Psychiatric Nursing Overview

Overview of Psychiatric Nursing

• Psychiatric nursing is an interpersonal process focused on promoting and maintaining behavior that contributes to the integrated functioning of patients, including individuals, families, communities, and groups.
• Specialized nursing practice applies human behavior theories and therapeutic self-use.
• Focuses on preventing and correcting mental disorders and promoting optimal mental health for society, communities, and individuals.
• Goals include promotion of mental health, prevention of mental disorders, nursing care during mental illness, and rehabilitation.

Roles of a Psychiatric Nurse

• Primary roles are preventive and promotive: stress management, family therapy, counseling, people empowerment, collaboration with officials.
• Involves making appropriate referrals based on assessments of potential stressors and life changes.
• Secondary roles are curative, including community and organizational interventions for identified problems, emergency treatment, suicide prevention, and substance abuse services.
• Includes supervising medication, providing therapeutic environments, time-limited counseling, crisis intervention, and various psychotherapy.
• Tertiary roles are rehabilitative, promoting vocational training, organizing programs for discharged patients, and providing partial hospitalization options (OPD).

Mental Health

• Defined by the World Health Organization (WHO) as a state of wellbeing where individuals realize their abilities, cope with life stresses, and work productively.
• A person feels physically well, has organized thoughts and modulated feelings, and exhibits coordinated and appropriate behaviors.
• Lifelong process of adapting to changing environments: internal and external.
• Individual connects with reality, demonstrates love, and resolves conflicts reasonably.
• Criteria include positive self-attitude, striving for growth and self-actualization, integration, autonomy, realistic perception, and environmental mastery.

Mental Disorder/Illness

• Deficit in functioning/impaired affective, cognitive, or relational abilities
• Psychological/behavioral manifestations associated with impaired functioning due to biological, social, psychological, genetic, physical/chemical disturbance, measured by deviation from normative concepts.
• Characterized by an inability to respond to the environment effectively and patterns that impair functioning and cause distress.

Criteria for Mental Disorder

• Dissatisfaction with one's character, abilities, and accomplishments.
• Ineffective/ unsatisfactory interpersonal relationships (IPR).
• Dissatisfaction with one's place in the world.
• Ineffective coping/adaptation to life events, lack of personal growth.

Characteristics of Persons with Mental Illness

• Unacceptance of self, unrealistic perceptions, difficulty finding meaning, dependence on others.
• Feels out of control and has negative perceptions of the environment
• Exhibits ineffective coping mechanisms and interpersonal struggles, showing an inability to love, care, or accept feelings from others.
• Can be described as psychotic/psychosis, a traditional loss of reality testing, severe impairment of functioning, and examples include schizophrenia, schizophreniform disorder, and delusional disorder.
• Neurotic/neurosis: Based in intraphysic conflicts, no loss of reality testing, causing anxiety, and appears as symptoms like obsessions or phobias.
• Functional: No known structural damage/etiology to account for impairment.
• Organic: Caused by a specific agent that causes structural damage in the brain.

DSM IV Diagnosis

• Axis I: Mental disorders except those listed under Axis II (e.g., Schizophrenia, Catatonic Type).
• Axis II: Personality disorders and mental retardation.
• Axis III: Physical disorder or general medical condition present with the mental disorder: May be causative, interactive, an effect, or unrelated.
• Axis IV: Psychosocial and environmental problems that contribute significantly to the development or exacerbation of the current disorder (e.g., death of a loved one).
• Axis V: Global Assessment of Functioning (GAF) scale: 100-point scale representing the highest level of functioning in all areas; assesses social, occupational, and psychological areas.

Psychiatric Assessment

• Includes psychiatric history, identifying data, chief complaint, history of present illness, past personal & medical history, and family history.
• History of Present Illness:
  • Chronological account of illness from onset to present
• Past Personal & Medical History:
  • Includes client's past illnesses & life situation
• Family history:
  • Describes family situation & family incidence of mental illnesses.
• Social & environmental history involves living arrangements, relationships, employment, and emotional satisfaction; birth, infancy, early childhood, school, and adulthood experiences.
• Includes client's strengths, cultural factors, spirituality, current status, personality, and character structure.

Nurse-Client Relationship

• A professional therapeutic relationship
• Ultimate Goal: client becomes independent
• Stages: Initial Stage, Working Stage, Termination Stage
• Initial/Orientation Stage involves building trust, setting rules and limits, establishing goals, and creating a nurse-client contract

Neuropsychiatric Mental Status Examination

• Comprehensive Mental Status Examination
• Key to accurate neuropsychiatric diagnosis
• Observations: includes general appearance (dress, grooming) and motor behavior (manner of relating during interview). General appearance:
  • Dress (disheveled, eccentric, unilateral neglect)
  • Grooming and hygiene (neat/unkempt) Motor behavior:
  • Manner of relating/attitude during interview/social interaction
• Verbal output: language( aphrasia: fluent and non-fluent, Echolalia, Palilalia, Coprolalia, Clang association and speech (intensity, pitch, rate, spontaneity/productivity, relevance, coherence).
• Thought processes: including emotion (affect, mood), and thinking (content, process, form).
• Hallucinations: False sensory perception occurring in the absence of any relevant external stimulation of the sensory modality involved.

Mental Status Examination

• Sensorium
• Arousal, attention
• intellectual function/ cognition , memory, visuospacial skills
• Judgment and insight level