CHAPTER-1

NURSING PROCESS IN PSYCHIATRY

TIME- 7 AND HALF HOUR

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 Outlines

Introduction to nursing process in Planning phase in psychiatry setting

psychiatric setting

Implementation phase in
Psychiatry nursing assessment psychiatry setting

Nursing diagnosis in Evaluation phase in

psychiatric setting psychiatry setting

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 Objectives of the training
Conduct psychiatry nursing
assessment

Explain psychiatry nursing

diagnosis

Discus about planning phase of

process

Apply psychiatric nursing

intervention

Determine psychiatric nursing

evaluation

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 Activity 1.1 Describe nursing
process in psychiatric
nursing?
List five nursing process
in psychiatric nursing?
(10 minute)

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 INTRODUCTION

 The nursing process in psychiatric nursing is a

process by which psychiatry nurses deliver
nursing care to the psychiatric patients to
improve or solve their health response.

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 Purposes of psychiatry nursing process

 Providing professional, quality nursing care.

 Directs nursing activities

 Provides the basis for critical thinking in nursing.

 Ensures continuity of care

 Promotes involvement of clients in their own care

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 STEPS OF NURSING PROCESS

01 02
ASSESEMENT DIAGNOSIS

05
EVALUATION
03
PLANNING

04
IMPLEMENTATIO
N

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 PSYCHIATRY NURSING ASSESSMENT

 Psychiatry nursing assessment is a baseline

psychiatric mental health record that nurse
practitioners use in order to determine a patient
condition and form a health care plan
 It is the key to contributing to establishment of a
psychiatric diagnosis; proper diagnosis leads to
effective treatment
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 Sources of Data

 Primary sources: the client should be considered the

primary source of data. As much information as possible
should be gathered from the client, using both interview
techniques.
 Secondary sources: data source from other than the
clients are considered secondary sources (family
members,
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 Techniques of Data Collection in Psychiatric Nursing

 Patient observation
 patient interview (process recording)
 Family interview
 Physical examination
 Mental status examination

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 Interviewing

 Interviewing is a planned communication or a

conversation with a purpose of getting data from patient.
 Interview can be directive interview, which is highly
structured and elicits specific Information or nondirective
interview or rapport-building interview, in which the
nurse allows the client to control the purpose, subject
matter, and pacing.

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 Interview techniques
 Reflection. In the technique of reflection, a nurse repeats to a

patient in a supportive manner something that the patient has

said.

 Facilitation. Nurse’s help patients continue in the interview by

providing both verbal and nonverbal cues.

 Confrontation. The technique of confrontation is meant to point

out to a patient something that the nurse thinks the patient is not

paying attention to, is missing, or is in some way denying.

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 Cont…
 Clarification. In clarification, nurses attempt to get

details from patients about what they have already

said.

 Interpretation. The technique of interpretation is most

often used when a nurse states something about a

patient's behavior or thinking that a patient may not
be aware of.
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 Cont……
 Summation. Periodically during the interview, a nurse can take a

moment and briefly summarize what a patient has said thus far.

 Reassurance- this is a technique of offering comfort or support

to the patient who is experiencing distress, anxiety or fear.

 Explanation. Nurses explain treatment plans to patients in easily

understandable language and allow patients to respond and ask

questions

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 Cont…..
 Transition. The technique of transition allows nurses to

convey the idea that enough information has been

obtained on one subject; the nurse’s words encourage

patients to continue on to another subject.

 Positive Reinforcement- this is technique of providing

feedback or praise to the patient for their cooperation,

honesty or efforts
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 Psychiatry history taking

Activity 1.2 List components of history taking?

What is rational taking psychiatry history
regarding psychiatry nursing care plan
(Time 10 min)

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 Cont…..

 A psychiatric history is the result of a medical

process where a clinician working in the field
of mental health systematically records the
content of an interview with a patient.

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 Psychiatric nursing history
components

Identification data- is a process of collecting and

verifying relevant information about the patient’s
biographic data.

Presenting chief complaints- a concise statement

describing the reason for the encounter it usually
stated in the patient’s own word and reflects their
main concern we also collect data from collateral
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 Psychiatric nursing history
components

History of present illness- is a detailed description of the

development and progression of the patient’s current
problem in chronological order and rule out other
symptoms. It includes information about onset, duration,
frequency, severity, impact of symptoms, substance use,
suicidal (ideation, plan, attempt), medication history and
any factors that makes them better or worse.
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 Psychiatric nursing history
components

Past psychiatric history-a detailed description of

past illness, hospitalizations, substance use
history, and treatments include past problems
with suicidal thinking and attempt.

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 Psychiatric nursing history
components

Past medical history- is a process of obtaining and reviews

the patients past and current physical health condition,
medications, allergies, surgical procedure and accident.

Family history- it is a description of presence of

psychiatric and physical illness in family members and
treatment, presence or history of substance abuse and
history of suicide attempt
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 Psychiatric nursing history
components

Personal history- this is a detailed account of the patient’s life

history from birth to present. It should include information
about their prenatal, perinatal, postnatal development, child
hood, adolescence, education, occupation, forensic history,
relationships, sexuality, social network, hobbies, interests
and achievements. It should also include any history of
trauma, abuse, neglect, loss or stressor in their life.

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 Psychiatric nursing history
components

Pre-morbid personality- this is an evaluation of

the patient’s personality traits, coping styles,
strengths, and weakness before the onset of
their illness

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 Mental Status Examination
Activity 1.3
What do you mean mental status
examination and its components
what is the difference between
psychiatric nursing history and mental
status examination?(Time 10 min)

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 Cont….
 The mental status examination is an assessment
that the clinician snapshot of the patient’s thought,
feeling and behavior at the time of the interview
 Examination of mental status is done in anyone
with an altered mental status or evolving
impairment of cognition whether acute or chronic.

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 Cont….
Appearance and Behavior- which includes observing the
patient general appearance, hygiene, clothing, posture,
movement, eye contact and attitude towards the
examiner

Speech- which includes noting the patients rate , volume,

tone, fluency, and coherence of speech as well as any
abnormalities such as stuttering, slurring and neologisms.

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 Cont….

Emotion- which includes asking the patient how they feel

and observing their emotional expression, range,
intensity and appropriateness

Thought- which includes assessing the patients thought

content such as delusions, obsessions, suicidal or
homicidal ideation and thought process such as logics,
coherence and organizations
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 Cont….
Perception-which includes asking the patient about any
hallucinations, illusion or depersonalization experience

Cognition- which includes testing the patient’s orientation,

attention, memory, language, calculation and executive function

Insight and Judgment- which includes evaluating the patient

awareness and understanding of their condition, as well as their
ability to make reasonable and safe decisions

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 Gordon function health Pattern
Assessment

Gordon’s functional health patterns is a method

devised by Marjory Gordon to be used by
psychiatry nurses in the psychiatry nursing
process to provide a more comprehensive
nursing assessment of the patient

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 Cont…
Activity 1.4
Select three participants(psychiatry
nurse, patient and patient attendant)
for role play about Gordon’s pattern
assessment(25 min)

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 Gordon function health Pattern
Assessment

Health-Perception and Health-Management Pattern

Data collection is focused on the person's perceived
level of health and well-being, and on practices for
maintaining health.
Nutritional-Metabolic Pattern it focuses on the pattern
of food and fluid consumption relative to metabolic
need.
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 Gordon function health Pattern
Assessment
Elimination Pattern- it focused on excretory patterns (bowel,
bladder, skin). Excretory problems such as incontinence,
constipation, diarrhea, and urinary retention may be identified.

Activity-Exercise Pattern- it focused on the activities of daily living

requiring energy expenditure, including self-care activities,
exercise, and leisure activities.

Sleep-Rest Pattern- it pattern is focused on the person's sleep, rest,

and relaxation practices.
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 Gordon function health Pattern
Assessment
Cognitive-Perceptual Pattern- it describes the client’s cognitive and
sensory functions, such as memory, learning, problem-solving,
language, vision, hearing, taste, touch, and pain. It includes the
clients mental status, level of consciousness, orientation,
attention, perceptions and coping strategies.
Self-Perception-Self-Concept Pattern- it focused on the person's
attitudes toward self, including identity, body image, and sense
of self-worth.

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 Gordon function health Pattern
Assessment

Role-Relationship Pattern- it focused on the person's

roles in the country, community, and work area or
home and relationships with others.
Sexuality-Reproductive Pattern- it describes the client’s
sexual identity, function and behavior as well as the
client’s reproductive health and needs.

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 Gordon function health Pattern
Assessment

Coping-Stress-Tolerance Pattern it focused on the

person's perception of stress and on his or her coping
strategies. Support systems are evaluated, and
symptoms of stress are noted.
VALUE-BELIEF PATTERN it focused on the person's values
and beliefs (including spiritual beliefs), or on the goals
that guide his or her choices or decisions.
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 Psychiatry nursing diagnosis
Activity 1.5
 Discus types of psychiatry
nursing diagnosis?
 What are the components of
Psychiatry nursing diagnosis?
3 Groups for 20 min

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 PSYCHIATRY NURSING DIAGNOSIS

 A psychiatry nursing diagnosis is a clinical judgment

concerning human response to health
conditions/life processes, or a vulnerability for that
response, by an individual, family, group,
or community.

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 Types of psychiatric nursing diagnosis

Problem-focused or actual diagnosis

 A patient problem present during a nursing assessment
is known as a problem-focused diagnosis. Generally, the
problem is seen throughout several shifts or a patient’s
entire hospitalization.
 It has 3 components which are diagnostic label, cause,
defining characteristics

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 Cont…..

Psychiatry Nursing diagnosis/problem/ diagnostic label: this is

a concise term or phrase that represents a pattern of
related cues and describes the client’s health problem
Related factors: this is a condition, circumstance, or event that
contributes to or is associated with the problem. The
etiology should be connected to the problem by the phrase
(related to)

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 Cont…..

Defining characteristics: sign and symptoms, the defining

characteristics’ should be connected to the etiology by
the phrase (as evidenced by)

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 Cont…..

A risk psychiatry nursing diagnosis

 a type of nursing diagnosis that describes a clinical judgment
concerning the vulnerability of an individual, family, group, or
community for developing an undesirable human response to
health conditions or life process.
 Has two components which are diagnostic label and risk factors.

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 Cont…..
Activity 1.6
 Discus the difference between actual
and risk nursing diagnosis and share
to the whole group ?(Time 10 min)

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 Cont…..

Wellness Diagnosis
 Wellness diagnosis is “a clinical judgment concerning motivation
and desire to increase well-being and to actualize human health
potential.” These responses are expressed by the patient’s
readiness to enhance specific health behaviors
 Components of a health promotion diagnosis generally include
only the diagnostic label or a one-part-statement.

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 Cont…..
Activity 1.7
Define wellness nursing diagnosis and
syndrome nursing diagnosis ?(5 min)

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 Cont…..

Syndrome Diagnosis
A syndrome diagnosis is a clinical judgment concerning
with a cluster of problem or risk nursing diagnoses that
are predicted to present because of a certain situation or
event.

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 Cont…..
Activity 1.8
Formulate two actual and two risk
nursing diagnosis?
3 Groups for 20 min

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 Cont…..

Steps to formulate nursing diagnosis

Analyze the data collected during assessment to identify the
patients health problem, risks, and strengths.
 Choose a standardized nursing terminology
 Use formula to write the nursing diagnosis statement

 Validate the accuracy and relevance of the nursing diagnosis

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 PLANNING

The planning stage is where the nurse collaborates with the patient
and other member of the health care team to develop a plan of
care addresses the patients mental health needs.
Major activities in planning
 Setting expected out come
 Setting priorities
 Developing intervention

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 Cont…..
Activity 1.9
Discus what SMART stands for and
define each term (Time 10 min)

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 Cont….

 Expected outcomes: are specific objectives related to the goals

and are used to evaluate the nursing interventions . It must be
SMART
 Specific outcome: are clear, well defined, and unambiguous
 Measurable outcome: are observable and verifiable
 Achievable outcome: are realistic and attainable
 Realistic outcome: are relevant and meaningful
 Timed outcomes: are time bound and have a specific deadlines or
frequency for completion or evaluation
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 Cont….
Types of expected outcomes
1. Short-term outcome (STO):- are those that can be met relatively
quickly, often in less than a week, or in a short period. It is
usually focused on the etiology.
2. Long term outcome (LTO):- are those that are to be achieved
over a longer period of time, often weeks or months requires
more time. LTOs usually focused on the problem.

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 Cont…..
Activity 1.10 Discuss on how to write a SMART
outcome?
Discuss on the criteria during
prioritization of nursing outcome?
Divide in random 3 groups (20 minute)

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 Cont….
Setting priorities: a crucial step that helps the nurse to focus on
the most urgent and important needs of patient. Prioritization is
based on several factors
Strategies to prioritize
 Using ABC ( airway, breathing, circulations) or SAFETY( suicide,
aggression, falls, elopement, treatments and you) to rank
patients needs from the most to the least essential

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 Cont….
 Developing intervention: is a process of selecting and
documenting the appropriate actions that will help the patient
achieve expected outcomes. The intervention should be based
on the best available evidence, the nurse clinical judgment, and
the patients input. Intervention should also be specific,
individualized and documented

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 IMPLEMENTATION
Activity 1.11 Direction:- read and discus
Sam was team captain of his soccer team, but an
unexpected fight with another teammate
prompted his parents to meet with a clinical
psychologist. Sam was diagnosed with major
depressive disorder after showing an increase in
symptoms which is depressed mood, sleepless,
loss of interest over the previous three months.
as a psychiatric nurse or other health
professional, be in group and discus about
psychiatric nursing intervention(20 minute)

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 Cont….
 It means putting intervention in to action

main objectives of implementation phase

 ongoing assessment
 establishing priorities
 allocating resource
 initiating interventions
 documenting interventions and patient response

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 Specific psychiatric nursing
intervention
 counseling
 milieu therapy  health promotion and health
 self-care activities maintenance

 psychobiological intervention  psychotherapy

 health teaching  prescriptive authority and

 case management treatment

 consultation

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 EVALUATION
Activity 1.12 Discuss on the measurements of a
resolved nursing care plan?
Discuss on when to re-evaluate and
determine the indications of when to re-
assess?
Divide random 3 groups (20 minutes)

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 Cont….
The psychiatric nurse evaluates the clients progress in attaining
expected outcome
main objectives of evaluation
 to determine if interventions are helping clients achieve
expected outcome
 to verify the quality of nursing care provided
 to promote accountability
 to analyze current data
 to promote continuity of care
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 Cont….
Goal is Met- if the client‘s response matches the
outcome criteria.
Goal is partially Met- If the client‘s behavior begins to
show changes, but does not yet meet specified
criteria.
Goal is Not Met - If there is no progress

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 Cont….
When goals have been partially met or when goals have not been
met, two conclusions
 The care plan may need to be revised, since the problem is only
partially resolved OR
 The care plan does not need revision, because the client merely
needs more time to achieve the previously established goals.
So, the nurse must reassess.

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 Thanks

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