PSYCHIATRIC NURSING SKILLS
PSYCHIATRIC NURSING SKILLS
OBJECTIVES
Define key terms used
Mention 8 psychiatric nursing skills
Importance of self-awareness
Discuss the Johari window
Outline the counseling skills
Discuss the principles of counseling
Explain stress management MARKING KEY DEFINITION OF TERMS SKILL
This is an ability to do an activity or job well, especially because you have practiced it.
COMMUNICATION
Communication – The reciprocal exchange of information, ideas, beliefs, feelings and attitudes between 2 people or among groups of people.
SELF AWARENESS
Self awareness involves looking inward to understand oneself and objectively (without bias) examine one’s beliefs, values, attitudes, motivations, strengths and limitations. This means the nurse must be able to examine personal feelings, actions, and reactions. However, no one ever completely knows the inner self, as shown in the Johari window.
COUNSELING
Counseling is a method of relieving distress undertaken by means of a dialogue between 2 people. The aim Is to help the client find their own solutions to problems, while being supported and being guided by .
STRESS MANAGEMENT
Stress management involves the use of coping strategies that protect the individual from harm in response to stressful situations or stressors. To prevent people with vulnerability to mental illness falling sick, they can be taught how to manage the stress (precipitating factors in a person with an already existing vulnerability) at comes about in their lives.
BEHAVIORAL MODIFICATION
Behaviour modification is a practice that treats behavioral problems. It is based on operant, conditioning and social learning.
POSITIVE REINFORCEMENT – Adding a rewarding stimulus as a consequence of a behaviour, thus increasing the probability that it will occur again.
EXTINCTION – When positive reinforcement for a particular response (behaviour) is withdrawn, the behaviour usually stops.
SOCIAL LEARNING / observation (eg assertive skills & social skills) Is a strategy used to form new behaviour patterns by observing a person modelling the behaviour in a controlled environment. The person then imitates the model’s behaviour.
THERAPEUTIC RELATIONSHIP
It is An interaction between 2 people (usually a caregiver and a care receiver) in which input from both parties contributes to a climate of healing, growth promotion, and illness prevention.
A THERAPEUTIC or “helping” relationship is established through use of basic counseling skills.
EXAMPLES OF PSYCHIATRIC NURSING SKILLS
Communication Skills
Self-awareness
Assertiveness training
Counselling
Social Skills training
Observation
Stress management
Behaviour Modification
Therapeutic nursing interventions skills Physical assessment of psychiatric patients Admission of psychiatric patients
Types of admissions
Admission procedures
Discharge planning of psychiatric patients
COMMUNICATION SKILLS
Elements of communication include the source, message, channel, receiver and feedback.
Modes of Communication
Written
Spoken word
Non verbal communication – body language
SELF AWARENESS
Self awareness involves looking inward to understand oneself and objectively (without bias) examine one’s beliefs, values, attitudes, motivations, strengths and limitations. This means the
nurse must be able to examine personal feelings, actions, and reactions. However, no one ever completely knows the inner self, as shown in the Johari window.
IMPORTANCE OF SELF AWARENESS
To ensure the most effective use of self, it is important to be aware of personal stress that can interfere with one’s ability to communicate therapeutically with pts. If the nurse’s tired, anxious, angry or apathetic, it will be difficult to convey an interest in the concerns and fears of the pt.
Nurses’ social biases can influence the way they interact with pts.
The messages nurses communicate verbally & none verbally to pts can be clear when nurses acknowledge their own feeling even if they are negative.
A good understanding and acceptance of self allow the nurse to acknowledge a patient’s differences and uniqueness.
TRAINING A PATIENT TO BE ASSERTIVE
Patients can learn by participating in groups
Patients can watch staff demonstrate specific skills,
Then role play skills themselves
Staff can then provide feedback to pts on the appropriateness and effectiveness of their responses in the role play
Homework also can be assigned to pts to help them generalize these skills outside the group
Aggressive behaviours may diminish as the pt learns new and more effective social skills.
THE JOHARI WINDOW
The Johari Window consists of four quadrants that represent the total self as follows:
Quadrant 1 – Known to self and others. It includes the behaviours, feelings, and thoughts known to the individual and others.
Quadrant 2 – Known only to others. (Its an open secret!). It includes all the things that others know but the individual does not know.
Quadrant 3 – Known only to self. Includes the things about self that only the individual knows.
The goal of Increasing self awareness is to enlarge the area of quadrant 1 while reducing the size of the other quadrants.
THE JOHARI WINDOW
I) STRESS MANAGEMENT
Stress management involves the use of coping strategies that protect the individual from harm in response to stressful situations or stressors.
To prevent people with vulnerability to mental illness falling sick, they can be taught how to manage the stress (precipitating factors in a person with an already existing vulnerability) that comes about in their lives.
II) Coping Strategies
Awareness – Become aware of stressors, then omit, avoid, or accept them. Relaxation – Through physical exercises, breathing exercises and muscle relaxation. Meditation.
Seeking support and talking to others if anxiety is too much.
BEHAVIORAL MODIFICATION
Behaviour modification is a practice that treats behavioural problems. It is based on operant, conditioning and social learning. It is based on the premise that all behaviours are learned and can therefore also be unlearned. In this skill bad behaviours are unlearned while good behaviours are learned using the above mentioned principles.
For example: Positive reinforcement – Adding a rewarding stimulus as a consequence of a behaviour, thus increasing the probability that it will occur again.
THERAPEUTIC RELATIONSHIP
Definition of a therapeutic relationship:
An interaction between 2 people (usually a caregiver and a care receiver) in which input from both parties contributes to a climate of healing, growth promotion, and illness prevention. A therapeutic or “helping” relationship is established through use of basic counseling skills.
The relationship Is divided into 4 phases:
Pre interaction
Orientation (introduction)
Working
Termination
PRE-INTERACTION PHASE – begins before the nurse’s first contact with the patient. It is a time of self-exploration (self-awareness).
INTRODUCTION OR ORIENTATION PHASE
The nurse and patient first meet during this phase. The nurse’s primary concern is to find out why the patient sought help, & together with pt formulate objectives on what should be achieved in the relationship Tasks: Establish a climate of trust, understanding, acceptance , and open communication. Formulate a contract with the patient.
WORKING PHASE
Most of the therapeutic work is carried out in this phase. Problems (reasons patient sought for help) are dealt with using problem solving approach. Actual behavioral change is the focus of this phase. The psychiatric nursing skills are used to bring about this behavioural change.
TERMINATION PHASE
Prepare pt for termination by decreasing visits, incorporating others into meetings, or changing location of meetings. Clarify reason for such changes so pt does not interpret it as rejection by the nurse. Mutually explore feelings of rejection, loss sadness and anger etc. Review progress of therapy and attainment of goals.
NB: You need to remember that persons who are mentally ill often possess many of the characteristics of well persons; likewise, mentally healthy persons frequently exhibit characteristics similar to those of mental illness. The difference is often determined by the degree of impairment in functioning.
BY DR JONES H.M- RN/BscNsg/MBA/Ph.D.
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