1. INTRODUCTION TO PSYCHIATRIC NURSING Pamela Tusa, MSN, RN 1 NURS 383

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3. What is Mental Health? 3  What is Mental Health?  What is Mental Illness?  How does Culture play a role?

4. Multiaxial Assessment 4  Axis I  Clinical Disorders  Axis II  Personality Disorders/Mental Retardation  Axis III  General Medical Conditions  Axis IV  Psychosocial and Environmental Problems  Axis V  Global Assessment of Functioning (GAF scale)

5. Your client is currently going through a divorce, which Axis should this be noted under? 5 1. Axis I 2. Axis II 3. Axis III 4. Axis IV 5. Axis V

6. Role of the Mental Health Team 6  Nurse  Psychiatrist  Psychologist  Social Worker  Case Management/Utilization Review  Art/ Recreation Therapist  Mental Health Technicians

7. What do Psychiatric Nurse DO 7  Psychiatric mental health nursing is a specialty within nursing. Psychiatric mental health registered nurses work with individuals, families, groups, and communities, assessing their mental health needs. The PMHN develops a nursing diagnosis and plan of care, implements the nursing process, and evaluates it for effectiveness. Assessing and Providing a therapeutic environment or milieu asa treatment and management modality.

8. Peplau's Six Nursing Roles  Stranger role: Peplau states that when the nurse and patient first meet, they are considered to be strangers to one another. Therefore, the patient should be treated with much respect, courtesy and equally as anybody else. The nurse should not prejudge the patient or give assumptions on the patient but take the patient as they are. The nurse should treat the patient as emotionally stable, unless evidence states otherwise.  Resource role: The nurse provides answers to questions primarily on health information. The resource person is also in charge of relaying information to the patient about the treatment and plan of care. Usually the questions are arisen from larger problems therefore, the nurse would determine what type of response is appropriate for constructive learning whether giving straightforward answers or providing information on counselling.  Teaching role: The teaching role is a role that is a combination of all roles. Peplau determined that there are two categories that the teaching role consists of: Instructional and experimental. The instructional consists of giving a wide variety of information that is given to the patients and experimental is using the experience of the learner as a starting point to later form products of learning which the patient makes about their experiences.  Counseling role: Peplau believes that counselling has the biggest emphasis in psychiatric nursing. The councilor role helps the patient understand and remember what is going on and what is happening to them in current life situations. Also, to provide guidance and encouragement to make changes.  Surrogate role: The patient is responsible for putting the nurse in the surrogate role. The nurse’s behaviors and attitudes create a feeling tone for the patient that trigger feelings that were generated in a previous relationship. The nurse helps the patient recognize the similarities and differences between the nurse and the past relationship.  Leadership role: Helps the patient assume maximum responsibility for meeting treatment goals in a mutually satisfying way. The nurse helps the patient meet these goals through cooperation and active participation with the nurse. [14] 8

9. Peplau's Developmental Stages of the Nurse-Client Relationship  Orientation Phase is initiated by the nurse. This is the phase during which the nurse and the patient become acquainted, and set the tone for their relationship, which will ultimately be patient centered. During this stage, it is important that a professional relationship is established, as opposed to a social relationship. This includes clarifying that the patient is the center of the relationship, and that all interactions are, and will be centered around helping the patient. This phase is usually progressed through during a highly impressionable phase in the nurse-client relationship, because the orientation phase occurs shortly after admission to a hospital, when the client is becoming accustomed to a new environment and new people. The nurse begins to know the patient as a unique individual, and the patient should sense that the nurse is genuinely interested in them. Trust begins to develop, and the client begins to understand their role, the nurse's role, and the parameters and boundaries of their relationship.  Identification PhaseThe client begins to identify problems to be worked on within relationship. The goal of the nurse is to help the patient to recognize his/her own interdependent/participation role and promote responsibility for self.  Exploitation Phase / Working Phase the nurse and the patient work to achieve the patient's full potential, and meet their goals for the relationship. A sign that the transition from the orientation phase to the working phase has been made, is if the patient can approach the nurse as a resource, instead of feeling a social obligation to the nurse (Peplau, 1997). The client fully trusts the nurse, and makes full use of the nurse's services and professional abilities. The nurse and the patient work towards discharge and termination goals.  Resolution Phase/Termination Phase of the nurse client relationship occurs after the current goals for the client have been met. The nurse and the client summarize and end their relationship. One of the key aspects of a nurse-client relationship, as opposed to a social relationship, is that it is temporary, and often of short duration (Peplau, 1997). In a more long term relationship, termination can commonly occur when a patient is discharged from a hospital setting, or a patient dies. In more short term relationships, such as a clinic visit, an emergency room visit, or a health bus vaccination visit, the termination occurs when the patient leaves, and the relationship is usually less complex. However, in most situations, the relationship should terminate once the client has established increased self-reliance to deal with their own problems. 9

10.  Psychiatric nursing is the therapeutic use of self  Personal Qualities of the nurse:  Self-Awareness- “Know thyself”  Clarify Values- what is important to me? Accept differences Do not project your values  Explore feelings Awareness of feelings and meanings  Altruism- why do I want to help others? Nurse/Patient Relationship 10

11. Hospitalizing for Mental Illness 11  Voluntary  Involuntary  Court-Committed

12. Patients’ Rights 12  Universal Bill of Rights for Mental Health Patients  ADA of 1990  HIPPA  Tarasoff—duty to warn

13. Settings for Psychiatric Care  Inpatient Care Settings  Outpatient Care Settings  Psychiatric home care  Intensive Outpatient Programs (IOP)  Partial Hospitalizations Programs (PHP)  Residential Treatment Programs  Group Homes  Rehab Centers 13