The Use of the Nursing Process
in the Care of Psychiatric Patients
se in psychiatry
1.What is nursing care plan?
 2.Nursing process in psychiatry.
 3.The examination of mental health patient
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A nursing care plan outlines the nursing
care to be provided to a patient. It is a set of
actions the nurse will implement to resolve
nursing problems identified by assessment.
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The creation of the plan is an intermediate
stage of the nursing process. It guides in the
ongoing provision of nursing care and
assists in the evaluation of that care
Characteristics of the nursing
care plan
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It focuses on actions which are designed to solve or
minimize the existing problem.
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It is a product of a deliberate systematic process.
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It relates to the future.
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It is based upon identifiable health and nursing problems.
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Its focus is holistic.
Elements of the plan
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In the USA, the nursing care plan consists
of a NANDA nursing diagnosis with related
factors and subjective and objective data
that support the diagnosis, nursing outcome
classifications with specified outcomes (or
goals) to be achieved including deadlines,
and nursing intervention classifications with
specified interventions.
The nursing process
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Care plans are formed using the nursing
process- a process by which nurses deliver
care to patients. The nursing process is a
cyclical and ongoing process that can end at
any stage if the problem is solved.
Stages of nursing procese:
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Assessment (of patient's needs)
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Diagnosis (of human response needs that
nursing can assist with)
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Planning (of patient's care)
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Implementation (of care)
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Evaluation (of the success of the
implemented care)
When patients enter the office...
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pay close attention to
their personal
grooming.
establish adequate
rapport with the
patient by introducing
himself or herself.
PATIENT HISTORY: Identifying
data
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name(or what name
they prefer to be
called)
marital status
occupation
religious belief
living circumstance.
sex
race
Chief complaint
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"What brings you here today?"
History of present illness
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This is the main part of the interview
because there are no specific elements that
will lead to the diagnosis and ultimately
treatment besides the interview. An exact
history allows one to gather basic
information along with specific symptoms
including timing in the patient's life to allow
the healthcare provider to take care of the
whole patient.
History of present illness
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LISTENING
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Past medical history
Past surgical history
Medication
Allergies
Past psychiatric
history
Family history
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Social history
Perinatal and
developmental history
Assets
Mental Status Examination
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Appearance
Attitude toward the
examiner
Mood
Affect;Speech
Thought process
Thought content
Insight
Impulsivity
Reliability
Appearance
Recall how the patient first appeared ,
 Note:1. whether this posture has changed,
2.whether the patient appears more
relaxed,3. whether the patient has
maintained eye contact 4. has avoided eye
contact,5. whether the patient still seems
nervous.
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Attitude toward the examiner
patient's facial expressions and attitude,
 the patient appeared interested ,
 the patient appeared bored,
 the patient is hostile and defensive,
 the patient is friendly and cooperative,
 the patient seems guarded,
 the patient seems relaxed,
 the patient seems uncomfortable.
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Mood
is defined as "sustained emotion that the
patient is experiencing.»
 Ask questions such as "How do you feel
most days?".
 Helpful answers : "depressed," "anxious,"
"good," and "tired."
 Less helpful: "OK," "rough," and "don't
know."
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Affect
defined in the following terms: expansive
(contagious), euthymic (normal),
constricted (limited variation), blunted
(minimal variation), and flat (no variation).
 A patient whose mood could be defined as
expansive may be so cheerfucheerful and
full of laughter that it is difficult to refrain
from smiling while conducting the
interview.
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Speech
quality,
 quantity,
 rate,
 volume,
 how fast or slow they are speaking.
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Thought process
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looseness of
association
(irrelevance),
flight of ideas (change
topics),
racing (rapid
thoughts),
tangential (departure
from topic with no
return),
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circumstantial (being
vague, ie, “beating
around the bush”),
word salad
(nonsensical
responses, ie,
jabberwocky),
derailment (extreme
irrelevance),
neologism (creating
new words),
Thought process
clanging (rhyming words),
 punning (talking in riddles),
 thought blocking (speech is halted),
 poverty (limited content).
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Thought content
Hallucinations: "Do you hear voices when
no one else is around?”
 Delusions: ”Do you have any special
powers or abilities?"
 Obsessions or compulsions: "Are you
afraid of dirt?
 Phobias: "Do you have any fears, including
fear of animals, needles, heights, snakes,
public speaking, or crowds?"
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Thought content
Suicidal ideation or intent: "Do you have
any thoughts that you would be better off
dead?»
 Homicidal ideation or intent: "Do you have
any thoughts of wanting to hurt anyone?"
 Orientation:. "What is your full name?"
 Visuospatial ability: Have the patient draw
interlocking pentagons in order to determine
constructional apraxia.
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Thought content
Concentration and attention: Ask the patient
to subtract 7 from 100, then to repeat the
task from that response. This is known as
"serial 7s.” Next, ask the patient to spell the
word world forward and backward.
 Reading and writing: Ask the patient to
write a simple sentence (noun/verb). Then,
ask patient to read a sentence (eg, "Close
your eyes.").
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Thought content
Memory: "What was the name of your first
grade teacher?»
 Abstract thought: "Don't cry over spilled
milk" (good response is "don't get upset
over the little things"; poor response is
"spilling milk is bad").
 General fund of knowledge: “List 5 major
US cities."
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Thought content
Consciousness: levels of consciousness: (1)
coma, characterized by unresponsiveness;
(2) stuporous, characterized by response to
pain; (3) lethargic, characterized by
drowsiness; (4) alert, characterized by full
awareness.
 Intelligence: estimate the patient's
intelligence quotient (ie, below average,
average, above average).
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Folstein Mini-Mental State
Examination
Insight
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Assess the patients' understanding of the
illness.
Judgment
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"What would you do if you smelled smoke
in a crowded theater?
Impulsivity
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Estimate the degree of the patient's impulse
control. Ask the patient about doing things
without thinking or planning. Ask about
hobbies such as coin collecting, golf,
skydiving, or rock climbing.
Reliability
seems reliable,
 difficult to determine,
 seems "unreliable."
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Conclusions
1. Nursing care plan proclaimes the nursing
care to be provided to a patient.
 2. Nursing process- a process by which
nurses deliver care to patient
 3.The examination of mental health patient
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