Mental Health nursing The Role of the Psychiatric Nurse Historical Perspective Nursing Process

Defining Mental Health  State of emotional well-being in which one “functions comfortably within society and is satisfied with their achievements in the areas of work, play, love and relationships.”

Components of Mental Health  Self-control with socially acceptable behavior  Inner values  Growth-oriented  Tolerates uncertainty and stress with flexibility  Reality-oriented, sound judgment and decision-making  Experiences meaningful work  Humor  Optimistic  Satisfying relationships  Ability to give and receive

Being a Psychiatric Nurse  Clients do not need us personally as friends or companions…they need us to teach them, and model HOW to have friendships and relationships outside of treatment in society as a whole

Pre-requisites for the Role:  Self awareness is a key part of the psychiatric nursing experience.  You must be able to examine personal feelings, actions, and reactions.

Questions to ask yourself “Why do I want to help others?” “Who am I?” “What do I value?” “Am I open to my feelings and can I express them?”

Role cont.  “What is the key therapeutic tool of the psychiatric nurse?”

Role cont.  Answer: “use of oneself”

Some indicators of mental health  Positive attitudes toward self, growth, and development  Self-actualized  Integrated self  Autonomous  Reality-perception  Environmental mastery

Indicators cont.  Can a person adapt to changing needs throughout the life cycle?  How much resilience does a person have?  How does a person handle stress and adapt?  What kind of coping mechanisms are used?”

Mental health as a process  Mental health is ….a lifetime process that includes a sense of harmony and balance for the individual, friends, family, and community; it is more than the mere absence of a mental disorder

FACT  Nearly 50% of all people ages 15 to 54 have had a psychiatric or substance abuse disorder in their lifetime.

LEGAL ISSUES IN PSYCHIATRIC NURSING  Client Rights – Nursing Responsibility  Right to Appropriate Treatment  Right to know qualifications of those involved in treatment process  Right to receive explanations of treatment  Right to be involved in planning of own care  Right to refuse to be a part of experimental treatment methods  Right to understand the effects of prescribed medication  Right to treatment in least restrictive environment  Right to refuse treatment- decide which treatment option is best for them

Informed Consent  Explanation of client rights and unit policies to client/guardian  Signed statement of understanding/refusal to receive treatment  Explanation of insurance benefits or payment options/third-party reimbursement

Historical perspectives  1800’s-The mentally ill were no longer treated as “less than human.” Treatment was provided in asylums.  Linda Richards, the first American psychiatric nurse. Director of first school of psychiatric nursing; McLean Hospital in Massachusetts.

Beginning of Change  Benjamin Rush  Environmental influence on care  Dorothea Dix  Legislation and training programs aimed at improvement  Linda Richards  Education integral to treatment practices  1913 – First psychiatric content added to curriculum of nursing school  Beginning of psychiatric nursing as a specialty

Historical perspectives cont.  emergence of somatic therapies  ECT  After WWII major growth in psych nursing  1950’s –emergence of the role of the psych nurse & use of psychotropic drugs  Hildegard Peplau defined nursing as an interpersonal process, nurse role as counselor

History cont.  Deinstitutionalization Movement Community Mental Health Centers Act Founding of the American Psychiatric Nurses Assoc and the ANA published standards of mental health & nursing practice to present -significant changes in mental health treatment; focus on mental illness prevention

Contemporary psychiatric nursing practice  Reflects an interpersonal process  Is a specialized area of nursing practice utilizing theories of human behavior and the purposeful use of self.  The nurse-pt. partnership expands the nursing role to include: pt-family advocacy, clinical competence, collaboration, fiscal responsibility, and legal-ethical parameters.

Competent Caring 3 domains of psych nursing  Direct care  Communication  Management overlapped with teaching, delegating, and collaborating

Competent Caring cont.  Additional activities: Make culturally sensitive health assessments Engage in case management services Provide a health care map for families to guide them to community services Provide teaching and counseling

Levels of Performance  Laws: each state has its own nursing practice act, which regulates entry into the profession.  Qualifications include education, work experience, and certification.  2 levels: Basic-Psychiatric Mental Health RN  Advanced- Advanced Practice RN Psych Mental Health Nurse

Practice Settings  Vary widely for the psych nurse.  The role depends on the philosophy, mission, values of the setting, needs of the consumers, # of clinical staff available, resources, and presence of strong nursing leadership.

Focus for the future  Psych nurses focus on : -outcomes of care quality and cost -leadership skills-acting as change agents to advocate for the mental health needs of pts and families. Join organizations such as the American Psych. Nurses Assoc. (APNA) located in Washington DC -political action-increase political awareness to bring about changes in the MH delivery system.

PSYCHOSOCIAL NURSING ASSESSMENT  Subjective Data  Describe stressors  Perception of problem  Insight  Objective Data  Mental Status  Thought processes  Perceptual disturbances  Judgment  Adaptive or maladaptive defense mechanisms  Relationships  Appearance  Motor activity  Speech pattern  Mood  Mental Status (cont.)  Affect  Awareness  Orientation  Memory

NURSING DIAGNOSIS – (APPENDIX C – PAGE 374)  Identification of a client problem based on conclusions about the collected data Consists of 3 parts:  Actual or potential problem related to client condition (risk for injury)  Causative or contributing factors (related to marital breakup)  Behavior or symptom that supports the problem (evidenced by suicidal ideation and gestures)

EXPECTED OUTCOME  Planning measurable and realistic outcomes:  Anticipate improvement or stabilization of problem identified in nursing diagnosis  Short-term goals:  Meet immediate unmet needs of client  Long-term goals:  Achieve maximal, realistic level of health as a member of society

NURSING INTERVENTIONS  Actions taken to assist client in achieving anticipated outcomes  Consider what is realistic and appropriate for that client  Collaborative team effort to maintain consistency in approach by all disciplines  Nursing Focus:  Observing behaviors and symptoms  Improving communication strategies  Assisting the client in problem-solving  Improved overall functioning

EVALUATION & APPLICATION  Evaluate the success of nursing interventions in meeting criteria outlined in expected outcome  Has the goal been achieved?  Has any progress been made?  Is the goal realistic for this client?  What is the client’s expectation for outcome?  Do we need to try another approach?  Have any new problems added to the picture?