LIPPINCOTT’S HANDBOOK FOR

(1)

(2)

(3)

LIPPINCOTT’S HANDBOOK FOR

PSYCHIATRIC NURSING

AND CARE PLANNING

(4)

(5)

LIPPINCOTT’S

HANDBOOK FOR PSYCHIATRIC

NURSING AND CARE PLANNING

Maryann Foley, RN, BSN Clinical Consultant

Foley Consulting, LLC

Flourtown, Pennsylvania

(6)

%GUYMWMXMSRW)HMXSV (IZIPSTQIRXEP)HMXSV (MVIGXSVSJ2YVWMRK4VSHYGXMSR 7IRMSV1EREKMRK)HMXSV4VSHYGXMSR 4VSHYGXMSR)HMXSV

%VX(MVIGXSV (IWMKR

%VX(MVIGXSV -PPYWXVEXMSR 1ERYJEGXYVMRK'SSVHMREXSV 4VSHYGXMSR7IVZMGIW'SQTSWMXSV

Library of Congress Cataloging-in-Publication Data

(7)

SSU UBBJJEEC CTT M MAATTTTEERR EEXXPPEERRTT

Maryann Foley, RN, BSN

REVIEWERS

Jean S. Anthony, PhD, MSN, RN

Joan C. Masters, EdD, RN

Gail Marlene Day, PhD, MSN, CNS Psy/MH, BC

Marilyn S. Fetter, PhD, APRN

Pamela J Nelson, PhD(c), MS, BSN, CNS, RN

v

(8)

(9)

PPRREEFFAAC CEE

0MTTMRGSXXoW,ERHFSSOJSV4W]GLMEXVMG2YVWMRKERH'EVI 4PERRMRK

7IGXMSR3RI

7IGXMSR8[S

vii

(10)

viii PREFACE

7IGXMSR8LVII

7IGXMSR*SYV

7IGXMSR*MZI

(71-:86

(11)

7IGXMSR7M\

7IGXMSR7IZIR

0MTTMRGSXXoW,ERHFSSOJSV4W]GLMEXVMG2YVWMRKERH'EVI 4PERRMRK

PREFACE ix

(12)

(13)

C

CO ON NTTEEN NTTSS

Section One: FOUNDATIONAL CONCEPTS OF PSYCHIATRIC-MENTAL HEALTH NURSING, 1

Chapter 1:

Core Concepts of Psychiatric-Mental Health Nursing, 2

Chapter 2:

Legal and Cultural Considerations, 23

Section Two: ASSESSMENT, INTERVIEWING, AND COMMUNICATION, 35

Chapter 3:

The Nurse–Client Relationship, 36

Chapter 4:

Common Psychiatric Assessment Tools, 47

Section Three: THERAPEUTIC MODALITIES, 107

Chapter 5:

Individual, Group, and Family Therapies and Interventions, 108

Chapter 6:

Integrative and Somatic Therapies, 138

Section Four: PSYCHOPHARMACOLOGY, 149

Chapter 7:

Anxiolytics/Sedative-Hypnotics, 150

Chapter 8:

Antidepressants, 185

Chapter 9:

Mood Stabilizers, 224

Chapter 10:

Antipsychotics, 237

Chapter 11:

Cognitive Enhancers, 269

Chapter 12:

Stimulants/Nonstimulants, 275

Chapter 13:

Miscellaneous Drugs, 291

Section Five: MENTAL HEALTH AND PSYCHIATRIC DISORDERS, 299

Chapter 14:

Anxiety Disorders, 300

Chapter 15:

Cognitive Disorders, 331

Chapter 16:

Dissociative Disorders, 349

Chapter 17:

Eating Disorders, 357

Chapter 18:

Impulse-Control Disorders, 375

Chapter 19:

Mood Disorders, 382

xi

(14)

xii CONTENTS

Chapter 20:

Personality Disorders, 397

Chapter 21:

Sexual and Gender Disorders, 427

Chapter 22:

Sleep Disorders, 436

Chapter 23:

Somatoform Disorders, 446

Chapter 24:

Substance-Related Disorders, 457

Chapter 25:

Thought Disorders, 488

Section Six: EMERGENCY SITUATIONS, 503

Chapter 26:

Anger and Aggression, 504

Chapter 27:

Abuse and Violence, 509

Chapter 28:

Suicide, 524

Chapter 29:

Crisis and Disaster, 529

Section Seven: SPECIAL POPULATIONS, 533

Chapter 30:

Forensic Clients, 534

Chapter 31:

Children and Adolescents, 538

Chapter 32:

Older Adult Clients, 563

Chapter 33:

Homeless Clients, 570

Appendices, 575

Appendix A:

Quick Reference to Disorders, 576

Appendix B:

Quick Reference to Therapeutic Modalities, 578

Appendix C:

Internet Resources, 579

Index, 585

(15)

Foundational Concepts of Psychiatric-Mental Health Nursing

one

S E C T I O N

(16)

2

C H A P T E R

1 Core Concepts of

Psychiatric-Mental Health Nursing

Mental Health

Mental health

7IPJKSZIVRERGI

4VSKVIWWXS[EVHKVS[XLSVWIPJVIEPM^EXMSR

(17)

CHAPTER 1Core Concepts of Psychiatric-Mental Health Nursing 3

8SPIVERGISJXLIYRORS[R 7IPJIWXIIQ

6IEPMX]SVMIRXEXMSR 1EWXIV]SJIRZMVSRQIRX 7XVIWWQEREKIQIRX

Mental Disorders and Mental Illness

Mental disorders

Mental illness

Incidence and Etiology

Classification

(18)

4 SECTION one Foundational Concepts of Psychiatric-Mental Health Nursing

box

1.1

DSM-IV-TRClassification System

WIITJSVXLIEGXYEP+%*

(MEKRSWXMGERH7XEXMWXMGEP1ERYEPSJ1IRXEP

(MWSVHIVW (71-:86

(71

Neurotransmission

Neurotransmitters

(19)

table

1.1.

Some Neurotransmitters and Their Functions Possible Implications NeurotransmitterPresumed Functionfor Mental Illness Biogenic Amines: Catecholamines Biogenic Amines: Indolamines 0S[PIZIPW ,MKLPIZIPW

5

GSRXMRYIHSRTEKI

(20)

table

1.1.

Some Neurotransmitters and Their Functions GSRXMRYIH Possible Implications NeurotransmitterPresumed Functionfor Mental Illness Biogenic Amines: Cholinergics Amino Acids )\GMXEXSV] -RLMFMXSV]

6

(21)

4W]GLSTLEVQEGSPSK]

Theories and Frameworks

[SVPH ZMI[W

(22)

table

1.2.

Neurotransmission

Presynaptic receptor

Receptor Na+

Neurotransmitter

Neurotransmitter Synaptic

cleft Postsynaptic

receptor

Ion channel Nerve Nerve impulse impulse Nerve impulse

Presynaptic neuron Synaptic vesicles

with neurotransmitter Neurotransmitter Synaptic cleft Postsynaptic receptor

Postsynaptic neuron Postsynaptic

membrane Ion channel Receptor

Defense Mechanisms

Defense mechanisms Synthesis and Release.

Binding.

(23)

table

1.3.

Major Neurotransmitter Pathways in Mental Health

Dopamine. (1)2MKVSWXVMEXEP

(2)1IWSPMQFMG

(3) 1IWSGSVXMGEP

(4)8YFIVSMRJYRHMFYPEV

Norepinephrine.

Basal ganglia

Nucleus accumbens Hypothalamus

Pituitary gland

Cerebellum Substantia nigra

Neocortex

Hypothalamus Temporal lobe Locus ceruleus

table

1.5.

Defense Mechanisms Defense MechanismDescriptionExample from Popular Culture 7E]%R]XLMRK 8LI3JJMGI 8LI7STVERSW )XIVREP7YRWLMRISJXLI7TSXPIWW1MRH 7IMRJIPH

17

GSRXMRYIHSRTEKI

(32)

table

1.5.

Defense Mechanisms GSRXMRYIH Defense MechanismDescriptionExample from Popular Culture ,SYWI *VMIRHW -XoWE;SRHIVJYP0MJI %QIVMGER&IEYX] 8LI&SYVRI-HIRXMX] 8LI4YVWYMXSJ,ETT]RIWW 0SWX 18

(33)

Anxiety

Anxiety versus Stress

(34)

Response to Anxiety

Levels of Anxiety

(35)

CHAPTER 1Core Concepts of Psychiatric-Mental Health Nursing 21 table

1.6.

Levels of Anxiety

Anxiety Psychological Physiologic

Level Responses Responses

(36)

Normal versus Abnormal Anxiety

box

1.2

Adaptive and Maladaptive Coping Mechanisms for Anxiety

(37)

23

Client Rights

Informed Consent

Informed consent C H A P T E R

2 Legal and Cultural

Considerations

(38)

box

2.1

Federal Bill of Rights for Mental Health Patients

GSRXMRYIHSRTEKI

(39)

box

2.1

Federal Bill of Rights for Mental Health Patients GSRXMRYIH

CHAPTER 2Legal and Cultural Considerations 25

(40)

Confidentiality

Health Insurance Portability and Accountability Act

(41)

Privileged Communication

TVMZMPIKIHGSQQYRMGEXMSR

Breach of Confidentiality

Treatment in the Least Restrictive Environment

(42)

Voluntary versus Involuntary Admission

Cultural Perspectives of Mental Health and Mental Illness

Factors Affecting Use of Mental Health Services

(43)

table

2.1.

Types of Admission and Client Rights Type of AdmissionDescription of Clients/SituationClient’s Rights

29

GSRXMRYIHSRTEKI

(44)

30 table

2.1.

Types of Admission and Client Rights GSRXMRYIH Type of AdmissionDescription of Clients/SituationClient’s Rights

(45)

Variability and vulnerability:

Ethnopharmacology:

Traditional medicine:

(46)

Accessibility:

Racial bias:

Religious and spiritual influences:

Culturally Competent and Congruent Care

(47)

table

2.2.

Critical Skills for Culturally Competent Care

Skill Strategies

GSRXMRYIHSRTEKI

(48)

table

2.2.

Critical Skills for Culturally Competent Care ^GSRXMRYIH

Skill Strategies

(49)

Assessment, Interviewing, and Communication

two

S E C T I O N

(50)

36

The Nursing Process

nursing process

Assessment

Assessment C H A P T E R

3 The Nurse–Client

Relationship

(51)

Interviewing

psychiatric interview

CHAPTER 3The Nurse–Client Relationship 37

(52)

38 SECTION two Assessment, Interviewing, and Communication

Communication

Communicators

Encoding

Decoding Channel Feedback

Therapeutic Communication

Therapeutic communication

Nontherapeutic Communication

Nontherapeutic communication

(53)

Therapeutic Relationship

therapeutic relationship

Elements of a Therapeutic Relationship

Trust

Professionalism

Mutual respect Caring

Partnership

(54)

table

3.1.

Therapeutic Communication Techniques TechniqueDescriptionExamples 40

(55)

41

(56)

42

table

3.2.

Nontherapeutic Communication Techniques TechniqueDescriptionExamples

(57)

43

(58)

table

3.3.

Social Versus Therapeutic Relationships AspectSocial RelationshipsTherapeutic Relationships 44

(59)

GSRXMRYIHSRTEKI table

3.4.

Phases of the Therapeutic Relationship

Phase Description

Therapeutic versus Social Relationship

Phases of a Therapeutic Relationship

(60)

46 SECTION two Assessment, Interviewing, and Communication

Phase Description table

3.4.

Phases of the Therapeutic Relationship GSRXMRYIH

(61)

C H A P T E R

4 Common Psychiatric Assessment Tools

47

A

(62)

48 SECTIONtwo Assessment, Interviewing, and Communication

General Assessment Tools Brief Psychiatric Rating Scale

B O X 4 . 1

❏ ❏ ❏ ❏ ❏ ❏ ❏

Extremely Severe

Severe

Not Present Very Mild Mild Moderate Moderate/Severe

❏ ❏ ❏ ❏ ❏ ❏ ❏

(63)

Brief Review of Sleep Patterns

CHAPTER4Common Psychiatric Assessment Tools 49

4W]GLSTLEVQEGSPSK]&YPPIXMR

B O X 4 . 1

GSRXMRYIH

❏ ❏ ❏ ❏ ❏ ❏ ❏

Extremely Severe

Severe

Not Present Very Mild Mild Moderate Moderate/Severe

B O X 4 . 2

(64)

FICA Spiritual Assessment Tool B O X 4 . 3

-RRSZEXMSRWMRIRHSJPMJI GEVI 4VEGXMGEPWXVEXIKMIWERHMRXIVREXMSREPTIVWTIGXMZIW

(65)

Global Assessment of Functioning (GAF) Scale

CODE(Note: Use intermediate codes when appropriate, eg, 45, 68, 72.) Superior functioning in a wide range of activities,life’s problems never seem to get out of hand,is sought out by others because of his or her many positive qualities. No symptoms. Absent or minimal symptomsgood functioning in all areas,interested and involved in a wide range of activities,socially effective,generally satisfied with life,no more than everyday prob- lems or concerns If symptoms are present,they are transient and expectable reactions to psychosocial stressors ; no more than slight impairment in social,occupational,or school functioning Some mild symptoms OR some difficulty in social,occupational,or school functioning ,but generally functioning pretty well,has some meaningful interpersonal relationships. Moderate symptoms OR moderate difficulty in social,occupational,or school functioning

BOX4.4 GSRXMRYIHSRTEKI

(66)

CODE(Note: Use intermediate codes when appropriate, eg, 45, 68, 72.) Serious symptoms OR any serious impairment in social,occupational,or school functioning Some impairment in reality testing or communication OR major impairment in several areas,such as work or school,family relations,judgment,thinking,or mood Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment OR inability to function in almost all areas Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impair- ment in communication Persistent danger of severely hurting self or others OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death. (MEKRSWXMGERH7XEXMWXMGEP1ERYEPSJ1IRXEP(MWSVHIVWXLIHXI\XVIZ

BOX4.4GSRXMRYIH

(67)

Mini-Mental State Examination

B O X 4 . 5

MMSE Sample Items

PERSONS Acronym for Identifying Major Aspects of Psychiatric Mental Health Nursing Assessment

B O X 4 . 6

(68)

Psychosocial Assessment Guide with Questions

AREA OF FOCUS

8LIRYVWIWLSYPHXV]RSXXS WTIRHXSSQYGLXMQIMRXLMW EVIEEXJMVWX,ISVWLIGER KEXLIVQSVIHEXEEWXLI RYVWIsGPMIRXVIPEXMSRWLMT HIZIPSTW

B O X 4 . 7

INFORMATION TO CONSIDER

(69)

AREA OF FOCUS

B O X 4 . 7

GSRXMRYIH

GSRXMRYIHSRTEKI

(70)

Recent Life Changes Questionnaire

AREA OF FOCUS

B O X 4 . 7

GSRXMRYIH

SOCIAL AREA

B O X 4 . 8

LIFE CHANGES LCU VALUES

(71)

(76)

Anxiety Assessment Tools Hamilton Rating Scale for Anxiety

ITEM

BOX4.11 -RWXVYGXMSRW = RATINGITEMRATING

(77)

ADDITIONAL COMMENTS: Investigator’s signature: 6ITVMRXIH[MXLTIVQMWWMSRJVSQXLIt&VMXMWL4W]GLSPSKMGEP7SGMIX]

(78)

Yale-Brown Obsessive Compulsive Scale

B O X 4 . 1 2

(79)

B O X 4 . 1 2

GSRXMRYIH

GSRXMRYIHSRTEKI

(80)

6ITVMRXIH[MXLTIVQMWWMSRJVSQ+SSHQER ; / 4VMGI 0 , 6EWQYWWIR 7 % IXEP 8LI=EPI&VS[R3FWIWWMZI'SQTYPWMZI7GEPI (IZIPSTQIRX YWIERHVIPMEFMPMX]

B O X 4 . 1 2

GSRXMRYIH

(81)

Abuse and Violence Assessment Tools Abuse Assessment Screen

B O X 4 . 1 3

(82)

Burgess-Par tner Abuse Scale for Teens

BOX4.14 -J]SYLEZIRSXLEHETEVXRIVMRXLITEWXQSRXLWHSRSXJMPPXLMWJSVQSYX NEVERONCEA FEW TIMESMORE THAN A FEW TIMESROUTINELY OR A LOT

(83)

%UYMGLER

(84)

Violence Danger Assessment

SAFE Questions for Abuse

S S

A A

F F

E

B O X 4 . 1 5

.%1%

B O X 4 . 1 6

(85)

2YVWMRKGEVISJWYVZMZSVWSJJEQMP]

ZMSPIRGI

B O X 4 . 1 6

GSRXMRYIH

(86)

Dementia Assessment Tools Questionnaire for Dementia

Subjective Data

B O X 4 . 1 7

(87)

Objective Data

B O X 4 . 1 7

GSRXMRYIH

(88)

Functional Dementia Scale

BOX4.18

(89)

.SYVREPSJ*EQMP]4VEGXMGI

(90)

Eating Disorder Assessment Tools

Criteria for Hospitalization: Eating Disorders

%QIVMGER.SYVREPSJ4W]GLMEXV]

MEDICAL

B O X 4 . 1 9

PSYCHIATRIC

Disordered Eating Screening Questions B O X 4 . 2 0

.SYVREPSJ

%HSPIWGIRX,IEPXL

(91)

Eating Attitudes Test

ALWAYSVERY OFTENOFTENSOMETIMESRARELYNEVER

BOX4.21 GSRXMRYIHSRTEKI

(92)

ALWAYSVERY OFTENOFTENSOMETIMESRARELYNEVER

BOX4.21GSRXMRYIH

(93)

Scoring:

(94)

Inventory for Clients with Eating Problems

Health Perception–Health Management

Nutrition–Metabolism

Elimination

Activity–Exercise

Sleep–Rest

Cognition–Perception

Self-perception–Self-concept

Roles–Relationships

B O X 4 . 2 2

(95)

Sexuality–Reproduction

Coping–Stress Tolerance

Values–Beliefs

B O X 4 . 2 2

GSRXMRYIH

(96)

Mood Disorder Assessment Tools Beck Depression Inventory

1. Sadness

2. Pessimism

3. Past Failure

4. Loss of Pleasure

5. Guilty Feelings

6. Punishment Feelings

7. Self-Dislike

8. Self-Criticalness

B O X 4 . 2 3

(97)

9. Suicidal Thoughts or Wishes

10. Crying

11. Agitation

12. Loss of Interest

13. Indecisiveness

14. Worthlessness

15. Loss of Energy

16. Changes in Sleeping Pattern

17. Irritability

B O X 4 . 2 3

GSRXMRYIH

GSRXMRYIHSRTEKI

(98)

18. Changes in Appetite

19. Concentration Difficulty

20. Tiredness or Fatigue

21. Loss of Interest in Sex

B O X 4 . 2 3

GSRXMRYIH

(99)

Geriatric Depression Scale (short form)

7GSVI

B O X 4 . 2 4

'PMRMGEPKIVSRXSPSK] EKYMHI XSEWWIWWQIRXERHMRXIVZIRXMSR

(100)

Hamilton Rating Scale for Depression

BOX4.26 an accurate,thorough diagnosis can be made through a personal evaluation by your doctor. GSRXMRYIHSRTEKI

(104)

❏❏ ❏❏ ❏❏ ❏❏ ❏❏ ❏❏❏❏ ❏❏ ❏❏ %QIVMGER.SYVREPSJ4W]GLMEXV]

BOX4.26GSRXMRYIH

(105)

Suicide Assessment

5YIWXMSRWXS%WOJSVE

'SQTVILIRWMZI7YMGMHI%WWIWWQIRX

5YIWXMSRWXS%WOMJ%WWIWWMRKE 6IGIRX7YMGMHI%XXIQTX

B O X 4 . 2 7

:,%(3(GPMRMGEPTVEGXMGIKYMHIPMRIJSVXLIQEREKIQIRXSJ QENSVHITVIWWMZIHMWSVHIVMREHYPXW

(106)

Schizophrenia and Related Assessment Tools Abnor mal Involuntar y Movement Scale (AIMS)

BOX4.28 NONEMINIMALMILDMODERATESEVERE Facial and Oral Movements Extremity Movements

(107)

)'()9%WWIWWQIRXQERYEPJSVTW]GLSTLEVQEGSPSK]

Trunk Movements Global Judgment

(108)

Simplified Diagnoses for Tardive Dyskinesia (SD-TD)

PREREQUISITES

SCORING/INTENSITY LEVEL. TOTAL SCORE

OF FIVE (5) OR ABOVE.

DIAGNOSES

NO TD are not

PROBABLE TD are

or

PERSISTENT TD are and

or

MASKED TD are not but

REMITTED TD are not but

and

WITHDRAWAL TD are not seen while but are seen within

B O X 4 . 2 9

(109)

INSTRUCTIONS OTHER CONDITIONS

4W]GLSTLEVQEGSPSK]&YPPIXMR

B O X 4 . 2 9

GSRXMRYIH

(110)

Simpson-Angus Rating Scale

BOX4.30

(111)

GSRXMRYIHSRTEKI

(112)

%GXE4W]GLMEXVMGE7GERHMREZMGE

BOX4.30GSRXMRYIH

(113)

Substance Disorder Assessment Tools Addiction Research Foundation Clinical Institute Withdrawal Assessment for Alcohol Revised (CIWA-AR)

B O X 4 . 3 1

GSRXMRYIHSRTEKI

(114)

100 SECTIONtwo Assessment, Interviewing, and Communication

B O X 4 . 3 1

GSRXMRYIH

(115)

Alcohol Use Disorder Identification Test (AUDIT)

CHAPTER4Common Psychiatric Assessment Tools 101

B O X 4 . 3 2

%PGSLSP9WI(MWSVHIVW -HIRXMJMGEXMSR8IWX%9(-8+YMHIPMRIWJSV9WIMR4VMQEV],IEPXL'EV I

(116)

CAGE Questionnaire

'

%

+ )

B O X 4 . 3 3

Michigan Alcoholism Screening Test (MAST)

Scoring Yes to 3 or more indicates alcoholism.

B O X 4 . 3 4

%QIVMGER.SYVREPSJ4W]GLMEXV]

LXXTENT TW]GLMEXV]SRPMRISVK

*VSQ)[MRK . %(IXIGXMRKEPGSLSPMWQ 8LI'%+)UYIWXMSRREMVI s

(117)

Substance Use Inventory

Health History Questions

B O X 4 . 3 5

GSRXMRYIHSRTEKI

(118)

B O X 4 . 3 5

GSRXMRYIH

(119)

Physical Examination

B O X 4 . 3 6

(120)

(121)

Therapeutic Modalities Therapeutic Modalities

three

S E C T I O N

(122)

108

Behavioral Therapy Description

Focus

C H A P T E R

5 Individual, Group, and

Family Therapies and

Interventions

(123)

Uses/Indications

Components

Nurse’s Role

CHAPTER 5Individual, Group, and Family Therapies and Interventions 109

(124)

110 SECTION three Therapeutic Modalities

Client-Centered Therapy Description

Focus

Uses/Indications

Components

Empathy

(125)

Genuineness

Unconditional positive regard

Nurse’s Role

Cognitive Therapy

Description

(126)

Focus

Uses/Indications

Components

Nurse’s Role

(127)

table

5.1.

Cognitive Distortions Commonly Associated DistortionExamplePsychiatric Diagnoses

113

GSRXMRYIHSRTEKI

(128)

table

5.1.

Cognitive Distortions GSRXMRYIH Commonly Associated DistortionExamplePsychiatric Diagnoses 114

(129)

115

(130)

Cognitive-Behavioral Therapy Description

Focus

Uses/Indications

Components

(131)

table

5.2.

Therapeutic Techniques of Cognitive Therapy TechniqueDescriptionExamples

117

GSRXMRYIHSRTEKI

(132)

table

5.2.

Therapeutic Techniques of Cognitive Therapy GSRXMRYIH TechniqueDescriptionExamples 118

(133)

Nurse’s Role

Dialectical Behavior Therapy (DBT) Description

(134)

Focus

Uses/Indications Components

Nurse’s Role

(135)

Exposure Therapy Description

Focus

Uses/Indications

Components

(136)

Nurse’s Role

Family Therapy Description

Focus

Uses/Indication

Components

(137)

Nurse’s Role

Group Therapy Description

Focus

(138)

Uses/Indications

Components

(139)

CHAPTER 5Individual, Group, and Family Therapies and Interventions 125 table

5.3.

Advantages and Disadvantages of Group Therapy

Advantages Disadvantages

(140)

Nurse’s Role

Individual Psychotherapy Description

Focus

Uses/Indications

Components

(141)

Nurse’s Role

Limit Setting Description

Focus

Uses/Indications

Components

(142)

table

5.4.

Selected Approaches to Psychotherapy ApproachFocusKey Points for NursesDesired Outcome 6IGSKRMXMSRSJWIPJHIJIEXMRK XLSYKLXTEXXIVRW 6IPIEWISJWIPJFPEQI )RLERGIQIRXSJJYRGXMSREP VIWTSRWIW 'PMIRXGSRXVSPSJFILEZMSVERH XLMROMRK 'LERKIMRXLMROMRKPIEHMRKXSTSW MXMZIGLERKIMRFILEZMSV 'PMIRXoWTIVGITXMSRSJ WIPJ[SVPHERHJYXYVI GSKRMXMZIXVMEH )\TPSVEXMSRSJGPMIRXoWXLSYKLX TVSGIWWIW )\TPSVEXMSRSJMVVEXMSREPXLMROMRK (IZIPSTQIRXSJTVSFPIQPMWXW 7IWWMSREKIRHEW ,SQI[SVO )ZEPYEXMSRSJWYGGIWWIWERH JEMPYVIW -HIRXMJMGEXMSRSJEGXMZEXMRKWMXYEXMSRW ERHRIKEXMZIIQSXMSRWPIEHMRKXS MVVEXMSREPFIPMIJW

'SKRMXMZIXLIVET] 6EXMSREPIQSXMZI FILEZMSVXLIVET]

128

(143)

(MEPIGXMGEPFILEZMSV XLIVET]%GGITXERGISJIQSXMSRWJYWIH[MXL EGORS[PIHKQIRXSJRIIHJSV FILEZMSVGLERKI )QTEXL] 6IJPIGXMSRSJJIIPMRKW )\TPSVEXMSRSJTIVGITXYEPHMWXSVXMSRW ERHH]WJYRGXMSREPFILEZMSVW 'PMIRXoWIQFVEGMRKSJMRXIRWIIQS XMSRWPMZMRKMRXLIQSQIRX 7IPJEGGITXERGI 'LERKIMRGSKRMXMSRWPIEHMRKXS QSVIJYRGXMSREPGSTMRKTEXXIVRW