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Community settings .pp tt Community settings .pp tt Presentation Transcript

  • NUR 448
    • Mental Health Nursing in Community Settings
  • Helpful Attributes for CMHNs
    • Awareness of self; personal and cultural values
    • Calm external manner; nonjudgmental; flexible
    • Skills: problem solving, psychosocial and health assessment, communication
    • Ability to cross service systems, recognize need for consultation, see strength and ability in even the severely ill
    • Knowledge of community resources, psychopharmacology, political vision
    • Willingness to work with those identified by client as support people
    • Understanding of the social, cultural, and political issues that affect mental health and illness
    Menu F B
  • Bio-Psychosocial Nursing Assessment
    • Additional Elements of Importance for CMHNs
      • Recent service utilization
      • Vocational success/difficulty
      • Income and source of income
      • Housing adequacy and stability
      • Family and support system
      • Level of activity
      • Meets needs independently/with assistance
      • Cultural beliefs, re: care
    Menu F B
  • Comparison: Inpatient & CMH settings
    • 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
    Menu F B
  • Comparison: Inpatient & CMH Goals
    • 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
    Menu F B
  • Comparison: Inpatient & CMH Interventions
    • 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
    Menu F B
  • Comparison: Inpatient & CMH Interventions, cont.
    • 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
    Menu F B
  • Comparison: Inpatient & CMH Interventions, cont.
    • 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
    Menu F B
  • Comparison: Inpatient & CMH Interventions, cont.
    • 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
    Menu F B
  • Common Ethical Dilemmas in Community Mental Health Nursing
    • Issue of Social Control
    • What ’ s best for individual vs. what ’ s best for community
    • Issue of Privilege
    • Confidentiality vs. obligation to report
    Menu B