Mental Health NUR2459

• Role of the psychiatric Nurse o Work closely with treatment teams to develop individualized patient plans, aiming to maximize care and help patients live productive lives. They also provide individual counseling to patients and families to help them understand the illness. o Stranger ▪ Accepting the patient as he is ▪ Treating the patient as an emotionally able stranger and relating to him on this basis until evidence shows him to be otherwise. o Resource person ▪ In the role of resource person, the nurse explains, in language that the patient can understand, information related to the patient’s health care. o Teacher ▪ the nurse identifies learning needs and provides information required by the patient or family to improve the health situation. o Leader ▪ Autocratic leadership promotes overvaluation of the nurse and patients’ substitution of the nurse’s goals for their own. Laissez-faire leaders convey a lack of personal interest in the patient. o Surrogate ▪ Outside of their awareness, patients often perceive nurses as symbols of other individuals. They may view the nurse as a mother figure, a sibling, a former teacher, or another nurse who has provided care in the past. This perception occurs when a patient is placed in a situation that generates feelings similar to ones he or she has experienced previously. o Technical expert ▪ The nurse understands various professional devices and possesses the clinical skills necessary to perform interventions that are in the best interest of the patient. o Counselor ▪ The nurse uses “interpersonal techniques” to assist patients in adapting to difficulties or changes in life experiences. ▪ Counseling in nursing has to do with helping the patient to remember and to understand fully what is happening to him in the present situation, so that the experience can be integrated with, rather than dissociated from, other experiences in life. • Therapeutic use of self o strategic, useful tool for mental health professionals to improve empathy and identification with patients. o the ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention.” o Use of the self in a therapeutic manner requires that the nurse possess self- awareness and self-understanding, which are achieved by developing a philosophical belief about life, death, and the overall human condition. • Phases of the therapeutic nurse patient relationship o Therapeutic relationships are always goal oriented. o Pre-interaction ▪ Obtaining valuable info about client from chart, SO, family, or healthcare team. ▪ Examining one’s feelings, fears, and anxieties about working with this patient. o Orientation ▪ Introduction ▪ Create environment of trust and rapport ▪ Establish boundaries ▪ Assess patient Identify strengths and limitations ▪ Formulate nursing diagnosis ▪ Set goals for patient ▪ Develop plan of action ▪ Explore feelings of both patient and nurse o Working phase ▪ Maintain trust and rapport ▪ Promote client insight and perception of reality. ▪ Problem-solving ▪ Overcome resistance behaviors ▪ Evaluate progress toward established goals. ▪ Transference: This occurs when the client unconsciously displaces or transfers to the nurse feelings formed toward another person from his/her past. These can be positive or negative feelings. Common phenomena that may occur during the working phase and can interfere with the therapeutic relationship. ▪ Countertransference: This refers to the nurse’s behavioral and emotional response to the client. The nurse is to recognize the occurrence of this phenomenon and remain professional at all times. Common phenomena that may occur during the working phase and can interfere with the therapeutic relationship. o Termination phase ▪ Progress has been made toward attainment of the goals. ▪ A plan of action for more adaptive coping with future stressful situations has been established. ▪ Feelings about termination of the relationship are recognized and explored. • Barriers to the therapeutic nurse patient relationship o Giving reassurance: “Everything is going to be fine.” o Rejecting: “That’s not possible.” o Approving/disapproving: “I think that is a great idea.” “I don’t think that is such a great idea.” o Agreeing/disagreeing: “That’s right.” “That’s wrong.” o Giving advice: “I think you should…” o Probing: The nurse is persistent in questioning. o Defending: “We are all here to help you.” o Requesting an explanation (Why?): Asking the client to defend his/her thoughts. o Indicating the existence of an external source of power: “What made you act like that?” o Belittling feelings expressed: Client- “I have nothing to live for.” Nurse- “Everyone gets down in the dumps sometimes.” o Making stereotyped comments: “Hang in there.” o Using denial: Client- “I’m nobody.” Nurse- “Of course, you are somebody.” o Interpreting: “What you mean is…” o Introducing an unrelated topic: the nurse changes the subject. • Boundaries in the Nurse client relationship and complicates if boundaries are breeched o Nurses must be consistently conscientious in avoiding any circumstance in which they might achieve persona gains. o Concerns regarding the nurse boundaries with the client include self-disclosure, and gift giving and receiving. o In mental health nursing, touch is generally avoided. This approach is often inappropriate with clients with mental health disorders. It can be misinterpreted as affection or aggression. o Types of boundaries ▪ Material ▪ Social ▪ Personal ▪ Professional Self-disclosure Gift-giving and receiving Touch Friendship or romantic association • Application of the nursing process through the care of clients with mental health risks and management o Mental Health Status o General Description ▪ Appearance Grooming Personal hygiene Posture Level of eye contact Evidence of scars or other distinguishing skin marks ▪ Motor Activity Tremors Tics Mannerisms Hyperactivity Restless or agitated Aggressive Echopraxia (involuntary imitation of movements of another person) Psychomotor retardation ▪ Speech Patterns Slowness or rapid speech Pressure of speech (frenzied) Volume Aphasia ▪ Attitudes Slowness or rapid speech Pressure of speech (frenzied) Volume Aphasia ▪ Emotions Depressed Irritable Anxious Elated Euphoric Fearful Guilty Labile (mood swings) ▪ Affects (the behavioral expression of emotion) Constricted or blunted (minimal emotional expression) Flat (absence of emotional expression) Appropriate Inappropriate ▪ Thought Processes Form of thought Content of thought (hallucinations/delusions) ▪ Cognitive Ability Level of alertness Clear-minded/attentive Orientation • Time • Place • Person • Situation Memory • Recent • Remote • Confabulation (create content for memory gaps) o Assessment: evaluate patient’s mental status and identify its impact on their safety and ability to function. o Diagnosis: The psychiatric-mental health registered nurse analyzes the assessment data to determine diagnoses, problems, and areas of focus for care and treatment, including level of risk. o Outcomes Identification: Psychiatric-mental health RN identifies expected outcomes and the healthcare consumer’s goals for a plan individualized to the healthcare consumer or to the situation. o Planning: Psychiatric-mental health RN develops a plan that prescribes strategies and alternatives to assist the healthcare consumer in attainment of expected outcomes. ▪ Priorities are based on safety needs and the patient’s risk for harm to self or others. o Implementation: Psychiatric-mental health RN implements the identified plan. ▪ Coordination of care, health teaching and health promotion, consultation, prescriptive authority and treatment, pharmacological/biological/integrative therapies, milieu therapy, therapeutic relationship and counseling, psychotherapy o Evaluation: Psychiatric-mental health RN evaluates progress toward attainment of expected outcomes. o Applying nursing process in psychiatry: ▪ Help patient adapt to environmental stressors as part of interdisciplinary team. ▪ Nursing diagnoses are prioritized according to life-threatening potential. ▪ Expected outcomes are patient-oriented, measurable, and focused on problem resolution. ▪ Nursing contributions to interdisciplinary treatment regimen Independent nursing actions and goals that enhance the achievement of the overall goals of treatment. ....................................................................................................CONTINUE.