Role Mental Health Nurse

8/3/2019 Role Mental Health Nurse

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MENTAL HEALTH NURSE

Mental health nurses work with children, adults and older

people suffering from various mental health conditions.

The work involves helping people to recover from their illness

or come to terms with it in order to maximise their life

potential.

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ROLE OF PSYCHIATRIC NURSE

a. Carries out traditional tasks :

Administering prescribed

drugs and monitoring effects

b. Acts as a primary therapist

c. Uses interpersonal approach to

help patients and families

d. Draws on psychosocial and

biophysical sciences to provide

care

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DEFINITION OF NURSE-PATIENT

RELATIONTHIPThe nurse patient relationship is an end result of

series of interaction between the nurse and

patient over a period of time with the nurse

focusing on need and problem of patient and hisfamily while using the scientific knowledge and

specific skills of nursing profession.

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PHASES OF NURSE PATIENT

RELATIONSHIP PRE INTERACTION PHASE

Occurs before direct patient contact

ORIENTATION PHASE Getting - to - know you

Sets tone for relationship

WORKING PHASE Exploration phase

Focuses on and evaluates patients problems

Works toward achieving established goals

TERMINATION PHASE Resolution phase

Marked by reviewing and summarizing patients progress

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Pre-interaction phase

Pre interaction is a phase which a nurse goes

through before actual interaction with the

patient. This phase begins when the nurse is

assigned a patient to develop therapeutic

relationship with him till she goes to him for

interaction

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Pre-Interaction Phase..

The pre interaction phase begins before the nurses first

contact with the patient.

This involves preparation for first encounter with the client.

This phase begins when the nurse is assigned a patient todevelop therapeutic relationship with him or her till she goes

him or her for interaction.

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Task of pre-interaction phase

Obtaining available information about the client from his or her

charts, significant others or other health team members. From

this information the initial assessment are begun.

This initial information may also allow the nurse to become awareof personal response to the knowledge about the client.

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Task of pre-interaction phase

Examining ones feelings, fears and anxieties about

working with a particular patient.

Set objective for the interaction phase.

Take help of the clinical supervisor or co-workers toovercome fears.

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Reactions of Nurse in

Pre-Interaction Phase The nurse thinks and feels about the patient before

interacting according to her knowledge, fears and

miss concepts.

She tries to collect information from secondary

sources like the patients records, a resource person

and other nurses working in the ward.

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Reactions Of Nurse in Pre Interaction

Phase .

The nurse plans how she is going to interact with the patient,

what she is going to achieve from this interaction and how she

is going to help the patient.

She plans her objective for interaction phase.

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Reactions Of Nurse in Pre Interaction

Phase . The nurse may experience anxiety.Anxiety may be manifested by standing in duty room and going

through the records, talking with the clinical instructor.

Anxieties maybe,

will the patient talk to me?

He may not accept me or like me?

He may beat me?

Once she goes to the patient the anxiety reduces.

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How to overcome anxieties

She can go through their record.

Talk to the clinical supervisor or othernurses about her fears.

Can set her goals very clearly.

Plan a brief interaction with the patient.

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INTRODUCTORY /

ORIENTATION PHASEBegins when the nurse goes to the patient, introduces herself

and gets introduction about him.

The nurse and client get acquainted.The orientation phase ends when the nurse and he patient

begin to accept each other as a unique human being.

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Task of introductory or orientation

phase a) Establishment of Contact

Nurse introduce herself to the patient

Build trust and rapport by demonstrating

acceptance.

Establishing a therapeutic environmentensuring safety and privacy

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phase..

b) Making Agreement or Pact

Initiating a therapeutic contract by establishing a time, place

and duration of each meeting as well as the length of time the

relationship will be in effect.

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phase.. c) Talking with the Patient

While talking with the patient, shows trust in her behaviour.

The patient may present a prepared spiel to the nurse when

she asks, what is your problem? during this task the nurse

should establish a mode of communication which is

acceptable to both the client and the nurse.

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phase..

d) Assess the Clients Need, Coping

Strategies, Defense Mechanisms,Strengths and Weakness

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BARRIERS TO ORIENTATION PHASE

1. Establishing an agreement or pact.

2. Social class of the patient or the nurse.

3. Status of the patient.

4. Anxiety level of the patient and nurse.

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5) Transference

When the patient perceive the nurse as asignificant individual from the past: for example the

perceives the nurse as his daughter and starts

behaving with her like a father

6) Counter transference

When the nurse perceives a male patient like her

father and gives him the same care that she would

have given to her father

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WORKING PHASE

Working Phase starts when the nurse and the

patient are able to overcome the barriers of orientation and

introductory phase.

During this phase the nurse and the patient activelywork on meeting the goals which they had establish during the

orientation phase.

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WORKING PHASE.

The characteristic feature of this phase is

that the nurse is able to overcome

anxiety and the patients fear of un

known is also decreased.

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Task of working phase

The nurse collects the data in detail from primary and secondary

sources and identifies the needs of the patent.

The nurse assists the patient to identify his or her problem.

She helps the patient to communicate.

She encourages the patient to socialize.

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The nurse helps the patient o find an alternative solution

to his or her problems

She encourage the patients to use new patterns of

behaviour.

Helps the client to develop positive coping behaviors.

Identifying available support system.

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The nurse helps the patient to understand that he has a

significant role in his treatment.

Exploring the clients perception of reality and provideconstructive feed back.

Developing and implementing plan of action with a

realistic goals.

Evaluating the results of plan of action.

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The nurse prepares the patient for

termination of relationship by reminding

him during the interviews

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Working phase

The working phase helps the nurse to developknowledge and skill in psychiatric nursing. She identifies

her strengths and weakness as a nurse while interacting

with patient.

It enables the nurse to achieve the goals which they

have plan for this phase. The end results lead the

patient to verbalize, socialize, identify and faces the

problems realistically

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BARRIERS OF WORKING PHASE

Testing of the nurseThe patient tests the nurse for the ability and

competence.

Example:

Patient: please continue talking I am very upset today.

If the nurse gives in to his demand, it indicates

manipulation.

He may deliberately be aggressive to test whether he isable to arouse anger in the nurse

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Progress of the patient

A mentally ill patient may not show a quick progress. He

may progress then regress and remains stagnant before

making further progress. In therapeutic relationship thenurse must understand the realistic progress in the

client

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Difficulty in collecting and interpreting the data

The nurse is unwilling to engage in TDS task in

collecting and interpreting the data, applying the

knowledge and skills in helping the patient, she findstoo hard to do this acts as a barrier in completing the

task of working phase.

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Fear of closeness

The nurse feels that she is working closely with

the patient she may find difficult to terminate the

relationship.The patient may not like to discontinue the

relationship. To avoid closeness she doesnt

communicate freely and makes deliberate attempts

to avoid going to the patient.

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STRATEGIES TO OVERCOME BARRIERS

Learn the subject in depth

Taking help from supervisors and experts

Discussions with peer group

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TERMINATION PHASE

The final step of the therapeutic relationship is the

termination phase. The nurse terminates the

relationship when they mutually agreed: on goals are

reached.

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TERMINATION PHASE.

The nurse discusses the termination phase with the

client encourages to identify the progress that the client

has made and explores the necessity of any referral that

may be beneficial to the patient. As separations occurs clients commonly exhibit

regressive behaviour demonstrates hostility or

experience sadness.

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TERMINATION PHASE.

The client may attempt to prolong the relationship as

clinical symptoms of separation anxiety are experienced

however; termination needs to occur if a therapeutic

relationship to be a complete process. Preparation for termination actually begins during the

initiation phase

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CAUSES

The client is transferred or discharge.

The nurse is finished clinical rotation.

The patient may go on parole and doesnt come backto hospital.

The client has improved and no longer needs to have

one to one relationship.

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TASK OF TERMINATION

Bring a therapeutic end to the relationship. Review feelings about relationship.

Evaluate progress towards goal.

Establish mechanisms for meeting future therapyneeds.

Summarize entire communication and follow up

treatments.

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PREPARATION OF PATIENT Explain whatever goals of therapeutic relationship

where plans have been met.

Allow the patient to talk about his or her fear and an

individualistic approach has to be used.

A psychiatric social worker can be contacted to meet

to visit the office and family of the patient.

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PREPARATION OF PATIENT

The patient may sent on parole beforedischarge, so that he gradually goes

through the weaning of the phase.

The patient may be sent through a half way

home.

The patient may be asked to attend the daycare center for few days.

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BARRIERS OF TERMINATION PHASE The patient may ask the nurse to write to him or

come back from duty and see him.

The patient may ask the address and telephone

number of nurse and ask permission to visit her inhospital

Gift giving

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BARRIERS OF TERMINATION PHASE.

The nurse may withdraw earlier from the patient due

to her own anxiety she may not interact with the

patient

The nurse may not assess the patient which she

could otherwise do

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STRATEGIES TO OVERCOME

Nurse needs to explore her own feelings and

thoughts about separation from the patient which

will help her to accomplish the task of termination

phase The patient should be explained that every

relationship terminates

Getting help from supervisors

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STRATEGIES TO OVERCOME.

After discharge the patient comes for

intervention he or she should be referred to a

second in charge.

If the patient is giving some gifts: the patientneed to be explained about the professional

ethics, if he wants to give a gift he may be

encourage to gift out something for theutilization of other patients.

Role Mental Health Nurse

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