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