Settings for Psychiatric
Care
1950s: Thorazine
1960s: Community Mental Health Centers Act
deinstitutionalization
1980s: Carters Commission on Mental Health
recommended more community-based care
George W. Bushs New Freedom Commission
on Mental Health
2010Affordable Care Act
Social Influences on Psychiatric
Health Care
Prevention Strategies
Primary prevention
Secondary prevention
Tertiary prevention
Outpatient Psychiatric
Mental Health Care
Primary care providers
Specialty psychiatric care providers
Patient-centered health/medical homes
Community clinics
Psychiatric home care
Assertive community treatment (ACT)
Outpatient Psychiatric
Mental Health Care (Cont.)
Partial hospitalization programs (PHPs)
Other outpatient venues for psychiatric care
Telephone crisis counseling
Telephone outreach
Internet
Telepsychiatry
Psychiatric Nursing in
Outpatient and Community
Settings
Strong problem-solving and clinical skills
Cultural competence
Flexibility
Knowledge of community resources
Autonomy
Biopsychosocial assessment
Case management
Promoting continuation of treatment
Teamwork and collaboration
Case Study
You are working with a patient who will be
discharged into the community soon. What
are some problems that may affect the
success of treatment?
Side effects, money issues, no teaching,
addicts discharged to the same area that fall
back into addiction
Emergency Care and
Crisis Stabilization
Comprehensive emergency service model
Hospital-based consultant model
Mobile crisis team model
Crisis stabilization/observation units
Inpatient Psychiatric Care
Admission reserved for individuals who are
Suicidal
Homicidal
Extremely disabled and in need of short-term acute
care
Catatonic do not move, will die b/c they cant feed
themselves
You cannot hospitalize someone for being noncompliant
with their medicine.
Inpatient Psychiatric Care
(Cont.)
Admission options
Direct admission
Hospital emergency department
Criteria to justify admissions
Danger to self or others or
Unable to fulfill basic needs
Voluntary or involuntary
Patients Rights
Hospitalized patients retain their rights as citizens
Patients need for safety must be balanced
against patients rights as a citizen
Mental health facilities have written statements of
patients rights and applicable state laws
Pts rights must be balanced against safety
Right to privacy with mail, you cannot just
read it. You can check it for objects
Multidisciplinary Treatment
Team
Members of each discipline are responsible for
gathering data and participating in the
planning of care
Treatment plan or clinical pathway provides a
guideline for patients care during hospital
stay
Therapeutic Milieu
Surroundings and physical environment
Managing behavioral crises
Safety
Suicide risk
Nursing Care
Admission assessment
Physical health assessment
Milieu Management
Therapeutic groups
Documentation
Medication management
Medical emergencies
Preparation for discharge to community
Audience Response
Questions
1. An occupational health nurse screens factory
workers for depression. Which level of
prevention is applicable to this activity?
A.
B.
C.
D.
Primary
Secondary
Tertiary
Not sure
Audience Response
Questions
1. An occupational health nurse screens factory
workers for depression. Which level of
prevention is applicable to this activity?
A.
B.
C.
D.
Primary
Secondary
Tertiary
Not sure
Audience Response
2. A hospitalized client diagnosed with major
Questions
depression tells the nurse, I need my belt to
keep my pants up. They keep falling down.
Which response should the nurse provide?
A.
Your belt is locked in the business office for safekeeping,
along with all your other valuables.
B. For safety reasons, hospitalized clients are not allowed to
keep certain personal possessions.
C. I cannotprovide your belt, butI will help youget some
pants with an elastic waistband.
D. I will ask the psychiatric technician to get your belt for
you.
Audience Response
2. A hospitalized client diagnosed with major
Questions
depression tells the nurse, I need my belt to
keep my pants up. They keep falling down.
Which response should the nurse provide?
A.
Your belt is locked in the business office for safekeeping,
along with all your other valuables.
B. For safety reasons, hospitalized clients are not allowed to
keep certain personal possessions.
C. I cannotprovide your belt, butI will help youget
some pants with an elastic waistband.
D. I will ask the psychiatric technician to get your belt for you.
Am I addressing the needs of the client? Or am I just
stating the obvious?
Chapter 5
Cultural Implications for
Psychiatric Mental Health
Nursing
Eastern Tradition
Family basis for identity
Body-mind-spirit one entity
Disease caused by fluctuations in
opposing forces
Time is circular and recurring
Born into a fate; duty to comply
20
Indigenous Culture
Place significance on place of humans
in natural world
Basis of identity is the tribe
Person an entity only in relation to
others
Disease lack of harmony of individual
with environment
21
Ethnocentric Tendencies
Nurses influenced by their own
professional and ethnic cultures
Ethnocentrism
Assuming ones own beliefs, values, and
practices are the best, preferred, or only
way
Cultural imposition does not promote
client health and well-being
22
Barriers to Quality
Mental Health Services
Communication barriers
Stigma of mental illness
Misdiagnosis
Culture-bound syndromes
Ethnic variation in pharmacodynamics
23
Populations at Risk of Mental
Illness and Inadequate Care
Immigrants
Refugees
Cultural minorities
24
Cultural Competence for
Psychiatric Mental Health Nurses
Five constructs
1. Cultural awareness
2. Cultural knowledge
3. Cultural encounters
4. Cultural skill
5. Cultural desire
25
Cultural Competence for
Psychiatric Mental Health Nurses
Continued
1. Cultural awareness
Examine beliefs, values, and practices of own
culture
Recognize that during a cultural encounter, three
cultures are intersecting
Culture of the patient, nurse, and setting
Understand role as patient advocate
Negotiates and advocates on behalf of the
patient's cultural needs and preferences
26
Cultural Competence for
Psychiatric Mental Health Nurses
Continued
2. Cultural knowledge
Learn by attending cultural events and programs
Forge friendships with diverse cultural groups
Learn by studying
Learning cultural differences helps nurse
Establish rapport
Ask culturally relevant questions
Avoid cultural insensitivity
27
Cultural Competence for
Psychiatric Mental Health Nurses
Continued
3. Cultural encounters
Deter nurses from stereotyping
Help nurses gain confidence in crosscultural interactions
Help nurses avoid or reduce cultural
pain
28
Cultural Competence for
Psychiatric Mental Health Nurses
Continued
4. Cultural skill
Ability to perform a cultural assessment in a
sensitive way
Use professional medical interpreter to ensure
meaningful communication
Use culturally sensitive assessment tools
Goal
A mutually agreeable therapeutic plan
Culturally acceptable
Capable of producing positive outcomes
29
Cultural Competence for
Psychiatric Mental Health Nurses
Continued
5. Cultural desire
Genuine concern for client's welfare
Willingness to listen until client's viewpoint
understood
Patience, consideration, and empathy
30
Mental health is seen as the degree to
which a person fulfills the expectation
of the culture.
Good nursing adapts care to the
clients cultural needs and
preferences.
31
