Psychiatric Nursing N127A

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Psychiatric Nursing (N127A)

• Chia-Ling Mao
• Phone [phone]
• clmao_at_son.sjsu.edu
• http//www.sjsu.edu/faculty_and_staff/faculty_deta
  il.jsp?id405
• Office HB 308
• Office hours
• Monday 300-500
• Tuesday 200-400
• Wed 200-300

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Introduction

• Course reader
• Exams dates 2/22 4/11 5/15 (?)
• Passing rate
• Student handbook special accommodation
• Concurrent session - N137
• Calendar changes April 18 Forensic Nursing

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How to ACCESS ATN Streaming Broadcast

• 56 K modem required
• To access the class, go to ATN website at
  http//sjsu.edu/depts/atn
• Click on webcasting
• Click on realplayer website and download
  realplayer 8 BASIC, free program
• Archived Webcasts Available after the class
  meets

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Evolution of the Care for the Mentally Ill
Chlopromazine Freud
Managed Care
Enlightenment Period
Neurotransmitter
Community Support System Dark Period
Community Mental Health Act
18C 19C 20C-50s 60s 80s
90s 21C _________________________
_____________________
The decade of the
brain Humanistic Care
Atypical antipsychotics
Psychodynamic Theory
Neurosurgery
Partnership

Parity
Psychopharmacology
Group therapy family therapy
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Health Continuum
Adaptive
Maladaptive
Rational Logical Realistic Productive Satisfying
activity Fulfilling R
Anxiety Disorders
Mood Disorders
Personality Disorders
Psychoses
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Commonly adopted Patients right

• To treatment using the least restrictive
  alternative/environment
• To confidentiality
• To freedom from restraints and seclusion
• To give or refuse consent to treatment
• To access to personal belongings
• To daily exercise, to have visitors, to use of
  telephone, writing materials, uncensored mail.
• To refuse ECT or psychosurgery

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Psychotherapeutic Management

• Nurse-Patient Relationship the main tool in
  treating clients
• Psychopharmacology biochemical imbalance
• Milieu Management -

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Continuum of Psychiatric Care

• Def Levels of care through which an individual
  can move depending on his needs at a given point
  in time.
• Hospital-based care
• Community based care
• Case management

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Types of Community Services

• In-patient service
• Out patient service
• Emergency service
• Partial hospitalization
• Education and counseling

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Challenges

• Use traditional knowledge/skill in new setting
• Short, crisis oriented inpatient stay,
• Intensive outpatient services,
• Wider range of treatment modalities
• Multidisciplinary collaboration

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Levels of Prevention

• Primary prevention - educating women regarding
  drugs, alcohol, smoking effects on developing
  fetus/infant.
• Secondary prevention - National Depression
  Project, screening and encouraging treatment.
• Tertiary prevention - Rehab, work skills with
  chronic schizophrenics

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Managed Care

• Background - Cost-effective
• Problem oriented, outcome based,
• Who - HMO, Independent practice association, and
  preferred provider organizations
• Treatment type, medication, hospital stay

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In-patients Risk assessment

• Dangerous to self/others
• Gravely disables
• Acutely psychotic
• Suicidal/homicidal

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Hospital Based Care

• Shorter stay - deinstitutionalization
• Priority is on safety, gravely disabled
• Minimal time for thorough evaluation and
  establishing diagnosis and treatment
• Major issues - time for stabilization on
  medications noncompliance readmission
  (revolving door syndrome)

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Community-based Care - Assessment

• Severity of individuals illness
• Amount of supervision required by the individual

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Range of Community-based Care

• Home care - homebound clients
• Outreach services - for homeless clients
• Residential services -
• Group homes - temp./permanent housing
• Halfway house - chemical dependency
• Apartment living programs
• Foster care and boarding homes
• Self-help groups

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Community Based Care

• Goal - most effective care in least restrictive
  setting and
• Programs - sub-acute, independent living, to home
  care
• Holistic nursing with community orientation - N-P
  relationship, medication compliance, functioning
  in the milieu, application of nursing process

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Milieu Management - Definition

• Use all therapeutic resources, including the
  environment, to facilitate patient care.
• It involves purposeful use of all interpersonal
  and environmental forces to enhance mental
  health.

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Milieu Management - Goals

• to develop an atmosphere that facilitates
  patients growth, rehabilitation, restoration
  of health.

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Milieu Management

• Community MH movement - therapeutic community
• Laboratory (microcosm) for living, learning
  effective personal social coping, problem
  solving/ testing behaviors in a more secure
  environment
• Shared governance control
• Variation is used in some substance abuse programs

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Elements of the Effective Milieu

• Safety - no danger or harm, both psychological
  physical
• Structure - physical environment, unit
  regulations, daily schedule
• Norms - expected behaviors for a given unit
• Limit setting -
• Balance
• Environmental modification

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Safety - structure, designs, ...

• Ongoing assessment and maintenance of all
  equipment
• Hazard surveillance
• Reporting and investigation of safety issues
• Monitoring of safety management techniques and
  procedures
• Orientation programs that address safety issues

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Security - pt, staff, visitors

• Mechanisms for addressing security issues
• Provision of appropriate identification for all
  staff, patients, and visitors
• Security orientation programs
• Mechanisms for handling emergencies
• Mechanisms for interacting with the media

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Social environment - unique individuals

• Space for storage of grooming and hygiene
  articles
• Closet and drawer space for personal property
• Clothing that is suitable for clinical conditions

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Physical setting

• Adequate privacy to insure respect for patients
• Door locks consistent with program goals
• Availability of telephones that allow for
  private conversation
• Sleeping rooms with doors for privacy unless
  clinically contraindicated
• Furnishing suitable to the population served
• Access to the outdoors unless contraindicated for
  therapeutic reasons

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Roles of Nurse in Milieu Management

• Group leader, co-leader - treatment philosophy,
  collaborator, ...
• Team member/ leader - supervisor, trainer...
• Therapist/counselor - group, family therapy
• Psychopharmacology/ drug expert - a monitor,
  educator,
• Milieu manager - safety, structure, limit setting

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Case Manager

• Basic level practice of the nurse
• Effective team member for the benefit of
  patients, caregivers, and providers
• Advocate for both consumer and providers access,
  cost, outcomes
• Balancing cost with outcomes personal and
  professional ethics applied to managing care

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Elements of Case Management

• Psychiatric rehabilitation
• Resource linkage
• Consultation/ liaison
• Advocacy - NAMI
• Crisis intervention
• Home care
• Therapy

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Case Management
1. Coordination of care 2. Access to care 3.
Holistic care
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The Negative Impact of Severe Mental Illness

• Impairment hallucination, depression
• Dysfunction lack of work adjustment skills,
  social skills, or ADL skills
• Disability unemployment, homelessness
• Disadvantage discrimination, poverty

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Essential Client Services in a Caring System (I)
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Essential Client Services in a Caring System (II)
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Essential Client Services in a Caring System (III)
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Theory and model

• Theory beliefs about how things happen and work
• Theory lead to the expansion of knowledge
• Theories models
• Psychoanalytic theory
• Behavior theory
• Cognitive-behavior theory
• Ecologic-developmental model

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Family Adaptation Model

• Dealing with the catastrophic event
• Crisis, chaos, shock
• Denial
• Hoping against hope
• Learning to cope
• Anger, gild, resentment
• recognition
• grief
• Moving into the advocacy
• Understanding, acceptance, advocacy and action

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Evidence based practice

• Nursing practice based on the scientific method
  and empirical evidence
• Def Care that integrates the best available
  evidence from research with clinical expertise
• Barrier
• some clients are disenchanted with the outcomes
  of professionally approved treatments
• Pseudoscientific information from internet

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Conclusion

• Political and social involvement in pt care
• Roles of the psychiatric nurse
• Counseling, crisis intervention,
• managing the therapeutic environment,
• health and psycho-educational teaching,
• case management,
• administration and monitoring of psychobiological
  treatment

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Have a wonderful semester
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