PSYCHIATRIC NURSING

PSYCHIATRY

Mental health:
– If a person is able to coup up with stress or day today events. He is said to be mentally healthy
OR
– Maintaining an equilibrium between external and internal environment makes a person mentally healthy.
FACTOR EFFECT MENTAL HEALTH






• Physical condition
• Loss of loved one
• Calamity
Admission types: voluntary
Involuntary
• Voluntary: means own admission by patient
• Involuntary:
o admission through other person
o no need of consent from the pt for admission
o for any procedure take consent from both voluntary and involuntary patient
o most of the hospital has the policy of admission for 48 to 78 hr for observation
Discharge types
o conditional (discharge with condition)
o unconditional (discharge without any condition)
THERAPEUTIC COMMUNICATION:
o Goal oriented communication which include verbal and nonverbal expression within the professionals frame work
 OR
o It is structured goal oriented communication to collect the information from the client to provide information to the patient and help them to solve problem.
DOs & DO NOTS
• Being silent asking “why”
• Listening arguing with client
• Nonverbal encouragement challenging the pt
• Presenting reality asking closed ended question
• Providing information making judgmental comment
• Repeating and restating
• Summarizing giving false promises
• Asking open ended question double bind communication
• clarifying flattering the client
Complement the client
Giving opinion or advice
Disagreeing or agreeing with patient
Changing the subject
Over loading and under loading
(Not giving proper explanation)
COPING MECHANISM OR DEFENSE MECHANISM
1. DENIAL –consciously disowning intolerable though and ideas
2. RATIONALIZATION-justify own behavior ,by giving reasons
3. INTELLECTUALIZATION-it is a form of rationalization giving excessive reason which are dealt with a cognitive level
4. CONVERSION- emotional stress are converted in to a physical symptoms
5. DISPLACEMENT- feeling towards one person are directed towards another person who is less threatening
6. IDENTIFICATION- a conscious attempt to change oneself to resemble an admired person
7. INTROJECTIONs – incorporates values, behaviors, ideas ,or cultures of another person into self
8. REACTION FORMATION – consciously developing attitudes towards one persons or towards an object which is exactly opposite to what once really feels
9. REGRESSION- going back to an earlier development stage to reduce anxiety (return to childhood behavior)
10. SUPPRESSION –consciously trying to forgets painful ideas thought or events
11. REPRESSION – unconscious effort to forget painful ideas thought or event
12. ISOLATION – person separate feeling associated with unpleasant event from conscious expression
13. PROJECTION – transferring own feeling attitude to another person
14. UNDOING- doing something which is exactly opposite to the previous act
15. SUBLIMATION- channelization of social unacceptable behavior into acceptable one (orphanage)
16. SUBSTITUTION- Replacement with a valued unacceptable object with another object which is more satisfying to our ego
17. COMPENSATION: putting extra effort in areas, to compensate other area in which one person has real or imagine deficiently
18. FANTASY- gratification by imaginary achievements and wishful thing
19. SYMBOLIZATION: conscious use of an idea or object to represent internal feeling
20. BLOCKING: sudden stopping in the speech
21. CONFABULATION: filling the gap from fantasy

MODELS OF CARE OR DIFFERENT TYPES OF THERAPY

MILIEU THERAPY: (therapeutic environment):
– physical, social, spiritual, emotional, safe or hazard free environment
– otherwise living, learning and working environment
PSYCHOTHERAPY (therapeutic communicate)
 express the feeling and helps to solve the problems
Level of psycho therapy
I. supportive- give support, Don’t introduce anything
II. re educative- educating the client regarding the new ways of behaving and preserving (understanding the environment)
III. reconstructive: it include psycho analysis, emotion and cognitive restructuring
BEHAVIOUR MODIFICATIN THERAPY;
 BEHAVIOR THERAPY – an approach to bring about behavioral change, by ways to deal with the stress and deal with maladaptive behavior
SELF CONTROL THERAPY : own control
AVERSION OR NEGATIVE REINFORCEMENT – A stimulus which is attractive to the client is paired with an unpleasant event with negative property to discourage the behavior
 POSITIVE REINFORCEMENT – Rewarding the client for a desired behavior
 SYSTEMIC DESENSITIZATION- Gradually reducing the intense reaction to a stimulus by repeated exposure to it




 MODELING: therapist act as the role model for the client in certain behaviors
COGNITIVE THERAPY
• it is a time oriented structure reality testing to correct distorted and dysfunctional believes
GROUP THERAPY:
• Maximum not to members are 8 to 10
• Leader is the nurse or therapist
Phase of Group therapy
 Initial phase or orientation phase
– Self-introduction
– Introduce regarding goal of therapy.
– Termination process begin
 Working phase: (problem solving)
– Patient will explain their own problem and discus the solving method and practicing them self
 Termination phase (end stage)
– Normal reaction of the patient during termination is crying
ANONYMOUS GROUP THERAPY
 Leader will be a member
 First step to attend the therapy only to admit with a problem
 No need of prescription from the doctor
 Primary purpose of group therapy is socialization
ROGERIAN THERAPY
 The therapist encourage the group members to express their feeling towards each other
INDIVIDUAL THERAPY
 1:1 relationship with patient
FAMILY THERAPY
 Organized for the family member
PSYCHODRAMA (role play):
 exploring the truth by using the dramatically method
COMMUNALLY SUPPORT GROUP
REMINISCENCE: helping to remember the past things
COMMON BEHAVIOR IN THE PSYCHIATRIC UNITS
1: CRYING: *
• being silent
• offering help
• set limit on behavior
2: AGGRESSION /ANGER/HOSTILITY (VIOLENT)
• being the world as an enemy
Management:
• allow the patient to express his feeling
• Provide an atmosphere of acceptance
• Find out the reason of anger
• Call for assistance if needed
• Supervise the patient
• Reduce environmental stimuli
• Keep a personal space
• Divert the attention
• Use low pitched clam voice
• Monitor for self-injury and injury to other
3. RESTRAINS
• Obtain consent and doctor order before putting the patient to restraint
• If emergency without consent and doctor order we can do restraint but obtain order later
• Restraint should be check every 15 -30 minutes
• Place the patient alone in room and attach restrain to the bed frame
• Room must be near to nurse’s station or to the TV room
• Purpose of restraint or seclusion is protection and close supervision
• Restraint should be check for skin intact
• Frequent assessment of the patient whether he is able to come out
• Principle of selection is least restriction for least possible time
• Do not use occlusion and restraint as a method of punishment
• Safety is the priority
• Remove other patients from the area when patient suddenly harming to others or harming self
• Impose limitation
• Patient can be removed from the seclusion if patient shows calm and quit behaviors, if he is able to explain what happening before seclusion, or if able to follow instruction
• Don’t carry harmful object in to the room like scissor, and stethoscope
• Don’t walk alone
• Alert the patient before entering the room
• Keep a safe distance
4. SUICIDAL IDEATION
High risk group:
• Old age (increased 50yrs)
• Sense of helplessness
• adolescent(15-19yrs)
• Body image damage
• Chronic illness
• Memory impairment
• IV drug abuses
• Family history
• Previous suicidal attempt
LETHALITY
• High risk of death
Types:
• More lethal (suicide drugs with a alcohol, gunshot ,hanging, jumping from height
• Less lethal (cutting veins, drug alone)
SUICIDAL CLUES
• Verbal comments
• depressed patient after 10-14 days of medication
• Sudden socialization
• Difficulty in concentration
• Giving valuable object to lovable Pearson
• Changing will and LIC policy
• Changes in appetite and sleep
• Asking about lethal object
Nursing responsibility
• Ask patient directly about suicidal plans
• Keep the patient matter confidential
• Inform all the staff member and unit about suicidal ideation
• Check the patient s belongings
• Provides a safe environment
• Provide 24 hours supervision by L P N
• Closely monitor patient activity
• Establish written contract
• Do not judges the patient
• Provide support system
WANDERING:
– Wandering is a common behavior usually seen in disoriented and confused client
Management
• Supervision
• Safety measures
• Reorientation
• Place a clock and single dated calendar in the room
• Keep familiar object in the room
• Engage in activity
• Consistency of care and care giver
• Placing alarm on the door
• Give identification bracelet
• Call the client by name and introduce yourself each and every time when you enter the room
• Use simple sentence while explaining
DEPENDENCY
Management
 Rotating the staff member
 Clearly explain to the patient what we are expecting from him
SPLITTING
Telling different thing to different nurses with the aim of secondary gain
Management
 frequently rotating staff
 provide a primary nurse

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