E-Book, Englisch, 560 Seiten
Elder RN / Elder / Evans RPN Mental Health Nursing E-Book
1. Auflage 2013
ISBN: 978-0-7020-4664-3
Verlag: Elsevier HealthScience EN
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Mental Health Nursing E-Book
E-Book, Englisch, 560 Seiten
ISBN: 978-0-7020-4664-3
Verlag: Elsevier HealthScience EN
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Written by an experienced team of contributors, the client- and student-centred approaches focus closely on providing students with practical examples and guidance on helpful and transformative communication. There is useful content on mental health education and health promotion. Free online Evolve Resources are available for both the Student and Instructor.
•Client focused and clear holistic approach, recognising the various approaches to mental health nursing
•Evidence based framework and up-to-date research has been integrated through the fully revised new edition
•Case studies, Critical thinking challenges and Exercises for class engagement encourage an active awareness of the complex issues related to mental health and illness
•Evolve resources
Autoren/Hrsg.
Weitere Infos & Material
1;Front Cover;1
2;Mental Health Nursing;4
3;Copyright Page;5
4;Contents;6
5;Foreword;8
6;Preface;10
7;Contributors;12
8;1 Preparing for mental health nursing;16
8.1;1. The effective nurse;18
8.1.1;Introduction;19
8.1.2;Caring;19
8.1.2.1;Hope and spirituality;20
8.1.3;Therapeutic Use of Self;21
8.1.3.1;Empathy and therapeutic use of self;21
8.1.3.2;Evidence-based practice and therapeutic alliance;22
8.1.4;Self-Awareness;22
8.1.5;Reflection;22
8.1.5.1;Developing reflective practices;23
8.1.6;Professional Boundaries;23
8.1.6.1;Self-disclosure;23
8.1.7;Stress and Burnout;24
8.1.7.1;Stress;24
8.1.7.2;Burnout syndrome;24
8.1.7.3;Avoiding burnout syndrome;25
8.1.8;Professional Supportive Relationships;25
8.1.8.1;Clinical supervision;25
8.1.8.2;Preceptorship;26
8.1.9;Conclusion;26
8.1.10;References;27
8.2;2. The context of practice;30
8.2.1;Introduction;31
8.2.2;The Relationship between Theory and Practice;32
8.2.2.1;What is a theory?;32
8.2.2.2;Which theory best guides practice?;32
8.2.2.3;Nursing theorists;32
8.2.2.4;Incorporating theory into practice: the personal context;33
8.2.2.5;The importance of reflection;33
8.2.2.6;Putting theory into practice: the wider context;34
8.2.2.7;Demand for evidence-based practice;34
8.2.2.7.1;Issues for discussion;34
8.2.3;Changing Beliefs about the Focus of Nursing Practice;35
8.2.3.1;From dualism to holism;35
8.2.3.1.1;Dualism: issues for mental health practice;35
8.2.3.1.2;Holism: issues for mental health practice;36
8.2.3.2;From deficits to strengths;37
8.2.3.3;From patient to service user: a person with lived experience;39
8.2.3.4;Distinguishing rehabilitation from recovery;39
8.2.4;Essentials of Recovery-Orientated Practice;40
8.2.4.1;Personal characteristics of recovery;41
8.2.4.2;Facilitating self-help and personal responsibility;41
8.2.4.3;Promoting overall health and wellness;42
8.2.5;Recovery-Orientated Service Provision;42
8.2.5.1;The community;42
8.2.5.2;The mental health service;43
8.2.5.3;Multidisciplinary teams;43
8.2.5.4;Third-sector organizations;43
8.2.5.5;Partnerships, participation and empowerment;44
8.2.5.6;Professional boundaries;45
8.2.6;Conclusion;45
8.2.7;References;46
8.3;3. Historical foundations;48
8.3.1;Introduction;49
8.3.2;The Value of Historical Antecedents;49
8.3.3;Past Ideas about Mental Health Problems;51
8.3.3.1;The ‘humours’;51
8.3.3.2;Supernatural influences;52
8.3.3.3;Greece and Rome;52
8.3.3.4;The Christian era;53
8.3.4;Mental Health Problems found in Graeco-Roman Sources;54
8.3.4.1;Mental health problems not found in the ancient literature;55
8.3.4.2;Historical perspective on schizophrenia;55
8.3.4.3;‘Hysteria’: a translation error;56
8.3.5;Gender and Healthcare;56
8.3.6;Caring for People with Mental Health Problems;57
8.3.6.1;Graeco-Roman origins of Western care;57
8.3.6.2;Eastern medical care;59
8.3.6.3;Western developments;59
8.3.6.4;The asylum;59
8.3.7;Doctors and Nurses;60
8.3.7.1;Ancient Greece and Rome;60
8.3.7.2;Midwives and nurses;61
8.3.8;Pioneers and Professionalization;62
8.3.8.1;The USA;63
8.3.8.2;The UK;63
8.3.8.3;New Zealand;63
8.3.8.4;Australia;64
8.3.9;Conclusion;64
8.3.10;References;65
8.4;4. The politicolegal context;68
8.4.1;Introduction;69
8.4.2;Historical Landmarks;69
8.4.3;The Current Global Perspective;69
8.4.4;Mental Health Policy;70
8.4.5;Mental Health Legislation;72
8.4.5.1;Mental Health Act 1983 (amended 2007);72
8.4.5.1.1;Guiding principles;72
8.4.5.1.2;Definition of a mental disorder;72
8.4.5.1.3;Applications for detention in hospital;73
8.4.5.1.4;Holding powers;73
8.4.5.1.5;Appropriate medical treatment test;74
8.4.5.1.6;Supervised community treatment and community treatment orders;74
8.4.5.1.7;Roles;74
8.4.5.1.8;Consent to treatment;75
8.4.5.1.9;Rights under the Act;75
8.4.5.1.10;Advance decisions;76
8.4.5.2;Mental Capacity Act (2005);76
8.4.6;Risk Management and the Concept of Dangerousness;78
8.4.7;Managing Behavioural Emergencies;79
8.4.8;Conclusion;83
8.4.9;References;83
8.5;5. Professional and ethical issues;86
8.5.1;Introduction;87
8.5.2;Regulation of Professional Practice;87
8.5.3;Nursing Education;88
8.5.4;Standards of Practice;88
8.5.5;Standards;89
8.5.6;Career Pathways;89
8.5.7;Prescribing;89
8.5.8;Reviews of Mental Health Nursing;90
8.5.9;Ethics and Professional Practice;91
8.5.9.1;Ethical issues in mental health practice;91
8.5.9.1.1;Psychiatric diagnosis;91
8.5.9.1.2;Mental healthcare and treatment;92
8.5.9.1.3;Psychopharmacology;93
8.5.9.1.4;Electroconvulsive therapy;93
8.5.9.1.5;Seclusion;93
8.5.9.1.6;Suicidal behaviour;94
8.5.9.1.7;Involuntary treatment;94
8.5.9.1.8;Psychological therapy;95
8.5.9.1.9;Professional boundaries;96
8.5.9.1.10;Confidentiality;96
8.5.10;Conclusion;97
8.5.11;References;97
9;2 Mental health and wellness;100
9.1;6. Mental health and wellness;102
9.1.1;Introduction;103
9.1.2;Incidence and Prevalence of Mental Health Problems;103
9.1.2.1;Comorbidity;104
9.1.2.2;Suicidal behaviour;104
9.1.3;Gender Differences;104
9.1.4;Marital Status;105
9.1.5;Disability and Mental Health;106
9.1.6;Misconceptions about Mental Health Problems;107
9.1.6.1;The media and misconceptions about mental health problems;109
9.1.7;What is Culture?;109
9.1.7.1;Culture and health beliefs;109
9.1.7.2;Black and minority ethnic and culturally and linguistically diverse groups;111
9.1.7.3;Culture and communication style;112
9.1.7.4;Culture and self-reflection;112
9.1.7.5;Cultural competence and cultural safety;112
9.1.8;Approaches to Care and Service Delivery;113
9.1.8.1;Factors that could prevent black and minority ethnic and culturally and linguistically diverse clients using services;113
9.1.8.2;Model of care delivery;114
9.1.8.3;Alternative models of care delivery;114
9.1.8.4;Definition of the problem and diagnosis;114
9.1.8.5;Structural barriers;114
9.1.8.6;Gender-appropriate service;114
9.1.9;Incorporating Culturally Safe Practice;115
9.1.10;Conclusion;115
9.1.11;References;116
9.2;7. Theories on mental health and ill health;118
9.2.1;Introduction;119
9.2.2;What is Mental Health?;119
9.2.2.1;Defining mental health;119
9.2.2.2;‘Mental health’ as a euphemism for ‘mental disorder’;120
9.2.3;Theories of Personality;121
9.2.3.1;Biomedical model;121
9.2.3.1.1;Critique of the biomedical model;122
9.2.3.2;Psychoanalytic theory;122
9.2.3.2.1;Sigmund Freud (1856–1939);122
9.2.3.2.2;Defence mechanisms;122
9.2.3.2.3;Critique of psychoanalytic theory;123
9.2.3.3;Behavioural psychology;123
9.2.3.3.1;Ivan Pavlov (1849–1936);123
9.2.3.3.2;John B Watson (1878–1958);123
9.2.3.3.3;B F Skinner (1904–90);123
9.2.3.3.4;Critique of behaviourism;123
9.2.3.4;Cognitive psychology;124
9.2.3.4.1;Albert Bandura (b. 1925);124
9.2.3.4.2;Aaron T Beck (b. 1921);124
9.2.3.4.3;Martin Seligman (b. 1942);124
9.2.3.4.4;Critique of cognitive psychology;124
9.2.3.5;Humanistic psychology;124
9.2.3.5.1;Charlotte Bühler (1893–1974);125
9.2.3.5.2;Carl Rogers (1902–87);125
9.2.3.5.3;Abraham Maslow (1908–70);125
9.2.3.5.4;Critique of humanistic psychology;125
9.2.3.6;Sociological models;126
9.2.3.6.1;Emile Durkheim (1858–1917);126
9.2.3.6.2;Thomas Szasz (b. 1920);126
9.2.3.6.3;Critique of sociological models;126
9.2.4;From Theory to Practice;127
9.2.4.1;Theories of psychology, sociology and nursing;128
9.2.4.1.1;Hildegard Peplau (1909–99);129
9.2.4.1.2;Joyce Travelbee (1926–73);129
9.2.4.1.3;Phil Barker (b. 1946);129
9.2.5;Personality and Behaviour: Nature versus Nurture;130
9.2.5.1;Theoretical perspectives on nature versus nurture;130
9.2.5.2;Nature or nurture?;130
9.2.5.3;Nature and nurture;130
9.2.6;Conclusion;131
9.2.7;References;132
9.3;8. Mental health across the lifespan;134
9.3.1;Introduction;135
9.3.2;A Lifespan Approach;135
9.3.2.1;A lifespan approach to nursing practice;135
9.3.3;Mental Health across the Lifespan;136
9.3.3.1;‘Ideal’ development;136
9.3.3.2;Stages and theoretical issues in human development;138
9.3.3.2.1;Freud;138
9.3.3.2.2;Erikson;138
9.3.3.2.3;Piaget;139
9.3.3.2.4;Moral development;139
9.3.3.2.5;Attachment, parenting and family factors;140
9.3.3.3;Implications for nursing practice;140
9.3.4;Vulnerability, Risk and Resilience;141
9.3.5;Primary Healthcare and Mental Health Promotion;142
9.3.6;Mental Ill Health Prevention and Recovery;143
9.3.7;Childhood;144
9.3.7.1;Development and theoretical issues;144
9.3.7.2;Risk factors;145
9.3.7.3;Prevention and promotion;145
9.3.8;Adolescence;146
9.3.8.1;Development and theoretical issues;146
9.3.8.2;Identity;146
9.3.8.3;Risk factors;147
9.3.8.4;Prevention and promotion;147
9.3.9;Adulthood;148
9.3.9.1;Development and theoretical issues;148
9.3.9.2;Intimacy versus isolation (early adulthood);148
9.3.9.2.1;Generativity versus self-absorption (middle adulthood);148
9.3.9.3;Attachment, gender, identity and risk;149
9.3.9.4;Prevention and promotion;150
9.3.10;Older Adulthood;150
9.3.10.1;Development and theoretical issues;150
9.3.10.2;Risk factors;150
9.3.10.3;Prevention and promotion;151
9.3.11;Conclusion;151
9.3.12;Acknowledgement;152
9.3.13;References;152
9.4;9. Crisis and loss;156
9.4.1;Introduction;157
9.4.2;What Constitutes a Crisis?;158
9.4.3;Consequences of a Personal Crisis;158
9.4.4;A Framework for Coping and Adapting to Crisis;158
9.4.5;Events and Perceptions that Can Lead to Personal Crisis;159
9.4.6;Intervening at a Time of Crisis;160
9.4.7;Crisis, Loss and Grief;161
9.4.8;Suicide and Attempted Suicide;161
9.4.8.1;Griever concerns following suicide;163
9.4.9;Self-Harm;163
9.4.10;Being a Victim of Crime;163
9.4.11;Sudden Death;165
9.4.11.1;Parental bereavement;165
9.4.11.2;Sudden death of a partner;166
9.4.11.3;Attitudes to death;166
9.4.12;Crisis, Loss and Culture;166
9.4.13;Nursing Interventions: Attitudes and Skills;167
9.4.13.1;Developing enhanced cultural sensitivity;167
9.4.13.2;Helping service users deal with loss;168
9.4.13.2.1;Being there for the service user;168
9.4.13.2.2;Allowing the service user to express emotional pain;169
9.4.13.2.3;Being sensitive to cultural considerations in death and dying;169
9.4.13.2.4;Acknowledging the meaning of death and dying in different cultures;169
9.4.13.2.5;Acknowledging difficulties;170
9.4.13.2.6;Exploring opportunities for advanced training;170
9.4.14;Conclusion;171
9.4.15;References;173
9.5;10. Assessment and diagnosis;176
9.5.1;Introduction;177
9.5.2;Classification Systems;177
9.5.3;Assessment;178
9.5.3.1;Assessment methods;178
9.5.3.1.1;Diaries and personal records;178
9.5.3.1.2;Questionnaires and rating scales;179
9.5.3.1.3;Direct observation;179
9.5.3.1.4;Interviewing;179
9.5.3.1.4.1;The craft of interviewing;180
9.5.3.1.4.2;The interview setting;181
9.5.3.1.4.3;Safety;182
9.5.4;Biopsychosocial Model of Assessment;182
9.5.4.1;Mental health assessment;183
9.5.4.2;Identifying key information;183
9.5.4.2.1;Example;183
9.5.4.3;Reason for referral;183
9.5.4.3.1;Example;183
9.5.4.4;Presenting problem;183
9.5.4.4.1;Example;184
9.5.4.4.2;Example;184
9.5.4.5;Mental health history;184
9.5.4.5.1;Example;185
9.5.4.6;Medical history;185
9.5.4.6.1;Example;185
9.5.4.7;Drug history;185
9.5.4.7.1;Example;185
9.5.4.8;Psychosocial/relationship history;185
9.5.4.8.1;Example;185
9.5.4.9;Determining risk factors;186
9.5.4.9.1;Example;186
9.5.4.10;Assessment of strengths;186
9.5.4.11;Collaborative assessment of strengths;186
9.5.4.12;Mental status examination;187
9.5.4.12.1;Example;187
9.5.4.12.2;Overview;188
9.5.4.12.2.1;Appearance and behaviour;188
9.5.4.12.2.2;Speech;188
9.5.4.12.2.3;Mood and affect;188
9.5.4.12.2.4;Form of thought;188
9.5.4.12.2.5;Thought content;189
9.5.4.12.2.6;Perception;189
9.5.4.12.2.7;Sensorium and cognition;190
9.5.4.12.2.8;Insight;190
9.5.4.13;Physical assessment;190
9.5.4.13.1;Present and past health status;190
9.5.4.13.2;Physical examination;190
9.5.4.13.3;Physical functions;191
9.5.4.13.4;Laboratory results;191
9.5.4.14;Spiritual assessment;193
9.5.4.15;Cultural assessment;193
9.5.5;Triage Assessment;194
9.5.5.1;Risk of harm to others;197
9.5.5.2;Risk of harm to self;197
9.5.5.3;Risk of suicide;197
9.5.5.4;Risk of absconding;197
9.5.5.5;Vulnerability to exploitation or abuse;197
9.5.6;Mental Health Assessment and Outcome Measures;199
9.5.6.1;What to measure?;199
9.5.6.2;Methods of administering service user outcome measures;199
9.5.6.3;The Health of the Nation Outcome Scales (HoNOS);199
9.5.7;Classification of Mental Disorders;200
9.5.7.1;ICD-10: International Classification of Diseases;200
9.5.7.2;ICD-10 diagnostic categories;200
9.5.7.3;DSM-IV TR: Diagnostic and Statistical Manual;200
9.5.7.3.1;Multiaxial classification;201
9.5.8;Conclusion;201
9.5.9;References;202
10;3 Understanding mental health problems;204
10.1;11. Learning disabilities;206
10.1.1;Introduction;207
10.1.2;The Language of Learning Disability Services;207
10.1.2.1;Terminology;207
10.1.2.2;Systems of classification;208
10.1.3;Causes of Learning Disability and Associated Disorders;209
10.1.4;Services for People With a Learning Disability;209
10.1.4.1;Service philosophy in learning disability services;210
10.1.5;Prevalence of Dual Diagnosis;210
10.1.6;Falling Through the Cracks;211
10.1.6.1;Comments on Roy and John’s case studies;212
10.1.7;Acute Assessment;213
10.1.7.1;Assessment and communication issues;213
10.1.7.2;Enhancing the assessment process;214
10.1.7.3;Other pitfalls in the assessment process;216
10.1.8;Acute Nursing Care;216
10.1.9;Facilitating Continuous Care;220
10.1.9.1;Understanding disability support services;220
10.1.9.2;Discharge planning;220
10.1.9.3;Information sharing;221
10.1.9.4;Person-centred plans;221
10.1.9.5;Assessment and treatment services for people with dual diagnosis;222
10.1.10;Mental Capacity;223
10.1.11;Conclusion;224
10.1.12;AcknowledgEments;224
10.1.13;Disclaimer;224
10.1.14;References;225
10.1.15;Useful Websites;227
10.2;12. Working with children and young people;228
10.2.1;Introduction;229
10.2.2;Diagnosis in Child and Adolescent Mental Healthcare;229
10.2.3;Incidence;230
10.2.4;Mental Health Problems in context;230
10.2.5;Services Available to Children and Young People;231
10.2.6;The Nursing Role;232
10.2.7;Engaging with Children and Young People;232
10.2.7.1;Children;233
10.2.7.1.1;Discussion of case study: Adam;233
10.2.7.1.2;Discussion of case study: Tim;234
10.2.7.1.3;Discussion of case study: Fiona;235
10.2.7.1.3.1;Skills required;235
10.2.7.1.3.2;Approach taken and outcome achieved;235
10.2.7.2;Adolescents;236
10.2.7.2.1;Psychosis and behaviour issues;237
10.2.7.2.2;Discussion of case study: David;237
10.2.7.3;Depression and suicide;238
10.2.7.3.1;Engagement;238
10.2.7.3.2;Discussion of case study: Julie;238
10.2.8;Working with Families;239
10.2.9;Confidentiality;239
10.2.10;Medication Adherence;239
10.2.11;Legal Issues;240
10.2.12;Conclusion;240
10.2.13;References;241
10.3;13. Mental disorders of older age;242
10.3.1;Introduction;243
10.3.2;Demography of Ageing in the UK;243
10.3.3;Assessment of Older People;244
10.3.3.1;Ageism in assessment;244
10.3.4;Mental Health Problems in the Older Population;245
10.3.4.1;Depression;245
10.3.4.1.1;Presentation;245
10.3.4.1.2;Prevalence;245
10.3.4.1.3;Aetiology;245
10.3.4.1.4;Assessment;246
10.3.4.1.5;Nursing care of people diagnosed with depression;247
10.3.4.1.6;Psychotherapeutic support;247
10.3.4.1.7;Pharmacotherapy and electroconvulsive therapy;247
10.3.4.2;Anxiety disorders;248
10.3.4.3;Suicide;248
10.3.4.3.1;Prevalence;248
10.3.4.4;Substance misuse;248
10.3.4.5;Delirium;249
10.3.4.5.1;Risk factors;250
10.3.4.6;Schizophrenia;250
10.3.4.7;Dementia;251
10.3.4.7.1;Prevalence;251
10.3.4.7.2;Aetiology;251
10.3.4.7.3;Clinical features;252
10.3.4.7.4;Pharmacological treatment for dementia;252
10.3.4.7.5;Psychological interventions and therapies for dementia;253
10.3.4.8;Comparing delirium, dementia and depression;253
10.3.5;Nursing Care and Treatment of Older People;254
10.3.6;The Nurse–Service User Relationship;254
10.3.6.1;Maintaining health and function;254
10.3.7;Staff Attitudes;255
10.3.8;Conclusion;256
10.3.9;References;256
10.4;14. Schizophrenic disorders;260
10.4.1;Introduction;261
10.4.2;Prevalence;262
10.4.3;Aetiology;262
10.4.3.1;Biological theories;262
10.4.3.1.1;Neuroanatomical abnormalities;262
10.4.3.1.2;Genetic predisposition;263
10.4.3.1.3;Biochemical theories;263
10.4.3.2;The stress-diathesis model;263
10.4.4;Diagnostic Criteria;264
10.4.4.1;Diagnostic and statistical manual of mental disorders;264
10.4.4.1.1;A. Characteristic symptoms of schizophrenia;264
10.4.4.1.2;B. Social/occupational dysfunction;264
10.4.4.1.3;C. Duration;264
10.4.4.1.4;D. Excluding other diagnoses;264
10.4.4.2;Schizophrenia subtypes;265
10.4.4.2.1;a. Paranoid type;265
10.4.4.2.2;b. Catatonic type;265
10.4.4.2.3;c. Disorganized type;265
10.4.4.2.4;d. Undifferentiated type;265
10.4.4.2.5;e. Residual type;265
10.4.5;Historical Development in Understanding Schizophrenia;266
10.4.6;Contemporary Understanding of Schizophrenia;266
10.4.6.1;Prodromal phase;266
10.4.6.2;Acute phase;267
10.4.6.3;Chronic phase;268
10.4.7;NonpsychopharmAcological Treatment;268
10.4.7.1;Cognitive behavioural therapy;268
10.4.7.1.1;CBT interventions for hallucinations;269
10.4.7.1.2;CBT interventions for delusional thinking;269
10.4.7.1.3;CBT interventions for stress and stigma;269
10.4.7.2;Supportive therapy;269
10.4.7.3;Family intervention;269
10.4.8;Psychopharmacological Intervention;271
10.4.8.1;Goals of antipsychotic medication administration;272
10.4.8.2;Adverse effects;273
10.4.8.2.1;Weight gain;273
10.4.8.2.1.1;Nursing interventions;273
10.4.8.2.2;Parkinsonian effects;273
10.4.8.2.2.1;Nursing interventions;274
10.4.8.2.3;Akathisia;274
10.4.8.2.3.1;Nursing interventions;274
10.4.8.2.4;Neuroleptic malignant syndrome;274
10.4.8.2.4.1;Nursing interventions;274
10.4.8.2.5;Tardive dyskinesia;274
10.4.8.2.5.1;Nursing interventions;274
10.4.8.2.6;Acute dystonic reaction (spasm);274
10.4.8.2.6.1;Nursing interventions;274
10.4.8.3;Medication adherence;274
10.4.9;Living with Schizophrenia;275
10.4.9.1;Homelessness;275
10.4.9.2;Work;275
10.4.9.3;Labelling and stigma;275
10.4.9.4;General health;276
10.4.10;Conclusion;277
10.4.11;References;278
10.5;15. Mood disorders;282
10.5.1;Introduction;283
10.5.2;Comorbidity;284
10.5.3;Epidemiology and Economic Cost of Mood Disorders;284
10.5.4;Service Response;284
10.5.5;Depression;285
10.5.5.1;Mild depression;285
10.5.5.2;Major depression;285
10.5.5.2.1;Appearance and behaviour;285
10.5.5.2.2;Mood;285
10.5.5.2.3;Thinking and speech;286
10.5.5.2.4;Thinking about the past, present and future;286
10.5.5.2.5;Perception;286
10.5.5.2.6;Biological symptoms;286
10.5.5.3;Aetiology of depression;286
10.5.5.3.1;Biopsychosocial model of causation;286
10.5.5.3.2;Genetic factors;287
10.5.5.3.3;Gene–environment interaction;287
10.5.5.3.4;Neurochemical factors;287
10.5.5.3.5;Hormone systems and circadian rhythms;287
10.5.5.3.6;Gender differences;288
10.5.6;Mania and Bipolar Disorder;288
10.5.6.1;Appearance and behaviour;289
10.5.6.2;Mood;289
10.5.6.3;Thinking and speech;289
10.5.6.4;Perception;289
10.5.6.5;Biological symptoms;289
10.5.6.6;Aetiology of bipolar disorder;290
10.5.6.6.1;Genetic factors;290
10.5.6.6.2;Neurochemical factors;290
10.5.6.6.3;Hormone systems and circadian rhythms;290
10.5.6.6.4;Psychosocial factors;290
10.5.7;Dysthymia and Cyclothymia;291
10.5.8;Childbirth and Mood Disorders;291
10.5.8.1;Postpartum ‘blues’;291
10.5.8.2;Postpartum depression;291
10.5.8.3;Interventions;291
10.5.8.4;Postpartum psychosis;291
10.5.8.5;Infant loss;292
10.5.9;Grief and Mood Disorders;292
10.5.10;Older Adults and Mood Disorders;292
10.5.11;Cultural Considerations;293
10.5.12;Medical Conditions and Drug Reactions;293
10.5.12.1;Medical conditions that cause depression and mania;293
10.5.12.2;Drug reactions that cause depression and mania;293
10.5.12.3;Overview of causation;293
10.5.13;Suicide;294
10.5.13.1;Epidemiology;294
10.5.13.2;Aetiology of suicide;294
10.5.13.2.1;Psychosocial factors;294
10.5.13.2.2;Biological factors;294
10.5.13.3;Nursing interventions for suicide prevention;294
10.5.13.4;Suicide-prevention contracts and observation;295
10.5.13.5;Suicide-prevention contracts;295
10.5.13.6;Constant observation;295
10.5.14;Pharmacology;295
10.5.14.1;Drugs used in the treatment of depression;295
10.5.14.1.1;Antidepressants;295
10.5.14.1.2;Selective serotonin-reuptake inhibitors (SSRIs);296
10.5.14.1.2.1;Side effects;296
10.5.14.1.3;Drugs used in the treatment of bipolar disorder;296
10.5.14.1.3.1;Lithium carbonate;296
10.5.15;Other Treatments;296
10.5.15.1;Psychotherapy;296
10.5.15.2;Light therapy;297
10.5.15.3;Electroconvulsive therapy;297
10.5.16;Conclusion;299
10.5.17;References;300
10.6;16. Personality disorders;304
10.6.1;Introduction;305
10.6.2;‘Trait’ Versus ‘Disorder’;305
10.6.3;Classification of Personality Disorders;306
10.6.4;Problems of Diagnosis;307
10.6.5;Epidemiology;310
10.6.6;Aetiology;311
10.6.6.1;Evolution-based theory of personality;311
10.6.6.1.1;Reproduction;312
10.6.6.1.2;Survival;312
10.6.6.1.3;Homeostasis;312
10.6.7;Assessment;312
10.6.8;Interventions;314
10.6.8.1;Interactive therapies;315
10.6.8.2;Pharmacological intervention;315
10.6.8.3;Therapeutic community;315
10.6.8.4;Team or triumvirate nursing interventions;316
10.6.9;Working with People Diagnosed with Personality Disorder;316
10.6.10;Conclusion;318
10.6.11;References;320
10.7;17. Anxiety disorders;322
10.7.1;Introduction;323
10.7.2;Epidemiology;324
10.7.3;Aetiology;324
10.7.3.1;Stress theory;325
10.7.3.2;Biological theories;325
10.7.3.2.1;Genetic theories;325
10.7.3.2.2;Neurochemical theories;325
10.7.3.3;Personality/temperament theory;325
10.7.3.4;Psychoanalytic theory;325
10.7.3.5;Interpersonal theory;325
10.7.3.6;Behavioural theory;325
10.7.4;Anxiety and Stress-Related Disorders;326
10.7.4.1;Panic attacks;326
10.7.4.1.1;Nursing interventions;326
10.7.4.1.1.1;During a panic attack;327
10.7.4.1.1.2;After a panic attack;328
10.7.4.2;Panic disorder;328
10.7.4.2.1;Nursing interventions;329
10.7.4.2.1.1;Teaching plan: panic attacks;329
10.7.4.2.1.2;Slow-breathing technique;330
10.7.4.2.1.2.1;Putting the slow-breathing technique into practice ;330
10.7.4.3;Agoraphobia;330
10.7.4.3.1;Types of agoraphobia;330
10.7.4.4;Social phobia (social anxiety disorder);330
10.7.4.5;Specific phobia;331
10.7.4.5.1;Nursing and psychological interventions for phobias;332
10.7.4.5.1.1;Graded exposure;332
10.7.4.5.1.2;Prolonged exposure;332
10.7.4.5.1.3;Repeated exposure;332
10.7.4.5.1.4;Focused exposure;332
10.7.4.5.1.5;Practised exposure;333
10.7.4.6;Adjustment disorder;333
10.7.4.7;Acute stress disorder;334
10.7.4.7.1;Nursing and psychological interventions;334
10.7.4.7.1.1;Debriefing;334
10.7.4.7.1.2;Progressive muscle relaxation;334
10.7.4.7.1.3;Guided imagery;335
10.7.4.7.1.4;Meditation;335
10.7.4.8;Post-traumatic stress disorder;335
10.7.4.8.1;Trauma-focused psychological therapy;335
10.7.4.9;Generalized anxiety disorder;336
10.7.4.9.1;Nursing interventions;336
10.7.4.9.1.1;Problem-solving;336
10.7.4.10;Obsessive–compulsive disorder;337
10.7.4.10.1;Nursing interventions;338
10.7.4.10.1.1;Exposure and response prevention;338
10.7.5;Therapies with Broad Applications;338
10.7.5.1;Cognitive behavioural therapy;338
10.7.5.1.1;Monitoring thoughts and feelings;339
10.7.5.1.2;Questioning the evidence, examining alternatives and role reversal;339
10.7.5.1.3;Probability;339
10.7.5.1.4;Degree of emotion;340
10.7.5.2;Psychopharmacology;340
10.7.5.2.1;Antidepressants;340
10.7.5.2.1.1;Action;341
10.7.5.2.1.1.1;Selective serotonin-reuptake inhibitors ;341
10.7.5.2.2;Anti-anxiety medication;341
10.7.5.2.3;Nonbenzodiazepine anxiolytics;342
10.7.5.2.4;Hypnotics;342
10.7.6;Conclusion;342
10.7.7;References;343
10.8;18. Eating disorders;346
10.8.1;Introduction;347
10.8.2;Characteristics of Eating Disorders;348
10.8.2.1;Anorexia nervosa;348
10.8.2.2;Bulimia nervosa;349
10.8.2.3;Unspecified eating disorder;349
10.8.2.4;Eating disorders in children and adolescents;350
10.8.2.5;Eating disorders in males;350
10.8.3;Incidence and Prevalence;350
10.8.4;Aetiology and Risk Factors;350
10.8.4.1;Gender;350
10.8.4.2;Age;351
10.8.4.3;History of dieting;351
10.8.4.4;Social factors;351
10.8.4.5;Psychological factors;351
10.8.4.6;Familial factors;352
10.8.4.7;Genetic and biological factors;352
10.8.5;Medical Complications;352
10.8.5.1;Cardiovascular effects;352
10.8.5.2;Electrolyte abnormalities;353
10.8.5.3;Renal dysfunction;353
10.8.5.4;Gastrointestinal effects;353
10.8.5.5;Endocrine effects;353
10.8.5.6;Musculoskeletal effects;353
10.8.5.7;Dental and oral effects;353
10.8.5.8;Skin/integument effects;353
10.8.5.9;Neurological effects;353
10.8.5.10;Cognitive changes;353
10.8.6;Comorbidity;354
10.8.7;Assessment;354
10.8.7.1;Physical assessment;354
10.8.7.2;Mental state examination;355
10.8.7.3;Body image assessment;355
10.8.7.4;Nutritional assessment;355
10.8.7.5;Disordered eating behaviours and rituals;355
10.8.7.6;Family assessment;356
10.8.8;Treatment;356
10.8.8.1;Hospitalization;357
10.8.8.2;Nutritional rehabilitation;358
10.8.8.3;Nursing care;359
10.8.8.4;Therapeutic relationship;360
10.8.8.5;Normalization of eating patterns;361
10.8.8.5.1;Binge eating and purging behaviours;361
10.8.8.5.2;Monitoring weight gain;361
10.8.8.5.3;Refeeding syndrome;361
10.8.8.6;Psychotherapeutic techniques and treatments;362
10.8.8.6.1;Supportive therapy;362
10.8.8.6.2;Goal setting;362
10.8.8.6.3;Socratic questioning;362
10.8.8.6.4;Cognitive behavioural therapy;363
10.8.8.6.5;Interpersonal therapy;363
10.8.8.6.6;Motivational enhancement therapy;363
10.8.8.6.7;Psychoeducation;363
10.8.8.6.8;Family therapy and support;364
10.8.8.6.9;Self-help programmes;364
10.8.8.6.10;Pharmacotherapy;364
10.8.9;Outcome;366
10.8.10;Conclusion;366
10.8.11;Acknowledgement;367
10.8.12;References;367
10.9;19. Substance-related disorders and dual diagnosis;370
10.9.1;Introduction;371
10.9.2;Substance Use and Misuse;372
10.9.3;Epidemiology;372
10.9.3.1;Pregnant and/or breastfeeding women;372
10.9.4;Pharmacology of Psychoactive Drugs;373
10.9.5;How do Drugs Work?;373
10.9.6;Core Diagnoses for Substance Use;374
10.9.6.1;Intoxication;374
10.9.6.2;Hazardous use;375
10.9.6.3;Harmful use;375
10.9.6.3.1;Episodic heavy drinking or ‘binge’ drinking;375
10.9.6.4;Dependence;375
10.9.7;Assessment and Diagnosis;375
10.9.7.1;Presentation, setting and history;376
10.9.7.2;Substance use history;376
10.9.7.2.1;Taking a substance use history;376
10.9.7.3;Observations;377
10.9.7.4;Tests;378
10.9.7.4.1;Mental status examination;378
10.9.7.4.2;Laboratory tests;378
10.9.7.4.3;Screening tests;378
10.9.8;Interventions;378
10.9.8.1;Early and brief interventions;378
10.9.8.2;Motivational interviewing;380
10.9.8.3;Harm reduction;381
10.9.8.4;Managing an intoxicated service user;382
10.9.8.5;Substance withdrawal;382
10.9.8.5.1;Alcohol withdrawal;383
10.9.8.6;Other interventions;384
10.9.9;Dual Diagnosis;384
10.9.9.1;Clinical significance of dual diagnosis;385
10.9.9.2;Why do people with a mental disorder use nonprescribed drugs?;385
10.9.9.3;Assessing substance misuse in a mental health unit;386
10.9.9.4;Caring for service users with a dual diagnosis;387
10.9.9.5;Service delivery models for dual diagnosis service users;388
10.9.10;Conclusion;388
10.9.11;References;389
10.10;20. Somatoform and dissociative disorders;392
10.10.1;Introduction;393
10.10.2;Somatoform Disorders;393
10.10.2.1;The process of somatization;395
10.10.2.2;Epidemiology;396
10.10.2.3;Aetiology;396
10.10.2.3.1;Psychodynamic theory;396
10.10.2.3.2;Amplification;397
10.10.2.3.3;Interpersonal theory;397
10.10.2.3.4;Developmental theory;397
10.10.2.3.5;Personality;397
10.10.2.3.6;Biological theories;397
10.10.2.3.7;Behavioural theory;397
10.10.2.3.8;Familial factors;397
10.10.2.3.9;Culture;397
10.10.2.4;Assessment;397
10.10.2.4.1;Somatization disorder;398
10.10.2.4.2;Hypochondriasis;398
10.10.2.4.3;Pain disorder;399
10.10.2.4.4;Conversion disorder;399
10.10.2.4.5;Body dysmorphic disorder;401
10.10.2.4.6;Interventions;402
10.10.2.4.7;The therapeutic relationship;403
10.10.2.4.8;Reassurance;403
10.10.2.4.9;Relief of symptoms;404
10.10.2.4.10;Cognitive behavioural therapy;404
10.10.2.4.11;Psychopharmacology;404
10.10.2.4.12;Support;405
10.10.2.4.13;Family involvement;405
10.10.2.4.14;Validation;405
10.10.2.4.15;Reality therapy;405
10.10.2.4.16;Lifestyle interventions;406
10.10.3;Dissociative Disorders;406
10.10.3.1;Dissociative amnesia;407
10.10.3.2;Dissociative fugue;407
10.10.3.3;Dissociative identity disorder;407
10.10.3.4;Depersonalization disorder;408
10.10.3.5;Assessment;408
10.10.3.6;Interventions;408
10.10.4;Conclusion;409
10.10.5;References;409
11;4 Developing skills for mental health nursing;412
11.1;21. Settings for mental healthcare;414
11.1.1;Introduction;415
11.1.2;Historical Overview;416
11.1.3;Therapeutic Communities;417
11.1.4;Principles Governing the Inpatient Therapeutic Milieu;418
11.1.4.1;Open communication;418
11.1.4.2;Democratization;418
11.1.4.3;Reality confrontation;419
11.1.4.4;Permissiveness;419
11.1.4.5;Group cohesion;419
11.1.5;Inpatient Mental Health Services;419
11.1.5.1;Goals of the therapeutic milieu;420
11.1.5.1.1;Containment;420
11.1.5.1.2;Structure;421
11.1.5.1.3;Support;422
11.1.5.1.4;Involvement;422
11.1.5.1.5;Validation;422
11.1.5.1.6;Symptom management;422
11.1.5.1.7;Maintaining links with the service user’s family or significant others;422
11.1.5.1.8;Developing and maintaining links with the community;423
11.1.5.1.9;Criticisms of acute inpatient care;423
11.1.6;Community Care;424
11.1.7;Community Mental Health Services in the UK;425
11.1.7.1;Primary care;425
11.1.7.2;Community Mental Health Teams;425
11.1.7.3;Assertive Outreach Teams;426
11.1.7.4;Older Persons Services;426
11.1.7.5;Home Treatment/Crisis Resolution Teams;426
11.1.7.6;Accident and emergency mental health liaison;427
11.1.7.7;Child and Adolescent Mental Health Services;427
11.1.7.8;Early Intervention Service;427
11.1.8;Community Mental Health Service Models;427
11.1.8.1;The Care Programme Approach;427
11.1.8.1.1;Historical development of the CPA process;427
11.1.8.2;Principles and models underlying mental healthcare in the community;428
11.1.8.2.1;Self-determination;428
11.1.8.2.2;Normalization;429
11.1.8.2.3;Focus on service user strengths;429
11.1.8.2.4;Recruiting environmental agencies;430
11.1.8.2.5;The strengths model;430
11.1.8.2.6;The rehabilitation model;430
11.1.8.2.7;The MDT in the community;431
11.1.9;The Future of Mental Health Services in the UK;432
11.1.10;Conclusion;432
11.1.11;References;433
11.2;22. Person-centred approaches to managing risk;436
11.2.1;Introduction;437
11.2.2;Communicating with Service Users and Families;437
11.2.2.1;Therapeutic relationships;438
11.2.2.1.1;Empathy;438
11.2.2.1.2;Active listening;439
11.2.2.1.3;Closed and open-ended questions;439
11.2.2.1.4;Reflective listening;439
11.2.2.1.5;Paraphrasing;440
11.2.2.1.6;Summarizing;440
11.2.2.1.7;Body language and touch;440
11.2.2.1.8;Influence;440
11.2.2.2;Transference and counter-transference;441
11.2.2.3;Boundaries;441
11.2.2.4;Issues in working with families and carers;442
11.2.3;Skills in Specific Risk Situations;442
11.2.3.1;Risk assessment and management;442
11.2.3.2;Managing aggressive behaviour;442
11.2.3.2.1;Seclusion;445
11.2.3.2.1.1;Why use seclusion?;445
11.2.3.2.1.2;Service user perspectives on seclusion;445
11.2.3.2.1.3;Nurse perspectives on seclusion;446
11.2.3.2.1.4;Policy perspectives on seclusion;446
11.2.3.3;Self-harming behaviours and suicide risk;447
11.2.3.3.1;Working with the person who self-harms;447
11.2.3.3.1.1;Reasons for self-harming behaviour;448
11.2.3.3.1.2;Providing care and communicating with the person who self-harms;448
11.2.3.3.1.3;Comprehensive assessment of the person who self-harms;448
11.2.3.3.1.4;Interventions for self-harming behaviour;448
11.2.3.3.2;Working with the person who is suicidal;449
11.2.3.3.2.1;Reasons for suicidal behaviours;450
11.2.3.3.2.2;Assessing for risk of suicide;450
11.2.3.3.3;Caring for and communicating with the person who is suicidal;450
11.2.3.3.4;Service user perspectives on being cared for while suicidal;451
11.2.3.3.5;Nursing interventions for the person who is suicidal;451
11.2.4;Ethicolegal Issues;453
11.2.4.1;Service user choice in the therapeutic setting;453
11.2.4.2;Informed consent;454
11.2.4.2.1;Consent must be voluntary;454
11.2.4.2.2;Consent must be specific;454
11.2.4.2.3;Capacity to give consent;454
11.2.4.2.4;Ongoing consent;455
11.2.5;Conclusion;455
11.2.6;References;456
11.3;23. Therapeutic interventions;460
11.3.1;Introduction;461
11.3.2;Stress Management;462
11.3.2.1;Relaxation training;463
11.3.2.2;Assertiveness training;463
11.3.3;Risk Assessment;465
11.3.3.1;Risk for violence;465
11.3.3.2;Self-harm and suicide;465
11.3.3.3;Crisis intervention;466
11.3.3.4;Telephone counselling;467
11.3.4;Psychotherapy;467
11.3.4.1;Individual psychotherapy;467
11.3.4.2;Brief therapies;468
11.3.4.3;Motivational interviewing;468
11.3.4.4;Cognitive behavioural therapy;470
11.3.4.5;Dialectical behaviour therapy;471
11.3.5;Behaviour Therapy;472
11.3.6;Group Therapy;474
11.3.6.1;Activity groups;475
11.3.7;Family Therapy;475
11.3.7.1;Psychoeducation;476
11.3.8;Psychosocial Rehabilitation and Recovery;477
11.3.8.1;Instilling hope;478
11.3.8.2;Social skills training;479
11.3.9;Interviewing;480
11.3.10;Care Coordination;481
11.3.11;Electroconvulsive Therapy;481
11.3.12;Conclusion;482
11.3.13;References;483
11.4;24. Psychopharmacology and medicines management;488
11.4.1;Introduction;489
11.4.2;Important Pharmacological Principles;489
11.4.3;Important Psychotropic Drugs;490
11.4.3.1;Anti-anxiety or anxiolytic medications;492
11.4.3.1.1;Indications for use;492
11.4.3.1.2;Side effects;492
11.4.3.1.3;Contraindications/precautions;493
11.4.3.1.4;Interactions;493
11.4.3.1.5;Service user education;493
11.4.3.2;Nonbenzodiazepine anti-anxiety drugs;493
11.4.3.3;Antidepressant drugs;493
11.4.3.3.1;Indications for use;494
11.4.3.3.2;Side effects;494
11.4.3.3.2.1;Tricyclic antidepressants;494
11.4.3.3.2.2;Monoamine oxidase inhibitors;494
11.4.3.3.2.3;Selective serotonin-reuptake inhibitors;495
11.4.3.3.3;Contraindications/precautions;495
11.4.3.3.4;Interactions;495
11.4.3.3.4.1;Tricyclics;495
11.4.3.3.4.2;MAOIs;495
11.4.3.3.4.3;SSRIs;495
11.4.3.3.5;Service user education;495
11.4.3.4;Mood stabilizers;495
11.4.3.4.1;Indications for use;496
11.4.3.4.1.1;Lithium;496
11.4.3.4.1.2;Antipsychotics;496
11.4.3.4.1.3;Anticonvulsants;496
11.4.3.4.2;Side effects;496
11.4.3.4.2.1;Lithium;496
11.4.3.4.2.2;Anticonvulsants;496
11.4.3.4.3;Contraindications/precautions;496
11.4.3.4.3.1;Lithium;496
11.4.3.4.3.2;Anticonvulsants;496
11.4.3.4.4;Interactions;497
11.4.3.4.4.1;Lithium;497
11.4.3.4.4.2;Anticonvulsants;497
11.4.3.4.5;Service user education;497
11.4.3.4.5.1;Lithium;497
11.4.3.4.5.2;Anticonvulsants;497
11.4.3.5;Antipsychotic or neuroleptic drugs;497
11.4.3.5.1;Indications;498
11.4.3.5.2;Side effects: traditional antipsychotics;498
11.4.3.5.2.1;Antiparkinsonian medications;500
11.4.3.5.3;Side effects: atypical antipsychotics;500
11.4.3.5.4;Contraindications/precautions;500
11.4.3.5.4.1;Traditional antipsychotics;500
11.4.3.5.4.2;Atypical antipsychotics: clozapine;501
11.4.3.5.5;Interactions;501
11.4.3.5.5.1;Traditional antipsychotics;501
11.4.3.5.5.2;Atypical antipsychotics;501
11.4.3.5.5.3;Smoking;501
11.4.3.5.6;Service user education;501
11.4.3.5.6.1;Traditional antipsychotics;501
11.4.3.5.6.2;Atypical antipsychotics;501
11.4.4;PRN (As-Needed) Antipsychotic Drug Administration;501
11.4.5;Medication Concordance;502
11.4.6;Depot Preparation of Antipsychotic Drugs;505
11.4.7;Psychotropic Drug Use in Special Populations;505
11.4.7.1;Pregnant and lactating women;505
11.4.7.2;Children;506
11.4.7.3;Older people;506
11.4.8;Nonmedical Prescribing;506
11.4.9;NMC Standards of Medicines Management;507
11.4.10;Conclusion;507
11.4.11;References;508
11.5;25. Physical health;512
11.5.1;Introduction;513
11.5.2;Health Inequalities;513
11.5.3;Comorbidity;515
11.5.4;Role of the Mental Health Nurse;515
11.5.5;Factors Affecting Physical Health;516
11.5.5.1;Smoking;516
11.5.5.2;Diet;517
11.5.5.3;Exercise;517
11.5.5.4;Medication;517
11.5.5.5;Drug and alcohol use;518
11.5.6;Physical Health Assessment;518
11.5.6.1;Structured assessments;518
11.5.6.1.1;Pain;518
11.5.6.1.2;Dizziness;519
11.5.6.1.3;Breathlessness;519
11.5.6.1.4;The ABCDE approach;519
11.5.6.1.4.1;Airway;519
11.5.6.1.4.2;Breathing;519
11.5.6.1.4.3;Circulation;520
11.5.6.1.4.4;Disability;521
11.5.6.1.4.4.1;AVPU ;521
11.5.6.1.4.4.2;Glasgow Coma Scale;521
11.5.6.1.4.4.3;Blood glucose ;522
11.5.6.1.4.5;Exposure/environment;522
11.5.6.1.5;Clinical skills;523
11.5.6.1.5.1;Vital signs;523
11.5.7;Sleep;524
11.5.7.1;Sleep problems;524
11.5.7.2;Improving sleep;525
11.5.7.3;Assessing sleep;525
11.5.8;Sexual Health;525
11.5.9;Mental Health and Childbirth;529
11.5.10;Conclusion;531
11.5.11;References;532
12;Glossary;536
13;Index;548
