Psychiatric Nursing -Concepts And Communication- Slides - 2

Front 1

“Abnormality”

Back 1

Some elements:
•Suffering
•Maladaptiveness
•Irrationality and Incomprehensibility
•Unpredictability and loss of control
•Vividness and Unconventionality
•Observer Discomfort
•Violation of moral and ideal standards

Front 2

“Mental Illness”:
.

Back 2

•Has both objectiveand subjectivesymptoms.
•Has characteristics, e.g.:
–Duration
–Intensity
–Cycles
–Age of onset
–Others
•Has treatment options

Front 3

Mental Illness in HistoryAncient Times:

Back 3

“Supernatural” Causes
•Trephining
•“Possession”
•Witches

Front 4

Asylum

Back 4

–Sanctuary and Protection
–Isolated and Strange

Front 5

Linda Richards

Back 5

–First US Psychiatric nurse
•Schools of Nursing

Front 6

Psychotropic Drugs
1950’s-60’s

Back 6

•Chlorpromazine (Thorazine)
–Antipsychotic
•Imipramine (Tofranil)
–Antidepressant

Front 7

Homelessness

Back 7

•25-50% with severe mental illness.
•33-50% with alcoholism and/or drug addiction.
•Much overlap.
•Evidence that homelessness can lead to mental illness.

Front 8

The homeless mentally ill:

Back 8

•Most severely mentally ill men and women are not homeless.
Among those who are:
•Younger onset
•Personality D/O
•Physical illness
•ETOH/Drug abuse

Front 9

DSM-IV Diagnosis

Back 9

Axis I -Major mental disorders
•Axis II -Personality Disorder or Developmental Disorder
•Axis III -General medical conditions
•Axis IV -Psychosocial & environmental conditions
•Axis V -Global assessment of functioning (GAF)

Front 10

Common Treatment Modalities

Back 10

•Individual Therapy
•Group Therapy
•Milieu Therapy
•Family Therapy
•Cognitive-Behavioral Therapy
•Psychopharmacological Therapy
•Others

Front 11

Legal & Ethical Issues

Back 11

•Therapeutic Boundaries
•Voluntary vs. involuntary admission
–“Commitment”
•Guardianship
•Competency
•Informed Consent
•Patient Rights
•Confidentiality
•Reporting
•Duty to Disclose
•Elopement/Leaving AMA

Front 12

Patient’s Rightsin the Mental Health Setting

Back 12

•Right to treatment
•Right to treatment in least restrictive setting
•Right to giveor refuseconsent to treatment
–exceptions made for emergencies
•Right to confidentiality
•Right to freedom from restraint and seclusion
–Try other methods first
•Some rights suspended in patient’s interest
–documentation is critical

Front 13

Standards of Psychiatric-Mental Health Nursing Practice: Standards of Care

Back 13

I. Assessment
II. Diagnosis
III. Outcome Identification
IV. Planning
V. Implementation
Va. Counseling
Vb. Milieu Therapy
Vc. Self-Care Activities
Vd. Psychobiological Interventions
Ve. Health Teaching
Vf. Case Management
Vg. Health Promotion and Health Maintenance

Front 14

Standards of Professional Performance

Back 14

Quality of Care
Performance Appraisal
Education
Collegiality
Ethics
Collaboration
Research
Resource Utilization

Front 15

Therapeutic Use of Self

Back 15

•Usingone’s personality consciouslyand in full awarenessto establish relatedness and to structure nursing interventions.

Front 16

Goals of the therapeutic relationship

Back 16

•Promote use of healthy, adaptive relational and coping skills.
•Promote self-care and independence.
•Facilitating communication of distressing thoughts and feelings (promote sense of being understood).
•Assisting patients with problem solving to help facilitate ADLs
•Helping the patient recognize self-defeating behaviors and test alternatives

Front 17

Essential Elements in a Therapeutic Relationship

Back 17

•Genuineness
•Empathy
•Positive Regard
–Attitudes
–Actions
•Attending
•Suspending Value Judgments
•Helping Patients Develop Resources

Front 18

Boundaries of the Therapeutic Nurse-Patient Relationship

Back 18

•Social vs. Therapeutic Relationships
•Guidelines
–Defining the parameters of the relationship
–Avoiding physical contact
–Maintaining confidentiality
–Minimizing self-disclosure
–Accepting gifts
–Addressing the person
–Managing social encounters

Front 19

Pre-Orientation Phase

Back 19

•Obtain information about the
client from chart, significant
others, or other health
team members.
•Examine one’s own feelings, fears, and anxieties about working with a particular person.

Front 20

Orientation PhaseCreating the Therapeutic Alliance

Back 20

•Establish the nurse-patient contract
•Purpose of the relationship
•Duration of the relationship
•Where, when, and how long we’ll meet
•Confidentiality
•Create an environment for trust and
•Assessment -Identify client’s strengths & challenges.
•Help with management of emotions
•Provide support and structure
•Establish goals
•Establish a realistic plan of action

Front 21

Working Phase

Back 21

•Maintain trust and rapport.
•Use problem-solving model to work toward established goals.
•Promote client’s insight and perception of reality.
•Help patient recognize and manage resistance behaviors.
•Continuously evaluate progress toward goals.

Front 22

Termination Phase:Facilitating a Healthy Closure

Back 22

•Therapeutic conclusion of relationship occurs when:
–Progress has been made toward attainment of the goals.
–A plan of action for more adaptive coping with future stressful situations has been established.
•Evaluation and summary
•Final collaboration on discharge plans
•The process of goodbye
–Feelings about termination of the relationship are recognized and explored

Front 23

Transference

Back 23

-Feelings that the pt develops toward the nurse

Front 24

Countertransference

Back 24

- feelings that the nurse may develop towars the pt.
-My be related to something that goes on with you or tells you someting about the pt or both

Front 25

Nonverbal Communication

Back 25

•Eye Contact
•Five Senses
•Use of Space
•Gestures and Postures

Front 26

The Duchenne Smile

Back 26

-genuine smile

Front 27

Therapeutic Communication:

Back 27

Interactive verbal and nonverbal strategies that:
1) Focus on the needs of the patient
2) Facilitate goal-directed,
patient-oriented
communication process.

Front 28

Therapeutic Communication Techniques:
overview

Back 28

•Are based on your attention to the patient’s behavioral, affective and cognitive communication.
•Communicate your listening, caring and understanding.
•Encourage the patient to:
–examine feelings,
–explore problems,
–build on strengths, and
–develop new coping strategies.

Front 29

Active Listening

Back 29

•To listen actively is to be attentive to what client is saying, both verbally and nonverbally.
•What nonverbal behaviors show the client that you are actively listening?

Front 30

Therapeutic Communication Techniques
list

Back 30

•Using silence
•Accepting
•Giving recognition
•Offering self
•Offering general leads
•Giving broad openings
•Placing the event in time or sequence
•Making observations
•Encouraging description of perceptions
•Encouraging comparison
•Restating
•Reflecting
•Focusing
•Exploring
•Giving information
•Seeking clarification
•Presenting reality
•Voicing doubt
•Seeking consensual validation
•Verbalizing the implied
•Encouraging evaluation’
•Attempting to translate fee•Suggesting collaboration
•Summarizing
•Encouraging formulation of a plan of actionlings into words