Mental Health Ch06 Nursing Process9 06


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Mental Health Ch06 Nursing Process9 06

  1. 1. Chapter 6 The Nursing Process in Psychiatric/Mental Health Nursing
  2. 2. The Nursing Process <ul><li>It is a systematic framework for the delivery of nursing care. </li></ul><ul><li>It uses a problem-solving approach. </li></ul><ul><li>It is goal-directed, its objective being the delivery of quality client care. </li></ul><ul><li>It is dynamic, not static. </li></ul>
  3. 3. Standards of Care <ul><li>The standards of care for psychiatric nursing are written around the six steps of the nursing process. </li></ul><ul><li>Standard I. Assessment </li></ul><ul><li>The psychiatric / mental health nurse collects client health data. </li></ul><ul><li>P 90-97 in text </li></ul><ul><li>Here, the nurse writes while </li></ul><ul><li>Interviewing the client </li></ul>
  4. 4. Standards of Care <ul><li>Standard II. Diagnosis </li></ul><ul><li>The psychiatric / mental health nurse analyzes the assessment data in determining diagnoses </li></ul>
  5. 5. Nursing Diagnosis <ul><li>The nursing Diagnosis describes the client ’ s condition </li></ul><ul><li>For example: Disturbed sensory perception, evidenced by hearing voices </li></ul>
  6. 6. Standards of Care (cont.) <ul><li>Standard III. Outcome Identification </li></ul><ul><li>The psychiatric / mental health nurse identifies expected outcomes that are measurable and realistic and individualized to the client. </li></ul><ul><li>For example: </li></ul><ul><li>The client will demonstrate </li></ul><ul><li>trust in one staff member </li></ul><ul><li>In 5 days. The client will express </li></ul><ul><li>understanding that the voices are not </li></ul><ul><li>real (not heard by others ) in 10 days. </li></ul>
  7. 7. Standards of Care (cont.) <ul><li>Standard IV. Planning </li></ul><ul><li>The psychiatric / mental health nurse develops a plan of care that is negotiated among the client, nurse, family, and healthcare team and prescribes evidence-based interventions to attain expected outcomes. </li></ul>
  8. 8. Standards of Care (cont.) <ul><li>Standard IV. Planning (cont.) </li></ul><ul><li>Nursing Interventions Classification (NIC) - a comprehensive, standardized language describing treatments that nurses perform in all settings and in all specialties </li></ul><ul><li>NIC interventions based on research and reflect current clinical practice </li></ul>
  9. 9. Standards of Care (cont.) <ul><li>Standard V. Implementation </li></ul><ul><li>The psychiatric/mental health nurse implements the interventions identified in the plan of care. Specific interventions: </li></ul><ul><ul><li>Standard Va. Counseling: to assist clients in improving coping skills and preventing mental illness and disability </li></ul></ul><ul><ul><li>Standard Vb. Milieu therapy: to provide and maintain a therapeutic environment for client </li></ul></ul><ul><ul><li>Standard Vc. Self-care activities: to foster independence and mental and </li></ul></ul><ul><ul><li>physical well-being </li></ul></ul>
  10. 10. Standards of Care (cont.) <ul><ul><li>Standard Vd. Psychobiological </li></ul></ul><ul><ul><li>interventions: to restore the client ’ s </li></ul></ul><ul><ul><li>health and prevent further disability </li></ul></ul><ul><ul><li>Standard Ve. Health teaching: to assist </li></ul></ul><ul><ul><li>clients in achieving satisfying, productive, </li></ul></ul><ul><ul><li>and healthy patterns of living </li></ul></ul><ul><ul><li>Standard Vf. Case management: to </li></ul></ul><ul><ul><li>coordinate comprehensive health services </li></ul></ul><ul><ul><li>and ensure continuity of care </li></ul></ul>
  11. 11. Standards of Care (cont.) <ul><li>Standard Vg. Health promotion and health maintenance: implements strategies with clients to promote and maintain mental health and prevent mental illness </li></ul>
  12. 12. Standards of Care (cont.) <ul><li>Advanced practice interventions also include: </li></ul><ul><ul><li>Standard Vh. Psychotherapy: </li></ul></ul><ul><ul><li>provides therapy for individuals, </li></ul></ul><ul><ul><li>groups, families, and children to </li></ul></ul><ul><ul><li>foster mental health and prevent disability </li></ul></ul><ul><ul><li>Standard Vi. Prescriptive authority and treatment: provides pharmacological intervention, in accordance with </li></ul></ul><ul><ul><li>state and federal laws and regulations, </li></ul></ul><ul><ul><li>to treat symptoms of psychiatric illness </li></ul></ul><ul><ul><li>and improve functional health status </li></ul></ul>
  13. 13. Standards of Care (cont.) <ul><li>Advanced practice interventions (cont.) </li></ul><ul><li>Standard Vj. Consultation: </li></ul><ul><li>provides consultation to enhance </li></ul><ul><li>the abilities of other clinicians to </li></ul><ul><li>provide services for clients and </li></ul><ul><li>effect change in the system </li></ul>
  14. 14. Standards of Care (cont.) <ul><li>Standard VI. Evaluation </li></ul><ul><li>The psychiatric/mental health nurse evaluates the client ’ s progress in attaining expected outcomes. </li></ul>
  15. 15. Applying Nursing Process <ul><li>Role of the nurse in psychiatry </li></ul><ul><li>The nurse assists the client ’ s successful adaptation to stressors within the environment. </li></ul><ul><li>Goals are directed toward change in thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms. </li></ul><ul><li>The nurse is a valuable member of the interdisciplinary team, providing a service that is unique and based on sound knowledge of psychopathology, scope of practice, and legal implications of the role. </li></ul>
  16. 16. Documentation of the Nursing Process <ul><li>Documentation of the steps of the nursing process is often considered as evidence in determining certain cases of negligence by nurses. </li></ul><ul><li>It is also required by some agencies that accredit healthcare organizations. </li></ul>
  17. 17. Documentation of the Nursing Process (cont.) <ul><li>Examples of documentation that reflect use of the nursing process </li></ul><ul><li>Problem-Oriented Recording (POR) </li></ul><ul><ul><li>Has a list of problems as its </li></ul></ul><ul><ul><li>basis </li></ul></ul><ul><ul><li>Uses subjective, objective, </li></ul></ul><ul><ul><li>assessment, plan, intervention, </li></ul></ul><ul><ul><li>and evaluation (SOAPIE) format </li></ul></ul>
  18. 18. Documentation of the Nursing Process (cont.) <ul><li>Focus Charting ® </li></ul><ul><ul><li>Main perspective is to choose a </li></ul></ul><ul><ul><li>“ focus ” for documentation. A focus </li></ul></ul><ul><ul><li>may be </li></ul></ul><ul><ul><ul><li>a nursing diagnosis </li></ul></ul></ul><ul><ul><ul><li>a current client concern or behavior </li></ul></ul></ul><ul><ul><ul><li>a significant change in the client ’ s status or </li></ul></ul></ul><ul><ul><ul><li>behavior </li></ul></ul></ul><ul><ul><ul><li>a significant event in the client ’ s therapy </li></ul></ul></ul><ul><ul><li>The focus cannot be a medical diagnosis. </li></ul></ul><ul><ul><li>It uses data, action, and response (DAR) format. </li></ul></ul>
  19. 19. Documentation of the Nursing Process (cont.) <ul><li>APIE method </li></ul><ul><ul><li>A problem-oriented system </li></ul></ul><ul><ul><li>Utilizes flow sheets as accompanying documentation </li></ul></ul><ul><ul><li>Uses assessment, problem, intervention, and evaluation (APIE) format </li></ul></ul>