Transcript Chapter 30
Chapter 30: Community Mental Health Nursing for Patients with Severe and Persistent Mental Illness Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Role of the Community Mental Health Nurse Provide compassionate, professional care Helps patient maintain highest level of functioning Supports during crisis and helps develop coping skills Helps families cope Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 2 Role of the Community Mental Health Nurse, cont’d. Serve as care/case managers Home health care providers Members of psychiatric care team Advanced Practice Nurses or Clinical Nurse Specialists can serve in community mental health centers Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 3 Severe and Persistent Mental Illness Has numerous emotional, cognitive, and behavioral symptoms Associated with specific disorders, such as schizophrenia and mood disorders Remissions and recurrence of severe and disabling symptoms Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4 Psychotropic Medications Influenced deinstitutionalization Drug research and development influences prognosis and treatment Side effects and response Non-adherance Weight gain, sleep apnea, diabetes, cardiovascular complications Patient and family education Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5 Legal Influences Least restrictive alternative Mental Health Courts attempting to divert persons with severe and persistent mental illness away from the criminal justice system Signed consent Patient confidentiality Failure to warn Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 6 Severe and Persistent Mental Illness in Adults Schizophrenia Mood disorders Delusional disorders Dementia Amnesia Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7 Community Mental Health Centers Funding Philosophy Freedom of choice Continuity of care Partial hospitalization programs Psychosocial rehabilitation and skills training Programs for assertive community treatment Clubhouse model Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8 Goals of Case Management Identification and outreach Assessment Improving patient activities of daily living Service plan Monitoring Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 9 Levels of Assisted Living Adult residential treatment program Congregate care facilities Adult family homes Home visits Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10 Behavioral Manifestations Medication noncompliance Negative attitudes about medication Improvement leads to noncompliance Cost Side effects Lack of knowledge Undiagnosed/untreated medical illness Employment Difficulty obtaining and retaining jobs related to lack of skills, deficits Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11 Behavioral Manifestations, cont’d. Dependent living with family Parent Life is unstable for spouse and children Educate about child development and needs Consider family in plan of care Adult children Behaviors are often disruptive Parents feel shame, guilt, chronic sorrow There is no relief from stress of parenthood Resource: NAMI Siblings Household disruptions Loss of parental attention Assume care of sibling Resource: Support groups Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12 Behavioral Manifestations, cont’d. Sexuality Normal sex drive; inappropriate sexual responses Promiscuity Vulnerable to exploitation Risk for HIV/AIDS, other STDs Education, birth control, screening Exposed to more violence Prenatal care; effect of psychotropic medication Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13 Behavioral Manifestations, cont’d. Assault behaviors/criminal activity Related to lack of judgment and self-control, means of survival, delusions, and hallucinations Predictors: History of past violence, drug/alcohol abuse, medication noncompliance Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14 Special Problems Mental retardation: IQ 70 Sensory and communication impairment Older adults Hearing impaired Blind May have grown old with the disorder Disorder may be newly diagnosed Substance abuse (dual diagnosis) Symptoms distorted, impulse control Prone to homelessness Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 15 Homeless Individuals Often have dual diagnosis Causes: Economic constraints, unemployment, cutbacks in federal programs, restrictive admission policies, lack of low-cost housing Risks: Medical illness, accidents, hypothermia, victimization, murder Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 16