Name
Chamberlain University
NR-326: Mental Health Nursing
Prof. Name
Date
The concepts of mental health and mental illness are shaped by cultural definitions. Psychological adaptation to stress can occur in two main forms: 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 explained this through the hierarchy of needs, where individuals strive continuously toward self-actualization. The hierarchy includes physiological/safety needs, love and belonging, self-esteem, and self-actualization (Maslow, 1943).
In contrast, mental illness is described as “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 reflects the transactional model of stress and adaptation.
Anxiety is a vague, diffuse apprehension often linked with uncertainty and helplessness. While it is a normal reaction to stress, it becomes problematic when uncontrollable. The four recognized levels of anxiety are described below:
| 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 diminishes | Headache, backache, urinary urgency/frequency, insomnia, difficulty concentrating |
| Severe | Greatly reduced perceptual field; learning and problem-solving do not occur | 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 |
Grief is a subjective emotional state resulting from a perceived loss, usually expressed through mourning. Kübler-Ross (1969) described 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 |
Ethics involves determining right from wrong, while bioethics applies these principles to medical contexts. A legal right is established by law, such as freedom of speech.
| Perspective | Core Principle |
|---|---|
| Utilitarianism | Greatest good for the greatest number |
| Kantianism | Actions judged by duty and intention, not outcomes |
| Christian Ethics | Follows the Golden Rule |
| Natural Law | Humans inherently know right from wrong |
| Ethical Egoism | Decisions based on self-interest |
An ethical dilemma arises when a choice must be made between two equally unfavorable outcomes, such as end-of-life decisions for patients on life support.
| 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 be used only as a last resort. Orders depend on age: 4 hours for adults, 2 hours for children over 8, and 1 hour for children under 8.
To avoid liability, nurses should practice effective communication (iBAR, SBAR, AIDET), maintain accurate documentation, follow standards of care, consider the client’s background, and stay within their scope and competence.
The nurse–client relationship is central to mental health care. It fosters growth, healing, and illness prevention. It should be patient-centered, goal-oriented, and mutually established.
| 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 is a purposeful, patient-centered interaction where the nurse focuses solely on the client’s needs. Unlike personal communication, it carries no self-interest for the nurse.
| 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 | Lets client 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.” |
| 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?” |
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.
Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396.
