Preventive mental health nursing

Prepared by:

M.Vijayarani.Bsc(N),R.N.R.M

PREVENTIVE MENTAL HEALTH NURSING

(SOCIAL SUPPORTING SYSTEM ,WORKING WITH GROUPS & EVALUATION)

SOCIAL SUPPORTING SYSTEM

INTRODUCTION:

As a primary prevention strategy, supporting social systems means strengthening the social supports in place to enhance their protective factor and developing ways to buffer or cushion the effects of a potentially stressful event.

DEFINITION:
Facilitation of support to patient by family, friends, and community.

PURPOSES OF SUPPORTING SOCIAL SYSTEMS:

Social support systems can be helpful in emphasizing the strengths of individuals and families and in focusing on health rather than illness. This support is important for all levels of prevention – primary, secondary and tertiary – and it influences all of the following,

1. Encouraging health promotion behaviour.

2. Helping people seek assistance earlier.

3. Improving the functioning of the immune system or other biological processes

4. Reducing the occurrence of potentially stressful events

5. Fostering the ability to cope with chronic mental and physical illness

ACTIVITIES OF SUPPORTING SOCIAL SYSTEMS:

1. Assess the psychological response to situation and availability of social system

2. Determine adequacy of existing social networks

3. Identify degree of family support

4. Identify degree of family financial support

5. Determine support systems currently used

6. Determine barriers to using supporting systems

7. Monitor current family situation

8. Encourage the patient to participate in social and community activities

9. Encourage the relationships with persons who have common interests and goals

10. Refer to a self-help group as appropriate.

11. Assess community resource adequacy to identify strength and weakness.

12. Refer to a community based promotion / prevention / treatment / rehabilitation program as appropriate.

13. Provide services in caring and supportive treatment

14. Explain to concern others how they can help.

FACTORS INFLUENCING SOCIAL SUPPORT:

People with poor social support – whether it if defined by the number of social contacts, the satisfaction derived from them or a combination of the two – have a higher risk of dying in all cases.

The effects of ‘isolation’ are even more dramatic in those with chronic illnesses

People with coronary artery disease who lack both a spouse and a confident have a 50% death rate over a 5-year period.

The need for social support is influenced by predisposing factors, the nature of the stressors and the availability of other coping resources such as economic assets, individual abilities, and skills, and defensive techniques. The availability of social support is also influenced by age, gender, socio-economic status, the nature of the stressors, and the characteristics of the environment.

Acute episodic stressors tend to elicit more intense support, whereas a support resource for chronic problems tends to fade away. Also changes or stressors viewed in a positions way by the individual social network, such as the birth of a baby or a promotion, may generate a great deal of support, whereas a negative event, such as divorce, might stimulate little support. Finally, the quantity and type of social support that meets one need may not meet another.

TYPES OF INTERVENTION:

Eventhough many variables related to social support need further study, social support can still be used to design and implement interventions in primary prevention. Four particular types of interventions are possible.

1. Social support patterns can be used to assess communities and neighborhoods to identify problem areas and high-risk populations. Not only will information about the quality of life be gained but also the social isolation of a particular group may become apparent, as many central individuals who can be entrusted to help develop community based programs

2. Links can be improved between community support systems and formal mental health services. Often mental health professionals are not aware of or comfortable with the existence or functioning of community support systems. All health care providers need to be able to recognize when patients are in need of social support and provide them with assesses to appropriate community support systems.

3. Naturally existing care giving networks can be strengthened. Health professionals can provide information and support to informal caregivers in the community, who serve a very important and somewhat different function than more formalized and organized support system.

Informal support systems provide

a) A natural training ground for the development of problem solving skills

b) A medium in which people grow and develop by learning to direct the process of change for themselves

c) A supportive milieu that capitalizes on the strengths of existing ties among people in communities, rather than fragmenting intact social units on the basis of diagnosed needs or specialized services.

4. Individuals and groups can be helped to develop, maintain, expand, and use their social networks. For example, network therapy involves bringing together all the important member of the families’ kin and friendship network. The focus is then on tightening bonds within the network and breaking dysfunctional patterns. For families who are isolated and whole networks are depleted, too few network members may not be available for such a strategy to be feasible. In this care, arranging for the use of mutual support groups may be effective.

PREVENTIVE MENTAL HEALTH:

WORKING WITH GROUPS:
A group is three or more people with elated goals. There are influenced by many factors – intrapersonal and interpersonal needs, the physical environment, and the unique interaction of the group.
Groups can be composed of as few as 3 or as many as 20 members. When a group is larger than the number of individuals who can comfortably relate to one another simultaneous ‘subgroups’ are formed.

CHARACTERISTICS OF GROUPS:

1. Size of the group

2. Homogeneity or heterogeneity of group members

3. Stability of the group

4. Degree of cohesiveness, or bonding power, between members

5. Climate of the group (e.g. warm, friendly, cold, aloof)

6. Conformity to group norms

7. Degree of agreement with the leaders and the group’s norm

8. Ability to deal with member’s infractions.

9. Goal – directedness and task orientation of the group’s work.


TYPES OF GROUP:

Groups may be primary or secondary, formal or informal.

PRIMARY GROUPS:

Members of primary groups have face-to-face contact. They have boundaries, norms and explicit and in explit interdependent roles. An example for a primary group is family.

SECONDARY GROUPS:

Secondary groups are usually larger and more personal than primary groups. Members of secondary groups do not have the relationship bonds or emotional entities of members of a primary group. An example of secondary group is a political party or a business.

FORMAL GROUP:

A formal group has structure and authority. Authority in a formal group usually emanates from above and interaction in the group is usually limited. A faculty meeting is an example for formal group.

INFORMAL GROUP:

Informal group provide much of a person’s education and contribution greatly to his or her cultural values. The members of a informal group do not depend on each other, such as in friendship groups and hobby groups.

OPEN GROUPS:

Open groups do not have established boundaries; members may join and leave the group at different times.

CLOSED GROUPS:

Closed groups have a set membership, a specific time frame, or both of these components

1. Support groups: focus on increasing the member’s adaptation, self esteem, and sense of emotional well being.

2. Reeducation and re motivation groups: often very beneficial for psychiatric clients who are withdrawn, or socially isolated, attempt to increase communication and interaction among members to foster m ore acceptable and appropriate behaviour.

3. Problem solving therapy groups: focus on the resolution of specific problems that clients’ have identified.

4. Insight without reconstruction groups: have group leaders who place their major emphasis on interpersonal communication and work on effecting change by increasing the member’s cognitive and emotional understanding of their problems.

5. Personality reconstruction groups: make use of psychoanalytic theory and encourage the members to explore formal relationships and problems and their impact on the present.

GROUPS COMMONLY ENCOUNTERED IN NURSING PRACTICE:

Many groups have therapeutic value for their members. Through belonging to a group, an individual’s needs may be gratified and growth maybe facilitated.

FAMILY:

Family is a specific kind of group, often called the primary group. A primary group fosters warm, relationships among its members.


INFORMAL GROUPS:

Informal groups are perhaps the most frequent type of groups the nurse encounters. Informal groups are groups are groups that do not have formalized structure and task and are often more spontaneous in nature than formal groups. E.g. patient and staff group.

SENSITIVITY TRAINING GROUPS:

These groups are usually small, comprised of 8-12 members. The purposes of these groups are to increase self awareness, to increase an understanding of group processes, and or to increase an awareness of the effects one’s behaviour in groups. These groups usually focus on present individual and group behaviour.

THERAPEUTIC GROUPS:

Therapeutic groups are groups that have a broad goal of preventing emotional turmoil or disturbances. They are different from traditional psychotherapy groups in that emotional stress is secondary to physical disease.


PSYCHOTHERAPY GROUPS:

Group psychotherapy is the treatment of emotional stress and disorder through the means of a group method and group process. As a treatment, the group psychotherapeutic processes are systematical, planned, goal oriented, and based on theoretical formulations

GROUP FUNCTIONS:

All groups have two basic needs or functions the need to work on or complete a task or goal (there may be more than one), and the need to satisfy some psychosocial or emotional need or needs of its members.

The task of a group can be further divided into a primary task, which is necessary for the group’s survival or existence, and secondary, or ancillary, tasks, consisting of those tasks which may enhance the group but are not basic to its survival.

ESSENTIAL ELEMENTS OF GROUP THERAPY

Yalom (1985) has identified 11 factors as essential components of group therapy.

1. Instillation of hope:

those who are not coping well can gain hope from those who have benefited from the group experience.

2. Universality:

a group member observers that others in the world share similar feeling or have similar problems therefore anxiety is decreased

3. Altruism:

the opportunity to support and to help increased self awareness in other group members gives the helping individual increased self esteem. It also encourages a preoccupied individual to become less self focused.

4. Imitative behaviour:

the group leader, or a group member who has already mastered a particular psychosocial skill, can be valuable role model. The group members get the help that they need to dissolve their rigid t=behavioural styles and become more flexible in their interactions.

5. Imparting information:

interpersonal relating, developmental tasks and stages, medications by other somatic treatments, and the structure of the setting are only a few areas in which information may be shared.

6. Interpersonal learning:

the group offers varied opportunities for relating to other people. Members learn to identify, clarify, and modify maladaptive behaviour.

7. The development of socializing techniques:

is essential in the group as m embers are given the opportunity to learn and test new social skills.

8. Group cohesiveness:

is the development of a strong sense of group membership and alliance.

9. Corrective recapitulation of the primary group:

allows members in the group to correct some of the perceptions and feelings associated with unsatisfactory experiences they have had with their family.

10. Catharsis:

similar to cohesiveness involves members relating to one another through the verbal expression of positive and negative feelings.

11. Existential factors:

these intangible issues encourage each group member to accept the motivating idea that he or she is ultimately responsible for his or her own life choices and actions.


STAGES OF GROUP DEVELOPMENT

INITIAL STAGE:

1. Works on getting acquainted with group leader and members.

2. Depends on the leader for direction

3. Searches for meaning and purpose of the group

4. Restricts content and communication style

5. Searches for similarity among members

6. Gives advice

WORKING PHASE

1. Solves selected problems of working together

2. Conflicts between members or between members and leaders

3. Works on issues of dominance, control, and power within group.

4. Co-operates to accomplish the group work.

MATURE PHASE

1. Develops workable norms and a group culture

2. Resolves conflict when it occurs; conflict arises due t issue of importance, not emotional issues.

3. Evaluates own work and individuals assume responsibility for their work.

4. Accepts each other’s differences without placing value judgment on them.

5. Sanctions role assignment by members of the group.

6. Discusses topics and makes decisions by means of rational behaviour, such as sharing information and open discussion.

7. Provides a feeling of ‘we’ for the leader and members

8. Demonstrate cohesion

9. Validated itself, has a group image.


TERMINATION

1. Evaluating and summarizing the group experience

2. Exploring positive and negative feelings about the group experiences.


ADVANTAGES OF GROUP THERAPY:

1. A greater number of clients can be treated in group therapy. Making the method cost effective.

2. Members profit by hearing other members discuss their problems. This discussion decreases members’ feelings of isolation, alienation, and uniqueness, which encourage them to share feelings and problems.

3. Group therapy provides on opportunity for clients to explore their specific styles of communication in a safe atmosphere where they can receive feedback and undergo change.

4. Members learn multiple ways of solving a problem from other group members, and group exploitation may help them discover new ways of solving problem.

5. Members learn about the functional roles of individuals in a group. Sometimes a member shares their responding as the co-therapist. Members become culture carriers.

6. The group provides for its member’s understanding confrontation and identification with more than an individual. The member gains a reference group.


DISADVANTAGES:

1. An individual’s privacy may be violated, for example when a conversation shared within the group is repeated outside the group. This behaviour obstructs confidentiality and hampers complete and honest participation in a group.

2. Clients may experience difficulty in exposing themselves to a group or believe that they back the skill to communicate effectively in a group. Some client’s may use these factors as resistance; others may be reluctant to expose themselves to the group because they do not want to change.

3. Group therapy is not a helpful form of therapy if the therapist conducts the group as it is individual therapy.


INFORMAL SUPPORT GROUPS:

There are informal support groups. They may include church groups, civic organizations, clubs, women’s groups, or work and neighborhood support groups.
Self-help groups are becoming more common as members organize themselves t solve their own problems. The members are sharing a common experience, work together toward a common goal, and use their strengths to gain control over their lives. Such groups are also forming on the internet (Bacon, Condon, and F ernsler, 2000)

Self help groups such as alcoholics, anonymous, weight watches; parents without partners, recovery and parents anonymous are familiar to the public.
Because self help groups use a variety of stress coping methods and have differing memberships criteria, each group should be assessed individually for its general effectiveness and appropriateness for particular individual and familiar.
Working with occurring, informal support systems should be done cautiously, however, to minimize under stable consequences. The nurse attempts to create the least amount of disruption possible and not suppress the natural repertoire of helping behaviours of informal caregivers.

Finally, although supporting social supports is an effective intervention, it is not limited to primary prevention activities. Rather all nurses in all settings can use this strategy as a way of providing holistic care to maximize the health of individuals, families and groups.

STIGMA REDUCTION:

An important aspect of mental health promotion involves activities related to dispelling myths and stereotypes associated with vulnerable groups, providing knowledge of normal parameters, increasing sensitivity to psychosocial factors affecting health and illness, and enhancing the ability to give sensitive, supportive and humanistic health care.

STIGMA:

Stigma is defied as a mark of disgrace or discredit that is used to identify and separate out people whom society sees as deviant, sinful, or dangerous. Misperceptions about vulnerable subgroups of the population must be corrected. In the report of the new freedom commission on mental health, achieving the promise: Transforming mental health care in America, (2003), stigma is defined as “a cluster of negative attitudes and beliefs that motivate the general public to fear, reject avoid, and discriminate against people with mental illness”.
For the psychiatrically ill, stigma is a barriers that separates them from society and keeps them apart from others.

The impact of their stigma is enormous. Nearly two thirds of people with diagnosable mental disorders do not seek treatment, and stigma related to mental illness is one of the major barriers that discourage people from seeking needed care. Another sign of stigma is evident in the public reluctance to pay for mental health services and to provide the same coverage for physical and mental health care.

Patients and their families often report that the diagnosis of a mental illness is followed by increasing isolation and loneliness as family and friends withdraw.
Patients feel rejected and feared by others, and their families are met by blame.
Yet stigma must be over come reducing stigma must involve programs of public advocacy, public education on mental health issues, and contact with persons with mental illness through schools and other social situation. Another way is to reduce stigma is to find causes and effective treatments for mental disorders.
Mental health professionals can educate the public and teach them that metal health is a continuum and mental illness is caused by a complex combination of factors. The public needs to realize that mental disorders are no the result of moral failing or limited will power, but rather they are legitimate medical illness or emotional problems that respond to specific treatment.


EVALUATION OF PREVENTIVE MENTAL HEALTH

When talking about ‘primary prevention’ there is a tendency to think in terms of the total elimination of ‘mental illness’ and ‘stress’. Yet there are not realistic goals, and maintaining them can only discourage any possible action. Perhaps it is possible to set goals of reducing suffering and enhancing the capacity to cope, but even there may be unattainable, given that the environment is constantly changing and adaptation is an ongoing challenge. Rather, if the focus is directed toward specific problems of a vulnerable group in society, nursing activity becomes more concentrated and the change of success increases.
Clearly a need exists for the evaluation of programs in primary prevention. In a world of shrinking resources, only programs with proven effectiveness are likely to be supported in the future.

It must be demonstrated that the prevention strategy used has both short-term and long-term effects that will benefit the individual and society. Also it is necessary to determine whether the specific strategy implemented was the most effective, appropriate and efficient considering alternative approaches and comparing clinical and financial outcomes are essential aspects of the evaluation process.

Although preventing all illness is not possible preventing some particular problems is but a number of barriers exit that make expansion of primary prevention activities difficult. When faced with a choice, the needs of the ill consistently take precedence over promoting prevention. This holds true for nurse providing care as well as for the larger society yet by being more visionary, both groups could benefit greatly.

SUMMARY:

Supporting social systems means strengthening the social supports in place to enhance their protective factor and developing ways to buffer or cushion the effects of a potentially stressful event. Mental health promotion includes activities related to reducing stigma by dispelling myths and stereotypes associated with vulnerable groups, providing knowledge of normal parameters, increasing sensitivity to psychological factors affecting health and illness, and enhancing the ability to give sensitive, supportive and humanistic health care. Also it is necessary to determine whether the specific strategy implemented was the most effective, appropriate and efficient.


REFERENCE:

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2. Johnson B.S. Psychiatric mental health nursing. 4th ed. Philadelphia: Lippincott 1997. Pp 258-273.

3. Taylor C.M. Mereners. Essentials of psychiatric nursing. 12th ed. St. Louis: CV Mosby. 1986. Pp 536-559.

4. Sheives. L.R, Isaacs.A. Concept of psychiatric mental health nursing. 5th ed. Philadelphia: Lippincott. 2002. Pp 178-183.

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7. Fortinash. K.M. Holoday P.A. Psychiatric Mental health nursing. Philadelphia: Mosby. 1996. Pp 520-526.


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