1. What is psychiatric nursing?
- psychiatric nursing, is a specialized field of nursing practice that
involves the care of individuals with a mental health disorder to help
them recover and improve their quality of life.
- Mental health nurses have advanced knowledge of the assessment,
diagnosis, and treatment of psychiatric disorders that helps them
provide specialized care. They typically work alongside other health
professionals in a medical team with the aim of providing the
optimal clinical outcomes for the patient.
2. Links between stress and disease
- This long-term ongoing stress can increase the risk for
hypertension, heart attack, or stroke. Repeated acute stress and
persistent chronic stress may also contribute to inflammation in the
circulatory system, particularly in the coronary arteries, and this is
one pathway that is thought to tie stress to heart attack.
- Chronic stress may also cause disease, either because of changes in
your body or the overeating, smoking, and other bad habits people
use to cope with stress.
3. Intro to DSM V mental health classification
a. Neurodevelopmental disorder- Intellectual, communication, autism
spectrum disorder, ADHD, Motor disorder
b. Schizophrenia Spectrum and Other Psychotic Disorders
c. Bipolar and Related Disorders
d. Depressive Disorders
e. Anxiety Disorders
f. Obsessive-Compulsive and Related Disorders
g. Trauma- and Stressor-Related Disorders
h. Dissociative Disorders
i. Somatic Symptom and Related Disorders
j. Feeding and Eating Disorders
4. Role of psychiatric nurses
- The National Institute of Mental health recognizes psychiatric
nursing as a one mental health discipline
- The nurse’s rule is helping emotionally troubled patients has grow
considerably, she has many roles
* Carries out the traditional task of administering therapies in some
cases, monitoring, drug affects
* Acts as the primary therapist or directs behaviour therapies in
some case.
* Use an interpersonal approach to promote, maintain, restore and
rehabilitate individual family and community mental health and
functioning.
5. ANA standards of care for psychiatric and mental health nursing
- STANDARDS OF CARE
Standards of care pertain to professional nursing activities demonstrated
through the nursing process. These standards encompass assessment,
diagnosis, outcome identification, planning implementation and evaluation.
The nursing process is the foundation of clinical decision making
and encompass all significant action taken by nurses in providing psychiatric
and mental health care to all patients.
Standard I: Assessment
The nurse collects patient health data. Rationale. The assessment interview-
which requires linguistically and culturally effective communication skills,
interviewing, behavioural observation, database record review and
comprehensive assessment of the patient and relevant systems – enables
the psychiatric and mental health nurse to make sound clinical judgments
and plan appropriate interventions.
Standard II: Diagnosis
The nurse analyses assessment data to determine applicable diagnoses.
Rationale The basis for providing psychiatric and mental health nursing care
is recognizing and identifying patterns of response to actual or potential
psychiatric illnesses mental health problems, and potential comorbid
physical illnesses.
Standard III: Outcome Identification
The nurse identifies expected outcomes individualized for the patient.
Rationale: Within the content of providing nursing care, the ultimate goal is
to influence health outcomes and improve the patient’s health status.
Standard IV: Planning
The nurse develops a care plan that’s negotiated among the patient, nurse
family and significant others and health care team. The plan prescribes
evidence-based interventions to attain expected outcomes. Rationale: A care
plan is used to guide therapeutic intervention systematically document
progress are achieve expected patient outcomes.
Standard V: Implementation
The nurse implements the interventions identified in the care of plan
Rationale: Nurses use a wide range of interventions designed to prevent
mental and physical illness and to promote, maintain and restore mental and
physical health. They select interventions according to the practice level. At
the basic level nurses may select counselling milieu therapy, self-care
activities, psychobiological interventions, health teaching, case
management, health promotion and maintenance, crisis intervention,
community-based care, psychiatric home health care, telehealth, and various
other approaches to meet the patient’s mental health needs.
6. Theoretical basis of psychiatric nursing
7. Nurse patient relationship
- Series of interaction between the nurse and patient in which the
nurse assists the patient to attain positive behavioral changes.
- CHARACTERISTICS: Goal-oriented, focused on the needs of the
patient, planned, time-limited, professional
- Trust, rapport, therapeutic communication
8. Effective communication- therapeutic and non-therapeutic
- Interpersonal interaction between the nurse and client during which
the nurse focuses on the client’s specific needs to promote an
effective exchange of information. Skilled use of therapeutic
communication techniques helps the nurse understand and
empathize with client’s experience.
- For a nurse to be successful in dealing with clients it is very
essential that she empathize with the client. Empathy is the nurse’s
ability to perceive the meanings and feelings of the client and
communicate that understanding to the client. It is simply being
able to put oneself in the client’s shoes.
- Nontherapeutic: “If I were you, I would put your father in a nursing
home to reduce your stress.” Therapeutic: “Let's explore options for
your father's care
- Therapeutic communication will likely lead to a deeper insight of the
patient's reality and their ability to care for themselves outside of
the formal healthcare setting. This is the opposite of non-
therapeutic communication, which as we saw, can lead to
unintentional miscommunication between the nurse and the
patient.
9. Psychiatric nursing interview
10. Master mental health examination
11. Defense mechanism
- Defense mechanisms were first described by Sigmund Freud. He
believed that individual uses defense mechanism consciously or
unconsciously as a way to deflect anxiety and to cover up feelings
that affects self-esteem.
- Additionally, these intrapsychic processes modify, nullify, or
convey painful affects or tendencies so they can be tolerated
consciously.
- Defense mechanisms mostly operate at the subconscious level
of awareness, so people are not aware of what they are doing.
12. Personality and projective test
- A projective test is a personality test in which subjects are shown
ambiguous images and asked to interpret them. The subjects are to
project their own emotions, attitudes, and impulses onto the image;
and then use these projections to explain an image, tell a story, or
finish a sentence.
- A personality test is a tool designed to assess human personality.
Personality tests are used to understand the characteristic patterns
of feelings, thoughts and behaviors that people reveal across
various situations. Such tests can be used to validate a clinical
diagnosis, lead therapeutic interventions and help predict how
individuals may react to and respond in different situations.
13. Treatments psychotherapy and electroconvulsive therapy
- Electroconvulsive therapy (ECT) is a medical treatment most
commonly used in patients with severe major depression or bipolar
disorder that has not responded to other treatments. ECT involves a
brief electrical stimulation of the brain while the patient is under
anesthesia. This causes a brief surge of electrical activity within
your brain (also known as a seizure). The aim is to relieve severe
symptoms of some mental health problems.
- Psychotherapy (sometimes called talk therapy) refers to a variety of
treatments that aim to help a person identify and change troubling
emotions, thoughts, and behaviors
a. Cognitive therapy. Cognitive therapy emphasizes what people think
rather than what they do.
- Cognitive therapists believe that it's dysfunctional thinking that
leads to dysfunctional emotions or behaviors. By changing their
thoughts, people can change how they feel and what they do.
b. Behavior therapy. This approach focuses on learning's role in
developing both normal and abnormal behaviors.
- Ivan Pavlov made important contributions to behavior therapy by
discovering classical conditioning, or associative learning.
Pavlov's famous dogs, for example, began drooling when they heard
their dinner bell, because they associated the sound with food.
- "Desensitizing" is classical conditioning in action: A therapist
might help a client with a phobia through repeated exposure to
whatever it is that causes anxiety.
c. Humanistic therapy. This approach emphasizes people's capacity to
make rational choices and develop to their maximum potential.
Concern and respect for others are also important themes.
- Client-centered therapy rejects the idea of therapists as
authorities on their clients' inner experiences. Instead, therapists
help clients change by emphasizing their concern, care and interest.
14. Trends and concern in psychiatric care
15. Legal and ethical issues
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