TAFE NSW Training and Education Support Industry Skills Unit, Meadowbank HLTEN510A Implement and monitor nursing care for consumers with mental health conditions Version 1.0 Flexible Learning Resource Product Code: 2636 ISO 9001
HLTEN510A Implement and monitor nursing care for consumers with mental health conditions V1.0 i Acknowledgments TAFE NSW Training and Education Support, Industry Skills Unit, Meadowbank would like to acknowledge the support and assistance of the following people in the production of this resource package. Writers: Christine Hurst Elizabeth Holroyd Reviewed by: Kylie Brennan Trent Taylor Project Manager: Di Dawbin R/Education Programs Manager Training and Education Support, Industry Skills Unit, Meadowbank Acknowledgements are also given to all TAFE NSW teachers of the Enrolled Nurse Education Program. Enquiries: Enquiries about this and other publications can be made to: TAFE NSW Training and Education Support, Industry Skills Unit, Meadowbank Locked Bag No. 6 MEADOWBANK NSW 2114 Tel: 02-9942 3200 Fax: 02-9942 3257 The State of New South Wales, Department of Education and Training, TAFE NSW, Training and Education Support, Industry Skills Unit, Meadowbank, 2009. Copyright of this material is reserved to Training and Education Support, Industry Skills Unit, Meadowbank, TAFE NSW. Reproduction or transmittal in whole or in part, other than for the purposes of private study or research, and subject to the provisions of the Copyright Act, is prohibited without the written authority of Training and Education Support, Industry Skills Unit, Meadowbank, TAFE NSW. ISBN 978-0-7348-9050-4 ISO 9001
HLTEN510A Implement and monitor nursing care for consumers with mental health conditions V1.0 v TABLE OF CONTENTS INTRODUCTION... 1 LEARNER INFORMATION... 2 TOPIC 1 Introduction to mental health nursing... 15 TOPIC 2 Mental health care teams/nurses role... 21 TOPIC 3 Legal and ethical issues specific to mental health... 25 TOPIC 4 Common mental health behaviours... 31 TOPIC 5 Cultural factors affecting people with mental health problems... 33 TOPIC 6 Communication specific to the needs of mental health clients... 35 TOPIC 7 Management of self-harm/suicide attempts... 41 TOPIC 8 Planning care for individuals with common mental health problems... 45 TOPIC 9 Community services... 55 TOPIC 10 Communication... 59 TOPIC 11 Assessment... 65 TOPIC 12 Classification of medication... 69 TOPIC 13 Therapeutic environment... 75 TOPIC 14 Types of therapies... 77 Assessment requirements... 81 Resource List... 85 ISO 9001
HLTEN510A Implement and monitor nursing care for consumers with mental health conditions V1.0 15 TOPIC 1 Introduction to mental health nursing TOPICS TO BE COVERED IN THIS AREA Terminology. Concepts of mental health and mental illness and theories of personality. History and social context of mental health in Australia. Classification of mental disorders, assessment tools and care planning. ACTIVITY 1 Learners should prepare a glossary of terminology encountered in this unit of competency. Terms Psychology Psychiatry Reality Testing Risk assessment Psychosis Anxiety Neurosis Using a relevant mental heath text book, dictionary or the internet, define the following terms. Definition Phobias Anorexia nervosa Bulimia nervosa Restraint
16 HLTEN510A Implement and monitor nursing care for consumers with mental health conditions V1.0 Terms Seclusion Definition Advocacy Dual diagnosis Delusion Hallucination Perception Affect Mood Dementia Motivation DSM-IV-TR MH-OAT Depression Dysthymia Depressive disorders
HLTEN510A Implement and monitor nursing care for consumers with mental health conditions V1.0 17 The following resources may assist you to obtain information. Elder, R, Evans, K and Nizette, D 2005, Psychiatric and Mental Health Nursing, Elsevier, Sydney, Chapter 10. World Health Organization Collaborating Centre for Mental Health and Substance Abuse 2000, Management of Mental Disorders: A Treatment Protocol Project, 3rd edn, Sydney. Suggested websites Mental Health Association, NSW Inc. Retrieved from: http://www.mentalhealth.asn.au/ Mental Health and Wellbeing at Aust. Govt. Dept of Health and Ageing. Retrieved from: http://www.mentalhealth.gov.au Consolidated Acts. Mental Health Act, 2007 Retrieved from: http://www.austlii.edu.au/au/legis/nsw/consol_act/mha1990128/ Health topics may be retrieved from the government website below: http://www.healthinsite.gov.au/ Passage 1 ACTIVITY 2 Read the following passages. THEORIES OF MENTAL ILLNESS Historical perspectives in the treatment of the person with a mental illness It is important to recognise the historical background and the contemporary approaches (theories) used in nursing individuals with mental illness. In ancient times people with mental illness were viewed as being either divine or demonic, depending on their behaviour. The divine were worshipped and adored whereas the demonic were punished and ostracized and even burnt at the stake. In 382-322BC Aristotle attempted to relate mental disorders to physical illness and provided a theory that the amount of blood, water and yellow and black bile in the body controlled a person s emotions. These fluids or humors were thought to correspond with emotions of happiness, calmness, anger and sadness. Imbalance of the humours lead to mental illness and therefore treatment aimed at restoring the balance and the use of bloodletting, starvation and purging were utilised. Later exorcisms were used to rid the body of evil spirits but it was not until 1300-1600 in England that criminals were distinguished from the mentally ill and many people were let out of prison, only to wander the countryside. In the 1700s the concept of the mental asylum was formulated as a means of providing refuge for people who were mentally ill. Many large institutions were opened in the 1800s to provide for the basic needs of people with mental illness. Sigmund Freud (1856-1939) was the pioneer of the psychiatry who challenged society to view human beings differently. Over the years there have been many theories on how to treat people with mental illness. References 1. Elder, R, Evans, K and Nizette, D 2005, Psychiatric and mental health nursing, Elsevier, Sydney. 2. Videbeck, SL 2006, Psychiatric Mental Health Nursing, 3 rd edn, Lippincott Williams and Wilkins, Philadelphia. 3. Womble, DM 2005, Introductory Mental Health Nursing, Lippincott, Williams and Wilkins, Philadelphia.
18 HLTEN510A Implement and monitor nursing care for consumers with mental health conditions V1.0 Passage 2 An overall view of problems experienced by the individual with a mental illness The problems that are given can vary widely and can overlap complaints that stem from organic illness. Examples of client complaints/problems are: Fear, free-floating anxiety or fear of a specific situation (phobia). An obsessional thought, or a compulsive act that s/he feels unable to resist. Depression, suicidal thoughts, feelings of hopelessness, feelings of being run down, lack of energy, sleeplessness, loss of drive, and loss of sexual function (all these are suggestive of depression). Physical complaints: pain, headache, not feeling well, and there are varying degrees of insight by the client that this may be psychological in origin. Unpleasant and vague feelings, depersonalisation (an alteration in the perception or experience of the self so that one feels detached from, as if one is an outside observer, of one's mental processes or body), and derealisation (an alteration in the perception or experience of the external world so that it seems strange or unreal). Statements that may suggest a psychosis (a loss of ego boundaries or a gross impairment in reality testing in which hallucinations and delusions are prominent): Electric waves are being sent through my body People are discussing me behind by back People are out to poison me I am dead, bury me or other delusions (a false belief about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes obvious proof or evidence to the contrary). Difficulty getting along with people, problems with the opposite sex, not being able to make friends, feeling shy. There may be complaints of marital difficulty or of impotence or frigidity. Abuse of alcohol and/or drugs. Behaviour disturbance considered reasonable by the consumer may cause others to complain as the consumer may have lost insight into their condition as a result of psychosis. Relatives, friends or police may bring them to the hospital for assessment. Other signs are considered according to the Mental State Assessment (see Topic 6). HISTORY AND SOCIAL CONTEXT ACTIVITY 3 Suggested websites Using a relevant mental health text book, dictionary or the internet, answer the following questions. http://www.health.gov.au/internet/wcms/publishing.nsf/ http://www.abs.gov.au/ausstats/abs@.nsf/mf/4824.0.55.001 http://www.healthinsite.gov.au/ a) Discuss the demographic data relating to mental illness in Australia b) Who is likely to get mental illness? c) Where do they live and what are precipitating factors? d) Research the implications of mental illness consider stigma and 'revolving door' syndrome.