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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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Community Nursing Explained: Unit One

people wearing shoes in community join together

Community Nursing applies to all nurses who work in, as well as with the community in a variety of areas such as public health, home health, and occupational health.

First adopted in 2003, The Canadian Community Health Nursing Standards of Practice has reinforced community nursing as a specialty field of practice within nursing. This form of nursing focuses on the community, family, individuals, groups, and populations. Community is people and relationships that emerge among them as they develop and commonly share agencies, institutions, and a physical environment.

Community Health Nursing includes public health, home health, occupational health, forensic, outpost, and parish.

There are many roles and specialties of a community health nurse.

Specialties include military nurse, school nurse, public health nurse, forensic nurse, home health nurse, occupational health nurse, nurse entrepreneur, and street/outreach nurse.

Roles include advocator, collaborator, researcher, educator, coordinator, leader, manager, consultant, and facilitator. Community-based nursing focuses on health promotion and disease prevention. It involves acute, chronic, and palliative care. It also enhances self-care and promotes autonomy in decision making.

Population Health

Population Health refers to the health outcomes of a population measured by the determinants of health and health status indicators. Health status indicators are wellbeing, life expectancy, incidence and prevalence rate, mortality rate, and burden of illness. Population health involves eight key elements. First, to focus on the health of populations. Second, to address the determinants of health and their interactions. Third, to base decisions on evidence. Fourth, to increase upstream investments. Fifth, to apply multiple interventions and strategies. Sixth, for collaboration across sectors and levels. Seventh to employ mechanisms for public involvement. Lastly, to demonstrate accountability for health outcomes.

Disease Prevention

nurse takes a patients blood with gloves on

A focus of community nurses is disease prevention. There are three levels of disease prevention. Primary prevention is to prevent the occurrence of a disease or injury such as immunizations and hand washing. Secondary prevention is to detect disease early on in its progression before clinical signs and symptoms become apparent such as hypertension and breast cancer. Tertiary prevention occurs once a disease has become obvious, the goals are to interrupt the course of the disease, reduce the amount of disability that might occur, and begin rehabilitation.

Downstream thinking considers individual health concerns and treatments but does not consider the sociopolitical, economic, and environmental variables. It is a microscopic individual curative focus. Upstream thinking is a macroscopic “big picture” approach. It considers the determinants of health and other economic, political, and health factors.

Social Determinants of Health

Social determinants for health are the social conditions and broader forces that interact to influence risks to health and wellbeing and affect how vulnerable or resilient people are to disease and injury. These determinants of health include income, education, employment, working conditions, food insecurity, housing, health services, race, disability, and gender. Social determinants of health have profound impacts on all of society’s efforts to improve health and reduce health inequalities.

Primary Health Care

Primary Health Care is comprehensive care that includes disease prevention, community development, a widespread spectrum of services and programs, working in interprofessional teams, and intersectoral collaboration for healthy public policy. There are five principles of primary health. First, for equal distribution of essential health services to all populations. Second, to increase emphasis on services that are preventive and promotive, rather than curative only. Third, for maximum individual and community involvement in the planning and operation of health care services. Fourth, for the integration of health development with social and economic development. Lastly the use of appropriate technology.

Primary care is the first contact with the health care system which focuses on treating disease, rehabilitation, and preventive measures. Primary health care includes disease prevention, community development, services and programs, and working in teams.

Public Health

people in community join hands and hold arms

Public health is an organized activity of society to promote, protect, improve, and restore the health of individuals. it is a combination of science, skills, and values, that function through collective societal activities and involves programs, services, and institutions aimed at protecting and improving the health of all people. It is a set of scientific, professional, and technological forms of practice. Public health focuses to have “the greatest good for the greatest number”.

Collaboration is the commitment between two or more parties who set goals to address identified client health concerns. There are six principles of collaboration: client focus, population health approach, quality care and services, access, trust/respect, and communication.

Population Focused Practice

Population-focused practice directs community health nursing practice: in contrast to individual-focused health care, it emphasizes reducing health inequalities of a defined population or aggregate. The group is the focus.

Health Promotion is when community nurses work alongside low incomes to support health promotion and disease prevention to support health promotion and disease prevention by supporting education and demonstration programs for healthy eating on a restricted budget (e.g. grocery store tours, community gardens, and cooking classes).

Nursing Metaparadigm

In community-nursing, health is looked at as a whole. It involves working in groups to reach long term goals as opposed to the short term. Determinants of health play a big factor in health. The environment can include physical and social. The environment is important because this is both where client interaction takes place and may be a focus for nursing intervention. Nursing is at a more collaborative level. You look at the needs of larger groups rather than individual needs.

History

Throughout history, people have worked to understand, prevent, and control disease, illness, and injury. Ancient Babylonians understood the importance of hygiene, had some medical skills and knew how to use medicine to treat the sick. The Egyptians developed a variety of Pharmaceutical preparations and public drainage systems. Roman civilization viewed medicine from the perspective of community health and social medicine. They established sewage systems and drainage of swamps, as well as street cleaning. During the middle ages, European cities suffered high-density populations, lacked clean water, and had insufficient systems to dispose of body waste.  Poor sanitary conditions and crowding increases in communicable diseases such as cholera, smallpox, and plague.  There are established hospitals to care for the sick, poor, and neglected including the aged, disabled, and orphaned.

Later on in the Middle Ages, there was an increase in health education, promotion of personal hygiene, and moderate eating was encouraged. In the eleventh century Muslim nurses in what is now Saudi Arabia, a school of nursing for women and developed a code for nursing conduct and ethics. During the Renaissance, there were public health efforts and community health nursing in western Europe and North America.

The Industrial Revolution in the nineteenth century in Europe led to advances in transportation, communication, and other forms of technology. Many early hospitals in Great Britain were poorly ran and had untrained nurses.

In the early 1900’s public health nursing made visits to people with TB. Around 1910 Canada Public Health Association was founded to deliver and support national health programs. After world war 2 focus shifted to treatment focus/ medical focus (use of antibiotics). in the 1970s the Lalonde Report initiated the health promotion movement. This looked at wellness through lifestyle changes. In 1978 the Alma Ata Declaration defined primary health care. The Epp Report of 1986 stated that all public policy sectors (income, employment, education, and housing) all impact health. Home health care became popular in 1980-1990. There was a shift in public health strategy from illness prevention to health promotion. Before 1980 “public health nurse” and “community health nurse” were used interchangeably.

In 2001 researchers determined that home care for older adults cost less than institutional care. In 2002 the Romanow Report identified home care as the most rapidly growing area of community health, part of this was due to early discharge.

Inspiring Nurses

Kate Brighty Colley developed two long term facilities in Alberta that didn’t have road access, traveling to communities via horse-drawn carriage or sled. She provided health information to community residence through radio broadcast.

Eunice Dyke had a vision for public health nursing and was the first director of public health nursing in Toronto.

Lillian Wald thought sickness should be considered in its social and economic context. Her visionary work is recognized in three critical areas: the intervention of public health nursing, the establishment of an American insurance system for home-based care, and the creation of an American public health nursing service. She created the Life Insurance Company for life insurance. Wald’s program included the following: to provide home nursing care on a fee-for-service basis, establishing an effective cost-accounting system for visiting nurses, using advertisements in newspapers and on the radio to recruit nurses, and reducing mortality rates from infectious diseases.

During the Crimean War, (1854-1856) the British military established hospitals for the sick and wounded. These hospitals were crowed and had poor sanitation, lice, and rats. They also had insufficient food and medical supplies. Florence Nightingale asked to be sent to go work. Her personal wealth, social, and political connections and knowledge of hospitals influenced the British government, along with 40 other women, 117 hired nurses, and 15 paid servants. She significantly improved soldiers’ health by better environmental conditions and excellent nursing. She documented a decrease in the mortality rate from 415/1000 to 11.5/1000.

After the war, Nightingale went on to organize hospital nursing practice and nursing education. She focused on sanitation, rest, nutrition, and hygiene. Her work marks the beginning of community health nursing as we know it today.

Florence Nightengale, Lillian Wald, Eunice Dyke, and Kate Colley continued to inspire practice in the present and the future. These nurses developed an exceptional ability to develop approaches and programs to solve health care and social problems of their time.

Government Agencies

There are many agencies in Canada such as the Public Health Agency of Canada, Canadian Institutes of Health Research, Health Products and food branch, First Nations and Inuit Health Branch and Healthy Environments, and Consumer Safety Branch. Health Canada safeguards the populations’ health through surveillance, prevention, legislation, and research in areas such as environmental health, disease outbreak, drug products, and food safety.

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5 Active and Productive Things To Do When Stuck At Home

Welcome Home sign on front door

You may find yourself being stuck at home for many reasons such as: Self-isolation, quarantine, Spring and Summer break, holidays, or snow days. Depending on why you are are trapped at home, you may feel super excited for the first little while. No school, no work, yay! But, after a while being stuck in the same environment doing the same things over and over again can really drive you crazy. When stuck at home people tend to live a more sedentary lifestyle. Being inactive and bored has a huge negative impact on your mental health and wellbeing.

Be creative and resourceful by creating tasks and activities that you can do at home. Take this time to be productive around the house. Get tasks that you have been prolonging or never had the time for, finally finished! There are many fun and efficient things you can do during your time at home (other than binge watching Netflix). I hope these ideas below inspire you to stay active, stay busy and most importantly, stay healthy.

Paint Night

If you have never been to a paint night, I strongly suggest going. Paint nights are instructed painting classes that are hosted at restaurants and pubs. The instructors are so comical and make for a really amazing time. People usually drink, quite a bit, and have snacks while they have fun painting. No talent is needed to enjoy this event. One of my past instructors who had me laughing all night long said “when you mess up its called a “Oh Shit” and those are always welcome and easy to fix, but if you get five “Oh Shits” in a row its called a “Oh F*ck” and that is what we don’t want”. The goal of this activity is not to create a masterpiece, but if you do thats a bonus!

Why not recreate this fun activity at home? Youtube has many painting videos that you can follow along too and create a paint night right in the comfort of your own home. Prepare some snacks such as cheese, meat, cracker, fruit, and veggie platters. Have some drinks such as a few glasses of wine and get artsy. Talented with arts and crafts or not, this is extremely fun to challenge yourself and you may be surprised with the outcome, if not you will have a good laugh.

Experiment In The Kitchen

Growing up I was always helping my mom in the kitchen, baking and cooking. I loved growing up around homemade delicious food and desserts. As an adult, cooking meals from scratch is something I still find very important and would love to practice. Unfortunately, when trying to balance school life, work life, as well as my friendships and relationship, I tend to not always have a lot of time left over to spend in the kitchen. Therefore, I tend to stick to the same basic meals that I am comfortable with like chicken, potatoes, and veggies. I just lack the energy to try to attempt a new meal. But when stuck at home, with more time on my hands, I have been able to explore and attempt new recipes in the kitchen.

When stuck at home, take this time as an opportunity to experiment in the kitchen. Try making recipes you have never tried before, or require more work than others. Try to master that recipe that just didn’t go so well in the past. Start saving your favourite baking and cooking recipes in a recipe book. You can handwrite these new recipes or print them off of an online website. You can collect these recipes over the years and pass on this book to your children and their children, so that family favourite recipes are kept in the family over generations to come.

Cleaning And Decluttering

Use this extra time around the house as an opportunity to be productive by cleaning, decluttering, and organizing. Having a well kept environment contributes to your mental heath and well being. When coopted up in the same environment everyday you want it to be an environment that is uncluttered and clean, and overall pleasant to be in. Designate an area of the house to clean and organize each day to feel productive, and feed your boredom. Although, it may seem like a huge task, it will feel really good once the job is done. Play some music, or have Youtube or Netflix on in the background and try to have fun with this activity.

There is always lots to do around the house. For a change in scenery and environment, rearrange furniture around the house. Draw up a blueprint of the different rooms in your house that you want to change up. Reposition the living room and bedroom furniture. In the kitchen, wash out all the drawers and cupboards and reorganize where the silver wear, dishes, and cups go. Wash out and organize the fridge and freezer. Throw away expired or freezer burnt food. Tidy the pantry into categories; pasta, baking, canned goods, breakfast, drinks, and snacks. Toss old food out and collect food for charity/donations. Wash baseboards, sweep and mop the floors. Catch up on laundry, and go through your shoe collection to see what you can donate. Get your children to go through their toys, and get them to donate unused toys, books, games, and clothes. In the garage pressure wash the floor. Organize tools, camping equipment, seasonal gear into bins. Give your vehicles a good cleaning, clean rugs, leather, seats, hard surfaces, and nooks and crannies.

Workout

Stay active by developing at home workout routines. Youtube and many Apps have free at home work out routines. You can also create routines of your own. Incorporate Yoga, Pilates, skip rope, jumping jacks, stairs, pushups, and much more into your workout routine. Try to schedule these routines to insure you make time for this activity. Scheduling helps keep you accountable. Create a makeshift gym in a spare room or the living room in your house. Use foam matts or yoga matts on the ground to create a work space. When stuck at home, it is essential to find ways to keep active. Activity supports a healthy mind and body. You can keep an activity log so you can keep track of your activity, and so you can look back on your progress and achievements. Create an encouraging and energetic playlist to help support, and motivate your active lifestyle.

Game Night

Game nights always make for super fun and interactive nights. Play your favourite games with family and friends for an entertaining night. My family’s favourite games are Settlers of Catan and Flinch. I highly recommend learning these two games, my family has been playing these two games my whole life. Blow the thick layer of dust, that has been collecting over the years, on old board games that are tucked away. Old games are new games. Bring out old fan favourites like Monopoly, Sorry, and The Game of Life. Explore new games like Qwirkle, Mastermind and Mexican Train. Learn new card games such as Honeymoon Whist and Rummy.

I hope these at home activities motivate you to stay active and be productive when stuck at home. Make the most out of your new found time and freedom by getting tasks done that you have been prolonging, but also have an enjoyable and relaxing time. Stay healthy, stay safe, and stay home.

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A Daughter and Son in Heaven; A Miscarriage Story

blue sky with clouds and bright sun

Growing up my mother always told me that I couldn’t possibly understand a mother’s love until I had children of my own. As they say “mother’s are always right,” and boy was she right.

I have a daughter and a son, and in a matter of months they have changed my world. The first thing you should know my little loves is that they are in heaven. My daughter, my first, was given to God at 5 weeks. My son, my second, was given to God at 13 weeks. Unfortunately I miscarried both my babies but have, with time, learned acceptance and understanding. One may assume that the love I carry for my children can not compare to the love that a mother feels towards her baby that she birthed, met, and raised. But that’s the true strength of a mother’s love. That’s why once again my mother was 150% right.

Having a miscarriage is traumatic and emotional for every mother, but I’m sure every woman reacts differently to the news. This is my story, experience and perception.

I’m Pregnant!

When I found out I was pregnant with my daughter it came as no shock. I was taking a maternity class in my nursing program and was very in tune with my body. I had many early pregnancy symptoms, which led me to believe I was pregnant. But, when I had a insanely clear vivid dream of holding my daughter, and looking into her wide open bright eyes, that is the moment I really knew. When I took that pregnancy test a week before my period I was confident that when I looked at that stick I was going to see a magical second pink line appear out of know where. And when it did wow, just wow!

Lying next to my sleeping partner Andy, I thought about that pregnancy test that was hidden under the bathroom sink. I brainstormed, for what seemed like two hours, on how I was going to leave the room and get the pregnancy test that was wrapped in a grocery bag, without Andy waking up and hearing me. Finally, I managed to move his arm that was wrapped tightly around my body and snuck off to the bathroom. Anxiously, I waited for the two minutes to elapse so I could receive the most satisfying and extravagant news of my life. The result that was about to change my life forever.

A rush of adrenaline flood my body from my toes to my very tip of my head, bright and early at 3 AM. I felt lifted from the toilet seat, like I was swirling and floating around in the tiny bathroom located in Andy and I’s first apartment. The realization that I was a mother was like the biggest high that you just can’t relive. When I lied back down for the night there was nothing that could have helped me fall back asleep.

Miscarrying

It was only two weeks until once again life took a turn. That’s all I got, two short weeks and a dream with my little love. Of course, these were the two fastest weeks of my life. Throughout my whole life I wished for life to speed up. If only Friday could come sooner. If only I was 18 already. This was the first time that I more than anything wished that time would slow, if not stop completely. Just one more second holding my stomach. Just one more second lying next to Andy in complete raw happiness. In just one second, I noticed the blood in my panties. In just one second, I broke the news to Andy. And in the next he rushed to pick me up from maternity class to take me to the hospital.

Of course now time slowed. Everyday of the grieving stages seemed to be the longest days and nights of my life. There were times that I just felt frozen in time until slowly the ice melted away. Gratefully I have that dream permanently engraved in my mind. I am so blessed that I was able to see her eyes and soft new skin. Yes I met my daughter. I was granted a dream and two weeks, and therefore I am a thankful and proud mother.

I’m Pregnant! Again!

My son came 4 months later. My strong, brave, little fighter. Andy was convinced I was pregnant, but I strongly believed otherwise. So I waited to take the pregnancy test the day before my projected period and when Andy was out of the house. This time, I was in complete and utter shock. Frozen in disbelief, mouth wide open. A familiar rush of energy spiralled through my body.

Another blessing from God. A baby that I would be able to hold and kiss and never take for granted. Well worth the wait, and the past grief. Thirteen weeks of extreme nausea and vomiting passed. As well as three months of ultimate gratitude. The easiest yet most difficult time in my life.

Second Miscarriage

I lye on the bed getting my second ultrasound, Andy recording the big ear to ear smile on my face and the monitor. Life was perfect and beautiful. My soulmate standing tall, looking down on baby and me. Capturing a breathtaking moment in our lives, but then one second passes.

Concern and heartache flood Andy’s eyes. My body, my eyes, my heart goes numb. Numb. The best description. Andy’s balling into my shoulder. I know he is squeezing me so tightly. I can tell he is shaking. But my eyes are fixed. My chest is not rising and falling with my respirations. Life, I’m telling you! It’s a really puzzle. Do you ever win?

Grieving and Acceptance

One of the most challenging things about grieving is that you don’t know how long it will last. It seems like time will never heal the hole in your chest. Unforgettably, I had the most amazing support from my partner Andy. We took turns holding each other tight as the other cried. Together we got through the many nights we couldn’t fall sleep, and all the times we woke up crying.

Andy had all the right words to help me get through this huge challenge in my life. One thing Andy said was “Our son and daughter’s souls are so pure that they do not need to experience this life any further than the time they were given”. This gave me a rational for why I lost both my babies. It is very hard to forgive and accept a loss, so finding a reasoning that helps you personally find peace and acceptance is essential. It turns out that grieving never really does come to an end. We just learn how to adapt.

Now I realize that life isn’t about winning or loosing. But if it were to be, I have won. I have won by gaining perspective and understanding. And I would gladly be a home for my two special esoteric babies, again and again, for their ever so short, but grand emasculate little life.