Psychiatric Mental Health Nursing

• Psychiatric–Mental Health Nursing: is a specialty within the discipline of Nursing, that is recognized as one of the four core mental health practice areas, which also include psychiatry, psychology, and social work.

• Defined by the American Nurses Association as: “Specialty area of Nursing practice employing theories of human behavior, as its science and the purposeful use of self as its art “In the Diagnoses and Treatment of human responses to actual or potential mental health problems”.

• The discipline of Nursing is relatively young and continues to define it self.

Principles of the Nurse – Client Relationship ( R/T)

• This R/T is therapeutic rather than social.

• The focus remains on the client’s issues rather than on nurse’s or other issues.

• The R/T is purposeful and goal directed.

• It is time – limited versus open ended.

*Therapeutic versus (v/s) social:

• Therapeutic R/T is formed to help client to: Solve problems, make decisions, achieve growth, learn coping strategies, reinforce self worth and examine R/T.

• R/T between nurse and client is not for mutual satisfaction.

• The nurse is not to be the client’s friend but he can be friendly with client.

• Boundaries are important, which define us and our roles, especially in therapeutic R/T, and when trying to be client’s friend breaking to boundaries will result and confusing to roles.

• The nurse helps the client increase awareness of boundaries and practice boundary–setting.

• Some social conversation is used at the beginning of meetings and may help to establish or maintain rapport.

Do my clients have the right to know my name?

• As a general rule, clients have a right to know who is caring for them. One way of demonstrating accountability is sharing your name and title with your clients.

• All nurses have the right to be safe. Health care agencies need to balance clients' interests with staff safety. Agencies should have policies on staff identification, documentation and releasing employee names.

How do I separate my professional & personal roles when I work in a small community?

When someone from your community becomes your client: • Clarify the change from a personal to a professional

relationship;• Distinguish between “being friendly” and “being

friends”;• Focus on the needs of your client; and• Be vigilant about confidentiality issues.

Sometimes we buy our patients gifts & cake for their birthdays; is this is appropriate?

• Gift giving is a complex issue and can blur boundaries. Giving token gifts as a group may be acceptable. When deciding, discuss with your colleagues and consider:

• The intent of the gift.• The implications of singling out clients.• If a gift could be seen as an attempt to create a special

relationship.• Any agency policy about giving and receiving gifts.• Developing unit guidelines for celebrating client

birthdays would provide direction.

A client died and left me something in her will. What should I do?

• Nurses cannot benefit personally by accepting a gift that results from a professional relationship. The best options are to refuse the gift with an explanation or ask that it be donated to a charitable organization

A client sent me a Facebook request. Is it okay to accept it?

• It's not appropriate for you to be a client's Facebook friend. The reason for your relationship with the client is to provide professional nursing services. Nurse-client relationships occur within boundaries that separate professional relationships from personal ones. As the nurse, you are responsible to set, maintain and communicate these boundaries with your clients, both face-to-face and online.

Stage of the nurse client R/T

1)Pre – orientation phase: • Includes gathering facts about client (present

situation chart, staff report physician report, family members).

• From gathered information: Auto-diagnosis –(Regarding the nurse thoughts, feelings, and perceptions about client).

• Bias, judgmentalism may result before dealing with client.

2)Orientation phase:

• Allowing nurse – client introduction, building trust, demonstrates acceptance of the process that will take place.

• Contract B/W Nurse and client may be established:-It could be formal or informal.-In acute care setting: verbal informal contract.-In outside acute setting clinic: formal.-Includes: Explaining the purpose of settings, expected results time of appointment .-If something prevents appointment: call the client, explaining the situation and set a new appointment.

3)Working phase:

• Client takes responsibility for his own behavior change.

• Prioritization of problems that require immediate attention first.

• Safety is first.

4)Termination phase:

• Begins in orientation phase when nurse states time.

• Nurse doesn’t continue R/T after clients leave Rx.

• Termination occurs when client improved or nurse transferred.

• Ending Rx may be traumatic to client, so us: a. Reduce time of session increase amount of time B/W sessions (depends on improvement of condition). b. Focus (when discharge) on post discharge situation plan of future. c. Have client identify changes – he made forward growth. d. Helping client to express feelings about ending.

Essential Characteristics of Successful Therapist

• Empathy: placing self in client’s internal perception without losing objectivity or identity.

• Warmth: the nurse is wholly and intently attentive to the interaction, resulting in client feeling accepted and significant.

• Genuineness: nurse’s verbal and non-verbal messages are entirely congruent with way he feels.

• Respect: unconditional positive regard for client’s uniqueness regardless of his present life situation.

• Concreteness: use of specific, realistic terminology rather than – vague abstract concepts.

• Immediacy: interactions and commination focus on inter personal R/T as if exists at the moment.

• Confrontation: constructive confrontation is necessary for client behavior changes. If the client remains unaware of problems he will continue to conduct life in the same self - defeating patterns and will avouch getting well.

• Self–Disclosure: The nurse volunteers personal information (ideas, feelings, experiences) only when relevant to client’s concerns and interests.

Roles of mental health team

1-Psychiatric Nurse• Nurses have the most widely focused position

description of any of the member roles.• They interact with clients in individual and group

settings.• Manage client’s care. • Administer and monitor medications.• Assist with numerous psychiatric or physical treatments.• Participate in interdisciplinary team meetings• Teach clients of families.

• Take responsibility for client advocate.

• Interact with clients significant others.

• Act as a client advocate.

• Interact with client’s significant others.

• Assess and intervene with client’s psychiatric, biological, psychosocial, cultural or spiritual problems.

• Master’s and doctoral –prepared nurses act as clinical specialists in individual group at family therapy, with expanded roles within psychiatric setting, or they act autonomously in private practice.

• In some US states clinical nurse specialists prescribe medications and manage client case loads.

2-Psychiatric social worker: • Can work with clients on an individual basis. • Conduct group therapy sessions. • Work with client’s family. • Act as a liaison with the community to place

clients after discharge. • They emphasize intervention with the client in

the social environment in which he / she will live.

3-Psychiatrist: • Licensed medical physician who specialized in

psychiatry. • Responsibilities include: -Admitting clients into acute care settings. -Prescribing &monitoring psychopharmacologic agents. -Administering electroshock therapy. -Conducting individual and family therapy. -Participating in interdisciplinary team meeting that focus on their clients.

4-Psychologist: • Licensed individual with a doctoral degree in psychology.

• Not MD.

• Can specialize further -Ex. Clinical psychology , educational psychology, etc…

• Trained in using tools such as IQ test.

• Works along with psychiatrist – helps –diagnosis and treat people with mental or emotional illness.

5-Psychiatric technician: • Has direct client contact in psychiatric setting

and usually reports to the registered nurse.

• Trained to observe and record symptoms and intervene under supervision.

• In some states they can administer med. under supervision of RN.