UNIT 1: Foundations
of Psychiatric
Mental Health Nursing
Please read the chapters in your reading
list for Unit1.This outline is what I consider
important. Please be able to demonstrate
understanding of this material.
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A. Student’s reaction
What will I talk about?
 Will I hurt the client?
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Tools
 Self-awareness
 Positive self regard
 Values
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B. Please use your text
book and define the
following terms
Transference
 Counter transference
 Self perceptions
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C. Defense Mechanisms
Please know the definition,
and examples from the chart
in your book.
Compensation
 Denial
 Displacement
 Identification
 Intellectualization
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Introjection
Isolation
Projection
Rationalization
Reaction Formation
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Defense Mechanisms
Continued…
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Regression
Repression
Sublimation
Suppression
Undoing
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D. Mental Status Assessment
focuses on the patient’s
current state in terms of
feelings, thoughts, and
behaviors.
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The following categories help
to organize a summary
of the patient assessment.
Please refer to your text for the
information in each category.
1. General appearance
2. Mood and affect
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Be able to define the following
behaviors and thought disorders.
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Behaviors:
Catalepsy
Compulsion
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Thought Processes
Flight of ideas
 Associative
looseness
 Circumstantiality
 Tangentiality
 Neologisms
 Concrete Thinking
 Clang Associations
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Thought Processes (cont.)
Clang Associations
 Word Salad
 Perseveration
 Echolalia
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Content of Thought

Delusions
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 Persecutory
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 Grandiose
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Obsessions
Paranoia
Phobias
 Reference
 Nihilistic
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Perceptual Disturbances
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Hallucinations
 Involves
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all 5 senses
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Sensorium/ Cognition
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Orientation x4
Memory
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Abstract Thought
 Recent
 Remote
 Confabulation
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Judgement/ Insight
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E. Nurse-Client Relationship
Essential Qualities:
 The nurse’s use of self is the most
important tool.
 The nurse must be value neutral.
 Hope!!! The nurse must believe that
each patient can be helped.
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F. Therapeutic Communication
Offering self
- I’ll sit with you awhile
 Reflecting- “I depended on the wrong
people.” “The wrong people.”
 Giving broad openings- “Is their something
you would like to talk about?”
 Using silence
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Therapeutic Communication
continued…
Seeking consensual validation- “Do I
understand correctly that?”
 Offering general leads- “And then what
happened?”
 Restating- P – “I can’t eat –it hurts when it
goes down” N- “You have
difficulty swallowing.”
 Exploring- “Tell me more about that.”
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Therapeutic Communication
continued…
Encouraging description of perception“Tell me when you feel anxious.”
 Focusing down- “Your ideas seem worth
viewing more closely.”
 Giving information- “My name is… You & I
are going too…Breakfast will be at…”
 Encourage formulation of a plan- “Next
time this comes up how might you handle
it?”
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Therapeutic Communication
continued…
Giving recognition- “You have painted a
beautiful picture.”
 Showing acceptance-…(nodding)
 Making observations- “You appear angry.”
“I feel uncomfortable when you…”
 Placing events in sequence of time- “What
happened before you left school?”
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Therapeutic Communication
continued…
Stating reality- “I don’t see anything under
the bed.”
 Verbalizing the implied- P- “I never get any
visitors.” N- “You feel no one cares.”
Encouraging comparison-Has anything
like this happened to you before?”
 Voicing doubt- “That seems very unusual.”
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G. Non-therapeutic Techniques
Rejecting-“I don’t want to hear about…”
 Advising- “Why don’t you…?”
 Probing- “Tell me about your childhood”
 Requesting an explanation- “Why did you
do that?’
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Non-therapeutic Techniques
continued…
Interpreting- “unconsciously you believe…”
 Interpreting- “Unconsciously you believe”
 Introducing an unrelated topic- c-“I’d like to
hit him over the head” n- “How was lunch
today?”
 Challenging- “You can’t possibly be
Napoleon. He’s dead.”
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Non-therapeutic Techniques
continued…
Disagreeing /Agreeing- “I agree, she’s
awful.”
 Reassuring- “Everything will be alright.”
 Disapproving- “That’s terrible
 Belittling feelings expressed- “Everybody
feels like that occasionally”
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Non-therapeutic Techniques
continued…
Making stereotype remarks- “Keep your chin
up.:
 Giving literal responses- c- They are looking
into my head with a camera. N- A 35mm
camera?
 Defending- “Dr. Jones is an excellent
physician.”
 Using denial- p “I’m nobody.” n-you’re
somebody, don’t be silly.
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I. Crisis Intervention Theory

Definition- A turning point when a person is
confronted by a situation in which his
usual problem solving no longer works.
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Phases
1.
2.
3.
4.
Precipitating Event (loss of a job, personal failure.)
The event is perceived as a threat and causes
increased anxiety
The person becomes increasingly anxious and
thinking becomes disorganized. As coping
mechanisms fail, the person’s thoughts begin to
race and the feel as if they are falling apart.
The person mobilizes internal and external
resources and tries new problem solving methods.
The person is able to re-define the problem
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Types
1.
2.
Developmental Crisis -(Erickson’s
Stages)- predictable life events that
normally occur in most people’s lives.
Situational Crisis- These crises occur
when unanticipated events threaten a
person’s integrity.
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Nursing Interventions
Assessment- Collect data about the
nature of the crisis. Establish trust with
the client.
Ask questions like: “What brought you
for help today?”
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Nursing Interventions
continued…
Identify the precipitating event and the client’s
perception of the problem “How is this problem
affecting your life now?”
2. Identify the client’s strengths and coping skills
“Has anything like this ever happened before?”
“How have you handled other crisis?
3. Identify the client’s support system.
“Who do you trust?”
1.
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Planning
Assist the client to propose alternative
solutions and ways to accomplish them
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Intervention
The goal-directed plan is implemented by
the client
 Assist the client to focus on the crisis, not
a major personality change
 Give the client positive feedback to
increase their self-esteem
 Set limits on self-destructive behavior
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Evaluation
Compare the client’s goals to the client’s
behavior
 Trouble-shoot for the future
 Encourage the client to make future plans
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Crisis can be individual or
community-wide. Caplan
identified a 3-tiered approach
for community intervention in
mental-health problems.
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Primary Prevention

Identifies a population at risk for
experiencing psycho-social problems. The
population is supported to not experience
the problem.
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Secondary Prevention
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Aims at early diagnosis and treatment of
mental-health problems.
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Tertiary Prevention

Attempts to reduce the long-term effects of
a mental –health problem.
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