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Chapter 09
- 1. Psychiatric Mental Health Nursing,
6th Edition
Chapter 9
The Nursing Process in
Psychiatric/Mental Health Nursing
Copyright © 2009. F.A. Davis Company
- 2. Psychiatric Mental Health Nursing,
6th Edition
The Nursing Process
It is a systematic framework for the delivery of
nursing care.
It uses a problem-solving approach.
It is goal-directed, its objective being the delivery
of quality client care.
It is dynamic, not static.
Copyright © 2009. F.A. Davis Company
- 3. Psychiatric Mental Health Nursing,
6th Edition
Standards of Practice
The standards of practice for psychiatric nursing
are written around the six steps of the nursing
process.
Assessment—information is gathered from which
to establish a client database. Box 9 - 1
Interviews
Observation
Health team members
Medical records
Copyright © 2009. F.A. Davis Company
- 4. Psychiatric Mental Health Nursing,
6th Edition
Standards of Practice
Diagnosis—data from the assessment are
analyzed. Diagnoses and potential problem
statements are formulated and prioritized.
It includes level of risks assessed in your
Psychosocial assessment
Problems identified
See Appendix D and E
Copyright © 2009. F.A. Davis Company
- 5. Psychiatric Mental Health Nursing,
6th Edition
Standards of Practice
Outcome identification—
Expected outcomes of care are identified.
They must be measurable and estimate a time for attainment.
Realistic for client’s capabilities
Effective when written by the health care team and client/significant
others
Nursing Outcomes Classification (NOC)—
a comprehensive, standardized classification of patient outcomes
developed to evaluate the effects of nursing interventions.
Linked to NANDA and NIC (nursing interventions classifications)
Copyright © 2009. F.A. Davis Company
- 6. Psychiatric Mental Health Nursing,
6th Edition
Standards of Practice
Planning—
evidence-based interventions for achieving the outcome criteria are
selected.
Individualized to the client’s mental health problems, condition, or needs
Developed collaboratively with the mental health team
The nursing interventions should occur independently but in concert with
overall treatment
Nursing Interventions Classification (NIC)—
a comprehensive, standardized language describing treatments that
nurses perform
in all settings and in all specialties.
NIC interventions are based on research and reflect current clinical
practice.
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- 7. Psychiatric Mental Health Nursing,
6th Edition
Standards of Practice
Implementation—interventions selected during
the planning stage are executed. Specific
interventions include
Coordination of care
Health teaching and
health promotion
Milieu therapy
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- 8. Psychiatric Mental Health Nursing,
6th Edition
Coordination of Care
Role of the Nurse
As a Case Manager the nurse acts to negotiate with multiple providers to
obtain diverse services.
Helps achieve health care goals within a prescribed period of time and
finances
Mental health case managers provide:
Improve functioning through problem solving
Improve social skills to be able to work in the community
Promote leisure time activities
Enhance overall productiveness
Copyright © 2009. F.A. Davis Company
- 9. Psychiatric Mental Health Nursing,
6th Edition
Health Teaching and Promotion
The role of the nurse as teacher:
Patients learn in three domains:
Cognitive domain – storing and recalling of new knowledge
Intellectual behaviors – acquisition of knowledge, comprehension, application,
analysis, synthesis, and evaluation
Psychomotor domain
Physical skills – the integration of mental and muscular activity
Ex: patient demonstrates how to change a dressing
Affective domain
Includes changes in attitude, values, and feelings
Ex: patient expresses renewed self confidence after physical therapy
Copyright © 2009. F.A. Davis Company
- 10. Psychiatric Mental Health Nursing,
6th Edition
Milieu therapy
The Nurse as the milieu therapists acts to:
The goal is to manipulate the environment so that all aspects of the client’s
hospital experience are considered therapeutic.
The purpose is to affect behavioral changes and improve the psychological
health and functioning of the individual
The therapeutic environment maintained by the healthcare team can
provide:
Aid in promoting adaptive coping
Increased interactions
Improved social skills
Build relationships to improve quality of life
Copyright © 2009. F.A. Davis Company
- 11. Psychiatric Mental Health Nursing,
6th Edition
Standards of Practice
Pharmacological, biological, and integrative
therapies.
Incorporating knowledge of pharmacological,
biological, and complementary intervention with
applied clinical skills to restore
the patient’s health and
prevent further disability.
Copyright © 2009. F.A. Davis Company
- 12. Psychiatric Mental Health Nursing,
6th Edition
Standards of Practice
Advanced Practice Interventions
Prescriptive authority and treatment
Psychotherapy
Consultation
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- 13. Psychiatric Mental Health Nursing,
6th Edition
Standards of Practice
Evaluation—measures progress toward
attainment of expected outcomes
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- 14. Psychiatric Mental Health Nursing,
6th Edition
Why Nursing Diagnosis?
Identification and classification of nursing
phenomena began in 1973 with the First National
Conference on Nursing Diagnosis.
Both general and specialty standards are written
around the six steps of the nursing process, of
which nursing diagnosis is an inherent part.
It is defined in most state nursing
practice acts as a legal responsibility
of nursing.
It promotes research in nursing.
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- 15. Psychiatric Mental Health Nursing,
6th Edition
Nursing Case Management
Case management—A health
delivery process whose goals
are to provide quality health care,
decrease fragmentation, enhance
the client’s quality of life, and
contain costs.
Managed care—A concept designed to control
the balance between cost and quality of care.
Individuals receive care based on need, which is
determined by coordinators of the providership.
Copyright © 2009. F.A. Davis Company
- 16. Psychiatric Mental Health Nursing,
6th Edition
Nursing Case Management
Case manager—The individual responsible for
negotiating with multiple health care providers to obtain a
variety of services for the client.
Critical Pathways of Care (CPCs)—The tools for
provision of care in a case management system. CPCs
are abbreviated plans of care on
which outcome-based guidelines
for goal achievement within a
designated length of time
have been established.
Copyright © 2009. F.A. Davis Company
- 17. Psychiatric Mental Health Nursing,
6th Edition
Nursing Case Management
CPCs are used by the entire interdisciplinary team. They determine
which categories of care will be provided, by what date, and by
whom.
Nurses may be identified as case managers and are ultimately
responsible for ensuring that goals on the CPC are achieved within
the designated time dimension.
CPCs may be standardized
because they are intended to
be used with uncomplicated cases.
A CPC can be viewed as a protocol
for clients with problems for which a
designated outcome can be predicted.
Copyright © 2009. F.A. Davis Company
- 18. Psychiatric Mental Health Nursing,
6th Edition
Applying Nursing Process
Role of the nurse in psychiatry
To assist the client’s successful adaptation to stressors
within the environment.
Goals are directed toward change in thoughts, feelings,
and behaviors that are age-appropriate and congruent
with local and cultural norms.
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.
Copyright © 2009. F.A. Davis Company
- 19. Psychiatric Mental Health Nursing,
6th Edition
Concept Mapping
A diagrammatic teaching
and learning strategy
Shows interrelationships
among medical and nursing
diagnoses, assessment data
and treatments
They are practical, realistic,
and time-saving
They enhance critical thinking skills
Copyright © 2009. F.A. Davis Company
- 20. Psychiatric Mental Health Nursing,
6th Edition
Concept Mapping (cont.)
Based on the components of the nursing process
Helps students develop a
holistic view of their clients
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- 21. Psychiatric Mental Health Nursing,
6th Edition
Documentation of the Nursing
Process
Documentation of the steps of the nursing
process is often considered as evidence in
determining certain cases of negligence by
nurses.
It is also required by
some agencies that
accredit health care
organizations.
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- 22. Psychiatric Mental Health Nursing,
6th Edition
Documentation of the Nursing
Process
Examples of documentation that reflect
use of the nursing process
Problem-Oriented Recording (POR)
Has a list of problems as its
basis
Uses subjective, objective,
assessment, plan, intervention,
and evaluation (SOAPIE) format
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- 23. Psychiatric Mental Health Nursing,
6th Edition
Documentation of the Nursing Process
Focus Charting
Main perspective is to choose a
“focus” for documentation. A focus may be
a nursing diagnosis
a current client concern or behavior
a significant change in the client’s status or behavior
a significant event in the client’s therapy
The focus cannot be a medical diagnosis.
It uses data, action, and response (DAR) format.
Copyright © 2009. F.A. Davis Company
- 24. Psychiatric Mental Health Nursing,
6th Edition
Documentation of the Nursing
Process
APIE method
A problem-oriented system
Uses flow sheets as accompanying
documentation
Uses assessment, problem,
intervention, and evaluation
(APIE) format
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- 25. Psychiatric Mental Health Nursing,
6th Edition
Electronic Documentation
Most health care facilities have implemented—or
are in the process of implementing—some type of
electronic health records (EHRs) or electronic
documentation system.
EHRs have been shown to
improve both the quality of
client care and the efficiency
of the health care system.
Copyright © 2009. F.A. Davis Company
- 26. Psychiatric Mental Health Nursing,
6th Edition
Electronic Documentation (cont.)
Eight Core Functions of EHRs:
Health information and data
Results management
Order entry/order management
Decision support
Electronic communication
and connectivity
Copyright © 2009. F.A. Davis Company
- 27. Psychiatric Mental Health Nursing,
6th Edition
Electronic Documentation (cont.)
Eight Core Functions of EHRs (cont.):
Patient support
Administrative processes
Reporting and population health management
Copyright © 2009. F.A. Davis Company
- 28. Psychiatric Mental Health Nursing,
6th Edition
Advantages and Disadvantages of Paper
and EHR charting
Paper EHRs
Advantages Advantages
Fast Accessed by many
Portable Facilitates research
and billing
People know it Reduces errors
Disadvantages Disadvantages
Can be lost Expensive
Hard to read Large learning curve for
Hard to store new users
Difficult to research Technical difficulties
Copyright © 2009. F.A. Davis Company