shared with team members, except in certain circumstances. In cases of suicidal or homicidal thoughts, sexual abuse, or other high-risk behaviors, the nurse must share the assessment
information with other healthcare professionals and the parents. In fact, identifying risk factors in this age group is an important aspect of the assessment.
THE NURSING PROCESS IN MENTAL HEALTH
The nursing process is a systematic way of developing an individualized plan of care for those experiencing a disruption in mental health status. The traditional nursing process consists of performing a comprehensive assessment, formulating nursing diagnoses, developing a care plan, implementing selected nursing interventions, and evaluating the outcome or effectiveness of those interventions (Boyd, 2018). Most facilities have their own documentation that follows accepted guidelines for mental health assessment. personal safety is a concern, the nurse may request another staff member to be present. The nurse should remove distracting elements such as a television or radio. If the nurse determines that the patient is too ill to be able to provide accurate information or that the interview process itself will be detrimental to the patient’s health, then the nurse should obtain information from other reliable sources, such as family members, social workers, therapists, and primary healthcare providers (Boyd, 2018). Documentation of the source of information is important, particularly when the patient is unable to provide an accurate history. Although the psychiatric nurse may gather information from other sources, it is important that the nurse not disclose any information regarding the patient’s status without the patient’s written consent to avoid a breach in confidentiality. the planning process in the care of patients with psychiatric- mental health disorders. Implementation of interventions is driven by goals established during the planning process. Short- and long-term goals must be observable, measurable (i.e., goals or outcomes that can be evaluated) and realistically attainable in the given time frame and setting. Identifying contributing factors and behavioral symptoms can directly lead to the development of short- and long-term goals that help evaluate progress. Interventions for this population will always include therapeutic communication and the mental status examination (Boyd, 2018).
The physiological health exam and work-up is an initial step for thoroughly and accurately diagnosing and managing mental health conditions, including common screening labs and physical exams to rule out common medical issues that could be causing, mimicking, or contributing to mental health symptoms. Some physiological conditions present with psychiatric symptoms. Ensuring that the patient has a baseline physical assessment assist in the accurate diagnosis and appropriate treatment of all conditions, thus demonstrating the mind-body connection. Because of this link, the history and presenting symptoms of the patient are of utmost importance. Assessment Creating a therapeutic alliance is an important step in the holistic care of the patient. This connection provides an optimal setting for obtaining the psychosocial and psychiatric history. The first step is to obtain a thorough history of the patient, incorporating elements of current and past health problems, social issues affecting health, and cultural or spiritual beliefs that may support or interfere with prescribed healthcare treatments (Halter, 2018). The nurse should obtain the history in an environment conducive to effective communication between the nurse and the patient. Family members and significant others may or may not be present, or they may be present for a portion of the time and then be asked to step out to maintain the patient’s confidentiality. Interviews should be conducted in a private conference room or patient’s room (if inpatient or residential) rather than in a public area where others may overhear. If Nursing diagnosis and planning Most healthcare facilities have an existing form to guide the nurse in data collection. The data collection process assists the nurse in developing a nursing diagnosis list. After identifying real and potential problems, the nurse develops written nursing diagnoses to address each problem. Nursing diagnoses are important in structuring appropriate, efficient nursing care while serving as a common language nursing team members. Prioritization is also based on Maslow's Hierarchy of needs so that physiological and safety needs that are outlined in nursing diagnoses will be addressed first. The nursing diagnosis drives The biopsychosocial framework The biopsychosocial framework is a well-accepted, holistic model for organizing healthcare issues (Boyd, 2018). Three interdependent domains have separate treatment focus but interact to provide a framework for implementing nursing care through a systematic process. The biologic domain is related to functional health patterns in mental health such as sleep, exercise, and nutrition. Pharmacologic principles in medication administration are related to neurobiological theories. The psychological domain contains the interpersonal dynamics that influence emotions, cognition, and behavior. This generates theories and research critical in understanding symptoms and responses in mental disorders. Therapeutic communication techniques exist in this domain, as there are many cognitive and behavioral approaches in patient care. The social domain accounts for the family and community influences in mental disorders. While these influences do not cause mental illness, manifestations and disorders are significantly affected by these factors.
Boyd, 2018
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Book Code: ANCCUS3023
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