1. Chapter 6Mental Health Nursing in Community Settings F Menu

2. Helpful Attributes for CMHNs • Awareness of self; personal and cultural values • Calm external manner; nonjudgmental; flexible • Skills: problem solving, psychosocial and health assessment, communication • Ability to cross service systems, recognize need for consultation, see strength and ability in even the severely ill • Knowledge of community resources, psychopharmacology, political vision • Willingness to work with those identified by client as support people • Understanding of the social, cultural, and political issues that affect mental health and illness B F Menu

3. Bio-Psychosocial Nursing Assessment Additional Elements of Importance for CMHNs • Recent service utilization • Vocational success/difficulty • Income and source of income • Housing adequacy and stability • Family and support system • Level of activity • Meets needs independently/with assistance • Cultural beliefs, re: care B F Menu

4. Comparison: Inpatient & CMH settings • CMH Settings • Locked apartment • Client-set boundaries • Erratic food, housekeeping, security services • Client may be noncompliant • Social isolation • Limited support • Inpatient Settings • Locked unit • Staff-set boundaries • Regular food, housekeeping, security services • Medication encouraged • Milieu • Health care team support B F Menu

5. Comparison: Inpatient & CMH Goals • CMH Goals • Client will maintain stability in the community • Client will participate as active member of treatment team • Client will demonstrate improved ability to function • Inpatient Goals • Client symptoms will be stabilized • Client will return to community B F Menu

6. Comparison: Inpatient & CMH Interventions • CMH Boundaries • Access negotiated with client or gained trough family, police, or landlord • Inpatient Boundaries • Enforced by seclusion and restraint • Inpatient Relationship • Develop short-term therapeutic relationship • CMH Relationship • Maintain long-term therapeutic relationship B F Menu

7. Comparison: Inpatient & CMH Interventions, cont. • CMH Medication • Negotiate consent for and adherence to taking medication • Inpatient Medication • Supervised, even court-ordered • Inpatient Socialization Activities • Provided and required • CMH Socialization Activities • Assist client to identify and use community resources B F Menu

8. Comparison: Inpatient & CMH Interventions, cont. • CMH Self Care, Nutrition, Health Care • Negotiate meaning of adequate self care, nutrition, and health care with client and social support system • Assist client in assessing for needed community services • Inpatient Self Care, Nutrition, Health Care • Assist self care, nutrition • Health assessment and intervention prn B F Menu

9. Comparison: Inpatient & CMH Interventions, cont. • Inpatient Sociocultural Context • Develop plan of care that attends to sociocultural context of individual • CMH Sociocultural Context • Work with client and support system to plan and implement care consistent with sociocultural belief system and context B F Menu

10. Common Ethical Dilemmas in Community Mental Health Nursing • Issue of Social Control What’s best for individual vs. what’s best for community • Issue of Privilege Confidentiality vs. obligation to report B Menu