Presented by Payal Pradhan Psychiatric Care Goal of tertiary prevention is to limit the amount of disability and maladaptive functioning resulting from an illness.
Concepts of tertiary prevention relevant to patients with
serious mental illness.
1 in 17 adults in USA have a serious mental illness.
Nurses care for these people in a variety of settings:-
• Private and public psychiatric hospitals.
• Psychiatric and medical-surgical units in general hospitals. • Emergency rooms. • Community-based treatment and rehabilitation programs. • Primary care settings. • Patients homes. Rehabilitation Tertiary prevention is carried out through activities identified as rehabilitation, which is the process of helping the person return to the highest possible level of functioning. Psychiatric rehabilitation is a combination of services incorporating social, educational, occupational, behavioral, and cognitive interventions aimed at long-term recovery and maximization of self-sufficiency. Psychiatric rehabilitation grew out of a need to create opportunities for people diagnosed with severe mental illness to live, learn, and work in their own communities. Psychiatric rehabilitation uses a person-centered, people-to- people approach that differs from the traditional medical model of care ( Table 14-1 ). Although research has reported that certain interventions effectively assist people who have serious mental illnesses function productively in their communities.
The first group of disseminated evidence-based practices that
support and enhance psychiatric rehabilitation included the following: assertive community treatment, supported employment, illness management and recovery, integrated treatment for co-occurring mental illness and substance abuse, family psycho-education, and medication management.
Rehabilitative psychiatric nursing takes place in the context of a
multidisciplinary treatment team.
Other team members may include: psychiatrists, psychologists,
social workers, occupational therapists, rehabilitation counselors, case managers, consumer team members, family advocates, employment specialists, or job coaches. Recovery Recovery is the process in which people are able to live, work, learn, and participate fully in their communities.
Recovery is a journey of healing and
transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. Characteristics of Serious Mental Illness People who have SMI are likely to have primary and secondary symptoms. Primary symptoms are directly caused by the illness. For example, hallucinations and delusions are primary symptoms of schizophrenia, and elation and hyperactivity are primary symptoms of bipolar disorder. Secondary symptoms, such as loneliness and social isolation, are caused by the person response to the illness or its treatment.
Behaviors related to primary symptoms may violate social norms and be
considered deviant. Society tries to protect itself from the persons norm violation. As behavior problems become more serious, people increasingly identify themselves as mentally ill. They begin to relate to society in terms of this identity rather than others, such as wife, mother, husband, father, or worker. The persons acceptance of mentally ill status and adjustment to society in terms of this role are accompanied by the secondary symptoms of SMI. Social Support Needs Families who are providing care for members who have SMI often feel isolated and alone in dealing with the challenges of care giving. Previous sources of social support may be lost or limited because of the demands of attending to the mentally ill family member. Caregivers may be embarrassed about the illness or fear that the person with mental illness will behave inappropriately in the presence of others. Nurses can play an important role in offering family members opportunities to discuss their concerns and taking action to meet their needs whenever possible. Table 14-3 lists support needs expressed by family caregivers. Developing strengths and potential The development of the patient’s strengths and potential is critically important. Nursing interventions that develop strengths and potentials can help patients develop independent living skills, interpersonal relationships, and coping resources and thus help meet their special needs. Ultimately, the expected outcome of such intervention is change in the patient’s self-concept and an increase in self-esteem. The negative self-concept and low self- esteem that characterize people who have serious mental illnesses interfere with their ability to see the themselves as individuals with strengths and potentials. Rehabilitation programs psychiatric rehabilitation programs were developed in response to the plight of people who had been discharged from state mental hospital lacking the skill and resources needed to live independently several models are presented here as an over-view of some of the psychiatric rehabilitation approaches that have evidence supporting their effectiveness. CONCLUSION Evaluation of psychiatric rehabilitations services usually covers the impact on the patient and family and the effectiveness of the community service system. Evaluation of the services provider to patient and family member must focus on the achievement of the expected outcome of the intervention . Most psychiatric rehabilitation evaluation program rely on both objective and subjective measure of outcome.