope.

Relationship Development

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

Phases of the Therapeutic Relationship

Phase	Description
Pre-interaction	Review client information and reflect on personal biases
Orientation	Introduce self, gather data, set goals and boundaries
Working	Maintain trust, implement interventions, evaluate outcomes
Termination	Facilitate transition to next level of care

Transference occurs when a patient redirects feelings toward the nurse, while countertransference is the nurse’s emotional response toward the patient.

Therapeutic Communication

Therapeutic communication is a purposeful, patient-centered interaction focusing entirely on the client’s needs. Unlike personal communication, it avoids self-interest for the nurse.

Examples of Therapeutic Techniques

Technique	Definition	Example
Silence	Allows client to process 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	Lets client guide 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’s 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

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

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

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

NR 326 Week 1

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