Chapter 11 - Diagnosis, Intervention, and Outcomes in Psychiatric and Mental Health Nursing Flashcards
What are PMH nursing interventions?
Nursing activities that promote mental health, prevent mental illness, assess dysfunction, assist clients to regain or improve their coping abilities, and/or prevent further disabilities
The Canadian Collaborative Mental Health Care Charter principles
Health promotion and prevention of mental health problems Holistic promotion Collaboration Partnership Respect for diversity Information exchange Resources
Best Practice Guidelines purpose
To deliver care that is effective and based on current evidence
To aid in seeking resolutions to clinical problems
To meet or exceed current quality standards in providing excellent care
To initiate use of innovations
To eliminate interventions that are not meeting best practice standards
To foster clinical excellence through supportive work environments
Nursing diagnosis factors
Pathophysiologic, biologic, or psychological
Treatment related
Situational
Maturational
What is a nursing diagnosis?
Clinical judgment about individual, family, or community responses to actual or potential problems/life processe
Defining characteristics
Key sign and symptoms (clues) that relate to each other and that validate a nursing diagnosis
Outcomes
Individual response to nursing care at a given point in time. They are concise, stated in few words, and in neutral terms
Diagnosis specific outcomes
Show that the intervention resolved the problem or nursing diagnosis
Indicators
Answer the question, “how close is the individual moving towards the outcome?”
Initial outcomes
Those written after the initial interview and assessment
Revised outcomes
Those written after each evaluation
Discharge outcomes
Outcomes to be met before discharge
How are outcomes expressed?
In terms of the individual’s actual responses or the status of a nursing diagnosis at a point in time after implementation of nursing interventions
Primary purpose of developing individual outcomes
To ensure quality care and that the needs of the individual are being met
Class or groups of interventions
Physiologic basic Physiologic complex Behavioural Safety Family Health system Community
Biologic interventions
Focus on physical functioning
Directed towards the client’s self-care, activities and exercise, sleep, nutrition, relaxation, hydration, and thermoregulation, as well as pain management and medication management
Self-care
Ability to perform activities of daily living successfully
Counselling
Specific, time-limited interactions between a nurse and a client, family, or group experiencing immediate or ongoing difficulties related to their health or well-being
Conflict resolution
Specific type of intervention through which the nurse helps clients resolve disagreements or disputes with family, friends, or other clients
Steps of conflict resolution
- Identify conflict issues
- Know our own response to the conflict
- Separate the problem from the people involved
- Stay focused on the issue and the underlying motivations behind the position the other person took
- Identify available options
- Try to identify the established standards to guide the decision-making process
Cultural brokering
Use of culturally appropriate strategies that aid in bridging or mediating between the client’s culture and the healthcare system
Recovery orientation
A journey that is self-directed and person-centered. the individual takes responsibility for his or her part and is empowered in a process that focuses on strengths, peer support, and respect
Tidal model
Emphasizes the importance of a collaborative relationship between the nurse and client
Reminiscence
The thinking about or relating of past experiences, is used as a nursing intervention to enhance life review for older adults
Behaviour therapy interventions focus
On reinforcing or promoting desirable behaviours or altering undesirable ones
Behaviour modification
Specific, systematized behaviour therapy technique that can be applied to individuals, groups, or systems
Token economy
Applies behaviour modification techniques to multiple behaviours. Clients are rewarded with tokens for demonstrating selected desired behaviours
Aim of behaviour modification
To reinforce desired behaviours and extinguish undesired ones
Cognitive intervention
Verbally structured interventions that reinforce and promote desirable, or alter undesirable, cognitive functioning
Underlying belief of cognitive intervention
Thoughts guide emotional reactions, motivations, and behaviours
Automatic thinking
Subject to errors or tangible distortions of reality that contradict object appraisals
Illogical thinking
Another thinking error, occurs when a person draws a faulty conclusion
Psychoeducation
Uses educational strategies to teach clients the skills they lack because of a psychiatric disorder
Goal of psychoeducation
Change in knowledge and behaviour
Health teaching
Involves collaborating with the client to determine learning needs and transmitting new information, “while considering the context of the client’s life experiences.”
Milieu therapy/therapeutic environment
Provides a stable and coherent social organization to facilitate an individual’s treatment
A therapeutic milieu facilitates
Client interactions and promotes personal growth
Basic concepts of milieu therapy
Safety and security
Validation
Open communication
Structured interaction
De-escalation
An interactive process of calming and redirecting a client who has an immediate potential for violence directed towards self or others
De-escalation involves
Assessing the situation and preventing it from escalating to one in which injury occurs to the client or others
Seclusion
Involuntary supervised isolation of a patient in a locked, nonstimulating room
Chemical restraints
Use of medication to control clients or manage their behaviour
Physical restraints
Any human or mechanical method that restricts the freedom of movement or normal access to one’s body, material, or equipment and cannot be easily removed
