mental health ch06 nursing process9 06

Chapter 6Chapter 6

The Nursing Process in Psychiatric/Mental Health Nursing

The Nursing ProcessThe 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 is dynamic, not static.

Standards of CareStandards 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.

P 90-97 in text

Here, the nurse writes while Interviewing the client

Standards of CareStandards of Care

Standard II. Diagnosis

The psychiatric/mental health nurse analyzes the assessment data in determining diagnoses

Nursing DiagnosisNursing Diagnosis

The nursing Diagnosis describes the client’s condition

For example: Disturbed sensory perception, evidenced by hearing voices

Standards of Care (cont.)Standards of Care (cont.)

Standard III. Outcome Identification

The psychiatric/mental health nurse identifies expected outcomes that are measurable and realistic and individualized to the client.

For example:The client will demonstrate trust in one staff member In 5 days. The client will expressunderstanding that the voices are not real (not heard by others ) in 10 days.

Standards of Care (cont.)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.

Standards of Care (cont.)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

Standards of Care (cont.)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 assist

clients in improving coping skills andpreventing mental illness and disability

Standard Vb. Milieu therapy: to provide and maintain a therapeutic environment for client

Standard Vc. Self-care activities: tofoster independence and mental and

physical well-being

Standards of Care (cont.)Standards of Care (cont.)

Standard Vd. Psychobiological interventions: to restore the client’s health and prevent further disability Standard Ve. Health teaching: to assist clients in achieving satisfying, productive, and healthy patterns of living Standard Vf. Case management: to coordinate comprehensive health services and ensure continuity of care

Standards of Care (cont.)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

Standards of Care (cont.)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

Standard Vi. Prescriptive authority and treatment: provides pharmacological intervention, in accordance with

state and federal laws and regulations, to treat symptoms of psychiatric illness and improve functional health status

Standards of Care (cont.)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

Standards of Care (cont.)Standards of Care (cont.)

Standard VI. Evaluation

The psychiatric/mental health nurse evaluates the client’s progress in attaining expected outcomes.

Applying Nursing ProcessApplying Nursing Process

Role of the nurse in psychiatry The nurse assists the client’s 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.

Documentation of the Nursing ProcessDocumentation 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.

Documentation of the Nursing Process (cont.)Documentation of the Nursing Process (cont.)

Examples of documentation that reflect use of the nursing process

Problem-Oriented Recording (POR) Has a list of problems as its

basis Uses subjective, objective,

assessment, plan, intervention,

and evaluation (SOAPIE) format

Documentation of the Nursing Process (cont.)Documentation of the Nursing Process (cont.) Focus Charting®

Main perspective is to choose a “focus” for documentation. A focus may be

a nursing diagnosis a current client concern or behavior a significant change in the client’s status or behavior a significant event in the client’s therapy

The focus cannot be a medical diagnosis. It uses data, action, and response (DAR)

format.

Documentation of the Nursing Process (cont.)Documentation of the Nursing Process (cont.)

APIE method

A problem-oriented system Utilizes flow sheets as accompanying

documentation Uses assessment, problem, intervention,

and evaluation (APIE) format