Psychiatric Nursing ( N127A )

1. Psychiatric Nursing (N127A) Chia-Ling Mao Phone: 924-3152 Chia-Ling.Mao@sjsu.edu http://www.sjsu.edu/people/chia-ling.mao Office: HB 411 Office hours: by appointment Monday: 2:30-5:00 Tuesday: 2:00-4:30 • Lou Ellen Barnes-Willis • Phone: 924-3178 • louellen.barnes-willis@sjsu.edu • Office: HB 411 • Office hours: by appointment 1

2. Course reader – Exams & dates 9/20; 11/1 ; Final (?) ATI psychiatric-mental health nursing 12/5 at MH 321 & 332 Passing rate- 73% Student handbook – special accommodation Concurrent session - N137 Calendar is subject to change Introduction 2

3. Evolution of the Care for the Mentally Ill Chlopromazine Freud Managed Care Enlightenment Period Neurotransmitter Community Support System Dark Period Community Mental Health Act 18C 19C 20C-50’s 60’s 80’s 90’s 21C ______________________________________________ The decade of the brain Humanistic Care Atypical antipsychotics Psychodynamic Theory Neurosurgery Partnership Parity Psychopharmacology Group therapy; family therapy 3

4. Health Continuum Adaptive Maladaptive Rational Logical Realistic Productive Satisfying activity Fulfilling R Anxiety Disorders Mood Disorders Personality Disorders Psychoses 4

5. To treatment using the least restrictive alternative/environment To confidentiality To freedom from restraints and seclusion To give or refuse consent to treatment To access to personal belongings To daily exercise, to have visitors, to use of telephone, writing materials, & uncensored mail. To refuse ECT or psychosurgery Commonly adopted Patient’s right 5

6. Nurse-Patient Relationship – the main tool in treating clients Psychopharmacology – biochemical imbalance Milieu Management - Psychotherapeutic Management 6

7. Def: Levels of care through which an individual can move depending on his needs at a given point in time. Hospital-based care Community based care Case management Continuum of Psychiatric Care 7

8. In-patient service Out patient service Emergency service Partial hospitalization Education and counseling Types of Community Services 8

9. Use traditional knowledge/skill in new setting; Short, crisis oriented inpatient stay, Intensive outpatient services, Wider range of treatment modalities Multidisciplinary collaboration Challenges 9

10. Primary prevention - educating women regarding drugs, alcohol, smoking effects on developing fetus/infant. Secondary prevention - National Depression Project, screening and encouraging treatment. Tertiary prevention - Rehab, work skills with chronic schizophrenics Levels of Prevention 10

11. Background - Cost-effective Problem oriented, outcome based, Who - HMO, Independent practice association, and preferred provider organizations Treatment type, medication, hospital stay Managed Care 11

12. Dangerous to self/others Gravely disables Acutely psychotic Suicidal/homicidal In-patients: Risk assessment 12

13. Shorter stay - deinstitutionalization Priority is on “safety”, gravely disabled Minimal time for thorough evaluation and establishing diagnosis and treatment Major issues - time for stabilization on medications; noncompliance; readmission (revolving door syndrome) Hospital Based Care 13

14. Severity of individual’s illness Amount of supervision required by the individual Community-based Care - Assessment 14

15. Home care - homebound clients Outreach services - for homeless clients Residential services - Group homes - temp./permanent housing Halfway house - chemical dependency Apartment living programs Foster care and boarding homes Self-help groups Range of Community-based Care 15

16. Goal - most effective care in least restrictive setting and $$$ Programs - sub-acute, independent living, to home care Holistic nursing with community orientation - N-P relationship, medication compliance, functioning in the milieu, application of nursing process Community Based Care 16

17. Use all therapeutic resources, including the environment, to facilitate patient care. It involves purposeful use of all interpersonal and environmental forces to enhance mental health. Milieu Management - Definition 17

18. to develop an atmosphere that facilitates patients’ growth, rehabilitation, & restoration of health. Milieu Management - Goals 18

19. Community MH movement - therapeutic community Laboratory (microcosm) for living, learning effective personal & social coping, problem solving/ testing behaviors in a more secure environment Shared governance & control Variation is used in some substance abuse programs Milieu Management 19

20. Elements of the Effective Milieu • Safety - no danger or harm, both psychological & physical • Structure - physical environment, unit regulations, daily schedule • Norms - expected behaviors for a given unit • Limit setting - • Balance • Environmental modification 20

21. Ongoing assessment and maintenance of all equipment Hazard surveillance Reporting and investigation of safety issues Monitoring of safety management techniques and procedures Orientation programs that address safety issues Safety - structure, designs, ... 21

22. Mechanisms for addressing security issues Provision of appropriate identification for all staff, patients, and visitors Security orientation programs Mechanisms for handling emergencies Mechanisms for interacting with the media Security - pt, staff, visitors 22

23. Space for storage of grooming and hygiene articles Closet and drawer space for personal property Clothing that is suitable for clinical conditions Social environment - unique individuals 23

24. Adequate privacy to insure respect for patients Door locks consistent with program goals Availability of telephones that allow for private conversation Sleeping rooms with doors for privacy unless clinically contraindicated Furnishing suitable to the population served Access to the outdoors unless contraindicated for therapeutic reasons Physical setting 24

25. Group leader, co-leader - treatment philosophy, collaborator, ... Team member/ leader - supervisor, trainer... Therapist/counselor - group, family therapy Psychopharmacology/ drug expert - a monitor, educator, … Milieu manager - safety, structure, limit setting Roles of Nurse in Milieu Management 25

26. Basic level practice of the nurse Effective team member for the benefit of patients, caregivers, and providers Advocate for both consumer and providers; access, cost, outcomes Balancing cost with outcomes; personal and professional ethics applied to managing care Case Manager 26

27. Psychiatric rehabilitation Resource linkage Consultation/ liaison Advocacy - NAMI Crisis intervention Home care Therapy Elements of Case Management 27

28. Case Management 1. Coordination of care 2. Access to care 3. Holistic care 28

29. Impairment – hallucination, depression Dysfunction – lack of work adjustment skills, social skills, or ADL skills Disability – unemployment, homelessness Disadvantage – discrimination, poverty The Negative Impact of Severe Mental Illness 29

30. Essential Client Services in a Caring System (I) 30

31. Essential Client Services in a Caring System (II) 31

32. Essential Client Services in a Caring System (III) 32

33. Theory – beliefs about how things happen and work Theory lead to the expansion of knowledge Theories & models: Psychoanalytic theory Behavior theory Cognitive-behavior theory Ecologic-developmental model Theory and model 33

34. Nursing practice based on the scientific method and empirical evidence Def: Care that integrates the best available evidence from research with clinical expertise Barrier – some clients are disenchanted with the outcomes of professionally approved treatments Pseudoscientific information from internet Evidence based practice 35

35. Political and social involvement in pt care Roles of the psychiatric nurse Counseling, crisis intervention, managing the therapeutic environment, health and psycho-educational teaching, case management, administration and monitoring of psychobiological treatment Conclusion 36

36. Havea wonderful semester 37