community mental health nursing 9+10

8/8/2019 Community Mental Health Nursing 9+10

1/24

Community Mental

Health Nursing


2/24

Introduction

Mental Health Nursing Practice (ANA, 2000) states that, The

psychiatric-mental health nurse provides, structures, andmaintains a therapeutic environment in collaboration with the

client and other health care clinicians.

Milieu Therapy : A scientific structuring of the environment in

order to effect behavioral changes and to improve thepsychological health and functioning of the individual (Skinner).

In psychiatry, therapy involving the milieu, or environment,

may be called milieu therapy, therapeutic community, or

therapeutic environment. The goal of milieu therapy is to

manipulate the environment so that all aspects of the clients

hospital experience are considered therapeutic. Within this

therapeutic community setting the client is expected to learn

adaptive coping, interaction, and relationship skills that can be

generalized to other aspects of his or her life.2


3/24

Current Status of the Therapeutic Community

Psychiatric inpatient treatment provided sufficient time to

implement programs of therapy that were aimed at socialrehabilitation.

Nursings focus of establishing interpersonal relationships

with clients fit well within this concept of therapy.

The current focus of inpatient psychiatric care has changed.Care in inpatient psychiatric facilities can now be

characterized as short and biologically based. The strategies

for milieu therapy have been modified to conform to the

short term approach to care or to outpatient treatment programs. Some programs (e.g., those for children and

adolescents, clients with substance addictions, and geriatric

clients) have successfully adapted the concepts of milieu

treatment to their specialty needs .3


4/24

Basic Assumptions on which a Therapeutic

Community is Based:

1. The health in each individual is to be realized and

encouraged to grow.

2. Every interaction is an opportunity for therapeutic

intervention.

3. The client owns his or her own environment.

4. Each client owns his or her behavior.

5. Peer pressure is a useful and a powerful tool.6. Inappropriate behaviors are dealt with as they occur.

7. Restrictions and punishment are to be avoided.

4


5/24

CONDITIONS THAT PROMOTE

A THERAPEUTIC COMMUNITY

Basic physiological needs are fulfilled.

The physical facilities are conducive to achievement of

the goals of therapy.

A democratic form of self-government exists. Responsibilities are assigned according to client

capabilities.

A structured program of social and work-related

activities is scheduled as part of the treatment program.

Community and family are included in the program of

therapy in an effort to facilitate discharge from

treatment.5


6/24

THE PROGRAM OF THE THERAPEUTIC

COMMUNITY

An initial assessment is made by the admitting psychiatrist, nurse, or other agent who establishes a

priority of care.

The (interdisciplinary treatment ) IDT team determines

a comprehensive treatment plan and goals of therapy

and assigns intervention responsibilities.

All members sign the treatment plan and meet regularly

to update the plan as needed. Depending on the size ofthe treatment facility and scope of the therapy program,

members representing a variety of disciplines may

participate in the promotion of a therapeutic

community.6


7/24

THE ROLE OF THE NURSE Nurses spend time with the clients on a 24-hour basis, and they assume

responsibility for management of the therapeutic milieu.

Ongoing assessment, diagnosis, outcome identification, planning,

implementation, and evaluation of the environment which are necessary for the

successful management of a therapeutic milieu.

Nurses are involved in all day-to-day activities to client care.

Nurses participate in the regular updates and modification of treatment plans.

Nurses are responsible for ensuring that clients physiological needs are met.

Encourage clients to perform activities of daily living independently .

Assessing physical status is an important nursing responsibility.

Nurses are responsible for the management of medication administration.

Determine methods that result in achievement and provide positive feedbackfor successes.

The nurse is responsible for setting limits on unacceptable behavior in the

therapeutic milieu.

Nurses must be able to assess learning readiness in individual clients.

7


8/24

ResponsibilitiesTeam

Member

Leader of the team. Responsible for diagnosis and treatment of mental

disorders. Performs psychotherapy; prescribe medication and other somatic

therapies.

Psychiatrist

Conducts individual, group, and family therapy. Administers, interprets and

evaluates psychological tests that assist in the diagnostic process.Clinical

psychologist

Conducts individual, group, and family therapy. Presents educational programs

for nursing staff. Provides consultation services to nurses who require assistancein the planning and implementation of care for individual clients.

Psychiatricclinical nurse

specialist

Provides ongoing assessment of client condition, both mentally and physically.

Manages the therapeutic milieu on a 24-hour basis. Administers medications.

Assists clients with all therapeutic activities as required. Focus is on one-to-one

relationship development.

Psychiatricnurse

Provides assistance to clients in the fulfillment of their activities of daily living.

Assists activity therapists as required in conducting their groups. May also

participate in one-to-one relationship development.Mental health

technician

8


9/24

ResponsibilitiesTeam Member

Conducts individual, group, and family therapy. Is concerned with

clients social needs, such as placement, financial support, and

community requirements. Conducts in-depth psychosocial history on

which the needs assessment is based. Works with client and family toensure that requirements for discharge are fulfilled and needs can be

met by appropriate community resources.

Psychiatric social

worker

Works with clients to help develop (or redevelop) independence in

performance of activities of daily living. Focus is on rehabilitation and

vocational training in which clients learn to be productive, thereby

enhancing self-esteem. Creative activities and therapeutic relationship

skills are used.

Occupational

therapist

Uses recreational activities to promote clients to redirect their thinking

or to rechanneled destructive energy in an appropriate manner. Clients

learn skills that can be used during leisure time and during times of

stress following discharge from treatment. Examples include bowling,volleyball, exercises, and jogging. Some programs include activities

such as picnics, swimming, and even group attendance at the state fair

when it is in session.

Recreational

therapist

Encourages clients in self-expression through music. Clients listen to

music, play instruments, sing, dance, and compose songs that help them

get in touch with feelings and emotions that they may not be able toexperience in any other way.

Music therapist9


10/24

ResponsibilitiesTeam

Member

Encourages clients in self-expression through music. Clients listen to music,

play instruments, sing, dance, and compose songs that help them get in touch

with feelings and emotions that they may not be able to experience in any other

way.

Music

therapist

Uses the clients creative abilities to encourage expression of emotions and

feelings through artwork. Helps clients to analyze their own work in an effort

to recognize and resolve underlying conflict.

Art therapist

Directs clients in the creation of a drama that portrays real-life situations.

Individuals select problems they wish to enact, and other clients play the roles

of significant others in the situations. Some clients are able to act out

problems that they are unable to work through in a more traditional manner. All

members benefit through intensive discussion that follows.

Psycho-

dramatist

Plans nutritious meals for all clients. Works on consulting basis for clients with

specific eating disorders, such as anorexia nervosa, bulimia nervosa, obesity,

and pica.

Dietitian

Assesses, identifies, and attends to the spiritual needs of clients and their family

members. Provides spiritual support and comfort as requested by client or

family. May provide counseling if educational background includes this type ofpreparation.

Chaplain

10


11/24

Nursing Process in The

Psychiatric/MentalHealth Nursing

11


12/24

THE NURSING PROCESS

Definition

The nursing process consists of six steps and uses a

problem-solving approach that has come to be

accepted as nursings scientific methodology. It is goal

directed, with the objective being delivery of quality

client care.

Nursing process is dynamic, not static. It is an

ongoing process that continues for as long as the nurseand client have interactions directed toward change in

the clients physical or behavioral responses.

12


13/24

STANDARDS OF CARE

The standards of care for psychiatric nursing arewritten around the six steps of the nursing process.

Assessment : A systematic, dynamic process by

which the nurse, through interaction with the client,

significant others, and health care providers,collects and analyzes data about the client. Data

may include the following dimensions: physical,

psychological, sociocultural, spiritual, cognitive,

functional abilities, developmental, economic, andlifestyle (ANA, 2004).

13


14/24

StandardI. Assessment

The psychiatric/mental health nurse collects clienthealth data.

Assessment Tools

We use a nursing history format to learn more about the

client and his needs

Assessment includes general information, psychiatric

and medical history, family history, cultural and social

history, stage of development, support systems, coping

styles, stressors, losses/changes, education, strengths,

precipitating event, anxiety level, defense mechanisms ,

medications, physical , assessment , mental statues

assessment.14


15/24

StandardII. Diagnosis

Nursing

Diagnosis

Nursing diagnoses are clinical judgments about

individual, family, or community responses to actual

or potential health problems/life processes. A nursing

diagnosis provides the basis for selection of nursinginterventions to achieve outcomes for which the nurse

is accountable (NANDA, 2007).

The psychiatric-mental health nurse analyzes the

assessment data in determining diagnoses.

15


16/24

StandardIII. Outcome Identification

Outcomes

Measurable, expected, patient-focused goals that

translate into observable behaviors (ANA, 2004).

The psychiatric-mental health nurse identifies

expected outcomes individualized to the patient.

16


17/24

StandardIV. Planning

The psychiatric-mental health nurse develops a plan of

care that is negotiated among the patient, nurse, family,

and health care team and prescribes evidence-based

interventions to attain expected outcomes.

The care plan is individualized to the clients mentalhealth problems, condition, or needs and is developed

in collaboration with the client, significant others, and

interdisciplinary team members, if possible. For each

diagnosis identified, the most appropriate interventions, based on current psychiatric/mental health nursing

practice and research, are selected. Client education and

necessary referrals are included. Priorities for delivery

of nursing care are determined.17


18/24

StandardV.Implementation

The psychiatric-mental health nurse implements theinterventions identified in the plan of care.

Psychiatric/mental health nurses select interventions

according to their level of practice, education, and

certification. The care plan serves as a blueprint for delivery of

safe, ethical, and appropriate interventions.

Documentation of interventions also occurs at this

step in the nursing process.

18


19/24

Specific Interventions

The standards of psychiatric/mental health clinical nursing :

Counseling. To assist clients in improving or regaining their

previous coping abilities, fostering mental health, and

preventing mental illness and disability.

Milieu Therapy. Nurse provides, structures, and maintains a

therapeutic environment in collaboration with the client and

other health care clinicians.

Promotion of Self-Care Activities. Foster self-care and

mental and physical well-being.

Psychobiological Interventions. Nurse uses knowledge of

psychobiological interventions and applies clinical skills to

restore the clients health and prevent further disability.

19


20/24


Health Teaching. Assists clients in achievingsatisfying, productive, and healthy patterns of living.

Case Management. Provides case management to

coordinate comprehensive health services and ensure

continuity of care. Health Promotion and Health Maintenance.

Employs strategies and interventions to promote and

maintain health and prevent mental illness.

20


21/24


Psychotherapy. Nurse uses individual, group, and

family psychotherapy, and other therapeutic treatmentsto assist clients in preventing mental illness and

disability, treating mental health disorders, and

improving mental health status and functional abilities.

Prescriptive Authority and Treatment. Nurse uses

prescriptive authority, procedures, and treatments in

accordance with state and federal laws and regulations,

to treat symptoms of psychiatric illness and improvefunctional health status.

Consultation. Nurse provides consultation to enhance

the abilities of other clinicians to provide services for

clients and effect change in the system.21


22/24

StandardVI. Evaluation

The psychiatric-mental health nurse evaluatesthe clients progress in attaining expected

outcomes.

Evaluation

The process of determining both the clients progress

toward the attainment of expected outcomes and the

effectiveness of nursing care.

22


23/24


24/24

Role of the Nurse in Psychiatry

The nurse assists the client clients successfuladaptation to stressors within the environment.

Goals are directed toward change in thoughts,feelings, and behaviors that are age-appropriate andcongruent with local and cultural norms.

The nurse is a valuable member of theinterdisciplinary team, providing a service that isunique and based on sound knowledge of

psychopathology, scope of practice, and legalimplications of the role.

Documentation of the steps of the nursing process isoften considered as evidence in determining certaincases of negligence by nurses. It is also required bysome agencies that accredit healthcare organizations.

24

community mental health nursing 9+10

Documents