Mental Health Chapter 6 PDF

Chapter 6 The Nursing Process in Psychiatric Mental Health Nursing Copyright ©2019 F.A. Davis Company The Nursing Process § Is a systematic framework for the delivery of nursing care § Uses a problem-solving approach § Is goal-directed, with its objective being the delivery of quality client care §...

Chapter 6 The Nursing Process in Psychiatric Mental Health Nursing Copyright ©2019 F.A. Davis Company The Nursing Process § Is a systematic framework for the delivery of nursing care § Uses a problem-solving approach § Is goal-directed, with its objective being the delivery of quality client care § Is dynamic, not static Copyright ©2019 F.A. Davis Company Standards of Practice The standards of practice for psychiatric nursing are written around the six steps of the nursing process. 1. Assessment: Information is gathered from which to establish a client database. Copyright ©2019 F.A. Davis Company Standards of Practice (continued_1) 2. Diagnosis: Data from the assessment are analyzed. Diagnoses and potential problem statements are formulated and prioritized. Copyright ©2019 F.A. Davis Company Standards of Practice (continued_2) 3. Outcome identification: Expected outcomes of care are identified. They must be measurable and estimate a time for attainment. Nursing Outcomes Classification (N O C): A comprehensive, standardized classification of patient outcomes developed to evaluate the effects of nursing interventions. Copyright ©2019 F.A. Davis Company Standards of Practice (continued_3) 4. Planning: Evidence-based interventions for achieving the outcome criteria are selected. Nursing Interventions Classification (N I C): A comprehensive, standardized language describing treatments that nurses perform in all settings and in all specialties. N I C interventions are based on research and reflect current clinical practice. Copyright ©2019 F.A. Davis Company Standards of Practice (continued_4) 5. Implementation: Interventions selected during the planning stage are executed. Specific interventions include ‒ Coordination of care; health teaching and health promotion; consultation ‒ Prescriptive authority and treatment; pharmacological, biological, and integrative therapies ‒ Milieu therapy; therapeutic relationship and counseling; psychotherapy Copyright ©2019 F.A. Davis Company Standards of Practice (continued_5) 6. Evaluation: Measures progress toward attainment of expected outcomes. Copyright ©2019 F.A. Davis Company Clicker Question 1 1. According to the American Nurses Association standards of practice for psychiatric/mental health nurses, which specific intervention can be implemented by any psychiatric/mental health nurse generalist? A. Milieu therapy B. Psychotherapy C. Consultation D. Prescriptive authority Copyright ©2019 F.A. Davis Company Clicker Question Answer 1 Correct Answer: A Milieu therapy, which is the scientific structuring of the environment in order to affect behavioral change, is a nursing intervention that can be implemented by any psychiatric/mental health nurse generalist. Copyright ©2019 F.A. Davis Company Why Nursing Diagnosis? § The identification and classification of nursing phenomena began in 1973 with the First National Conference on Nursing Diagnosis. § General and specialty standards are written around the six steps of the nursing process. § It is defined in most state nursing practice acts as a legal responsibility of nursing. § Promotes research in nursing. Copyright ©2019 F.A. Davis Company Clicker Question 2 2. Which nursing diagnosis is written correctly? A. Risk for social isolation related to low self-esteem evidenced by staying in room during the day B. Low self-esteem related to major depressive disorder evidenced by childhood abuse C. Imbalanced nutrition: less than body requirements related to suspiciousness evidenced by 20-pound weight loss D. Conduct disorder related to childhood sexual abuse evidenced by hostile and aggressive behaviors Copyright ©2019 F.A. Davis Company Clicker Question Answer 2 Correct Answer: C Imbalanced nutrition: less than body requirements related to suspiciousness evidenced by 20-pound weight loss is a correctly written nursing diagnosis. Evidence of a nutritional problem is documented and the cause of the problem, suspiciousness, is identified. “Imbalanced nutrition: less than body requirements” is an approved N A N D A diagnostic stem. Copyright ©2019 F.A. Davis Company Nursing Case Management § Case management: A health delivery process whose goals are to provide quality healthcare, decrease fragmentation, enhance the client’s quality of life, and contain costs. § Managed care: A concept designed to control the balance between cost and quality of care. Individuals receive care based on need, which is determined by coordinators of the providership. Copyright ©2019 F.A. Davis Company Nursing Case Management (continued_1) § Case manager: The individual responsible for negotiating with multiple healthcare providers to obtain a variety of services for the client. § Critical pathways of care (C P C’s): The tools for provision of care in a case management system. Copyright ©2019 F.A. Davis Company Nursing Case Management (continued_2) § C P C’s Determine which categories of care will be provided, by what date, and by whom. Nurses may be identified as case managers and are ultimately responsible for ensuring that C P C goals are achieved within the designated time dimension. C P C’s may be standardized because they are intended to be used with uncomplicated cases. Copyright ©2019 F.A. Davis Company Applying the Nursing Process Role of the nurse in psychiatry § Assist with the client’s successful adaptation to stressors within the environment. § Goals are directed toward change in thoughts, feelings, and behaviors that are age-appropriate/congruent with local and cultural norms. § The nurse is a valuable member of the interdisciplinary team. Copyright ©2019 F.A. Davis Company Concept Mapping § A diagrammatic teaching and learning strategy § Shows interrelationships among medical and nursing diagnoses, assessment data, and treatments § Practical, realistic, and time-saving § Enhance critical-thinking skills Copyright ©2019 F.A. Davis Company Concept Mapping (continued) § Based on the components of the nursing process § Helps students develop a holistic view of their clients Copyright ©2019 F.A. Davis Company Documentation of the Nursing Process § Documentation of the steps of the nursing process is often considered as evidence in determining certain cases of negligence by nurses. § It is also required by some agencies that accredit healthcare organizations. Copyright ©2019 F.A. Davis Company Documentation of the Nursing Process (continued_1) § Examples of documentation that reflect use of the nursing process § Problem-oriented recording Has a list of problems as its basis Uses subjective, objective, assessment, plan, intervention, and evaluation format Copyright ©2019 F.A. Davis Company Documentation of the Nursing Process (continued_2) § Focus charting Main perspective is to choose a “focus” for documentation. The focus cannot be a medical diagnosis. Focus charting uses a data, action, and response format. Copyright ©2019 F.A. Davis Company Documentation of the Nursing Process (continued_3) § A P I E method A problem-oriented system Uses flow sheets as accompanying documentation Uses assessment, problem, intervention, and evaluation (A P I E) format Copyright ©2019 F.A. Davis Company Clicker Question 3 3. Which charting entry is an example of the documentation of a subjective symptom? A. Temperature 101.4 degrees Fahrenheit B. No muscle rigidity or drooling noted C. Client is hypervigilant and scanning the environment. D. Client states, “I’m seeing green men in my room.” Copyright ©2019 F.A. Davis Company Clicker Question Answer 3 Correct Answer: D The client statement, “I’m seeing green men in my room,” is documentation of a subjective symptom reported by the client. Copyright ©2019 F.A. Davis Company Electronic Documentation § Most healthcare facilities have implemented, or are in the process of implementing, some type of electronic health records (E H R’s) or electronic documentation system. § E H R’s have been shown to improve both the quality of client care and the efficiency of the healthcare system. Copyright ©2019 F.A. Davis Company Electronic Documentation (continued) § Eight core functions of E H R’s Health information and data Results management Order entry/order management Decision support Electronic communication and connectivity Patient support Administrative processes Reporting and population health management Copyright ©2019 F.A. Davis Company