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.
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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 focuses on dementia and delirium because these are the two most common types of neurocognitive disorders found in clinical practice. Although both result in cognitive impairment and have profound implications for patients and their caregivers, the respective etiologies, treatments, and outcomes are distinctly different. The chapter covers the historical aspects and epidemiology of neurocognitive disorders and includes a detailed description of the major neurocognitive disorders as described according to discrete symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It describes relevant scientific theories related to the etiology and pathophysiology of dementia along with common pharmacotherapy and nonpharmacotherapy strategies used in the treatment of dementia, specifically dementia of the Alzheimer’s type (DAT). The chapter discusses application of the nursing process from an interpersonal perspective and includes a plan of care for a patient with dementia.
This chapter addresses the concept of suffering as it relates to the therapeutic use of self and its impact on the nurse. It describes the most common issues that affect the mental health of physically ill patients, end-of-life care, and the role of the mental health liaison/consultation nurse. Nurses are routinely involved in procedural interventions such as collecting vital signs, administering medications, and performing treatments for individuals with physical illness. Physical illness may be acute or chronic. Although acute illness is often accompanied by high levels of anxiety, and chronic illness may be attended by depression, anxiety and depression are frequently comorbid conditions occurring during bouts of physical illnesses. Finally, the chapter concludes by applying the nursing process from an interpersonal perspective to promote the mental health of patients with physical illness.
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.
Psychiatric-mental health nursing is a specialized area of nursing practice committed to promoting mental health through the assessment, diagnosis, and treatment of patients presenting with mental health problems and psychiatric disorders along a continuum of care in a variety of health care settings. The practice of psychiatric-mental health nursing is based on the nursing process and operationalized through the scope and standards outlined by the American Nurses Association (ANA), the American Psychiatric Nurses Association, and the International Society of Psychiatric-Mental Health Nurses. This chapter describes the various levels of care in which the psychiatric-mental health nurse (PMHN) practices and the principles of practice are appropriate for each level of care. Many practice sites employ basic and advanced practice PMHNs as providers of direct mental health care within the primary care setting to provide psychoeducation about mental health issues, symptom management, and relaxation techniques via individual and/or group modality.
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 begins with definitions of legislative politics, policy, political action, and lobbying; examinations of the intersection of policy, political action, lobbying, and the provision and quality of mental health services. It discusses the impact of nurses’ roles in the political arena. The active involvement of psychiatric nurses in protecting the rights of those facing mental illness and homelessness, with or without additional substance abuse challenges, is encouraged. The chapter highlights the importance of political activism to promote uniform advanced practice across the country. It considers means of achieving policy changes through grassroots, community-based initiatives, as well as through the support of or direct involvement in the legislative process. The chapter concludes with a review of the ‘call to action’ by the Institute of Medicine (IOM) and an educational and professional roadmap for baccalaureate-prepared psychiatric nurses, including entry to practice and advanced practice educational issues.
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.
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 discusses the relationship among culture, ethnicity, spirituality, and health, and identifies the influence these factors have on mental health and illness. Psychiatric-mental health nurses (PMHNs) must be cognizant of the impact of globalization on health care and be prepared to intervene appropriately with patients who are culturally, ethnically, and spiritually different. To provide optimal person-centered care that respects cultural, spiritual, and ethnic differences, nurses must empower patients to act as full partners in the health care process to improve their health outcomes. The Institute of Medicine (IOM) report, Unequal Treatment, stressed the importance of cultural competence in eliminating racial and ethnic health care disparities. The chapter describes the essential need for nurses to continuously strive toward cultural competence when providing mental health care.
- Go to chapter: Anxiety Disorders, Obsessive-Compulsive-Related Disorders, and Trauma- and Stress-Related Disorders
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 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.
Most people experience transient periods of depressed moods in their life. Mood disorders influence a person’s thoughts, emotions, and behavior. Some of these disorders include major depressive disorder; persistent depressive disorder; disruptive mood dysregulation disorder; premenstrual dysphoric disorder; bipolar disorder types I and II, and cyclothymic disorder; and substance/medication-induced bipolar and depressive disorder. Psychiatric-mental health nurses need to be able to understand these different types of mood disorders when caring for individuals. This chapter addresses the historical perspectives and epidemiology of mood disorders. It also addresses current proposed psychosocial and biological/etiological influences of mood disorders along with current treatment modalities. The chapter presents an application of the nursing process from an interpersonal perspective, including a nursing plan of care for a patient with a depressive disorder who is suicidal.
Adolescence is characterized by a period of transition from childhood through puberty and on into adulthood. This transition brings with it physical and emotional challenges and is part of normal growth and development. When problems occur in adolescence, particularly mental health problems, they often can be dismissed as part of normal development. This chapter reviews adolescent growth and development, including the important role of peer relationships, and describes important areas to be included in the assessment. Assessment of the adolescent must include a family history addressing information on pregnancy, birth and early health history, medical history, school history, and family health problems. Obsessive-compulsive disorder (OCD) in adolescents can have an enormous impact on the family. The chapter concludes with a discussion of the nursing process from an interpersonal perspective related to the care of an adolescent with a mental health problem.
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.
Impulse control disorders include gambling disorder, kleptomania, pyromania, intermittent explosive disorder, and trichotillomania. This chapter addresses the historical perspectives and epidemiology of impulse control disorders followed by a detailed description of these disorders. Neurotransmitters in the mesocortico-limbic pathway play a critical role in reinforcement within the brain and have been observed to play a role in impulse control disorders. Nonpharmacological therapies found to be helpful in the treatment of impulse control disorders include cognitive restructuring, relaxation, anger management, family therapy, support groups, and coping skill training. The chapter describes scientific theories focusing on psychodynamic and neurobiological influences along with common treatment options, including pharmacotherapy and nonpharmacotherapy strategies. It presents application of the nursing process from an interpersonal perspective. Finally, the chapter highlights a plan of care for a patient with an impulse control 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 major theories related to growth and development in children and explores normative versus non-normative behavioral patterns in relation to developmental milestones. Childhood behavior varies significantly with developmental stage, psychosocial environment, and genetic influence. The chapter also helps the students to describe the major mental health disorders found in children and to identify the primary treatment options available for mental disorders found in children. Due to differences between childhood and adult behavior, emotional problems and mental health disorders in children can be difficult to determine. Attention deficit hyperactivity disorder (ADHD) was formerly grouped with disruptive behavior disorders including oppositional defiant disorder (ODD) and conduct disorder (CD), based on the common, underlying symptom of inability to control impulses. The nursing process is applied from an interpersonal perspective to provide a framework when caring for a child with a mental health disorder.
Feeding and Eating disorders are characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning. Eating disorders include pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, and binge eating disorder. This chapter addresses the historical perspectives and epidemiology of eating disorders and describes eating disorders and the development of a greater phenomenological understanding of eating disorders through collaborative case conceptualization. It also describes biological, sociocultural, familial, and psychological factors that may potentially contribute to eating disorders along with common treatment options, including pharmacotherapy, psychoanalytical approaches, cognitive and behavioral treatments, group and family therapy, supportive therapy, and nutritional therapies. The chapter presents application of the nursing process from an interpersonal perspective, including a plan of care for a patient with an eating disorder.
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.
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.
- Go to chapter: Theories of Mental Health and Illness: Psychodynamic, Social, Cognitive, Behavioral, Humanistic, and Biological Influences
Theories of Mental Health and Illness: Psychodynamic, Social, Cognitive, Behavioral, Humanistic, and Biological Influences
Psychiatric-mental health professionals need to have a comprehensive knowledge foundation about mental illness and the theoretical underpinnings associated with it. Definitions of theory, as well as theories of mental health and illness, abound. Variation in these definitions can be influenced by or contingent on a number of factors, including the disciplinary and specialty perspective. This chapter provides an overview of various prominent theories of mental illness. Mental health and psychology are associated with numerous theories, such as grand, middle-range, and micro-level theories. The chapter describes the work of influential theorists, researchers, and practitioners from several disciplines, including but not limited to nursing, medicine, and psychology. It presents theoretical concepts and explanations of the potential etiology of mental illness from within the framework of psychodynamic, behavioral, cognitive, social, humanistic, and biological theory. The chapter includes pertinent definitions, historical background, epidemiological incidence and prevalence rates, and comparative disease burden of mental illness.
This chapter discusses the five phases of Joyce Travelbee’s model and also discusses the importance of these theories in the professional practice of psychiatric-mental health nursing. It examines Hildegard Peplau’s and Travelbee’s theories to patient care delivery in the clinical setting and incorporates the models of interpersonal relationships in professional psychiatric nursing practice. An interpersonal relationship is the connection that exists between two or more individuals. Observation, assessment, communication, and evaluation skills serve as the foundation for an interpersonal relationship. Development of any interpersonal relationship requires the individual to have a basic understanding of self and what that individual brings to the relationship. The interpersonal relationship in nursing is often considered to be the one-to-one relationship between the nurse and patient. However, the nurse also needs to develop interpersonal relationships with the patient’s family and key individuals in the patient’s environment.
This chapter describes the vulnerable populations most often encountered by psychiatric-mental health nurses (PMHN). It addresses the major mental health issues commonly involved and the nurse’s role when working with each of these populations. The chapter explores the specialty practice of forensic nursing, and describes the requirements for practice and the forensic nurse’s roles and functions. In the emergency or trauma setting, forensic nurses work with victims of automobile accidents, suicide attempts, disasters, work-related injuries, and traumatic injuries. In the area of interpersonal violence, the forensic nurse may work with victims of domestic violence or sexual assault, child or elder abuse, human trafficking, and physical or psychological abuse. In patient-care facilities such as hospitals or nursing homes, they may help investigate accidents, injury, neglect, and inappropriate medication or other treatments.
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.
Psychiatric-mental health nursing care is practiced in multiple settings across the health care continuum. Patients of all ages in need of psychiatric-mental health nursing care can be found in hospitals, community agencies, and residential settings. Critical thinking and clinical decision making are crucial elements to ensure that the patient’s needs are assessed, relevant problems are identified, and therapeutic nursing interventions are planned, implemented, and evaluated. Clinical decision making based on critical thinking is similar across all clinical settings. One unique dimension of critical thinking in psychiatric-mental health nursing is the importance of the interpersonal relationship as a major healing factor in delivering psychiatric nursing care. This chapter focuses on how psychiatric nurses integrate the concepts of critical thinking, clinical decision making, and the nursing process within the interpersonal relationship to address patient needs and delivery of nursing care.
- Go to chapter: Known Risk Factors for Prevalent Mental Illness and Nursing Interventions for Prevention
This chapter provides an overview of risk factors and how they are categorized. It describes the impact of protective factors on the development of a mental illness. Although the stress-vulnerability-coping model was originally developed to explain the development of schizophrenia, it is now used to understand other psychiatric disorders as well. The chapter addresses the important risk factors associated with major classifications of psychiatric-mental health disorders and describes preventive strategies to reduce the impact of risk factors for developing a psychiatric-mental health disorder. In actuality, attentional disorders may begin during the first part of life, but often continue into adulthood. The mental illnesses under this category include attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Genetics/biology and temperament are two important intrapersonal risk factors for the development of psychiatric-mental health disorders that may begin at infancy and progress to adolescence and adulthood.