Orientation and Foundations of

Psychiatric Mental Health

Nursing
Definition of Psychiatric Mental
Health Nursing:
A specialty within the nursing profession
that focuses primarily on the use of
therapeutic interpersonal interactions
and biologic and interpersonal
interventions with clients.
 PMHN focuses on human aspects and
responses to illness and is therefore
part of all areas of nursing.
Four Core Mental Health Practice
Areas:
 Psychiatric nursing
 Psychiatry
 Psychology
 Social work
Professional attributes of
psychiatric nurses include:
 Promotion of mental health
 Prevention and treatment of mental
disorders
 Rehabilitation after the disorder
I. Principles of the Nurse-Client
Relationship
Principles of the Nurse-Client
Relationship
– The relationship is therapeutic rather than
social
– The focus remains on the client’s issues
rather than on the nurse’s or other issues
– The relationship is purposeful and goal
directed
– It is objective versus subjective in quality
– It is time limited versus open ended
Therapeutic vs Social
A therapeutic relationship is formed to
– help clients solve problems
– make decisions
– achieve growth
– learn coping strategies
– let go of unwanted behaviors
– reinforce self-worth
– examine relationships
Therapeutic vs Social
 The meetings between nurse and client
are not for mutual satisfaction.
 The nurse can be friendly with the
client, but is not there to be the client’s
friend.
 The majority of the interaction is
focused and therapeutic.
Stages of the Nurse-Client
Relationship
 Pre-orientationphase
 Orientation phase
 Working phase
 Termination phase
Pre-orientation Phase

 Takes place prior to meeting with the

client
 1st gather data about the client, his or
her condition, and the present situation
 Nurse then examines his or her
thoughts, feelings, perceptions, and
attitudes about this particular client
Orientation Phase
 The nurse-client become acquainted; build
trust and rapport
 A contract is established
– Includes time and place for the meeting, as well as
the purpose of the meetings
 Dependability is imperative for both the nurse
and the client
 Client strengths, limitations, and problem
areas are identified
 Outcome criteria and a plan of care are
established
Working Phase
 Orientation phase ends and working phase
begins when the client takes responsibility for
his or her own behavior change
 Client shows commitment to working on
issues that have caused a life disruption
 Clients’ needs are prioritized- safety and
health come first
 RN assists the client to change problematic
behaviors in a safe environment
Termination Phase
 Relationship comes to a close
 This phase begins in the orientation phase
when meeting times are established- lets the
client know that the relationship will come to
an end
 Avoids confusing the client who may be
unable to recognized boundaries in a
relationship
 Termination occurs when the client has
improved or has been discharged
III. Mental Health and
Mental Disorder
Defining and Classifying Mental
Health and Mental Disorder
 The ANA defines mental health as a
state of well-being in which individuals
function well in society and are
generally satisfied with their lives.
– Results in socially acceptable behavior and
the ability to respond productively and
appropriately in the environment
Defining and Classifying Mental
Health and Mental Disorder
 Mental disorder is a disturbance in an
individual’s thinking, emotions,
behaviors, and physiology.
– Leads to problems with behavior,
relationships, and functioning.
Mental Illness and Mental Health
Continuum
 Mildjoys, sorrows, and anxiety levels that
aid in the work of living
 Mild-Moderatepsychophysiologic factors
affecting medical conditions
 Moderate-Severeanxiety d/os, dissociative
d/os, somatoform d/os, personality d/os, and
eating d/os
 Severe-Psychosisdepressive d/os, bipolar
d/os, schizophrenic d/os, and cognitive d/os
DSM IV-TR
 A multiaxial classification scheme that allows
for the interrelation of biological,
psychological, and social aspects of an
individual’s condition.
 Axis I – the psychiatric diagnosis
 Axis II – personality disorders and mental
retardation
 Axis III – general medical conditions
 Axis IV – psychosocial and environmental
problems
 Axis V – GAF- rates the overall psychological
functioning of the client on a scale of 0-100.
V. The Nursing Process
IX. Roles of the Mental Health
Team
Roles of the Mental Health Team
 Psychiatric Nurse
– Has the most widely focused position description
of any of the member roles
– Interacts with clients in individual and group
settings
– Manages client care
– Administers and monitors meds
– Teaches both clients and families
– Acts as a client advocate
Roles of the Mental Health Team

 Psychiatric Social Worker

– Graduate level position
– Work with clients on an individual basis
– Conduct group therapy sessions
– Act as liaisons with the community to place
clients after discharge
Roles of the Mental Health Team

 Psychiatrist
– Licensed medical physician who
specializes in psychiatry
– Prescribe and monitor meds
– Admit clients into acute care settings
– Administer ECT
– Conduct individual and family therapy
Roles of the Mental Health Team
 Psychologist
– Licensed individual with a doctoral degree
in psychology
– Assess and treat psychologic and
psychosocial problems of individuals,
families, or groups
– Do not prescribe or administer medications
– Administer psychometric tests that aid in
the diagnosis of disorders
Roles of the Mental Health Team

 Marriage, Family, Child Counselor

– Licensed individuals who frequently work in
private practice
– Prepared to work with individuals, couples,
families, and groups
– Emphasize the interpersonal aspects of
achieving and maintaining relationships
Roles of the Mental Health Team

 Case managers
– Facilitate the delivery individualized,
coordinated care in cost-effective ways
– Need to know the various types of
hospitalization and outpatient care settings,
the coverage offered by different payers,
and the impact of state and federal
legislation