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what are the classifications of mental disorders
precently there are two major classification systems. 1- DSM-IV-TR, 2- international statistical classification of diseases and related health problems.
what is DSM-IV-TR
- is an axis system, that consist of five axis.
- AXIS I- sign and symptoms that together make up a particular disorder.
- AXIS II- refers to personality disorders and mental retardation.
- AXIS III- refers to general medical condition.
- AXIS IV- reports psychosocial and environmental problems.
- AXIS V- is a global assesment of functioning during the preceding year. rated on a scale of 1-100
levels of psychiatric mental health clinical nursing practice are:
- basic level
- advance practice
a psychiatric mental health registered nurse holds a bacculaureate degree in nursing and may become certified.
an advanced practice registered nurse-psychiatric mental health(APRN-PMH) will have preparation at the masters degree or higher level in psychiatric nursing.
what are the major theories of personality
freud,erickson,sullivan,paplau and maslow
SIGMUND FREUD(psychoanalytic theory)
- freud believed that there were 3 levels of psychological awareness.
the 3 personality structures:
- ID- (fun) source of drives and instinct.lacks ability to problem solve.
- EGO-(it restricits) follows the reality principle.
- SUPEREGO-)perfection) it strives for perfection as opposed to seeking pleasure or engaging reason.
ERIK ERIKSON(ego theory)
erikson believed that personality was not set in stone,but that it continues to develop throughout lifespan.
- THEORY OF INTERPERSONAL RELATIONSHIP IN NURSING.
- she was influenced by sullivans interpersonal theory.
- developed the 1st systematic theoretical framework for PSYCHIATRIC NURSING(the one-to-one nurse-patient relationship)
- her theory is mainly concerned with the process by wich the nurse helps patients make positive changes in their health care status and well being.
- she identifyed stages of nurse-patient relationship:
- she also believed thst nurses working with psychiatric pt need to have an awareness of their own behavior.
behavioral theories and therapies
- behavioral therapies- developed as a protest to freuds assumption that a persons destiny is carved in stone. they argue that personality simply consist of lerned behavior.
- based on learning theory. maladaptive behavior can be unlearned and adaptive behavior learned.
- useful techniques are:
- operant conditioning
- systematic desensitization
ABRAHAM MASLOW(humanistic psychology theory)
- humanistic theories focus on human potential.
- maslows hierarchy of six incremental stages assumes that humans are active rather than passive participants in life. striving for self-actualization.
this therapy establishes a safe,supportive environment with an emphasis on group and social interaction.
purpose of psychiatric assessment are:
- establish report
- obtain understanding of current problem
- assess persons current level of psychological function
- identify goals
- perform MSE(mental status examination)
- identufy behaviors/beliefs
- formulate a plan of care
- PRIMARY SOURCE OF DATE COLLECTION IS THE PATIENT.
- nursing dx has 3 components:
- problem (unmet need)-nursing dx tittle states what should change
- etiology(probable cause)-linked to the dx tittle with words "related to"
- supporting data(signs&symptoms)-state what condition is presently like and validate dx.
consist of identifying nursing interventions that help meet the outcome.interventions need to be safe, realistic. appropriate, evidence based and individualized
is an ongoing process throughout all phases of the nursing process
barrieres to quality mental health services
- ethnic variations in pharmacodynamics-
- populations at risk for mental illness and inadequate care
- cultural minorities
concept of nurse-patient relationship
this is the basis of all psychiatric mental health nursing treatment.it promotes self care and independence
primarily initiated for the purpose of friendship,socialization, enjoyment or task accomplishment.
therapeutic relationships(unequal/strong boundaries)
these focus on pt needs rather then the nurse. pt issues, problems and concerns are explored and potential solutions are discussed.
PEPLAU'S MODEL OF THE NURSE-PATIENT RELATIONSHIP
- in this professional helping relationship relevant behaviors include
- focus on pt needs
- clinical competence
- supervision to validate performance quality
THERAPEUTIC ENCOUNTER- an abbreviated or limited relationship
- there are 4 phases:
PREORIENTATION(b4 u c pt)
phase involves thoughs and feelings the nurse experiences prior to the 1st clinical session
2nd phase ranges from few meetings to longer term. establishing trust/ establishing a rapport/confidentiality. and planning for termination.
3rd phase. task include maintainig the relationship,gathering further data, promoting pt problem solving skills, self esteem and use of language
final stage- this phase will provide an excellent learning experience for both pt and nurse and its time to summerize goals, reviewing situations that occurred and evaluating progress.
factors that enhance growth in others
- empathy-ability to see things from the other persons perspective, to experience what other is feeling, objective
- positive regard-implies respect
- suspecting value judgement
- helping pt develop resources
- consist of all words a person speaks. when we speak we communicate beliefs and values, perceptions and meanings. words have different meanings for different people
INTERACTION OF VERBAL AND NONVERBAL COMMUNICATION
- VERBAL MESSAGE-is considered the content.
- NONVERBAL MESSAGE- is considered the process
THERAPEUTIC COMMUNICATION TECHNIQUES
- using silence
- active listening-includes observing a pts nonverbal behaviors.
- listening with empathy-(empathy the most important elementin therapeutic therapy)
- clarifying techniques- seeks verification of interpretation( paraphrasing/restating/reflecting/exploring)
- asking questions and eliciting pt responces(open ended quest.
NON-THERAPEUTIC COMMUNICATION TECHNIQUES
- excessive quest.
- giving approval or disapproval
- asking "why" quest
- giving advice
- cultural considerations
HOW TO BEGIN AN INTERVIEW
- pace-permitt pt to set the pace.
- setting-conversation should take place in normal tones and eye contact. door accessible to both
- introductions- rn tell pt who they are, name and purpose of meeting confidentiality should be address at this point.
- initiate interview- after intro, give pt the lead by using an open ended statement
- tactic to avoid- arguing, praising, giving false reassurance, speculating