1. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Chapter 6 Mental Health Nursing in Community Settings Menu F

2. Copyright © 2002 by W. B. Saunders Company. All rights reserved. l Awareness of self; personal and cultural values l Calm external manner; nonjudgmental; flexible l Skills: problem solving, psychosocial and health assessment, communication l Ability to cross service systems, recognize need for consultation, see strength and ability in even the severely ill l Knowledge of community resources, psychopharmacology, political vision l Willingness to work with those identified by client as support people l Understanding of the social, cultural, and political issues that affect mental health and illness l Awareness of self; personal and cultural values l Calm external manner; nonjudgmental; flexible l Skills: problem solving, psychosocial and health assessment, communication l Ability to cross service systems, recognize need for consultation, see strength and ability in even the severely ill l Knowledge of community resources, psychopharmacology, political vision l Willingness to work with those identified by client as support people l Understanding of the social, cultural, and political issues that affect mental health and illness Helpful Attributes for CMHNs Menu FB

3. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Additional Elements of Importance for CMHNs l Recent service utilization l Vocational success/difficulty l Income and source of income l Housing adequacy and stability l Family and support system l Level of activity l Meets needs independently/with assistance l Cultural beliefs, re: care Additional Elements of Importance for CMHNs l Recent service utilization l Vocational success/difficulty l Income and source of income l Housing adequacy and stability l Family and support system l Level of activity l Meets needs independently/with assistance l Cultural beliefs, re: care Bio-Psychosocial Nursing Assessment Menu FB

4. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Inpatient Settings Locked unit Staff-set boundaries Regular food, housekeeping, security services Medication encouraged Milieu Health care team support CMH Settings Locked apartment Client-set boundaries Erratic food, housekeeping, security services Client may be noncompliant Social isolation Limited support Comparison: Inpatient & CMH settings Menu FB

5. Copyright © 2002 by W. B. Saunders Company. All rights reserved. CMH Goals Client will maintain stability in the community Client will participate as active member of treatment team Client will demonstrate improved ability to function Inpatient Goals Client symptoms will be stabilized Client will return to community Comparison: Inpatient & CMH Goals Menu FB

6. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Inpatient Boundaries Enforced by seclusion and restraint CMH Boundaries Access negotiated with client or gained trough family, police, or landlord Inpatient Relationship Develop short-term therapeutic relationship CMH Relationship Maintain long-term therapeutic relationship Comparison: Inpatient & CMH Interventions Menu FB

7. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Inpatient Medication Supervised, even court- ordered CMH Medication Negotiate consent for and adherence to taking medication Inpatient Socialization Activities Provided and required CMH Socialization Activities Assist client to identify and use community resources Comparison: Inpatient & CMH Interventions, cont. Menu FB

8. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Inpatient Self Care, Nutrition, Health Care Assist self care, nutrition Health assessment and intervention prn CMH Self Care, Nutrition, Health Care Negotiate meaning of adequate self care, nutrition, and health care with client and social support system Assist client in assessing for needed community services Comparison: Inpatient & CMH Interventions, cont. Menu FB

9. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Inpatient Sociocultural Context Develop plan of care that attends to sociocultural context of individual CMH Sociocultural Context Work with client and support system to plan and implement care consistent with sociocultural belief system and context Comparison: Inpatient & CMH Interventions, cont. Menu FB

10. Copyright © 2002 by W. B. Saunders Company. All rights reserved. l Issue of Social Control What’s best for individual vs. what’s best for community l Issue of Privilege Confidentiality vs. obligation to report l Issue of Social Control What’s best for individual vs. what’s best for community l Issue of Privilege Confidentiality vs. obligation to report Common Ethical Dilemmas in Community Mental Health Nursing Menu B