Introduction to Psychiatric Mental Health Nursing 47
Hospitalization 52
Health Concepts Nursing Liability 54
Summary and Key Points 55
Chapter 1
... [Show More] Mental Health and Mental Illness 2
Introduction 2 Chapter4 Psychopharmacology 59
Mental Health 3 Introduction 60
Mental Illness 3 Historical Perspectives 60
Physical and Psychological Responses Role of the Nurse 60
to Stress 5 Ethical and Legal Implications 60
Physical Responses 5 Assessment 61
Psychological Responses 6 Medication Administration and
Summary and Key Points 11 Evaluation 61
Client Education 63
Chapter 2 Biological Implications 14 How do Psychotropics Work? 63
Introduction 15 Applying the Nursing Process
The Nervous System: An Anatomical Review 15 in Psychopharmacological Therapy 64
The Brain 15 Antianxiety Agents 67
Nerve Tissue 19 Antidepressants 68
Autonomic Nervous System 20 Mood-Stabilizing Agents 72
Neurotransmitters 21 Antipsychotic Agents 77
Neuroendocrinology 26 Sedative-Hypnotics 85
Pituitary Gland 26 Agents for Attention Deficit/Hyperactivity
Circadian Rhythms 30 Disorder (ADHD) 87
Genetics 30 Summary and Key Points 90
Psychoneuroimmunology (PNI) 31 Cultural and Spiritual Concepts Normal Immune Response 31 Chapter 5
Psychopharmacology and the Brain 34 Relevant to Psychiatric Mental
Implications for Nursing 34 Health Nursing 94
Summary and Key Points 35 Cultural Concepts 95
How Do Cultures Differ? 96
Chapter 3 Ethical and Legal Issues 39 Communication 96
Introduction 40 Space 96
Ethical Considerations 41 Social Organization 97
Theoretical Perspectives 41 Time 97
Ethical Dilemmas 42 Environmental Control 97
Ethical Principles 42 Biological Variations 97
A Model for Making Ethical Decisions 43 Application of the Nursing Process 97
Ethical and Legal Issues in Psychiatric Background Assessment Data 97
Mental Health Nursing 43 African Americans 99
Legal Considerations 46 American Indian and Alaska Natives 100
Nurse Practice Ads 46 Asian/Pacific Islander Americans 101
Types of Law 47 Latino Americans 102
Classifications Within Statutory and Arab Americans 103
Common Law 47 Cultural Syndromes 105
xxii Contents
Planning and Implementation 109 Why Nursing Diagnosis? 157
Evaluation 110 Nursing Case Management 158
Spiritual Concepts 110 Critical Pathways of Care 159
Spiritual Needs 110 Applying the Nursing Process in the
Religion 112 Psychiatric Setting 159
Addressing Spiritual and Religious Needs Concept Mapping 161
Through the Nursing Process 113 Documentation of the Nursing Process 162
Assessment 113 Problem-Oriented Recording 162
Diagnoses and Outcome Identification 113 Focus Charting 164
Planning and Implementation 115 The PIE Method 165
Evaluation 115 Electronic Documentation 165
Summary and Key Points 115 Summary and Key Points 167
Chapter 8 Milieu Therapy-The Therapeutic
UNIT .2 Community 171
Psychiatric Mental Health Nursing Introduction 171
Interventions 123 Milieu, Defined 172
Current Status of the Therapeutic
Relationship Development and Community 172
Chapter6 Basic Assumptions 172 Therapeutic Communication 124 Conditions That Promote a Therapeutic
Introduction 125 Community 173
The Therapeutic Nurse-Client Relationship 125 The Program of Therapeutic Community 174
Therapeutic Use of Self 126 The Role of the Nurse in Milieu Therapy 175
Conditions Essential to Development Summary and Key Points 178
of a Therapeutic Relationship 126
Rapport 126 Chapter 9 Intervention in Groups 182
Trust 126 Introduction 183
Respect 127 Functions of a Group 183
Genuineness 127 Types of Groups 183
Empathy 127 Task Groups 183
Phases of a Therapeutic Nurse-Client Teaching Groups 183
Relationship 128 Supportive-Therapeutic Groups 184
The Preinteraction Phase 129 Self-Help Groups 184
The Orientation (Introductory) Phase 129 Physical Conditions That Influence
The Working Phase 129 Group Dynamics 184
The Termination Phase 130 Seating 184
Boundaries in the Nurse-Client Relationship 131 Size 185
Interpersonal Communication 132 Membership 185
The Impact of Preexisting Conditions 132 Curative Factors 185
Nonverbal Communication 134 Phases of Group Development 186
Therapeutic Communication Techniques 136 Phase I. Initial or Orientation Phase 186
Nontherapeutic Communication Phase II. Middle or Working Phase 186
Techniques 136 Phase Ill . Final or Termination Phase 186
Active Listening 136 Leadership Styles 187
Process Recordings 138 Autocratic 187
Summary and Key Points 142 Democratic 187
Laissez-Faire 187
Chapter7 The Nursing Process in Psychiatric Member Roles 187
Mental Health Nursing 146 Psychodrama 188
Introduction 147 The Family as a Group 189
The Nursing Process 147 The Role of the Nurse in Therapeutic
Definition 147 Groups 189
Standards of Practice 147 Summary and Key Points 190
Contents xxiii
Chapter 10 Crisis Intervention 193 Epidemiological Factors 229
Introduction 193 Risk Factors 230
Characteristics of a Crisis 194 Marital Status 230
Phases in the Development of a Crisis 194 Gender 230
Types of Crises 195 Age 231
Class T: Dispositional Crises 196 Religion 231
Class 2: Crises of Anticipated Life Socioeconomic Status 231
Transitions 196 Ethnicity 231
Class 3: Crises Resulting from Other Risk Factors 232
Traumatic Stress 196 Predisposing Factors: Theories of Suicide 232
Class 4: Maturational and Psychological Theories 232 Developmental Crises 196 Sociological Theory 233 Class 5: Crises Reflecting Biological Theories 233 Psychopathology 197
Application of the Nursing Process Class 6: Psychiatric Emergencies 197 With the Suicidal Client 233 Crisis on the Inpatient Unit: Anger and Assessment 233 Aggression Management 197 Diagnosis and Outcome Identification 237 Assessment 197 Planning and Implementation 237 Diagnosis and Outcome Identification 199 Evaluation 241 Planning and Implementation 200
Summary and Key Points 242 Evaluation 200
Crisis Intervention 203 UNIT3 Phases of Crisis Intervention:
The Role of the Nurse 203 Care of Clients With Psychiatric Disorders 247
Phase T. Assessment 203
Phase 2. Planning of Therapeutic Chapter 13 Neurocognitive Disorders 248
Intervention 204 Introduction 248
Phase 3. Intervention 205 Delirium 249
Phase 4. Evaluation of Crisis Clinical Findings and Course 249
Resolution and Anticipatory Planning 205 Predisposing Factors 249
Disaster Nursing 205 Neurocognitive Disorder 250
Application of the Nursing Process
206 Clinical Findings, Epidemiology,
250 to Disaster Nursing and Course
Background Assessment Data 206 Predisposing Factors 253
Nursing Diagnoses and Outcome Application of the Nursing Process 259 Identification 206 Assessment 259 Planning and Implementation 206 Nursing Diagnosis and Outcome Evaluation 206 Identification 262
Summary and Key Points 212 Planning and Implementation 263
Concept Care Mapping 267 Chapter 11 n,e Recovery Model 215
Client and Family Education 267 Introduction 215
What Is Recovery? Evaluation 267 216
Quality and Safety Education Guiding Principles of Recovery 216 for Nurses (QSEN) 268 Models of Recovery 218 Medical Treatment Modalities 268 The Tidal Model 218 Delirium 268 The Wellness Recovery Action Plan 220 Neurocognitive Disorder (NCO) 268 The Psychological Recovery Model 222 Summary and Key Points 278 Nursing Interventions that Assist with
224 Substance Use and Addictive Recovery Chapter 14
Summary and Key Points 226 Disorders 282
Introduction 283 Chapter 12 Suicide Prevention 228
Substance Use Disorder, Defined 283 Introduction 228
Historical Perspectives 229 Substance Addiction 283
xxiv Contents
Substance-Induced Disorders, Defined 284 Non-substance Addictions 330
Substance Intoxication 284 Gambling Disorder 330
Substance Withdrawal 284 Summary and Key Points 335
Classes of Psychoactive Substances 284
Predisposing Factors to Substance-Related Chapter 15 Schizophrenia Spedrum and Other
Disorders 284 Psychotic Disorders 340
Biological Factors 284 Introduction 341
Psychological Factors 285 Nature of the Disorder 341
Sociocultural Factors 285 Phase I: The Premorbid Phase 342
The Dynamics of Substance-Related Phase II: The Prodromal Phase 342
Disorders 286 Phase Ill: Schizophrenia 342
Alcohol Use Disorder 286 Phase IV: Residual Phase 343
Alcohol Intoxication 291 Prognosis 343
Alcohol Withdrawal 291 Predisposing Factors 343
Sedative, Hypnotic, or Anxiolytic Biological Factors 343
Use Disorder 291 Psychological Factors 346
Sedative, Hypnotic, or Anxiolytic Environmental Influences 346
Intoxication 294 Theoretical Integration 347
Sedative, Hypnotic, or Anxiolytic Types of Schizophrenia and Other Withdrawal 294 Psychotic Disorders 347
Stimulant Use Disorder 294 Delusional Disorder 347
Stimulant Intoxication 298 Brief Psychotic Disorder 348
Stimulant Withdrawal 298 Substance- and Medication-Induced
Inhalant Use Disorder 298 Psychotic Disorder 348
Inhalant Intoxication 299 Psychotic Disorder Due to Another
Opioid Use Disorder 300 Medical Condition 348
Opioid Intoxication 302 Catatonic Disorder Due to Another
Opioid Withdrawal 302 Medical Condition 348
Hallucinogen Use Disorder 302 Schizophreniform Disorder 348
Hallucinogen Intoxication 304 Schizoaffective Disorder 349
Cannabis Use Disorder 305 Application of the Nursing Process 350
Cannabis Intoxication 307 Schizophrenia: Background
Cannabis Withdrawal 307 Assessment Data 350
Application of the Nursing Process 307 Diagnosis and Outcome Identification 353
Assessment 307 Planning and Implementation 354
Diagnosis and Outcome Identification 316 Concept Care Mapping 355
Planning and Implementation 317 Evaluation 360
Concept Care Mapping 317 Quality and Safety Education
Client and Family Education 321 for Nurses (QSEN) 362
Treatment Modalities for Schizophrenia Evaluation 321 and Other Psychotic Disorders 362
The Chemically Impaired Nurse 322 Psychological Treatments 362
Codependency 323 Social Treatments 366
The Codependent Nurse 324 Organic Treatment 368
Treating Codependency 324 Summary and Key Points 373
Treatment Modalities for Substance-Related
Disorders 325 Chapter 16 Depressive Disorders 377
Alcoholics Anonymous 325 Introduction 378
Pharmacotherapy 325 Historical Perspective 378
Counseling 328 Epidemiology 378
Group Therapy 328 Age and Gender 379
Psychopharmacology for Substance Social Class 379
Intoxication and Substance Race and Culture 379 Withdrawal 328
Contents XXV
Marital Status 379 Predisposing Factors 422
Seasonality 379 Biological Theories 422
Types of Depressive Disorders 380 Psychosocial Theories 423
Major Depressive Disorder 380 The Transactional Model of Stress
Persistent Depressive Disorder and Adaptation 423
(Dysthymia) 382 Developmental Implications 424
Premenstrual Dysphoric Disorder 382 Childhood and Adolescence 424
Substance- or Medication-Induced Application of the Nursing Process
Depressive Disorder 382 to Bipolar Disorder (Mania) 425
Depressive Disorder Due to Another Background Assessment Data 425
Medical Condition 382 Diagnosis and Outcome Identification 426
Predisposing Factors 382 Planning and Implementation 427
Biological Theories 383 Concept Care Mapping 427
Psychosocial Theories 387 Client and Family Education 427
Developmental Implications 388 Evaluation of Care for the Client
Childhood 388 Experiencing a Manic Episode 430
Adolescence 390 Treatment Modalities for Bipolar
Senescence 390 Disorder (Mania) 432
Postpartum Depression 391 Individual Psychotherapy 432
Application of the Nursing Process 392 Group Therapy 432
Background Assessment Data 392 Family Therapy 433
Diagnosis and Outcome Identification 395 Cognitive Therapy 433
Planning and Implementation 395 The Recovery Model 433
Concept Care Mapping 395 Electroconvulsive Therapy 434
Client and Family Education 401 Psychopharmacology With
Evaluation of Care for the Depressed Mood-Stabilizing Agents 434
Client 401 Summary and Key Points 442
Quality and Safety Education Chapter 18 Anxiety, Obsessive-Compulsive, for Nurses (QSEN) 401
Treatment Modalities for Depression 403 and Related Disorders 446
Individual Psychotherapy 403 Introduction 447
Group Therapy 403 Historical Aspects 447
Cognitive Therapy 405 Epidemiological Statistics 449
Electroconvulsive Therapy 405 How Much Is Too Much? 449
Transcranial Magnetic Stimulation 406 Application of the Nursing ProcessVagal Nerve Stimulation and Deep Assessment 449
Brain Stimulation 407 Panic Disorder 449
Light Therapy 407 Generalized Anxiety Disorder 450
Psychopharmacology 408 Phobias 451
Summary and Key Points 414 Anxiety Disorder Due to Another
Medical Condition and SubstanceChapter 17 Bipolar and Related Disorders 418 or Medication-Induced Anxiety
Introduction 419 Disorder 455
Historical Perspective 419 Obsessive-Compulsive Disorder 455
Epidemiology 419 Body Dysmorphic Disorder 456
Types of Bipolar Disorders 419 Trichotillomania (Hair-Pulling Disorder) 457
Bipolar I Disorder 420 Hoarding Disorder 457
Bipolar II Disorder 420 Assessment Scales 459
Cyclothymic Disorder 420 Diagnosis and Outcome Identification 459
Substance- and Medication-Induced Outcome Criteria 459
Bipolar Disorder 421 Planning and Implementation 460
Bipolar Disorder Due to Another Concept Care Mapping 460
Medical Condition 421 Client and Family Education 465
xxvi Contents
Evaluation 465 Diagnosis and Outcome Identification 513
Treatment Modalities 467 Planning and Implementation 514
Individual Psychotherapy 467 Concept Care Mapping 521
Cognitive Therapy 467 Evaluation 521
Behavior Therapy 468 Treatment Modalities 521
Psychopharmacology 469 Somatic Symptom Disorders 521
Summary and Key Points 474 Dissociative Amnesia 524
Trauma-and Stressor-Related Dissociative Identity Disorder 524
Chapter 19 Depersonalization-Derealization Disorders 477 Disorder 524
Introduction 478 Summary and Key Points 527
Historical and Epidemiological Data 478
Application of the Nursing Process- Chapter 21 Issues Related to Human Sexuality
Trauma-Related Disorders 479 and Gender Dysphoria 530
Posttraumatic Stress Disorder and Introduction 531
Acute Stress Disorder 479 Development of Human Sexuality 531
Theories of Etiology related to Birth Through Age 12 531
Trauma-Related Disorders 479 Adolescence 532
Trauma-Informed Care 482 Adulthood 533
Diagnosis and Outcome Identification 483 Sexual Disorders 534
Planning and Implementation 483 Historical Aspects 534
Concept Care Mapping 483 Paraphilic Disorders 534
Evaluation 483 Sexual Dysfunctions 538
Application of the Nursing Process- Application of the Nursing Process to Stressor-Related Disorders 486 Sexual Disorders 541
Adjustment Disorders-Background Assessment 541 Assessment Data 486 Diagnosis and Outcome Identification Theories of Etiology Related to 544
Adjustment Disorders 491 Planning and Implementation 545
Diagnosis and Outcome Identification 491 Concept Care Mapping 545
Planning and Implementation 492 Client and Family Education 548
Concept Care Mapping 494 Evaluation 548
Evaluation 494 Quality and Safety Education
Treatment Modalities for Nurses (QSEN) 548 494 Treatment Modalities for Sexual Trauma-Related Disorders 494 Dysfunctions 548
Adjustment Disorders 497 Gender Dysphoria 552
Summary and Key Points 500 Course and Epidemiology 552
Chapter 20 Somatic Symptom and Dissociative Predisposing Factors 552
Disorders 503 Application of the Nursing Process to
Introduction Gender Dysphoria in Children 553 504 Background Assessment Data Historical Aspects 504 (Symptomatology) 553
Epidemiological Statistics 505 Diagnosis and Outcome Identification 553
Application of the Nursing Process 506 Planning and Implementation 554
Background Assessment Data: Evaluation 554 Types of Somatic Symptom Treatment Issues 556 Disorders 506
Predisposing Factors Associated With Gender Dysphoria in Adolescents
Somatic Symptom and Related or Adults 556
Disorders 509 Treatment Issues 556
Background Assessment Data: Variations in Sexual Orientation 558
Types of Dissociative Disorders 510 Homosexuality 559
Predisposing Factors Associated With Bisexuality 561
Dissociative Disorders 512 Summary and Key Points 563
Contents xxvii
Chapter 22 Eating Disorders 567 Treatment Modalities 615
Introduction 568 Individual Psychotherapy 617
Epidemiological Factors 568 Milieu or Group Therapy 617
Application of the Nursing Process 569 Cognitive Behavior Therapy 617
Background Assessment Data: Dialectical Behavior Therapy 617
Anorexia Nervosa 569 Psychopharmacology 618
Background Assessment Data: Summary and Key Points 621 Bulimia Nervosa 569
Background Assessment Data: UNIT4 Binge Eating Disorder 570
Background Assessment Data: Psychiatric Mental Health Nursing
Body Mass Index 572 of Special Populations 625
Diagnosis and Outcome Identification 572
Planning and Implementation 574 Chapter 24 Children and Adolescents 626
Concept Care Mapping 579 Introduction 627
Client and Family Education 582 Neurodevelopmental Disorders 627
Evaluation 582 Intellectual Disability (Intellectual Quality and Safety Education Developmental Disorder) 627
for Nurses (QSEN) 583 Autism Spectrum Disorder 631
Treatment Modalities 583 Attention Deficit/Hyperactivity Disorder 636
Behavior Modification 584 Tourette's Disorder 645
Individual Therapy 584 Disruptive Behavior Disorders 649
Family Treatment: Oppositional Defiant Disorder 649 The Maudsley Approach 584 Conduct Disorder 653 Psychopharmacology 584 Anxiety Disorders 657 Summary and Key Points 587 Separation Anxiety Disorder 657
Chapter 23 Personality Disorders 590 Quality and Safety Education
for Nurses (QSEN) 659 Introduction 591
General Therapeutic Approaches 661 Historical Aspects 591
Behavior Therapy 661 Types of Personality Disorders 593
Family Therapy 662 Paranoid Personality Disorder 593
Group Therapy 662 Schizoid Personality Disorder 594
Psychopharmacology 662 Schizotypal Personality Disorder 595
Summary and Key Points 664 Antisocial Personality Disorder 596
BPD 596 Chapter 25 The Aging Individual 668
Histrionic Personality Disorder 596 Introduction 669
Narcissistic Personality Disorder 597 How Old Is Old? 669
Avoidant Personality Disorder 598 Epidemiological Statistics 670
Dependent Personality Disorder 599 The Population 670
Obsessive-Compulsive Personality Marital Status 670 Disorder 599 Living Arrangements 670 Application of the Nursing Process 601 Economic Status 670 BPD (Background Assessment Data) 601 Employment 671 Diagnosis and Outcome Identification 604 Health Status 671 Planning and Implementation 604 Theories of Aging 671 Concept Care Mapping 604 Biological Theories 671 Evaluation 604 Psychosocial Theories 672 Antisocial Personality Disorder The Normal Aging Process 674 (Background Assessment Data) 610
Biological Aspects of Aging 674 Diagnosis and Outcome Identification 612
Psychological Aspects of Aging 676 Planning and Implementation 613
Sociocultural Aspects of Aging 679 Concept Care Mapping 615
Sexual Aspects of Aging 680 Evaluation 615
xxviii Contents
Special Concerns of the Elderly Population 681 Application of the Nursing Process 764
Retirement 681 Background Assessment Data:
long-Term Care 683 Concepts of Death-Developmental
Issues 764 Elder Abuse 684
Background Assessment Data: Concepts Suicide 686 of Death-Cultural Issues 765 Application of the Nursing Process 686 Nursing Diagnosis and Outcome Assessment 686 Identification 767
Diagnosis and Outcome Identification 687 Planning and Implementation 768
Planning and Implementation 688 Evaluation 768
Evaluation 688 Additional Assistance 770
Summary and Key Points 696 Hospice 770
Suavivors of Abuse or Negled Advance Directives 771 Chapter 26 700
Summary and Key Points 773 Introduction 701
Predisposing Factors 701 Chapter 29 Military Families 777
Biological Theories 702 Historical Aspects 778
Psychological Theories 702 Epidemiological Statistics 778
Sociocultural Theories 702 Application of the Nursing Process 778
Application of the Nursing Process 704 Assessment 778
Background Assessment Data 704 Diagnosis and Outcome Identification 786
Diagnosis and Outcome Identification 711 Planning, Implementation, Planning and Implementation 712 and Evaluation 786
Concept Care Mapping 712 Treatment Modalities 790
Evaluation 714 Posttraumatic Stress Disorder 790
Treatment Modalities 715 Traumatic Brain Injury 792
Crisis Intervention 715 Summary and Key Points 792
The Safe House or Shelter 716
Family Therapy 716 Appendix A Assigning NANDA Nursing Diagnosis Summary and Key Points 718 to Client Behaviors 797
Chapter 27 Community Mental Health Nursing 722 Appendix B Mental Status Assessment 799
Introduction 723 Appendix C Glossary 803
The Changing Focus of Care 723 Appendix D Answers to Review Questions 827
The Public Health Model 724 Appendix E Examples of Answers to Communication The Community as Client 726 Exercises 829
Primary Prevention 726 DSM-5 Classification: categories and Secondary Prevention 731 Appendix F
Codes 832 Tertiary Prevention 735
Summary and Key Points 752 Index 851
Chapter 28 n,e Bereaved Individual 756
Introduction 757
Theoretical Perspectives on Loss
and Bereavement 757
Stages of Grief 757
Length of the Grief Process 761
Anticipatory Grief 762
Maladaptive Responses to Loss 762
Delayed or Inhibited Grief 762
Distorted (Exaggerated) Grief
Response 762
Chronic or Prolonged Grieving 763
Normal versus Maladaptive Grieving 763 [Show Less]