overview of pschyhitric nursing

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mental health

a state of emotional, psychological, and

social wellness

evidenced by:

satisfying interpersonal relationships

effective behavior and coping

positive self-concept emotional stability


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FACTORS INFLUENCING MENTALHEALTH


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1. Autonomy and independence

2. Maximization of ones potential

3. Tolerance of lifes uncertainties4. Self Esteem

5. Mastery of the environment

6. Reality orientation7. Stress management


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MENTAL ILLNESS


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Mental illness

a clinically significant behavioral or

psychological syndrome or pattern that occurs

in an individual and that is associated with

present distress or disability

or with a significantly increased risk of

suffering death, pain, disability, or an

important loss of freedom


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General criteria to diagnose

mental disorders:

dissatisfaction with ones characteristics, abilities, andaccomplishments

ineffective or nonsatisfying relationships

Dissatisfaction with ones place in the world

ineffective copingwith life events

lack of personal growth

In addition,

the persons behavior must not be culturalyl expectedor sanctioned

nor does deviant behavior necessarily indicate amental disorder (APA, 2000).


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INDIVIDUAL, INTERPERSONAL, AND

SOCIAL/CULTURAL CATEGORIES.


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Individual factors:

biologic

Makeup

anxiety, worries and fears, a sense of disharmony in life

a loss of meaning in ones life (Seaward, 1997).


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Interpersonal factors:

Ineffective communication

excessive dependency or withdrawal from

relationships

loss of emotional control.


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Social and Cultural Factors:

lack of resources,

Violence

Homelessness Poverty

Discrimination such as racism, classism,

ageism, and sexism.


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HISTORICAL PERSPECTIVES and

TRENDS

People of ancient times believed that any

sickness indicated displeasure of the gods and

in fact was punishment for sins and

wrongdoing.

Those with mentaldisorders were viewed as

being either divine or demonic depending on

their behavior.


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Individuals seen as divine were worshipped

and adored;

those seen as demonic were ostracized,punished, and sometimes burned at the stake.


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Aristotle (382- 322 BC)

related mental disorders to physical disorders

theorized that the amounts of blood, water,

and yellow and black bile in the body

controlled the emotions.

These 4 substances were also called humors

corresponded with happiness, calmness,

anger, and sadness.


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Imbalances of the four humors were believed tocause mental disorders

so treatment aimed at restoring balance

through:1. Bloodletting

2. starving

3. purging Such treatments persisted well into the 19th

century (Baly, 1982).


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early Christian times (11000 AD),

Primitive beliefs and superstitions were strong

All diseases were again blamed on demons

mentally ill were viewed as possessed.

Priests performed exorcisms to rid evil spirits.

When that failed, they used more severe

measures such as

incarceration in dungeons,

flogging, starving, and other brutal treatments.


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Renaissance (13001600)

people with mental illness were distinguished

from criminals in England.

Those considered harmless were allowed to

wander the countryside or live in rural

communities

but the more dangerous lunatics were

thrown in prison, chained, and starved

(Rosenblatt, 1984).


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In 1547, the Hospital of St. Mary of Bethlehemwas officially declared a hospital for the insane(the first of its kind)

1775, visitors at the institution were charged afee for the privilege of viewing and ridiculing theinmates, who were seen as animals, less than

human (McMillan, 1997). During this same period in the colonies (later the

United States), the mentally ill were consideredevil or possessed and were punished.

Witch hunts were conducted, and offenders wereburned at the stake.


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Period of Enlightenment and

Creation of Mental Institutions


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1790s, a period of enlightenment concerning

persons with mental illness began.

Phillippe Pinel in France and William Tukes in

England formulated the concept ofasylum

as a safe refuge or haven

offering:

protection at institutions where people had

been whipped, beaten, and starved justbecause they were mentally ill (Gollaher,

1995).


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Dorothea Dix (18021887) began a crusade to reformthe treatment of mental illness after a visit to Tukesinstitution in England.

was instrumental in opening 32 state hospitals thatoffered asylum to the suffering.

HOWEVER:

The period of enlightenment was short-lived.

Within 100 years after establishment of the firstasylum, state hospitals were in trouble.

Attendants were

accused of abusing the residents, the rural location of

hospitals was viewed as isolating patients from family

and their homes, and the phrase insane asylum

took on a negative connotation.


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SIGMUND FREUD AND TREATMENTOF MENTAL DISORDERS


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The period of scientific study and treatment of

mental disorders began with

Sigmund Freud (18561939)

Emil Kraepelin (18561926)

Eugene Bleuler (18571939).


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Freud challenged society to view human

beings objectively. He studied the mind, its

disorders, and their treatment as no one had

before. Many other theorists built on Freuds

pioneering work

Kraepelin began classifying mental disorders

according to their symptoms,

Bleuler coined the term schizophrenia.


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DEVELOPMENT OFPSYCHOPHARMACOLOGY


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A great leap in the treatment of mental illness

began in about 1950 with the development of

psychotropic drugs (drugs used to treat

mental illness).

Chlorpromazine (Thorazine), an antipsychotic

drug, and lithium, an antimanic agent, were

the first drugs to be developed.


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For the first time, drugs actually reduced

agitation, psychotic thinking, and depression.

Hospital stays were shortened, and manypeople were well enough to go home.

The level of noise, chaos, and violence greatly

diminished in the hospital setting (Trudeau,

1993).


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MENTAL ILLNESS

IN THE 21ST CENTURY


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The Department of Health and Human

Services (2002) estimates that 56 million

Americans have a diagnosable mental illness

Four of the ten leading causes of disability in

theUnited States and other developed

countries are mental disorders: majordepression, bipolar disorder, schizophrenia,

and obsessive-compulsive disorder


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revolving door effect

While people with severe and persistent

mental illnesses have shorter hospital stays,

they are admitted to hospitals more

frequently.

In some cities, emergency department visits

for acutely disturbed persons have increased

by 400% to 500%.


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Many providers believe todays clients to be

more aggressive than those in the past. Four

to eight percent of clients seen in psychiatricemergency rooms are armed (Ries, 1997)


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OBJECTIVES FOR THE FUTURE


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Decrease rates of suicide and homelessness

to increase employment among those with

serious mental illness

to provide more services for both juveniles

and adults who are incarcerated and have

mental health problems.


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Community-Based Care

Developed to meet the needs of persons withmental illness outside the walls of aninstitution.

focus on rehabilitation, vocational needs,education,and socialization

as well as management of symptoms and

medication. These services are funded by states (orcounties) and some private agencies.


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UNFORTUNATELY:

community-based system did not accurately

anticipate the extent of the needs of people

with severe and persistent mental illness.

Many clients do not have the skills needed to

live independently in the community

nature of some mental illnesses makes

learning these skills more difficult


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For example, a client who is hallucinating, or

hearing voices, can have difficulty listening

to or comprehending instructions.

Other clients experience drastic shifts in

mood, being unable to get out of bed one day,

then unable to concentrate or pay attention afew days later.


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Positive impact:

Clients can remain in their communities, maintain

contact with family and friends, and enjoy personal

freedom that is not possible in an institution.

People in institutions often lose motivation and hope as well as functional daily living skills such as shopping

and cooking. Therefore treatment in the community

is a trend that will continue.


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Cultural Considerations

The United States Census Bureau (2000)

estimates that 62% of the population has

European origins.

This number is expected to continue to

decrease as more U.S. residents trace their

ancestry to Africa, Asia, or the Arab or

Hispanic worlds in the future.


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Nurses must be prepared to care for thisculturally diverse population, and thatincludes being aware of cultural differencesthat influence mental health and thetreatment of mental illness

Diversity is not limited to culture the structure

of families in the United States has changed aswell.

With a divorce rate of 50% in the United

States, single parents head many families, andmany blended families are created whendivorced persons remarry.


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Twenty-five percent of households consist of a

single person (Wright, 1995)

many people live together without beingmarried.

Gay men and lesbians form partnerships and

sometimes adopt children. The face of the family in the United States is

varied, providing a challenge to nurses to

provide sensitive, competent care.


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PSYCHIATRIC NURSING PRACTICE

In 1873, Linda Richards graduated from the New

England Hospital for Women and Children in

Boston.

She went on to improve nursing care in

psychiatric hospitals and organized educational

programs in state mental hospitals in Illinois.

Richards is called the first American psychiatricnurse


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she believed that the mentally sick should be

at least as well cared for as the physically sick

(Doona, 1984)

The first training of nurses to work with

personswith mental illness was in 1882 at

McLean Hospitalin Waverly, Mass.


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Care focused on:

nutrition, hygiene, and activity. Nurses

adapted medical-surgical principles to the care

of clients with psychiatric disorders and

treated them with tolerance and kindness.


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The role of psychiatric nurses expanded as

somatic therapies for the treatment of mental

disorders were developed. Treatments such as

insulin shock therapy (1935),

psychosurgery (1936) electroconvulsive therapy (1937) required

nurses to use their medical-surgical skills

further.


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Nursing

Mental Diseases (Harriet Bailey)

first psychiatric nursing textbook published in

1920.


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In 1913, Johns Hopkins was the first school of

nursing to include a course in psychiatric

nursing in its curriculum. 1950 - National League for Nursing, which

accredits nursing programs, required schools

to include an experience in psychiatricnursing.


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NURSING THEORISTS


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Hildegard Peplau

published Interpersonal Relations in Nursing in

1952

Interpersonal Techniques: The Crux of

Psychiatric Nursing in 1962.

Described the therapeutic nurseclient

relationship with its phases and tasks and

wrote extensively about anxiety


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June Mellow

Nursing Therapy (1968)

described her approach of focusing on the clients

psychosocial needs and strengths.

Contends that the nurse as therapist is

particularly suited to working with those with

severe mental illness in the context of daily

activities, focusing on the here-and now to meeteach persons psychosocial needs (1986).


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Standards of care

Developed by American Nurses Association

Authoritative statements by professionalorganizations that describe the responsibilities

for which nurses are accountable. not legally binding unless they are incorporated

into the state nurse practice act or state boardrules and regulations.

used to determine what is safe and acceptablepractice and to assess the quality of care whenlegal problems or lawsuits arise


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Phenomena of concern describe the 12 areas of concern that mental

health nurses focus on when caring for clients

The standards of care incorporate the phasesof the nursing process, including specific types

of interventions, for nurses in psychiatricsettings

outline standards for professionalperformance:

quality of care, performance appraisal,education, collegiality, ethics, collaboration,research, and resource utilization


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STUDENT CONCERNS:

Wh t if I th thi ?


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What if I say the wrong thing?

No one magic phrase can solve a clients

problems; likewise, no single statement will

significantly worsen them.

Listening carefully, showing genuine interest, andcaring about the client are extremely important.

A nurse who possesses these elements but says

something that sounds out of place can simplyrestate it by saying:

That didnt come out right. What I meant was ..


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What will I be doing?

The student must deal with his or her own

anxiety about approaching a stranger to talk

about very sensitive and personal issues.

Development of the therapeutic nurseclient

relationship and trust takes times and

patience.


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What if no one will talk to me?

Students sometimes fear that clients will

reject them or refuse to have anything to do

with student nurses

Some clients may not want to talk or arereclusive, but they may show that same

behavior with experienced staff

students should not see such behavior as apersonal insult or failure.


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Generally many people in emotional

distress welcome the opportunity to

have someone listen to them and

show a genuine interest in their

situation. Being available and willing to listen is

often all it takes to begin a significant

interaction with someone.

A I i h I k l


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Am I prying when I ask personal

questions?

questions involving personal matters should

not be the first thing a student says to the

client.

These issues usually arise after some trust andrapport have been established.

H ill I h dl bi


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How will I handle bizarre or

inappropriate behavior?

It is important to monitor ones facial

expressions and emotional responses so that

clients do not feel rejected or ridiculed.

Students should never feel as if they will haveto handle situations alone.

What happens if a client asks me for a date or


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What happens if a client asks me for a date or

displays sexually aggressive or inappropriate

behavior?

Some clients have difficulty recognizing or

maintaining interpersonal boundaries.

When a client seeks contact of any type

outside the nurseclient relationship, it is

important for the student (with the assistance

of theinstructor or staff) to clarify the

boundaries of the professional relationship


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Likewise, setting limits and maintaining

boundaries are needed when the client's

behavior is sexually inappropriate.

It is also important to protect the clientsprivacy and dignity when he or she cannot do

so.


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Is my physical safety in jeopardy?

clients hurt themselves more often than they

harm others.

Staff members usually monitor clients with

potential for violence closely for clues of an

impending outburst.

When physical aggression does occur, staff

members are specially trained to handleaggressive clients in a safe manner.


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When talking to or approaching clients who

are potentially aggressive:

the student should sit in an open area rather

than a closed room, provide plenty of space

for the client, or request that the instructor or

a staff person be present..

What if I encounter someone I know being


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What if I encounter someone I know being

treated on the unit?

It is essential in mental health that the clients

identity and treatment be kept confidential.

If the student recognizes someone he or she

knows, the student should notify the instructor,who can decide how to handle the situation.

It is usually best for the student (and sometimes

the instructor or staff) to talk with the client andreassure him or her about confidentiality.


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INTERDISCIPLINARY TEAM


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Multidisciplinary team approach

Members include:1. Pharmacist

2. Psychiatrist

3. Psychologists4. Psychiatric nurse

5. Psychiatric social worker

6. Occupational therapist

7. Recreation therapist8. Vocational rehabilitation specialists

Core skill areas of an Effective team


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Core skill areas of an Effective team

member:

Interpersonal skills Humanity such as warmth, acceptance, empathy,

genuineness and non judgemental attitude

Knowledge base about mental disorders

Communication skills

Personal qualities such as consistency,assertiveness and problem solving abilities

Teamwork skills such as collaborating, sharingand integrating

Risk assessment and risk management skills


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SELF-AWARENESS ISSUES


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Self-awareness

is the process by which the nurse gains

recognition of his or her own feelings, beliefs,

and attitudes.

particularly important in mental healthnursing.

Everyone, including nurses and student

nurses, has values, ideas, and beliefs that areunique and different from others.

Accomplished through:


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Accomplished through:

reflection,

spending time consciously focusing on how

one feels and what one values or believes.

The goal of self awareness is to know oneself


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The goal of self-awareness is to know oneself

so that ones values, attitudes, and beliefs are

not projected to the client, interfering withnursing care.

Self-awareness does not mean having to

change ones values or beliefs unless one

desires to do so.


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THE MENTAL HEALTH ILLNESS

CONTINUUMRefer to pdf (chapter 1 slide- 7)


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II. MENTALHEALTH-PSYCHIATRICNURSINGPRACTICE


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A. PERSONALITYTHEORIESANDDETERMINANTSOFPSYCHOPATHOLOGY: IMPLICATIONSFORMENTALHEALTH-PSYCHIATRICNURSINGPRACTICE

PE1. PSYCHOANALYTIC


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ERSONA

LITYTHEORIES

1. PSYCHOANALYTIC

2. BEHAVIORAL

3. INTERPERSONAL

4. COGNITIVE

5. HUMANISTIC

6. PSYCHOBIOLOGIC

7. COGNITIVE

8. PSYCHOSOCIAL

9. PSYCHOSPIRITUAL

10. ECLECTIC


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SIGMUND FREUD:THE FATHER OFPSYCHOANALYSIS

Psychoanalytic Theories


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PSYCHOANALYTIC

Developed by sigmund freud (18561939) in thelate 19th and early 20th century in vienna

supports the notion that all human behavior is

caused and can be explained (deterministic theory).

Freud believed that repressed(driven fromconscious awareness) sexual impulses and desires

motivated much human behavior.

1 PERSONALITY COMPONENTS: ID EGO AND


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1. PERSONALITYCOMPONENTS: ID, EGO, ANDSUPEREGO.

id is the part of ones nature that reflects basic orinnate desires such as pleasure-seeking behavior,

aggression, and sexual impulses.

The id seeks instant gratification; causes impulsive,

unthinking behavior; and has no regard for rules orsocial convention.


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SUPEREGO

is the part of a persons nature that reflects moraland ethical concepts, values, and parental and

social expectations; therefore, it is in direct

opposition to the id.


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EGO

is the balancing or mediating force between the idand the superego.

The ego represents mature and adaptive behavior

that allows a person to function successfully in the

world. Freud believed that anxiety resulted from the egos

attempts to balance the impulsive instincts of the id

with the stringent rules of the superego.


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2. BEHAVIORMOTIVATEDBYSUBCONSCIOUST


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THOUGHTSANDFEELINGS.

human personality functions at three levels ofawareness: conscious, preconscious, and

unconscious


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CONSCIOUS

refers to the perceptions, thoughts, and emotions

that exist in the persons awareness such as being

aware of happy feelings or thinking about a loved

one


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PRECONSCIOUS

Preconscious thoughts and emotions arenotcurrently in the persons awareness, but he or she

can recall them with some effortfor example, an

adult remembering what he or she did, thought, or

felt as a child.


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UNCONSCIOUS

is the realm of thoughts and feelings that motivate aperson, even though he or she is totally unaware of

them. This realm includes most defense

mechanisms (see discussion below) and some

instinctual drives or motivations.According to Freud's theories, the person represses

into the unconscious the memory of traumatic

events that are too painful to remember.


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FREUDSDREAMANALYSIS.

a persons dreams reflected his or hersubconscious and had significant meaning,

although sometimes the meaning was hidden or

symbolic (Gabbard, 2000).

FREE ASSOCIATION


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FREEASSOCIATION

in which the therapist tries to uncover the clients

true thoughts and feelings by saying a word and

asking the client to respond quickly with the first

thing that comes to mind. Freud believed that such quick responses would be

likely to uncover subconscious or repressed

thoughts or feelings.

FIVE STAGES OF PSYCHOSEXUAL


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FIVESTAGESOFPSYCHOSEXUALDEVELOPMENT.

Refer to table 3.2 page 60

Oedipus complex (boys)- the boy fears retaliation

from his father for desiring his mother and

fantasizes that the father will cut of his penis

(castration anxiety)Electra Complex(girls)- has no penis to fear of losing

but believes that she has a penis at one time but

was cut off and blames her mother

TRANSFERENCE AND


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TRANSFERENCEANDCOUNTERTRANSFERENCE.

Transference occurs when the client displacesonto the therapist attitudes and feelings that the

client originally experienced in other relationships

Countertransference occurs when the therapist

displaces onto the client attitudes or feelings fromhis or her past.


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BEHAVIORAL THEORIES

Behaviorism is a school of psychology thatfocuses on observable behaviors and what one can

do externally to bring about behavior changes.

It does not attempt to explain how the mind works.

Behaviorists believe that behavior can be changedthrough a system of rewards and punishments

IVAN PAVLOV: CLASSICAL


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IVAN PAVLOV: CLASSICAL

CONDITIONING

theory of classical conditioning: behavior can bechanged through conditioning with external or

environmental conditions or stimuli.

2 B F SKINNER: OPERANT


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2. B. F. SKINNER: OPERANT

CONDITIONING

developed the theory ofoperant conditioning,

which says people learn their behavior from their

history or past experiences, particularly those

experiences that were repeatedly reinforced.

PRINCIPLES:

1. All behavior is learned.

2. Consequences result from behaviorbroadly

speaking, reward and punishment.

3. Behavior that is rewarded with rein forcers tends to

recur.

4. Positive reinforcers that follow a behavior

i th lik lih d th t th b h i ill


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increase the likelihood that the behavior will recur.

5. Negative reinforcers that are removed after a

behavior increase the likelihood that the behaviorwill recur.

6. Continuous reinforcement (a reward every time

the behavior occurs) is the fastest way to increase

that behavior, but the behavior will not last long

after the reward ceases.

7. Random, intermittent reinforcement (an

occasional reward for the desired behavior) is

slower to produce an increase in behavior, but the

behavior continues after the reward ceases.


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Behavior modification is a method of attemptingto strengthen a desired behavior or response by

reinforcement, either positive or negative.


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HARRY STACK SULLIVAN:INTERPERSONALRELATIONSHIPS AND MILIEUTHERAPY

Interpersonal Theories


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INTERPERSONAL

Harry Stack Sullivan (18921949; Fig. 3-2) was anAmerican psychiatrist.

include the significance of interpersonal relationships.

Sullivan believed that ones personality involved more

than individual characteristics, particularly how oneinteracted with others. He thought that inadequate or

non satisfying relationships produced anxiety, which he

saw as the basis for all emotional problems

The importance and significance of interpersonal

relationships in ones life was probably Sullivansgreatest contribution to the field of mental health.

Life stages- table 3-4 page: 63

DEVELOPMENTAL COGNITIVE MODES OF


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DEVELOPMENTALCOGNITIVEMODESOF

EXPERIENCE

prototaxic mode, characteristic of infancy andchildhood, involves brief unconnected experiences

that have no relationship to one another. Adults with

schizophrenia exhibit persistent prototaxic

experiences.


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parataxic mode begins in early childhood as thechild begins to connect experiences in sequence.

The child may not make logical sense of theexperiences and may see them as coincidence or

chance events.The child seeks to relieve anxiety by:

repeating familiar experiences, although he or she

may not understand what he or she is doing.

Sullivan explained paranoid ideas and slips of thetongue as a person operating in the parataxicmode.


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syntaxic mode, which begins to appear inschoolage

children and becomes more predominant in

preadolescence, the person begins to perceive

himself or herself and the world within the contextof the environment and can analyze experiences in

a variety of settings.

Maturity may be defined as predominance of the

syntaxic mode (Sullivan, 1953).


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JEAN PIAGET AND COGNITIVESTAGES OF DEVELOPMENT


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COGNITIVE

Jean Piaget (18961980) explored how intelligenceand cognitive functioning developed in children.

He believed that human intelligence progresses

through a series of stages based on age with the

child at each successive stage demonstrating ahigher level of functioning than at previous stages.


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FOURSTAGESOFCOGNITIVEDEVELOPMENT

1. Sensorimotorbirth to 2 years: The child develops a sense of self as separate from

the environment and the concept of object

permanence; that is, tangible objects dont cease to

exist just because they are out of sight. He or she begins to form mental images.


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2. Preoperational2 to 6 years: The child developsthe ability to express self with language,

understands the meaning of symbolic gestures, and

begins to classify objects.


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3. Concrete operations6 to 12 years: The child begins to apply logic to thinking,

understands spatiality and reversibility, and is

increasingly social and able to apply rules;

however, thinking is still concrete.


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4. Formal operations12 to 15 years and beyond The child learns to think and reason in abstract

terms, further develops logical thinking and

reasoning, and achieves cognitive maturity.


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HUMANISTIC

Humanism focuses on a persons positivequalities, his or her capacity to change (human

potential), and the promotion of self-esteem.

Humanists do consider the person's past

experiences, but they direct more attention towardthe present and future.


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PSYCHOBIOLOGIC


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ERIK ERIKSON ANDPSYCHOSOCIALSTAGES OF DEVELOPMENT


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PSYCHOSOCIAL

1950, Erikson published Childhood and Society, inwhich he described eight psychosocial stages of

development.(Vp61)

In each stage, the person must complete a life task

that is essential to his or her well-being and mentalhealth.

These tasks allow the person to achieve lifes

virtues: hope, purpose, fidelity, love, caring, and

wisdom. REFER TO TABLE 3.3 PAGE 61


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PSYCHOSPIRITUAL


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ECLECTIC


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GENERAL ASSESSMENTCONSIDERATIONS


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PRINCIPLES AND TECHNIQUES OFPSYCHIATRIC NURSING INTERVIEWRefer to 142 videbeck 5th edition


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ENVIRONMENT

comfortable, private,

safe for both the client and the nurse

fairly quiet with few distractions allows the client to

give his or her full attention to the interview.)

The nurse must ensure the safety of self and client

even if that means another person is present during

the assessment.


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MENTAL STATUS EXAMINATION

purpose of the psychosocial assessment is toconstruct a picture of the clients current emotional

state, mental capacity, and behavioral function.

This assessment serves as the basis for developing

a plan of care to meet the clients needs. The assessment is also a clinical baseline used to

evaluate the effectiveness of treatment and

interventions or a measure of the clients progress


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CONTENT OF THE ASSESSMENT

History General appearance and motor behavior

Mood and affect

Thought process and content

Sensorium and intellectual processes

Judgment and insight

Self-concept

Roles and relationships Physiologic and self-care concerns


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DIAGNOSTICEXAMINATIONSSPECIFICTOPSYCHIATRICPATIENTS

DIAGNOSTICAND STATISTICAL MANUALOFMENTAL


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DISORDERS-TEXT REVISION (DSM-IV-TR),

a taxonomy published by the APA. The DSM-IV-TR describes all mental disorders,

outlining specific diagnostic criteria for each based

on clinical experience and research.

All mental health clinicians who diagnosepsychiatric disorders use the DSM-IV-TR.

THREEPURPOSES:


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To provide a standardized nomenclature and

language for all mental health professionals

To present defining characteristics or symptoms that

differentiate specific diagnoses To assist in identifying the underlying causes of

disorders

A 1


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AXIS 1

is for identifying all major psychiatric disorders exceptmental retardation and personality disorders.

Examples include

depression,

schizophrenia,

Anxiety substance-related disorders.

AXIS II


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AXIS II

is for reporting mental retardation and personalitydisorders as well as prominent maladaptive

personality features and defense mechanisms.

AXIS III


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AXIS III

is for reporting current medical conditions that arepotentially relevant to understanding or managing

the persons mental disorder as well as medical

conditions that might contribute to understanding

the person.

AXIS IV


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AXIS IV

is for reporting psychosocial and environmentalproblems that may affect the diagnosis, treatment,

and prognosis of mental disorders. Included are

problems with primary support group, social

environment, education, occupation, housing,economics, access to health care, and legal

system.

AXIS V


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AXIS V

presents a Global Assessment of Functioning(GAF), which rates the persons overall

psychological functioning on a scale of 0 to 100.

This represents the clinicians

functioning; the clinician also may give a score forprior functioning (for instance, highest GAF in past

year or GAF 6 months ago)


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BUILDING NURSE- CLIENTRELATIONSHIP


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NURSE CLIENT INTERACTIONVS. NURSE CLIENTRELATIONSHIPRefer to table 5.3 and 5.2


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THERAPEUTICUSEOFSELFRefer to the book page 102


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THERAPEUTICCOMMUNICATIONa. Characteristics

b. techniques

THERA COM


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THERACOM

is an interpersonal interaction between the nurseand client during which the nurse focuses on the

clients specific needs to promote an effective

exchange of information.

Skilled use of therapeutic communicationtechniques helps the nurse understand and

empathize with the clients experience.

All nurses need skills in therapeutic communication

to effectively apply the nursing process and to meetstandards of care for their clients.

THERACOM CHARACTERISTICS


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THERACOMCHARACTERISTICS

THERACOM TECHNIQUES


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THERACOMTECHNIQUES

Refer to table 6-1 page 116


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PHASESINTHEDEVELOPMENTOFNURSECLIENTRELATIONSHIPRefer to page 100 table 5-3


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THERAPEUTICMODALITIESPSYCHOSOCIALSKILLSANDTHERAPEUTICMODALITIES

BIOPHYSICAL/ SOMATIC INTERVENTIONS


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BIOPHYSICAL/ SOMATICINTERVENTIONS

ECT AND OTHER SOMATIC THERAPIES


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ECTANDOTHERSOMATICTHERAPIES

PSYCHOPHARMACOLOGY


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PSYCHOPHARMACOLOGY

2 SUPPORTIVE PSYCHOTHERAPY


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2. SUPPORTIVEPSYCHOTHERAPY

1. nurse- patient relationship therapy2. Group therapy

3. Family therapy

3 COUNSELLING


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3. COUNSELLING

4. MENTALHEALTHTEACHING/ CLIENT

EDUCATION


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EDUCATION

5. SELFENHANCEMENT, GROWTH/

THERAPEUTIC GROUPS


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THERAPEUTICGROUPS

6 ASSERTIVENESS TRAINING


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6. ASSERTIVENESSTRAINING

7 STRESS MANAGEMENT


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7. STRESSMANAGEMENT

8 BEHAVIOR MODIFICATION


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8. BEHAVIORMODIFICATION

9 COGNITIVE RESTRUCTURING


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9. COGNITIVERESTRUCTURING

10 MILLEU THERAPY


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10. MILLEUTHERAPY

11 PLAY THERAPY


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11. PLAYTHERAPY

12. PSYCHOSOCIAL SUPPORT INTERVENTIONS


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12. PSYCHOSOCIALSUPPORTINTERVENTIONS


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overview of pschyhitric nursing

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