Multiple physical changes can impair the mental health of the aging individual. These changes include: acid-based imbalances, dehydration, electrolyte changes, hypothermia or hyperthermia, and hypothyroidism. This chapter reviews the most common mental health disorders affecting the elderly population and trends affecting care delivery. Moreover, chronic, unresolved pain has been associated with an increased risk of a mental health disorder such as depression, suicide, or anxiety. The aging individual may exhibit signs and symptoms of insomnia such as sleeping for short periods during the night, sleeping during times of normal social activities, arising early in the morning while others sleep, and experiencing daytime sleepiness. The chapter concludes by applying the nursing process from an interpersonal perspective to the care of an elderly patient with a mental health disorder.

Nurses have many opportunities to interact with patients while engaged in the interpersonal relationship for delivering psychiatric-mental health nursing care. It is inevitable that many of these interactions will occur during moments of crisis. Crisis in mental health may range from violent out-of-control behavior to withdrawal and suicidal ideation, affecting individuals, families, communities, and the world. Nurses have the ability and moral obligation to prepare for and respond to these critical moments of human need. With knowledge in crisis intervention, nurses are thus empowered to make a difference during these pivotal moments. This chapter briefly reviews the stress response and how it relates to crisis. It discusses the characteristics and types of crises and the factors that can affect an individual’s response to a crisis. Integrating the interpersonal relationship and therapeutic use of self, the nurse’s role in crisis intervention is explored by applying the nursing process.

This chapter describes the types of abuse and provides an overview of the historical aspects and epidemiology related to abuse and violence. Violence is demonstrated through physical, sexual, economic, or psychological abuse, or a combination of methods. The abuse is used to dominate the person. Domestic violence involving abuse perpetrated by an intimate partner, immediate family member, or other relative accounted for more than one fifth of all nonfatal violent crime against victims during the aggregate period of 2003 to 2012. Some cases of elder abuse involve intimate partner violence (IPV), but many cases also involve abuse by an adult child of the victim. Abusers may be dependent on their victims for financial assistance due to personal issues, substance abuse issues, or psychiatric problems. The chapter concludes with a discussion of the nursing responsibilities from an interpersonal perspective when caring for victims of abuse and their victimizers.

This chapter defines the term self and components of recovery. It identifies the principles of dialogue, describes ways to develop greater self-awareness, and also defines therapeutic communication. The chapter discusses the key concepts of therapeutic communication and explains the significance of therapeutic communication to establish and maintain therapeutic nurse-patient relationships. It examines techniques of therapeutic communication and barriers to effective therapeutic communication. The chapter also examines the foundations of Emotional Connection, emPowerment, and Revitalization (eCPR) and the five intentions of eCPR. It presents the role of nurses in helping relationships and integrates three important trends in mental health care: use of self, the recovery paradigm, and the dialogical practice. A combination of eCPR and the Open Dialogue is well suited to reestablishing connections between the person in distress and his or her natural network.

Personality, essentially, refers to who a person is and how that person behaves. It influences an individual’s thoughts, feelings, attitudes, values, motivations, and behaviors. Personality disorders are classified into clusters A, B, or C based on the predominant symptoms. Cluster A personality disorders include: paranoid, schizoid, and schizotypal personality disorders. Cluster B personality disorders include: antisocial, borderline, histrionic, and narcissistic personality disorder. Cluster C personality disorders include: avoidant, dependent, and obsessive-compulsive personality disorders. This chapter addresses the historical perspectives and epidemiology of personality disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It also addresses current psychosocial and biological etiological influences of personality disorders along with current treatment modalities. The chapter presents application of the nursing process from an interpersonal perspective, including a nursing plan of care for a patient with a personality disorder.

This chapter addresses the historical perspectives and epidemiology of addictive disorders followed by a detailed description of these disorders as defined by the National Institute on Drug Abuse (NIDA) and the American Society of Addiction Medicine (ASAM). Substance use and addictive disorders refers to a disease that can occur at any time across the life span, manifesting as chronic with remissions and exacerbations, or as an isolated episode. ASAM discusses the neurobiological adaptation, the interactive nature of genetic predisposition and environmental stressors, and its characteristic bio-psycho-social-spiritual factors. The chapter describes specific scientific theories focusing on the disease substance use and addictive disorders (SUDs) along with current trends and common treatment options. Finally, it presents application of the nursing process from an interpersonal perspective and includes a plan of care for a patient with an addictive disorder.

This chapter discusses the common assessment strategies for individuals with sexual dysfunctions and examines the importance of assessing sexual functioning as part of the nursing assessment. Sexual dysfunctions are conditions characterized by a disturbance in the sexual response cycle or pain associated sexual intercourse. Paraphilic disorders are more characterized by recurrent, intense sexual urges, fantasies, or behaviors involving certain activities or situations. Gender dysphoria specifically relates to an individual experiencing incongruence between his or her expressed gender and his or her assigned gender. The chapter addresses the historical perspectives and epidemiology of sexual disorders and dysfunctions. It also describes scientific theories focusing on psychodynamic and neuro-biological influences. Professional sex therapists report that the work required with patients in sex therapy frequently has to do with the resolution of a psychodynamic conflict.

This chapter discusses how family is considered a specialized type of group and describes the use of a genogram in family assessment. It provides an overview of general systems theory and exposes the reader to systems thinking. The chapter discusses groups, group therapy, and family therapy as they relate to systems theory and systems thinking with examples of applications to each. It reviews examples of how systems theory is reflected in nursing theory. Professional or more formal group affiliations may include the clinical group of students in the psychiatric-mental health nursing rotation, the student body of a college of nursing, all student nurses belonging to Student Nurses Association, club memberships, as well as work-related groups such as the treatment team in the place of employment. The chapter integrates exercises to facilitate understanding of personal experiences within systems thinking and its relevance to psychiatric-mental health nursing practice.

This chapter describes professional boundaries and discusses the importance of boundary management as an integral part of the interpersonal process between the nurse and the patient. The first step in understanding professional boundaries between nurses and patients is to remember that there is an imbalance of power in the nurse-patient relationship. The American Nurses Association (ANA) Code of Ethics for Nurses describes the nurse-patient relationship, addressing boundaries in this relationship: The work of nursing is inherently personal. Applying Peplau’s or Travelbee’s theories about the nurse-patient relationship, boundaries are initially established during the orientation or original encounter phase and then maintained throughout the other phases. In addition to the aforementioned strategies, it is important to remember that people will also be held to the patient-centered care practice knowledge and skills in accordance with quality and safety education for nurses (QSEN) initiatives.