Unformatted text preview: Essentials
of Psychiatric
Mental Health Nursing
Everything you need to succeed ...
in class, in clinical, on exams and on the NCLEX® DA~ ~ euge.
LEARNING
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knowledge you need to know. APPLYING
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clinical scenarios that show you
how theory applies to practice. ASSESSING
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Don't miss everything that's waiting on line to make learning less
stressful. ..and save you time. Follow the instructions on the inside
front cover to use the access code to unlock your resources today. STEP #1
Builda solidfoundation.
Communication Exerciseslet you
practice your communication skills
with vignettes and questions that
prepare you for clinical and practice. Quality and Safety Educationfor Nurses(QSEN)
Activities help you attain the knowledge, skills,
and attitudes required to fulfill the initiative's
quality and safety competencies. • Ci)Communication Exercises I. Hal, a patient on the psychiatricunit, has a diagno- sis of schizophrenia. He lives in a halfway house,
where last evening he began yellingthat "aliens
were on the way to take over our bodies! The
message is coming through loud and clear!"The
residence supervisor became frightened and called
911. Hal tells the nurse, "I'm special! I get messages
from a higher being! We are in for big trouble!"
How would the nurse respond appropriately to this
statement by Hal? BOX 24-4 QSEN TEACHING STRATEGY
Assignment: Using Evidenceto AddressClinicalProblems
Intervention With a Combative Client
Competency Domain : Evidenc<>Based Practice
Leaming Objectives: Student will:
cfinicalopinionfrom researchandevidencesummaries.
• Differentiate
• Explain the roleof evidencein determining the best clinicalpracticefor intervening withcombativeclients.
• Identifygaps betweenwhat is observedin the treatmentseningto what has been identifiedas best practice.
nate betweenvalidand invalid reasonsfor modifyingevidence-basedclinicalpraClicebasedon clinical
• Discrimi
expertiseor other reasons.
• Participate effectively
in app,opriatedata collectionand other researchactivities.
• Acknowledge
own limitat
ions in knowledgeand clinicalexpertisebefore determining when to deviatefrom
evidenc<>-based
best p,actices.
Strategy Overview: 1. Investigatethe researchrelatedto interveningwitha oornbativeer.en!.
2. Identifybest practicesdesaibed in the riterature
. Howwere these best p,actices determined?
3. Compareand contraststaffinterventionwithbest practicesdescribedin the literature.
4. Investigate
staffpe<ceptionsrelated10 interveningwitha combativeclient.Howhavethey developedthese
re tions? Movie Connections list films that
demonstrate the conditions and
behaviors you may not encounter
in clinical. • MOVIE CONNECTIONS
NEW! "Real People. Real Stories"
features interviews with patients
to bring their experiences to life. I Never Promised You a Rose Garden (schizophrenia)
• A Beautiful Mind (schizophrenia) • The Fisher King
(schizophrenia) • Bennie & Joan (schizophrenia) • Out
of Darkness (schizophrenia) • Conspiracy Theory (delusional disorder) • The Fan (delusional disorder) RELATED
TO: Panicanxiety,extremeloneliness.and .,;il,d,awalintothe sell
EVIDENCED
BY: 1nappropri3
te responses.disorderedthought
sequenci'1g.
rapidmoodsv,;ngs.poorconcenttatioo.
<isorientatioo
OUTCOMECRITERIA NURSINGINTERVENTIONS RATIONALE 1- Earlymtervennon
may prevent . d1ent Ylilldiswss contenl of
halluonatJons
wrthnurSe
therapistwrth1nt ~ I Obseoieclientforsignsof halluonat10ns(ltsleningpose, laughinga
talkingto self,stoppmgm molsentence), Asl<.
"Ne yoo hearingthe °' lOnt-Ttrmc;o,I
be at>eto defineand
· 01entW111
test realrty,reduong or elimmatmg
the o«u•ence of halluonatJOns.
Thisgoalmaynot be reallSllC
for
the mdMdualW1thsevereand
"'10 has
persistentilll>O$$
expenenced
auditoryhalluonanons
for manyyears..
A more real1St1c
goalmaybe: Therapeutic Communication Icon identifies helpful interventions and guidance on how
to speak with your patients. Look for this
icon in Care Plan sections. IIOicesagam?"
2. AIIOld
toudungthe d1entwithout
wammghm or her thal you are
aboutto do so.
3. An amtudeof acceptance
wil
encouragethe d1entto sharethe
contentof the halluonaoonwnh
you.Asl<.
'\M\llt do you hearthe --·---- _,, _____
._ ~~ ~~~ ==.::=-..=
-- --==--= STEP #2
Practicein a
safe environment.
Clinical Scenarios on walk you
through the nursing process with client summaries ,
multiple-choice questions with rationales , drag- and
drop activities, and so much more. { hailuc1naoons. 2. Chentmayperceive
toucha,s
threateningand may respond 1n an aggressrve
manner.
3. Thisrs,mponantto preventpc,ssi
·
ble m1uryto the d1entor others
from commandhanuonations
, \l'OICeS sayingto you?' O Do not reinforcethe hanuV anatloo. Use '"'thevoices·
that the ,.,,cesaiea resultof his or
msteadof wordslike "they' that
~ ~h~er~1~
lln~es~•~•~nd~d~e~mon=s~ua~te~wa==
to~_ •m
~ply
~ validation.Letdien1know
• Clientwill verbahzeunderstanding aggreswe response to command 4 4. It is importantfa, the nurseto be honest.and the d""1t mustaccl!jlt
the perceptionas unrealbefo,e
hallucinanons
canbe eliminated
. FREE ebook version of your text is available with
ach new printed book to make studying and reviewing
asier. Use the access code on the inside front cover. ~ DA~ euge.
STEP #3
Studysmarter,not harder.
@ Practice Quiz 13 08-02-2016 Question 4. While caring for a client with borderline personality disorder, the nurse observes symptoms of posttraumatic stress Davis Edgeis the interactive,
online Q&A review platform
that provides the practice
you need to master course
content and to improve your
scores on classroom exams.
Access it from a laptop,
tablet, or mobile device for
review and study on the go. disorder (PTSD). Which findings suggest PTSD? Select all that apply. iii 1. Intrusion
~ 2 . Avoidance ra 3. Hyperarousal
4 . Euphor ia 63 5 . Xenophobia 4o f 5 I Submt Question 4. While caring for a client with borderline personality disorder, the nurse observes symptoms of posttrau matic
stress disorder (PTSO). Which findings suggest PTSD? Select all that apply. Course Topic: Per.;onality Disorders )( I Concept(s): Mood; Self I Cognitive le ve l: Application {Applying] t. Intrusion
., 2, Avoidance )C )( 3. Hyperarousal
., 4, Euphoria
5, Xenophob ia Rationale
Option 1: Intrusion is a posttraumatic symptom in which the client occasionally reexpe riences the trauma, This finding supports the nuBe's
assumption. Option 2: The client avoids places, activities, and people in order to avoid reexperie ncingthe traumatic event. This finding supports the nurse's
assumption. Optiot1J: Hyperarousal is the state in which the client has difficulty in sleeping and has. difficulty in concentrating due to a traumatic
experience, This finding supports the nurse's assumption. Option 4: Euphoria is the state in which the client appears cheerful with an expans ive mood. It is not a symptom of posttraumatic event;
instead, it is a symptom of mania. Option 5: Xenophob ia is the condition in wh ich the client has a fear of strangeB. It is not a symptom of a posttraumatic event; instead, it is a
sym ptom of anxiety. Assignmentsare made by
your instructor. Or, create
your own practice quizzes
to review before an exam. I Question1, Whltecommunicatlngwith a cllen~ the nurse finds that the clientspends more than 1 hourfolding and arranging
clothes fivetimes a day. Whichnursingintervention would be beneficialto the client in this situation? CoW"MTop K! Amde-ty,Obsewv..-Compubltt Cop itiv• Ln-4 : ~lu and Related ~sorder,, I Conc •pt (1J: Cognition; Mood;AsSHs nlfflt; Critial Thin•ln.&
I tlon (Apptyinc] l. Distract the cllen t with other actlvltl!S .
l . Report to the primary htallh-c.arl!'pro vider . 3. DiKu~ the triggers provoking th ii bth1vior . ,. Administer antianxlety medlc.ationto the client. Comprehensive rationales explain
why your responses are correct or
incorrect . Page-specific references
direct you to the relevant content
in Essentials of Psychiatric Mental Ration ale
~~ Optklnll Distr•c.tingthe cliffl t with other .ctlvitin don not p,wffll rftNlistic DptJonl.: ~nur5eshouklrPpOJtrothe~m.1,yMalth-ca~provktedfthedl.nt'scoodl1Jonispafnful.tndself-mlltllilltlng. Op\lonl: Thtclltntshc)uld Rrstlearn t4 recognln thel)ff(l~t0itlng factors to IVOldtht 1nlf.ltty.lbtrtfort,
•r\)Jtty·ptavoklng trtf&trJ W1th1tt. ditnt that pttCJplt11tes lht n,wnsuc beh.wtor. discuss lht the nur-s,e~Id Health Nursing. @ Success Cente r ~ Review Mode
Pract ice Quiz Report Feedback Report I Gradebook Practice Quiz Success l evel Pract ice Quiz Report The Success Center offers a snapshot of your progress
and identifies your strengths
and weaknesses . L
Lates t Pra cti ce Quiz Pro gress SCORE: Pr,wceOu ·- 991-27- 40%
(Que,tton 1 2outof5 ) 1: Beginner Personality Disorders Crisis 71%
(Queitiom.Uoutof4S ) E+i
·ii·:.ili+
-1 ® reecJl:iockReµurl .............., , - .........,, FHdbac k Report
S-trtncths and Wulcntsses will iipptiir for• specifk course topk or c:onc•ptonce-you have ,nswend • minimumof 10
quest ioM in tha t aru. Sel.« to view by Caurse Topk or Concept from 1he drop down bo,c above. Choose 'C,..ate quit onwe-,i!
uus' above to becin cru ting • new quit based on ,u wuk , ...,,,. (o..,. The Feedback Report drills down to Topk ~.Ob-Ml!¥
t -C~bfV4:
·•ll<l~ehttdOilOl"dffl ,. Stte, hfl\edoJtlMtt'lt.i
HttlttlH1onil\SOf Seiq!M •ndl\'NMlni.n will~•r for• .pK!fic. <ourwt.:ri-cCir (Ol'IC"9(0n< t JOl,lt'I.WM1J,-flft1m1rWnumilfl0~Ol'llt.ln'ltlM.•1 t• ·" show your performance in individual
content areas. It's easy to create new
practice quizzes that focus on your
areas of weakness or to select the
top ics or concepts you want to study . ESSENTIALS
OF
Psychiatric
Mental Health
Nursing
Conceptsof Care in Evidence-BasedPractice 7th EDITION Mary C. Townsend, DSN, PMHCNS-BC
Clinical Specialist/Nurse Consultant
Adult Psychiatric Mental Health Nursing
Former Assistant Professor and
Coordinator, Mental Health Nursing
Kramer School of Nursing
Oklahoma City University
Oklahoma City, Oklahoma Karyn I. Morgan, RN, MSN, CNS
Psychiatric Clinical Nurse Specialist
Professor of Instruction, Mental Health Nursing
The University of Akron
Akron, Ohio • FA. Davis Company • Phil, dd phi, F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
Copyright© 2017 by F. A. Davis Company Copyright© 2017 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be
reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Printed in the United States of America
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Senior Acquisitions Editor, Nursing: Susan R. Rhyner
Content Project Manager II: Amy M. Romano
Design and Illustrations Manager: Carolyn O'Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug
therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up
to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not
responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed
or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader
in accordance with professional standards of care used in regard to the unique circumstances that may apply in each
situation. The reader is advised always to check product information (package inserts) for changes and new information
regarding dose and contraindications
before administering any drug. Caution is especially urged when using new or
infrequently ordered drugs.
Library of Congress Cataloging-in-Publication Data
Names: Townsend, Mary C., 1941- author. I Morgan, Karyn I., author.
Title: Essentials of psychiatric mental health nursing : concepts of care in
evidence-based practice / Mary C. Townsend, Karyn I. Morgan.
Description: Seventh edition. I Philadelphia, PA: F.A. Davis Company, [2017]
I Includes bibliographical
references and index.
Identifiers: LCCN 20160359401 ISBN 9780803658608 I ISBN 0803658605
Subjects: I MESH: Psychiatric Nursing-methods
I Mental Disorders-nursing
I
Nursing Process I Evidence-Based Nursing
Classification: LCC RC440 I NLM WY 160 I DDC 616.89 / 0231-dc23
LC record available at https: / / lccn.loc.gov / 2016035940
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted
by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service,
provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee
code for users of the Transactional Reporting Service is: 978-0-8036-5860-8 / 17 0 + $0.25. To my bestfriend,Jimmy
-Mary Townsend
To the loving memory of my father, Robert D. Morgan
-Karyn Morgan Contributors Lois Angelo, MSN, APRN, BC
ED Care Manager
Newton Wellesley Hospital
Newton, Massachusetts Cathy Melfi Curtis, MSN, RN-BC
Nursing Educator Consultant
Charleston, South Carolina Tona Leiker, PhD, APRN, CNE
Assistant Dean, Nursing Curriculum and Assessment
American Sentinel University
Aurora, Colorado Mary Jean Thompson, RN, BN, MHS, MPC
Instructor, MHC
University of Calgary
Medicine Hat, Alberta, Canada Carol Norton Tuzo, MSN, RN-BC
Nursing Educator Consultant
Charleston, South Carolina Reviewers
Lois Angelo, MSN, APRN, BC
Assistant Professor
MA College of Pharmacy and Health Sciences
Boston, Massachusetts Linda Blair, BSN, RN
Nursing Instructor
Central Carolina Community College
Sanford, North Carolina Debra De Voe, RN, MSN, NE-BC
Nursing Instructor
Thomas Edison State University
Trenton, New Jersey Donna A. Enrico, MBS, BSN, RN
Clinical Instructor
College of Southern Nevada
Las Vegas, Nevada Elizabeth Fife, MSN, RN, CNS, CPN
Associate Professor
Louisiana Tech University
Ruston, Louisiana Wanda Golden, RN, MSN, CCRN, PhD(c)
Dean and Associate Professor of Nursing
Abraham Baldwin Agricultural College
Tifton, Georgia Sandra Gustafson, MA, RN, CNE
Nursing Faculty
Hibbing Community College
Hibbing, MN Patricia]. Hefner, MSN, RN-BC
Faculty; Course Coordinator of Psychiatric Mental
Health Nursing
Heritage Valley Sewickley
Moon, Pennsylvania Sharon A. Henle, Ed.D, ANP, RHIA , CNE
Assistant Professor of Nursing
Farmingdale State College
Farmingdale, New York Jennifer E. Herrold, RN, MSN, CRNP
Instructor
ThomasJefferson University
Danville, Pennsylvania Beverly J. Howard, MSN, RN, FNP
Instructor
Alvin Community College
Alvin, Texas Katherine M. Howard, MS, RN-BC
Nursing Instructor
Middlesex County College Nursing Program,
Raritan Bay Medical Center
Edison, New Jersey Janet KJohnson, MBA, MSN, RN Nursing Coordinator
Fort Berthold Community College
New Town, North Dakota Rebecca King, RN, MSN, PMHCNS-BC
Division Chair for Nursing and Allied Health
University of Arkansas, Community College of
Batesville
Batesville, Arkansas Brenda Kucirka, PhD(c), RN, PMHCNS-BC, CNE
Clinical Instructor
Widener University
Chester, Pennsylvania Jan E. Lawrenz Blasi, MSN, RN
Nursing Instructor
Chandler School of Nursing and Allied Health,
Pratt Community College
Pratt, Kansas Anne Marie Leveille, RN, MSN, MPH
Assistant Professor
Medgar Evers College
Brooklyn, New York Tamar Lucas, BSN, MSN, RN, BC
Nursing Instructor
Itawamba Community College
Fulton, Mississippi Jana S. Martin, MS, RN, CNE
Division Chair, Allied Health Services
OSU Institute of Technology
Okmulgee, Oklahoma Renee Menkens, RN, MS
Assistant Professor
Southwestern Oregon Community College
Coos Bay, Oregon xiv Reviewers Bonnie Parker, DNP, RN, CRRN
Assistant Professor of Nursing, Malek School
of Health Professions
Marymount University
Arlington, Virginia Norma Perez, MSN/Ed, RN
Assistant Professor
Ivy Tech Community College Northwest
Valparaiso, Indiana Larry Purnell, PhD, RN, FAAN
Professor Emeritus, University of Delaware
Adjunct Professor, Florida International University
Adjunct Professor, Excelsior College Susan M. Reading-Martin, MS, RN, CS, FNP,
ARNP-BC
Nursing Faculty
Western Nebraska Community College
Scottsbluff, Nebraska Donna F. Rye, MSN, RN
Assistant Professor
Cox College
Springfield, Missouri Karen B. Silva, RN, MSN, MFN, BC
Nursing Faculty
Keiser University
Sarasota, Florida Alexandra Winter, RN, MSN
Assistant Director of Nursing
Metropolitan Community College
Omaha, Nebraska Acknowledgments
Sincere thanks go to
Susan Rhyner, for your skills, your integrity, and your
gift of encouragement.
Christina Snyder and Arny Romano, for all your
support, accessibility, and assistance in preparing the
manuscript.
The nursing educators, students, and clinicians, who
provide critical information about the usability of the
textbook, and offer suggestions for improvements.
Many changes have been made based on your input.
The individuals who critiqued the manuscript for this
edition and shared your ideas, opinions, and suggestions for enhancement. I sincerely appreciate your
contributions to the final product. Mary C. Townsend
First of all, sincere thanks to Mary Townsend for having the confidence in me to be included in authoring this exceptional text. I have the utmost respect
for what you have created and for your foresight in
recognizing the most relevant issues in the changing
face of psychiatric mental health nursing care.
Special thanks also to Erin Barnard, Fred Frese,
and the others who courageiously allowed their stories to be told, and to Jennifer Feldman for research
assistance.
I appreciate each of you more than I can say. Karyn I. Morgan Tothe Instructor
Currently in progress, implementation of the recommendations set forth by the New Freedom Commission on Mental Health has given enhanced priority
to mental health care in the United States. Moreover,
at the 65th meeting of the World Health Assembly
(WHA) in May 2012, India, Switzerland, and the
United States cosponsored a resolution requesting
that the World Health Organization, in collaboration with member countries, develop a global mental health action plan. This resolution was passed at
the 66th WHA in May 2013. By their support of this
resolution, member countries have expressed their commitment to "promotion of mental health, prevention of mental disorders, and early identification,
care, support, treatment, and recovery of persons
with mental disorders." With the passage of this resolution, mental health services may now be available
for millions who have been without this type of care.
Many nurse leaders see this period of mental
health-care reform as an opportunity for nurses to
expand their roles and assume key positions in education, prevention, assessment, and referral. Nurses
are, and will continue to be, in key positions to assist individuals to attain, maintain, or regain optimal
emotional wellness.
As it has been with each new edition of Essentials
of Psychiatric Mental Health Nursing: Concepts of Care
in Evidence-Based Nursing, the goal of this seventh
edition is to bring to practicing nurses and nursing
students the most up-to-date information related to
neurobiology, psychopharmacology,
and evidencebased nursing interventions. Notable in this edition
are changes associated with the recently published
fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Content and Features New to the Seventh Edition.
• All conte...
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