W9 - Community Mental Health Nursing Flashcards
What are the MAIN OBJECTIVES of community mental health nursing?
- Follow up on defaulters to provide treatment and supervise compliance
- Enhance patients’ optimal functioning level to prevent frequent relapses and re-admissions.
- Provide psychological support to the patients and their families in coping with stress and crisis situations.
- Re-integrate patients into the community through psychosocial rehabilitation and community support programmes.
- Promote community awareness in mental health through provision of mental health education.
What’s the assessment that has to be performed BEFORE the visit?
- Establish rapport with patient and family -> nurses do not wear scrubs to visit the pt to reduce stigma associated with the illness
- Verify address and contact number
- Set mutually accepted goals/plans of care during or before visit
- Assess mental status
- Esp. Paranoid Schizophrenia - can be harmful for nurses if pt is paranoid towards nurses - Check with patients/family their specific needs
- Ask family to be present if possible during the 1st appointment - can see how family & pt interact in a comfortable environment
Which patients are excluded from community mental health nursing?
- Patient with primary diagnosis of Drug or Alcohol Dependence, Anti-social Personality Disorder, concurrent diagnosis of severe mental retardation, Organic Psychosis and potential homicidal tendency.
- Patient and caregiver unreceptive towards CPN intervention.
- Patient with no fixed address/wandering tendency
- CPNs will not provide escort service
for absconder. - No crisis intervention for patients who
are violent and suicidal - only nurses trained in crisis intervention can do
Role of CPNs?
- provide continuity of care for discharged
patients in their homes: - Support patients living in the community
- Counsel and psycho-educate patients on need for compliance with medication
- Monitor patients’ compliance to treatment
- Administer depot injections
- Psycho-educate and provide psychological support for caregivers
- Perform mental state assessment (MSE) everytime they meet pt
What do community psychiatric nurse do as an Assessor?
- assesses the nursing needs of the
patient: plan, deliver the care and assess its
effectiveness.
A) Inpatient
- CPN interviews the patient and
relatives prior to discharge.
- Patient’s needs and nursing requirements
- Establish rapport & Obtain consent
B. Outpatient assessment is done at patient’s
home: - Mental State
- Home environment
- family setup
What do community psychiatric nurse do as an clinician?
- Administration of depot injections for
some patients in their homes. E.g Resistive patients who refuse to go to clinic for their injection. - Supervise patient’s:
- personal hygiene
- diet
- medication
What do community psychiatric nurse do as a consultant?
- Act as an advisor to other professionals & Work closely with Primary Health Care team
- work with VWOs - voluntary welfare organisiations
- nursing homes
What do community psychiatric nurse do as an educator?
Educate patient and caregiver in the community on:
- Understanding Mental Illness
- Medications
- Coping Skills e.g problem solving.
- ISMR – ILLNESS self-management prog. for ppl rehab with mental illness
What do community psychiatric nurse do as a case manager?
- organisation of work priorities
- bridge between hospital and pt & pt & community resources
- ACT model
What do community psychiatric nurse do as a therapist?
- Behaviour therapy.
Psychological interventions are effective for dealing with hallucinations and delusions - Family work
Influenced by early researchers who found family intervention effective work with cancer pt and families - eg: Thorn Programme - Counselling
What do community psychiatric nurse do as an advocator?
- “advocate” speak on behalffor the patient.
- Ensures MDT members work
collaboratively to meet patient’s needs. - Ensures members of Health Care
Team understands patient’s needs
What are the Challenges faced by Community Mental Health Services?
i. Stigmatization
ii. Readiness to acceptance
iii. Insufficient reimbursement for services
iv. Lack of availability of services
v. Lack of accessibility to needed services
vi. Fragmentation of services - overlapping services -> wasting resources
vii. Insufficient range of services
Discharge criterias from CPNS?
- Stable mental state
Regular with TCUs
Patient and/or caregiver’s request
Uncooperative patient and/or caregiver
Persistent no contact visits/uncontactable
Transfer to other agencies:
o Long-term institution care e.g. nursing homes
o Prison/DRC
o Private Psychiatrist/GP
- Persistently defaults treatment despite CPN’s
continued interventions
Aggression/violence towards the CPN despite
transfer to other members of the team
When MSE has been done (if referral is for MSE)
When care has been right-sited to GPs
