Introduction to Psychiatric Nursing PDF

INTRODUCTION TO PSYCHIATRIC NURSING PROFESSOR CHEESMAN MENTAL HEALTH State of well-being – Realize potential – Cope with normal stress – Work productively – Contribute to the community Provides capacity for – Rational thinking – Communication skills – Learnin...

INTRODUCTION TO PSYCHIATRIC NURSING PROFESSOR CHEESMAN MENTAL HEALTH State of well-being – Realize potential – Cope with normal stress – Work productively – Contribute to the community Provides capacity for – Rational thinking – Communication skills – Learning – Emotional growth – Resilience – Self-esteem MENTAL ILLNESS Refers to all psychiatric disorders that have definable diagnoses substance use disorders and serious mental illness  DIATHESIS-STRESS MODEL Diathesis - biological predisposition Stress - environmental stress or trauma ààà Most accepted explanation for mental illness Combination of genetic vulnerability and negative environmental stressors  DSM-5 LIST OF DISORDERS Neurodevelopmental Elimination Disorders Disorders Sleep-Wake Disorders Schizophrenia Spectrum Sexual Dysfunctions Disorders Disruptive, Impulse Control, Bipolar and Related and Conduct Disorders Disorders Substance-Related and Depressive Disorders Addictive Disorders Anxiety Disorders Neurocognitive Disorders Obsessive-Compulsive Personality Disorders Disorders Paraphilic Disorders Trauma and Stressor- Related Disorders Dissociative Disorders Somatic Symptom Disorders Feeding and Eating Disorders  RELEVANT THEORY AND THERAPIES FOR P S Y C H I AT R I C NURSING PROFESSOR CHEESMAN TRANSFERENCE/COUNTERTRANSFERENCE TRANSFERENCE Feelings the client has developed toward the therapist in relation to similar feelings toward significant persons in the client’s early childhood C O U N T E RT R A N S F E R E N C E The unconscious feelings that the healthcare worker has toward the client – The client can remind them of a person from their past – Positive or negative  PSYCHOANALYSIS Assessing unconscious thoughts/feelings – Free association – Dream analysis and interpretation Months to years to complete Focus is on concepts of intrapsychic conflict Freud is father of psychoanalysis – Personality Structure Id – Birth drive—instincts, reflexes, drives, needs, and desires – Exists in unconscious only Ego – Problem solver and reality tester – Exists in conscious, preconscious, and unconscious Superego – Moral component – Exists in conscious, preconscious, and unconscious PSYCHOTHERAPY PSYCHODYNAMIC INTERPERSONAL PSYCHOTHERAPY PSYCHOTHERAPY – Same tools as psychoanalysis – Harry Stack Sullivan creator – All behavior is motivated by – Many mental health disorders are influenced by unconscious content interpersonal interaction and social context – Focuses on present instead of past – Addresses specific problems – Also lasts months to years Familial and intimate relationships Communication Role-relationships Bereavement PEPLAU’S OF INTERPERSONAL RELATIONSHIPS Participant observer – Mutuality – Respect for the patient – Unconditional acceptance – Empathy Aim to improve patient’s ability to think and function Peplau’s Model of the Nurse-Patient Relationship – Preorientation Phase – Preparing for assignment Chart inspection – Orientation Phase – Initial interview – Working Phase – Working relationship and goals established – Termination Phase – Review of goals and achievements  COGNITIVE THERAPY Cognitive therapy – Focuses on individual thoughts and behaviors to solve current problems – Thoughts come before feelings and actions – Can treat Depression Anxiety Eating disorders Cognitive-behavioral therapy (CBT) – Adjusts how clients perceive things in order to influence their feelings and behavior Dialectical-behavioral therapy (DBT) – Same as cognitive-behavioral therapy (CBT) – Focuses specifically on personality disorders and self-injurious behavior Cognitive reframing - assists client in identifying negative thoughts that produce anxiety, examine the cause, and develop supportive ideas to replace negative self-talk – Priority restructuring – assists in identifying what requires priority adjustment – Journal keeping – aids client in writing down stressful thoughts and improves well-being – Assertiveness training – teaches expressing feelings and problem solving in a nonaggressive manner – Monitoring thoughts – helps client be aware of negative thinking BEHAVIORAL THERAPY Classical conditioning theory – Neutral stimulus repeatedly paired with another stimulus – Pavlov’s dog – Involuntary Operant conditioning theory – Method of learning that occurs through rewards and punishment – Skinner’s box – Voluntary Behavioral therapy modalities – Operant conditioning therapy – Client receives rewards for positive behaviors – Aversion therapy – Pairing maladaptive behavior with a punishment or unpleasant stimuli to promote change in behavior Disulfiram – Modeling – Therapist serves as a role model for client to imitate and improve behavior – Systematic desensitization Planned, progressive, or graduated exposure (slowly) to anxiety-producing situations/phobias Client uses relaxation techniques to desensitize to stimuli Behavioral techniques – Flooding – Exposing (quickly) to undesirable stimuli without relaxation techniques – Thought stopping – When negative compulsions or thoughts arise have client say or shout “stop!” Substitute with a positive thought Over time command silently HUMANISTIC THEORY M A S L OW ’ S HIERARCHY OF NEEDS  BIOLOGICAL MODEL Focuses on – Neurological – Chemical – Biological – Genetic How the body and brain interact to create – Emotions – Memories – Perceptual experiences Psychopharmacology therapy – Use of medication to treat psychiatric illness Brain stimulation – Electroconvulsive therapy (ECT) – Transcranial magnetic stimulation (TMS) – Vagus nerve stimulation (VNS) – Deep brain stimulation (DBS) DEVELOPMENTAL THEORY ERIKSON PIAGET LEGAL AND ET H I C A L GUIDELINES PROFESSOR CHEESMAN  CLIENT’S RIGHTS Treated with dignity Informed consent Involved in treatment planning and Confidentiality regarding one’s disorder and decisions treatment Refuse treatment—including Choose or refuse visitors medications! Informed of research and to refuse to participate (If vol) Request to leave hospital Least restrictive means of treatment Protected against harming oneself or Send and receive mail and to be present during others packages received Timely evaluation in the event of Keep personal belongings unless they are involuntary hospitalization dangerous Legal counsel Lodge a complaint through a plainly publicized To vote procedure Communicate privately by telephone and Participate in religious worship in person  HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT - HIPAA Confidentiality after death Confidentiality of professional communications – Continuity of care – Must be part of treatment plan Exceptions – Tarasoff Ruling—threatens harm to 3rd party – Abuse (mandated reporter even if only suspected) – May be court mandated with certain patients  ADMISSION TO INPATIENT CARE Goal of inpatient care to rapid stabilization and return to the community Well-defined psychiatric problem must be established based on current illness in DSM-5 Less-restrictive alternatives are inadequate or unavailable – Outpatient – Partial hospitalization program (PHP) Voluntary admission – May leave against medical advice (AMA) – Before release AMA client may be evaluated for involuntary hold Involuntary admission – 5150 (CA) 72-hour hold Danger to self Danger to others Gravely disabled – 5250 (CA) 14-day hold Total 17 days – Conservatorship Annual legal proceeding Must be gravely disabled Can be financial or total SECLUSION AND RESTRAINTS LAST RESORT – Least restrictive means are not sufficient Restraints can be chemical (neuroleptic) or physical Never to be used for: – Convenience – Punishment – Unstable and exhibiting disease characteristics Physician’s order necessary—MAY NOT BE PRN Time limits for seclusion/restraints – 18 & older = 4 hours – 9 to 17 = 2 hours – 8 & younger = 1 hour Assessment – Circulation and mechanical respirations – Food and water – Toileting – V/S – Pain Document every 15-30 minutes Must release when exhibiting behavior safer or quieter—no longer an imminent threat to self or others ADVANCE DIRECTIVES Durable power of attorney for health care (or healthcare proxy) – Legally binding in all 50 states – Designates, in writing, an agent to act on behalf of a person should they become unable to make healthcare decisions – Not limited to terminal illness Also covers other aspects of illness Financial decisions during a person’s illness – Should be considered as an aspect relapse planning for clients with chronic psychiatric disorders Living will – Document prepared while client is mentally competent to designate preferences for care if client becomes incompetent or terminally ill Not legally binding in all states BIOETHICS & TORT LAW Bioethics Beneficence – The quality of doing good—can be described as charity Autonomy – The client’s right to make their own decisions Justice – Fair and equal treatment Fidelity – Loyalty and faithfulness to the client and to one’s duty Veracity – Honesty when dealing with a client Nonmaleficence – Doing no harm Intentional Torts False Imprisonment – Engaging in chemical or physical restraints without proper cause Assault – Making a threat to a client’s person Battery – Touching a client in a harmful or offensive way  BIOETHICS & TORT LAWS: UNINTENTIONAL Negligence – Failing to provide adequate care in a personal or professional situation when one has an obligation to so – 5 tenets required Duty – Something that one is expected or required to do by moral or legal obligation Breach of duty – Violation or omission of a legal or moral duty Cause in fact – Known as “the actual cause” Proximate cause – Described as the affective or primary cause of injury – We are always the proximate cause in these scenarios Damages – Actual damages as well as pain and suffering Malpractice – A type of professional negligence where an unintentional error is made that the practitioner is aware of but chooses to ignore.