Chapter 6
The Nursing Process in
Psychiatric/Mental Health Nursing
The
Nursing Process
It is a systematic framework for the delivery of
nursing care.
It uses a problem-solving approach.
It is goal-directed, its objective being the delivery
of quality client care.
It makes use of the nurse/Patient relationship.
The
Nurse/Client Relationship
What is it?
The process by which the nurse
provides care for the client in
need of psychosocial intervention.
We use ourselves.
The
Goal of the Nurse Client Relationship
The relationship focuses on the needs
of the client, has goals which are specific, is theory based, and is open to
supervision.
Goals
Are Not:
To make the client happy
to get him to laugh or smile
to fix them
to solve their problems
The
Therapeutic Use of Self
How does it differ from a social
relationship?
.
The
Therapeutic Use of Self
How does it differ from a social
relationship?
The ability to use ones personality
consciously and in full awareness in an attempt to establish relatedness and to
structure nursing interventions
We decide what to do or say based on
whether it meets the needs of the clients
goals
.
Therapeutic use of self
Self awareness
we must be willing to look at our thoughts, feelings,
and behaviors honestly
without judgment
Unconditional positive regard toward the client and
ourselves
Standards of Care
The standards of care for psychiatric nursing are
written around the six steps of the nursing process.
Standard I.
Assessment
The
psychiatric/mental health nurse collects client health data.
Assessment Tools
We use a nursing history format to learn more about
the client and his needs
Assessment includes general information, psychiatric
and medical history, family history, cultural and social history, stage of
development, support systems, coping styles, stressors, losses/changes,
education, strengths, prrecipitasting event, anxiety level, defense
mecvhanisms, medications, physical assessment,mental statues assessment.
Other Assessment Tools
Domestic Violence Assessment
Suicidal Risk Assessment
Lethality Risk Scale
Sociocultural Concepts
How
Do Cultures Differ?
Standards of Care
Standard
II. Diagnosis
The psychiatric/mental health nurse analyzes
the assessment data in determining diagnoses
Anxiety
related to Change of life style (nursing school) as evidenced by sleeplessness
Standards
of Care (cont.)
Standard
III. Outcome Identification
The psychiatric/mental health nurse
identifies expected outcomes individualized to the client.
Standards
of Care (cont.)
Standard IV.
Planning
The psychiatric/mental health nurse develops
a plan of care that is negotiated among the client, nurse, family, and
healthcare team and prescribes evidence-based interventions to attain expected
outcomes.
Standards
of Care (cont.)
Standard
IV. Planning (cont.)
Nursing Interventions Classification (NIC) - a
comprehensive, standardized language describing treatments that nurses perform
in all settings and in all specialties
NIC interventions based on research
and reflect current clinical practice
Standards
of Care (cont.)
Standard V. Implementation
The psychiatric/mental health nurse implements the interventions
identified in the plan of care. Specific interventions:
Standard Va. Counseling: to assist
clients in improving coping skills and
preventing mental illness and disability One-to one listening
Standard Vb. Milieu therapy: to provide and
maintain a therapeutic environment for client- RN designs unit activites based on client needs
Standard Vc. Self-care activities: to
foster independence and mental and
physical well-being-
Bathing, eating,working, paying bills
Standards
of Care (cont.)
Standard Vd. Psychobiological
interventions: to restore the clients
health and prevent
further disability-medications
Standard Ve. Health teaching: to assist
clients in
achieving satisfying, productive,
and healthy
patterns of living- Stress management, anger mangement
Standard Vf. Case management: to
coordinate
comprehensive health services
and ensure continuity of care- refer to programs,community
support groups
Standards
of Care (cont.)
Standard Vg. Health promotion and health maintenance: implements strategies
with clients to promote and maintain mental health and prevent mental illness-
Teach
Standards
of Care (cont.)
Advanced
practice interventions also include:
Standard Vh. Psychotherapy:
provides therapy for individuals,
groups, families, and children to
foster mental health and prevent disability-Advanced practice role
Standard Vi. Prescriptive authority and treatment: Advanced
Practice Role- ARNP
Standards
of Care (cont.)
Advanced
practice interventions (cont.)
Standard Vj. Consultation:
provides
consultation to enhance
the abilities of
other clinicians to
provide services for
clients and
effect change in the
system- Usually advanced practice Masters Prepared nurse
Standards
of Care (cont.)
Standard
VI. Evaluation
The psychiatric/mental health nurse evaluates
the clients progress in attaining expected outcomes.
Collaborate with others on the team including
patient and family.
Applying Nursing Process
Role of the nurse in psychiatry
The nurse assists the clients
successful adaptation to stressors within the environment.
Goals are directed toward change in
thoughts, feelings, and behaviors that are age-appropriate and congruent with
local and cultural norms.
The nurse is a valuable member of the
interdisciplinary team, providing a service that is unique and based on sound
knowledge of psychopathology, scope of practice, and legal implications of the
role.
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.
Documentation of the Nursing Process (cont.)
Examples of
documentation that reflect use of the nursing process
Problem-Oriented
Recording (POR)
Focus Chartingฎ
APIE method