1. Promoting Psychological Adaptations
NRS 201
Ohio Institute of Allied Health
Department of Nursing Education

3. Psychiatric Nursing: Theory, Principles, Trends
It is widely accepted and agreed upon in the US that mental health is an inextricable component of overall human health.
There are four main objectives
promotion and protection of mental health
prevention of mental disorders
treatment of mental disorders
recovery and rehabilitation
Prevention has three levels:
primary
secondary
tertiary
(Maslow’s hierarchy of needs)

4. Patients’ Rights
Are encouraged to make important decisions that affect them.
Their health/safety may become jeopardized by impaired judgment which will result in loss of right to make choices.
Under what circumstances??
When a person is unable to cognitively process information or to make decisions about their treatment
When a person is so severely depressed that they have intent to commit suicide.

6. RISK FACTORS
Biologic
Psychological
Sociocultural
environmental

7. Nursing Practice in the Clinical Setting
Principles of the nurse-patient relationship
the relationship is therapeutic rather than social.
the focus remains on the patient needs and Dx rather than nurse issues
the relationship is purposeful and goal directed
the relationship is objective rather than subjective in quality
the relationship is time limited rather than open ended.

8. Additional clinical principles
Accept the patients feelings; not the patients behavior
Avoid false reassurances, clichés, and global statements
Avoid giving advice.
Avoid rescue fantasy
Use simple, concrete, and direct language with patients
Avoid heroics
Consider the clinical setting the patient’s laboratory
Encourage patients to take responsibility for their own actions, decisions, choices, and lives whenever they are capable.

9. The Nursing Process and Standards of Practice
The nursing process is an organized problem-solving method that is unique to nursing
It is designed to meet the needs of the patient
The family
The community
The environment

10. The six steps of the nursing process focus on patient care provided by nurses and allied health personnel in clinical practice settings.

11. Outcome Identification
Assessment
MMSE
Diagnosis
Identify problem
Outcome Identification
Construct outcomes
Planning
Priorities of care
Implementation
Promote safety
Evaluation
Continuous evaluation

12. Assessment LOC MMSE Hamilton Anxiety Scale
Global Assessment of Functioning Scale
Mania Rating Scale
Perception of own health
Daily activities
Substance abuse
Stress/coping abilities
Cultural beliefs
Spiritual beliefs
LOC =
Alert
Lethargic
Obtunded
Stupor
Coma
Physical appearance (hygiene, clothing, ect…)
Behavior (voluntary/involuntary, eye contact)
Mood
Affect
Cognitive/intellectual abilities (especially elderly)
a/o x 4
memory check
level of knowledge (adding/subtracting)
ability to think abstractly
judgment
rate/volume/quality of speech
Peds
temperament/social/environment factors
level of trust
coping skills

13. MMSE
Used to objectively evaluate a client’s cognitive status by determining the following:
orientation to time and place
attention span and ability to calculate by counting backwards in multiples of seven
registration and recalling of objects
language, including naming of objects, following commands, and ability to write

14. Assessment Collection
Private, quiet, good lighting
Establish name preference
Maintain client’s level (stand/sit)
Respect personal space
Include questions r/t physical homeostasis
Include family if able
Medication history
Summarize data back to pt for clarification
Observe for visual stressor cues on patients with specific family or others in room.

15. Diagnosis DSM Identify problem Axis I Axis II Axis III Axis IIII
Axis IV
I – psychiatric diagnosis
II – personality disorder or mental retardation
III – Medical Diagnosis
IV – psychosocial stressors
V – Global assessment of functioning
uses a 1 – 100 scale, the higher the scale the higher level of functionality
80 – 100 = normal/near-normal function
60 – 80 = moderate problems
40 – 60 = serious mental disability
present and past years scores are compared in order to track progress.

16. Outcome Identification
Construct outcomes
Using the NADA and NOC books to obtain an outcome.

17. Planning EBP Clinical Pathways Concept Mapping Priorities of care
Clinical pathways – a standardized multidisciplinary planning tool that monitors patient care through projected caregiver interventions and expected patient outcomes and that is based on the patients DSM mental disorder.
Concept mapping – a problem-solving plan that includes all the relevant elements of the patients database.

18. Implementation Promote safety PATENT AND STAFF
Engage with patent gradually
Educate patient and family of expected therapeutic affects and time
Assist with patient talking
Follow plan as written, do not vary without express direction from provider.

19. Evaluation Continuous evaluation
Nurse compares patients current condition with outcome statement
Nurse considers all possible reasons that the patient did not achieve outcomes
Development of SOAP note.

20. SOAP Charting

21. Use therapeutic communications skills Assist with problem solving
Counseling
Use therapeutic communications skills
Assist with problem solving
Identify a crisis intervention
Milieu Therapy
Orient clients to the physical setting
Identify rules and boundaries of the setting
Ensure a safe environment for clients
Promotion of self-care activities
Offer assistance with self-care tasks
Allow time for the client to complete tasks
Set incentives to promote client self-care
Psychobiological interventions
Administer prescribed medications
Reinforce teaching to the client/family
Monitor for side effects and effectiveness
Cognitive and behavioral therapies
Modeling
Operant condition
Systematic desensitization
Health teaching
Encourage the development of social and coping skills
Health promotion and health maintenance
Assist clients with cessation of smoking
Monitor other health conditions
Mental Health Nursing Interventions

22. Children & Adolescents
Evaluate the patients temperament, social and environmental factors, cultural and religious concerns, and developmental level.
Mentally healthy children and adolescents should trust others, view the world as a safe, accurately interpret their environments, master developmental tasks, and use appropriate coping skills.
They experience some of the same mental health problems as adults
Observe this age group for mood, anxiety, developmental, behavioral, and eating disorders. Risk of suicide should be considered.
Mental health and developmental disorders are not always easily diagnosed, and treatment interventions may be delayed or inadequate.
Factors contributing to this include:
lack of ability/skills to describe what is happening
a wide variation of “normal” behavior, especially in different developmental stages

23. STANDARDIZED ASSESSMENTS
The Older Adult
Evaluate for functional ability (such as the ability to get up out of a chair.)
Economic and social status
Environmental factors (such as stairways in the home)
STANDARDIZED ASSESSMENTS
Geriatric Depression Scale
Michigan Alcoholism Screening Test – Geriatric
MMSE
Pain assessments