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.
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- Go to chapter: Anxiety Disorders, Obsessive-Compulsive-Related Disorders, and Trauma- and Stress-Related Disorders
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.
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.
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.
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.
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.
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.
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.
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 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.