Basic Concepts of Psychiatric Mental Health Nursing 8th Edition by Louise Rebraca Shives 9781605478876 1605478873

UNIT I: Psychiatric–Mental Health Nursing

1: Self-Awareness

LEARNING OBJECTIVES

KEY TERMS

SELF-AWARENESS

SELF-AWARENESS PROMPT

FREQUENTLY ASKED QUESTIONS BY STUDENT NURSES

Will the Client Know That I Am a Student Nurse?

How Do I Introduce Myself?

What Do I Wear?

What if I Say the Wrong Thing?

Will I Be Left Alone with a Client?

What if the Client Becomes Violent?

RECOMMENDATIONS BY STUDENT NURSES

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

2: History and Trends in Psychiatric–Mental Health Nursing

LEARNING OBJECTIVES

KEY TERMS

CONCEPT OF MENTAL HEALTH

Factors Influencing Mental Health

Genetic Characteristics

Nurturing During Childhood

Life Circumstances

SUPPORTING EVIDENCE FOR PRACTICE 2.1: The Relationship Between Environment and Mental Health

Characteristics of Mental Health

FIGURE 2-1

Factors Affecting Mental Health Maintenance

Interpersonal Communication

BOX 2.1: Five Levels of Communication

Ego Defense Mechanisms

TABLE 2.1: Definition and Examples of Commonly Used Ego Defense Mechanisms

Significant Others or Support People

SELF-AWARENESS PROMPT

BOX 2.2: Examples of Situations Involving the Use of a Support Person

Personal Strategies for Mental Health Maintenance

BOX 2.3: Personal Strategies for Reducing Stress and Enhancing Well-Being

SELF-AWARENESS PROMPT

CONCEPT OF MENTAL ILLNESS

TABLE 2.2: Characteristics of Mental Health and Mental Illness

Stigma and Perceptions About Mental Illness

Diagnosis of a Mental Illness

HISTORICAL DEVELOPMENT OF PSYCHIATRIC–MENTAL HEALTH NURSING

Middle Ages to 1773

1773 to 1956

TABLE 2.3: Development of Psychiatric–Mental Health Nursing

Other Developments Since the 1950s

SELF-AWARENESS PROMPT

TABLE 2.4: Events Influencing Psychiatric–Mental Health Nursing

BOX 2.4: Results of Research on Biologic Aspects of Mental Illness

PSYCHIATRIC–MENTAL HEALTH NURSING: SCOPE AND STANDARDS OF PRACTICE

BOX 2.5: Standards of Practice

BOX 2.6: Standards of Professional Performance

PSYCHIATRIC–MENTAL HEALTH NURSING TODAY

Education

Licensed Practical or Vocational Nursing Programs

Associate’s Degree Nursing Programs

Baccalaureate Degree Nursing Programs

Master’s Degree Nursing Programs

Continuing Education

BOX 2.7: Certification Organizations

Career Opportunities

TABLE 2.5: Use of Psychiatric–Mental Health Nursing Skills in Career Opportunities

Expanded Role of the Psychiatric–Mental Health Nurse

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

3: Development of Psychiatric–Mental Health Nursing Theory

LEARNING OBJECTIVES

KEY TERMS

TABLE 3.1: Theoretical Frameworks Influencing the Development of Psychiatric Nursing Theory

TABLE 3.2: Chronology of Nursing Theorists and Theories

NURSING THEORY AND RESEARCH

Nursing Theories

Peplau’s Interpersonal Theory

Orem’s Behavioral Nursing Theory

Roy’s Theory of Adaptation

Parse’s Theory of Human Becoming

SELF-AWARENESS PROMPT

Leininger’s Theory of Cultural Care Diversity and Universality

APPLICATION TO PRACTICE

Needs-Oriented Approach

Interaction-Oriented Approach

Outcome-Oriented Approach

Eclectic Approach

AGREEMENT AMONG NURSING THEORISTS

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

UNIT II: Special Issues Related to Psychiatric–Mental Health Nursing

4: Spiritual, Cultural, and Ethnic Issues

LEARNING OBJECTIVES

KEY TERMS

SPIRITUALITY

CULTURE AND NURSING

SELF-AWARENESS PROMPT

Culturally Congruent Nursing Care

SELF-AWARENESS PROMPT

POPULATION GROUPS

USE OF MENTAL HEALTH SERVICES BY ETHNIC GROUPS

Nature of the Mental Health System

Socioeconomic Status of Ethnic Groups

CULTURAL PERCEPTIONS: MENTAL ILLNESS AS A SPIRITUAL CONCERN

CLINICAL EXAMPLE 4.1: Culturally Competent Care for the Client with Schizophrenia

CULTURAL PERCEPTIONS: MENTAL ILLNESS AS IMBALANCE OR DISHARMONY IN NATURE

CULTURAL EXPRESSIONS OF MENTAL ILLNESS AND NURSING IMPLICATIONS

TABLE 4.1: Culture-Bound Syndromes

PSYCHIATRIC NURSING OF ETHNIC GROUPS

Ethnopharmacologic Considerations

TABLE 4.2: Selected Cultural Implications of Psychotropic Agents

Nursing Implications

Role of Family

Nursing Implications

Role of Healers

TABLE 4.3: Healers and Their Scope of Practice

Nursing Implications

Role of Translators

Nursing Implications

THE NURSING PROCESS

Assessment

BOX 4.1: Brief Cultural Assessment Guide for a Client with a Mental Illness

Nursing Diagnoses and Outcome Identification

TABLE 4.4: Nursing Diagnoses and Statements of Outcome for Clients from Diverse Cultures

Implementation

Establishing a Trusting Relationship

SELF-AWARENESS PROMPT

Communicating With the Client and the Family

Incorporating Cultural Beliefs

Evaluation

NURSING PLAN OF CARE 4.1: THE CLIENT FROM A DIFFERENT CULTURE

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

5: Ethical and Legal Issues

LEARNING OBJECTIVES

KEY TERMS

ETHICS IN NURSING

BOX 5.1: Code of Ethics for Nurses—Provisions

Model of Ethical Nursing Care

BOX 5.2: Examples of Nursing Resources on Ethics

Ethics in Pain Management

BOX 5.3: Examples of Ethical Dilemmas Associated With Pain Management

Ethics in Genetic Testing and Clinical Research

LEGAL ISSUES IN NURSING

BOX 5.4: The American Nurses Association’s Bill of Rights for Registered Nurses

Malpractice

BOX 5.5: Potential Legal Issues in Psychiatric–Mental Health Nursinga

Breaches of Client Confidentiality and Privacy

BOX 5.6: HIPAA Privacy Provisions Rule

Failure of Duty to Warn

Bill of Rights for Psychiatric–Mental Health Clients

SELF-AWARENESS PROMPT

Advance Psychiatric Directives

Psychiatric Hospitalization

Hospitalization of Minors

Long-Term Care Facilities

FORENSIC PSYCHIATRY

BOX 5.7: Elements of Mental Competency to Stand Trial

Role of the Forensic Nurse

SELF-AWARENESS PROMPT

The Forensic Nurse as a Legal Nurse Consultant and an Expert Witness

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

6: Forensic Nursing Practice

LEARNING OBJECTIVES

KEY TERMS

INTRODUCTION TO FORENSIC NURSING PRACTICE

HISTORY OF FORENSIC NURSING PRACTICE

SCOPE OF FORENSIC NURSING PRACTICE

Unique Characteristics of Forensic Nursing

BOX 6.1: Examples of Forensic Nursing Scope of Practice

STANDARDS OF FORENSIC NURSING PRACTICE

SELF-AWARENESS PROMPT

THE FORENSIC NURSE’S CODE OF ETHICS

BOX 6.2: Forensic Nursing Responsibilities and Obligations

FORENSIC NURSING EDUCATION

SELF-AWARENESS PROMPT

CLINICAL EXAMPLE 6.1: Investigation of Violent Behavior

Functions of the Forensic Nurse

BOX 6.3: Examples of Forensic Nursing Education Programs

Practice Areas

Special Roles of the Forensic Nurse

BOX 6.4: Practice Areas of Forensic Nurses

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

7: Loss, Grief, and End-of-Life Care

LEARNING OBJECTIVES

KEY TERMS

LOSS

Types of Loss

BOX 7.1: Examples of Losses Identified by Student Nurses

GRIEF

Grief Theory

BOX 7.2: Five Stages of Grief Identified by Kübler-Ross

Unresolved or Dysfunctional and Disenfranchised Grief

SELF-AWARENESS PROMPT

END-OF-LIFE CARE

Advance Care Planning

BOX 7.3: Five Wishes

Ethnic Considerations and Cultural Sensitivity

Palliative Care and Hospice Care

Manifestations of Suffering

BOX 7.4: Common Responses Associated with Suffering at End of Life

Pain

BOX 7.5: ABCDE Mnemonic of Pain Management

The Act of Dying

SUPPORTING EVIDENCE FOR PRACTICE 7.1: Providing Interventions for End-of-Life Ethical Concerns of Clients in the Psychiatric–Mental Health Clinical Setting

TABLE 7.1: Needs of Dying Persons and Survivors

BOX 7.6: The Dying Person’s Bill of Rightsa

Spiritual Needs

CHILDREN AND DEATH

SELF-AWARENESS PROMPT

TABLE 7.2: Research Results: Mourning the Death of a Parent from Cancer

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

8: Continuum of Care

LEARNING OBJECTIVES

KEY TERMS

FIGURE 8-1

INPATIENT CARE

Acute Care Facilities

FIGURE 8-2

Subacute Care Units

Long-Term Care Facilities

COMMUNITY MENTAL HEALTH

Historical Development of Community Mental Health

TABLE 8.1: Examples of Creative Community-Based Mental Health Programs

Types of Community Mental Health Services

Psychiatric Emergency Care

Day-Treatment Programs

BOX 8.1: Examples of Day-Treatment Program Interventions

Residential Treatment Programs

BOX 8.2: Examples of Residential Treatment Program

Psychiatric Home Care

Aftercare and Rehabilitation

BOX 8.3: Therapeutic Services Provided by Community Mental Health Centers (CMHCs)

Role of the Community Mental Health Nurse

THE CONTINUUM OF CARE IN THE 21ST CENTURY

SELF-AWARENESS PROMPT

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

UNIT III: Components of the Nurse–Client Relationship

9: Assessment of Psychiatric–Mental Health Clients

LEARNING OBJECTIVES

KEY TERMS

FIGURE 9-1

CLIENT ASSESSMENT

Types of Assessment

FIGURE 9-2

Cultural Competence During Assessment

COLLECTION OF DATA

Appearance

Affect or Emotional State

BOX 9.1: Types of Affective Responses

Behavior, Attitude, and Coping Patterns

Communication and Social Skills

Impaired Communication

Blocking.

Circumstantiality.

Clang Association.

Echolalia.

Flight of Ideas.

Looseness of Association.

Mutism.

Neologism.

Perseveration.

Tangentiality.

Verbigeration.

Word Salad.

Content of Thought

Delusions

TABLE 9.1: Types of Delusions Frequently Reported

Hallucinations and Illusions

TABLE 9.2: Types of Hallucinations

Depersonalization

Obsessions

Compulsions

Orientation

TABLE 9.3: Levels of Orientation and Consciousness

Memory

Intellectual Ability

Insight Regarding Illness or Condition

Spirituality

FIGURE 9-3

Sexuality

Neurovegetative Changes

Sleep Pattern

SUPPORTING EVIDENCE FOR PRACTICE 9.1: Nursing Assessment and Interventions for Clients in the Psychiatric–Mental Health Setting Who Experience Insomnia

BOX 9.2: Common Sleep Disorders

MEDICAL ISSUES

Pain

Physiological Responses to Medication

Supporters or Caregivers Assessment

DOCUMENTATION OF ASSESSMENT DATA

SELF-AWARENESS PROMPT

Examples of Documentation

BOX 9.3: Example of DAP Nursing Progress Notes

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

10: Nursing Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation

LEARNING OBJECTIVES

KEY TERMS

NURSING DIAGNOSIS

TABLE 10.1: Classifications of Nursing Diagnoses

Diagnostic Systems

BOX 10.1: Examples of Nursing Diagnoses in Psychiatric–Mental Health Nursing

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR)

BOX 10.2: DSM-IV-TR Multiaxial System

Decision Trees for Differential Diagnoses

Psychodynamic Diagnostic Manual (PDM)

Mnemonics

SELF-AWARENESS PROMPT

OUTCOME IDENTIFICATION

PLANNING

FIGURE 10-1

Plan of Care

IMPLEMENTATION

SELF-AWARENESS PROMPT

EVALUATION

NURSING PLAN OF CARE 10.1: THE CLIENT WITH INSOMNIA RELATED TO DEPRESSED MOOD

KEY CONCEPTS

CHAPTER WORKSHEET

Critical Thinking Questions

Reflection

NCLEX-Style Questions

REFERENCES

SUGGESTED READINGS

11: Therapeutic Communication and Relationships

LEARNING OBJECTIVES

KEY TERMS

COMMUNICATION

Factors Influencing Communication

FIGURE 11-1

Attitude

Values

Gender

Sociocultural or Ethnic Background

Past Experiences

Knowledge of Subject Matter

Ability to Relate to Others

Interpersonal Perceptions

Environmental Factors

Types of Communication

Verbal Communication

Nonverbal Communication

Vocal Cues