Mental Health Care for Nurses Applying Mental

Mental health is a significant factor in providing effective nursing care for patients in hospital and residential settings. Non-mental health nursing staff often lack the confidence, knowledge and skills to effectively meet the mental health needs of patients who are experiencing psychiatric problems and psychological distress. Mental Health Care for Nurses: Applying mental health skills in the general hospital provides a step-by-step guide which will help nurses identify these needs and address them in practice.

Anthony Harrison is Consultant Nurse in Liaison Psychiatry and Visiting Fellow, University of the West of England, Bristol. Chris Hart is Nurse Consultant in Liaison Psychiatry and Principle Lecturer, Kingston. The contributors are all consultant nurses in liaison psychiatry.

Foreword

ix

Editors

xi

Contributors

xii

Dedication and Acknowledgements

xiii

Introduction

xv

Chris Hart and Anthony Harrison

Terminology

xv

Structure of the book

xvi

References

xviii

Part 1: The Principles of Mental Health Care in the General Hospital

1

(108)

1 The Provision of Holistic Care

3

(29)

Chris Hart and Lyn Williams

Chapter aims

3

(1)

Introduction

3

(1)

The focus of nursing and its relationship to holistic care

4

(2)

The context of care: mental health in the general hospital

6

(3)

Stigma and mental health in the general hospital

9

(1)

The impact on nurses of meeting the mental health needs of the patient

9

(2)

Overview of mental health problems commonly encountered in the general hospital

11

(7)

Mental health assessment

18

(3)

The nurse–patient relationship

21

(1)

Effective use of interpersonal skills and therapeutic communication

22

(4)

Communication and recording of patient-related information

26

(1)

Support mechanisms for nursing staff and other clinicians

26

(1)

Conclusions

27

(1)

References

27

(4)

Websites

31

(1)

2 Psychological Responses to Illness and Injury

32

(17)

Anthony Harrison

Chapter aims

32

(1)

Introduction

32

(1)

Influences upon health and ill health

33

(1)

Personal beliefs, understandings and interpretations of health and illness

34

(3)

Coping and adaptation to illness and injury

37

(1)

Acute stress reactions

40

(1)

Impact of illness on families and carers

41

(2)

Nursing priorities in the provision of psychological care

43

(1)

Dealing with emotions

44

(3)

Conclusions

47

(1)

References

47

(2)

3 The Legal and Ethical Context of Mental Health Care in the General Hospital

49

(15)

Anthony Harrison and Lyn Williams

Chapter aims

49

(1)

Introduction

49

(1)

The ethical and professional context

50

(3)

The legal context: decision-making, capacity and competence

53

(2)

Consent

55

(1)

Duty of care

56

(4)

The Mental Health Act 1983

60

(2)

Conclusions

62

(1)

References

62

(2)

4 Caring for the Person Displaying Challenging Behaviour

64

(18)

Chris Hart

Chapter aims

64

(1)

Introduction

64

(1)

The nature of challenging behaviours

65

(4)

Causes and triggers of disturbed behaviour

69

(2)

What is it that challenges us?

71

(3)

The patient, the institution and the situation

74

(1)

Risk assessment

75

(1)

An organisational response to challenging behaviours

75

(2)

Working with people who challenge us

77

(2)

Conclusions

79

(1)

References

80

(2)

5 Breaking Bad News

82

(13)

Chris Hart

Chapter aims

82

(1)

Introduction

82

(1)

What is bad news?

83

(1)

Issues of grief and loss

84

(2)

How people 'hear' what is said and 'understand' - the difference between being told something and understanding

86

(1)

Preparing to provide information

87

(4)

Impact on practitioners

91

(1)

Conclusions

92

(1)

References

93

(2)

6 The Role of the Mental Health Liaison Team

95

(16)

Anthony Harrison

Chapter aims

95

(1)

Introduction

95

(1)

The development of mental health liaison practice

96

(4)

The role of the mental health liaison team

100

(3)

The process of referral

103

(3)

Conclusions

106

(1)

References

106

(3)

Part 2: Mental Health Care in the General Hospital

109

(114)

7 Depression and Anxiety

111

(19)

Gina Bird

Chapter aims

111

(1)

Introduction

111

(1)

Theoretical perspectives on the causes of depression

112

(1)

Terms used to describe the various types of mood disorder

112

(2)

Recognising depression

114

(1)

Anxiety

115

(1)

Panic attacks

118

(1)

Phobias

119

(1)

Assessment

119

(2)

Treatment strategies for depression

121

(1)

Physical treatments

121

(1)

Psychological treatments

123

(1)

Combination of physical and psychological treatments

123

(1)

Planning care for the person who is depressed or anxious

124

(1)

Use of interpersonal skills

125

(1)

Responding to the person's care needs

125

(2)

Conclusions

127

(1)

References

128

(2)

8 Self-harm and Suicide Prevention

130

(18)

Anthony Harrison

Chapter aims

130

(1)

Introduction

130

(1)

Terminology

131

(1)

Incidence of self-harming and suicidal behaviour

131

(3)

'Causes' of self-harming behaviour

134

(2)

Attitudes

136

(1)

Risk assessment

137

(1)

Short-term risk assessment

139

(1)

Medium-term risk assessment

139

(1)

Long-term risk assessment

142

(1)

Caring for the person who has self-harmed

142

(1)

Initial assessment

142

(1)

Treatment

144

(1)

Managing the potential risk of further self-harm

144

(1)

Observation

144

(1)

Pre-discharge care

144

(1)

Conclusions

145

(1)

References

145

(3)

9 Perinatal and Maternal Mental Health

148

(18)

Alison Blofield

Chapter aims

148

(1)

Introduction

148

(1)

Policy and professional context

149

(1)

Prevalence of perinatal mental health problems

150

(1)

The impact of mental illness

151

(1)

Common perinatal mental health problems

151

(1)

Maternity or baby blues

152

(1)

Postnatal depression

152

(1)

Puerperal psychosis

157

(1)

Breast feeding and the use of psychotropic medication

160

(1)

Principles of effective perinatal mental health care

161

(2)

Conclusions

163

(1)

References

163

(3)

10 Caring for the Person with a Serious Mental Illness

166

(15)

Bob Gardner

Chapter aims

166

(1)

Introduction

166

(1)

Definitions and terminology

167

(1)

Schizophrenia

167

(1)

Bipolar affective disorder

169

(1)

Mortality and morbidity associated with serious mental illness

170

(1)

Factors that contribute to poor physical health

170

(2)

Assessment

172

(1)

Pharmacological treatment of serious mental illness

173

(1)

Antipsychotic medication

173

(1)

Mood stabilisers

175

(1)

Principles of caring for a person with a serious mental illness

176

(2)

Conclusions

178

(1)

References

179

(2)

11 Alcohol and Illicit Drug Use

181

(17)

Bob Gardner

Chapter aims

181

(1)

Introduction

181

(1)

Definitions and terminology

182

(1)

Acute intoxication

182

(1)

Harmful use

183

(1)

Dependency

184

(1)

Withdrawal

185

(2)

Commonly misused illicit drugs

187

(1)

Assessment

188

(2)

Clinical management of alcohol withdrawal

190

(2)

Clinical management of opiate dependence during hospital admission

192

(2)

Mental health promotion

194

(1)

Conclusions

195

(1)

References

196

(2)

12 Caring for Older People with Mental Health Problems

198

(17)

Anthony Harrison

Chapter aims

198

(1)

Introduction

198

(1)

Prevalence of mental health problems

199

(1)

The impact of ageism

199

(1)

Assessment

200

(3)

Dementia

203

(1)

Nursing interventions

205

(4)

Acute confusion (delirium)

209

(3)

Conclusions

212

(1)

References

212

(3)

13 Challenges to the Delivery of Holistic Care

215

(8)

Chris Hart and Anthony Harrison

Chapter aims

215

(1)

Introduction

215

(1)

Impact of changes in the NHS on nursing

216

(1)

Holistic care and the expanding role of the nurse

217

(2)

Difficulties encountered by contemporary nurses in the provision of holistic care

219

(3)

Achieving holistic care for the patient in the modern NHS

222

(1)

References

223

(1)

Website

224

(1)

Index

225

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Mental Health Care for Nurses Applying Mental Health Skills in the General Hospital

Summary

Author Biography

Table of Contents

Supplemental Materials