PDN23_MHN_L2_3_Principles_of_Mental_Health_Nursing_CMC.pdf

Caritas Medical Centre/ Queen Elizabeth Hospital/ Tuen Mun Hospital School of General Nursing Professional Diploma in Nursing (PDN23) Mental Health Nursing...

Caritas Medical Centre/ Queen Elizabeth Hospital/ Tuen Mun Hospital School of General Nursing Professional Diploma in Nursing (PDN23) Mental Health Nursing Principles of Mental Health Nursing Intended Learning Outcomes: Elaborate on the characteristics of psychiatric nursing, nurse’s roles and competencies. Identify the therapeutic components in relationship, communication and environment. Describe different domains in Murphy-Moller wellness model. Outline the critical aspects of mental health nursing. Identify the relationship between stress and resilience. Psychiatric Nursing - A specialty branch of nursing - Provides services to individuals with primary health needs related to mental, emotional and developmental problems, especially serious disorders and persistent disabilities. - Maintenance, promotion and restoration of optimal mental health for individuals, families, community groups, and society - Employ therapeutic relationships and interventions. - View the patient as a unique, holistic being with the potential to learn and develop through interacting with the changing environment. Roles and Competencies of Psychiatric Nurses HKNC has illustrated 14 roles of RNP. The below table outlines five roles in accordance with five core competencies. Role Competency Ability Carer: Professional, Legal and Able to employ psychotherapeutic intervention Ethical Nursing Practice to perform effective psychiatric nursing care safely, legally and ethically. Care co-ordinator Health Promotion and Work in partnership with the health care team, Education client, families, caregivers and the community in preventing illness, promoting and protecting the mental health of the individual and society. 1  Manager Management and Effective managerial, supervision and Leadership leadership skill in mental health nursing practice. Researcher Nursing Research Apply knowledge and skills in nursing research, collect in different healthcare settings and the community, and use research data to improve nursing and healthcare practices. Nursing Personal and Maintain own physical, mental and emotional professional Professional well-being. Develop and maintain nursing as a Development profession. Functions of Psychiatric Nurses in Mental Health Settings Psychiatric nurses perform numerous roles and functions in clinical settings, some of which are essential and directly related to patient care: - Provide counselling for problem-solving of patients. - Assess the patient’s mental status and level of functioning. - Provide training on self-care activities to encourage the independence. - Carry out crisis intervention during the acute stage of mental illness. - Administer medication with relevant teaching and observation. - Supervise colleagues and supporting staff in patient care in clinical settings. - Provide health teaching and health promotion programs to improve patients' health. Therapeutic Relationship and Communication - Mental Health Nursing emphasizes the therapeutic nurse-patient relationship since it can help the patient develop a positive attitude about managing their health, boost their satisfaction with the service, and maximize the effectiveness of a psychosocial intervention. - The therapeutic relationship is developed through therapeutic communication. Communication involves transmitting and interpreting verbal and nonverbal messages and may include counselling techniques. - The communication becomes therapeutic when the nurse listens, facilitates a goal-directed conversation, and guides the patient's communication in a helpful and comforting form. 2 Milieu Therapy - Mental Health Nursing manage the patient’s surroundings as therapeutic as possible for the patient. - The milieu therapy does not refer to a specific intervention. It comprises principles related to an environment promoting mental health and desired behaviours. The element of milieu therapy involves: ⮚ (1) Utilizing every component of the physical and social environment to promote therapeutic change. ⮚ (2) Acknowledging the milieu as a therapeutic strategy for mental illness. ⮚ (3) Using the milieu as a context for learning and practising adaptive behaviour. Complicated Health Condition and Wellness Domain Framework for Mental Health Nursing In fact, patients with mental illness have complicated health conditions that reduce their wellness and quality of life. For examples: - People with schizophrenia or bipolar disorder could have lower life expectancy, 10 to 20 years, than the general population. - Being overweight and obese and subsequent cardiovascular risk factors are frequently comorbid with a psychiatric diagnosis. - Typically, psychiatric patients experience two more comorbid psychiatric conditions. - Poor diet, poor sleep, and higher consumption of alcohol are more likely to occur in people with mental illness. One of the reasons for these complex and undesirable health conditions is their inability and barriers to receiving treatment due to factors such as distance to travel to services, lack of transportation, difficulty with health insurance, the providers focus on mental illness and do not believe the physical symptoms reported by them. Mental health nursing needs a holistic wellness approach to care for patients with psychiatric illnesses to maximize their response to treatment and improve overall health outcomes. Murphy-Moller wellness model illustrates five major wellness domains are used to approach the understanding and care of mental illnesses. Domain and focus Areas to assess and intervene Biological Domain: Exercise Nutrition This domain focuses on a person's overall health, and Each body system in balance nursing care considers maintaining a patient’s body Rest 3 system function compatible with life and social Good health practices position. Information processing Endocrine / immure Sensory function Psychological Domain: Enjoy life Manage wellness This domain focuses on the attitudes and behaviours Pain/pleasure of a person, and nursing care facilitates the patient to Outlook use knowledge, moral development and Worthwhile incorporation of self and social values and norms Elect to love into a worldview. Responsible for own behaviour Success takes action Sociological Domain: School/work Enjoy nature This domain focuses on environment and Resources/residence relationship, and nursing care encourages a patient to Value life skills get out to have recreational activities in the Interpersonal relations environment, assists the patient in engaging in Communication skills meaningful conversation and comfortable Economics relationships, and facilitates the patient to understand Support the requirement of essential communication skills to manage the illness and promote health. Cultural Domain: Customs and actions Understand speech and communication This domain focus on how individuals organize Language themselves socially, the nursing care assist patient in Thoughts and beliefs managing the cultural implications of mental illness Understand values and enhance the patient's ability to exhibit behaviour Race and religion that is congruent with their value system. Ethnicity Social groupings Spiritual Domain: Positive attitude Embrace truth This domain focuses on meaning and purpose in Accept forgiveness 4  patients' lives in good and bad times. Nursing care Clarify values facilitates the patient's seeking intellectual, moral Express gratitude and spiritual enjoyment and developing hope and Friendship with self and others forgiveness toward self and others. Understanding heart Learn to develop insight Critical Aspects of Mental Health Nursing Safety - Safety is critical in mental health nursing care and the clinical setting. - Safety involves patients, family, their significant others and staff. - Patient safety may be threatened by several common components or clinical situations, such as a patient's self-harm, use of restraint and seclusion, psychiatric medications, fall risk, dangerous articles in the hospital, command hallucination, confidentiality, etc. Treatment Adherence - Facilitation of good adherence to treatment is a high priority for mental health nursing. - Several factors, including financial considerations, medication side effects, illness denial, etc., cause non-adherence. - Nurses should understand the unique reasons for each patient's treatment adherence difficulties. - Patients are encouraged to participate in the planning of treatment regimens. In mental health nursing, the use of coercion is minimized. Trauma-Informed Care (TIC) - Many patients in mental health services, particularly substance abuse services, experienced childhood violence, abuse, and neglect. - When assessing and planning nursing care, mental health nurses consider the patient's traumatic experience. - Trauma-Informed Care aims to prevent re-traumatization and symptom exacerbation for traumatized patients and to facilitate their participation in treatment regardless of the traumatic experience. - Example of TIC in clinical settings: 5  Scenario Consideration in nursing care A newly admitted - The traumatic experience to be aware of. secondary school - Explanation of procedures that may be done. student with an anxiety - The loud noises that might occur in the hospital setting. disorder was injured in - The patient's activity level is based on his physical and a car accident in the mental condition. past, which left him with severe arm fracture. A schizophrenic 65- - Assertiveness and social skills of patient. year-old female refused - Interaction and other patients in the ward. family visits. She was a - Patient’s support network, resources in the community and victim of parental discharge plan. physical abuse as a - The pace of conversation when talking about the family young child. issue. Suffering and Resilience - Suffering is the condition of bearing pain or distress, which can have emotional, spiritual, and psychological impacts. - Identifying psychiatric patients' suffering is more complex than identifying a patient with apparent physical symptoms. - Suffering from mental illness influences more than the individual experience. It is a shared family experience since the symptoms may disrupt connections and interactions with significant ones. - Patients' relatives or original social networks may ostracize them. Their level of distress could be worsened by isolation and loneliness. - The nurse can foster increased resilience and alleviate patients' suffering. - Resilience is the capacity to adapt to adversity. Patients with greater resilience may exhibit positive changes as a result of a major life crisis, including: ⮚ (1) Improvement in interpersonal strength ⮚ (2) Increased connectedness in relationships ⮚ (3) Greater appreciation of life ⮚ (4) Changed or reinforced beliefs ⮚ (5) Interest in or excitement about new possibilities 6 References Beckett, P., Holmes, D., Phipps, M., Patton, D., & Molloy, L. (2017). Trauma-informed care and practice: Practice Improvement Strategies in an Inpatient Mental Health Ward. Journal of Psychosocial Nursing and Mental Health Services, 55(10), 34–38. https://doi.org/10.3928/02793695-20170818-03 Gonzalbo, F. E. (2006). In the eyes of god: A study on the culture of suffering. University of Texas Press, Teresa Lozano Long Institute of Latin American Studies. Moller, M. D., & Zauszniewski, J. A. (2011). Psychophenomenology of the post-psychotic adjustment process. Archives of Psychiatric Nursing, 25(4), 253–268. https://doi.org/10.1016/j.apnu.2010.10.005 Ross, L. E., Vigod, S., Wishart, J., Waese, M., Spence, J. D., Oliver, J., Chambers, J., Anderson, S., & Shields, R. (2015). Barriers and facilitators to primary care for people with mental health and/or substance use issues: A qualitative study. BMC Family Practice, 16(1). https://doi.org/10.1186/s12875-015-0353-3 Potter, M. L., & Moller, M. D. (2020). Psychiatric Mental Health Nursing: From suffering to hope. Pearson Education. The Nursing Council of Hong Kong. (2012). Core-Competencies for Registered Nurses (Psychiatric). Videbeck, S. L. (2020). Psychiatric-Mental Health Nursing (8th ed.). Wolters Kluwer. 7