THE NURSING PROCESS IN PSYCHIATRIC/MENTAL HEALTH NURSING – Flashcards

A systematic framework for the delivery of nursing care. -It uses a problem-solving approach. -It is goal-directed—the delivery of quality client care. - It is dynamic, not static.

for psychiatric nursing are written around the six steps of the nursing process:

The collection of health data pertinent to patient's health or situation.

Data from the assessment are analyzed. Diagnoses and potential problem statements are formulated and prioritized.

Expected outcomes of care are identified. They must be measurable and estimate a time for attainment.

(NOC)—a comprehensive, standardized classification of patient outcomes developed to evaluate the effects of nursing interventions.

Evidence based interventions for achieving the outcome criteria are selected.

(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.

Interventions selected during the planning stage are executed.

-Coordination of care. -Health teaching and health promotion. -Milieu therapy: providing and maintaining a therapeutic environment for the client. -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.

-Prescriptive authority and treatment: in accordance with state and federal laws and regulations. -Psychotherapy: with individuals, couples, groups, and families, using evidence-based psychotherapeutic frameworks and nurse-patient therapeutic relationships. -Consultation: to influence the identified plan, enhance the abilities of other clinicians to provide services for patients, and effect change. Evaluation: measures progress toward attainment of expected outcomes.

-Identification and classification of nursing phenomena began in 1973 with the First Task Force to Name and Classify Nursing Diagnoses. -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.

A health delivery process whose goals are to provide quality health care, decrease fragmentation, enhance the client's quality of life, and contain costs.

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.

The individual responsible for negotiating with multiple healthcare providers to obtain a variety of services for the client.

-are the tools for provision of care in a case management system. It is an abbreviated plan of care on which outcome-based guidelines for goal achievement within a designated length of time have been established. -are used by the entire interdisciplinary team, who determines what categories of care are to be performed, by what date, and by whom. -Nurses may be identified as case managers and will be ultimately responsible for ensuring that goals on the CPC are achieved within the designated time dimension. -may be standardized, because they are intended to be used with uncomplicated cases. A CPC can be viewed as protocol for client with problems for which a designated outcome can be predicted.

-To assist the client to successfully adapt 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.

A diagrammatic teaching and learning strategy that allows students and faculty to visualize interrelationships between medical diagnoses, nursing diagnoses, assessment data, and treatments. -Based on the components of the nursing process. -Helps students develop a holistic view of their clients.

-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 healthcare organization accrediting agencies.

-Has a list of problems as its basis. -Uses subjective, objective, assessment, plan, intervention, and evaluation

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-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 a data, action, and response (DAR) format.

-A problem-oriented system. -It utilizes flow sheets as accompanying documentation. -It uses an assessment, problem, intervention, and evaluation (A PIE) format.

-Most healthcare 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 healthcare system. -Eight core functions that EHR systems should perform in the delivery of more efficient health care include: -Health information and data. More rapid access to patient information. -Results management. Easier access to computerized test results. -Order entry/order management. Computer-based order entries are safer and more efficient. -Decision support. Information support systems enhance clinical performance for many aspects of health care. -Electronic communication and connectivity. Improved communication among healthcare providers enhances client safety and quality of care. -Patient support. Improvement in control of chronic illnesses through computer-based client education, self-testing, and self-monitoring. -Administrative processes. Efficiency of healthcare organizations is increased through electronic scheduling systems. -Reporting and population health management. Computer assisted reporting increases speed and accuracy.

Healthcare professionals not only share their personal lives with groups of people but also encounter multiple group situations in their professional operations.

from each other in a group setting.

-A collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose. -Membership in a group is generally by chance (born into a group), by choice (voluntary affiliation), or by circumstance (the result of life-cycle events over which an individual may or may not have control).

The teaching of social norms.

Fellow members are available in time of need.

Groups provide assistance in endeavors that result in more effective outcomes than can be achieved by an individual alone.

Individuals receive joy and pleasure from interactions with significant others.

Learning takes place when group members share their knowledge with the others in the group.

Different groups enforce the established norms in various ways.

Groups often can bring about change at times when individuals alone are ineffective.

Large organizations often have leadership that is provided by groups rather than by a single individual.

A group formed to accomplish a specific outcome.

Focus is to convey knowledge and information to a number of individuals.

The concern of these groups is to prevent possible future upsets by educating the participants in effective ways of dealing with emotional stress arising from situational or developmental crises.

-Group therapy has a sound theoretical base and the leaders generally have advanced degrees in psychology, social work, nursing, or medicine. -Therapeutic groups are based to a lesser degree in theory. Focus is on group relations, interactions between group members, and the consideration of a selected issue. -Leaders of both types of groups must be knowledgeable about group process (the way in which group members interact with each other), as well as group content (the topic or issue being discussed in the group).

Composed of individuals with a similar problem. Serve to reduce the possibilities of further emotional distress leading to pathology and necessary treatment. May or may not have a professional leader. Run by members, and leadership often rotates from member to member.

-Seating: It is best when there is no barrier between the members. For example, a circle of chairs is better than chairs set around a table. -Size of the group makes a difference in the interaction among members. -Seven or eight members provides a favorable climate for optimal group interaction and relationship development. - Membership. Two types of groups exist: --open-endedgroups (those in which members leave and others join at any time during the existence of the group) and closed-endedgroups (those in which all members join at the time the group is organized and terminate at the end of the designated length of time).

By observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved.

Individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing.

Group members share their knowledge with each other. Leaders of teaching groups also provide information to group members.

Individuals provide assistance and support to each other, thereby helping to create a positive self-image and promote self-growth.

Group members are able to re-experience early family conflicts that remain unresolved.

Through interaction with and feedback from other members within the group, individuals are able to correct maladaptive social behaviors and learn and develop new social skills.

Group members who have mastered a particular psychosocial skill or developmental task serve as valuable role models for others.

The group offers many and varied opportunities for interacting with other people.

Members develop a sense of belonging that separates the individual ("I am") from the group ("we are").

Within the group, members are able to express both positive and negative feelings.

The group is able to help individual members take direction of their own lives and to accept responsibility for the quality of their existence.

Leader and members work together to establish rules and goals for the group. -The leader promotes trust and ensures that the rules do not interfere with the fulfillment of the goals. -Members are superficial and overly polite. Trust has not yet been established.

-Productive work toward completion of the task is undertaken. -Leader role diminishes and becomes more one of facilitator. -Trust has been established between the members and cohesiveness exists. Conflict is managed by the group members themselves.

-A sense of loss, precipitating the grief process, may be experienced by group members. -The leader encourages the group members to discuss these feelings of loss, and to reminisce about the accomplishments of the group. -Feelings of abandonment may be experienced by some members. Grief for previous losses may be triggered.

The focus is on the leader, on whom the members are dependent for problem solving, decision-making, and permission to perform. Production is high, but morale is low.

The focus is on the members, who are encouraged to participate fully in problem solving of issues that relate to the group, including taking action to effect change. Production is somewhat lower than it is with autocratic leadership, but morale is much higher.

There is no focus in this type of leadership. Goals are undefined, and members do as they please. Productivity and morale are low.

Members play one of three types of roles within a group: -Task roles. Roles that serve to complete the task of the group. -Maintenance roles. Roles that serve to maintain or enhance group processes. -Individual (personal) roles. Roles that serve to fulfill personal or individual needs.

Defined as a type of therapeutic group that employs a dramatic approach in which clients become "actors" in life-situation scenarios. -An identified client (called the protagonist) is selected to portray a life situation. Other members of the group play the roles of people with whom the protagonist has unresolved issues. Group members who do not participate in the drama act as the audience, and the group leader is called the director. -The purpose is to provide the client with a safe place in which to confront unresolved conflicts, and hopefully progress toward resolution. -Nurses who work as psychodramatists require specialized training beyond the master's degree.

Nurses who work in psychiatry may lead various types of therapeutic groups, such as client education groups, assertiveness training, support groups for clients with similar problems, parent groups, transition to discharge groups, and others.

specify that nurses who serve as group psychotherapists should have a minimum of a master's degree in psychiatric nursing.