General Nurses Role in child mental CAP.pptx

1. Roles of Nurse in CAP
• Several interventions were identified as primary care in relation to
children and adolescents with mental health conditions. Early detection
was a critical in terms of providing needed treatment to the youth in
order to minimize further progresses of the illness and its influences on
their lives. Nurse can also enhance help-seeking behavior of the youth
through educating them with appropriate knowledge.

2. Roles of Nurse in CAP
• Primary care giver
• Coordinator and collaborator
• Advocate
• Health educator
• Consultant
• Counselor
• Case Manager
• Recreationist
• Social worker and
• Researcher

3. • Primary care giver: Nurse should provide preventive, promotive, curative and
rehabilitative care in all levels of health services. Mental Health Integration into
Primary Care is important.
• In hospital, care of mentally sick children includes comfort, feeding, bathing,
safety, providing various psychotherapies etc.
• At community set up, basic responsibilities include health assessment,
immunization, primary health care, conduct school mental health programs and
referral, continuation of the psychiatric treatment and rehabilitation etc.

4. • Coordinator & Collaborator: The nurse plays an extremely important
role with the combination of mental health care team members. Nurse
maintains good inter personal communication with the child, family and
health care team members.
• The nurse coordinates nursing care with other services for meeting the
needs of child. For ex: Child and adolescent Psychiatrist, pediatrist ,
developmental podiatrist psychiatric social worker, child Psychologist,
physiotherapist, dietician etc.

5. • Health Educator: The nurse’s goal of health teaching is to provide
information to the child parents and significant other about
prevention of illness, promotion or health maintenance.
• Characteristics of nurse teacher includes 4 C's
• C — Confidence
• C — Competence
• C — Communication
• C — Caring & empathy

6. • Nurse Consultant: The nurse can act as consultant to guide parents
for maintenance and promotion of health. For ex: Guiding parents
about feeding practices, accident prevention, Psycho education,
Individual therapy,Family Therapy, Group Therapy.

7. • Nurse Counselor: Providing guidance to parents in health hazards of
children, mental health issues and help them for own decision making
in different situations.

8. • Case Manager: The nurse should organize care, monitor and evaluate
patient treatment for successful outcome. She/he acts as a manager
of Child and adolescent mental health care units in hospital clinics
and community.

9. • Recreationist: The nurse plays supportive role for the child to provide
play facilities for recreation and diversion. It helps to decrease crisis
imposed by illness or hospitalization

10. • Social Worker: Nurse can participate in social services or refer child &
family , child mental health welfare agencies for necessary support.

11. • Nurse researcher: Research is an integral part of professional
nursing. Nurse should participate or perform research activities.
• It helps to provide basis for changes in nursing practice, improvement
in the child mental health care and evaluate the care.

12. General Nursing Role in Child Mental Health
Care
To provide Pharmacological treatment
To provide Psychological therapies including Play therapy and yoga
To associate with Juvenile justice system for Placement of child in
correctional home
To provide counseling and guidance:Individual, Family and Teacher (
destructive family correction )
To provide Family oriented Life skill management program

13. Conti…..
• Nurses Role in clinical area
• Nurses will Assist & Participate in ……..
❑General physical examination
❑Blood investigations ( Including metabolic error workups)
❑Specific workups to identify some neuro developmental disorders
such as ADHD, Autism, Learning disorders, conduct disorders,
Childhood Depression and other sever mental illness.(At the tertiary
care level)
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14. Nurses Role in Referrals
Where the nurses will refer the for further assessment and
treatment?
In community:
• To the Primary Health Centres,
• Child Assessment Centres,
• Special Child Care Centres,
• Paediatric departments of hospitals,
• District Early Intervention Centres,
• Education and Training Centres
At Clinical Areas: To the treating team 14

15. NURSES’ ROLE & PREVENTIVE-APPROACHES
• Primary prevention = stop from occurring
• Secondary prevention includes early detection and treatment
• Tertiary prevention = reduce consequences of existing health
condition

16. LEVEL APPROACH EXAMPLE OF STEPS
PRIMARY
PREVENTION
(preventing the
occurrence
Health
promotion
Providing Health education, especially for adolescent girls
Improvement of nutritional status
Providing optimum health care facilities
Specific
protection
Appropriate pre, peri and postnatal care
Universal iodization of salt
Rubella immunization for women before Pregnancy
Folic acid administration in early pregnancy
Prevention of teratogen exposure (e.g.,teratogenic drugs, substance
abuse, toxins, irradiation
Assist in Prenatal ultra sonographic screening
Provide Genetic counselling
Assist in detection and care for high-risk pregnancies
Providing Universal immunization for Antenatal mother & children

17. LEVEL APPROACH
SECONDARY
PREVENTION
(halting disease
progression)
 Assist in Early diagnosis and
treatment
 Provide Early childhood care
and education
 Understand importance of play
 Encourage Age appropriate
activities in children
 Support families in making
choices
 Work towards inclusive early
 Neonatal screening for treatable
disorders (hypothyroidism,
phenynlketonuria,hydrocephalus)
 Perform the regular developmental
monitoring & screening
 Address the parental concerns
 Provide the guidance to promote the
positive development
 Provide-referral/Reporting services

18. LEVEL APPROACH EXAMPLE OF STEPS
TERTIARY
PREVENTION
(preventing
complications and
maximization of
functions)
Assist in
Disability
limitation and
Rehabilitation
• Provide early stimulation,
training, and education,
• Provide vocational
opportunities for grown
up children
• Guidance for
Mainstreaming
integration
• Support families
• Support Parental self-help
groups

19. NURSING INTERVENTION IN CLINICAL AREA
• Nurses should work with the children on individual basis.
Nurses will participate in Specific Nursing
Intervention :
• – Participate in Medical interventions
• –Assist for Speech and language therapy
• –Assist for Physiotherapy and occupational therapy
• – Encourage Self-help and social skills training
• – Facilitate Education – (inclusion in normal stream or special
education)

20. Enhance sensory stimulation:
• Provide Tummy time to the infants
• Encourage child to touch and play with variety of textures
to stimulate different senses.
• Support the child to learn their name and their own
body parts.
• Encourage sensory stimulation by appropriate touching of
the body parts.
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21. Conti….
Protect child from self-injury:
• Use protective devices such as helmet, and hand mitts.
Develop social interaction:
• Provide familiar caregivers to improve warmth,
acceptance.
• Provide child with familiar toys and support
• Give positive reinforcement for appropriate social
interaction
21

22. Conti….
Improve verbal communication:
• Provide constant caregivers
• Anticipate and fulfil the child’s need
• Seek clarification for inappropriate communication.
• Provide positive reinforcement for verbal expression
22

23. Nurses and Care Givers Role in Dealing with
the challenging behaviours of children with
Developmental Delays and Disorders
23

24. Technique Brief description
Disregarding Ignoring the behavior (as if it is not occurring at all) but continuing the
attention to child
Ignoring Ignoring both the child and behavior
Redirecting Catching the child during an odd behavior is beginning and guiding to
child towards an appropriate behavior
Limit-setting Clearly communicating what is acceptable and unacceptable behaviors to
the child and enforcing these
Blocking Preventing the behavior from being completed (example: Deviating the
aggression in to constructive activities ).
Gradual guidance Gradual guidance towards completion of task
Time-out (from
positive
reinforcement)
Removal of attention and reinforcement contingent upon occurrence of a
specified maladaptive / undesirable behavior
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25. Nurses and Care Givers Role in Dealing
with behavior modification techniques for
eliminating odd and problematic behavior
in children
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26. Technique Brief definition
Task analysis  Breaking activity into sequential steps
 Number of steps depends on child's learning capacity
Rewarding Pleasant event following a given behavior; can be material (chocolate,
pen, pencil) or social (praise, giving more attention/grace time to play
or TV time)
It should be immediate, consistent, appropriate.
Modeling Showing how or demonstrating, so that the child imitate and learn
(parents or caregivers models appropriate behavior when stressed out,
overwhelmed, or in conflict, so that their children sobserve the proper
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27. Technique Brief definition
Shaping Successive approximation to final task; teaching the simplified version
of the total task and gradually increasing the complexity (Hand
washing, Eating with fingers & Spoon)
Chaining Breaking the task into small steps and teaching one after another
Forward chaining
Back chaining
Teaching the first step first ( eg: buttoning the shirt)
Teaching the last step first and then going backwards (Un buttoning)
Prompting Assisting the child verbally or physically ( to explain how to greet
elders) and gradually fading the assistance
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28. Nurses Role in Early Intervention & Parental
Activities

29. Nurses need to help the child and parents in following activities…
• In Understanding child’s developmental progress.
• Help in Identifying the child’s strengths to enhance self-confidence.
• Help in Participate in the training services
• To Share feelings with others to relieve negative emotions.
• To Join with parent self-help groups and make good use of
community and governmental resources and benefits
29

30. Nurses Role In Support parents/ caregivers
•Parent Mediated Training for home based
intervention(PMT)
•Family networking; Parent associations
•Parental counselling is an effective therapy in reducing
parental anxiety, guilt and mental exhaustion.

31. Trend in Child Care
Old concepts New Concepts
Disease (centered care) Child centered care
Discourage the families on neglect
of the female child
Take care of female child with
Immunization of tetanus
Care of the women afterbecoming
pregnant
Health education on planned
parenthoods and doing the maternalhealth
Special care during the last trimester and
the postnatal period to the child born
withcongenital anomalies and
hereditary disorders.
Early identification & family counseling based
on bio chemical screening & chromosomal
studies it helps to prevent congenital
anomalies and hereditary disorders
in children.
Caring of child after the birth
only
Caring the health of the child from
the day of conception.

32. Conclusion
• Child mental health nurses are vital to improving access to mental
health services and the well-being of children and their families. In
most countries there are too few mental health nurses to serve the
needs of the citizenry (WHO, 2015).As the roles of child mental health
nurses and community workers expand so must the documentation
of their efforts: whom they see, what needs they address, and with
what outcomes.

33. •Thank you