Essentials of Psychiatric Mental Health Nursing 2

• Mental health nursing is a specialized field of nursing which focuses on meeting the mental health needs of the consumer, in partnership with family, significant other and the community in any setting
• it is a specialized interpersonal process embodying a concept of caring

• each individual:think of your pt as human
• has intrinsic worth and diginity and each person is worthy of respect
• has the potential to change
• has common basic human needs
• varies in the coping capacities
• behavior is meaningful (pt perpective)
• be non judgemental and try to find the good in the person

can assess bio-functioning, set up functioning, set up therapeutic interventions, provide for therapeutic milieu, use psychobiologic techniques, adminster medication, educate patients, intervene in crisis, promote short term rehab goals and help develop long term goal with interdisciplinary

delivers primary mental health services, manages the illness, formalute dx, order and interpret lab test, prescribing and managing medication, running therapeutic groups, family and individual education, and provide for community outreach. Participate in research and scholarly works

• in patient
• outpt and day treatment
• school based programs
• substance abuse clinics
• residential tx
• managed care teams
• crisis intervention teams
• education & research
• policy and leadership
• opportunities growing for the last two

• advocacy for MH- teach kids about bullying
• stigma reduction
• public education- how to help
• clients rights
• collab with multi-disciplinary team
• safety/restraints/seclusion

• Communicating with pt experiencing mental health symptoms
• developing approriate relationships within therapeutic boundaries
• include pt and care givers in all aspects of care
• collab with multi-disciplinary team
• assessing LOTS of observing (esp. non-verbal)

• accurate reporting and documentation
• confidentiality/safety- 1st priority
• self-awareness/professional boundaries
• develop insight into the practice
• safety, recognize and responding
• practicing within legal framework
• participating in pt education & tx
• be well educated on specific competencies such as suicide assessment

• professional boundaries are limits and outlined expections for appropriate professional relationships with clients.
• watch for the following signs of poor boundarly development

• favoring one clients' care over another's
• keeping secrets with a client
• changing dress style for working with a particular client
• swapping client assignments to care for a particular client
• giving special tx or attention to one client over another
• spending free time with client
• frequently thinking about the client when you are away from work
• seeing pt out of work
• getting involved in a business with pt

• Be aware of delineation of education
• work with zone of pt centered care
• examine boundary crossing and avoid
• post-termination relationship especially w/pt with mental health issue'
• be aware of situations in the nature of your work and setting that may affect delineation of boundaries

• IF right task, right circumstances, to right person, right communication and supervision
• nurse can delegate basic elements of care but no the nursing process or nursing assessment
• nurse must know the skill, competency and training level of staff delegated task
• nurse must use critical thinking prior to delegation & take into considration pt condition
• nurse must follow all policies and procedures outline in facility for delegation and be aware of your scope of practice

• nursing process
• mental status exam
• therapeutic communication
• thorough assessment
• diagnostic tools/rating scales
• therapeutic milieu
• multidisciplinary team
• models of recovery
• collab professional agencies

• the risk of violence is often associated with mental health nursing and a number of skills are needed to spot the build-up of tension and be able to defuse it include :
• oberservationa;
• interpersonal communication
• psychosocial
• thinking on your feet and staing calm are essential traits of a mental health nurse. you'll also use a number of other skills on a daily basis, including :
• problem solving
• good judgement
• offering advice

• demands intelluctual, interactional and technical skills, plus a well defined relationship with the multidisciplinary team
• use of clinical judgement and reasoning individual experience and interaction styles and contextual application of care. this type of nursing does not adhere to black & white thinking
• consist of (re)-assessment, nx dx, outcome identification, planning, implementation, eval and safety

• hollistic psychiatric nursing care requires the nurse to complete an assessment of the pt's biological, psychological, and sociocultural health status
• composed of hx taking, physical assessment, mental status exam, and psychological and behavioral tests
• developmental stage of pt may dictate how you connect with pt and may need to use age appropriate jargon and length of time it make take

• compare what pt says to other family members, friends or signifcant others, particularly about current situations be cognizant of previous psychiatric history/tx
• be sure about the reliability of sources, consult medical record and you may supplement the exam with these
• always ask about herbals, OTC meds or nontraditional txs (EG st john wort, ephedra (ma huang), Kava kava and yohimbe-interactions, cause symptoms, etc ex gingseng

• cardiac issue- no TCA's may cause life-threatening arrhythias
• in myasthenia gravis, it is contraindication to use antipsychotics
• tremors could be caused by parkinson's or by an antipsychotic med
• lithuim can precipitate psoriasis  (w/hx of psoriasis) or acne & must be used with caution in pt with thyroid & kidney disease
• antipsychotics/anticholinergic are contraindicated glaucoma

• check for past mediation adverse or untoward reactions
• use open-ended questions rather than staccato yes-no questions. ex what is your problem, as you see it?
• focus on both content (what is said) and process (how the communication occurs and includes feelings, intuition, and behaviors that accompany speech and thought)
• content and process may not always be congruent. Ex: pt denies being depressed, yet appears sad and is crying during the interview)

• consider cultural differences, manner of dress, direct eye contact, personal hygiene, body language and need for personal space, education level, social class, lifestyle, sexual preference
• family hx- medical and psychiatric (note consistent or repeating patterns)
• ask patient about cultural religious practices which are important to him her (which should be observed during tx); ask about the meaning of the illness for the pt and fam

• examine how your own feelings and behavior influence the pt. ex your own anxiety could keep you from hearing the pt or cause you to talk to much, display nervous habits, or misperceive the patient's problem. (asking for clarification and repeating back to pt i helpful here)
• give pt info about the interview, notes, taken, right to what is written, establish honestly and begin the orientation phase of the relationship

• be prepared to have to take breaks. rarely is the assessment or mental status exam completed fully in one sitting
• maybe able to get additional info from pt just by observing pt with fam partner or in milieu
• record specific statements by patient, keep language of report specific, concise, and non-judgmental ie pt says 'I just can't get these ideas oout of my head'

• identifying data- ask pt to state name- name, address, date, phone numbers, DOB maritial status, employer/occupation, emergency contact
• physical assessment- allergies, current meds (schedule/last dose) recent surgeries and/or major illnesses, chronic conditions, respiration (rate, cough, wheezing, asthma), cardiac (HR, BP strength of pulse etc)
• get full set of vital signs
• skin tone condition (include, scars/self infliction injuries/bruises)

• assess for use of stimulants/alcohol, nicotine, drugs (amt, duration, time of last use) anomalies of gait
• sleep patterns, physical impairments/pain
• intake (poor nutrition/hydration)
• elimination/incontinence/frequency/burning bleeding or retention
• sexual function (active, not, sexual orientation, number of children, dysfunction, date of last menstrual period)

• identification of problem- what brought you here
• onset- when did this problem begin
• duration- how long have you been bother by this problem
• precipitating event- what happened during the past few days that made you decide to seek tx
• coping mechanism- what have done about the problem (works or not)
• insight and motivation for chx- what has worked for you in the past when something like this happened
• resources/help- who have you asked for help

• hx suicide attempts- method, precipitator, hospitalization, tx
• existence of a plan- specificity, availablity of the means, knowledge of use of means, lethality of means (what were you going to use)
• status of relationship support of significant other
• content and frequency/psychiatric illness (their understanding of illness)

• pressence of depression, schizo, mania, substance use
• age, sex coping strategies, cultural beliefs
• what/who prevent the suicide- you or someone else
• ability to contact for safety- however, be aware that this could be invalid and use your clinical judgment as to what level of monitoring the patient may need

• sad person scale
• S- sex 1 male 0 female (more females attempt, most male succeed)
• A- agae 1 if <20 or >44
• D- depression 1 if depression is present
• P- previous attempt 1 if present
• E- ethanol abuse 1 if present
• R- rational thinking loss 1 if present
• S- social supports lacking 1 if present
• O- organized plan 1 if plan is made and lethal
• N- no spouse 1 if divorced, widowed, separated or single
• S- sickness, 2 if chronic, debilitating, and severe

• guidelines for action with the SAD PERSONS scale
• total points
• proposed clinical actions
• 0-2 send pt home
• 3-4 close f/u consider hosp
• 5-6 strongly consider hosp, depending on the confidence on f/u arrangement
• 7-10 hospitalize or commit

• hx of frequent arrest, fights, or assaults
• hx of impulsive behavior
• hx of reckless disregard for others or self
• availability of weapons/lethality
• presence of medical/psychiatric illness/ r/o medical illness first
• hx of substance use/current level of substance in body

• caution- hands on intervention may escalate verbal violence and cause it to become physical
• also always be aware of your surroundings andmay want to have other team member in the area
• placement in room, stance, voice, resources, common sense

• drug/trough levels
• chemistry- liver
• WBC and special medication monitoring
• neuroendocrine studies-prolactin elev
• check for CAT scan etc
• liver enzymes
• thyriod- med like lithium can burn thyroid
• kidney function- meds lithium toxicity
• vital protocol for psychotropic med and substance abuse withdrawals

look at power points