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Community settings .pp tt

  1. 1. NUR 448 <ul><li>Mental Health Nursing in Community Settings </li></ul>
  2. 2. Helpful Attributes for CMHNs <ul><li>Awareness of self; personal and cultural values </li></ul><ul><li>Calm external manner; nonjudgmental; flexible </li></ul><ul><li>Skills: problem solving, psychosocial and health assessment, communication </li></ul><ul><li>Ability to cross service systems, recognize need for consultation, see strength and ability in even the severely ill </li></ul><ul><li>Knowledge of community resources, psychopharmacology, political vision </li></ul><ul><li>Willingness to work with those identified by client as support people </li></ul><ul><li>Understanding of the social, cultural, and political issues that affect mental health and illness </li></ul>Menu F B
  3. 3. Bio-Psychosocial Nursing Assessment <ul><li>Additional Elements of Importance for CMHNs </li></ul><ul><ul><li>Recent service utilization </li></ul></ul><ul><ul><li>Vocational success/difficulty </li></ul></ul><ul><ul><li>Income and source of income </li></ul></ul><ul><ul><li>Housing adequacy and stability </li></ul></ul><ul><ul><li>Family and support system </li></ul></ul><ul><ul><li>Level of activity </li></ul></ul><ul><ul><li>Meets needs independently/with assistance </li></ul></ul><ul><ul><li>Cultural beliefs, re: care </li></ul></ul>Menu F B
  4. 4. Comparison: Inpatient & CMH settings <ul><li>Inpatient Settings </li></ul><ul><li>Locked unit </li></ul><ul><li>Staff-set boundaries </li></ul><ul><li>Regular food, housekeeping, security services </li></ul><ul><li>Medication encouraged </li></ul><ul><li>Milieu </li></ul><ul><li>Health care team support </li></ul><ul><li>CMH Settings </li></ul><ul><li>Locked apartment </li></ul><ul><li>Client-set boundaries </li></ul><ul><li>Erratic food, housekeeping, security services </li></ul><ul><li>Client may be noncompliant </li></ul><ul><li>Social isolation </li></ul><ul><li>Limited support </li></ul>Menu F B
  5. 5. Comparison: Inpatient & CMH Goals <ul><li>CMH Goals </li></ul><ul><li>Client will maintain stability in the community </li></ul><ul><li>Client will participate as active member of treatment team </li></ul><ul><li>Client will demonstrate improved ability to function </li></ul><ul><li>Inpatient Goals </li></ul><ul><li>Client symptoms will be stabilized </li></ul><ul><li>Client will return to community </li></ul>Menu F B
  6. 6. Comparison: Inpatient & CMH Interventions <ul><li>Inpatient Boundaries </li></ul><ul><li>Enforced by seclusion and restraint </li></ul><ul><li>CMH Boundaries </li></ul><ul><li>Access negotiated with client or gained trough family, police, or landlord </li></ul><ul><li>Inpatient Relationship </li></ul><ul><li>Develop short-term therapeutic relationship </li></ul><ul><li>CMH Relationship </li></ul><ul><li>Maintain long-term therapeutic relationship </li></ul>Menu F B
  7. 7. Comparison: Inpatient & CMH Interventions, cont. <ul><li>Inpatient Medication </li></ul><ul><li>Supervised, even court-ordered </li></ul><ul><li>CMH Medication </li></ul><ul><li>Negotiate consent for and adherence to taking medication </li></ul><ul><li>Inpatient Socialization Activities </li></ul><ul><li>Provided and required </li></ul><ul><li>CMH Socialization Activities </li></ul><ul><li>Assist client to identify and use community resources </li></ul>Menu F B
  8. 8. Comparison: Inpatient & CMH Interventions, cont. <ul><li>Inpatient Self Care, Nutrition, Health Care </li></ul><ul><li>Assist self care, nutrition </li></ul><ul><li>Health assessment and intervention prn </li></ul><ul><li>CMH Self Care, Nutrition, Health Care </li></ul><ul><li>Negotiate meaning of adequate self care, nutrition, and health care with client and social support system </li></ul><ul><li>Assist client in assessing for needed community services </li></ul>Menu F B
  9. 9. Comparison: Inpatient & CMH Interventions, cont. <ul><li>Inpatient Sociocultural Context </li></ul><ul><li>Develop plan of care that attends to sociocultural context of individual </li></ul><ul><li>CMH Sociocultural Context </li></ul><ul><li>Work with client and support system to plan and implement care consistent with sociocultural belief system and context </li></ul>Menu F B
  10. 10. Common Ethical Dilemmas in Community Mental Health Nursing <ul><li>Issue of Social Control </li></ul><ul><li>What ’ s best for individual vs. what ’ s best for community </li></ul><ul><li>Issue of Privilege </li></ul><ul><li>Confidentiality vs. obligation to report </li></ul>Menu B

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