Basic Concepts of Psychiatric–Mental Health Nursing

The aim of this edition has been to address current issues and trends in psychiatric-psychiatric health care in order to promote competence in the delivery of mental health care. Clinical psychopharmacology, which includes a practical knowledge of the pharmacodynamics and pharmacokinetics of psychoactive substances and the potential for drug-drug interactions, is an integral part of psychiatric-psychiatric nursing.

TEXT ORGANIZATION

As a result of these changes and limitations in the provision of psychiatric-mental health care, student nurses are now challenged to apply the basic concepts of psychiatric-mental health care in diverse settings.

Pedagogic Features

New and Expanded Features and Content

The same format used for Unit VI, such as discussion of etiology, theory, clinical symptoms, application of the nursing process, and continuum of care, is followed as appropriate.

ANCILLARY PACKAGE

STUDENT RESOURCE DVD-ROM

CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 5
CHAPTER 6
CHAPTER 7
CHAPTER 8
CHAPTER 9
CHAPTER 10
CHAPTER 11
CHAPTER 12
CHAPTER 13
CHAPTER 14
CHAPTER 15
CHAPTER 16
CHAPTER 17
CHAPTER 18
CHAPTER 19
CHAPTER 20
CHAPTER 21
CHAPTER 22
CHAPTER 23
CHAPTER 24
CHAPTER 25
CHAPTER 26
CHAPTER 27
CHAPTER 28
CHAPTER 30
CHAPTER 31
CHAPTER 32
CHAPTER 33
CHAPTER 34
CHAPTER 35

Theories of Personality Development 370 Etiology of Personality Disorders 372 Characteristics of Personality Disorders 373 Clinical Symptoms and Diagnostic Features of Personality Disorders 374. Overview of Gender Identity and Sexual Orientation 428 Clinical Symptoms and Diagnostic Features of Gender Identity Disorders 430.

UNIT I

LEARNING OBJECTIVES

KEY TERMS

Nursing students have described psychiatric-mental health nursing as a challenging experience that provides an opportunity for personal and professional growth. Working with clients who exhibit a wide range of clinical symptoms of various psychiatric-mental health disorders can elicit a variety of emotional or behavioral responses.

SELF-AWARENESS

Therefore, many individuals who would benefit from mental health services choose not to attend or fail to participate fully once treatment has begun (Corrigan, 2004; Hayden, 2007). Clients in the psychiatric-mental health clinical setting should receive emotional support as part of their care plan.

FREQUENTLY ASKED

The following Self-Awareness Exercise is designed to help you identify personality traits you may possess. Throughout this text, Self-Awareness Prompts are presented to encourage you to examine attitudes and feelings toward clients who exhibit various clinical symptoms.

QUESTIONS BY STUDENT NURSES

These examples are provided to stimulate your introspection or self-reflection prior to your clinical experience in the psychiatric setting. After you resolve fundamental issues and concerns about this clinical experience, you will grow in confidence in your ability to interact with clients in a variety of settings.

These traits often develop over time as the individual matures and engages in interactions with clients and others during the clinical experience.

How Do I Introduce Myself?

What Do I Wear?

What if I Say the Wrong Thing?

SELFAWARENESS PROMPT

Be Left Alone with a Client?

What if the Client Becomes Violent?

RECOMMENDATIONS BY STUDENT NURSES

KEY CONCEPTS

When assuming the role of a student nurse in the psychiatric-mental health setting, what behaviors would be most effective in helping achieve personal and professional growth. Which of the following are good guides for your clinical practice, regardless of what type of rotation you participate in.

KEY TERMSLEARNING OBJECTIVES

Adverse circumstances such as poverty, poor physical health, unemployment, abuse, neglect, and unresolved childhood loss Psychiatric-mental health nursing includes the diagnosis and. Psychiatric-mental health nursing is holistic and considers the needs and strengths of the individual, family, group, and community (American Nurses Association [ANA], 2000).

CONCEPT OF MENTAL HEALTH

Childhood upbringing refers to the interaction between family and child, which also affects the development of mental health. This chapter serves two main purposes: to introduce the concepts of mental health and mental illness and to describe the historical development of the role of the psychiatric-psychiatric nurse.

Factors Inﬂ uencing Mental Health

These negative reactions put a person at risk for depression, substance abuse or other mental health disorders. Supporting Evidence for Practice 2-1 provides information about the possible impact of the environment on mental health.

Characteristics of Mental Health

Factors Affecting Mental Health Maintenance

Cliché Conversation—No sharing of oneself occurs during this interaction. Statements such as

Reporting of Facts—Communicating at this level reveals very little about oneself and minimal

Spontaneous, Here-and-Now Emotions—

Introjection Unconscious application of another person's philosophy, ideas, habits, and attitudes to oneself. Replacement Unconscious replacement of unacceptable impulses, attitudes, needs, or emotions with more acceptable ones.

Personal Strategies for Mental Health Maintenance

CONCEPT OF MENTAL ILLNESS

Stigma and Perceptions About Mental Illness

According to statistics provided by the National Institute of Mental Health (2004), more than 40 million Americans have a psychiatric diagnosis at any given time. Can delay gratification Desires or demand immediate gratification Mental health reflects a person's approach to life through commu-.

Diagnosis of a Mental Illness

Early detection and treatment can alleviate symptoms and allow the person to function normally in society. These public revelations have, in part, contributed to greater public understanding of the causes and treatment of mental illness (Mayo Clinic.com, 2008).

HISTORICAL DEVELOPMENT OF PSYCHIATRIC–MENTAL

As a result of deinstitutionalization and the implementation of managed care, clients are enabled to function as independently as possible.

Middle Ages to 1773

Other Developments Since the 1950s

1949 The National Institute of Mental Health was established to (1) provide grants, (2) fund training programs and demonstration projects, and (3) provide support for research. 2007 Paul Wellston Mental Health and Addiction Equity Act was introduced by the House of Representatives.

PSYCHIATRIC–MENTAL HEALTH NURSING: SCOPE AND

The Mental Retardation Facilities and Community Mental Health Centers Act provided federal funding to help state and local agencies decentralize mental health care, provided community-based services and substance abuse treatment facilities, and proposed that mental health programs in the community include special programs for the treatment of children and the elderly. The Mental Health Systems Act of 1980 (1980), intended to strengthen existing community efforts and develop new initiatives, was never implemented because of the 1981 legislation.

STANDARDS OF PRACTICE

Greater emphasis was placed on the biological aspects of mental illness and on advances in neuropharmacology. Untreated hypothyroidism can play an unanticipated role in treatment resistance and development.

PSYCHIATRIC–MENTAL HEALTH NURSING TODAY

High-dose electroconvulsive therapy on the right side of the brain increases the effectiveness of therapy while reducing adverse effects. Alcoholics can be divided into subgroups of type A or B according to the etiological elements of the disease, the onset and.

Education

Assessment: The psychiatric–mental health registered nurse collects comprehensive
Diagnosis: The psychiatric–mental health registered nurse analyzes the assessment data to
Outcomes Identiﬁ cation: The psychi- atric–mental health registered nurse identiﬁ es
Planning: The psychiatric–mental health registered nurse develops a plan that prescribes
Implementation: The psychiatric– mental health registered nurse implements the identiﬁ ed
Evaluation: The psychiatric–mental health registered nurse evaluates progress toward

Implementation: Psychiatric - mental health registered nurse implements the defined health registered nurse implements the defined plan. Milieu therapy: A registered psychiatric and mental health nurse provides, structures and maintains a safe and therapeutic environment in.

Career Opportunities

Nurses can also apply for a certificate of competency in psychiatric nursing from organizations such as the ANA. Certification is available for various levels of psychiatric nursing, such as generalist, clinical specialist, and nurse practitioner.

Expanded Role of the Psychiatric–Mental Health Nurse

Quality of Practice: The psychiatric– mental health registered nurse systematically evaluates the
Education: The psychiatric–mental health registered nurse attains knowledge and compe-
Professional Practice Evaluation: The psychiatric–mental health registered nurse evalu-
Collegiality: The psychiatric–mental health registered nurse interacts with and contributes to the
Collaboration: The psychiatric–mental health nurse collaborates with patients, family, and
Ethics: The psychiatric–mental health registered nurse integrates ethical provisions in all
Research: The psychiatric–mental health registered nurse integrates research ﬁ nd-
Resource Utilization: The psychiatric–
Leadership: The psychiatric–men- tal health registered nurse provides leadership

Applying Psychiatric and Mental Health Nursing Skills to Career Opportunities Career Opportunities Applying Psychiatric and Mental Health Nursing Skills. Which of the following nursing functions is different in current psychiatric and mental health nursing compared to practice from 1915 to 1935.

NURSING THEORY AND RESEARCH

This chapter highlights the major theories and nursing theorists and describes the application of nursing theory to psychiatric-psychiatric nursing. It is the result of collaborative research conducted by mental health nurses and clients who have used mental health services that focused on the continuous process of change inherent in all people.

Nursing Theories

It is the first model of mental health care to be used as a foundation for interdisciplinary mental health care with the goal of empowering clients to lead their own recovery rather than being managed by professionals. It is based on the nurse's need to be aware of and sensitive to the clients' cultural needs.

APPLICATION TO PRACTICE

Lived human experiences such as loss and grief are believed to respond well to interventions based on Parse's theory. Leininger's Theory of Diversity and Universality of Cultural Care developed in 1973 states that care is universal and varies cross-culturally.

AGREEMENT AMONG NURSING THEORISTS

Needs-Oriented Approach

Interaction-Oriented Approach

Outcome-Oriented Approach

Eclectic Approach

34 UNIT II Special Issues Related to Psychiatric Mental Health Nursing Psychiatric mental health nursing provides care for clients who. Therefore, it is essential to include knowledge about the spiritual needs of clients and their cultural diversity in psychiatric mental health nursing.

SPIRITUALITY

Psychiatric nursing considers how the relationships between these factors affect the client with mental illness. Because of the increasing cultural diversity in the United States, the nurse encounters clients with spiritual beliefs, customs, and lifestyles that differ from his own.

CULTURE AND NURSING

The client and the nurse may therefore be members of very different subcultures, as well as share membership in other specific subcultures. In psychiatric-mental health nursing, the nurse must be sensitive to factors that affect the client and to the influences on his or her own behavior.

Culturally Congruent Nursing Care

In maintaining/maintaining cultural care, the nurse assists the client in maintaining health practices derived from membership in a particular ethnic group. In cultural care remodeling/restructuring, the nurse educates the client to change practices that are not conducive to health.

POPULATION GROUPS

In cultural care accommodations/negotiation, the nurse adapts nursing care to accommodate the client's beliefs or negotiate aspects of care that would require the client to change. The nurse meets this wish and negotiates with the client to include the rituals of the tribal healer in his medical treatment.

USE OF MENTAL HEALTH

Andrews and Boyle (2008) point out in their discussion of panethnic groups that the nurse should ask the client, "With which cultural group(s) do you identify?" This question allows the client to establish his own ethnicity and helps the nurse avoid making assumptions about ethnicity.

SERVICES BY ETHNIC GROUPS

Nature of the Mental Health System

Socioeconomic Status of Ethnic Groups

38 UNIT II Special Issues Related to Psychiatric-Mental Health Nursing Poor living conditions and lack of financial resources. Psychiatric-mental health care, like other health care, tends to occur as a crisis intervention for those individuals without sufficient income to meet basic needs.

CULTURAL PERCEPTIONS

Although the need for services may be increased, help may not be accessible due to lack of finance. The psychiatric mental health nurse meets clients with multiple, complex problems related to the effects of poverty, whose insurance plans do not pay for psychiatric care, or who lack family resources for payment.

MENTAL ILLNESS AS A SPIRITUAL CONCERN

Even when available, services may not be used due to fundamental cultural differences between providers and users of these services. The nurse working in the community or in a hospital emergency department encounters many clients who, because they are unable to pay for health care or early intervention, seek treatment only for serious illnesses.

MENTAL ILLNESS AS

IMBALANCE OR DISHARMONY IN NATURE

CULTURAL EXPRESSIONS OF MENTAL ILLNESS AND

PSYCHIATRIC NURSING OF ETHNIC GROUPS

Ethnopharmacologic Considerations

Psychiatric and mental health nurses should be aware of the increased incidence of adverse events in Asian and African American ethnic groups, with an emphasis on further collection of data related to dosing and incidence of adverse events. Non-biological factors such as diet and nutrition also influence the action and adverse effects of psychotropic drugs.

Role of Family

Some Asian clients metabolize these drugs more slowly than whites and require smaller doses. The nurse also teaches the client and family about measures to combat adverse effects and the importance of reporting any adverse effects experienced.

Role of Healers

For example, herbal and homeopathic remedies taken by clients may alter responses to medications. The nurse asks assessment questions about the use of herbal and homeopathic remedies and communicates this information to the physician who is collaborating on the treatment plan.

Role of Translators

If a translator with these qualifications is not available, someone from the client's culture is used. The nurse demonstrates patience by speaking directly to the client and using eye contact that is consistent with the client's culture.

THE NURSING PROCESS

Ideally, the translator will have knowledge of the client's specific ethnic group and an appropriate professional background in mental health. When using a translator, it is important that you are given additional time to discuss the client's answers.

Assessment

Avoids interrupting the client and translator or using medical jargon or slang. The client's use of any alternative therapies, including herbal or other nutritional substances or drugs, may interfere with prescribed psychotropic medications.

Nursing Diagnoses and Outcome Identiﬁ cation

Information about religious and spiritual practices and the use of healers helps the client maintain practices that are congruent with his or her ethnic group. The explanation by the client and family about the cause of the illness and beliefs about treatment provide relevant data with which to ensure culturally relevant treatment.

Implementation

The nurse also ensures that the family is a part of any teaching related to the client's. The nurse supports the client and family in their beliefs regarding the use of healers and facilitates their use in treatment.

NURSING PLAN OF CARE 4.1

The nurse's knowledge of the client's culture is used to select culturally congruent actions. The nurse facilitates this visit by speaking for the client at the treatment team meeting.

ETHICS IN NURSING

The daily practice of psychiatric-mental health care is full of value-laden decisions that require the use of critical. This chapter discusses the major ethical and legal issues that arise in psychiatric-psychiatric nursing.

Model of Ethical Nursing Care

The nurse promotes, advocates and strives to protect the health, safety and rights of the patient. Is anyone else aware of the client's depression, or does the client wish to keep the information confidential.

Ethics in Pain Management

52 UNIT II Special Issues Related to Psychiatric-Mental Health Nursing Chally and Loriz (1998) developed a six-step ethic. The nurse evaluates whose problem it is, who should make the decision about the use of antidepressant medication, who is affected by the decision and which ethical principles are related to the problem.

Ethics in Genetic Testing and Clinical Research

LEGAL ISSUES IN NURSING

Malpractice

Only healthcare providers who care for a client can view the client's medical records. Failure to comply with the duty to warn is another form of malpractice that nurses in psychiatric healthcare encounter.

Bill of Rights for Psychiatric–Mental Health Clients

The client subsequently killed the woman, and her parents successfully sued the psychologist and the Regents of the University of California for failure to warn. Discontinuing treatment without providing alternatives to care means that the mental health professional has left.

Advance Psychiatric Directives

These rights are adapted from the Mental Health Systems Act of 1980 and the Protection and Advocacy Bill for Mentally Ill Individuals Act of 1986. The exception arises when the public is threatened; the client is transferred to another facility; the client's lawyer, law enforcement authorities or a court requests information; the client participates in research; or insurance companies require information to complete insurance claims;.

Psychiatric Hospitalization

During these 72 hours, the client still retains the right to make decisions about care, including the decision to refuse treatment or prescribed medication. Then, if the client is located, they are returned to the crisis center or mental health facility from which the escape occurred.

Long-Term Care Facilities

In such a situation, a psychiatric consultation is required to determine whether the client is capable of making a stable, informed medical decision, meets the criteria for civil commitment, or is incapacitated, as noted in the following discussion (Kirn, 2007). Based on the information presented at the hearing, the court may order the client to remain in the institution for a certain period (civil commitment) or be released from the institution.

Role of the Forensic Nurse

The Legal Nurse Consultant (LNC) is a specialist area within forensic nursing. The client tells the nurse, “I really don't know why I need this procedure, but everyone has been telling me it's the best thing to do.” The basis for the ethical dilemma facing the nurse in this situation most likely includes which of the following.

SCOPE OF FORENSIC NURSING PRACTICE

INTRODUCTION TO FORENSIC NURSING PRACTICE

HISTORY OF FORENSIC NURSING PRACTICE

The current publication of the Standards of Forensic Nursing Practice consists of the Standards of Care and the Standards of Professional Performance. The Standards of Care describe a competent level of forensic nursing practice as demonstrated by the nursing process.

THE FORENSIC NURSE’S CODE OF ETHICS

It also defines the services provided to all forensic nurse or physician clients, including providing culturally and ethnically relevant services, maintaining a safe environment, and planning for continuity of care and services. Professional Performance Standards describe a competent level of behavior by the forensic nurse, including activities related to quality of services, performance evaluation, education, collegiality, ethics, collaboration, research, and use of resources (ANA & IAFN, 1999).

Unique Characteristics of Forensic Nursing

STANDARDS OF FORENSIC NURSING PRACTICE

Forensic nursing education can be obtained through colleges and universities that offer online courses, distance education, or on-campus education. Curriculum courses for forensic nursing include interview skills; documentation; collection of forensic evidence; and criminal, procedural and constitutional law.

Practice Areas

Special Roles of the Forensic Nurse

Standards of Forensic Nursing Practice consist of Standards of Care and Standards of Professional Performance. Forensic nursing is considered one of the fastest growing nursing specialties in the 21st century.

LOSS

Coping styles (see Chapter 2) depend on medical, psychological, cultural and social factors, as well as the individual's personality and experiences. Today's fast-paced healthcare environment conditions us to view death as a physiological event rather than a sacred passage of life and as a failure rather than part of the human cycle (Rushton, Roshi, & Dossey, 2007).

Types of Loss

Caring for clients experiencing bereavement or who are terminally ill is an integral part of nursing; but, because we live in a culture characterized by dramatically different responses to experiences of loss and grief, nurses often feel inadequate in planning interventions to facilitate grief management and the healing process, or to accompany clients during the dying process. This chapter provides information to familiarize the student with the concepts of loss, grief, and end-of-life care as experienced by individuals, families, and/or their significant others.

GRIEF

The individual experiences emotional detachment from the object or person, which eventually allows the individual to find other interests and pleasures. The accumulation of losses over time can lead to grief overload if the individual is unable to process the grief or pain.

Grief Theory

Unresolved or Dysfunctional and Disenfranchised Grief

Opted-in grief is a term that describes the experience of individuals whose grief is not recognized or supported by their social network, or who are excluded from participating in grief-related rituals (Schultz & Videbeck, 2009).

END-OF-LIFE CARE

For example, a client who is aware that death is imminent and has not yet made a living will may let the nursing staff know that he or she wants all medications, including intravenous (IV) therapy, to be discontinued.

Ethnic Considerations and Cultural Sensitivity

Advance Care Planning

State the name of the person you want to make health care decisions about medical tests,
Describe the kind of medical treatment you want or don’t want. Choices are listed for clinical
State how comfortable you want to be
Describe how you want people to treat you. This wish addresses the spiritual needs of
Explain what you would like your loved ones to know. This wish addresses how the client

Cultural competence requires nurses to see clients through their own eyes and the eyes of the client and family. The client has the right to choose how much information he or she wants to hear.

Palliative Care and Hospice Care

Believe the client, family, and/or signiﬁ cant other in their reports of pain and what relieves it

Choose pain-control options that are appropriate for the client, family, or signiﬁ cant other

Deliver nursing interventions in a timely, logical, and coordinated fashion

Department of Health and Human Services is involved in research initiatives to improve care at the end of life. Clients with life-limiting conditions may benefit from research developments as understanding of the unique aspects of end-of-life care improves (Knebel, 2002).

Spiritual Needs

Dying is a deeply personal matter, and end-of-life care, such as hospice, provides a final respite and a time of acceptance and peace for both the client and the client's family or significant other. If discussing various spiritual issues is uncomfortable, the nurse may suggest that the client talk to the hospital chaplain, the client's own clergy, members of his or her congregation, or other clients with similar religious beliefs.

CHILDREN AND DEATH

Are you comfortable providing end-of-life care for clients whose cultural beliefs and practices may differ from your own? A woman diagnosed with terminal breast cancer discusses her wishes for end-of-life care, including her funeral, with her husband.

INPATIENT CARE

A complete range of programs and services that treat the whole person from wellness to illness to recovery within the community is called the continuum of care. The continuum of care is designed to meet the biopsychosocial needs of a client at any given time.

Acute Care Facilities

This chapter focuses on the continuum of care available to clients as they progress from the most restrictive clinical setting (hospitalization) to the least restrictive clinical setting in which they reside. The continuum of care may continue in subacute care units, transition units, nursing homes or skilled nursing facilities, or adult day care, or may be part of home care, as depicted in Figure 8-2.

Subacute Care Units

If a client meets the criteria for a serious mental illness (excluding dementia or organic brain disorders), state mental health authorities must provide mental health services or arrange for these services to be provided in the LTC facility. Direct admissions may also occur from psychiatric hospitals or community mental health centers (CMHCs) once clinical symptoms have stabilized and continued care is necessary.

COMMUNITY MENTAL HEALTH

For example, clients who exhibit anxiety or depression due to relocation or loss, delirium due to adverse drug reactions or medical problems (eg, urinary tract infection), or behavioral disturbances due to changes in mental status may also require consultation. A psychiatric consultation or evaluation is often required by the treating physician to determine the cause of the change in mental status, mood, or behavior.

Historical Development of Community Mental Health

As noted in Chapter 2, the New Freedom Commission on Mental Health was formed on April 29, 2002, as a result of an executive order from President George W. This commission is charged with studying the mental health care system in the United States. United States.

Types of Community Mental Health Services

With a greater emphasis on mental health in the community in the 1960s, programs were established to treat psychiatric clients at home with the care of a visiting nurse. Psychiatric home care can fill a gap in the mental health care continuum by providing nursing resources as an adjunct to outpatient treatment.

Role of the Community Mental Health Nurse

Visiting a primary care setting eliminates the stigma of seeking mental health care in a segregated mental health setting. The presence of field mental health practitioners in the primary care setting has resulted in improved recognition and treatment of psychiatric disorders (Roberts, Robinson, Stewart, & Wright, 2008).

THE CONTINUUM OF CARE IN THE 21ST CENTURY

Miller further stated that community mental health nurses must continue to broaden their roles to include a more holistic approach in the assessment, planning and implementation of community services. Interview a local mental health nurse about the system in which he or she works.

CLIENT ASSESSMENT

The nursing process is a deliberate, six-step problem-solving approach to meeting the health care and nursing needs of clients. The nursing process sets nursing practice in motion and serves as a monitor of quality nursing care.

Cultural Competence During Assessment

For example, a screening assessment using the Abnormal Involuntary Movement Scale could be used to evaluate the frequency and severity of a client's movement disorder during neuroleptic drug administration to stabilize the clinical symptoms of schizophrenia. During each assessment, the psychiatric-mental health nurse uses a psychosocial nursing history and assessment tool to obtain factual information, observe the client's appearance and behavior, and evaluate the client's mental or cognitive status.

Types of Assessment

Recognizing that differences exist is the most important thing a psychiatric mental health nurse can do. See Chapter 4 for more detailed information about the cultural competence of the psychiatric-mental health nurse. the client must give permission for a family member or an interpreter to be involved in the hearing; otherwise there could be a breach of client confidentiality.).

Behavior, Attitude, and Coping Patterns

When conducting the interview, always record a verbatim response to questions about the client's mood and note whether an intense emotional response accompanies the discussion of specific topics. The person with emotional conflict may have a persistent emotional reaction based on this conflict.

COLLECTION OF DATA

Affective responses may be appropriate, inappropriate, unstable, blunted, limited or limited, or flat. The lack of an affective response to a highly emotional event may also be considered inappropriate, such as not showing emotion when discussing the death of a close family member or when discussing another traumatic event.

Appearance

A leading question like "What do you feel?" can elicit responses such as "nervous", "angry", "frustrated", "depressed". As the investigator or observer, identify the abnormal emotional response and explore its depth, intensity, and persistence.

Affect or Emotional State

These techniques are selected to meet the needs of the client and can be modified based on their effectiveness during the nurse-client interaction (Schultz & . Videbeck, 2009). Their behavior may be the result of inadequate coping patterns or the lack of a support system.

Communication and Social Skills

This impairment is commonly found in clients with mania and those with certain cognitive impairments, such as early stage dementia or mild delirium. This is observed in clients with certain psychotic reactions or clients with cognitive impairment disorders.

Content of Thought

For example, a client expresses a recurring desire to gamble even though his wife has threatened to divorce him if he does not stop playing poker. Compulsions are often seen in clients with anxiety, obsessive-compulsive or personality disorder, body dysmorphic, eating, or autism spectrum disorders.

Orientation

If the person does not perform the repetitive action, he or she usually experiences feelings of tension and anxiety.

Memory

Religious and spiritual beliefs often play an important role in the lives of the elderly. Non-judgmental questions asked in a matter-of-fact manner may focus on the religious background of the client, parents, spouse or significant other;.

Intellectual Ability

Ignoring spiritual assessment of clients, including those with severe and persistent mental illness, deprives clients of the opportunity to reflect on the meaning of their disorder, to use their religious beliefs or spiritual practices as a means of coping with their illness, or to consider ways , in which their beliefs may contribute to their suffering (Kehoe, 1999; Zoler, 2007). Obtaining a spiritual history enables nurses to identify significant spiritual practices that may influence care.

Insight Regarding Illness or Condition

Spirituality

Sexuality

Newborns have many short periods of sleep for a total of about 16 to 20 hours of sleep per day. Dyssomnias are disorders in which a client has difficulty with the amount, quality, or timing of sleep, such as sleep apnea, insomnia, narcolepsy, and periodic restless legs/limb movement disorder.

Neurovegetative Changes

Because insomnia is common in clients with psychiatric disorders, nurses should ask the client about any sleep pattern disturbances in order to plan appropriate interventions. In addition, patients with serious medical problems usually present with clinical symptoms of comorbid psychiatric and mental disorders, such as

MEDICAL ISSUES

In the past, psychiatric nurses were trained to assess clients for emotional and behavioral changes in the psychiatric-mental health clinical setting, while other members of the multidisciplinary treatment team attended to medical issues. Additionally, population studies have shown that clients with mood disorders are also likely to have an endocrine disorder such as hypothyroidism or diabetes mellitus or a cardiovascular disorder such as cardiomyopathy.

Pain

For example, hypothyroidism or congestive heart failure can cause subtle or overt changes in energy, mood, anxiety level, or cognition. Depression or anxiety associated with various major medical illnesses such as cardiovascular disease, stroke, or Parkinson's disease can impede medical treatment and increase mortality if clinical symptoms of the disorders are not identified and treated (Ellen, 2001; Geracioti, 2006).

Physiological Responses to Medication

However, collaboration and communication between psychiatric nurses, primary care providers and other clinicians is becoming increasingly critical.

Supporters or Caregivers Assessment

The nurse documents what the client says by stating facts and quoting the client's conversation. All examinations, treatments, medications, therapies, nursing interventions and the client's response to them should be included in the client's chart.

DOCUMENTATION OF ASSESSMENT DATA

The nurse expects a client exhibiting flow of ideas to do which of the following. Assessing Client Response to Interventions The nursing process is an ongoing, systematic series of actions, interactions, and transactions.

NURSING DIAGNOSIS

118 UNIT III Components of the Nurse-Client Relationship As stated in Chapter 9, the nursing process consists of six steps and uses a problem-solving approach. Planning (formulation of a nursing care plan) 4. Implementation of nursing actions or efforts 5. Evaluation of the client's response to efforts The nursing process is an ongoing, systematic series of actions, interactions and transactions.

Diagnostic Systems

The student collected data regarding the client's emotional response to her medical condition and her ability to cope with the diagnosis of a terminal condition. The student nurse then validated the psychosocial data with the head nurse and asked the client to verify his statements during the assessment.

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision

DSM-IV-TR)

Psychodynamic Diagnostic Manual (PDM)

Mnemonics

Do you have difficulty distinguishing one diagnosis (e.g. disturbed sleep pattern) from another (e.g. activity intolerance).

Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention

Personality Disorders and Mental Retardation Examples: 301.83: Borderline Personality Disorder,

General Medical Conditions (with ICD-9-CM codes)

Psychosocial and Environmental Problems This axis is for reporting psychosocial and envi-

Global Assessment of Functioning (GAF) This axis is for reporting the clinician’s judgment

OUTCOME IDENTIFICATION

Do they present a systematic approach to organizing data and formulating a nursing diagnosis? The expected results serve as a record of changes in the client's health status (ANA, 2000; Schultz & Videbeck, 2009).

PLANNING

They must be clearly stated by the nurse and they must describe the expected end result of the care. Critical pathways are care plans that contain interdisciplinary practice guidelines (eg, for bipolar disorder) with predefined standards of care (Critical and Clinical Pathways, 2003).

IMPLEMENTATION

Lerner and Colone (1996) discuss the development and use of clinical pathways for clients with psychiatric-mental health disorders. Managed care companies use standardized nursing care plans and clinical pathways to balance quality of care and cost control.

EVALUATION

Their intent is to avoid or limit what is considered unnecessary treatment, such as using brand-name drugs instead of generic drugs, requesting repeat laboratory work, and using multiple therapies when the prognosis of the client's disease is limited or poor. . The PMHN community has agreed to use the existing NANDA classifications until further integration of the two models takes place.

NURSING PLAN OF CARE 10.1

As you developed the plan of care for the client listed in Question 4 of the Critical Thinking Questions, did you encounter any difficulties arriving at a nursing diagnosis or diagnoses. I would do anything before she divorces me." Which of the following would be the priority nursing diagnosis for this client.

COMMUNICATION

Factors Inﬂ uencing Communication

She's so easy to get along with," and "I could talk to him for hours" are just a few comments made about people who have the ability to relate well to others. 130 UNIT III Components of Nurse-Client relationship, the child may not be able to relate to him about the incident that occurred earlier.

Types of Communication

In contrast, a nurse sitting in a chair, leaning slightly forward and maintaining eye contact with the patient gives the impression that she is interested in what the client is saying or doing (Figure 11-2). A child suffering from abuse may recoil from a nurse's attempt to comfort him, while a dying person may be comforted by the presence of a nurse sitting at the bedside quietly holding his hand.

SOCIAL AND THERAPEUTIC COMMUNICATION

For example, handshakes, hugs, holding hands, and kisses typically denote positive feelings for another person. The client with depression or grieving may respond to touch as a gesture of concern, whereas the client who is sexually promiscuous may consider touch an invitation to sexual advances.

Conﬁ dentiality During Communication

Making broad openings or asking open-ended questions Is there something you want to do. Needs are identified by the client with the assistance of the nurse if necessary.

Effective Therapeutic Communication

Encouraging verbalization of feelings after the death of one's child or exploring ways to cope with increased stress are examples of therapeutic help. Seeking clarification or clarification I'm not sure I understand what you're trying to say.

Ineffective Therapeutic Communication

Your nonverbal communication can contradict your spoken words if you are not honest with the customer. Such a response puts the nurse in control of what is being discussed and diminishes the importance of the client's statements.

THE ONE-TO-ONE

For example, during a physical examination, a young female client states to the nurse that she cannot have oral sex with her husband. The nurse feels uncomfortable with the topic of oral sex and tells the client that she wants to take her vital signs before her lab work is drawn, thus cutting off communication.

NURSE–CLIENT THERAPEUTIC RELATIONSHIP

Someone preoccupied with thoughts is not as receptive to messages as a person with a clear mind. A person who hears voices saying that he or she is being poisoned may not be receptive to a nurse's request to take medication.

Conditions Essential for a Therapeutic Relationship

Boundaries of Therapeutic Relationships

A boundary violation occurs when the nurse uses the nurse-client relationship to satisfy emotional, financial, or sexual needs. Consequently, the relationship between the nurse and the male client becomes unacceptable by violating the therapeutic needs or basic rights of the client (Bensing, 2007;

Roles of the Psychiatric–Mental Health Nurse in a Therapeutic Relationship

Such a boundary crossing can be a short excursion over a personal boundary or lead to a boundary crossing by the nurse. The nurse is responsible for monitoring professional boundaries; acting as an advocate for the client; and to intervene, where necessary, to prevent or stop boundary violations (Nurses Board of South Australia, 2002).

Phases of a Therapeutic Relationship

The client begins to relax, trusts the nurse, and is able to discuss mutually agreed upon goals with the nurse as the assessment process progresses and a plan of care emerges. During the work phase, the client focuses on unpleasant, painful aspects of life while the nurse provides support.

Utilizing Therapeutic Interactions with Difﬁ cult Clients

The client may try to prolong the relationship as clinical symptoms of separation anxiety are experienced. Verbal Communication: Verbatim the communication, including what the customer says and your responses.

Process Recording

Which of the following situations should occur during the initial phase of the nurse-client relationship? Discuss the role of the psychiatric-mental health nurse in the therapeutic milieu or environment.

DEVELOPMENT OF THE THERAPEUTIC MILIEU

The environment in which the treatment service is provided is called the therapeutic environment. This chapter describes the development of the therapeutic environment, including the criteria for its creation.

COMPONENTS OF A THERAPEUTIC MILIEU

Participants in the Therapeutic Milieu

Interventions Used in the Therapeutic Milieu

When preparing educational materials, the nurse must also consider the client's cultural and ethnic identity. Once the nurse has established a therapeutic relationship with the client, she must inform the multidisciplinary team of the client's spiritual and religious needs.

EVALUATION OF THE THERAPEUTIC MILIEU

Which of the following interventions is appropriate for the nurse's role as a mother surrogate? Analyze the role of the psychiatric-mental health nurse in crisis intervention and disaster nursing.

CRISES

Types of Crises

If they are able to resume normal activities while living in the hospital and their son's illness, they are in the post-crisis phase. Experiencing a crisis and moving through the stages can result in permanent emotional damage or make new parents feel a stronger bond with each other and their son, depending on their ability to cope. .

Paradigm of Balancing Factors

Characteristics of a Crisis

Phases of a Crisis

She can cope by burying herself in her work, calling an emergency board of trustees meeting to discuss the situation, or withdrawing from the situation. Post-crisis begins May be at a higher level of maturity and adaptation due to acquisition of new positive coping skills, or may be functioning at a limited level in one or all areas of the personality due to denial, suppression, or mastery ineffective coping and problem solving. solving skills.

CRISIS AND DISASTER INTERVENTION

The client is encouraged to be active in all steps of the crisis intervention process, including clarifying the problem, verbalizing feelings, identifying goals and opportunities to achieve goals, and deciding on a plan. During a 3- to 4-hour session, participants are asked to describe the stressor, provide a factual account of the event, and then describe their thoughts during the event.

The Role of the Psychiatric–Mental Health Nurse or Nurse Practitioner During a

The assessment of a client during a crisis intervention depends on several factors, such as the severity of the crisis situation, the client's perception of the crisis and the correct interpretation of data to formulate a nursing diagnosis. The first factor in the assessment process is to determine the severity of the crisis situation and to identify the degree of disruption experienced by the client.

Steps in Crisis Intervention

The nurse helps the person establish an intellectual understanding of the crisis by noting the connection between the trigger and the crisis. As a result of any misunderstandings about the severity of the crisis event, the client in crisis may be misdiagnosed and receive inappropriate treatment.

Legal Aspects of Crisis Intervention*

This type of counseling is considered the preferred method of crisis intervention for children and young people. Mental health crisis intervention services are often hospital-based or attached to community mental health centers.

Crisis Intervention Modes

Suicide prevention and crisis intervention counseling centers offer 24-hour hotlines (Figure 13-2). Behavioral outreach programs designed to provide on-site crisis intervention services to persons with serious and persistent mental illness living in rural communities have been known to reduce psychiatric hospitalizations by approximately 60%.

Interventions for a Child or Adolescent in Crisis or During a Disaster

CRISIS AND DISASTER

INTERVENTION FOR CHILDREN AND ADOLESCENTS

Assessment of Children and Adolescents During a Crisis or Disaster

Resolution of a Child’s or Adolescent’s Response to a Crisis or Disaster

The nurse identifies that the client is in the initial impact of the crisis phase. The client fears that she will not be able to return to her previous independent lifestyle.

INDIVIDUAL PSYCHOTHERAPY

Other qualified professionals, such as licensed mental health counselors or licensed clinical social workers, can offer guidance or help the client see possibilities for problems discussed by the client in the context of the nurse-client relationship (ANA, 2007). If a client is also prescribed medication to stabilize clinical symptoms of a psychiatric disorder (eg, anxiety, depression), the therapist may choose to discuss the effectiveness of the medication with the client during a therapy session.

Modes of Individual Psychotherapy

Brief Cognitive Therapy

Behavior Therapy

Currently, when psychopharmacology (when indicated) is combined with BIPT, the relapse or recurrence of psychiatric disorders is dramatically reduced. Today, the combination of pharmacotherapy and psychotherapy is the most commonly used treatment modality for a wide range of psychiatric disorders.

INDIVIDUAL THERAPY WITH CHILDREN AND ADOLESCENTS

Parents may be involved to varying degrees depending on the age of the client and the nature of the identified conflict or disturbance. The therapist acts as an advocate and may be asked to make recommendations that affect various aspects of the client's life (American Academy of Child & Adolescent Psychiatry, 2005; Sadock & Sadock, 2008).

COUNSELING

ALTERNATE APPROACHES TO PSYCHOTHERAPY

TRANSCULTURAL PSYCHOTHERAPY

During which phase of individual therapy does the nurse expect problems to be noticed and coping skills to be learned. Which of the following forms of individual and active psychotherapy focuses on the here and now, with little emphasis on the cause of the problem?