Psychiatric Mental Health Nursing

Definition of mental health The capacity of individuals within groups and the environment to interact with one another in ways that promote subjective wellbeing, optimal development and use of mental abilities, and achievement of individual and collective goals consistent with justice. It means that mental health and mental illness are not mutually exclusive. Psychiatric and Mental Health Nursing

Definition of mental disorder DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition  The DSM-5 was published on May 18, 2013 from the American Psychiatric Association's(APA) classification and diagnostic tool. DSM serves as a universal authority for psychiatric diagnoses. Treatment recommendations) ICD-10: International Statistical Classification of Diseases and Related Health Problems 10th Revision (all types of diseases) Psychiatric and Mental Health Nursing

DSM-V defined mental disorder as: Syndrome characterized by significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in mental functioning. Mental Disorder :are usually associated with significant disability in social, occupational, or other important activities. Psychiatric and Mental Health Nursing

Nurse client relationship: Psychiatric nurses use interpersonal therapeutic relationship which is the central activity of mental health nursing, not social or friendship. Clients may be fearful of talking to others about their symptoms or difficulties because they fear being rejected and seen as 'crazy‘. The purpose of using self therapeutically is to establish a therapeutic alliance with the client. Psychiatric and Mental Health Nursing

Empathy has three components: 1- Understand the client's situation. Ability to see the world from another person's perspective (active listening, understanding and rapport). Empathy has three components: 1- Understand the client's situation. 2- Verbalize the understanding to the client. 3- Client's validation of the nurse's understanding. To be empathic we must be able to suspend our own perceptions and judgments of the world. Psychiatric and Mental Health Nursing

Phases of a therapeutic relationship: 1. Preinteraction phase Obtaining available information about the client from chart, significant others, or other health team members. Examining one’s feelings, fears, and anxieties about working with a particular client. For example, the nurse may have drug abuser father & caring for a client who is drug dependent Psychiatric and Mental Health Nursing

Phases of a therapeutic relationship… cot.: 2. The Orientation (Introductory) Phase: - Establishment of trust and rapport - Establishing a contract for intervention (expectations and responsibilities of nurse and client) - Gather information to build a strong client database Identifying the client’s strengths and limitations Formulating nursing diagnoses, Setting goals & Developing a plan of action Explore feelings of client & nurse. Psychiatric and Mental Health Nursing

Phases of a therapeutic relationship… cot.: 3. The Working Phase: Maintaining the trust and rapport - Promoting the client’s insight and perception of reality - Problem-solving technique is used. - Overcoming resistance behaviors of the client - Continuously evaluating progress toward goal attainment Psychiatric and Mental Health Nursing

Phases of a therapeutic relationship… cot.: 4. The Termination Phase: - Termination of the relationship may occur for these reasons: - Goals may have been reached. - The client may be discharged from hospital. - Student nurse finished a clinical practice. Both nurse and client may experience feelings of sadness and loss. The client learns that it is acceptable to have these feelings at a time of separation Psychiatric and Mental Health Nursing

Transference and Countertransference Are barriers often interfere with developing a therapeutic relationship. Transference: Occurs when the client unconsciously transfers to the nurse feelings formed toward a person from his or her past. These feelings may be triggered by the nurse’s appearance or personality that remind the client of the person Psychiatric and Mental Health Nursing

Can interfere with the therapeutic interaction include anger and hostility manifested by uncooperativeness and resistance to the therapy. Transference can also take the form of overwhelming affection for or excessive dependency on the nurse. The client forms unrealistic expectations of the nurse, and may become angry and hostile. Psychiatric and Mental Health Nursing

Transference and Countertransference .. Cont. Interventions for transference: - Do not terminate relationship , except when there is serious barrier to therapy or safety. Nurse should work with the client in sorting out the past from the present, and assist the client to reassign a new appropriate meaning to the current nurse-client relationship. The goal is to guide the client to independence Psychiatric and Mental Health Nursing

Transference and Countertransference .. Cont. Refers to the nurse’s behavioral and emotional response to the client. May be related to unresolved feelings toward significant others from the nurse’s past, or they may be generated in response to transference feelings. - It is not easy to refrain from becoming angry when the client is consistently antagonistic. exhibits excessive dependency on the nurse. Psychiatric and Mental Health Nursing

Transference and Countertransference .. Cont. These feelings interfere with the therapeutic relationship, the nurse and client develop a social or personal relationship. - The nurse begins to give advice or attempts to rescue the client. - The nurse encourages and promotes the client’s dependence. - The nurse has difficulty setting limits on the client’s behavior. * The nurse may be completely unaware of the countertransference as it is occurring & defends the client’s behavior to other staff members Psychiatric and Mental Health Nursing

Transference and Countertransference .. Cont. Interventions for countertransference: The relationship usually should not be terminated. The nurse experiencing the countertransference should be supported by others e.g. supervisor. - Do evaluative sessions after each encounter with the client, between nurse and his supervisor to discuss nurse client relationship. Psychiatric and Mental Health Nursing

The essential characteristics of successful therapist: 1- Empathy: is necessary for the client to feel understood. 2-Warmth: being attentive to the interaction, which results in client feeling accepted. 3- Genuineness: Verbal and nonverbal messages are congruent with the nurse feels, as honest, sincere. 4- Respect: valuing the client and conveying recognition of client's human worth. 5- Concreteness: use of realistic terminology rather than vague abstract concepts Psychiatric and Mental Health Nursing

The essential characteristics of successful therapist: 6- Immediacy: Interactions focus on interpersonal relationship as it exists 7- Confrontation: Constructive confrontation is necessary for client behavioral changes. 8- Self-disclosure: Nurse volunteers personal information (ideas, feelings, experiences) only when relevant to the client concerns, nurse supports the client and models success in problem solving. 9-Privacy and confidentiality: the client's information should be confidential. not be shared by other mental health team against the benefit and desire of the client Psychiatric and Mental Health Nursing