Nursing Study Guide/Care of Mental Health Needs

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Introduction

Mental Health Nursing is a discrete area of nursing from neurological and mental disability nursing. The client population for mental health nursing largely suffers functional rather than organic conditions. The majority of mental health clients suffer from psychoses or neuroses or a variety of related conditions. Drug addiction, for example, falls outside the role of most mental health units or deserves a special place with dedicated facilities and trining. Psychogeriatric clients tend to suffer from a representative range of dementias while in treatment for pre-existing mental illnesses.

Hildegard Peplau is regarded as the mother of modern psychiatric nursing. She is famous for reframing nursing as a relationship, rather than viewing the client as a passive vessel into which health-care can be poured.

Legislation

Mental Health Nurses need to be aware of the mental health legislation affecting practise in their area. Mental health regulations may differ slightly with regard to classification of clients and their rights. Some general principles

• People may not be defined as mentally ill unless they are given a diagnosis which appears in the ICD (International Classification of Disease).
• Clients so identified are entitled to the least restrictive modality of care (involuntary admission, community treatment)
• Clients are offered the opportunity to appeal their involuntary status under the law (second opinion).
• Clients have a process for complaints about their treatment.

Sample care plan for schizophrenia

Altered Thought Process

• Refer to a Mental Health Practitioner
• Build trust and empathise with client
• Don’t force client into reality, but don’t confirm that delusions are real or agree with her.

Poor Nutrition/Hydration

• Establish a rapport with client and gain trust.
• Take a therapeutic approach to her treatment/nutrition.
• Focus on regaining her health and recovering, rather than curing her.
• Choose a safe and comfortable place for eating her meals, where client will not feel threatened by others.
• Give finger-food (which can also rid the threat of sharp objects), also give her regular and small snacks throughout the day rather than a ‘sit down meal’ so she can keep moving/busy
• Make food look presentable and appetising
• Allow her to eat in her own time and not feel pressured
• Encourage hydration (either through an IV cannula or frequent sips of water)
• Give foods client can prepare themself/knows are safe such as boiled eggs, tinned food etc.

Impaired sleep Pattern

• Ensure Gabriella is comfortable
• Use relaxation techniques such as soft music, a room with a soothing aroma etc.
• Have a routine sleep schedule, to keep ‘body clock’ in a good pattern
• Ensure the environment she is in is free from loud noises and is warm and dark.
• Provide warm drink of milk before bed (active ingredient tryptophan)

Self Care Deficit

• Help client see a need for self care, and a reason to look after herself
• Encourage client to launder clothes
• Encourage client to wash themselves and care for her hygiene (including dental)
• but give client some other clothes (similar to the overalls) to wear in the meantime.

Social Isolation

• Involve her family in her treatment process if possible

• Treat clienta with the same empathy and understanding as you would with any other patient.
• Build a rapport, give client someone to trust, this will make them feel safe and possibly ‘open up’ more as a person, it will also give them someone to talk to about issues when the opportunity arises.
• Show her that you trust/respect the client and have an unconditional positive regard for client, this will help increase her trust toward you and other people.
• Slowly get client involved in groups (in the hospital) with other people who have a similar condition and may be able to help each other, this will help mutual confidence in people and also help clients socialise with others.