Islamic University of GazaFaculty of nursing

Community Mental Health Nursing

Placement : Semester 2Credits : 3 crds

Lecturer : Dr. Ashraf El-Jedi RN, DrPH

Course DescriptionCourse Description :- :- This module aims to provide students with an opportunity to explore This module aims to provide students with an opportunity to explore

the role and position of the community mental health nurse within a the role and position of the community mental health nurse within a broad social, political and ethical context.  broad social, political and ethical context.  Community mental health Community mental health is a key feature of this course with specific reference made to the is a key feature of this course with specific reference made to the use of cognitive behavioral therapy in the treatment of mental health use of cognitive behavioral therapy in the treatment of mental health problems. Dealing with the human mind and behaviours is not an problems. Dealing with the human mind and behaviours is not an exact science. The job of helping people back to mental health is exact science. The job of helping people back to mental health is every bit as valuable and satisfying as caring for those with a every bit as valuable and satisfying as caring for those with a physical. physical. It also focuses on investigating cultural perspectives of It also focuses on investigating cultural perspectives of mental health/ illness, stigma, stereotyping and labeling. A range of mental health/ illness, stigma, stereotyping and labeling. A range of material will be drawn upon in the module:  from empirical and material will be drawn upon in the module:  from empirical and theoretical sources to service-user perspectives and accounts, theoretical sources to service-user perspectives and accounts, which will offer the student insights and challenges to mental health which will offer the student insights and challenges to mental health nursing practice.nursing practice.

Course objectives Course objectives

On completion of this course the student will be able to:On completion of this course the student will be able to: Understand the community mental health nursing, with specific Understand the community mental health nursing, with specific

reference to the increasing use of cognitive behavioral therapy.reference to the increasing use of cognitive behavioral therapy. Apply case management and promoting recovery.Apply case management and promoting recovery. Explore the role of community mental health nurse within a broad Explore the role of community mental health nurse within a broad

social, political and ethical context. social, political and ethical context. Focus on theoretical issues related to negative cultural practices.Focus on theoretical issues related to negative cultural practices. Utilize effective communication process to collaborate with patients, Utilize effective communication process to collaborate with patients,

staff, and families to promote and maintain mental health.staff, and families to promote and maintain mental health. Provide sensitive nursing care to culturally disadvantaged population Provide sensitive nursing care to culturally disadvantaged population

of women, children, and aged population.of women, children, and aged population. Utilize theories focusing on occupational health.Utilize theories focusing on occupational health. Promote healthy attitudes toward mental health and illness. Promote healthy attitudes toward mental health and illness.

Teaching MethodsTeaching Methods

You will experience a variety of teaching and You will experience a variety of teaching and learning methods such as: lectures, seminars, learning methods such as: lectures, seminars, reflective practice, debates, simulation reflective practice, debates, simulation exercises, role-play, problem based learning and exercises, role-play, problem based learning and independent study. You will learn practical skills independent study. You will learn practical skills in a clinical environment where you will be fully in a clinical environment where you will be fully supported by experienced qualified nurses. You supported by experienced qualified nurses. You will use a fully equipped skills centre to develop will use a fully equipped skills centre to develop your clinical skills. your clinical skills.

Course ContentsCourse Contents

1.1. Person, environment, mental health and nursingPerson, environment, mental health and nursing2.2. Community-based psychiatric nursing careCommunity-based psychiatric nursing care3.3. Purpose of community mental health.Purpose of community mental health.4.4. Prevention and mental health promotionPrevention and mental health promotion5.5. Families as resources, caregivers and collaboratorsFamilies as resources, caregivers and collaborators6.6. Family interventionFamily intervention7.7. Crisis interventionCrisis intervention8.8. Recovery and psychiatric rehabilitationRecovery and psychiatric rehabilitation9.9. Care of survivors of abuse and violenceCare of survivors of abuse and violence10.10. Implementing the nursing process: standards of Implementing the nursing process: standards of

practice and professional performancepractice and professional performance

11.11. Social factors and mental illness.Social factors and mental illness.12.12. Rehabilitation and mental illness.Rehabilitation and mental illness.13.13. Stress and mental illness.Stress and mental illness.14.14. Suicide and attempted suicide.Suicide and attempted suicide.15.15. The practice use of social services in The practice use of social services in

mental health work.mental health work.16.16. Social policy and mental illness.Social policy and mental illness.17.17. Alternatives in mental health care.Alternatives in mental health care.

Course Evaluation:Course Evaluation:

30 % Mid-Term30 % Mid-Term 10% presentation10% presentation 10% Case study10% Case study 10 % family assessment report10 % family assessment report 40 % final Exam40 % final Exam

ReferencesReferences

Stuart, G. (2005). Principles and Practice of Psychiatric Stuart, G. (2005). Principles and Practice of Psychiatric Nursing. 9th editin. Mosby.Nursing. 9th editin. Mosby.

Sheila forster (2005). The role of the mental health Sheila forster (2005). The role of the mental health nurse. london:nelson thornes ltd 2005 nurse. london:nelson thornes ltd 2005

Puckett A (1993). community mental health. W.B. Puckett A (1993). community mental health. W.B. Saunders. SydneySaunders. Sydney

Mental Health Work in the Community: Theory and PractMental Health Work in the Community: Theory and Practice in Social Work and Community Psychiatric Nursingice in Social Work and Community Psychiatric Nursing by Michael Sheppard (Paperback - 30 May 1991) by Michael Sheppard (Paperback - 30 May 1991)

A Handbook for the Study of Mental Health: Social ConteA Handbook for the Study of Mental Health: Social Contexts, Theories, and Systemsxts, Theories, and Systems by Allan V. Horwitz and Teresa L. Scheid (Paperback). by Allan V. Horwitz and Teresa L. Scheid (Paperback).

The Domains of Psychiatric The Domains of Psychiatric NursingNursing

Nursing is and exciting, challenging, dynamic profession Nursing is and exciting, challenging, dynamic profession embedded in a stressed, underdeveloped, and rather embedded in a stressed, underdeveloped, and rather chaotic health care system whatever nurses may say chaotic health care system whatever nurses may say about their work, boredom and superficiality are rarely about their work, boredom and superficiality are rarely mentioned. The intensity of the emotion, the challenge mentioned. The intensity of the emotion, the challenge of engaging a client in pursuit of health, and the of engaging a client in pursuit of health, and the knowledge that nursing is a vital service all serve to give knowledge that nursing is a vital service all serve to give meaning to even the most difficult workdays. Because of meaning to even the most difficult workdays. Because of the importance of the work, nurses must learn and use the importance of the work, nurses must learn and use nursing theories and concepts (the knowledge domain) nursing theories and concepts (the knowledge domain) to effect specific outcomes for the clients. The “how” of to effect specific outcomes for the clients. The “how” of nursing is the nursing process (the practice domain)nursing is the nursing process (the practice domain)

PersonPerson

Person is defined as a living being with Person is defined as a living being with physical, cognitive, affective, behavioral, physical, cognitive, affective, behavioral, and social dimensions, who interacts with and social dimensions, who interacts with the environment to achieve a chosen life the environment to achieve a chosen life purpose. Three aspects of the definition purpose. Three aspects of the definition are explored. are explored.

Dimensions of the PersonDimensions of the Person

a person is thought to consist of five a person is thought to consist of five dimensions: physical, cognitive, affective, dimensions: physical, cognitive, affective, behavioral, and social. The physical behavioral, and social. The physical dimension includes neurobiologic, dimension includes neurobiologic, neurophysiologic, and biochemical neurophysiologic, and biochemical aspects of the person. aspects of the person.

However, persons do not function in the physical However, persons do not function in the physical dimensions. The cognitive dimension is involved dimensions. The cognitive dimension is involved in the person’s ability to formulate thoughts, in the person’s ability to formulate thoughts, process information, and solve problems. The process information, and solve problems. The affective dimension is involved the person’s affective dimension is involved the person’s actions in the integration of the physical, actions in the integration of the physical, cognitive, and affective dimensions. A person’s cognitive, and affective dimensions. A person’s behavior is an expression of individuality and is behavior is an expression of individuality and is reflective of the uniqueness of both the reflective of the uniqueness of both the dimensions and the patterns of interaction the dimensions and the patterns of interaction the person develops with the environment. The person develops with the environment. The social dimension involves the person’s skills in social dimension involves the person’s skills in living as a member of a family and community. living as a member of a family and community.

Interaction with the EnvironmentInteraction with the Environment

People interact, or engage in mutual, ongoing, patterned People interact, or engage in mutual, ongoing, patterned relationships with other people and with objects in the relationships with other people and with objects in the environment. Patterns of interaction are identifiable, environment. Patterns of interaction are identifiable, rhythmic, measurable, and changing over rhythmic; they rhythmic, measurable, and changing over rhythmic; they can also be described. can also be described.

For a person who has well-established patterns, life For a person who has well-established patterns, life becomes predictable and comfortable. A healthy person becomes predictable and comfortable. A healthy person is able to balance the need for predictability with the is able to balance the need for predictability with the need for change. need for change.

Behavior patterns are useful to the person because they Behavior patterns are useful to the person because they are reliable, flexible ways to interact with the are reliable, flexible ways to interact with the environment in a variety of situations. environment in a variety of situations.

Chosen life purpose:Chosen life purpose:

A A life purpose is an integrative spiritual function that life purpose is an integrative spiritual function that gives meaning to each person’s existence. Behavior gives meaning to each person’s existence. Behavior patterns are developed to achieve a chosen life purpose. patterns are developed to achieve a chosen life purpose. The need for a purpose in life is a uniquely human The need for a purpose in life is a uniquely human characteristic. This need and the capacity to choose characteristic. This need and the capacity to choose combine so that each person actively chooses a life combine so that each person actively chooses a life purpose. purpose.

Purposes are chosen early in life as an outgrowth of Purposes are chosen early in life as an outgrowth of interaction with the environment. The quality of the interaction with the environment. The quality of the choice is and important focus for nurses working with choice is and important focus for nurses working with clients with mental or emotional problems. clients with mental or emotional problems.

EnvironmentEnvironment

Environment is defined as everything outside a Environment is defined as everything outside a person. It includes the physical and social person. It includes the physical and social elements that are external to and interactive with elements that are external to and interactive with the client. As the nurse assesses the client’s the client. As the nurse assesses the client’s determine together which aspects of the determine together which aspects of the environment need to be included in the focus of environment need to be included in the focus of treatment. Many aspects of the physical treatment. Many aspects of the physical environment, such as light, heat, and sound may environment, such as light, heat, and sound may influence the client and need to be addressed in influence the client and need to be addressed in the nursing care plan. the nursing care plan.

The nurse is part of the environment of the client in the The nurse is part of the environment of the client in the treatment setting. The nursing staff can help make the treatment setting. The nursing staff can help make the interaction with the hospital system healthy and interaction with the hospital system healthy and constructive for the client. The client may have constructive for the client. The client may have developed unhealthy patterns of interaction with aspects developed unhealthy patterns of interaction with aspects of the social environment, that is, family and community. of the social environment, that is, family and community. The opportunity for healthy interaction with people in the The opportunity for healthy interaction with people in the hospital environment creates the possibility that the hospital environment creates the possibility that the client will interact in more healthy ways after discharge. client will interact in more healthy ways after discharge. Therefore, the hospital environment, or milieu, is thought Therefore, the hospital environment, or milieu, is thought to be a major treatment opportunity for which nurses are to be a major treatment opportunity for which nurses are responsible. responsible.

Family:Family: The family is the basic unit of society, transmits cultural The family is the basic unit of society, transmits cultural

norms and values, and is the most influential socializing agent norms and values, and is the most influential socializing agent for learning how to relate to people, groups, and community. for learning how to relate to people, groups, and community. Subsystems within a family may be the married couple, the Subsystems within a family may be the married couple, the sibling group, and the extended family. The family with a sibling group, and the extended family. The family with a mentally ill member struggles to maintain a normal household mentally ill member struggles to maintain a normal household and healthy relationships with friends and community groups. and healthy relationships with friends and community groups. However, many of the family’s resources are consumed in the However, many of the family’s resources are consumed in the care and treatment of its ill members. Often the family ends care and treatment of its ill members. Often the family ends up isolated, impoverished in resources and relationships, and up isolated, impoverished in resources and relationships, and dysfunctional in intrafamily relationships. The family is dysfunctional in intrafamily relationships. The family is usually the strongest, most reliable support system the usually the strongest, most reliable support system the mentally ill person has. Building on family strengths while mentally ill person has. Building on family strengths while decreasing dysfunctional, energy draining interactions assists decreasing dysfunctional, energy draining interactions assists both the ill person and the other family membersboth the ill person and the other family members

CommunityCommunity

Community is defined as a group of people with Community is defined as a group of people with common characteristics, location, or interests. common characteristics, location, or interests. A community is not just a mixture or assembly A community is not just a mixture or assembly of people. Rather, community implies of people. Rather, community implies organization, roles, growth, development, and organization, roles, growth, development, and relationships among people. Relationships in a relationships among people. Relationships in a community may be related to community may be related to

1.1. Common characteristics such as ethnicity or social status, which Common characteristics such as ethnicity or social status, which bind people together; bind people together;

2.2. Geographic location; Geographic location;

3.3. And common interestsAnd common interests. .

For instance, the nursing profession may be considered For instance, the nursing profession may be considered a community. It has organization, roles, growth and a community. It has organization, roles, growth and development as a profession, and common interests at development as a profession, and common interests at the heart of its identity. the heart of its identity.

The community that is the environment for individuals The community that is the environment for individuals and families is itself part of a larger environment, society. and families is itself part of a larger environment, society. A community influences and is influenced by society. A community influences and is influenced by society. Growth and development, resources, and attainment of Growth and development, resources, and attainment of goals are influenced and somewhat determined by the goals are influenced and somewhat determined by the larger society, the community interacts as a whole with larger society, the community interacts as a whole with the society, whether the community be a city, hospital, the society, whether the community be a city, hospital, ideologic group, or group with common characteristics. ideologic group, or group with common characteristics.

The community is composed of many The community is composed of many subsystems. The client determines relevant subsystems. The client determines relevant subsystems, which may include the subsystems, which may include the neighborhood, school, church, employment neighborhood, school, church, employment office, public assistance office, visiting nurse, or office, public assistance office, visiting nurse, or child protection unit. Organized groups such as child protection unit. Organized groups such as adult education classes, Alcoholics Anonymous, adult education classes, Alcoholics Anonymous, parent effectiveness training groups, and state parent effectiveness training groups, and state nurses’ associations are also subsystems. nurses’ associations are also subsystems.

HealthHealth

Health is defined as a synthesis of the Health is defined as a synthesis of the client’s internal patterns with those of the client’s internal patterns with those of the environment; it is measured on a environment; it is measured on a continuum from functional to dysfunctional continuum from functional to dysfunctional patterns of interaction. Health is a patterns of interaction. Health is a dynamic , changing state determined by dynamic , changing state determined by changing patterns of interaction. It may be changing patterns of interaction. It may be described and measured. described and measured.

Health exists on a a continuum from functional to Health exists on a a continuum from functional to dysfunctional. Health implies the ability to dysfunctional. Health implies the ability to function, and illness implies the “disability” to function, and illness implies the “disability” to function, that is , dysfunction. function, that is , dysfunction.

A person’s health status varies considerably A person’s health status varies considerably over time because of the dynamic nature of over time because of the dynamic nature of patterns of interaction. Nurses seek to improve patterns of interaction. Nurses seek to improve a client’s health by influencing patterns of a client’s health by influencing patterns of interaction between the client and the interaction between the client and the environment. environment.

Mental HealthMental Health

Mental health is defined as a dynamic process in which a Mental health is defined as a dynamic process in which a person’s physical, cognitive, affective, behavioral, and person’s physical, cognitive, affective, behavioral, and social dimensions interact functionally with one another social dimensions interact functionally with one another and with the environment. Mentally healthy patterns and with the environment. Mentally healthy patterns reflect and ability to perceive reality accurately; modulate reflect and ability to perceive reality accurately; modulate the way emotions are experienced and expressed; think the way emotions are experienced and expressed; think clearly and logically; communicate thoughts, emotions, clearly and logically; communicate thoughts, emotions, feelings, needs, and desires effectively; anticipate events feelings, needs, and desires effectively; anticipate events and solve problems; initiate and maintain meaningful and solve problems; initiate and maintain meaningful relationships; relationships;

establish and maintain boundaries; use establish and maintain boundaries; use resources appropriately; develop a resources appropriately; develop a positive self-concept; and , in general, positive self-concept; and , in general, behave in ways that facilitate personal behave in ways that facilitate personal growth and development. Mental health growth and development. Mental health permits persons to pursue life goals in a permits persons to pursue life goals in a way that affirms other people, facilitates way that affirms other people, facilitates the growth and quests of others, and the growth and quests of others, and culminates in the fulfillment of their own culminates in the fulfillment of their own life purpose. life purpose.

Mental Illness:Mental Illness: Mental illness is defined as physical, cognitive, Mental illness is defined as physical, cognitive,

affective, behavioral, and social patterns that affective, behavioral, and social patterns that interact dysfunctionally with the environment. interact dysfunctionally with the environment. Dysfunctional patterns of interaction make it Dysfunctional patterns of interaction make it difficult to satisfy needs, develop and maintain difficult to satisfy needs, develop and maintain social relationships, address growth and social relationships, address growth and developmental tasks, and pursue a productive developmental tasks, and pursue a productive an d gratifying life. Patterns of interaction within an d gratifying life. Patterns of interaction within the person and among the person, the person’s the person and among the person, the person’s family, and the community significantly influence family, and the community significantly influence the development and maintenance of mental the development and maintenance of mental illness. illness.

NursingNursing

The American Nurses Association (ANA) defines nursing The American Nurses Association (ANA) defines nursing as the diagnosis and treatment of human responses to as the diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980). Human actual or potential health problems (ANA, 1980). Human responses are the synthesis of physical, cognitive, responses are the synthesis of physical, cognitive, affective, behavioral, and social dimensions of the affective, behavioral, and social dimensions of the person expressed in interaction with the environment. person expressed in interaction with the environment. Nursing for the purposes of this text, is defined as a Nursing for the purposes of this text, is defined as a goal-directed process that promotes functional patterns goal-directed process that promotes functional patterns of interaction between client and environment. of interaction between client and environment. “Functional patterns of interaction” is synonymous with “Functional patterns of interaction” is synonymous with health; therefore, nursing is a goal-directed process that health; therefore, nursing is a goal-directed process that promotes health. promotes health.

ANA has defined psychiatric and mental health ANA has defined psychiatric and mental health nursing g as a specialized area of nursing nursing g as a specialized area of nursing practice that employs theories of human practice that employs theories of human behavior as its science and purposeful use for behavior as its science and purposeful use for self as its art ( ANA, 1976). It is directed toward self as its art ( ANA, 1976). It is directed toward both preventive and corrective effects upon both preventive and corrective effects upon mental disorders and their sequel and is mental disorders and their sequel and is concerned with the promotion of optimal mental concerned with the promotion of optimal mental health for society, the community and individuals health for society, the community and individuals (ANA, 1976). (ANA, 1976).

The Nursing Process:The Nursing Process:

The nursing process in other areas of The nursing process in other areas of practice is also used in psychiatric – practice is also used in psychiatric – mental health nursing. It is composed of mental health nursing. It is composed of assessment, nursing diagnosis, client assessment, nursing diagnosis, client outcomes, nursing interventions, and outcomes, nursing interventions, and evaluation of outcomes. The process is evaluation of outcomes. The process is ongoing, an evaluation is part of the ongoing, an evaluation is part of the assessment once the process is assessment once the process is established. established.

Collaboration with other disciplinesCollaboration with other disciplines

Nursing practice can be thought of as Nursing practice can be thought of as occurring in two contexts: within particular occurring in two contexts: within particular settings, and within a multidisciplinary settings, and within a multidisciplinary team. team.

Mental Health Disciplines:Mental Health Disciplines:

The four mental health disciplines that have The four mental health disciplines that have traditionally provide services to psychiatric traditionally provide services to psychiatric clients are nursing, medicine, social work, and clients are nursing, medicine, social work, and psychology. In addition to the four traditional psychology. In addition to the four traditional disciplines, occupational therapy and therapeutic disciplines, occupational therapy and therapeutic recreation are offered in almost every inpatient recreation are offered in almost every inpatient unit. Disciplines to whom referrals for unit. Disciplines to whom referrals for psychiatric clients are made include dietary, psychiatric clients are made include dietary, physical therapy, pharmacy, and others. physical therapy, pharmacy, and others.

Teamwork:Teamwork:

Working together is a challenge for my two people, no Working together is a challenge for my two people, no matter what the task. Increasing the number of people matter what the task. Increasing the number of people with different educational backgrounds, vocabulary, with different educational backgrounds, vocabulary, priorities, methods of problem solving goals, and priorities, methods of problem solving goals, and communication styles adds to the challenge of working communication styles adds to the challenge of working together. The multidisciplinary team comes together for together. The multidisciplinary team comes together for a common purpose: planning and evaluating the a common purpose: planning and evaluating the treatment of individuals clients. The client is considered a treatment of individuals clients. The client is considered a member of the team. Each person on the team is treated member of the team. Each person on the team is treated with mutual respect, because everyone on the team has with mutual respect, because everyone on the team has a vital contribution to make. a vital contribution to make.

Thought team members may overlap in some areas of knowledge Thought team members may overlap in some areas of knowledge and responsibility, each team member also has a unique and responsibility, each team member also has a unique contribution to make that must be communicated for effective contribution to make that must be communicated for effective treatment planning to occur. Decision making usually occurs by treatment planning to occur. Decision making usually occurs by consensus, and all members specify the activities they will pursue. consensus, and all members specify the activities they will pursue. Any team member could coordinate the client’s care, but the nurse Any team member could coordinate the client’s care, but the nurse usually provides this service because members of the nursing staff usually provides this service because members of the nursing staff are always present in the inpatient environment. are always present in the inpatient environment.

Inherent in this view of teamwork are several principles. Inherent in this view of teamwork are several principles. Teamwork focuses on client outcomes to which all team members Teamwork focuses on client outcomes to which all team members

make a contribution. make a contribution. The client is a member of the team, creating a climate of The client is a member of the team, creating a climate of

cooperation among all members. cooperation among all members. Each mental health discipline makes a unique contribution, and Each mental health discipline makes a unique contribution, and

there is overlapping among disciplines as well. there is overlapping among disciplines as well.