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 addresses the topic of case management and the role of the case manager in psychiatric-mental health nursing practice. Case manager roles typically include advocate, consultant, educator, liaison, facilitator, mentor, and researcher. The chapter provides a definition for case management and traces the historical evolution of psychiatric case management. It reviews the key psychiatric case management models and the goals, principles, and skills involved in the case management process. The case management process involves the following functions: assessment, planning, implementation, coordination, monitoring, and evaluation. Case management is associated with the reduction of symptoms as well as a decrease in hospitalization. The chapter integrates the interpersonal process with case management and describes the roles of the psychiatric-mental health nurse (PMHN) case manager. It finally provides a description of how case management relates to quality of care.

Schizophrenia spectrum disorder (SSD) is a broad term applying to illnesses involving disordered thinking and disturbances in reality orientation and social involvement. Although symptoms of PSYCHOSIS are often intermittently or continuously present, the underlying THOUGHT DISORDER is the most prominent cause of disability associated with this group of psychopathologies. The term SCHIZOPHRENIA refers to a diagnostic category within the group of SSD. Types of schizophrenia includes: schizophreniform disorder, schizoaffective disorder, delusional disorder, and brief psychotic disorder. This chapter covers the historical aspects and epidemiology of SSD and includes a detailed description of thought disorders. It describes relevant psychodynamic, cognitive behavioral, genetic, and neurobiological influences, along with common pharmacotherapy and nonpharmacotherapy strategies used in the treatment of SSD. The chapter discusses application of the nursing process from an interpersonal perspective, including a plan of care for a patient with a thought disorder.

Anxiety becomes a symptom of a disorder or pathological when it interferes with one’s ability to function. Anxiety disorders include specific phobias, panic disorders, agoraphobia, social anxiety disorders, and generalized anxiety disorder (GAD). Obsessive-compulsive disorders (OCD) have historically been described as a type of anxiety disorder; however, more recent findings suggest that they have a unique biological origin and are theorized by many to be solely neu-rologically based disorders. This chapter addresses the historical perspectives and epidemiology of anxiety, obsessive-compulsive, and trauma- and stress-related disorders, followed by a description of specific disorders. It describes scientific theories focusing on psychodynamic, behavioral, and neurobiological influences plus common treatment options, including pharmacotherapy and nonpharmacotherapy strategies. The chapter presents application of the nursing process from an interpersonal perspective, guided by the Quality and Safety Education for Nurses competencies (QSEN). Finally, it includes a plan of care for a patient with an anxiety-based disorder.

This chapter helps students to identify the changes in the field of mental health that correlate with the evolution of psychiatric-mental health nursing. It provides an overview of the key historical events associated with the evolution of mental health care and their influence on psychiatric-mental health nursing. The chapter describes the current status of psychiatric-mental health nursing and focuses on the scope of practice for the two levels of psychiatric-mental health nursing practice: basic and advanced. It emphasizes the interpersonal models of practice as the standard of care across the full range of settings and client groups. Relationships, interactions, and environment are important components of these models. This focus was selected to enhance this crucial element of nursing practice, the nurse-patient relationship, and, in particular, to establish interpersonal relations as the cornerstone of psychiatric-mental health nursing practice to assist patients in meeting their needs.

This chapter discusses the major ethical theories that are used as a foundation for ethical decision making, and presents an example of the process based on the nursing process. Several ethical theories and principles mold the professional practice of psychiatric-mental health nursing and provide a firm foundation to guide professional decision making. The ethical principle of Kantianism is in contrast to utilitarianism. It focuses primarily on performing one’s duty rather than the ‘rightness’ or ‘wrongness’ of the outcome. This theory explores the concepts of autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. The chapter describes the legal issues involved in psychiatric-mental health nursing care and treatment, and addresses the nursing responsibilities necessary to ensure the ethical and legal provision of care. The American Nurses Association (ANA) Code of Ethics dictates that patients have the right to self-determination and autonomy.

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.