e s u m e s ed 013 333 vt 002 934 mental …r e f r e s u m e s ed 013 333 vt 002 934 mental...

R E F R E S U M E S

ED 013 333 VT 002 934MENTAL NURSING. LESSON FLANS PREPARED BY PRACTICAL NURSINGINSTRUCTORS FOLLOWING JOINT CONFERENCE HELD AT THE UNIVERSITYOF TENNESSEE, KNOXVILLE.

TENNESSEE STATE BOARD FOR VOC. EDUC., MURFREESBORO

PUB DATE 66EDRS PRICE MF -$0.25 MC NOT AVAILABLE FROM EDRS. 40F.

DESCRIPTORS- PRACTICAL NURSES, *MENTAL ILLNESS, *CURRICULUMGUIDES, *UNITS OF STUDY (SUBJECT FIELDS), NURSING, *HEALTHOCCUPATIONS EDUCATION, PSYCHIATRIC HOSPITALS,

THE LESSON FLANS FOR A UNIT ON MENTAL NURSING IN THEPRACTICAL NURSE EDUCATION PROGRAM WERE DEVELOPED BY A GROUPOF REGISTERED NURSES HOLDING TENNESSEE TEACHING CERTIFICATES.STUDENTS SELECTED FOR THE PROGRAM SHOULD BE HIGH SCHOOLGRADUATES OR EQUIVALENT. THE LESSONS DESIGNED FOR USE BY AREGISTERED NURSE CERTIFIED FOR TEACHING GIVE OBJECTIVES,REFERENCES, MATERIALS, INSTRUCTIONAL AIDS, OUTLINE OFPERTINENT MATERIAL TO BE PRESENTED, KEY POINTS TO DO OR SAY,TEST, AND SUMMARY. LESSONS ARE (1) INTRODUCTION TOPSYCHIATRIC NURSING, (2) THE MENTAL HOSPITAL, (3) BASICCONCEPTS OF A THERAPEUTIC, (4) ,OBSERVATION AND RECORDING, (5)THE NEW ADMISSION, (6) THE WITHDRAWN PATIENT, THE UNDERACTIVEPATIENT, (7) THE SUSPICIOUS PATIENT, THE WORRYING PATIENT,(8) SECURITY MEASURES IN A PSYCHIATRIC HOSPITAL, (9) TYPES OFMENTAL.DISEASES, (10) TYPES OF THERAPY, AND (11)REHABILITATION OF THE MENTALLY ILL PATIENT. THIS DOCUMENT ISAVAILABLE FOR $2.00 FROM VOCATIONAL CURRICULUM LABORATORY,BOX 1114, MURFREESBORO, TENNESSEE 37130. (PS)

. ,

006 000205-66-005C

Lesson Plans

Practical Nurse Education

MENTAL NURSING

TENNESSEE STATE BOARD FOR VOCATIONAL EDUCATIONCt, Trade and Industrial Education Service08). NASHVILLEC\1 In Cooperation With The

DEPARTMENT OF INDUSTRIAL EDUCATIONCOLLEGE OF EDUCATIONTHE UNIVERSITY OF TENNESSEE

>.

U.S. DEPARTMENT OF HEALTH, EDUCATION & WELFARE

OFFICE OF EDUCATIONTHIS DOCUMENT HAS BEEN REPRODUCED EXACTLY AS RECEIVED FROM THEPERSON OR ORGANIZATION

ORIGINATING IT. POINTS OF VIEW OR OPINIONSTATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDUCATIONLESSON PLANS POSITION OR POLICY.

MENTAL NURSING

Prepared by

PRACTICAL NURSING INSTRUCTORS

Following

JOINT CONFERENCE

Held at

THE UNIVERSITY OF TENNESSEE

KNOXVILLE

Published1966

Authorized and Conducted By

TENNESSEE STATE BOARD FOR VOCATIONAL EDUCATION

Trade and Industrial Education Service

Nashville, Tennessee

Edited and Published by

Vocational Curriculum Laboratory

Box 1114

Murfreesboro 37130

7 1 7, A7 sr a Tre a, .Y4T; t 71M ,,,, 77,1:i 4 .1, 1.1`K

PREFACE

During the first joint Conference of Vocational Education arrangementswere completed for the development of lesson plans for the PracticalNursing curriculum. The coordinators and instructors prepared theselesson plans.

It is hoped that the prepared lesson plans will serve as an instructionalaide for the practical nursing teacher. They should be used as a guide forthe teacher as she makes daily lesson plans. The lessons includeobjectives, references, materials, instructional aids, outline of pertinentmaterial to be presented, application, test and summary.

TABLE OF CONTENTS

PREFACE . 0 . 0 . 0 . i

CONTENTS . . 0 0 .0 . ii

LESSON

1. Introduction to Psychiatric Nursing . . 0

2. The Mental Hospital 0 . .

3. Basic Concepts of a Therapeutic0

.

0

1

5

9

4. Observation and Recording . . . 13

5. The New Admission 00 . . . 15

6. The Withdrawn Patient, the Underactive Patient . . 19

7. The Suspicious Patient, the Worrying Patient . . . 21

8. Security Measures in a Psychiatric Hospital . . . 25

9. Types of Mental Diseases . . . . 27

10. Types of Therapy . . . . . . 31

lf. Rehabilitation of the Mentally Ill Patient . . . . 33

INSTRUCTOR'S LESSON PLAN Lesson 1

NAME OF LESSON:

AIM OF LESSON:

REFERENCES:

MENTAL NURSING

Introduction to Psychiatric Nursing

To help the student to accept the need for inte-grating mental health. concepts into every phaseof the patient-nurse relationship.

Mental Health, the Nurse and the Patient OdiumPractical Nursing Rapier, et alSimplified Nursing Thompson and LeBaronThe Psychiatric Aide Robinson

Step I. INTRODUCTION:

No one is wholly successful in everything they wish to accomplishor achieve. Everyone meets with some frustrations. Some peopleare able to compensate for disappointments more than others. Ourhealthy state of mind assist us to achieve the ability to compensatefor tensions, disappointments and the stresses occurring in ourdaily life. Health has three faces, body, mind and emotions. Theymust be considered together. Mind is the reasoning part of theindividual. It is difficult to separate emotional and mental health.Mind is also the part of us that makes decisions. Individualsunable to make decisions which help them carry on as independentbeings and fit into the world are mentally ill.

Step II. PRESENTATION OF LESSONKey Points

(List Points of Information) (Things to Remember to Do or Say)

A. Historical Points1. Attitudes

2. Attitudes Changed

1

a. Biblical timesSince beginning of human ex-istence temples were built forcar of the mentally ill.

b. Greece in the Golden AgePhysicians tried to separatethose with mental illness fromthe physically ill. There was a,tolerant attitude toward the mentally ill or retarded.

a. During the latter part of theeighteenth century, at the time

...

3. Reform

4 . National Associationfor Mental Health

B. Discussion of Terms

the downfall of .the flourishingempires, the treatment underwentsevere change from tolerance andcare to mistreatment.

b. In Medieval times the mentallyill was looked upon as possessedby evil spirits.

a. Began at the end of 18th centuryb. Phillipe Pinel was French physician

who thought the ..responsibilityof the mentally ill should fall onthe mentally well

c. Dorthea Dix, school teacher, in-formed the public, especially thegovernment of existing conditions

d. Clifford Beers wrote "A Mind ThatFound Itself", a story concerninghis hospitalization in the early20th Century. He was instrumentalin founding the National Committeefor Mental Hygiene.

a. SponsorsGuidance clinicsAdjustment CentersVocational GuidancePrison Psychiatry

b. Educates byRadioTelevisionCommunity panel discussions,includes lay and professionalgroupsDistributes printed material,

1. Mental Illnessa. People with difficulties that

affect the mindb. Patient is as sick as if it were

a physical ailmentc. Modern medicine recognizes

difficulties people meetd. Many recover and return to

normal way of life

2

2. Psychiatrya,. Specialized field of medicinebc Constantly finding new and

better ways of treating mentalit

c. Mentally ill may be cared forin home or hospital

d. Many kinds of mental illnessSymptoms: Usua,lly recognizable,personality changesCause: May be due to shock, true:cause often unknown. There maybe a hereditary tendency. Moreoften arises from inability toadjust to difficult environment

3. Psychologya. Definitionb. Plays a very practical part in

our everyday life in the hospitalc. Why the nurse needs to know in

daily work with people.To understand people it is nec-essary that we have some idea ofthe way in which the human mindworks.Learn the manner in which theindividual is likely to behave.

Step III. APPLICATION:

Write brief outline of "Changing Public Attitudes Toward MentalIllness".Visit with instructor Mental Health Center

Step IV. CHECK UP OR TEST:

Write resume of field trip to Mental Health Center.

SUMMARY:

For many centuries mental illness was looked upon with dread.The mentally ill were condemned,. Gradually ideas regarding be-havior disorders changed with the advance of scientific medicine,Cases were explored and treatments studied and applied. Throughthe efforts of well known individuals as Dorthea Dix, Clifford Beers

3

and others dedicated to the improvement of care for the mentally

ill, the mental hygiene movement came into being. Out of this

beginning the National Association for 'Mental Health, Inc. ,

developed and piychiatry began to play an important part in every-

day activity.

No matter how unlikely the recovery of a patient may seem, no

patient is neglected or regarded as hopeless. Many hospitalized

patients return to their families and work in the community as

better adjusted citizens.

4

gfof, , ,

INSTRUCTOR'S LESSON PLAN

MENTAL NURSING

NAME OF LESSON: The Mental Hospital

AIM OF LESSON: To inform the student of the types of hospitalsavailable for the care of the mentally ill.

REFERENCES: Practical Nursing_- RapierThe Psychiatric Aide Robinson

MATERIALS: Chalkboard, chalk, eraser

Step I. INTRODUCTION

Lesson 2

Current authorities in the field of mental healthbelieve there are some 17,600,000 persons sufferingfrom some form of mental illness. Slightly more thanone out of every two hospital beds in the U. S. areoccupied by mental patients. The extent of mentalillness is generally underestimated because manypeople still think of it only as "insanity" or " craziness".Actually mental illness is very common. It can be asserious as cancer or as mild as a cold. Severe dis-turbances of mental health necessitate hospital care fornearly a million persons in this country. There are about496 hospitals for mental disease in the U. S. The averagedaily hospital census of mental patients in 1957 was673,115.

Step II. Presentation of Lesson

(List Points of Information)

A. Private Hospitals1. Basis for admission

a. Ability to payb. Facilities available

B. Public Hospitals1. Basis for admission

a. Resident of state

5

Key Points(Things to Remember to Do or Say)

a. Smaller than state owned hospitalsb. May or may not operate for profit

a. Usually patients requiring longerperiod of treatment may be 1,000to 10,000 patients.

7.7

2. Facilitiesa. Diagnosisb. Treatmentc. Research

CauseTreatment

d. Educational programs

C. Veterans Administration1. Federal hospitals

D. Psychopathic Hospitals1. Observation and

emergency treatment

a. Basis for admissionPatients connected withgovernment,Veterans

E. Residential Treatment Center1. Children

F. Day Care

G. Methods of Admission1. Voluntary2. Temporary Care3. Court Commitment

Step III. APPLICATION

Read unit in textbook on care of the mentally ill.Read "What is Mental Illness" U. S. Department of Health,Education, and Welfare.Read "There is Something You Can Do about Mental Health"W. C. Menninger, M. D.

Step IV. CHECKUP OR TEST

A. Outline briefly types of hospitals available for the mentallyill and basis for admission.

SUMMARYMental illness remains the nations number one health problem.Each year about 290,000 new patients are admitted to mentalhospitals and psychiatric units of general hospitals. There are

more patients in hospitals for mental illness than all other diseasescombined.

More mentally ill patients are recovering, more research is underway,more communities are providing facilities for early detection, treat-ment and rehabilitation than at any time in history.

There are three methods of admission to a mental hospital. Voluntaryadmission is the most desirable since it is acknowledged by thepatient who has insight into his problem and requests care and treat-ment.

7


MENTAL NURSING

NAME OF LESSON: Basic Concepts of a Therapeutic Environment

AIM OF LESSON: To teach the student the importance of a thera-peutic environment.

REFERENCES: Preview of Practical Nursing MosbySimplified Nursing Thompson and LeBaron

MATERIALS: One copy of test for each student

Step I. INTRODUCTION

The importance of the correct approach to mentally ill patientscannot be stressed too frequently, the nurses success dependson her ability to evaluate her patients and adjust her own behavioraccordingly.

Step II. PRESENTATION OF LESSON


A. Needs of the patient


1. His desires, wishes and opinionsare as important to him as arethose of the well personConsistent, non-punitive attitudesare essential.

3. Allow patient to set own pace inworking with his problemUnconditional acceptance

5. Allow to express both positive andnegative emotions

6. Permissiveness With consistantlimitations

7. Basic needs common-to all people,love, security, protection, elimi-nation, food, clothing and shelter.

B. Essential attitudes for 1. Wholesome and constructivethe nurse attitude

2. Love and esteem, matter offactnes s

3. Active friendliness, passivefriendline s s

4 . Politeness , patience , truth-fulness and poise

5. Tactfulness, skillful listening,confidence

C. Hygiene Basic hygiene needs known to allpersons

D. Factors preventing thera-peutic environment


1. Factors which would hindertherapy in any of the abovementioned points

A. Discuss the right attitudes and compare them with effects ofwrong attitudes

B. Discuss false notions of mental illnesses that exist todayC. Compare needs of the mentally ill with those of the well person

Step IV. CHECK-UP OR TEST

1. Essential attitudes for the nurse, to establish comfortable andagreeable relationships with mental patients would includethe following:A. Even temper 1. All of theseB. Noncritical attitude 2. A, C, and DC. Confidence in our- 3. B, D, and E

selves and others 4. A, B, and CD. Intimate friendships

with patient5. All except E

E. Hurried manner

2. Attitudes to avoid in caring for mental patientsA. Over-rating what 1. None of these

patient says 2. A, and D onlyB. Stimulating ideas of 3. All except E

reference 4. A, B, and C'C. Politeness and tact -

fullness5 . A, B, and D

D. Superior attitudesE. Friendliness

10

IX.

3. Basic needs of the mentally ill person include all of thefollowing except one. Select the one item that does notapply.A. Love 1. All except D and EB. Food, clothing and 2. All except D

shelter 3. B, C, and E onlyC. Security and protection 4. D onlyD. Punitive measures to

control behavior5. E only

E. Permissiveness withoutlimitations

4. The practical nurse's approach to the patient is determinedby:A. The doctor's ordets 1. C only

upon admis sion 2. B, C, and DB. Diagnosis, 3. All except EC. The patient's behavior 4. A, D, and ED. The patient's education 5. None of theseE. Likes and dislikes

5. The following are generalnursingA. Lack of orientation

promotes OomfortB. Mental patients need

to feel aqCeptedC. Mental patients need

to express emotionsD. Mental patients need

to feel securityE. Reassurance by nurse

skill

Answer Key

principles applying to mental

1. B, C, and E2. All except A3. All except E4. B, C, and D only5. All of these

1. 42. 5

3. 1

4. 1

5. 2

11

SUMMARY:

Mental patients need assistance from well-adjusted andmature persons who, by training, skill, and understanding,can provide healing and therapeutic environment.

The next assignment will cover guides for observing andrecording.


MENTAL NURSING

NAME OF LESSON: Observation and Recording

AIM OF LESSON:

Lesson 4

To teach basic approaches to psychiatric behaviorpatterns. Guides for admission observations andward observations.

REFERENCES: Preview of Practical Nursing - MosbySimplified Nursing Thompson and LeBaron

r

MATERIALS: A large picture of a group of people engaged insome activity

INSTRUCTIONAL AIDS: Chalk board and chalk


Today we will discuss basic approaches to psychiatric behaviorpatterns, what to look for in caring for the mentally ill and howto record your observations.

Step II. PRESENTATION OF LESSON


A. Admission observations

13

Key Points

(Things to Remember to Do or Say)

1. Physical condition is checked2. Careful and detailed obser-

vations made about behavior,notes are taken if possible

3. Appearance as to dress andfacial expression

4. Sociability, degree of5. General behavior, co-

operativeness; whether ornot-responsive

6. Emotional reactions7. Speech-normal or defective8. Conversation, whether it

appears normal in amountand content. Complaintsare noted in detail

B. Ward Observations


1. Purpose of ward ovservations2. Patients condition from time

to time .

3. Observe without patientsknowledge.Appearance, is patient neat,clean and tidy, or dirty anduntidy?

4. Sociability, does the patientassociate freely with otherpatients, or is he withdrawn?

5. Behavior, is patient orderly ordisorderly?

6. Restless, quiet or noisy, friendlyor indifferent

7. Interested or disinterested,destructive or violent

8. Emotional reactions, speech,complaints, sleep, appetite,and excretions.

Using these points as a guide, report your observations of someoneyou have been in contact with today. (Have three or four studentsreport.) Group discussion of important points of observing, stressingpoints that may have been left out.


SUMMARY

Show a picture to the group, preferrably a group picture, for a briefperiod, then have each student write as many observations about thepicture as they can.

If a person is not naturally observant, this trait can be cultivated.One must be alert with all senses. Observe and report in detail,taking great care to be accurate. Do not draw own conclusions.Choose words carefully in writing notes. Accurate observingand recording is of the utmost importance while no report is betterthan a misleading one.

The next topic for discussion will be the new admission.

14


NAME OF LESSON:

AIM OF LESSON:

REFERENCES:

MATERIALS:

MENTAL NURSING

The New Admission

To teach the student guides to follow in theadmission of a patient to a mental hospital.

Preview of Practical Nursing MosbySimniified Nursing Thompson and LeBaron

One copy of true or false test questions for eachstudent.


Step II.

It is important that a nurse know basic guide rules for admittingmentally ill patients. The patients initial contact with thehospital is very important, the saying "First impressions arelasting impressions'proves to be true quite frequently.

PRESENTATION OF LESSON


A. Guides to admission ofpatient to a mental hospital

15


1. Put patient at ease, thus in-creasing feelings of security

2. Admission of hospital routinesin relationship to the patientsperson and belongings.

3. No patient left alone duringadmission because of possibleescape or suicidal tendencies.

4. Orient patient to hospital en-vironment.

5, Introduce patient to others on theward, at his level of acceptance .

6. Be prepared to give acutely illpatient immediate and skillfulcare.

7. Friendly and gracious withpatient's family.

8. Observe patient and reportaccurately.

9. Give verbal reports awayfrom patient's hearing .

10. Keep written reports awayfrom patient's seeing.

11. Do not ask leading questions.12. All new admissions are

watched closely until it isdetermined if there are es-cape, suicidal, or combativetendencies present.


Group discussion of how guides for admission of a patient to amental hospital varies with the guides for admission to a generalhospital. Discuss why there is a need for these variations.


The following statements are either true or false regarding apatient who is a new admission to a mental hospital. Selecteither true or false and write the word that applies in front ofthe statement.. .

1. True Any behavior which might suggest self-injuryor injury to others should be reported at once.,

2. False It is acceptable to leave a new admission aloneif no escape tendencies are noted.

3. False A new admission patient should be introduced toall the other patients on the ward, and all thenursing personnel, even though he may act as ifhe would rather be alone.

4. False It is not important to spend time with the patient'sfamily because you owe all of your time to thepatient.

5. True A psychiatric nurse must be prepared to give acutelyill patients immediate and skillful care.

6. True To put a mentally ill person at ease increases hisfeelings of security.

7. False It usually is not necessary to acquaint the mentallyill patient with hospital routines because he alreadyhas enough to be concerned about.

8. True Nursing care should center on the patient as a personand not on control of symptoms.

9. True While admitting a new patient you remember thatbehavior differs in degree rather than kind.

10. True Human behavior is motivated and can be under-stood and interpreted.

SUMMARY

Today we have discussed basic guides to use when admitting apatient to a mental hospital, how these guides vary with the usualadmission routine and the importance of having such a guide inorder for the best possible care to be given to the patient. Byapplying these guides we are also of value in securing the co-operation of the patient, his family, as well as having an oppor-tunity to establish a good nurse-patient relationship.

The next assignment will be: The Withdrawn Patient, theUnderactive Patient.

17

.41,4 tvAtei *CV,


MENTAL NURSING

NAME OF LESSON: The Withdrawn Patient, the Underactive Patient

Lesson 6

AIM OF LESSON: To teach the student guides to nursing withdrawnand underactive patients according to behaviorshown

REFERENCES: Preview of Practical Nursing MosbySimplified Nursing - Thompson and LeBaron

Ste p I. INTRODUCTION:

Step II.

Nursing success of mentally ill patients depends on the nurse'sability to evaluate various behavior patterns. and adjust hernursing practices accordingly. Today we will discuss basicapproaches to the withdrawn patient and the underactive patient.

PRESENTATION OF LESSON: Key Points(List Points of Information) (Things to Remember to Do or Say)

A. The withdrawn patient

B. The underactive patient

19

1. Show interest by warm friendlyapproaches

2. Use simple direct approach3. Listen without indicating accep-

tance , dispute, or ridicule ifhallucinations present

4. Try to not do or say things thatmight create suspicion

5. Anticipate changes in behaviorso as to be ready to cope with it

6. Plan well for personal hygiene,the patient may forget or neglectto care for himself

7. Exercise must be planned for ifpatient stays in one position

1. Show sincere interest by attitude2. Try to keep patient's life simple

and free from confusion3. Patient slower in the morning

new activities should be usedin afternoon

4. Accept refusals to cooperatecalmly

5 Do not attempt to reason awayideas of guilt, but allow to domenial tasks if not tiring

6. Provide security from suicide.7 Be alert for signs of fatigue,

and neglect of personal hygiene.8. Be alert for physical illness, and

malnutrition. Insomnia is common.


Have each student plan the care for one day for each type of patientpointing out the plans necessary to meet the patients basic needs,such as personal hygiene, exercise and nutrition.


Role playing: Students acting part of the patient and the nurse.Every student need not play either a patient ornurse but each one being free to offer helpfulsuggestions. The instructor should check to makethe important points of approach to these two typesof patients brought out clearly.

SUMMARY:

Today we have learned the approach to two types of mentally illpatients, these are basic guides. Each patient is an individualand their behavior patterns will change. Remember always thatthe successful nurse changes her nursing approach as the patientchanges his behavior. It is impossible to predict all possiblebehavior that the patient may show at some time or other, however,with these guides, you can be sure of attending to the patientsneeds.

Tomorrows lesson will be "The Suspicious Patient" and TheWorrying Patient."


NAME OF LESSON:

AIM OF LESSON:

REFERENCES:

SUPPLIES:

Step I.

Step II.

MENTAL NURSING

The Suspicious Patient, The Worrying Patient

To teach the student guides to nursing thesuspicious patient and the worrying patientaccording to behavior shown.

Mental Health the Nurse and the Patient OdlumPractical Nursing Rapier, et alSimplified Nursing Thompson and LeBaronTre Psychiatric Aide Robinson

One copy of test for each student

INTRODUCTION:

We have studied the approach to use for the withdrawn and theunderactive patient, now we will discuss the approach to usefor the suspicious and the worrying type patients.

PRESENTATION OF LESSON:


A. The Suspicious Patient

21


1. Reduce threat by interest,tolerant attitude, and approvalfor work well done.

2. Accept aloofness with matter-of-fact attitude

3. Recognize conceit, sarcasm, andconceited attitudes as a part ofhis illness

4. Try to learn and avoid patientspoints of sen-.sitiVity' so that hewon't be offended

5. Listen without showing acceptanceor arguments if false suspicionsexist

6. Tactful indirect methods of feedingpatient if he feels he is beingpoisoned

B. The Worrying Patient(psychoneurotic)


7. Be alert for suicide tendencies orfeelings of persecution

8. Provide contacts that offer nopersonal threat.

Accept complaints as part ofillness, but plan work and playfor patients comfort.

2. Matter-of-fact acceptance ofpatient.

3. Attend to physical problems tact-fully and without undue concern

40 Observe for stealing, returnstolen item with quiet unconcern.

5. Be alerted for unbearable arociety,use tactful precautions for suicide.

6. Complaints may make him unaccept-able to others in a group, supporthim tactfully.

7. Provide simple health program

Group discussion of items that may make an already suspicious patienteven more suspicious. Discuss ways that the nurse can help to avoidbringing suspicion upon the nurses as they go about their daily ac-tivities. Using the guides that haVe been given, discuss ways ofhelping the worrying patient cope with his anxieties.

Step IV. CHECK-UP OR TEST:

Situation Questions; Please select the most nearly correct answerfrom the following: You have as one of your patients, a young motherof three children, she does not appear too upset, but you notice thatshe watches everyone about her, including you, very closely andpresents other symptoms of being suspicious of her surroundings.

1. Your patient refuses to enter into ward activities be cause shefeels that she cannot do as well as some of the other patients.You could best help by:

A. Insisting that she jointhe group.

B. Show disapproval becauseshe does not cooperate.

.22

1.2.3.4.

C and DB onlyA and DC only

C. Be tolerant and showfriendly interest insimple activities thatshe can do

D. Accept the fact that shefeels superior and tell herthat she will have to jointhe group if she hopes toget well enough to go home.

2. One morning when you carry the breakfast tray to your patientshe says, "Take it away, I am not going to eat anymore of thatpoison." You would:

A. Quietly remove the trayand offer food later inthe morning.

B. Tell her that she must eatto keep her strength

C. Discuss the disadvantagesof tube feedings.

D. Tell her that the food is notpoisoned and prove it byeating the food yourself

1.2.3040

D onlyB and CA onlyB and D

3. A new patient is admitted to your unit and soon you discoverthat he seems to worry constantly about small items that nor-mally do not bother most other patients. He has a lot of com-plaints and complains that the other patients avoid him becausehe is not good enough to associate with them. You Should

A. Tell him to stay awayfrom the group.

B. Accept his complaint,but assure him that heis probably better thanthey are

C., Accept his complaintmatter-of-factly andavoid comment on thepatients worth.

D. Tell him to quit worry-ing and join the groupanyhow.

Answer Key:1. 4, 2. 3, 3. 10

23

1. C only2. A and B3. D only4. B and D

R.1,7PN,,,

SUMMARY:

Today we have discussed the suspicious patient and the worrying typepatient. Possibly the key note in caring for these types of patients isto remember that the patient responds to a situation in relation to what-ever or whoever is in it with him, illusory or real. Permissiveness withbroad, consistent limitations is essential for the patient to be betterable to cope with and work out his problems.

The next lesson will be on: Security Measures in a Psychiatric Hospital.


NAME OF LESSON:

AIM OF LESSON:

REFERENCES:

MENTAL NURSING

Lesson 8

Security Measures in a Psychiatric Hospital

To teach the student measures that must beemployed in mental nursing to offer the fullestprotection to the patient, the hospital, and tothe personnel.

Mental Health the Nurse and the Patient OdiumPractical i -Rapier, et al.Simplified Nursing - Thompson and LeBaronThe Psychiatric - Robinson


Step II.

By the nature of mental illness, in which emotions become greatlydisturbed, the patient needs protection in different ways. Thetendency to harm self or others may be strong. Ideas of unworth-iness or hostility may be uncontrollable at times, poor judgmentand impulsive behavior is common. Security measures are a MUSTin psychiatric hospitals.

PRESENTATION OF LESSON


A. Security in relation to keys


1. Principles in proper handlingof keys .

2. Locked areas for the protectionof the patient in his environment .

B. Potentially dangerous 1. Sharps and silverware precautionsarticles and routines.

2. Necessary and unnecessary hazardsin environment.

3. Nurse's duties and routines whenhazardous articles are lost.

C. Precautions for the prevention 1. Well informed and constantlyof fire alert personnel.

25

D. Group Management

2. Fire prevention routines, useand care of equipment.

3. Practice "fire drills."

1. Preparation of group beforeleaving ward.

2. Management of group offward.

E. Precautions regarding elope- 10' Common methods used andreasons for patient elopement.Nurse's responsibility in pre-

-venting routines when elope-ment occurs.

ment.

F. Preventing injury to selfand others

1. Common reasons for attempt-ing suicide.

2. Methods of suicide, means forprecautions.

3. Types of patients likely to in-jure themselves or others.

G. Restraints 1. Principles of manual, mechan-ical and chemical restraints.


Student group point out both necessary and unnecessary environ-mental hazards in the immediate environment. Review of fire pre-cautions for the home, hospital, or school. Demonstration of asmany types of restraints as possible.

Step IV, CHECK-UP OR TEST

Return demonstration for correct use of manual and mechanicalrestraints. Have each student give location and procedure forusing the fire equipment in the area in which he is spending thegreater part of the day.

SUMMARIZATION:

Symptoms of mental illness may cause a patient to disregard hisown safety and the safety of others to the degree that securitymeasures must be observed constantly by well informed, alertpersonnel.

During our next meeting we will discuss: Types of Mental Diseases

26


MENTAL NURSING

NAME OF LESSON: Types of Mental Diseases

AIM OF LESSON:

REFERENCES:

Lesson 9

To acquaint the student with the different classificationsof mental diseases

Mental Health the Nurse and the Patient OdlumPractical Nursing Rapier, et alSimplified Nursing Thompson and LeBaronThe Psychiatric Aide - Robinson


There are many types of mental illnesses. Many types will lendthemselves to a definite classification, other mental illnessespresent symptoms of two or more,of these different types.

Step II. PRESENTATION:


A. Organic diseases

27

Key Points(Things to remember to do and say)

1. Acute Brain Disordersa. Associated with brain or

bodily infectionb. Drug or poisdn intoxicationc. Alcohol intoxicationd. Head injury

(1) Brain surgerye. Circulatory disturbances

(1) High blood pressurea. "Stroke"

f. Brain tumors

2. Chronic Brain Disordersa. Birth injury, illness,

or defectb. Chronic forms of the acute

brain disorders that havepassed the acute stage

c. Disorders of unknown oruncertain causes1. Multiple schlerosis2. Huntington's chorea

B. Psychotic Disorders 1. Involutional psychotic reactiona. Depression occurring at

middle age(1) "Change of life"

a. Menb. Women

2. Manic depressive reactionsa. Manic, overactivity

(1) Motor(2) Verbal

b. Depressed, underactivity(1) Motor(2) Verbal

c. Other(1) Mixed overactivity and

underactivity

3. Psychotic depressive reaction

4. Schizophrenic reactionsa. Simple typeb. Hebephrenic typec. Catatonic typed. Paranoid type

5. Schizophrenic reactions , acuteand chronic

6. Paranoid reactionsa. Paranoiab. Paranoid state

7. Psychophysiologic Autonomicand Visceral Disorders.(Psychosomatic Disorders)a. Skin reactionb. Musculoskeletal reactionc. Respiratory reactiond. Cardiovascular reactione. Gastro-intestinal reactionf. Genito-urinary reactiong. Endocrine (glandular)

reactionh. Nervous system reaction

28

C. Mental Deficiency 1. Defect in intelligence existingsince birth, without demonstratedorganic brain disease, or known'cause before birth

2. Degrees of intelligence defect:a. Mild-vocational impairmentb. Moderate. Requires special

training and guidancec. Severe. ROquires custodial

or complete protective care

D. Psychoneurotic disorders 1. Anxiety reactions

2. Obsessive reaction

3. Dissociative reactions

4. Conversion reaction

5. Depressive reaction

6. Phobic reaction

E. Personality Disorders 1. Define the following disorders

F. Transient SituationalPersonality Disorders

a. Inadequate personalityb. Schizoid personalityc. Cyclothymic personalityd. Paranoid personalitye. Emotionally unstablef. Passive-aggressive per-

sonalityg. Compulsive personalityh. Antisocial reactioni. Dissocial reactionj. Sexual deviation

1. Different types of transient disordersa. Gross stress reaction

(1) Combat, fire, tornado, etc.b. Adult situational reaction

(1) Difficult situations(2) New experiences

c. Adjustment reaction ofinfancy and childhood

d. Adju'stment reaction ofadolescence and late life


Classroom discussion of the types of mental diseases


Matching Classifications of Mental Illness are listed below.Select the major heading or classification and place the number inthe space provided in front of the type of illness that fits theclassification.

EXAMPLE: 1 Brain tumor. 1. Acute brain disorderNumber may be used more than once 2. Mental deficiency

2 Brain infection 1. Transient Situational5 Schizophrenic reaction Personality Disorder7 Respiratory reaction 2. Acute Brain Disorders1 Gross stress reaction 3. Chronic Brain Disorders8 Antisocial reaction 4. Mental Deficiency3 Associated with syphilis 5. Psychotic Disorders6 Phobic reaction 6. Psychoneurotic Disorder5 Paranoid reaction 70 Psychophysiologic Autonomic7 Nervous system reaction and Visceral Disorder8 Sexual deviation 8. Personality Disorder1 Adjustment reaction of late life8 Compulsive personality2 Associated with head injury8 Inadequate personality1 Adult situation reaction5 Manic depressive reaction7 Skin reaction2 Associated with alcoholic intoxication7 Gastro-intestinal reaction

.6 Conversion reaction

SUMMARY:',

Mental illness is being recognized as an illness, not a disgrace. The patientwill require special nursing techniques to meet his needs according to thereaction pattern that he presents. It is not the nurse's responsibility toclassify the type of mental illness that the patient has, but it is helpful toknow these classifications in order to be better equipped to predict a patientspossible reactions in given situations.

Tomorrow's lesson will be: Types of Therapy

30


MENTAL NURSING

NAME OF LESSON: Types of Therapy

AIM OF LESSON:

Lesson 10

To teach the student the types of therapy used to treatthe mentally ill patient, their basic principles and theirvalue to the patient.

REFERENCES: Mental Health the Nurse and the Patient OdlumPractical Nursing Rapier, et alSimplified Nursing Thompson and LeBaronThe Psychiatric Aide - Robinson


Special therapies are used at different periods of a patient's illness.Today we will discuss the different types of therapy used and theprinciples involved as well as the benefits the patient receivesfrom them.

Step II. PRESENTATION:(List Points of Information

A. Occupational Therapy

B. Recreational Therapy

C. Hydro-therapy

D. Group Therapy

31

Key Points(Things to remember to do or say)

.......

1. Mental or physical activity pre-scribed by the physician.

2. Occupational therapist speciallytrained.Scope and principles of occu-pational therapy.

1. Help patient relax.2. Learn to adjust to groups again.

1. Treatment of disease by waterin any of its forms.

2. Sedative type most commonly used.a. Wet sheet pack.b. Continuous tub bath.c. Ice caps and packs.

1. Patients with similar problemsgrouped.

.41

E. Shock Therapy

F. Fever Therapy

2. Psychiatrist leads discussion.3. Helpful to patient because

others have same or similarproblems.

4. Psychodrama used.

1. Insulin shock therapy.a. Therapeutic coma due to

insulin.2. Electroshock therapy.

a. Most common of shocktherapies.

b. Convulsive reactions.

1. Therapeutic high fever.a. Sterile malaria germs.b. Kettering Hypertherm,

fever apparatus.

G. Chemotherapy 1. Common standard drugs forhypnosis and tranquilizers


Classroom discussion of benefits of group discussion of mutual pro-blems. Question and answer session regarding nursing care ofpatients in insulin shock and convulsions, also nursing care of apatient with a high fever.


Oral quiz on effects of tranquilizing drugs, sedatives and hypnoticdrugs. Oral quiz on bodily reactions to effects of heat and cold inrelation to hydro-therapy.

SUMMARY:

Today we have discussed the special therapies used to treat the mentally illand the expected results of these treatments. At some time during the patient'sillness any one or all of these treatments may be employed. It is essentialthat you as the nurse who will be caring for the patients receiving these treat-ments understand the basic principles involved and the value of them to yourpatient.

Our final lesson in mental nursing will be on Rehabilitation.

32


NAME OF LESSON:

AIM OF LESSON:

REFERENCES:

MATERIALS:

Step I.

MENTAL NURSING

Rehabilitation of the Mentally Ill Patient

Lesson 11

To teach the student her role in the rehabilitation of thementally ill and to familiarize her with some of the facil-ities available to help the mentally ill.

Mental Health the Nurse and the Patient OdlumPractical Nursing - Rapier, et alSimplified Nursing Thompson and LeBaronThe Psychiatric Aide Robinson

Copy of final test for each student.

INTRODUCTION:

Medically used the word rehabilitation means to offer to the personwho is ill an opportunity to recover from his illness as well as tobecome again a member of the community at the best level of whichhe is capable. Today we shall discuss the basic steps of rehabilita-tion.

Step II. PRESENTATION:


A. Rehabilitation Team

33

Key Points(Things to remember to do or say)

1. Many people involved, psy-chiatrist, social worker,psychologist, occupationaland recreational therapistsand nurses.

Access to all facilities for allpatients.a. Levels of convalescense or

return to normal.Participation in simple

activities on ward.Participation in activities

in occupational therapydepartment.

Participation in recreationalactivities with supervision.

Extended privileges,ground, home.

Ground parole.Outside parole.Discharge from hospital.

Counseling for discharged.patient

4. Family responsibilities to thepatient

5. Community responsibilities

6. Role of the nurse in rehabilita-tion of the mentally ill


Comparison study of the physically ill patient and mentally illpatient and the factors involved in the rehabilitation of each typeof patient, using the seven steps listed in key point 2. This canbe handled in the form of a classroom question and answer period.A field`trip through a psychiatric hospital.

Step IV. CHECK -UP OR TEST:

Matching Test: Taken from "Simplified Nursing"

E 1.

G 2.

H 3.I 4,

K 6.

A 7.M 8.B 9.

Minor disorder which doesnot completely incapacitatethe patientMarked deviation from normalbehavior with irregular conductFunctional disorderToxic psychosesSystem of well organizeddelusions or false beliefsIllness borderline of psychiatry,often involved with the lawMedical term for mental illnessLegal term for the psychoticThe person who reviews thepatient's outgoing mail

Thompson and LeBaron

A. Mental illnessB. DoctorC. "Talking down"D. Suicide attemptE. ChemotherapyFo Psychoneurose sG. PsychosisH. SchizophreniaI. Drug addictionI. ParanoiaK. Psychopathic personalityL. Mental patient requiring

" specials "M. InsaneN. Manic retarded

34

C 10. Aggravates feelings of 0. Hypochondriacinferiority P. Pruritus

D 11. Should be reported immediately Q. Brain Tumor

E 12. Type of restraint used most R. Huntington's choreaoften now S. Involuntional reaction

L 13. Never leave this type patientalone for one second

T. Adjustment reaction ofinfancy

R 14. Chronic brain disorder U. Sadism

Q 15. Acute brain disorder V. Daydreaming

S 16. Psychotic disorder W. Electric shock therapy

P 17. Psychosomatic disorder X. Lobotomy

V 18. Fantasy Y. Insulin shock therapy

U 19. Sexual deviationT 20. Transient situational personality

disorder

35

e s u m e s ed 013 333 vt 002 934 mental …r e f r e s u m e s ed 013 333 vt 002 934 mental...

Documents