1 Orientation PMHN

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Orientation and Foundations of

Psychiatric Mental Health

Nursing


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Definition of Psychiatric Mental

Health Nursing: A specialty within the nursing profession

that focuses primarily on the use of

therapeutic interpersonal interactionsand biologic and interpersonal

interventions with clients.

PMHN focuses on human aspects andresponses to illness and is therefore

part of all areas of nursing.


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Four Core Mental Health Practice

Areas: Psychiatric nursing

Psychiatry

Psychology

Social work


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Professional attributes of

psychiatric nurses include: Promotion of mental health

Prevention and treatment of mental

disorders

Rehabilitation after the disorder


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I. Principles of the Nurse-Client

Relationship


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Principles of the Nurse-Client

Relationship The relationship is therapeutic rather than

social

The focus remains on the clients issuesrather than on the nurses or other issues

The relationship is purposeful and goal

directed

It is objective versus subjective in quality

It is time limited versus open ended


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Therapeutic vs Social A therapeutic relationship is formed to

help clients solve problems

make decisions

achieve growth

learn coping strategies

let go of unwanted behaviors

reinforce self-worth examine relationships


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Therapeutic vs Social

The meetings between nurse and client

are not for mutual satisfaction.

The nurse can be friendly with theclient, but is not there to be the clients

friend.

The majority of the interaction isfocused and therapeutic.


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Stages of the Nurse-Client

Relationship Pre-orientation phase

Orientation phase

Working phase

Termination phase


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Pre-orientation Phase

Takes place prior to meeting with the

client

1st gather data about the client, his orher condition, and the present situation

Nurse then examines his or her

thoughts, feelings, perceptions, andattitudes about this particular client


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Orientation Phase The nurse-client become acquainted; build

trust and rapport A contract is established

Includes time and place for the meeting, as well asthe purpose of the meetings

Dependability is imperative for both the nurseand the client

Client strengths, limitations, and problemareas are identified Outcome criteria and a plan of care are

established


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Working Phase

Orientation phase ends and working phase

begins when the client takes responsibility for

his or her own behavior change

Client shows commitment to working onissues that have caused a life disruption

Clients needs are prioritized- safety and

health come first

RN assists the client to change problematic

behaviors in a safe environment


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Termination Phase

Relationship comes to a close This phase begins in the orientation phase

when meeting times are established- lets the

client know that the relationship will come toan end

Avoids confusing the client who may beunable to recognized boundaries in a

relationship Termination occurs when the client has

improved or has been discharged


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III. Mental Health and

Mental Disorder


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Defining and Classifying Mental

Health and Mental Disorder The ANA defines mental health as a

state of well-being in which individuals

function well in society and aregenerally satisfied with their lives.

Results in socially acceptable behavior and

the ability to respond productively andappropriately in the environment


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Defining and Classifying Mental

Health and Mental DisorderMental disorder is a disturbance in an

individuals thinking, emotions,

behaviors, and physiology. Leads to problems with behavior,

relationships, and functioning.


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Mental Illness and Mental Health

Continuum Mildjoys, sorrows, and anxiety levels that

aid in the work of living

Mild-Moderate

psychophysiologic factorsaffecting medical conditions Moderate-Severeanxiety d/os, dissociative

d/os, somatoform d/os, personality d/os, and

eating d/os Severe-Psychosisdepressive d/os, bipolar

d/os, schizophrenic d/os, and cognitive d/os


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DSM IV-TR A multiaxial classification scheme that allows

for the interrelation of biological,psychological, and social aspects of anindividuals condition.

Axis I the psychiatric diagnosis Axis II personality disorders and mental

retardation Axis III general medical conditions Axis IV psychosocial and environmental

problems Axis V GAF- rates the overall psychological

functioning of the client on a scale of 0-100.


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V. The Nursing Process


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IX. Roles of the Mental Health

Team


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Roles of the Mental Health Team

Psychiatric Nurse

Has the most widely focused position description

of any of the member roles Interacts with clients in individual and group

settings

Manages client care

Administers and monitors meds Teaches both clients and families

Acts as a client advocate


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Psychiatric Social Worker

Graduate level position

Work with clients on an individual basis

Conduct group therapy sessions

Act as liaisons with the community to place

clients after discharge


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Psychiatrist

Licensed medical physician who

specializes in psychiatry Prescribe and monitor meds

Admit clients into acute care settings

Administer ECT Conduct individual and family therapy


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Psychologist Licensed individual with a doctoral degree

in psychology

Assess and treat psychologic andpsychosocial problems of individuals,families, or groups

Do not prescribe or administer medications

Administer psychometric tests that aid inthe diagnosis of disorders


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Marriage, Family, Child Counselor

Licensed individuals who frequently work in

private practice Prepared to work with individuals, couples,

families, and groups

Emphasize the interpersonal aspects ofachieving and maintaining relationships


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Case managers

Facilitate the delivery individualized,

coordinated care in cost-effective ways Need to know the various types of

hospitalization and outpatient care settings,

the coverage offered by different payers,

and the impact of state and federal

legislation

Documents

1 Orientation PMHN