Question

Nurse B is assigned to work at psychiatric clinic, he is expected to know the algorithm used in this clinic. Attach the algorithm for managing cases with acute psychiatric presentation? And mention what should be done if there is possibility of personality disorder?

Answer 1

Algorithm for managing cases with acute psychiatric presentation

Successful critical thinking in psychiatric nursing care requires synthesis of knowledge, experience, information gathered from patients and families, critical thinking attitudes, and ethical and professional standards. Solid clinical judgment requires anticipating and securing the necessary information, analyzing the data, and making appropriate decisions regarding patient care. In the case of self-concept, it is essential to integrate knowledge from nursing and other disciplines, including self-concept theory, communication principles, and a consideration of cultural and developmental factors. Previous experience in caring for patients with self-concept alterations helps to individualize care. Selfconcept profoundly influences a person’s response to illness. A critical thinking approach to care is essential.

Acute Stage

Nursing goal: remission of the patient’s illness

Nursing assessment: focuses on the patient’s symptoms and
maladaptive coping responses
Nursing intervention: directed toward treatment planning
with the patient and the modeling and teaching of adaptive
responses
Nursing expected outcome of care: symptom relief

ASSESSMENT

It is determined by four criterias : Knowledge , Experience , Standards , Attitudes

• Observe for behaviors that suggest an
alteration in the patient’s self-concept
• Assess the patient’s cultural background
• Assess the patient’s coping skills and resources
• Determine the patient’s feelings and
perceptions about changes in body image,
self-esteem, or role
• Assess the quality of the patient’s
relationships

PLANNING

   It is also determined by four criterias : Knowledge , Experience , Standards , Attitudes

• Select therapies that strengthen or maintain
   the patient’s coping skills
• Involve the patient to ensure that realistic
therapies are chosen
• Refer to community services as appropriate
• Minimize stressors aecting the patient’s
self-concept

EVALUATION

   It is also determined by four criterias : Knowledge , Experience , Standards , Attitudes

• Observe the patient’s nonverbal behaviors
• Ask the patient to share opinions and ideas
• Observe the patient’s appearance
• Ask the patient if expectations are being met

The image shown below explains all the nursing algorithm foir psychiatric nursing care

STUART`S STRESS ADAPTATION MODEL OF PSYCHIATRIC NURSING CARE

Nursing Management of Personality Disorders

The nursing management of a patient with personality disorder include the following:

Nursing Assessment

Assessment of the patient include:
• History. Many of these clients report disturbed early relationships with their parents that often begin at 18 to 30 months of age; 50% of these clients have experienced childhood sexual abuse; others have experienced physical and verbal abuse and parental alcoholism.
• Mood and affect. The pervasive mood is dysphoric, involving unhappiness, restlessness,

and malaise; clients often report intense loneliness, boredom, frustration, and feeling “empty”.
• Thought process and content. Thinking about self and others is often polarized and extreme, which is sometimes referred to as splitting; clients tend to adore and idealize other people even after a brief acquaintance but then quickly devalue them if these others do not meet their expectations is some way.
• Sensorium and intellectual process. Intellectual capacities are intact, and clients are fully oriented to reality.

Nursing Diagnosis

Nursing diagnoses for clients with personality disorder include the following:

• Risk for suicide related to low frustration tolerance.
• Risk for self-mutilation related to impulsive behavior.
• Risk for other directed violence related to lack of feelings of

remorse.
• Ineffective coping related to failure to learn or change behavior based on past experience or punishment.
• Social isolation related to ineffective interpersonal relationships.

Nursing Care Planning and Goals

Nursing care plan goals for personality disorders may include:

• The client will be safe and free of significant injury.
• The client will not harm others or destroy property.
• The client will demonstrate increased control of impulsive behavior.
• The client will take appropriate steps to meet his or her own needs.
• The client will demonstrate problem-solving skills.
• The client will verbalize greater satisfaction with relationships.

Nursing Interventions

Clients with personality disorder often are involved in long-term psychotherapy to address issues of family dysfunction and abuse.

• Promoting client’s safety. The nurse must always seriously consider suicidal ideation with the presence of a plan, access to means for enacting the plan, and self-harm behaviors and institute appropriate interventions.
• Promoting therapeutic relationship. Regardless of the cllinical setting, the nurse must provide structure and limit setting in the therapeutic relationship; in a clinic setting, this may mean seeing the client for scheduled appointments of a predetermined length rather than whenever the client appears and demands the nurse’s immediate attention.
• Establishing boundaries in relationships. The nurse must be quite clear about establishing the boundaries of the therapeutic relationship to ensure that neither the client’s nor the nurse’s boundaries are violated.
• Teaching effective com
• munication skills. It is important to teach basic communication skills such as eye contact, active listening, taking turns talking, validating the meaning of another’s communication, and using “I” statements.
• Helping clients to cope and to control emotions. The nurse can help the clients to identify their feelings and learn to tolerate them without exaggerated responses such as destruction of property or self-harm; keeping a journal often helps clients gain awareness of feelings.
• Reshaping thinking patterns. Cognitive restructuring is a technique useful in changing patterns of thinking by helping clients to recognize negative thoughts and feelings and to replace them with positive patterns of thinking
• thought stopping is a technique to alter the process of negative or self-critical thought patterns.
• Structuring the client’s daily activities. Minimizing unstructured time by planning activities can help clients to manage time alone; clients can make a written schedule that includes appointments, shopping, reading the paper, and going for a walk.