psychiatric mental health nursing in acute care settings
TRANSCRIPT
Chapter 4Psychiatric Mental Health Nursing in Acute
Care Settings
Inpatient Psychiatric CareAdmissions reserved for
SuicidalHomicidal orExtremely disabled in need of short-term acute
care
Funding Psychiatric Mental Health CarePrivate pay insuranceManaged care plans
Health maintenance organizations (HMOs)Preferred provider organizations (PPOs)Managed behavioral health care organizations
(MBHOs)MedicaidMedicare
Mental Health Funding LegislationPaul Wellstone and Peter Domenici Mental
Health and Addiction Equity Act of 2008Restricts insurance companies from requiring
higher co-payments or higher deductibles for mental health or substance abuse
Uninsured PatientsMedicare MedicaidSocial Security
Social Security Disability Income (SSDI)Supplemental Security Income (SSI)
Veterans Administration
Inpatient Psychiatric CareAdmission options
Direct admissionHospital emergency department
Criteria to justify admissionsDanger to self or others or unable to care for
basic needsVoluntary or involuntary
Patient RightsHospitalized patients retain their rights as
citizensObligation to balance patient's needs for
safety with patient's rights as a citizenMental health facilities have written
statements of patient's rights and applicable state laws
Multidisciplinary Treatment TeamMeet within 72 hours of patient's admissionMultidisciplinary treatment plan or clinical
pathway is guideline for patient’s care during hospital stay
Nursing CareAdmission assessmentEnsuring safetyPhysical health assessmentMilieu management
Nursing CareContinuedStructured group activitiesDocumentationMedication administrationMedication adherence
Nursing CareContinuedPain managementCrisis management
Medical crisesBehavioral crises
Preparation for discharge to community
Chapter 5Psychiatric Mental Health Nursing in
Community Settings
Community Mental Health Nursing Movement1963
Community Mental Health Centers Act (Kennedy)
Shift care from institution to the communityDeinstitutionalization
1960sFederal entitlement programsSocial Security DisabilitySupplemental Security IncomeMedicaidMedicareHousing assistanceFood stamps
Community Mental HealthNursing MovementContinued
ChallengesFew choices for outpatient treatmentLimited fundingMore clients than resourcesResistance of seriously mentally ill patients to
treatment1980s
Commission on Mental Health (Carter)
Roles and Functions of Community Mental Health Nurse Biopsychosocial assessment Negotiating flexible and resourceful
treatment goals and interventions Member of a multidisciplinary team Biopsychosocial Care Manager Promoting continuation of treatment Providing care in a variety of settings
Continuum of Psychiatric TreatmentMost acute treatment
(short-term)
Intensive outpatient treatment (usually short-term)
Transitional outpatient treatment (usually long-term)
Ongoing outpatient treatment (long-term)
Community SettingsPartial hospitalization program (PHP)
Intensive, short-term treatment with patient ableto return home each day Patients receive 5 to 6 hours of treatment dailyTypically 5 days a weekAverage length of stay 2 to 3 weeksMultidisciplinary team (psychiatrist, RN, and
social worker)
Community SettingsContinuedPsychiatric Home CareFour requirements
Homebound status of patientPresence of psychiatric diagnosisNeed for skills of RNPlan of care under physician
Community SettingsContinuedAssertive Community Treatment (ACT)
For clients with repeated hospitalizations, severe symptoms, or inability to participate in traditional treatment
Multidisciplinary team Work with patients in homes, agencies,
hospitals, or clinicsACT team provides support and resources; on
call 24 hours a day
Community SettingsContinuedCommunity Mental Health Centers
Emergency, adult, and children’s services for those
who have no access to private careProvideMedication administrationIndividual therapyPsychoeducational and therapy groupsFamily therapyDual-diagnosis treatment
Resolving Ethical DilemmasRole of nurse
Act in the best interests of the patient and society to the degree possible
Resources for consultationHospital ethics committeeAgency ethics consultantProfessional nursing organizationsState board of nursing
Barriers to Mental Health Treatment
Stigma associated with mental disordersScarcity of care in rural areasInability to afford health insuranceFragmented care for children and adults with
serious mental illnessHigh unemployment and disability among
seriously mentally illUndertreatment of older adults Lack of national priority for mental health