nursing care for mentally ill patients · psychiatric nursing is an interpersonal process that...
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DR. ARNEL BANAGA SALGADO, D.Sc., Ed.D., RN, MA, B.Sc, Cert .Ed, MAT (Psychology)
H/P No.: 050-799-3803 URL: www.ifeet.co; www.ifeet.org; www.ifeet.com.ph
Personal URL: www.abs.com.ph; www.arnelsalgado.com
Doctor of Science (D.Sc.)
Doctor of Education (Ed.D.)
Master of Arts in Nursing (RP)
Master of Arts in Teaching - Psychology (PNU)
Registered Nurse (RP, Mal, UAE)
Licensed Teacher (RP)
Certificate in Teaching,
Bachelor of Science in Nursing (BSN)
Author of
McGraw-Hill
NURSING CARE FOR
MENTALLY ILL PATIENTS
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Role of a Psychiatric Nurse
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Learning Objectives
Define therapeutic milieu
Discuss the role of the nurse in the psychotherapeutic process
Explain various phases of therapeutic relationship
Discuss factors important in the establishment of a nurse–patient relationship
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Introduction
Psychiatric nursing is an interpersonal process that promotes and maintains the integrated adaptive functioning of patients.
The psychiatric nurse works with other members of the treating team and facilitates the best possible treatment options for the patient.
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Therapeutic Milieu
Milieu is a term which encompasses:
i. Setting
ii. Structure
iii. People
iv. Emotional climate
Therapeutic milieu uses a combination of the social environment and therapeutic approaches for healing purposes.
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Therapeutic Milieu (cont.)
Therapeutic milieu provides a supportive and safe environment for the patient.
Group activities enhance the functional ability of the patient.
As the nurse spends a lot of time with a patient, she becomes a role model for various social behaviours and communication skills.
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Roles of a Psychiatric Nurse
The nurse performs three major functions which include:
i. Care
ii. Communication
iii. Management
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Roles of a Psychiatric Nurse (cont.)
The six major roles of a psychiatric nurse are:
i. Caregiver
ii. Educator
iii. Counsellor
iv. Advocate
v. Coordinator
vi. Health promoter
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The Nurse–Patient Relationship
This relationship forms the basis of all psychiatric nursing treatment approaches.
It is loosely defined as a therapeutic relationship.
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A therapeutic relationship:
i. focuses on the needs and problems of the patient
ii. establishes an understanding in the patient that the relationship is safe, reliable, and confidential and has clear boundaries
The Nurse–Patient Relationship (cont.)
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Phases of a Nurse–Patient Relationship
Peplau described three phases of nurse–patient relationship:
i. Orientation phase
ii. Working phase
iii. Termination phase
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Orientation Phase
Goal: Establishing trust
i. Defining and clarifying roles of nurse and patient
ii. Clarifying the purpose of meetings
iii. Drawing a contract—verbal or written
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iv. Identifying problems and setting the goals of the treatment
v. Maintaining confidentiality
vi. Setting the time limit of the working relationship
Orientation Phase (cont.)
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Working Phase
Goal: Identifying and exploring the needs and problems of the patient
i. Collecting data
ii. Identifying problems
iii. Promoting problem-solving skills
iv. Developing new coping skills
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Working Phase (cont.)
v. Facilitating behavioural changes
vi. Periodic evaluation of goals and progress made
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Termination Phase
Goal: Consolidating goals and objectives achieved
i. Summarizing accomplishments
ii. Addressing the emotions aroused because of separation
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Factors Promoting Establishment of Therapeutic Relationship
Nurse factors:
i. Consistency
ii. Positive attitude
iii. Active listening
iv. Setting of pace
v. Control
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Factors Promoting Establishment of Therapeutic Relationship (cont.)
Patient factors:
i. Trust
ii. Active participation
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Nurse factors:
i. Inconsistency
ii. Unavailability
iii. Negative attitude
iv. Lack of confidentiality
Factors Hindering Establishment of Therapeutic Relationship
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Patient factors:
i. Resistance
ii. Illness factors
Factors Hindering Establishment of Therapeutic Relationship (cont.)