1. Introduction to Mental Health Nursing Week 1
Trisha Ecomomidis
Marilee Elias
Fall 2010

2. Are you ready for this? Introduction to Behavioral Health Nursing
Roles of the Behavioral Health Nurse
Standards of Clinical Nursing Practice
DSM-IV-TR Multiaxial Evaluation System
Therapeutic Communication

3. Townsend definition of Mental Health
Successful adaptation
Age-appropriate
Congruent

4. What is your definition of Mental Illness?

5. Townsend on Mental Illness
Maladaptive responses
Incongruence with norms
Interferes with individual’s functioning

6. Neurobiological Disorders
Illness of the nervous system
Excess or deficiency of neurotransmitters
Neurotransmitters are the targets for many psychotropic medications (drugs that produce changes in neurotransmitter release and receptor binding)

7. Neurobiological Disorders
Bipolar Disorder
Schizophrenia
Many depressive and anxiety disorders
ADHD
OCD
Autism
More

8. The Nursing Process in Mental Health Nursing
The ANA Standards of Care (I-VI)
AD-O-PIE
I. Assessment
II. Diagnosis
III. Outcome Identification
IV. Planning
V. Implementation
VI. Evaluation (ongoing process)

9. Living up to the Standards Roles of the Mental Health Nurse
Standard V (Implementation) delineates roles in Behavioral Health Nursing
Counseling
Milieu Therapy
Promotion of Self-care Activities
Psychobiological Interventions
Health Teaching
Case Management
Health Promotion and Health Maintenance

10. Additional Roles for Advanced Practice Nurses
Psychotherapy
Prescriptive Authority (according to each state’s laws) and Treatment
Consultation with other clinicians

11. I’ve got 5 Axes to grind with you! Diagnoses Classification Systems
American Psychiatric Association (APA)
DSM-IV-TR Multiaxial Evaluation System
Axis I Clinical Disorders
Axis II Personality D/O or Mental Retardation
Axis III Relevant Medical D/O
Axis IV Psychosocial/Environmental Problems
Axis V GAF Score 0 (not enough info to rate)- 100 (superior functioning, No symptoms)

12. Example
Axis I: Bipolar 1 Disorder, recent manic episode, severe with Psychotic Features
Axis II: Borderline Personality Disorder
Axis III: Alopecia
Axis IV: Unemployed
Axis V: GAF on admission 28 (0-100)

13. The Therapeutic Nurse-Client Relationship
Therapeutic Communication is the core of the relationship
Respect and unconditional acceptance
Become partners with our patients
Powerful nursing intervention

14. Therapeutic Communication
Verbal and nonverbal techniques
Advance the promotion of healing and change.
Encourages exploration of feelings
Fosters understanding of behavioral motivation
It is nonjudgmental and promotes trust

15. Developing Therapeutic Communication Skills
We must develop critical thinking skills
Critical Thinking combines reasoned thinking, openness to alternatives, the ability to reflect, and a desire to seek truth.
(Wilkinson & Van Leuven, 2007)
Ask questions
Be open-minded
Be aware of your own perceptual biases

16. Levels of Communication
Intrapersonal
Interpersonal
Group Communication
Small group
Public speaking

17. Elements of the Communication Process
Sender/Receiver
Message
Channels
Feedback
Interpersonal Variables
Environment

18. Forms of Communication
Verbal
Vocabulary
Pacing & rhythm of speech delivery
Intonation
Clarity & Brevity
Timing & Relevance
Credibility of message sender

19. Forms of Communication
Non-verbal
Physical Appearance
Clothing
Body Movement & Posture
Touch
Facial Expression
Eye Behavior
Paralanguage (vocal cues)

20. Characteristics of Therapeutic Communication
Active Listening
Empathy (vs. sympathy)
Trust
Honesty
Validation
Caring

21. Active Listening Be attentive to client’s verbal and
non-verbal communication
Non-verbal behaviors to facilitate listening S O L E R

22. Communicate like a Professional
Appearance
Speak clearly & appropriately
Punctuality
Organization
Courteous

23. Communicate like a Professional
Respectful
Trustworthiness
Protect privacy & confidentiality
Demonstrate autonomy, responsibility, & assertiveness (vs. aggressiveness)

24. Don’t cross boundaries!
Professional boundaries for Therapeutic Nurse-Client Relationships
Self-disclosure
Gift-giving
Touch
Friendship
Romantic association

25. Ego Defense Mechanisms
Ego- element of personality that maintains harmony between external world, instinctual drives (Id), and the conscience (Superego)
Defense mechanisms used to deal with anxiety

26. What Ego Defense Mechanisms can we encounter?
Conscious or unconscious
-Denial
-Compensation
-Projection
-Repression
-Regression
-Displacement

27. Ready? On to the Clinical Interview
Provide a safe environment for both the nurse and client
Non-threatening seating
No physical barriers
Client not between nurse and door
Protect confidentiality
Respectful & courteous treatment

28. Communication Techniques
Therapeutic communication techniques
VS.
Non-therapeutic communication techniques

29. Therapeutic Communication Techniques
Using Silence
Accepting
Giving Recognition
Offering Self
Giving Broad Openings
Placing the Event in time or sequence
Making Observations
Verbalizing the implied

30. More Therapeutic Communication Techniques
Encouraging descriptions of perceptions
R & R (restating & reflecting)
Focusing
Exploring
Seeking Clarification & Validation
Presenting reality
Voicing doubt
Attempting to translate words into feelings
Formulating a Plan of Action

31. Nontherapeutic CTs Giving reassurance Rejecting Approving/Disapproving
Agreeing/Disagreeing
Giving advice
Probing
Defending
Requesting an explanation

32. More Nontherapeutic CTs
Indicating the existence of an external source of power
Belittling feelings expressed
Making stereotyped comments
Using denial
Interpreting
Introducing an unrelated topic

33. Coming Attractions Legal, Ethical, Cultural & Spiritual Issues Family Dynamics Stress & Adaptation/coping Crisis Intervention