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Psychiartic-Mental Health Nursing

Canadian Standards of Practice for the Psychiatric Mental Health Nurse

Mental health coach helps person go through therapy

The goal of psychiatric mental health nursing is the promotion of mental health and the prevention of mental disorders. The purpose of having standards is to provide direction for professional practice in order to promote safe, competent, and ethical service for clients. Standards are organized by a “Domain of Practice” framework with competencies classified within seven domains.

Domains include biological, social, sociobiological, psychological, psycho-social, psycho-biological and spirituality encompasses them all.

Standard one is to provide competent professional care through the development of a therapeutic relationship. It is based on trust and mutual respect. It is important to recognize the influences of culture, language, and ethnicity of the client.

Standard two is to perform client assessment through diagnostic and monitoring functions. This is where the nurse collaborates with the client and other members of the health care team for a holistic approach. Documentation and analysis of baseline data are collected.

Standard three utilizes evidence-based intervention to provide safe and effective nursing care. The administration of medication is done with close monitoring. Assist and educated clients to select choices that support positive changes in their life.

Standard four effectively manages rapidly changing situations while monitoring client safety. Resources are used to manage actual and potential crises.

Standard five intervenes through the teaching and coaching function. It determines clients learning needs through a collaborative process.

Standard six monitors and ensures the quality of health care practices. It identifies workplace attitudes and beliefs that may affect the nurses’ ability to perform duties safely.

Standard seven practices within the organizational and work-role structure. Works in partnership with client, family, and others to facilitate a safe supportive environment for all individuals.

Mental Health Assessment

The purpose of psychiatric assessment is to establish a report by health history, physical exam, and mental status examination. It also develops an understanding of how the client understands the meaning of health illnesses. This helps form a nursing diagnosis, goals, and interventions.

Observation is the first component of an interview. Here we read body language, facial expression, and perceptual disturbances. Next is the examination where nurses collect data such as health history, physical, and diagnostic tests. During an examination, there are several things health care professionals will pay attention to such as speech, appearance, mood, affect, cognition, and many more. Finally is the interview where the patient is the primary source of information but we can also talk to family, and look in their chart.

The mood is the pervasive sustained emotion that colors an individual’s perception. Affect is the expression of a mood in observable behaviors. Blunt effect is a limited range of emotions. Labile affect is intense frequently shifting emotional extremes.

Speech is observed for quality, quantity, rate, and frequency. Everyone has different strengths in how well they can respond and communicate with social clues. Speach is used to convey a person’s understanding of the situation. Speech gives health care professionals clues about a person’s thoughts, emotions, and cognitive ideas.

Perception can be either illusion or hallucination. Hallucinations can be auditory, visual, and tactile. It is false sensory perceptions not associated with real external stimuli. Illusions are misperception of a real external stimulus.

Insight is someone’s ability to understand the reality of a set of circumstances. Judgment is the ability to reach a logical decision about a situation

Always assess if the patient is a suicide risk. Ask them about suicide attempts, suicidal ideation, and threats of suicide.

Thought can only be assessed through language. Health care professionals must ask “how are you feeling”. Though content includes what the person is thinking about including their beliefs, ideas, obsessions, and preoccupations.

Alterations in People with Mental Illness

There are many signs to watch out for when observing and interviewing an individual. Delusions are a false fixed belief based on incorrect inference about reality. It cannot be corrected and is not shared by others. It is inconsistent with the level of education or cultural background. Clang associations are relating ideas based on sound or rhyme. Neologisms are the inventing of words by the client. Flight of ideas is rapid, continuous verbalization with frequent shifting in a topic. Echolalia is like an echo, imitation, or repeating what someone says.

Always assess the level of consciousness and their orientation to person, place, and time. Test retention and recall of information. For memory get them to recall 3 unrelated words at five-minute intervals for 15 minutes. Test Attention and concentration ability by asking them to subtract three from 20 or to spell mouse backward.

Therapeutic Groups

girl sits on bed drinking a glass of water

Group therapy is a great way for clients to get extra support. This creates awareness that they are not alone. They gain information from others and the instructor. They also gain insight into how their behaviors affect others.

Milieu Therapy is an environment designed to meet the clients’ emotional and interpersonal needs. This includes the physical surroundings, activities, and cultural setting. This will validate the clients’ individuality. It will support the clients’ safety in a familiar environment.

There are many different types of help support groups. Interactive groups are for self-help. Structured groups are for cognitive-behavioral and psychoeducational help. Common Nursing intervention groups are groups such as medication management and symptom management.

Medication

Medication is selected based on its effect and the client’s symptoms. Many medications take time to reach a therapeutic level, so be patient before switching to a new medication. The lowest effective dose is always given. Medications cannot be abruptly stopped. Please talk to a health care professional if you are considering to stop taking your medication. Follow up is needed to ensure compliance, make adjustments, and manage side effects.

Recovery

Recovery is a quality of life. Nurses and the health care team aim to enable individuals to have a meaningful, fulfilling life. This is supported by the strengths of the individual, family, and community. This occurs when the client is taking their meds regularly, therefore, decreasing their mental health symptoms and therefore increases their wellbeing.

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Mental Health Explained

Mental health is a huge umbrella term that is interpreted differently by each individual. The Mental Health Commission of Canada defines mental health as “a state of wellbeing in which the individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her own community”. Although mental illness can impact one’s quality of life, one can still experience mental health while living with, even, a severe mental disorder. In order to live a happy and sucessful life while treating your mental illness, it is important to remember that co-existance. A mental disorder is defined as health conditions characterized by alterations in a variety of factors including: mood, behaviour, thinking and cognition. The disorders are associated with various degrees of distress and impaired functioning.

Mental Illness Testing, Diagnosis and Treatment

mental health recovery and relaxation and meditation

It is vital to recognize signs and symptoms of mental disorders in order to get the proper treatment. Many individuals are aware that they are suffering from a mental illness, but never seek help or testing. The Diagnostic and Statistical manual (DSM-5) is used by professionals to test clients for mental illnesses. It provides a common language for health care professionsals to use.

DSM-5 has three sections. First off, an introduction and explanation of its use, including a caution regarding its forensic use. Secondly, the diagnostic criteria and codes. Lastly, emerging measures (assessment) and models, an alternative model for personalty disorders, and conditions for further study.

Diagnostic categories include: neurodevelopmental disorders, scizophrenia, bipolar, depressive disorder, anxiety disorder, obsessive- compulsive disorder, sexual dysfunctions, personality disorders and many more.

Other conditions that may be a focus of clinical attenion include: relationship issues, abuse and neglect, educational and occupational problems, housing and economic issues, issues related to crime or legal system, and counciling advice.

Receiving diagnoses can be a relief for both the individual and their families. Although, reciving a diagnosis may come as shocking, frightening and often scary, it gives an explaination to signs and symptoms a person is having. It also creates a better understanding for behaviour changes, and most importantly treatment can begin.  Evidence based care is used for a better understanding of mental health, illnesses, and wellbeing. This form of care insures the best interventions are used.

Now that researchers understand more about transmission, brain functioning, and psychopharmacology focus is shifting to find biological markers. Biological markers are diagnostic test findings and neuropathic changes that are only present in people with psychiatric disorders. These finding may have a predictive value allowing for the possibility of preventing the onset of illnesses. This can determine the expected prognosis early on.

Social Determinants Of Health

peoples hands

Social determinants of health are defined as the conditions which people are born, grow, live, and work in. Preconception up to the age of six is a very critical time for child development, positive stimulation, and influences for learning, behaviour and sense of identity. 

Socio-economic factors such as income, social status, social networks, education, employment, working conditions, physical enviroment, and avaliable health services all effect one’s wellbeing. Poorer socio-econimic circumstances and social exclusion can increase the likley hood of adopting unhealthy or risky behaviours and create feelings of hopelessness and helplessness. The lower the socio-economic status, the worse the health. 

Cultural Saftey

Vulnerable groups, such as Aboriginals, are at a disadvantage; one which leads to the risk of emotional or physical harm. All cultural groups must feel comfortable and safe when seeking help and treatment. Health care providers are all responsible for maintaining cultural safe practice. Cultural competence is considered an “entry to practice,” and involves respect, equality, cultural sensitivity and valuing diversity. Health care providers must acknowledge their own knowledge deflects regarding other cultures. Cultural competency involves cultural diversity through an atmosphere of respect. Please feel safe getting help and treatment knowing about the expectations and standards of health care providers.

The health care profession is one of the most trusted and ethical careers. As professionals, they profess a claim to use their skills to benifit the public.

Recovery

growth of a new plant

Recovery is a process which people living with mental health problems and illnesses are empowered and supported to be actively engaged in their own journey of wellbeing. The recovery process builds on individual, family, and community relationships. Recovery also enables people to enjoy a meaningful life in their community while striving to acheive their full potential. 

Federal And Provincial Laws For Mental Health

In Canada, each province and territory is guided by its own Mental Health Act which provides a framework for the delivery of mental health service and established rules for people suffering with mental illness. This ensures that everyone recives the required care and treatment. Each Act is congruent with the rights stipulated by The Charter Of Rights and Freedoms.

Mental health legislation means to protect and promote the mental wellbeing of citizens. This means to protect the rights of persons with mental disorders, and provide a mechanism for the care and treatment of those with illnesses that interfere with their ability to recognize their need for assistance and/or ability to seek help.

Involuntary Admission

If and when a person has been examined by a physician and indicates that the person has a mental illness, and is likely to cause harm to themselves or others, or to suffer substantial mental or physical harm then a person can be admitted for treatment involuntarily.

The competence of the person to make decisions regarding treatment, thus able to give consent, must be assessed as a form of respect. When a person is unable or unsuitable to give consent, the decisions can be made by family or a relative. The person’s best interest is always in mind. This means that treatment will make the person less ill and any benefits outweigh the risks.

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