Summary PSYCHIATRIC NURSING:FOUNDATIONS OF PSYCHIATRIC MENTAL NURSING
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Course
PSYCHIATRIC NURSING
Institution
PSYCHIATRIC NURSING
Mental Health
v It is a state of emotional, psychological, and social wellness evidenced by satisfying personal relationships, effective
behavior and coping, apositiveself-conceptand emotional stability
Mental Disorder
v A clinically significant behavioral or psychological syndrome or pattern t...
PSYCHIATRIC NURSING
FOUNDATIONS OF PSYCHIATRIC MENTAL NURSING
Mental Health
v It is a state of emotional, psychological, and social wellness evidenced by satisfying personal relationships, effective
behavior and coping, apositiveself-conceptand emotional stability
Mental Disorder
v A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated
with present distress or disability or with significantly increased risk of suffering, death, pain, disability or an
important loss of freedom (APA, 2000)
Components of Mental Health
v Autonomy and Independence
v Maximizing one's potential
v Tolerating Life's Uncertainties
v Self-esteem
v Mastering Orientation
v Reality Orientation
v Stress Management
HISTORICAL PERSPECTIVES OF THE TREATMENT OF MENTAL ILLNESS
Ancient Times
v A belief that any sickness indicates displeasure of the gods and punishment for sins and wrongdoing
v Peoplewithmentaldisordersareeither viewed as divine or demonic
v Divine = worshipped and adored
v Demonic = punished and burned
v Aristotledeveloped atheoryaboutthe amounts of blood, water and yellow and black bile in the body
v Thesefoursubstancescorrespondwith happiness, calmness, anger, and sadness.
v Any imbalance from the four substances will cause mental disorders
v Treatment: bloodletting, starving and purging
Early Christian Times
v Primitive and superstitious beliefs
v All diseases were blamed to demons.
v Mentally ill personswere viewed as possessed
v Treatment: performance of exorcisms to rid evil spirits
v If thatfails = incarceration in dungeons, flogging and starving
Renaissance
v People with mental illness were distinguished from criminals
v Ifharmless = allowed to wanderthe countryside
v Harmful (dangerouslunatics) = thrownin prison, chained and starved
v Hospital of St.Mary of Bethlehem = first hospital for insane
v Inmates were viewed as animals
v Also during this period, mentally ill people were viewed as evil and possessed.
v Treatment = witchhunts were conducted; offenders were burned
Period of Enlightenment
v Philippe Pinel and William Tuke
• Formulated the concept of asylum (safe refuge)
v Dorothea Dix advocated adequate shelter, nutritious food and warm clothing to those who are mentally ill.
EmilKraepelin =classifiesmentaldisorders according to their symptoms.
THERAPEUTIC USE OF SELF
v Main tool used by the nurse in Psychiatric Nursing.
v Nurses use themselves as a therapeutic tool to establish therapeutic relationship with the client
v Introduced by Hildegard Peplau (1952)
v According to him, nurses must have a clear understanding of themselves to promote client's growth.
v Therapeutic use of self requires self-awareness
SELF-AWARENESS
v It is the processby which the nurse gains recognition of his or her own feelings, beliefs, and attitudes.
Goal: To know oneself so that one's values,attitudes, and beliefs are not projected to the client, interfering with nursing
care.
v Onetoolthat is useful in learning about oneself is Johari's Window
Four Quadrants of Johari's Window
ü Arena/Open/ Public Self
Quadrant I
ü Qualities known to oneself and others
ü Blind/Unaware Self
Quadrant II
ü Qualities known only to others, not to self
ü Façade/ Hidden/ Private Self
Quadrant III
ü Qualities known only to oneself
ü Unknown
Quadrant IV
ü An empty quadrant to symboliz equalities as yet undiscoveredby oneself or others
METHODS USED TO INCREASE SELF — AWARENESS
v Role Play
v Introspection
v Discussion
v Enlarging one's experience
THERAPEUTIC COMMUNICATION
v It is an interpersonal interaction between the nurse and client during which the nurse focuses on the client's specific
needs to promote effective exchange of information
Goals
• Establish a therapeutic nurse—client relationship.
• Identify the most important client concern at that moment (the client-centered goal).
• Assess the client's perception of the problem as it unfolded.
• Facilitate the client's expression of emotions.
• Teach the client and family necessary self-care skills.
• Recognize the client's needs.
• Implement interventions designed to address the client's needs.
• Guide the client toward identifying a plan of action to a satisfying and socially acceptable resolution.
THERAPEUTIC COMMUNICATION TECHNIQUES
Accepting
- Indicating reception
Examples: "Yes";"I follow what you said"; Nodding
Rationale:An accepting response indicates the nurse has heard and followed the train of thought. It does not indicate
agreement but is non-judgmental.
Broad Openings
- Allowing client to take the initiative in introducing the topic
Examples: "Is there something you'dlike to talk about?";'Where would you like me to begin?"
Rationale: Broad opening makes explicit that the client has the leadin the interaction;may stimulate him or her to take
the initiative
2 TOPRANK REVIEW ACADEMY- NURSING MODULE
, NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*MIDWIFERY*MEDTECH
LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT
Consensual Validation
-Searching for mutual understanding, for accord in the meaning of the words.
Examples: "Tell me whether my understanding of it agrees with yours."; "Are you using this word to convey that?"
Rationale: For verbal communication to be meaningful, it is essential that the words being used should have the same
meaning for all participants.
Encouraging Comparison
-Helping the client to understand by looking at similarities and differences.
Examples:'Was it something like?"; "Have you had similar experiences?"
Rationale:Comparing ideas,experiences, or relationships brings out many recurring themes;
He or she might recall past coping strategies that were effective or remember the he or she has survived a similar
situation
Encouraging Description of Perceptions
-Asking client to verbalize what he or she perceives.
Examples:"Tell me when you feel anxious"; "What is happening?"; "What does the voice seem to be saying?"
Rationale: To understand the client. the nurse must see things from his or her perspective; may relieve the tension the
client is feeling and he or she might be less likely to take action on ideas that are harmful or frightening
Encouraging Expression
- Asking client to appraise the quality of his or her experience.
Examples:'Whatare your feelings in regard to?"
Rationale:Encourages the client to make his or her own appraisal rather than accepting the opinion of others.
Exploring
- Delving further into a subject or idea.
Examples; "Tell me more about that."; 'Would you describe it more fully'?"; 'What kind of work?"
Rationale: This can help them examine the issue more fully; If the client expresses an unwillingness to explore a
subject, however, the nurse must respect his or her wishes.
Focusing
- Concentrating on a single point.
Examples: "This point seems looking at more closely.";"Of all the concerns you have mentioned, Which is most
troublesome?"
Rationale: This encourages the client to concentrate his or her energies on a single point, which may prevent a
multitude of factors or problems from overwhelming the client; useful technique when a client jumps from one topic to
another.
Formulating a Plan of Action
- Asking the client to consider kinds of behavior likely to be appropriate in future situations.
Examples: 'What could you do to let your anger out harmlessly?"; "Next time this comes up, what might you do to
handle it?"
Rationale:It may be helpful for the client to plan in advance what he or she might do in future similar situations; making
definite plans increases the likelihood that the client will cope more effectively in a similar situation
General Leads
- Giving encouragement to continue.
Examples:"Goon.";"And then?";"Tell me about it."
Rationale:Thisindicates that the nurse is listening and following what the client is saying without taking away the
initiative for the interaction; encourage the client to continue if he or she is hesitant or uncomfortable about the
topic.
Giving Information
-Making available the facts that the client needs..
Examples:"My name is...";"Visiting hours are. . ."; "My purpose in being here is..."
Rationale: Informing the client of facts increases his or her knowledge about a topic or lets the client know what to
expect; builds trust with the client.
3 TOPRANK REVIEW ACADEMY- NURSING MODULE
, NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*MIDWIFERY*MEDTECH
LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT
Giving Recognition
- Acknowledging, indicating awareness.
Examples:"Good morning,Mr.S...";"You've finished your list of things to do."' "I noticed that you've combed your hair."
Rationale: Greeting the client by name, indicating awareness of change, or noting efforts the client has made all show
that the nurse recognizes the client as a person, as an individual.
Making Observations
- Verbalizing what the nurse perceives.
Examples: "You appear tense."; "Areyou uncomfortable when . . ?"; "I notice that you are biting your
Rationale: Sometimes clients cannot verbalize or make themselves understood.
Offering Self
- Making oneself available.
Examples: "I will sit with you a while."; "I will stay here with you."; "I am interested in what you think."
Rationale: The nurse can offer his or her presence, interest, and desire to understand; It is important that this offer is
unconditional, that is, the client does not have to respond verbally to get the nurse's attention.
Placing event in Time Sequence
- Clarifying the relationship of events in time.
Examples: 'What seemed to lead up to?"; Was this before or after?"; 'When did this happen?"
Rationale: This helps both the nurse and client 'to see them in perspective;The client may gain insight into cause-and-
effect behavior and consequences, or perhaps some things are not related. The nurse may gain information about
recurrent patterns or themes in the client behavior relationship.
Presenting Reality
-Offering for consideration that which is real.
Examples: "I see no one else in the room."; "That sound was a car back firing."; "Your mother is not here.I am a
nurse."
Rationale:When it is obvious that a client is misinterpreting reality, the nurse can indicate what is real.
Reflecting
- Directing client actions, thoughts, and feelings back to the client.
Examples
Client: "Do you think I should tell the doctor?"
Nurse: "Do you think you should?"
Client: "My brother spends all my money and then has the nerve to ask for more."
Nurse: "This causes you to feel angry'?"
Rationale: This encourages the client to recognize and accept his or her own feelings.
Restating
- Repeating the main idea expressed.
Examples
Client: "I can't sleep. I stay awake all night." Nurse: "You have difficulty sleeping."
Client: "I am really mad. I am really upset." Nurse: "You're really mad and upset."
Rationale: Restatement lets the client know that heor she communicated the idea effectively; encourages the client to
continue
Seeking Information
-Seeking to make clear that which is not meaningful or that which is vague.
Examples: "I am not sure that I follow."; "Have I heard you correctly?'
'Rationale:This can help the nurse to avoid making assumptions that understanding has occurred when it has not;helps
the client to articulate thoughts,feelings,and ideas more clearly.
Silence
-Absence of verbal communication,which provides time for the client to put thoughts or feelings in towords,regain
composure, or continue talking.
Examples:Nurse says nothing but continues to maintain eye contact and conveys interest
4 TOPRANK REVIEW ACADEMY- NURSING MODULE
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