PSYCHIATRIC NURSING SKILLS

4. DISCUSS THE PSYCHIATRIC NURSING SKILLS WITH THE GUIDANCE

BELOW

 Self awareness

 Assertiveness training

 Social skills training

 Behaviour modification

 Therapeutic nursing interventions

 Observation skills

 Interviewing skills

 Interpersonal skills

Psychiatric nursing requires a set of specialized skills to provide holistic and effective care for individuals with mental health disorders. These skills enable nurses to manage complex psychiatric symptoms, foster therapeutic relationships, and promote patient recovery. Below is a discussion of key psychiatric nursing skills:

Self-Awareness

Definition:

Self-awareness is the ability to understand one's own emotions, beliefs, biases, and behaviors. It allows psychiatric nurses to recognize how their own feelings and experiences may affect their interactions with patients.

Importance in Psychiatric Nursing:

Emotional Regulation: Nurses who are self-aware can better manage their emotions during challenging patient interactions, avoiding burnout or frustration.
Professional Boundaries: Self-awareness helps nurses maintain clear professional boundaries, ensuring that personal feelings do not interfere with patient care.
Cultural Competence: Being aware of one’s own cultural values and biases allows the nurse to provide culturally sensitive care to diverse patient populations.

Assertiveness Training

Definition:

Assertiveness training involves teaching individuals how to express their thoughts, feelings, and needs confidently and respectfully, without aggression or passivity.

Application in Psychiatric Nursing:

Patient Empowerment: Nurses can teach assertiveness to patients, especially those with low self-esteem or anxiety, helping them advocate for themselves and communicate their needs.
Conflict Resolution: Assertiveness training helps nurses resolve conflicts in a constructive manner, both with patients and within the healthcare team.
Promoting Healthy Communication: By encouraging assertiveness, nurses foster open and honest communication in therapeutic settings.

Social Skills Training

Definition:

Social skills training (SST) involves teaching patients how to interact appropriately with others, helping them develop communication, problem-solving, and relationship-building skills.

Use in Psychiatric Nursing:

Patient Rehabilitation: SST is particularly useful for patients with social difficulties, such as those with schizophrenia, autism, or social anxiety disorders, helping them reintegrate into society.
Enhancing Coping Mechanisms: Nurses use SST to teach patients how to manage social situations that may provoke stress or relapse.
Role-Playing: Nurses may engage in role-playing exercises with patients to practice social interactions, preparing them for real-world experiences.

Behavior Modification

Definition:

Behavior modification is a therapeutic approach based on operant conditioning, where desired behaviors are reinforced and maladaptive behaviors are discouraged.

Importance in Psychiatric Nursing:

Positive Reinforcement: Nurses use behavior modification techniques, such as positive reinforcement (e.g., rewards, praise), to encourage desired behaviors in patients with mental health conditions.
Management of Maladaptive Behaviors: This technique is especially effective in patients with behavioral disorders (e.g., ADHD, substance abuse) or in psychiatric settings, where controlling disruptive behaviors is essential.
Structured Treatment Plans: Behavior modification programs, such as token economies, are used to structure patient care, especially in inpatient psychiatric settings.

Therapeutic Nursing Interventions

Definition:

Therapeutic nursing interventions are actions taken by the nurse to promote the mental and emotional well-being of the patient. These interventions are aimed at fostering recovery and providing emotional support.

Key Examples:

Cognitive Behavioral Therapy (CBT): Psychiatric nurses may implement CBT principles, helping patients reframe negative thought patterns.
Stress Management Techniques: Nurses can teach relaxation techniques, breathing exercises, and mindfulness to help patients manage anxiety and stress.
Psychoeducation: Nurses provide education on mental health conditions, medications, and coping strategies to patients and their families.

Importance:

Therapeutic interventions help patients develop insight into their condition, manage symptoms, and enhance their quality of life.

Observation Skills

Definition:

Observation skills involve carefully monitoring patients' behavior, emotions, and physical health to identify signs of mental illness, distress, or improvement.

Application in Psychiatric Nursing:

Identifying Symptoms: Observation skills allow nurses to detect early signs of psychiatric disorders, such as changes in mood, behavior, or cognitive function.
Risk Assessment: Nurses use these skills to assess suicide risk, self-harm behaviors, or aggressive tendencies in psychiatric patients.
Tracking Progress: By continuously observing patients, nurses can assess the effectiveness of treatments and make necessary adjustments to care plans.

Interviewing Skills

Definition:

Interviewing skills refer to the nurse’s ability to gather accurate information from the patient through structured or semi-structured conversations. This includes active listening, empathy, and asking the right questions.

Importance in Psychiatric Nursing:

Patient Assessment: Effective interviewing helps nurses understand the patient's mental state, history, and current challenges, forming the basis of treatment plans.
Building Trust: A skilled interview can foster trust between the patient and nurse, encouraging the patient to open up and engage in treatment.
Therapeutic Communication: Nurses use therapeutic communication techniques, such as reflective listening and open-ended questions, to facilitate dialogue and encourage patients to express themselves.

Interpersonal Skills

Definition:

Interpersonal skills encompass the ability to effectively communicate, interact, and build relationships with patients and healthcare team members.

Role in Psychiatric Nursing:

Building Rapport: Nurses rely on interpersonal skills to develop rapport with patients, fostering trust and a sense of safety, which is crucial for effective psychiatric care.
Team Collaboration: Nurses with strong interpersonal skills communicate effectively with doctors, therapists, and other healthcare providers to coordinate care for psychiatric patients.
Empathy and Compassion: Interpersonal skills involve empathy, showing understanding and concern for the patient’s experiences, which enhances patient engagement and compliance with treatment.

Summary of Psychiatric Nursing Skills:

Self-Awareness: Critical for understanding personal biases and maintaining emotional balance.
Assertiveness Training: Teaches both nurses and patients to communicate needs confidently.
Social Skills Training: Helps patients improve communication and social interactions.
Behavior Modification: Uses reinforcement techniques to promote positive behaviors.
Therapeutic Nursing Interventions: Supports patients’ mental well-being through therapies and education.
Observation Skills: Enables early detection of mental health symptoms and risk factors.
Interviewing Skills: Facilitates patient assessment and therapeutic communication.
Interpersonal Skills: Builds trust and fosters collaboration in psychiatric care.

These skills ensure that psychiatric nurses can provide effective, compassionate care that addresses both the psychological and emotional needs of their patients.

The LATTE method, developed by Nurse Mo, can be effectively applied in psychiatric nursing care to organize and streamline the approach to patient care, particularly when dealing with complex mental health conditions. Below is an explanation of how each step of the LATTE method can be applied in psychiatric nursing:

L - Look at the Patient

In psychiatric nursing, this step focuses on observing the patient's mental and physical presentation as well as their chief complaints.

Application in Psychiatry Nursing:
- Look for signs of agitation, restlessness, withdrawal, or disheveled appearance.
- Assess body language, facial expressions, eye contact, and hygiene, which can reveal important information about the patient’s mental state (e.g., depression, anxiety, or psychosis).
- Identify the patient’s verbal complaints such as suicidal ideation, hallucinations, or paranoia.
Example:
A patient with schizophrenia might present with disorganized speech, flat affect, and hallucinations. They may seem unkempt, withdrawn, or agitated, which provides cues about their mental state.

A - Assess the Patient

In psychiatric nursing, assessment includes both mental and physical health. You'll use various mental health assessment tools and frameworks to gauge the patient’s condition.

Application in Psychiatry Nursing:
- Perform a mental status exam (MSE) to assess mood, thought content, cognition, perception, and insight.
- Ask open-ended questions to assess suicidal thoughts, homicidal ideation, or delusions.
- Monitor vital signs to check for any physical manifestations of distress, like elevated heart rate or increased blood pressure.
- Conduct ongoing risk assessments for self-harm or violence towards others.
Example:
For a patient with major depressive disorder, the nurse might assess the level of suicidal ideation, sleep disturbances, appetite changes, and fatigue. This might involve using screening tools like the Beck Depression Inventory or PHQ-9.

T - Tests and Diagnostics

In psychiatry, while there are no specific lab tests to diagnose mental illnesses directly, there are certain diagnostics used to rule out medical causes or complications, monitor medication effects, and guide treatment.

Application in Psychiatry Nursing:
- Prepare the patient for blood tests to check for drug levels (e.g., lithium), thyroid function tests (e.g., for hypothyroidism), or vitamin deficiencies (e.g., B12).
- Expect brain imaging tests like an MRI or CT scan if the patient has neurological symptoms or there's a need to rule out brain lesions or injury.
- Monitor for potential side effects of psychiatric medications through routine blood work, such as Complete Blood Count (CBC) or liver function tests.
Example:
A patient on clozapine might need regular blood tests to monitor for agranulocytosis, a serious potential side effect. The nurse would ensure the patient understands the need for these tests and helps prepare them accordingly.

T - Treatments

Treatment in psychiatric nursing involves medication management, therapies, and nursing interventions aimed at stabilizing the patient's mental health.

Application in Psychiatry Nursing:
- Administer prescribed psychotropic medications, such as antipsychotics, antidepressants, or mood stabilizers.
- Implement non-pharmacological treatments, such as cognitive-behavioral therapy (CBT), psychotherapy, or group therapy sessions.
- Provide safety interventions like ensuring the patient is in a safe environment (e.g., removing harmful objects) and monitoring for self-harm or violence.
- In some cases, coordinate with the team to facilitate electroconvulsive therapy (ECT) for treatment-resistant depression or severe mood disorders.
Example:
A patient with bipolar disorder might receive lithium or valproate to manage mood swings. The nurse would monitor for therapeutic levels of the drug, ensure the patient is compliant, and check for potential side effects like tremors or weight gain.

E - Educate the Patient

Patient education is a key aspect of psychiatric nursing, helping patients and their families understand the condition, treatment options, and lifestyle modifications that can support recovery.

Application in Psychiatry Nursing:
- Educate the patient on the importance of medication adherence, the risks of stopping medications suddenly, and possible side effects.
- Provide coping strategies for dealing with symptoms like anxiety, delusions, or depression.
- Educate about triggers that could exacerbate mental health issues, such as substance use or lack of sleep.
- Teach family members or caregivers how to recognize warning signs of a relapse or crisis.
- Encourage participation in support groups or therapy to enhance recovery.
Example:
A patient with schizophrenia may need education on the importance of continuing their antipsychotic medication even when they feel better. The nurse can explain how medication noncompliance might lead to a return of hallucinations or delusions. The patient can also be educated on coping mechanisms to manage stress and social withdrawal.

Conclusion:

The LATTE method helps psychiatric nurses stay organized and systematic when caring for patients with mental health conditions. By following this structured approach, nurses can ensure that they assess their patients thoroughly, prepare them for necessary diagnostics, provide appropriate treatments, and educate them for better long-term mental health outcomes.

GENERAL MANAGEMENT OF A PSYCHATRIC PATIENT

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CREATION OF A THERAPEUTIC NURSE-PATIENT RELATIONSHIP

Introduce yourself to the patient so that the patient can know you.

Explain your roles and responsibilities in order for the patient to understand your presence in the ward

Ask the patient to introduce her/himself and tell you the preferred name so that you can address him/her by that.

Avoid making promises you cannot fulfil to the patient to prevent patient losing confidence in you.

CREATING A SAFE ENVIRONMENT

Remove all dangerous items such as ropes, bars/rods from the patient unit to prevent the patient from harming him/herself.

Ensure that the windows in the patient unit are very high and with bars to prevent the patient from jumping out of the room.

Ensure enough lighting in the room to prevent patient from hiding and harm anyone who comes in the unit.

Ensure that the door of the patient unit or ward is kept locked all the time to prevent patient from running away.

COUNSELLING

Encourage the patient to express his/her emotions , concerns and worries in order to identify what could have caused the mental problem.

Answer the patient’s questions honestly in simple terms to help him/her understand the condition.

Allow the patient to talk freely without being interfered so that they can express their feelings at their own pace freely.

Encourage the family to visit the patient to reduce on anxiety and feeling of loss of independence.

ORIENTATION TO REALITY

Have the watch and calendar in the patient unit to orient the patient to time and date on a daily basis.

Ask the questions to the patient such as name and location atleast twice a day to assess orientation to reality.

Politely refuse hallucinatory statements of the patient and explain real situation to make the patient aware that what he is talking about are just hallucination.

Take the patient around the ward to show him/her of the geography of the ward to orient to reality.

SKILLS TRAINING

Teach social skills to help patient integrate well with others.

Teach anger management skill to help patient manage anger and prevent harm.

Teach assertiveness skills to help patient stand for what is right without violating anyone’s rights.

Teach behaviour modification skills to help patient change unacceptable behaviours to acceptable one.

Teach patient communication skills to empower them with good communication with others.

Do group therapy on a daily basis to assess the social skills acquisition by the patient.

HYGIENE

Encourage patient to take a bath to promote body hygiene.

Encourage patient to change clothes, comb hair and clean the teeth to promote self-esteem.

Encourage the patient to make his/her own bed to promote comfort.

Encourage patient to clean all his/her utensils to promote hygiene and prevent diarrhoea.

PROMOTION OF NUTRITION

Serve a well-balanced diet containing essential nutrients eg carbohydrates, proteins and vitamins to promote nutrition and energy atleast in 3 main meals of the day.

Give snacks rich in Vitamin B to help in the generation of brain cells.

Encourage meals rich in roughage to prevent constipation.

Encourage enough oral fluids on a daily basis to prevent dehydration.

Serve meals in a palatable manner on a tray if possible put flowers and fruits to promote appetite.

PATIENT OBSERVATION

Observe for signs of improvement on a patient on a daily basis by finding out about their current location.

Observe for improvement in terms of major signs of the condition such as hallucinations, illusions and delusion to assess prognosis.

Check routine vital signs of temperature, pulse, respirations and Blood pressure to identify any infection early, assess the cardiopulmonary system and identify hypertension early respectively and intervene accordingly.

Observe for adherence to learnt social skills in order to assess patient’s prognosis.

DISCHARGE PLANNING

Discharge planning should start as early as the patient stabilizes to let him/her aware that one day he/she will be out of the hospital to prevent institutionalism.

Remind him/her on the daily basis that he/she needs to adhere to social skills to make him/her integrate well in the community once discharged.

PROMOTION OF QUICK RECOVERY

Ensure that all ordered drugs are given to the patient at the right time and in the correct dosage to promote quick recovery.

Explain to the patient the importance of taking drugs as a way to promote quick recovery in order to have the patient motivated to take the drug.

Congratulate the patient upon taking the drugs in order to get him/her motivated to take the drugs.

Involve the family and significant others in giving drugs to the patient so that they can learn for continuity of drug administration after discharge from the hospital.

Explain to side effects of the drugs to the patient and family and how they are managed to ensure that they can continue giving drugs and managing side effects without stopping therapy.

LINKAGE TO COMMUNITY MENTAL HEALTH STRUCTURES

Communicate to the patient and family the available community mental health nurses in their community and how to contact them when face a problem with the patient in the community.

Tell the community the names of Psychosocial counsellors in their community where the patient can go for continued counselling to ensure continuity of care while in the community.

Tell the family and patients where to access the social welfare department for support in terms of housing and clothing for those patients who lose their houses while admitted in the hospital in order to prevent relapse of mental condition due to stress.

Explain to the patient and family the role of traditional leaders in ensuring that mental patients are not stigmatized in the community for stigma can cause relapse of mental condition.

DAY OF DISCHARGE

Get drugs from the pharmacy for the patient.

Give the drugs to the patient and family while giving instructions on how to take them to ensure continuity of care.

Ask the patient and family to re-explain the instructions and side effects of the drugs to ensure that they understood your explanation.

Assure the patient and family that the health facility is always open for them whenever a problem arises at home to ensure that the patient is attended to early before complications.

Bid farewell to the patient and family with a smile to gain their trust and confidence in your care.