Download - Role Mental Health Nurse
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MENTAL HEALTH NURSE
Mental health nurses work with children, adults and older
people suffering from various mental health conditions.
The work involves helping people to recover from their illness
or come to terms with it in order to maximise their life
potential.
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ROLE OF PSYCHIATRIC NURSE
a. Carries out traditional tasks :
Administering prescribed
drugs and monitoring effects
b. Acts as a primary therapist
c. Uses interpersonal approach to
help patients and families
d. Draws on psychosocial and
biophysical sciences to provide
care
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DEFINITION OF NURSE-PATIENT
RELATIONTHIPThe nurse patient relationship is an end result of
series of interaction between the nurse and
patient over a period of time with the nurse
focusing on need and problem of patient and hisfamily while using the scientific knowledge and
specific skills of nursing profession.
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PHASES OF NURSE PATIENT
RELATIONSHIP PRE INTERACTION PHASE
Occurs before direct patient contact
ORIENTATION PHASE Getting - to - know you
Sets tone for relationship
WORKING PHASE Exploration phase
Focuses on and evaluates patients problems
Works toward achieving established goals
TERMINATION PHASE Resolution phase
Marked by reviewing and summarizing patients progress
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Pre-interaction phase
Pre interaction is a phase which a nurse goes
through before actual interaction with the
patient. This phase begins when the nurse is
assigned a patient to develop therapeutic
relationship with him till she goes to him for
interaction
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Pre-Interaction Phase..
The pre interaction phase begins before the nurses first
contact with the patient.
This involves preparation for first encounter with the client.
This phase begins when the nurse is assigned a patient todevelop therapeutic relationship with him or her till she goes
him or her for interaction.
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Task of pre-interaction phase
Obtaining available information about the client from his or her
charts, significant others or other health team members. From
this information the initial assessment are begun.
This initial information may also allow the nurse to become awareof personal response to the knowledge about the client.
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Task of pre-interaction phase
Examining ones feelings, fears and anxieties about
working with a particular patient.
Set objective for the interaction phase.
Take help of the clinical supervisor or co-workers toovercome fears.
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Reactions of Nurse in
Pre-Interaction Phase The nurse thinks and feels about the patient before
interacting according to her knowledge, fears and
miss concepts.
She tries to collect information from secondary
sources like the patients records, a resource person
and other nurses working in the ward.
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Reactions Of Nurse in Pre Interaction
Phase .
The nurse plans how she is going to interact with the patient,
what she is going to achieve from this interaction and how she
is going to help the patient.
She plans her objective for interaction phase.
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Reactions Of Nurse in Pre Interaction
Phase . The nurse may experience anxiety.Anxiety may be manifested by standing in duty room and going
through the records, talking with the clinical instructor.
Anxieties maybe,
will the patient talk to me?
He may not accept me or like me?
He may beat me?
Once she goes to the patient the anxiety reduces.
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How to overcome anxieties
She can go through their record.
Talk to the clinical supervisor or othernurses about her fears.
Can set her goals very clearly.
Plan a brief interaction with the patient.
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INTRODUCTORY /
ORIENTATION PHASEBegins when the nurse goes to the patient, introduces herself
and gets introduction about him.
The nurse and client get acquainted.The orientation phase ends when the nurse and he patient
begin to accept each other as a unique human being.
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Task of introductory or orientation
phase a) Establishment of Contact
Nurse introduce herself to the patient
Build trust and rapport by demonstrating
acceptance.
Establishing a therapeutic environmentensuring safety and privacy
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Task of introductory or orientation
phase..
b) Making Agreement or Pact
Initiating a therapeutic contract by establishing a time, place
and duration of each meeting as well as the length of time the
relationship will be in effect.
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Task of introductory or orientation
phase.. c) Talking with the Patient
While talking with the patient, shows trust in her behaviour.
The patient may present a prepared spiel to the nurse when
she asks, what is your problem? during this task the nurse
should establish a mode of communication which is
acceptable to both the client and the nurse.
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Task of introductory or orientation
phase..
d) Assess the Clients Need, Coping
Strategies, Defense Mechanisms,Strengths and Weakness
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BARRIERS TO ORIENTATION PHASE
1. Establishing an agreement or pact.
2. Social class of the patient or the nurse.
3. Status of the patient.
4. Anxiety level of the patient and nurse.
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5) Transference
When the patient perceive the nurse as asignificant individual from the past: for example the
perceives the nurse as his daughter and starts
behaving with her like a father
6) Counter transference
When the nurse perceives a male patient like her
father and gives him the same care that she would
have given to her father
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WORKING PHASE
Working Phase starts when the nurse and the
patient are able to overcome the barriers of orientation and
introductory phase.
During this phase the nurse and the patient activelywork on meeting the goals which they had establish during the
orientation phase.
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WORKING PHASE.
The characteristic feature of this phase is
that the nurse is able to overcome
anxiety and the patients fear of un
known is also decreased.
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Task of working phase
The nurse collects the data in detail from primary and secondary
sources and identifies the needs of the patent.
The nurse assists the patient to identify his or her problem.
She helps the patient to communicate.
She encourages the patient to socialize.
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Task of working phase
The nurse helps the patient o find an alternative solution
to his or her problems
She encourage the patients to use new patterns of
behaviour.
Helps the client to develop positive coping behaviors.
Identifying available support system.
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Task of working phase
The nurse helps the patient to understand that he has a
significant role in his treatment.
Exploring the clients perception of reality and provideconstructive feed back.
Developing and implementing plan of action with a
realistic goals.
Evaluating the results of plan of action.
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Task of working phase
The nurse prepares the patient for
termination of relationship by reminding
him during the interviews
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Working phase
The working phase helps the nurse to developknowledge and skill in psychiatric nursing. She identifies
her strengths and weakness as a nurse while interacting
with patient.
It enables the nurse to achieve the goals which they
have plan for this phase. The end results lead the
patient to verbalize, socialize, identify and faces the
problems realistically
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BARRIERS OF WORKING PHASE
Testing of the nurseThe patient tests the nurse for the ability and
competence.
Example:
Patient: please continue talking I am very upset today.
If the nurse gives in to his demand, it indicates
manipulation.
He may deliberately be aggressive to test whether he isable to arouse anger in the nurse
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BARRIERS OF WORKING PHASE
Progress of the patient
A mentally ill patient may not show a quick progress. He
may progress then regress and remains stagnant before
making further progress. In therapeutic relationship thenurse must understand the realistic progress in the
client
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BARRIERS OF WORKING PHASE
Difficulty in collecting and interpreting the data
The nurse is unwilling to engage in TDS task in
collecting and interpreting the data, applying the
knowledge and skills in helping the patient, she findstoo hard to do this acts as a barrier in completing the
task of working phase.
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BARRIERS OF WORKING PHASE
Fear of closeness
The nurse feels that she is working closely with
the patient she may find difficult to terminate the
relationship.The patient may not like to discontinue the
relationship. To avoid closeness she doesnt
communicate freely and makes deliberate attempts
to avoid going to the patient.
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STRATEGIES TO OVERCOME BARRIERS
Learn the subject in depth
Taking help from supervisors and experts
Discussions with peer group
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TERMINATION PHASE
The final step of the therapeutic relationship is the
termination phase. The nurse terminates the
relationship when they mutually agreed: on goals are
reached.
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TERMINATION PHASE.
The nurse discusses the termination phase with the
client encourages to identify the progress that the client
has made and explores the necessity of any referral that
may be beneficial to the patient. As separations occurs clients commonly exhibit
regressive behaviour demonstrates hostility or
experience sadness.
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TERMINATION PHASE.
The client may attempt to prolong the relationship as
clinical symptoms of separation anxiety are experienced
however; termination needs to occur if a therapeutic
relationship to be a complete process. Preparation for termination actually begins during the
initiation phase
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CAUSES
The client is transferred or discharge.
The nurse is finished clinical rotation.
The patient may go on parole and doesnt come backto hospital.
The client has improved and no longer needs to have
one to one relationship.
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TASK OF TERMINATION
Bring a therapeutic end to the relationship. Review feelings about relationship.
Evaluate progress towards goal.
Establish mechanisms for meeting future therapyneeds.
Summarize entire communication and follow up
treatments.
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PREPARATION OF PATIENT Explain whatever goals of therapeutic relationship
where plans have been met.
Allow the patient to talk about his or her fear and an
individualistic approach has to be used.
A psychiatric social worker can be contacted to meet
to visit the office and family of the patient.
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PREPARATION OF PATIENT
The patient may sent on parole beforedischarge, so that he gradually goes
through the weaning of the phase.
The patient may be sent through a half way
home.
The patient may be asked to attend the daycare center for few days.
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BARRIERS OF TERMINATION PHASE The patient may ask the nurse to write to him or
come back from duty and see him.
The patient may ask the address and telephone
number of nurse and ask permission to visit her inhospital
Gift giving
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BARRIERS OF TERMINATION PHASE.
The nurse may withdraw earlier from the patient due
to her own anxiety she may not interact with the
patient
The nurse may not assess the patient which she
could otherwise do
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STRATEGIES TO OVERCOME
Nurse needs to explore her own feelings and
thoughts about separation from the patient which
will help her to accomplish the task of termination
phase The patient should be explained that every
relationship terminates
Getting help from supervisors
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STRATEGIES TO OVERCOME.
After discharge the patient comes for
intervention he or she should be referred to a
second in charge.
If the patient is giving some gifts: the patientneed to be explained about the professional
ethics, if he wants to give a gift he may be
encourage to gift out something for theutilization of other patients.