BASIC CONCEPTS IN PSYCHIATRIC NURSING MENTAL HEALTH Balance in a persons internal life and adaptation to reality.

y. A state of well being in which a person is able to realize his potentials.

Characteristics : attitude of self-acceptance growth, development and self-actualization integrative capacity autonomous behavior perception of reality environmental mastery

MENTAL ILLNESS A state of imbalance characterized by a disturbance

in a persons thoughts, feelings and behavior. Poverty abd abuses are major factors which increases the risk of mental illness in the home.

PSYCHIATRIC NURSING Interpersonal process whereby the professional nurse practitioner through the use of self, assist an individual family, group or community to promote mental health, to prevent mental illness and suffering, to participate in the treatment and rehabilitation of the mentally ill and if necessary to find meaning in these experiences. It is both Science and an Art.

Science in Psychiatric Nursing. the use of different theories in the practice of nursing, serves as the science of psychiatric nursing.

Art in Psychiatric Nursing.

The therapeutic use of self is considered as the art of psychiatric nursing.

Core of Psychiatric Nursing. The interpersonal process, that is, the human to human relationship, is the core of psychiatric nursing.

Clientele in Psychiatric Nursing. The individual, family, and the community, both mentally healthy and mentally ill.

Mental Hygiene. It is the science that deals with measures to promote mental health, prevent mental illness and suffering and facilitate rehabilitation.

THERAPEUTIC USE OF SELF - THERAPEUTIC USE OF SELF SERVES AS THE NURSES MAIN TOOL. CORE CONCEPT - It is the positive use of ones self in the process of therapy. - It requires self-awareness. BASIS OF THERAPEUTIC USE OF SELF JOHARIS WINDOW

Known to self Known to others Not known to others Public self I Private self III

Not known to self Semi-public self II Area of the unknown IV

METHODS USE TO INCREASE SELF AWARENESS

INTROSPECTION DISCUSSION ENLARGING ONES EXPERIENCE ROLE PLAY

CORE CONCEPTS ON THE CARE OF PSYCHOTIC PATIENT. COMMON BEHAVIORAL SIGNS AND SYMPTOMS 1. Disturbances in perception: Illusion misperception of an actual external stimuli. Hallucination false sensory perception in the absence of external stimuli. 2. Disturbances in thinking: Neologism pathological coining of new words. Circumstantiality over inclusion of details. Word salad incoherent mixture of words and phrases. Verbigeration meaningless reception of words or phrases. Perseveration persistence of a response to a previous question. Echolalia pathological repetition of words of others. Flight of ideas shifting of one topic form one subject to another in a somewhat related way. Looseness of association shifting of a topic from one subject to another in a completely unrelated way. Clang association the sound of the words gives direction to the flow of thought. Delusion false belief which is inconsistent with ones knowledge and culture and cannot be corrected by reasons. 3. Disturbances of affect. Inappropriate affect disharmony between the stimuli and the emotional reaction. Flat affect absence or near absence of emotional reaction. Apathy dulled emotional tone. Blunted affect severe reduction in emotional reaction.

Ambivalence presence of two opposing feelings. Depersonalization feeling of strangeness towards ones self Derealization feeling of strangeness towards the environment

4. Disturbances in motor activity Echopraxia the pathological imitation of posture/action of others. Waxy flexibility maintaining the desired position for long periods of time without discomfort. 5. Disturbances in memory. Confabulation filling in memory gap. Amnesia inability to recall past events. Anterograde amnesia loss memory of the immediate past. Retrograde amnesia loss of memory of the distant past. Dj vu feeling of having been to place which one has not yet visited. Jamais vu feeling of not having been to a place which one has visited.

CORE CONCEPTS ON THERAPEUTIC COMMUNICATION. Communication refers to the reciprocal exchange of ideas between or among persons. Elements of Communication: Sender originator of information. Message information being transmitted. Receiver recipient of information. Channel mode of communication. Feedback return response. Context the setting of communication.

Criteria of successful communication:

Feedback Appropriateness Flexibility Efficiency

Common problems in communication Dysfunctional communication Double blind communication Differences between the denotative and connotative meaning. Incongruent communication.

Common techniques in communication To initiate conversation: - Giving broad openiong: giving the patient an opportunity to set the direction of the conversation. Example: Is there anything that you want to talk about? - Giving recognition: focusing on the positive aspects of the patients personality. Example: I noticed that you combed your hair today. To establish rapport and build trust - Giving information: responding with the needed facts. - Use of silence: refraining from sppech to give the patient a time to sort out thoughts and feelings. To gather information - Focusing: assisting a patient to explore a specific topic. Example: Patient: I cant decide about Nurse: Lets talk about that. Perhaps if we talk about it, it will help you to decide. - Validating: confirming ones observation. Example: Are you saying that

- Relflecting: directing back ideas, feelings and content. Example: You feel tense when you fight. - Restating: repeating what the patient had said. - Summarizing: developing a concise resume of what has transpired NURSE PATIENT RELATIONSHIP - Series of interaction between the nurse and patient in which the nurse assist the patient to attain positive behavioral change. CHARACTERISTICS It is goal directed, focused on the needs of the patient, planned, time limited and professional.

BASIC ELEMENTS Trust Rapport Unconditional positive regard Setting limits Therapeutic communication PHASES A. PRE-INTERACTION PHASE Begins when the nurse is assigned to a patient.

Phase of NPR in which the patient is excluded as an active participant Nurse feels certain degree of anxiety Includes all of what the nurse thinks and does before interacting with the patient Major task of the nurse: develop self awareness Data gathering, planning for first interaction

B. ORIENTATION PHASE Begins when the nurse and the patients interacts for the first time

Parameters of the relationship are laid Nurse begins to know about the patient Major task of the nurse: develop a mutually acceptable contract Determine why the patient sought help Establish rapport, develop trust, assessment

C. WORKING PHASE It is highly individualized More structured than the orientation phase The longest and most productive phase of the NPR

Limit setting is employed Major task: Identification and resolution of the patients problems Planning and implementation

D. TERMINATION PHASE It is a gradual weaning process It is a mutual agreement It involves feelings of anxiety It should be recognized in the orientation phase Major task: to assist the patient to review what he has learned and transfer his learning to his relationship with others Evaluation

When to Terminate? When goals have been accomplished When the patient is emotionally stable When the patient exhibits greater independence When the patient able to cope with anxiety separation, fear and loss

How to Terminate? Gradually decreased interaction time Focus on future oriented topics Encourage expression of feelings Make the necessary referral

COMMON PROBLEMS AFFECTING COMMUNICATION Transference the development of an emotional attitude of the patient either positive or negative towards the nurse Resistance development of ambivalent feeling towards self- exploration Counter transference transference as experienced by the nurse

PRINCIPLES OF CARE IN PSYCHIATRIC SETTINGS The nurse views the patient as a Holistic human being with interdependent and interrelated needs The nurse accepts the patient as a unique human being with inherent value and worth exactly as he is. The nurse should focus on the patients behavior non-judgmentally, while assisting the patient to learn more adaptive ways of coping The nurse should explore the patients behavior for the need it is designed to meet and the message it is communicating The nurse has the potential for establishing a nurse-patient relationship with most if not all patients The quality of the nurse-patient relationship determines the degree of change that can occur in the patients behavior.

LEVELS OF INTERVENTIONS IN PSYCHIATRIC NURSING Primary interventions aimed at the promotion of mental health and lowering the rate of cases by altering the stressors Examples: Health education Information dissemination Counseling

Secondary Intervention that limit the severity of a disorder Two components 1. Case finding 2. Prompt treatment Examples: Crisis intervention Administration of medications

Tertiary interventions aimed at reducing the disability after a disorder Two components 1. Prevention of complication 2. Active program of rehabilitation Examples: Alcoholic anonymous Occupational therapy CHARACTERISTICS OF A PSYCHIATRIC NURSE Empathy the ability to see beyond outward behavior and sense accurately another persons inner experiencing Genuineness/Congruence ability to use therapeutic tools appropriately Unconditional positive regard RESPECT

ROLES OF THE NURSE IN PSYCHIATRIC SETTINGS Ward manager creates a therapeutic environment Socializing agent assists the patient to feel comfortable with others Counselor listens to the patients verbalizations Parent surrogate assists the patient in the performance of activities of daily lining

Patient advocate enables the patient and his relatives to know their rights and responsibilities Teacher assists the patient to learn more adaptive ways of coping

Technician facilitates the performance of nursing procedures Therapist explores the patients needs, problems and concerns through varied therapeutic means Reality base enables the patient to distinguish objective reality and subjective reality Healthy role model acts as a symbol of health by serving as an example of healthful livings

BASIC CONCEPTS ON PSYCHOPHARMACOLOGY C heck why the medication is given and know the classification of the drug. In other words you should know the purpose why the medication is given. H ow will you know if the medicaiton is effective. What is your assessment parameters in monitoring the effects of the drug. E xactly what tome should the medication be given. Some drugs are best taken with meals, some after meals, and some on an empty stomach. Other drugs may also be taken without regard to meals. You should know all of these. C lient teaching tips. What would you tell your patient to expect. You should be able to give instructions related to the therapeutic and side effects of the drug. K eys to giving it safely. You should be able to identify interventions to counteract the adverse/side effects of the drug. Psychopharmacolgic agents A. Major tranquilizers/antipsychotic/neuroleptics Common indication : Schizophrenia Examples: Haloperidol (Haldol) Prochlorperazine (Compazine) Fluphenazine (Prolixin) Chlorpromazine (Thorazine) Clozapine (Clozaril) Olanzapine (Zyprexa)