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what are the classifications of mental disorders
precently there are two major classification systems. 1- DSM-IV-TR, 2- international statistical classification of diseases and related health problems.
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what is DSM-IV-TR
- is an axis system, that consist of five axis.
- AXIS I- sign and symptoms that together make up a particular disorder.
- AXIS II- refers to personality disorders and mental retardation.
- AXIS III- refers to general medical condition.
- AXIS IV- reports psychosocial and environmental problems.
- AXIS V- is a global assesment of functioning during the preceding year. rated on a scale of 1-100
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levels of psychiatric mental health clinical nursing practice are:
- basic level
- advance practice
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BASIC LEVEL
a psychiatric mental health registered nurse holds a bacculaureate degree in nursing and may become certified.
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ADVANCED PRACTICE
an advanced practice registered nurse-psychiatric mental health(APRN-PMH) will have preparation at the masters degree or higher level in psychiatric nursing.
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what are the major theories of personality
freud,erickson,sullivan,paplau and maslow
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SIGMUND FREUD(psychoanalytic theory)
- freud believed that there were 3 levels of psychological awareness.
- conscious
- preconscious
- unconsious
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the 3 personality structures:
- ID- (fun) source of drives and instinct.lacks ability to problem solve.
- EGO-(it restricits) follows the reality principle.
- SUPEREGO-)perfection) it strives for perfection as opposed to seeking pleasure or engaging reason.
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ERIK ERIKSON(ego theory)
erikson believed that personality was not set in stone,but that it continues to develop throughout lifespan.
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HILDEGARD PEPLAU
- THEORY OF INTERPERSONAL RELATIONSHIP IN NURSING.
- she was influenced by sullivans interpersonal theory.
- developed the 1st systematic theoretical framework for PSYCHIATRIC NURSING(the one-to-one nurse-patient relationship)
- her theory is mainly concerned with the process by wich the nurse helps patients make positive changes in their health care status and well being.
- she identifyed stages of nurse-patient relationship:
- observation
- interpretation
- intervention
- she also believed thst nurses working with psychiatric pt need to have an awareness of their own behavior.
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behavioral theories and therapies
- behavioral therapies- developed as a protest to freuds assumption that a persons destiny is carved in stone. they argue that personality simply consist of lerned behavior.
- based on learning theory. maladaptive behavior can be unlearned and adaptive behavior learned.
- useful techniques are:
- modeling
- operant conditioning
- systematic desensitization
- aversion
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ABRAHAM MASLOW(humanistic psychology theory)
- humanistic theories focus on human potential.
- maslows hierarchy of six incremental stages assumes that humans are active rather than passive participants in life. striving for self-actualization.
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MILIEU THERAPY
this therapy establishes a safe,supportive environment with an emphasis on group and social interaction.
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purpose of psychiatric assessment are:
- establish report
- obtain understanding of current problem
- assess persons current level of psychological function
- identify goals
- perform MSE(mental status examination)
- identufy behaviors/beliefs
- formulate a plan of care
- PRIMARY SOURCE OF DATE COLLECTION IS THE PATIENT.
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NURSING DIAGNOSIS
- nursing dx has 3 components:
- problem (unmet need)-nursing dx tittle states what should change
- etiology(probable cause)-linked to the dx tittle with words "related to"
- supporting data(signs&symptoms)-state what condition is presently like and validate dx.
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NURSING PLANNING
consist of identifying nursing interventions that help meet the outcome.interventions need to be safe, realistic. appropriate, evidence based and individualized
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NURSING EVALUATION
is an ongoing process throughout all phases of the nursing process
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barrieres to quality mental health services
- communication
- stigma-shame/failure/weekness/negative
- misdiagnosis
- ethnic variations in pharmacodynamics-
- immigrants
- refugees
- populations at risk for mental illness and inadequate care
- cultural minorities
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concept of nurse-patient relationship
this is the basis of all psychiatric mental health nursing treatment.it promotes self care and independence
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social relationships(equal)
primarily initiated for the purpose of friendship,socialization, enjoyment or task accomplishment.
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therapeutic relationships(unequal/strong boundaries)
these focus on pt needs rather then the nurse. pt issues, problems and concerns are explored and potential solutions are discussed.
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PEPLAU'S MODEL OF THE NURSE-PATIENT RELATIONSHIP
- in this professional helping relationship relevant behaviors include
- accountability
- focus on pt needs
- clinical competence
- supervision to validate performance quality
THERAPEUTIC ENCOUNTER- an abbreviated or limited relationship
- there are 4 phases:
- preorientation
- orientation
- working
- termination
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PREORIENTATION(b4 u c pt)
phase involves thoughs and feelings the nurse experiences prior to the 1st clinical session
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ORIENTATION(meet pt)
2nd phase ranges from few meetings to longer term. establishing trust/ establishing a rapport/confidentiality. and planning for termination.
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WORKING PHASE(interview)
3rd phase. task include maintainig the relationship,gathering further data, promoting pt problem solving skills, self esteem and use of language
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TERMINATION PHASE
final stage- this phase will provide an excellent learning experience for both pt and nurse and its time to summerize goals, reviewing situations that occurred and evaluating progress.
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factors that enhance growth in others
- genuineness
- empathy-ability to see things from the other persons perspective, to experience what other is feeling, objective
- positive regard-implies respect
- attitudes
- actions
- attending
- suspecting value judgement
- helping pt develop resources
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VERBAL COMMUNICATION
- consist of all words a person speaks. when we speak we communicate beliefs and values, perceptions and meanings. words have different meanings for different people
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INTERACTION OF VERBAL AND NONVERBAL COMMUNICATION
- VERBAL MESSAGE-is considered the content.
- NONVERBAL MESSAGE- is considered the process
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THERAPEUTIC COMMUNICATION TECHNIQUES
- using silence
- active listening-includes observing a pts nonverbal behaviors.
- listening with empathy-(empathy the most important elementin therapeutic therapy)
- clarifying techniques- seeks verification of interpretation( paraphrasing/restating/reflecting/exploring)
- asking questions and eliciting pt responces(open ended quest.
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NON-THERAPEUTIC COMMUNICATION TECHNIQUES
- excessive quest.
- giving approval or disapproval
- asking "why" quest
- giving advice
- cultural considerations
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HOW TO BEGIN AN INTERVIEW
- pace-permitt pt to set the pace.
- setting-conversation should take place in normal tones and eye contact. door accessible to both
- introductions- rn tell pt who they are, name and purpose of meeting confidentiality should be address at this point.
- initiate interview- after intro, give pt the lead by using an open ended statement
- tactic to avoid- arguing, praising, giving false reassurance, speculating
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