Mental Health Supplemental Handouts PDF

Chapter Contents A. Overview of Psychiatric Nursing B. Mental Health – Psychiatric...

Chapter Contents A. Overview of Psychiatric Nursing B. Mental Health – Psychiatric Nursing Practice Mental Health PSYCHIATRIC NURSING I. Mental Health Nursing interventions/ strategies for the promotion/maintenance of mental health and the management of psychosocial problems of individuals, families, population groups and communities I. Foundations of Psychiatric Nursing Mental Health - it is related to the ability to see oneself as others do and fit into the culture and society where one lives. It is a positive state in which one is responsible, displays self-awareness, is self-directive, is reasonably worry-free and can cope with the usual daily tensions (Shives, 2008) - indicators of mental health include positive attitudes towards oneself, growth, development, self-actualization, integration, autonomy, reality perception and environmental mastery (Hogan, 2003). FACTORS INFLUENCING THE DEVELOPMENT OF MENTAL HEALTH 1. Inherited characteristics -theorists believe that no one is completely normal and that the ability to maintain a mentally healthy outlook on life is due, in part, to one’s genes 2. Nurturing during childhood - this refers to the interaction between the family and the child which also affects the development of mental health 3. Life circumstances - this can influence one’s mental health from birth. Individuals who experience positive life Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 1  circumstances are generally emotionally secure and successful and are able to establish healthy personal relationships Mental illness - it is the inability to see oneself as others do and not having the ability to conform to the norms of the culture and the society. The American Psychiatric association defined mental illness or disorder as an illness or syndrome with psychological or behavioral manifestations and/or impairment in functioning as a result of physical, social, psychological, genetic or biologic disturbance. - Medical diagnosis of mental illness is classified according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition or DSM-IV, of the American Psychiatric Association. Mental health and mental illness can be viewed as end points on a continuum, with movements back and forth throughout life. MENTAL ILLNESS MENTAL HEALTH Worries, loss of meaning to life, biological factors Positive self-worth, meaningful life, vitality Fear, anxiety, withdrawal, dependency, manipulation Support, Positive identity, Sense of harmony II. Promoting Psychosocial Health A. Crisis Intervention CRISIS Definition: CRISIS is an experience of being confronted by a stress in which the individual is unable to cope/problem-solve. The change or loss threatens the individual’s equilibrium. Hopelessness and helplessness results in a state of disorganization where previous experience and coping mechanisms are ineffective to enable to individual to problem-solve. They are generally time-limited, lasting from 4-6 weeks. Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 2  Four Phases of crisis (average crisis is four to six weeks but may vary widely) 1. Vulnerable state 2. Precipitating event a. developmental change (maturational crisis) b. a life change (situational crisis) c. loss of loved one or job (situational crisis) d. environmental disaster or war (adventitious crisis) 3. Acute crisis 4. Reorganization Types of crisis 1. Maturational crises – involve normal life transitions that evoke changes in individual self-perception in role, status and integrity 2. Situational crises - involve an external event that disturbs the individual equilibrium such as a loss or a change and threatens the consistency between self-behaviors and values or beliefs 3. Adventitious crises - involve external events such as natural disasters or other events of catastrophic proportion that are unpredictable. Individuals during a crisis experience: Mild to severe anxiety Anger Crying, social isolation, helplessness Impaired cognitive processes; inability to concentrate; confusion Insomnia Regression Nausea and vomiting Treatment: CRISIS INTERVENTION Objective: to help the client through the current crisis Brief supportive interventions focused on the phase of crisis Allow free discharge of emotions Enhance client's cognitive processes Pharmacologic: alprazolam (Xanax) Occupational therapy Recreational therapy Nursing care in crisis Provide a quiet, restful environment Help the client solve problems Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 3  Let the client ventilate Correct any misperceptions about the crisis that the client may have Help the client to identify support systems, alternative solutions Help the client to deal with long term impact of crisis Encourage relaxation strategies Assist the client in the development of new coping skills B. Stress Management STRESS Definition: A universal phenomenon, stress requires change or adaptation so that the person can maintain equilibrium. Stress can be internal or external. Nature of stressor involves: Intensity Scope Duration Other stressors: their number and nature Categories of stressors - and examples Physical - drugs or alcohol Psychological - such as adolescent emotional upheaval, or unexpressed anger Social - isolation, interpersonal loss Cultural - ideal body image Microbiologic - infection The greater the stressor as perceived by the client, the greater the stress response Stress response involves both localized and general adaptation Factors affecting stress response Personal: heredity, gender, race, age personality, cognitive ability Sociocultural: finances, support systems Interpersonal: self-esteem, prior coping mechanisms Spiritual: belief system Environmental: crowding, pollution, climate Occupational: work overload, conflict, risk Nursing interventions Explore the reasons for non-compliance Express genuine concern for client Discuss improvement potential Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 4  C. Dying and Death ✓ The concept of death is developed over time. ✓ Both the client who is dying and the family members grieve as they recognize the loss. ✓ The traditional clinical signs of death were cessation of the apical pulse, respirations and blood pressure also referred to as heart-lung death. ✓ In 1968, the World Medical Assembly adopted new guidelines as indications of death which include: ▪ Total lack of response to external stimuli ▪ No muscular movement, especially breathing ▪ No reflexes ▪ Flat brain waves ✓ Another definition of death is cerebral death or higher brain death which occurs when the higher brain center, the cerebral cortex is irreversibly destroyed. ✓ Advance health care directives include a variety of legal and lay documents that allow a person to specify aspects of care they wish to receive should he/she becomes unable to make or communicate his/her preferences. ✓ Living will provides specific instructions about what medical treatment the client chooses to omit or refuse in the event the client becomes unable to make those decisions. ✓ Health care proxy also referred to as durable power of attorney for health care is a notarized or witnessed statement appointing someone else (e.g., a relative or a trusted friend) to manage health care treatment decisions when the client is unable to do so. ✓ An autopsy or postmortem examination is an examination of the body after death. The organs and tissues are examined to establish the exact cause of death. ✓ The formal determination of death or pronouncement must be performed by a physician, a coroner or a nurse. DEVELOPMENT OF THE CONCEPT OF DEATH Age Beliefs/Attitudes Infancy to 5 years Does not understand the concept of death Believes death is reversible, a temporary departure or sleep. Emphasizes immobility and inactivity as attributes of death. 5 to 9 years Understands that death is final. Believes own death can be avoided. Associates death with aggression or violence. 9 to 12 years Understands death as the inevitable end of life. Begins to understand own mortality, expressed as interest in afterlife or as fear of death. 12 to 18 years Fears a lingering death. Seldom thinks about death, but views it in religious and philosophic terms. 18 to 45 years Has attitude toward death influenced by religious and cultural beliefs 45 to 65 years Accepts own mortality. Encounters death of parents and some peers. Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 5  Death anxiety diminishes with emotional well-being. 65+ years Fears prolonged illness. Sees death as having multiple meanings. D. Grief and Loss LOSS Definition: A universal phenomenon; it occurs across the lifespan Types of Loss Loss of external objects Loss of significant other: through death, divorce Loss of environment: by moving, taking a new job, hospitalization Loss of an aspect of self: may include a body part, physiologic or psychologic function Response to loss depends on: One's Personality, Values and Culture Previous Experience With Loss Perceived Value Of Loss and Support System GRIEF Definition: A normal and appropriate response to an external and consciously recognized loss. Types of Grief Anticipatory grief: person learns of impending loss and responds with processes of mourning, coping, interaction, planning, and psychosocial reorganization Disenfranchised grief: person experiences a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported Mourning: the individual’s outward expression of grief Tasks of mourning (common to the models of grief) spell R-E-A-L 1. Real: accept that the loss is real 2. Experience the emotions associated with the loss 3. Adjust or re-adjust to life and activities 4. Let go: move on with one's own life Bereavement: process of grief Nursing care in grief Support client's effective coping mechanisms Listen attentively Help client with problem solving and decision making as indicated Encourage the client and/or significant others to ventilate Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 6  Utilize therapeutic touch as appropriate Assist in discussions of future plans as appropriate II. Legal aspects in Psychiatric Nursing A. Development of mental health laws ✓ Federal and state legislation, along with significant case law, provides the basis for psychiatric practice. ✓ All states legislate their own laws to govern the treatment of mentally ill persons. ✓ Several federal laws have been passed to protect the basic rights of mentally ill and physically challenged U.S. citizens. ✓ In 1976, the Supreme Court of California found that a therapist must warn others when a mentally ill client poses a serious danger or threat to them; the “duty to warn:’ has since been adopted as law in many states. B. State commitment laws ✓ Each state has its own laws to determine types of admission for psychiatric treatment. ✓ Clients are either admitted voluntarily or committed involuntarily. *With voluntary admission, the client willingly enters and consents to treatment. Clients retain all of their civil rights and may discontinue treatment whenever they choose (some states require the client to sign a 72-hour notice of intent to leave). If the treatment team disagrees with a client’s decision to discontinue treatment, the client signs a form acknowledging that he has been discharged against medical advice, or the treatment team may decide to seek involuntary commitment of the client. *With involuntary inpatient commitment, the client is institutionalized against his will. State laws define which persons can be committed and generally include those who pose a threat to self or others, those who lack the capacity for meeting basic needs, and those who are seriously mentally ill but fail to seek treatment. State guidelines specify time limits for various types of involuntary commitment, including evaluation and emergency care, observation and treat- merit of a mental disorder, and extended or indeterminate care. Clients who are committed for extended care are entitled to legal representation and a court hearing before being committed and at specified times during their care, Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 7  *Involuntary outpatient treatment involves treatment mandated by a court order This option has been used as deinstitutionalization has progressed. Clients typically include substance-impaired individuals, homeless mentally ill persons, and sex offenders. *Important note: Involuntary commitment does not mean that an individual is incompetent; the client retains the right to consent to and refuse treatment. C. Federal legislation All clients admitted for psychiatric treatment retain their civil rights however, in an emergency involuntary commitment, state law covers deprivation of liberty The Patient’s Bill of Rights, which was originally published in 1973 by the American Hospital Association (AHA) and adopted into law by the Mental Health Systems Act in 1980, includes the following rights (among others not specified here): - The right to appropriate treatment in the least restrictive setting - The right to participate in the planning of treatment - The right to refuse treatment except in an emergency or as permitted by law The Americans with Disabilities Act, which was passed in 1990, ensures that those with a mental illness can fully participate in the economic and social mainstream. The Social Security Act, passed in 1993. provides clients with the right to an individual treatment plan of care, the right to participate in a plan of care, and the right to refuse treatment. The Health Insurance Portability and Accountability Act (HIPPA), signed into law in 1996, mandates standards for the privacy of individually identifiable health information for all health plans and health care providers. ✓ The law protects any health information that is kept, filed, used, or shared in oral, electronic, or written form. ✓ It includes mental health records, such as psychotherapy arid drug and alcohol treatment D. Key legal concepts Client information is considered privileged and must be treated with confidentiality. A client’s informed consent ensures that he received adequate information about his care and treatment prior to his consenting to treatment All clients (including those committed involuntarily) have the right to refuse treatment; however in an emergency, a client can be given medication or Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 8  confined by seclusion or restraints (institutional guidelines are important in these situations). The court determines client incompetence (or the inability to legally make decisions regarding one’s health care, finances, and properly) when self- management is so impaired that the client is at risk for grave harm. - The client will have legal representation during this period. - If the client is found to be incompetent, a legal guardian is appointed by the court to make decisions for him. Seclusion and restraint are methods of preventing a client from harming himself or others during a violent outburst; both methods are regulated by specific legal and ethical guidelines. - Federal agencies, professional associations, and health care facilities are all involved in a concerted effort to eliminate and/or reduce the use of these restrictive measures (a statement by the American Psychiatric Nurses Association can be accessed through the Web site http://apna.org). - The guiding principle of managing client acting-out behavior is the use of least restrictive measures, in which the nurse attempts to calm the client before advancing to interventions that require seclusion or restraint. Effective initial measures include limit setting, verbal interventions (including forming a therapeutic relationship with the client), and offering medication. When initial measures fail or are inappropriate, the client may be involuntarily confined (secluded) in a room or area to prevent him from physically leaving. In some cases, the client may require restraint; this refers to any method (such as manually holding a client or applying a device or piece of equipment that is attached or adjacent to the client’s body) to restrict freedom of movement or normal access to his body. III. Factors Affecting Mental Health Maintenance There are factors that can influence the ability to achieve and maintain mental health and this includes the use of ego defense mechanisms, interpersonal communication and the presence of significant others. A. Defense Mechanisms Definition: Defense mechanisms are psychological techniques that the personality develops to manage anxiety, aggression, hostility, etc. They are considered protective barriers used to manage instinct and affect stressful situations. Defense mechanisms represent conflicts between the id and superego Used by both mentally healthy and ill individuals May be used consciously, but are usually unconscious Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 9  TYPE DESCRIPTION AND EXAMPLE 1. Compensation -Extra effort in one area to offset real or imagined lack in another area Example: Short man becomes assertively verbal and excels in business. 2. Conversion -Unconscious expression of a mental conflict as a physical symptom to relieve anxiety. Example: Woman becomes blind after seeing her husband with another woman. 3. Denial -Treating obvious reality factors as though they do not exist because they are consciously intolerable. Example: A mother refuses to believe her child has been diagnosed with leukemia. "She just has the flu." 4. Displacement -Transferring unacceptable feelings aroused by one object to another, more acceptable substitute. Example: A teenager lashes out at parents after not being invited to party. 5. Dissociation – Separation and detachment of a strong, emotionally charged conflict from consciousness. Example: A college student talks about failing grades as if they belong to someone else and even jokes about them. 6. Fantasy - A conscious distortion of unconscious wishes and need to obtain satisfaction. Example: A student nurse fails the final exam and daydreams about her heroic role in a cardiac arrest 7. Fixation - Becoming stagnated in a level of emotional development in which one is comfortable. Example: A sixty year old man who dresses and acts as if he were still in the 1960's. 8. Identification - Subconsciously attributing to oneself qualities of others Example: Teenager dresses, walks and talks like her favorite actress 9.Intellectuali-zation -Use of thinking, ideas, or intellect to avoid emotions. Example: Parent becomes extremely knowledgeable about child's diabetes. 10. Introjection -Incorporating the traits of others to oneself. Example: Husband's symptoms mimic wife's before she died. 11. Projection - Unconsciously projecting one's own unacceptable qualities or feelings onto others. Example: A man who was late for work blames his wife for not setting the alarm clock. 12. Rationalization - Unconscious justification of one’s behaviors, emotions, motives, considered intolerable through acceptable excuses. Example: "I didn't get chosen for the team because the coach plays favorites." 13.Reaction Formation - Expressing unacceptable wishes or behavior by opposite overt behavior. Example: A man who dislikes his mother-in-law is very polite and courteous towards her 14. Regression - Retreating to an earlier and more comfortable emotional level of development. Example: A woman acts like a teenager on her first date with a fellow employee. 15. Repression - Unconscious, deliberate forgetting of unacceptable or painful thoughts, impulses, feelings or acts. Example: Adolescent "forgets" appointment with counselor to discuss final grades. 16. Sublimation - Diversion of unacceptable instinctual drives into personally and socially acceptable areas. Example: A young woman who hated school becomes a teacher. 17. Supression - Voluntary rejection of unacceptable thoughts or feelings from conscious awareness. This is the only conscious defense mechanism. Example: A Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 10  student who failed the test states that she is not ready to talk about her grades. 18. Symbolization - Use of external objects to become an outward representation of an internal idea, attitude or feeling. Example: An engagement ring symbolizes love and commitment to another person. B. Interpersonal Communication A relationship is only good as the intent of the interaction that occurs during interpersonal communication between two or more individuals. C. Significant Others or Support People People may also reach out to individuals and groups for support during periods of increased stress or anxiety. Such people are referred to as significant others or support people. Support people can be anyone with whom the person feels comfortable, trusts and respects. IV. Therapeutic Communication and Relationships Therapeutic Relationship Definition. It is a nurse-client interaction that focuses o n the client needs and is goal specific, theory based and open to supervision. It is a therapeutic professional relationship in which two people interact. Main tool: Therapeutic use of SELF (this requires SELF-AWARENESS) Phases of the nurse-client relationship As part of her interpersonal theory, Hildegard Peplau described the phases, also referred to as stages, of one-to-one nurse-client relationship established in psychiatric mental health nursing that is applicable for use in outpatient and inpatient settings. Such relationships can be divided into three phases. Each phase is associated with specific therapeutic tasks or goals to be accomplished. PHASE DESCRIPTION 1. Introduction or This phase includes establishing a contract, setting the stage for a one on one Orientation relationship with the client, discussing confidentiality, assessing thoroughly, establishing a therapeutic environment and developing the preliminary nursing plan. 2. Working The assessment process continues and a plan of care develops. Alternate behaviors and techniques are explored. This phase includes exploring the client’s perception of reality, helping the client develop positive coping behaviors, identifying available support system, encouraging verbalization of feelings, developing a plan of action, implementing a plan of action and evaluating results of the plan of action. Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 11  Transference – is the unconscious process of displacing feelings for significant people in the past onto the nurse in the patient relationship Countertransference- is the nurse’s emotional reaction to clients based on feelings for significant people in the past. 3. Termination This is the final step of the therapeutic relationship when the mutually agreed- on goals are reached, the client is transferred or discharged or the nurse has finished clinical rotation. This phase include: identification of the progress the client has made and exploration the necessity of the referrals. The primary goal of this phase is to review the client’s progress and plans for the immediate future. Characteristics of nurse-client relationship 1. Mutual definition: together, nurse and client define relationship 2. Goal direction: purpose, time, and place are specific 3. Specified boundaries: in time, space, content, and confidentiality 4. Therapeutic communication: nurse eases trust and open communication by these interpersonal techniques 5. Nurse helps client toward resolution Therapeutic Communication Definition: It is the process of influencing the behavior of others by sending, receiving and interpreting messages and providing feedback. It is also the foundation of interpersonal relationship and is a key process needed to use the nursing process. TERMS TO REMEMBER 1. Communication This refers to the giving and receiving of information involving 3 elements: the sender, the receiver and the message. The sender prepares or creates the message to a receiver or listener who then decodes it. The receiver may return the message or feedback to the initiator of the message. There are two types: verbal and non-verbal 2. Verbal An individual uses verbal communication to convey content such as ideas, communication thoughts and concepts to one or more listeners. 3. Non-verbal Clients may reveal their emotions, feelings and mood through their general communication appearance of their behavior termed nonverbal communication. Types of non-verbal communication: Vocal cues, gestures, physical appearance, distance or spatial territory, position or posture, touch and facial expressions and non-verbal communication techniques used in psychiatric- mental health clinical setting. Four zones of distance awareness of spatial territory: a. Intimate zone – body contact such as touching, hugging and wrestling b. Personal zone –1 ½ - 4 feet, arms length and some body contact such as holding hands, therapeutic communication occurs in this zone. c. Social zone- 1-12 feet, for formal business and social discourse d. Public zone- 12-25 feet, no physical contact, minimal, for public discourse Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 12  THERAPEUTIC COMMUNICATION TECHNIQUES 1. Giving broad openings Example: “What would you like to do today?” 2. Using silence … 3. Giving recognition Example: “I’ve noticed that you have made your bed” 4. Offering self Example: “I’ll walk with you” 5. Offering general leads Example: “Go on…” 6. Accepting Example: “Yes, that must have been difficult for you” 7. Making observations Example: “You appear to be angry” 8. Exploring Example: “Tell me more about your job” 9. Clarifying Example: “Could you explain more about that to me?” 10. Focusing Example: “Could we continue talking about you and your mother right now?” 11. Placing the event in time or Example: “Which came first…?” sequence 12. Restating Example: Client: “I can’t sleep, I stay awake all night” Nurse: You can’t sleep all night 13. Reflecting Example: Client: “I keep thinking about what my friends are doing right now” Nurse: “You’re worried that they aren’t missing you?” 14. Summarizing Example: “So far we have talked about…” 15. Giving information Example: “I’m going with you to the garden” 16. Presenting reality Example: “I see no monsters in the room” 17. Encouraging collaboration Example: “Perhaps together we can figure out…” 18. Encouraging formulation of a Example: “What do you think you can do the next time you feel plan of action that way?” NON-THERAPEUTIC COMMUNICATION TECHNIQUES 1. Stereotyping Example: “Still waters run deep” 2. Changing the topic Example: Client: “ I was so afraid I’m going to have a panic attack” Nurse: “What does your husband say about your panic attacks?” 3. Disagreeing Example: “I don’t see any reason for you to think that way” 4. Challenging Example: “Is that a valid reason to become angry?” 5. Requesting an explanation Example: “Why did you react that way?” 6. False reassurance Example: “Don’t worry anymore. Everything will be alright soon.” 7. Belittling expressed feelings Example: “It is wrong to even think of your husband like that” 8. Probing Example: “Tell me what secrets you keep from your husband” 9. Advising Example: “ I think you should divorce your husband” 11. Double/multiple questions Example: “What makes you feel you should stay? How would you get along if you left?” Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 13  V. Psychotherapies TYPE DESCRIPTION 1. REMOTIVATION T This is a treatment modality that promotes expression of feelings through THERAPY interaction facilitated by discussion of neutral topics. 2.MUSIC This involves use of music to facilitate expression of feelings, facilitate THERAPY relaxation and outlet of tension 3. PLAY THERAPY Enables patient to experience intense emotion in a safe environment with the use of play Children express themselves more easily in play. Revealing as reflection of child’s situation in the family Provide toys and materials – facilitate interaction – observe and help child resolve problems through play 4. GROUP Treatment modality involving three or more patients with a therapist to THERAPY relieve emotional difficulties, increase self – esteem, develop insight, learn new adaptive ways to cope with stress and improve behavior with others (relationship with others can be worked through) Ideal 8 – 10 members 5. MILIEU Consists of treatment by means of controlled modification of the patients THERAPY environment, facilitate positive behavioral change Increase patients awareness of feelings, increase sense of responsibility and help return to community Clients plan social and group interaction Token programs, open wards and self medication 6. Focuses on the exploration of the unconscious, to facilitate identification PSYCHOANALYTIC of the patients defenses Anxiety results between conflicts of id and ego (defense mechanisms form to ward off) Becomes aware of unconscious thoughts and feelings, understand anxiety and defenses 7. HYPNOTHERAPY Various methods and techniques to induce a trance state where patient becomes submissive to instructions 8. OPERANT Use of rewards to reinforce positive behavior CONDITIONING Perceived and self reinforcement becomes more important than external Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 14  9. BEHAVIOR A therapeutic intervention involving the application of learning principles MODIFICATION in order to change mal-adaptive behavior THERAPY Psychological problems are a result of learning Slow adjustment or exposure to feared objects (used in phobias) a. SYSTEMATIC Periodic exposure until undesirable behavior disappears or lessen DESENSITIZATION Example of behavior modification in which painful stimulus is introduced to bring about an avoidance of another stimulus with the end view of facilitating behavioral change b. AVERSION THERAPY Uses confrontation as a means of helping clients restructure irrational beliefs and behavior c. COGNITIVE Clients are taught to relate appropriately to others using frank, honest and BEHAVIOR direct expressions, whether these are positive or negative in nature THERAPY Is an important aspect of the therapeutic milieu. Limits reduce anxiety, d. ASSERTIVENESS minimize manipulation, provide a framework for client functioning and TRAINING enable a client to learn to make requests e. LIMIT SETTING 10. OTHER Token economy - rewarding desired behavior THERAPIES Humor therapy – to facilitate expression and enhance interaction Activity therapy – group interaction while working on a task together VI. The Nursing Process Assessment - establishing a database about the client, family or community. Observation of the client is extremely important in assessing clients with mental illness. Clients are observed in terms of their behavior, affect, cognition and interpersonal relationships. Diagnosis - this includes identifying the client’s health care needs and selecting the goals of care. Outcome identification - this includes establishing the criteria for measuring achievement of desired outcomes. Client outcomes are specific behavioral measures by which the nurse, client and significant others determine progress toward a goal Implementation - this includes initiating and completing actions necessary to accomplish the defined goals. Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 15  Evaluation - this includes determining the extent to which the goals of care have been achieved. Copyright © 2024 Professional Review Network, Inc. (PRN) This document may not be used, reproduced or disseminated to any third party without written permission from PRN. 16