The Nursing Process in PsychiatricMental Health Nursing

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Chapter 6

• The Nursing Process in Psychiatric/Mental Health
  Nursing

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The Nursing Process

• It is a systematic framework for the delivery of
  nursing care.
• It uses a problem-solving approach.
• It is goal-directed, its objective being the
  delivery of quality client care.
• It makes use of the nurse/Patient relationship.

3
The Nurse/Client Relationship

• What is it?
• The process by which the nurse provides care for
  the client in need of psychosocial intervention.
• We use ourselves.

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The Goal of the Nurse Client Relationship

• The relationship focuses on the needs of the
  client, has goals which are specific, is theory
  based, and is open to supervision.

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Goals Are Not

• To make the client happy
• to get him to laugh or smile
• to fix them
• to solve their problems

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The Therapeutic Use of Self

• How does it differ from a social relationship?
• .

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The Therapeutic Use of Self

• How does it differ from a social relationship?
• The ability to use ones personality consciously
  and in full awareness in an attempt to establish
  relatedness and to structure nursing
  interventions
• We decide what to do or say based on whether it
  meets the needs of the clients goals
• .

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Therapeutic use of self

• Self awareness
• we must be willing to look at our thoughts,
  feelings, and behaviors honestly
• without judgment
• Unconditional positive regard toward the client
  and ourselves

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Standards of Care

• The standards of care for psychiatric nursing are
  written around the six steps of the nursing
  process.
• Standard I. Assessment
• The psychiatric/mental health nurse collects
  client health data.

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Assessment Tools

• We use a nursing history format to learn more
  about the client and his needs
• Assessment includes general information,
  psychiatric and medical history, family history,
  cultural and social history, stage of
  development, support systems, coping styles,
  stressors, losses/changes, education, strengths,
  prrecipitasting event, anxiety level, defense
  mecvhanisms, medications, physical
  assessment,mental statues assessment.

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Other Assessment Tools

• Mental Status Exam
• Spiritual Assesment
• Substance Abuse Assessment- The Cage
• Domestic Violence Assessment
• Suicidal Risk Assessment
• Lethality Risk Scale

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Sociocultural Concepts

• Culture A particular societys entire way of
  living, encompassing shared patterns of belief,
  feeling, and knowledge that guide peoples
  conduct and that are passed down from generation
  to generation.

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How Do Cultures Differ?

• 1. Communication
• 2. Space
• 3. Social organization
• 4. Time
• 5. Environmental control
• 6. Biological variations

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Standards of Care

• Standard II. Diagnosis
• The psychiatric/mental health nurse analyzes the
  assessment data in determining diagnoses
• Anxiety related to Change of life style (nursing
  school) as evidenced by sleeplessness

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Standards of Care (cont.)

• Standard III. Outcome Identification
• The psychiatric/mental health nurse identifies
  expected outcomes individualized to the client.

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Standards of Care (cont.)

• Standard IV. Planning
• The psychiatric/mental health nurse develops a
  plan of care that is negotiated among the client,
  nurse, family, and healthcare team and prescribes
  evidence-based interventions to attain expected
  outcomes.

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Standards of Care (cont.)

• Standard IV. Planning (cont.)
• Nursing Interventions Classification (NIC) - a
  comprehensive, standardized language describing
  treatments that nurses perform in all settings
  and in all specialties
• NIC interventions based on research and reflect
  current clinical practice

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Standards of Care (cont.)

• Standard V. Implementation
• The psychiatric/mental health nurse implements
  the interventions identified in the plan of care.
  Specific interventions
• Standard Va. Counseling to assistclients in
  improving coping skills andpreventing mental
  illness and disability One-to one listening
• Standard Vb. Milieu therapy to provide and
  maintain a therapeutic environment for client- RN
  designs unit activites based on client needs
• Standard Vc. Self-care activities tofoster
  independence and mental and
• physical well-being- Bathing, eating,working,
  paying bills

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Standards of Care (cont.)

• Standard Vd. Psychobiological
• interventions to restore the clients
• health and prevent further
  disability-medications
• Standard Ve. Health teaching to assist
• clients in achieving satisfying, productive,
  
• and healthy patterns of living- Stress
  management, anger mangement
• Standard Vf. Case management to
• coordinate comprehensive health services
• and ensure continuity of care- refer to
  programs,community support groups

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Standards of Care (cont.)

• Standard Vg. Health promotion and health
  maintenance implements strategies with clients
  to promote and maintain mental health and prevent
  mental illness- Teach

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Standards of Care (cont.)

• Advanced practice interventions also include
• Standard Vh. Psychotherapy
• provides therapy for individuals,
• groups, families, and children to
• foster mental health and prevent
  disability-Advanced practice role
• Standard Vi. Prescriptive authority and
  treatment Advanced Practice Role- ARNP

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Standards of Care (cont.)

• Advanced practice interventions (cont.)
• Standard Vj. Consultation
• provides consultation to enhance
• the abilities of other clinicians to
• provide services for clients and
• effect change in the system- Usually advanced
  practice Masters Prepared nurse

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Standards of Care (cont.)

• Standard VI. Evaluation
• The psychiatric/mental health nurse evaluates
  the clients progress in attaining expected
  outcomes.
• Collaborate with others on the team including
  patient and family.

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Applying Nursing Process

• Role of the nurse in psychiatry
• The nurse assists the clients successful
  adaptation to stressors within the environment.
• Goals are directed toward change in thoughts,
  feelings, and behaviors that are age-appropriate
  and congruent with local and cultural norms.
• The nurse is a valuable member of the
  interdisciplinary team, providing a service that
  is unique and based on sound knowledge of
  psychopathology, scope of practice, and legal
  implications of the role.

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Documentation of the Nursing Process

• Documentation of the steps of the nursing process
  is often considered as evidence in determining
  certain cases of negligence by nurses.
• It is also required by some agencies that
  accredit healthcare organizations.

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Documentation of the Nursing Process (cont.)

• Examples of documentation that reflect use of
  the nursing process
• Problem-Oriented Recording (POR)
• Focus Charting
• APIE method