Promoting Psychological Adaptations NRS 201 Ohio Institute of Allied Health Department of Nursing Education

Psychiatric Nursing: Theory, Principles, Trends It is widely accepted and agreed upon in the US that mental health is an inextricable component of overall human health. There are four main objectives promotion and protection of mental health prevention of mental disorders treatment of mental disorders recovery and rehabilitation Prevention has three levels: primary secondary tertiary (Maslow’s hierarchy of needs)

Patients’ Rights Are encouraged to make important decisions that affect them. Their health/safety may become jeopardized by impaired judgment which will result in loss of right to make choices. Under what circumstances?? When a person is unable to cognitively process information or to make decisions about their treatment When a person is so severely depressed that they have intent to commit suicide.

RISK FACTORS Biologic Psychological Sociocultural environmental

Nursing Practice in the Clinical Setting Principles of the nurse-patient relationship the relationship is therapeutic rather than social. the focus remains on the patient needs and Dx rather than nurse issues the relationship is purposeful and goal directed the relationship is objective rather than subjective in quality the relationship is time limited rather than open ended.

Additional clinical principles Accept the patients feelings; not the patients behavior Avoid false reassurances, clichés, and global statements Avoid giving advice. Avoid rescue fantasy Use simple, concrete, and direct language with patients Avoid heroics Consider the clinical setting the patient’s laboratory Encourage patients to take responsibility for their own actions, decisions, choices, and lives whenever they are capable.

The Nursing Process and Standards of Practice The nursing process is an organized problem-solving method that is unique to nursing It is designed to meet the needs of the patient The family The community The environment

The six steps of the nursing process focus on patient care provided by nurses and allied health personnel in clinical practice settings.

Outcome Identification Assessment MMSE Diagnosis Identify problem Outcome Identification Construct outcomes Planning Priorities of care Implementation Promote safety Evaluation Continuous evaluation

Assessment LOC MMSE Hamilton Anxiety Scale Global Assessment of Functioning Scale Mania Rating Scale Perception of own health Daily activities Substance abuse Stress/coping abilities Cultural beliefs Spiritual beliefs LOC = Alert Lethargic Obtunded Stupor Coma Physical appearance (hygiene, clothing, ect…) Behavior (voluntary/involuntary, eye contact) Mood Affect Cognitive/intellectual abilities (especially elderly) a/o x 4 memory check level of knowledge (adding/subtracting) ability to think abstractly judgment rate/volume/quality of speech Peds temperament/social/environment factors level of trust coping skills

MMSE Used to objectively evaluate a client’s cognitive status by determining the following: orientation to time and place attention span and ability to calculate by counting backwards in multiples of seven registration and recalling of objects language, including naming of objects, following commands, and ability to write

Assessment Collection Private, quiet, good lighting Establish name preference Maintain client’s level (stand/sit) Respect personal space Include questions r/t physical homeostasis Include family if able Medication history Summarize data back to pt for clarification Observe for visual stressor cues on patients with specific family or others in room.

Diagnosis DSM Identify problem Axis I Axis II Axis III Axis IIII Axis IV I – psychiatric diagnosis II – personality disorder or mental retardation III – Medical Diagnosis IV – psychosocial stressors V – Global assessment of functioning uses a 1 – 100 scale, the higher the scale the higher level of functionality 80 – 100 = normal/near-normal function 60 – 80 = moderate problems 40 – 60 = serious mental disability present and past years scores are compared in order to track progress.

Outcome Identification Construct outcomes Using the NADA and NOC books to obtain an outcome.

Planning EBP Clinical Pathways Concept Mapping Priorities of care Clinical pathways – a standardized multidisciplinary planning tool that monitors patient care through projected caregiver interventions and expected patient outcomes and that is based on the patients DSM mental disorder. Concept mapping – a problem-solving plan that includes all the relevant elements of the patients database.

Implementation Promote safety PATENT AND STAFF Engage with patent gradually Educate patient and family of expected therapeutic affects and time Assist with patient talking Follow plan as written, do not vary without express direction from provider.

Evaluation Continuous evaluation Nurse compares patients current condition with outcome statement Nurse considers all possible reasons that the patient did not achieve outcomes Development of SOAP note.

SOAP Charting

Use therapeutic communications skills Assist with problem solving Counseling Use therapeutic communications skills Assist with problem solving Identify a crisis intervention Milieu Therapy Orient clients to the physical setting Identify rules and boundaries of the setting Ensure a safe environment for clients Promotion of self-care activities Offer assistance with self-care tasks Allow time for the client to complete tasks Set incentives to promote client self-care Psychobiological interventions Administer prescribed medications Reinforce teaching to the client/family Monitor for side effects and effectiveness Cognitive and behavioral therapies Modeling Operant condition Systematic desensitization Health teaching Encourage the development of social and coping skills Health promotion and health maintenance Assist clients with cessation of smoking Monitor other health conditions Mental Health Nursing Interventions

Children & Adolescents Evaluate the patients temperament, social and environmental factors, cultural and religious concerns, and developmental level. Mentally healthy children and adolescents should trust others, view the world as a safe, accurately interpret their environments, master developmental tasks, and use appropriate coping skills. They experience some of the same mental health problems as adults Observe this age group for mood, anxiety, developmental, behavioral, and eating disorders. Risk of suicide should be considered. Mental health and developmental disorders are not always easily diagnosed, and treatment interventions may be delayed or inadequate. Factors contributing to this include: lack of ability/skills to describe what is happening a wide variation of “normal” behavior, especially in different developmental stages

STANDARDIZED ASSESSMENTS The Older Adult Evaluate for functional ability (such as the ability to get up out of a chair.) Economic and social status Environmental factors (such as stairways in the home) STANDARDIZED ASSESSMENTS Geriatric Depression Scale Michigan Alcoholism Screening Test – Geriatric MMSE Pain assessments