Unit One: Role Of The Psychiatric/Mental Health Nurse
Unit One: Role of the Psychiatric/Mental Health Nurse
Scope of the Problem
How many people ages 15 – 54 had a psychiatric or substance abuse disorder in their lifetime?
Name the top three medical morbidities in the developed world:
How many of the 15 leading causes of disability in developed countries are mental problems?
25% affected in a year
1 in 5 children in U.S.
18 million in U.S. have problem with etoh
23 million in U.S. use illicit drugs
2/3 of nursing home residents
30% jails hold people but not charged with crime
Why Treatment?
2 Panic
3 Bipolar
4 Major Depression
5 Schizophrenia
6 Angioplasty: 41 % …show more content…
Objective 1: Discuss the historical evolution of role of the psychiatric/mental health nurse as a member of the nursing profession.
Psychiatric Nursing A Historical Evolution (pg 2-4) – see timeline pg 3
1873 - Linda Richards
1950 - Accreditation to include psychiatric nursing in curriculum
1973 - ANA publishes “Standards of Psychiatric-Mental Health Nursing”
Evolution of multiple roles for nursing in various aspects of psychiatric nursing
Evolving Functions & Roles (pg 5-6)
1950’s - Hildegard Peplau – Mother of Psychiatric Nursing
Nursing as a therapeutic process
1 Attitudes, mood & reality testing
2 Explore disturbing thoughts & emotion
3 Provide support & use of self to improve therapeutic homeostasis
Driving Factors in Psychiatric Nursing
2 Reimbursement
3 Paraprofessionals
4 Imaging technologies
5 Genetic decoding of neurotransmitter & receptor mechanics
6 Psychobiology of emotion
7 Consumer demand
Psychiatric Nursing Challenges
2 Realignment of care and caring
4 Refocus the balance on
6 Caring while integrating biological and behavioral concepts into practice
Contemporary Practice (pg 6-10)
Definition of psychiatric nursing: (from book): pg 6
4 An interpersonal process that promotes and maintains patient behavior that contributes to integrated functioning
6 ANA Scope & Standards of Psychiatric-Mental Health Nursing Practice defines psychiatric nursing as “a specialized are of nursing practice, employing the wide range of explanatory theories of human behavior as its science and purposeful use of self as its art”
8 The Center for Mental Health Services officially recognizes psychiatric nursing as “One of five core mental health disciplines “
9 Philosophical beliefs of nursing practice – see box 1-3 page 7
11 Nurse – patient partnership
Continuum of Care (pg 8)
2 Psychiatric facilities & Forensic Units
3 Community mental health centers
4 Psychiatric units in general hospitals
5 Residential facilities
6 Private practice
7 Primary care, Ob /Gyn, ED .
. .
Objective 3: Identify how nursing knowledge of cultural diversity affects the role of the nurse as provider and manager of care.
- Describe the term “competent caring”.
Competent Caring (see box 1-4 page 9)
Three domains of practice of psychiatric nurses
4 Direct care
6 Communication
8 Management
Other types of psychiatric nurse activities:
▪ Biopsychosocial
assessments
▪ Treatment plans
▪ Integration of services
▪ Health Care Map
Qualifications (pg 10-11)
Entry level – RN & certification
Advanced Level – MSN, APRN, Ph.D
Cultural Competency (pg 121 – Ch 8)
Attitudes & behaviors about others
Labels
Self-knowledge
Bases for Nursing Practice (pg 76 – Ch 5)
There are four bases for nursing practice
3 Traditional basis for practice: The lowest level is traditional basis for practice, which includes rituals, unverified rules, anecdotes, customs, opinions, and unit culture.
5 Regulatory basis for practice: The second level is the regulatory basis for practice, which includes state practice acts and reimbursement and other regulatory requirements.
32 Philosophical or conceptual basis for practice: The third level is the philosophical or conceptual basis for practice, which includes the mission, values, and vision of the organization; professional practice models; untested conceptual frameworks; and ethical frameworks and professional codes.
1 Vision & Mission
3 Values, ethical frameworks and professional codes
5 Professional Practice Models
7 ANA, APNA, ISPN
34 Evidence based practice: The fourth and highest level is evidence-based practice, which includes research findings, performace data, and consensus recommendations of recognized experts.
Psychological Context (pg 3)
1 Sigmund Freud Jean Piaget
3 Erik Erikson Albert Ellis
5 Aaron Beck Hildegarde Peplau
7 Victor Frankl Abraham Maslow
Stuart Stress Adaptation Model (pg 60-61, ch 4)
2 Biosphere
3 Society
4 Community
5 Group
6 Family
7 Individual:
8 System
9 Tissue
10 Organ
11 Cell
Defining Mental Health (pg 62)
2 State of well – being
4 Can not be confined to a simple definition
6 Various criteria: six criteria are indicators of mental health
8 Positive attitudes toward self: Includes an acceptance of self and self-awareness. Aperson must have some objectivity about the self & realistic aspirations that necessarily change with age. A healthy person also must have a sense of identity, wholeness, belongingness, security and meaningfulness.
10 Growth, development, and self-actualization: Means that the individual seeks new experiences to more fully explore aspects of oneself. (Rogers, 1961 & Maslow 1958) both describe a self as being engaged in a constant quest, always seeking new growth, development and challenges
12 The person is adequately in touch with one’s self and able to use the resources one has.
13 Has free access to personal feelings and can integrate them w/ thoughts & behaviors.
14 Can interact freely & openly w/ the environment
15 Can share w/ other people and grow from such experiences..
17 Integration: A balance between what is expressed & what is repressed, between outer & inner conflicts. It includes the regulation of emotional responses & unified philosophy of life. This criterion can be measured at least in part by the person’s ability to withstand stress & cope with anxiety. A strong but not rigid ego allows the person to handle change and grow as a result of it.
19 Autonomy: Involves self-determination, a balance between dependence & independence & acceptance of the consequences of one’s actions. It implies that the person is self-responsible for decisions, actions, thoughts & feelings. As a result, the person can respect autonomy & freedom in others.
21 Reality perception: Is the individual’s ability to test assumptions about the world by empirical thought. The mentally healthy person can change perceptions in light of new information. This criterion includes empathy or social sensitivity, a respect for the feelings & attitudes of others.
23 Environmental mastery: Enables a mentally healthy person to feel success in an approved role in society. The person can deal effectively witht eh world, work out personal problems, & obtain satisfaction from life. The person should be able to cope with loneliness, aggression & frustration w/o being overwhelmed. The person can respond to others, love & be loved, and cope w/ reciprocal relationships. This individual can build new friendships & have satisfactory social group involvement.
25 BASIC ID
Biopsychosocial Components (pg 64 – 69, ch 4)
Predisposing Factors: Risk factors that influence both the type and amount of resources the person can use to handle stress & are biological, psychological, and sociocultural in nature
4 Biological predisposing factors include genetic background, nutritional status, biological sensitivities, general health, and exposure to toxins.
6 Psychological predisposing factors include intelligence, verbal skills; morale; personality; past experiences; self concept, motivation; psychological defenses; and locus of control, or a sense of control over one’s own fate.
8 Sociocultural predisposing factors include age, gender, education, income, occupation, social position, cultural background, religious upbringing and beliefs, political affiliation, socialization experiences, and level of social integration or relatedness.
Precipitating Stressors are stimuli that are challenging, threatening, or demanding to the individual. The require excess energy & produce a state of tension and stress. (may be biological, psychological or sociocultural in nature and may originate either in the person’s internal or external environment.
Appraisal of Stressor (pg 67) involves determining the meaning of and understanding the impact of the stressful situation for the the individual. It includes cognitive, affective, physiological, behavioral, and social responses
12 Appraisal is an evaluation of the significance of an evenet in relation to a person’s well being.
Coping Resources & Mechanisms (pg 68)
16 Coping resources are options or strategies that help determine what can be done, as well as what is at stake. The take into account which coping options are available, the likelihood that a given option will accomplish what it is supposed to and the likelihood that the person can apply a particular strategy effectively
17 Examples: economic assets, abilities & skills, defensive techniques, social supports & motivation.
➢ Coping Mechanisms are any efforts directed at stress management. (3 main types of coping mechanisms)
▪ Problem-focused coping mechanisms, which involve tasks & direct efforts to cope w/ the threat itself (example: negotiation, confrontation & seeking advice)
▪ Cognitively focused coping mechanisms, by which the person attempts to control the meaning of the problem & thus neutralizing it (examples: positive comparison, selective ignorance, substitution of rewards, and the devaluation of desired objects)
▪ Emotion-focused coping mechanisms, by which the patient is oriented to moderating emotional distress (examples: use of ego defense mechanisms such as denial, suppression, or projection.)
Biopsychosocial Components (pg 64 – 69 ch 4) continued………………..
Relationship to Medical Diagnosis (pg 69): The health problem or disease state of the patient
3 Nurses assess risk factors & look for vulnerabilities.
4 Physicians assess disease states & look for causes.
6 Nursing diagnoses focus on the adaptive/maladaptive coping continuum of human responses.
7 Medical diagnoses focus on the health/illness continuum of health problems
9 Nursing intervention consists of care giving activities.
10 Medical intervention consist of curative treatments.
Classification of Mental Disorders: Mental illnesses can be broadly differentiated as neurotic or psychotic
14 Neuroses have the following characteristics
16 A symptom or group of symptoms is distressing & is recognized as unacceptable & alien to the individual
17 Reality testing is grossly intact
18 Behavior does not violate major social norms (although functioning may be significantly impaired).
19 The disturbance is enduring or recurrent w/o tx and is not merely a transitory reaction to stressors.
20 No demonstrable organic cause or factor is present.
22 However, in situations of severest conflict, the person may distort reality, as in Psychosis which consists of the following characteristics.
24 Regressive behavior
25 Personality disintegration
26 A significant reduction in level of awareness
27 Great difficulty in functioning adequately
28 Gross impairment in reality testing. (This characteristic is critical, when people demonstrate gross impairment in reality testing, they incorrectly evaluate the accuracy of their perceptions & draw incorrect inferences about external reality even in the fc3e of contrary evidence.)
30 Direct evidence of psychosis is the presence of delusions or hallucinations w/o insight into their pathological nature..
Objective 2: Describe the utilization of the nursing process, nursing standards of care & evidence based practice in the role of the psychiatric nurse.
Evidence Based Practice (pg 76-84, ch 5)
Evidence-based practice is the conscientious, explicit, and judicious use of the best evidence gained from systematic research for the purpose of making informed decisions about the care of individual patients.
3 Critical thinking
5 Standards of practice-clinical pathways (pg 78-80) ----- see box 5-3 pg 80
7 Practice guidelines in psychiatric care are strategies for mental health care delivery that are developed to facilitate clinical decision making and provide patients with critical information about their tx options
8 Clinical pathways identify the key clinical processes and corresponding timelines involved in patient care as a means to achieve standard outcomes within a specific period of time.
10 Theses pathways provide one way in which not only the rationale for mental health care but also the patient’s progress & response to care can be documented.
12 A clinical pathway is a written plan that serves as both a map and a timetable for the efficient and effective delivery of health care..
14 Outcome measurement (pg 81)
16 Outcomes are the extent to which health care services are cost-effective and have a favorable effect on the patient’s symptoms, functioning and well being.
18 They include all the things that affect the patient & his/her family while they are in the health care system, such as health status, functional status, quality of life, the presence or absence of illness, type of coping response, and satisfaction w/ tx.
19 They include both positive (well-being) and negative *illness state) dimensions.)
Research Agenda (pg 82-84, ch 5)
Identify core knowledge and skills
Evaluation research
1 Outcomes and cost effectiveness demonstrated
Evidence that interventions are effective for treatment of the mental health illness
Objective 2: Describe the utilization of the nursing process, nursing standards of care & evidence based practice in the role of the psychiatric nurse.
Elements of Psychiatric Nursing Continuum of Care (pg 8, ch 1)
[pic]
Psychiatric Nursing Practice see figure 1-3 page 9
1 Direct Care Communication
3 Management Teaching
5 Collaborating Delegating
7 Coordinating
Multiple Contexts for Practice
2 Biological
3 Psychological
4 Sociocultural
5 Environmental
6 Legal-Ethical
Biological Context
Neuroscience:
2 Genetics
3 Circadian Rhythms
4 Psychoneuroimmunology
5 Biological assessment of the patient
6 Endocrinology
7 Biological components of mental illness
Circadian Rhythms (pg 99)
54 Circadian rhythm is like a network of internal clocks that coordinate events in the body according to a 24 hour cycle
55 This cycle corresponds to the time it takes the earth to spin on its axis, exposing all of life to daily rhythms of light, darkness, and temperature..
The Human Brain (pg 87, ch 6)
[pic]
Important Brain Structures (pg 88-89)
[pic]
Neurotransmission Pg 88
Electrochemical action of neurons
Neurotransmission: The process by which neurons communicate with each other through electrical impulses and chemical messengers.
This communication between neurons is carried out by chemical “first” messengers called neurotransmitters and gives rise to human activity, body functions, consciousness, intelligence, creativity, memory, dreams and emotion.
Neurotransmission is a key factor in understanding how various regions of the brain function & how interventions, such as medications & other therapies, affect brain activity a7 human behavior.
Read up and take notes………………
Assessment of the Psychiatric Patient (pg 104-106) – see box 6-3
1 Health care history
2 Lifestyle
3 Physical examination
4 Laboratory values
5 Medical Illnesses
6 Family History / Genetics
Mental Status Exam (pg 108-119, ch 7)
2 GENERAL DESCRIPTION
3 SENSORIUM AND COGNITION
4 AFFECT & EMOTIONAL STATE
5 INTERPERSONAL FUNCTIONING
7 BEHAVIOR
Ob 3-2: Identify the major legal/ethical, biological, psychological, sociocultural and environmental contexts of nursing care.
Sociocultural Context (pg 120-131, ch 8)
[pic]
Sociocultural Stressors
2 Disadvantagement
5 Stereotype
8 Intolerance
11 Stigma:
2 Prejudice
4 Discrimination
6 Racism
Environmental Context (pg 134 – 145, ch 9)
Access to Services (pg 139)
Mental Health Delivery System (pg 136)
Managed Care (pg 137)
Federal and State Initiatives
Treatment Parity
Quality Assessment and Outcomes
Quality Assessment and Outcomes-Managed Care and Nursing Process
[pic]
Legal - Ethical Context (pg 147-169, ch 10)
Admission pg 150
4 Voluntary – Client chooses to engage in treatment
5 Involuntary - danger to self or others
1 Utah “substantial threat of harm”
Commitment Process (pg 151, figure 10-2)
[pic]
Circle of Confidentiality (pg 157, figure 10-3)
[pic]
Obtaining Informed Consent (pg 159)
2 INFORMATION TO DISCLOSE
4 Diagnosis
5 Treatment
6 Consequences
7 Alternatives
8 Prognosis
Ethical Dilemmas (160-161)
A difficult problem has no satisfactory solution
2 Patients rights vs. public safety
4 Forced treatment options
5 Rights of criminal but mentally ill offenders
Legal Role of Nurse (pg 161)
Nurse as provider and manager of care
2 Malpractice
3 Legal Responsibilities-duty to report
Nurse as employee
Nurse as citizen
Families (pg 170-181, ch 11)
Family dynamics
Family assessment
Working with families
Benefits of Family involvement
Family resources: NAMI, support groups. . .
Psychiatric Nursing Process (pg 183-205, ch 12)
Goal of Psychiatric Nursing: To maximize the patient’s positive interactions with the environment, promote a level of wellness, and enhance self actualization.
- By establishing a therapeutic nurse-ptient relationship and using the nursing process, the nurse strives to promote and maintain patient behavior that contributes to integrated functioning. - This is the essence of the nursing therapeutic process and the framework on which this book is based.
Nursing process
Assessment
Diagnosis
Outcome ID
Planning
Implementation
Evaluation
Scope of the Problem
How many people ages 15 – 54 had a psychiatric or substance abuse disorder in their lifetime?
Name the top three medical morbidities in the developed world:
How many of the 15 leading causes of disability in developed countries are mental problems?
25% affected in a year
1 in 5 children in U.S.
18 million in U.S. have problem with etoh
23 million in U.S. use illicit drugs
2/3 of nursing home residents
30% jails hold people but not charged with crime
Why Treatment?
2 Panic
3 Bipolar
4 Major Depression
5 Schizophrenia
6 Angioplasty: 41 % …show more content…
Objective 1: Discuss the historical evolution of role of the psychiatric/mental health nurse as a member of the nursing profession.
Psychiatric Nursing A Historical Evolution (pg 2-4) – see timeline pg 3
1873 - Linda Richards
1950 - Accreditation to include psychiatric nursing in curriculum
1973 - ANA publishes “Standards of Psychiatric-Mental Health Nursing”
Evolution of multiple roles for nursing in various aspects of psychiatric nursing
Evolving Functions & Roles (pg 5-6)
1950’s - Hildegard Peplau – Mother of Psychiatric Nursing
Nursing as a therapeutic process
1 Attitudes, mood & reality testing
2 Explore disturbing thoughts & emotion
3 Provide support & use of self to improve therapeutic homeostasis
Driving Factors in Psychiatric Nursing
2 Reimbursement
3 Paraprofessionals
4 Imaging technologies
5 Genetic decoding of neurotransmitter & receptor mechanics
6 Psychobiology of emotion
7 Consumer demand
Psychiatric Nursing Challenges
2 Realignment of care and caring
4 Refocus the balance on
6 Caring while integrating biological and behavioral concepts into practice
Contemporary Practice (pg 6-10)
Definition of psychiatric nursing: (from book): pg 6
4 An interpersonal process that promotes and maintains patient behavior that contributes to integrated functioning
6 ANA Scope & Standards of Psychiatric-Mental Health Nursing Practice defines psychiatric nursing as “a specialized are of nursing practice, employing the wide range of explanatory theories of human behavior as its science and purposeful use of self as its art”
8 The Center for Mental Health Services officially recognizes psychiatric nursing as “One of five core mental health disciplines “
9 Philosophical beliefs of nursing practice – see box 1-3 page 7
11 Nurse – patient partnership
Continuum of Care (pg 8)
2 Psychiatric facilities & Forensic Units
3 Community mental health centers
4 Psychiatric units in general hospitals
5 Residential facilities
6 Private practice
7 Primary care, Ob /Gyn, ED .
. .
Objective 3: Identify how nursing knowledge of cultural diversity affects the role of the nurse as provider and manager of care.
- Describe the term “competent caring”.
Competent Caring (see box 1-4 page 9)
Three domains of practice of psychiatric nurses
4 Direct care
6 Communication
8 Management
Other types of psychiatric nurse activities:
▪ Biopsychosocial
assessments
▪ Treatment plans
▪ Integration of services
▪ Health Care Map
Qualifications (pg 10-11)
Entry level – RN & certification
Advanced Level – MSN, APRN, Ph.D
Cultural Competency (pg 121 – Ch 8)
Attitudes & behaviors about others
Labels
Self-knowledge
Bases for Nursing Practice (pg 76 – Ch 5)
There are four bases for nursing practice
3 Traditional basis for practice: The lowest level is traditional basis for practice, which includes rituals, unverified rules, anecdotes, customs, opinions, and unit culture.
5 Regulatory basis for practice: The second level is the regulatory basis for practice, which includes state practice acts and reimbursement and other regulatory requirements.
32 Philosophical or conceptual basis for practice: The third level is the philosophical or conceptual basis for practice, which includes the mission, values, and vision of the organization; professional practice models; untested conceptual frameworks; and ethical frameworks and professional codes.
1 Vision & Mission
3 Values, ethical frameworks and professional codes
5 Professional Practice Models
7 ANA, APNA, ISPN
34 Evidence based practice: The fourth and highest level is evidence-based practice, which includes research findings, performace data, and consensus recommendations of recognized experts.
Psychological Context (pg 3)
1 Sigmund Freud Jean Piaget
3 Erik Erikson Albert Ellis
5 Aaron Beck Hildegarde Peplau
7 Victor Frankl Abraham Maslow
Stuart Stress Adaptation Model (pg 60-61, ch 4)
2 Biosphere
3 Society
4 Community
5 Group
6 Family
7 Individual:
8 System
9 Tissue
10 Organ
11 Cell
Defining Mental Health (pg 62)
2 State of well – being
4 Can not be confined to a simple definition
6 Various criteria: six criteria are indicators of mental health
8 Positive attitudes toward self: Includes an acceptance of self and self-awareness. Aperson must have some objectivity about the self & realistic aspirations that necessarily change with age. A healthy person also must have a sense of identity, wholeness, belongingness, security and meaningfulness.
10 Growth, development, and self-actualization: Means that the individual seeks new experiences to more fully explore aspects of oneself. (Rogers, 1961 & Maslow 1958) both describe a self as being engaged in a constant quest, always seeking new growth, development and challenges
12 The person is adequately in touch with one’s self and able to use the resources one has.
13 Has free access to personal feelings and can integrate them w/ thoughts & behaviors.
14 Can interact freely & openly w/ the environment
15 Can share w/ other people and grow from such experiences..
17 Integration: A balance between what is expressed & what is repressed, between outer & inner conflicts. It includes the regulation of emotional responses & unified philosophy of life. This criterion can be measured at least in part by the person’s ability to withstand stress & cope with anxiety. A strong but not rigid ego allows the person to handle change and grow as a result of it.
19 Autonomy: Involves self-determination, a balance between dependence & independence & acceptance of the consequences of one’s actions. It implies that the person is self-responsible for decisions, actions, thoughts & feelings. As a result, the person can respect autonomy & freedom in others.
21 Reality perception: Is the individual’s ability to test assumptions about the world by empirical thought. The mentally healthy person can change perceptions in light of new information. This criterion includes empathy or social sensitivity, a respect for the feelings & attitudes of others.
23 Environmental mastery: Enables a mentally healthy person to feel success in an approved role in society. The person can deal effectively witht eh world, work out personal problems, & obtain satisfaction from life. The person should be able to cope with loneliness, aggression & frustration w/o being overwhelmed. The person can respond to others, love & be loved, and cope w/ reciprocal relationships. This individual can build new friendships & have satisfactory social group involvement.
25 BASIC ID
Biopsychosocial Components (pg 64 – 69, ch 4)
Predisposing Factors: Risk factors that influence both the type and amount of resources the person can use to handle stress & are biological, psychological, and sociocultural in nature
4 Biological predisposing factors include genetic background, nutritional status, biological sensitivities, general health, and exposure to toxins.
6 Psychological predisposing factors include intelligence, verbal skills; morale; personality; past experiences; self concept, motivation; psychological defenses; and locus of control, or a sense of control over one’s own fate.
8 Sociocultural predisposing factors include age, gender, education, income, occupation, social position, cultural background, religious upbringing and beliefs, political affiliation, socialization experiences, and level of social integration or relatedness.
Precipitating Stressors are stimuli that are challenging, threatening, or demanding to the individual. The require excess energy & produce a state of tension and stress. (may be biological, psychological or sociocultural in nature and may originate either in the person’s internal or external environment.
Appraisal of Stressor (pg 67) involves determining the meaning of and understanding the impact of the stressful situation for the the individual. It includes cognitive, affective, physiological, behavioral, and social responses
12 Appraisal is an evaluation of the significance of an evenet in relation to a person’s well being.
Coping Resources & Mechanisms (pg 68)
16 Coping resources are options or strategies that help determine what can be done, as well as what is at stake. The take into account which coping options are available, the likelihood that a given option will accomplish what it is supposed to and the likelihood that the person can apply a particular strategy effectively
17 Examples: economic assets, abilities & skills, defensive techniques, social supports & motivation.
➢ Coping Mechanisms are any efforts directed at stress management. (3 main types of coping mechanisms)
▪ Problem-focused coping mechanisms, which involve tasks & direct efforts to cope w/ the threat itself (example: negotiation, confrontation & seeking advice)
▪ Cognitively focused coping mechanisms, by which the person attempts to control the meaning of the problem & thus neutralizing it (examples: positive comparison, selective ignorance, substitution of rewards, and the devaluation of desired objects)
▪ Emotion-focused coping mechanisms, by which the patient is oriented to moderating emotional distress (examples: use of ego defense mechanisms such as denial, suppression, or projection.)
Biopsychosocial Components (pg 64 – 69 ch 4) continued………………..
Relationship to Medical Diagnosis (pg 69): The health problem or disease state of the patient
3 Nurses assess risk factors & look for vulnerabilities.
4 Physicians assess disease states & look for causes.
6 Nursing diagnoses focus on the adaptive/maladaptive coping continuum of human responses.
7 Medical diagnoses focus on the health/illness continuum of health problems
9 Nursing intervention consists of care giving activities.
10 Medical intervention consist of curative treatments.
Classification of Mental Disorders: Mental illnesses can be broadly differentiated as neurotic or psychotic
14 Neuroses have the following characteristics
16 A symptom or group of symptoms is distressing & is recognized as unacceptable & alien to the individual
17 Reality testing is grossly intact
18 Behavior does not violate major social norms (although functioning may be significantly impaired).
19 The disturbance is enduring or recurrent w/o tx and is not merely a transitory reaction to stressors.
20 No demonstrable organic cause or factor is present.
22 However, in situations of severest conflict, the person may distort reality, as in Psychosis which consists of the following characteristics.
24 Regressive behavior
25 Personality disintegration
26 A significant reduction in level of awareness
27 Great difficulty in functioning adequately
28 Gross impairment in reality testing. (This characteristic is critical, when people demonstrate gross impairment in reality testing, they incorrectly evaluate the accuracy of their perceptions & draw incorrect inferences about external reality even in the fc3e of contrary evidence.)
30 Direct evidence of psychosis is the presence of delusions or hallucinations w/o insight into their pathological nature..
Objective 2: Describe the utilization of the nursing process, nursing standards of care & evidence based practice in the role of the psychiatric nurse.
Evidence Based Practice (pg 76-84, ch 5)
Evidence-based practice is the conscientious, explicit, and judicious use of the best evidence gained from systematic research for the purpose of making informed decisions about the care of individual patients.
3 Critical thinking
5 Standards of practice-clinical pathways (pg 78-80) ----- see box 5-3 pg 80
7 Practice guidelines in psychiatric care are strategies for mental health care delivery that are developed to facilitate clinical decision making and provide patients with critical information about their tx options
8 Clinical pathways identify the key clinical processes and corresponding timelines involved in patient care as a means to achieve standard outcomes within a specific period of time.
10 Theses pathways provide one way in which not only the rationale for mental health care but also the patient’s progress & response to care can be documented.
12 A clinical pathway is a written plan that serves as both a map and a timetable for the efficient and effective delivery of health care..
14 Outcome measurement (pg 81)
16 Outcomes are the extent to which health care services are cost-effective and have a favorable effect on the patient’s symptoms, functioning and well being.
18 They include all the things that affect the patient & his/her family while they are in the health care system, such as health status, functional status, quality of life, the presence or absence of illness, type of coping response, and satisfaction w/ tx.
19 They include both positive (well-being) and negative *illness state) dimensions.)
Research Agenda (pg 82-84, ch 5)
Identify core knowledge and skills
Evaluation research
1 Outcomes and cost effectiveness demonstrated
Evidence that interventions are effective for treatment of the mental health illness
Objective 2: Describe the utilization of the nursing process, nursing standards of care & evidence based practice in the role of the psychiatric nurse.
Elements of Psychiatric Nursing Continuum of Care (pg 8, ch 1)
[pic]
Psychiatric Nursing Practice see figure 1-3 page 9
1 Direct Care Communication
3 Management Teaching
5 Collaborating Delegating
7 Coordinating
Multiple Contexts for Practice
2 Biological
3 Psychological
4 Sociocultural
5 Environmental
6 Legal-Ethical
Biological Context
Neuroscience:
2 Genetics
3 Circadian Rhythms
4 Psychoneuroimmunology
5 Biological assessment of the patient
6 Endocrinology
7 Biological components of mental illness
Circadian Rhythms (pg 99)
54 Circadian rhythm is like a network of internal clocks that coordinate events in the body according to a 24 hour cycle
55 This cycle corresponds to the time it takes the earth to spin on its axis, exposing all of life to daily rhythms of light, darkness, and temperature..
The Human Brain (pg 87, ch 6)
[pic]
Important Brain Structures (pg 88-89)
[pic]
Neurotransmission Pg 88
Electrochemical action of neurons
Neurotransmission: The process by which neurons communicate with each other through electrical impulses and chemical messengers.
This communication between neurons is carried out by chemical “first” messengers called neurotransmitters and gives rise to human activity, body functions, consciousness, intelligence, creativity, memory, dreams and emotion.
Neurotransmission is a key factor in understanding how various regions of the brain function & how interventions, such as medications & other therapies, affect brain activity a7 human behavior.
Read up and take notes………………
Assessment of the Psychiatric Patient (pg 104-106) – see box 6-3
1 Health care history
2 Lifestyle
3 Physical examination
4 Laboratory values
5 Medical Illnesses
6 Family History / Genetics
Mental Status Exam (pg 108-119, ch 7)
2 GENERAL DESCRIPTION
3 SENSORIUM AND COGNITION
4 AFFECT & EMOTIONAL STATE
5 INTERPERSONAL FUNCTIONING
7 BEHAVIOR
Ob 3-2: Identify the major legal/ethical, biological, psychological, sociocultural and environmental contexts of nursing care.
Sociocultural Context (pg 120-131, ch 8)
[pic]
Sociocultural Stressors
2 Disadvantagement
5 Stereotype
8 Intolerance
11 Stigma:
2 Prejudice
4 Discrimination
6 Racism
Environmental Context (pg 134 – 145, ch 9)
Access to Services (pg 139)
Mental Health Delivery System (pg 136)
Managed Care (pg 137)
Federal and State Initiatives
Treatment Parity
Quality Assessment and Outcomes
Quality Assessment and Outcomes-Managed Care and Nursing Process
[pic]
Legal - Ethical Context (pg 147-169, ch 10)
Admission pg 150
4 Voluntary – Client chooses to engage in treatment
5 Involuntary - danger to self or others
1 Utah “substantial threat of harm”
Commitment Process (pg 151, figure 10-2)
[pic]
Circle of Confidentiality (pg 157, figure 10-3)
[pic]
Obtaining Informed Consent (pg 159)
2 INFORMATION TO DISCLOSE
4 Diagnosis
5 Treatment
6 Consequences
7 Alternatives
8 Prognosis
Ethical Dilemmas (160-161)
A difficult problem has no satisfactory solution
2 Patients rights vs. public safety
4 Forced treatment options
5 Rights of criminal but mentally ill offenders
Legal Role of Nurse (pg 161)
Nurse as provider and manager of care
2 Malpractice
3 Legal Responsibilities-duty to report
Nurse as employee
Nurse as citizen
Families (pg 170-181, ch 11)
Family dynamics
Family assessment
Working with families
Benefits of Family involvement
Family resources: NAMI, support groups. . .
Psychiatric Nursing Process (pg 183-205, ch 12)
Goal of Psychiatric Nursing: To maximize the patient’s positive interactions with the environment, promote a level of wellness, and enhance self actualization.
- By establishing a therapeutic nurse-ptient relationship and using the nursing process, the nurse strives to promote and maintain patient behavior that contributes to integrated functioning. - This is the essence of the nursing therapeutic process and the framework on which this book is based.
Nursing process
Assessment
Diagnosis
Outcome ID
Planning
Implementation
Evaluation