Delivery of Primary Mental Health Care II_1

8/8/2019 Delivery of Primary Mental Health Care II_1

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Vulnerabilities to Crisis

PhysicalDevelopmental

EnvironmentalFinancialPrior Unresolved Crisis (Multicrisis)- they can not

get over the physical and emotional things.



Manifestations of Crisis

PhysicalEmotional

InterpersonalBehavioral- it can range from anything such as depression,or denial

Developmental



Crisis Intervention I

Assessment: ± Precipitating Event- what is the thing that changed in your life that

brought the problem to you.

± Client s Coping Skills (strengths and weaknesses)- how doyou handle your stress in the past, what did you do in the past.

± Situational Supports- who do they have out there to support you?

Planning: ± Based on assessment data- what they tell you ± Situational supports identified ± Coping skills needing development or strengthening

identified and addressed



Crisis Intervention II

Intervention ± Goal-directed implementation ± Focus is on specific crisis-related problem ± Active participation by nurse: directive ± Nurse acts as role model

Evaluation ± Determine effectiveness of plan ± Consolidate learning ± Anticipate ongoing vulnerabilities and strategies ± Remaining available



Holistic Psychotherapy I

Integrated approach connecting mind, body, spirit theywant the patient to feel whole.To enhance healing processSymptoms:

± Not dysfunctional ± Act as communicators ± Do not need to be eradicated- this means you want the patient

to feel hopeful, kind in your mind. ± A necessary component to reach understanding/balance

Goal shifts from getting client to change and give upsymptoms to providing atmosphere of allowing peopleto be where they are right now



Holistic Psychotherapy II

Interventions: ± Honoring client s experience ± Respecting client s self-healing capacities ± Working with BODY:

AcupunctureTherapeutic touchGuided imageryBreathing exercises

± Working with SPIRIT:MeditationPrayer



Group Therapy

Conducted with group of 4-10 clientsAdvantages:

±

Feelings and behavior toward others can be examined in agroup context, you can do things in groups that u can notdo with an individual person .

± Allows for group feedback and support ± Try out new ways of thinking, experiencing, behaving in

group context ± Learn or strengthen interpersonal skills ± Establish more effective interpersonal relationships



Types of Groups

PsychoanalyticInterpersonalBehavioral- to help people learn new kinds of behaviors. ( drug education)Psychoeducational- teaching the patient. When patient learn about their

illness.Supportive- groups for those who are going though a crisis.Gestalt-Motivational-Task/activity activities which helps them socialize, and talk with theircollegesSocial skills training- Teaching them how to pay their bill., do groceries.ADLsMilieu



Why Do Nurses Work with Groups?

Efficient use of time and effortWorks well with expanded nursing roles in

community settings to reach larger numbersof clientsNature of group process provides therapeuticopportunities not possible working withindividuals( main reason why group isimportant)



Stages of Group Development I

Pre-group stage: ± Selection of group members- you have to decide who

you want in ur group. ± Setting- very often you want the nicest setting. ± Frequency of meetings- how of then are u going to

meet. ±

Rules- you should decide before the group start the rules,it is not the same as boundaries.

± Confidentiality- Is always a major. What happens in thegroup stays in the group. Once group is over, the

conversation is over.



Stages of Group Development II

Initial Stage: ± Norms- the group decides what the norms are,

the standard of behavior, ± Rank and Status ± Identification of Goals- that is the first and main

reason for the purpose of the group, this is

discussed with all the members of the group.



Cont .

Working Stage: ± Cohesiveness ±

Competition ± Working on the Problems Meeting Goals



Stages of Group Development III

Final Stage (Termination) ± Achieving closure ± Evaluation

Of goalsOf interaction

Of members achievements

± Acting out



Other Group Concepts

Group Roles- these are the parts and members takeimpart of the group.

Group Leadership-

Establishing /maintaining boundaries- Uestablish boundaries when social norms arebroken. The most important thing to do in thebeginning of a group is to establish the norms.



Yalom s Goals of Group Therapy(Yalom, 1995)

Instillation of Hope- groups help people gethopeful.

Universality- we are all in this together it is awonderful feeling to know you are not alone.

Imparting of informationAltruism-***Imitative behaviorInterpersonal Learning-Catharsis- u are allowed to vent in a group.



Goodwin et al., NEJM, 12/13/01

Research Question: What is the relationship between group therapyand length of survival in women with advanced metastatic breastcancer?N= 231 Groups of 10-12 women

Experimental Group: 2/3 of sample received supportive-expressive group therapy weeklyComparison group: no group therapyOutcome measured: length of survivalFindings:

± Experimental group: 18 months ± Comparison group: 17.6 months ± NOT STATISTICALLY SIGNIFICANT: Group therapy not associated with

differences in length of survival



Goodwin et al.

What do you think of the research questionposed?

Is it the most appropriate question to ask?What question do you think nurses wouldwant to ask about the effects of group therapywith women who have advanced metastaticbreast cancer?



Goodwin et al.

Clinical outcomes for experimental group: ± (ancillary findings of the study) ± Group seen as forum to vent fears, anger, frustration ± Improved relationships with families and friends ± Improved coping skills ± Greater emotional ease (by self report) ± Clinically less hostility, depression, anxiety compared to

comparison group ± Less pain reported (thought due to group encouragement

to take full advantage of pain meds)



Family TherapyFocus:- This is based on systems theory.- because the whole of thefamily is more important than some of the parts .

± On family as primary unit of treatment ± Family viewed as social system ± Different combinations of family members may be grouped for

individual sessionsGoals:

± Reduce anxiety and conflict ± Make family members more aware of each others thoughts,

feelings, needs ± Strengthen/develop family coping skills ± Improve conflict resolution skills ± Develop more appropriate role relationships ± Shift focus away from designated patient



Community Psychiatric NursingThe two types of teams. ACT and PACTAssertive Community Treatment (ACT)Programs for Assertive Community Treatment (PACT)Community Service to High-Risk Groups:

± Interdisciplinary- there are doctors, nurses, physical therapy, theywork as case management

± Total Case Management ± Expensive ±

Aims:Relapse prevention- medication managements, teachingReduction in re-hospitalization, ER visits, arrests, homelessnessRehabilitation



PACT Services

Medication SupportRehabilitation approach to AD Ls, IADLsFamily Involvement/ Social support

Work OpportunitiesEntitlementsHealth PromotionHousing AssistanceFinancial ManagementCounseling



Psychiatric Home Care

Cost-effective Alternative to HospitalizationUseful for Clients Recently discharged from HospitalInterventions:

± In-home complete assessment ± Crisis intervention ± 1/1 family/group therapy and counseling ± Verbal and written contracts- it helps people behavior in helpful ways. ± Medication administration/monitoring ± Psycho education plan- what they need to know about their illness,

medication ± Client advocacy ± Correction of actual/potential environmental safety hazards ± Case management ± Role-modeling

Delivery of Primary Mental Health Care II_1

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