THE NURSING PROCESS IN PSYCHIATRIC MENTAL 3.
Elimination Pattern
HEALTH CARE
NURSING PROCESS
✧ Is a process by which nurses deliver care to
psychiatric patients to improve or solve their mental
problems.
A. ASSESSMENT
✧ Information is obtained from the patient in a Direct
and Structured or Indirect manner through
observation of verbal and non-verbal behaviors
based on the knowledge of normal and dysfunctional
behaviors, interviews and examination.
Assessment may be:
1. Subjective Data
⮚ Refers to information obtained from the client,
family members, or significant others during direct
questioning or through the review of past medical
and psychiatric records
Nursing History
⮚ provides a description of a client's functional
patterns, offering subjective data in the form of
verbal reports obtained through questions that assist
clients in sharing their history and current health
status
Gordon’s Functional Health Patterns
⮚ A method devised by Marjory Gordon to be used by
nurses in the nursing process to provide a more
comprehensive nursing assessment of the patient.
⮚ Gordon's functional health pattern includes 11
categories which is a systematic and standardized
approach to data collection.
LIST OF FUNCTIONAL HEALTH PATTERNS
1. Health Perception – Health Management Pattern
Describes client’s perceived pattern of health and well
being and how health is managed.
2. Nutritional – Metabolic Pattern
Describes pattern of food and fluid consumption relative
to metabolic need and pattern indicators of local nutrient
supply.
Describes the function of the bowel, bladder and skin.
Through this pattern the nurse is able to determine
regularity, quality, and quantity of stool and urine.
4. Activity – Exercise Pattern
Describes patterns of exercise, activity, leisure, and
recreation.
5. Cognitive – Perceptual Pattern
Describes sensory, perceptual, and cognitive pattern
6. Sleep – Rest Pattern
Describes patterns of sleep, rest, and relaxation.
7. Self-perception – Self-concept Pattern
Describes self-concept and perceptions of self (body
comfort, image, feeling state)
8. Role – Relationship Pattern
Describes pattern of role engagements and relationships.
9. Sexuality – Reproductive Pattern
Describes client’s pattern of satisfaction and
dissatisfaction with sexuality pattern, describes
reproductive patterns.
10. Coping – Stress Tolerance Pattern
Describes general coping patterns and effectiveness of
the pattern in terms of stress tolerance.
11. Value – Belief Pattern
Describes a pattern of values and beliefs, including
spiritual and /or goals that guide choices or decisions.
2. Objective Data
⮚ Refers to measurable and observable information
obtained through physical examinations, laboratory
tests, and observations of the patient's behavior and
mental status.
a. Mental Status Assessment
⮚ Conducting a comprehensive mental status
examination to assess the patient's cognitive,
emotional, and behavioral functioning.
⮚ This examination involves evaluating the patient's
appearance, speech, mood, affect, thought content,
perception, cognition, and insight
b. Psychosocial Assessment
⮚ It assesses self-perception and the individual's ability
to function in the community.
⮚ Helps the nurse determine if the patient is in mental
health or a mental illness state.
 ✧ Mental Health is a state of well-being where one become critical in detecting the presence of these
can deal with the typical stresses of life, work disorders.
productively, and contribute to their community. ⮚ Important clinical laboratory tests include; serum
✧ Mental Illness is a pattern of behaviors troubling and urine, drug screens; thyroid, liver and kidney
the person or the community where the function tests; complete blood counts; and sexually
individual lives. transmitted disease screening.
⮚ Specialized diagnostic procedures include;EEG, which
The major components of a Psychosocial interview discerns a seizure-like basis for an illness, such as an
include: impulse control disorder, exists. In delirium, as a
result of metabolic problems, the EEG generally
● Identifying the patient ● Violence risk shows high-voltage, slow-wave activity.
● Chief complaint assessment
⮚ Other tests include; MRI, Computed Tomography
● History of presenting ● Family or social history
(CT), and Positron Emission Tomography (PET),
illness ● Occupational history
● Psychiatric history ● Educational history which identify space-occupying lesions and
● Medical or surgical ● Legal history metabolic brain disorders.
history ● Developmental history
● Medication list ● Spiritual assessment
● Alcohol and drug use ● Interests B. NURSING DIAGNOSIS
● Cultural assessment ● Abilities
● Financial assessment ● Mental status
● Coping skills examination ✧ A process whereby nurses interpret data collected
during assessment and apply standardized labels to
clients’ health problems and responses to illness
c. Ethno-Cultural and Spiritual Assessment ✧ Statements that describe an individual’s health state
or alteration in a person's life processes.
⮚ Involves ethnicity, race, social class, language,
spiritual beliefs and practices of an individual. These 1. NANDA Taxonomy
can significantly influence the development,
expression and reporting of mental disorders, ✧ NANDA (formerly the North American Nursing
thereby affecting diagnosis. Diagnosis Association) is a professional organization
of nurses to standardized nursing terminology that
Other Assessment Tools was founded in 1982 and develops and refines the
I. Psychological Tests nomenclature, criteria, and taxonomy of nursing
⮚ Measure personality, intelligence, mental abilities diagnoses.
and behavior. ✧ In 2002, the organization changed its name to
NANDA International to further reflect the
II. Personality Tests worldwide interest in nursing diagnosis.
⮚ Measures personality traits, and other aspects of ✧ TAXONOMY is a classification system or set of
personality; such as self concept. categories arranged based on a single principle or set
⮚ This test can help you learn more about yourself and of principles.
better understand both your strengths and ✧ The current structure of NANDAs nursing diagnoses
weaknesses. Learning that you might be high on a is referred to as Taxonomy II and has three levels: 13
specific trait can help you gain greater insight into domains, 47 classes, and 172 diagnoses.
your own behavioral patterns.

Domain 1. Health Promotion

III. Intelligence Tests Class 1. Health Awareness
⮚ Measurement of an individual’s intelligence, which is Class 2. Health Management
used to predict future behaviour, for interventions
and on some occasions for the diagnoses of some Domain 2. Nutrition
illnesses, such as developmental disorders Class 1. Ingestion
Class 2. Digestion
IV. Diagnostic and Laboratory Examinations Class 3. Absorption
⮚ A diagnostic tool in mental health disorders. Since Class 4. Metabolism
mental health disorders can be challenging to treat Class 5. Hydration
because they don’t have a physical manifestation like
other illnesses, psychiatric tests in a laboratory
Domain 3. Elimination and Exchange
Class 1. Urinary function
Class 2. Gastrointestinal function
Class 3. Integumentary function
Class 4. Respiratory function
Domain 4. Activity/Rest
Class 1. Sleep/Rest
Class 2. Activity/Exercise
Class 3. Energy balance
Class 4. Cardiovascular/Pulmonary responses
Class 5. Self-care
Domain 5. Perception/Cognition
Class 1. Attention
Class 2. Orientation
Class 3. Sensation/Perception
Class 4. Cognition
Class 5. Communication
Domain 6. Self-Perception
Class 1. Self-concept
Class 2. Self-esteem
Class 3. Body image
Domain 7. Role relationship
Class 1. Caregiving roles
Class 2. Family relationships
Class 3. Role performance
Domain 8. Sexuality
Class 1. Sexual identity
Class 2. Sexual function
Class 3. Reproduction
Domain 9. Coping/stress tolerance
Class 1. Post-trauma responses
Class 2. Coping responses
Class 3. Neurobehavioral stress
Domain 10. Life principles
Class 1. Values
Class 2. Beliefs
Class 3. Value/Belief/Action congruence
Domain 11. Safety/Protection
Class 1. Infection
Class 2. Physical injury
Class 3. Violence
Class 4. Environmental hazards
Class 5. Defensive processes
Class 6. Thermoregulation
Domain 12. Comfort
Class 1. Physical comfort
Class 2. Environmental comfort
Class 3. Social comfort
Domain 13. Growth/Development
Class 1. Growth
Class 2. Development
2. NOC (Nursing Outcomes Classifications)
✧ The NOC is a standardized classification system that
defines nursing outcomes for patients, family, and
the community.
NOC outcomes are grouped hierarchically into 34 classes
within seven domains. The seven domains are:
1. Functional Health
The individual’s ability to perform activities of daily living
(ADLs) and maintain a level of independence in daily life.
2. Physiologic Health
The physical well-being of an individual, including vital
signs, organ function, and overall physical health status.
3. Psychosocial Health
The emotional and social aspects of an individual’s well-
being, including mental health, relationships, and coping
mechanisms.
4. Health Knowledge & Behavior
The individual’s understanding of health-related
information and their ability to make informed decisions
and engage in behaviors that promote well-being.
5. Perceived Health
The individual’s subjective assessment of their own
health, including their perceptions of symptoms, comfort,
and overall sense of well-being.
6. Family Health
The well-being of the family unit as a whole, considering
the dynamics and interactions among family members.
7. Community Health
The well-being of a community or population, considering
factors such as access to healthcare, health education,
and community resources.
C. OUTCOME IDENTIFICATION
❖ The psychiatric mental health nurse identifies expected
outcomes individualized to the patient.
Example:
➔ Expected Outcome:
Patient will be socially engaged in the community
➔ Long Term Goal:
The p.twill travel about the community independently
within 2 months
 ➔ Short Term Goal:
At the end of 1 week the p.t will walk to the corner
and back home.

D. PLANNING

❖ The nurse develops a plan of care that prescribes

interventions
❖ The planning consists of:
➔ Prioritizing the nursing diagnoses
➔ Identifying long & short term goals
➔ Developing nursing interventions
➔ Recording /writing nursing care plan

E. IMPLEMENTATION

❖ The implementation phase of the nursing process : is the

actual initiation of the nursing care plan.
❖ Involves putting the nursing care plan into Action

F. EVALUATION

❖ Evaluation is an ongoing process

❖ The evaluation phase consist of two steps:
➔ First, the nurse compares the client's current mental
health state with that described in the outcome
criteria
➔ Second, the nurse considers all the possible reasons
why client outcomes were not attained , it may be too
soon to evaluate, and the plan of action needs further
implementation