Mental Health Nursing / Edition 6

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Overview

Written in a student-friendly style, this comprehensive text, and leading resource in the field of mental health nursing, emphasizes effective communication skills, details cultural considerations, and presents mental health disorders within a systematic organizational framework using the nursing process. It reflects the diversity of its student readers, and the belief that the practice of mental health nursing is in direct response to the social, cultural, environmental, and biological components of mental illness.

The book contains predominantly black-and-white illustrations, with some two-color illustrations.

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Editorial Reviews

Cheryl Laskowski
This fourth edition text, with its emphasis on mental health nursing, provides an inclusive and comprehensive description of essential concepts relating to mental health and illness. The editors have updated the text in order to further address concepts relating to neurobiology. In addition, material relating to nursing within the family and the community has been added. The text is separated into sections, including foundations, clinical practice, skills, mental disorders, crisis, and special topics. The stated purposes are to ""help students recognize that mental disorders are brain disorders,"" to emphasize mental health promotion, and to facilitate an optimal level of functioning for those clients with mental illness. Reources are provided, both practical and theoretical, for meeting these stated objectives. Nursing students, the targeted readership for this book, will find the chapters to be informative, clear, and concise. In each chapter, key concepts are highlighted and review questions are included. Multiple illustrations and figures add to readability. Chapters include theoretical information as well as practical techniques. Cultural diversity is highlighted, and feminist theoretical perspectives are identified throughout. Unique features are found in chapters relating to specific mental disorders. Removable psychotropic drug information cards and a mental health tutorial disk are also included. Nursing students, psychiatric nurses new to practice, and libraries would benefit from the purchase of this text. This book is well written, comprehensive, and clear. The editors and contributors address basic concepts related to mental health nursing -- theoretical as wellas practical. References suggest areas for further reading. Illustrations, tables, and figures add to the pedagogical usefulness of the text.
Booknews
With an emphasis on community mental health, this new edition of a nursing text covers such material as seven types of disorders, mental health crisis issues, special population topics, and treatment and communication skills. The tutorial disk contains some 150 multiple choice questions for testing knowledge. Annotation c. by Book News, Inc., Portland, Or.
Doody's Review Service
Reviewer: Marilyn Sample, B.S. and M.S.(Indiana State University)
Description: This mental health nursing textbook provides information about the theories and concepts foundational to the study of mental health nursing and presents information about the various mental health pathologies.
Purpose: This book has been written to provide current information related to mental health and mental health nursing. It is a concise text that addresses basic concepts and is a nice replacement for massive and redundant books on the subject.
Audience: It is appropriate for traditional and nontraditional nursing students who are being prepared at the associate degree level. It will be very appealing to educators due to the variety of learning tools and resources that accompany it. The author has been professionally involved in mental health nursing for many years and seems to be a credible authority.
Features: The author has presented basic information related to mental health nursing, psychosocial theories and concepts, and psychopathologies in a very concise manner. She has also included current nursing trends and terminology such as NIC and NOC in the various chapters. There are numerous vignettes of nurse/client interviews, and there is a critical thinking exercise in every chapter. There are numerous tables and boxes of information well integrated into the book. There is a wide variety of color used in each chapter which is a nice esthetic addition. Each chapter is introduced by artwork that has been created by various clients and effectively adds meaning to the concepts introduced in the chapters.
Assessment: This book is an asset to educators and students who study and provide care related to mental health. It is easy to read, is organized very well, and provides essential and basic information in a concise manner. This book is a fifth edition and, according to the author, new information has been added such as that related to complementary and alternative therapies, spectrum disorders, neuropsychiatric problems, and community violence. The author has also added media links which are useful to the student and educator. The book is valuable for learner and educator.

5 Stars! from Doody
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Product Details

  • ISBN-13: 9780135146552
  • Publisher: Prentice Hall
  • Publication date: 7/29/2008
  • Series: MyNursingLab Series
  • Edition description: New Edition
  • Edition number: 6
  • Pages: 760
  • Sales rank: 199,197
  • Product dimensions: 8.40 (w) x 10.80 (h) x 1.20 (d)

Meet the Author

Karen Lee Fontaine received her bachelor's degree from Valparaiso University, Valparaiso, Indiana, a nursing degree from Luthern Hospital in St. Louis, Missouri, and her master's degree in psychiatric nursing from Rush University, Chicago, Illinois. Karen is currently a Professor of Nursing at Purdue University Calumet, where she has been teaching for 20 years. She is also a certified sex therapist and maintains a private practice counseling individuals and couples.

Karen's publishing awards include the AJN Book of the Year Award 2000 for her text entitled Healing Practices: Alternative Therapies for Nursing, Prentice Hall, and the Annual Nursing Book Review, Sigma Theta Tau 2000 for Mental Health Nursing 4e, Addison Wesley. Karen's distinguishing academic honors include the Luther Christman Excellence in Published Writing Award, Gamma Phi Chapter, Sigma Theta Tau, Rush University, Chicago, Illinois, in 1997 and Distinguished Lecturer 1994-1995 from Sigma Theta Tau, International.

Karen is a frequent presenter at national and regional seminars covering psychiatric-mental health nursing practice, alternative therapies, sexuality, and sex therapy. She is a member of several professional associations, which include the International Society of Psychiatric-Mental Health Nurses, the National Alliance for the Mentally Ill (NAMI), and the American Association of Sex Educators, Counselors, and Therapists. Karen has also served on the Editorial Advisory Board for the Journal of Couple and Relationship Therapy since 2000.

Karen lives on a sand dune in Miller Beach with her soul mate, Al, and their Greater Swiss Mountain dog, Whitney. She has three children, jean-Marc, Simone and Marcel, and three grandchildren, Danielle, Christopher, and Jaycee. Karen enjoys spending time with her family, art, reading, walking on the beach, and throwing "Goddess" parties with her friends.

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Table of Contents

Unit I Foundations of Mental Health Nursing

Chapter 1 Introduction to Mental Health Nursing

Chapter 2 The Family in Mental Health Nursing

Chapter 3 The Community in Mental Health Nursing

Chapter 4 The Role of Cultural Diversity in Mental Health Nursing

Chapter 5 Legal and Ethical Issues

Chapter 6 Neurobiology and Behavior

Unit II Illness Management and Recovery

Chapter 7 Illness Management: Communication and Psychoeducation

Chapter 8 Illness Management: Common Clinical Behaviors

Chapter 9 Illness Management: Treatment Decisions

Chapter 10 Illness Management: Medications

Unit III Mental Disorders

Chapter 11 Anxiety, Dissociative, and Somatoform Disorders

Chapter 12 Eating Disorders

Chapter 13 Mood Disorders

Chapter 14 Schizophrenic Disorders

Chapter 15 Substance-Related Disorders

Chapter 16 Personality Disorders

Chapter 17 Disorders of Children and Adolescents

Chapter 18 Gender Identity and Sexual Disorders

Unit IV Neurobehavioral Disorders

Chapter 19 Cognitive Impairment Disorders

Chapter 20 Neuropsychiatric Problems

Unit V Violence

Chapter 21 Suicide

Chapter 22 Interpersonal Violence

Chapter 23 Sexual Violence

Chapter 24 Community Violence

Chapter 25 Nursing Management of the Problems Associated With Exposure to Natural Disasters and Terrorism

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Preface

Goals of Mental Health Nursing

Mental, behavioral, and social health problems are increasing throughout the world. According to recent world studies, four of the ten leading causes of disability worldwide are mental illnesses. In the United States, mental illnesses are the nation's second leading cause of disability, and mental illness has been classified as a public health crisis.

My goal is that nursing students and nurses in all professional practice specialties incorporate psychiatric nursing skills as they work with a variety of clients to improve the quality of life and achieve the highest possible level of functioning. Strong interpersonal and communication skills are critical to every area of practice. In addition, nurses encounter people with mental illnesses in inpatient, outpatient, and community sites including medical-surgical settings, intensive care units, emergency departments, obstetrics, and pediatrics. Thus, wherever you practice nursing, your mental health nursing skills will help you think critically and creatively.

The fifth edition of Mental Health Nursing is designed to appeal to both traditional and nontraditional nursing students. The text is written in a user-friendly style for undergraduate students with the understanding that students and clients encompass a wide range of ages and ethnic groups, both genders, and a variety of sexual identities. This diversity is reflected throughout the text.

This text is based on the belief that the practice of mental health nursing means taking time to be with clients and their families in deeply caring ways. To that end, nursing students are encouraged to engage inself-analysis in order to increase their self-understanding and self-acceptance. This is important because nurses who are able to clarify their own beliefs and values are less likely to be judgmental or to impose their own values and beliefs on clients.

Language is a powerful tool that reflects our beliefs and values. When we refer to someone with a disability by a label, we profess a belief that the disability is the most important feature about that person. This attitude is reflected when we label people as alcoholics, schizophrenics, or quadriplegics. In contrast, I use "people-first" language. I acknowledge the person first by saying, "a person with schizophrenia" or "a person who has a substance abuse problem." In the same spirit, I use the words "client" and "consumer" interchangeably. I believe these terms reflect people with options and choices who have the right to determine their own direction in life.

Philosophical and Theoretical Frameworks

Many theories and models are relevant to the practice of mental health nursing. It is the integration of these theories that creates the unique domain of mental health nursing as we respond to the social, cultural, environmental, and biological components of mental illness. It is important that we maintain the art of nursing, which is being there, with another person or persons, in a context of caring. It involves compassion and sensitivity to each person within the context of her or his entire life.

The model basic to this text is one of competency. This is based on the belief that individuals and families are resourceful and have the capacity to grow and change. The competency model does not ignore pathology and dysfunction but emphasizes strengths and adaptation. The role of nursing is to empower people to respond and adapt to life circumstances. In this spirit, nurses develop collaborative partnerships with clients and families. The overall goal is to provide the support, education, coping skills training, and advocacy necessary for successful living, learning, and working in the community. Consumer-sensitive nursing care helps people assume personal responsibility for where they are in their lives and for where they are going.

Traditional Strengths of Mental Health Nursing

In the fifth edition, Mental Health Nursing retains many of the strengths that have made it a popular "user-friendly" text for nursing students.

There is a heavy emphasis throughout the text on the development of effective communication skills. Chapter 2, Relating, Communicating, and Teaching, includes a new example of a student-client interaction and an analysis thereof in the form of a process recording. Each chapter in Part IV, Mental Disorders, features Clinical Interactions, illustrating a therapeutic interaction between a nurse and client.

The nursing process is the organizing framework for Chapters 11 through 23. This organizational consistency is extremely effective in helping students begin to assess, analyze, plan, implement, and evaluate in a systematic manner. The Focused Nursing Assessment feature aids students in learning the type and range of assessment questions to ask particular clients. NANDA diagnoses are correlated with Nursing Outcomes Classification (NOC) and with Nursing Interventions Classification (NIC) in tables. These taxonomies model a systematic use of the nursing process. At the same time, students are not limited to these taxonomies as the information flows well within other internal models of the nursing process.

Clinical Interactions present a brief patient history and then provide clinical interactions between client and nurse to promote effective therapeutic communication skills.

Vignettes give insights into brief client scenarios and their applications relevant to chapter topics.

Key Concepts are listed at the end of each chapter. Students who read these concepts before reading the chapter will find this helpful in focusing their attention. Key concepts are also a useful tool to quickly review the chapter content.

Culture-Specific Content continues to be a feature of Chapters 11 through 23. In addition to Chapter 5, The Role of Cultural Diversity in Mental Health Nursing, culture-specific characteristics are highlighted throughout these chapters to show students the importance of cultural considerations when caring for a variety of clients.

New Features in the Fifth Edition

While retaining many of the strengths of the previous edition, this new fifth edition of Mental Health Nursing includes much new and significantly updated material, new pedagogical features, and new emphases.

Learning Objectives and Key Terms introduce each chapter. Page numbers are included with each key term to identify the place where the term first appears in the chapter, in bold blue type. In addition, other important terms are bolded within the chapter content. The glossary on the student CD-ROM, is expanded to twice the previous size.

Critical Thinking Exercises are integrated in every chapter in the text. Answers to these exercises are found on the accompanying Student CD-ROM and the Instructor's Resource CD-ROM and Instructor's Resource Manual.

Complementary/Alternative Therapies describe the use of and "how to" apply complementary therapy as an adjunct to traditional psychiatric care. Books for Clients & Families provide a listing of useful books for clients and their families.

Community Resources include names and addresses of agencies and organizations that may provide additional information to students about a variety of topics.

Lengthy clinical pathways have been eliminated with the expansion of the nursing process section. A sample of a clinical pathway is provided in Chapter 11, Anxiety Disorders. Evaluation is linked to outcome criteria, enabling the student to see the ongoing process of professional nursing practice. Interactive Care Plan activities on the Companion Web site allow students to develop their own care plans based on a specific client scenario. Students can e-mail these custom care plans to their instructors as homework assignments.

A new feature, MediaLink, introduces each chapter of the text and lists additional specific content, animations, NCLEX Review, tools, and other interactive exercises that appear on the accompanying Student CDROM and the Companion Web site. MediaLink icons appear throughout the chapter to indicate topics in the textbook that are further explained on the accompanying media supplements. Finally, at the end of each chapter, the section entitled EXPLORE MediaLink encourages students to use the CD-ROM and the Companion Web site to apply what they have learned from the text in case studies, practice NCLEX questions, and use additional resources. The purpose of the MediaLink feature is to further enhance the student experience, build on knowledge gained from the text book, prepare students for the NCLEX, and foster critical thinking.

Chapter 17, a new chapter on Spectrum Disorders, focuses on attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, Tourette's disorder, bipolar disorder, Asperger's syndrome, and autistic disorder. These disorders are grouped together not only because they begin in childhood but also because they are linked by overlapping signs and symptoms and genetic similarities.

Chapter 19 is a new chapter on Neuropsychiatric Problems. While these are not mental disorders per se, the disorders covered in this chapter have significant psychiatric symptoms as part of the clinical picture. This chapter is designed to help students see the application of psychiatric nursing principles to medical conditions.

A new chapter on Community Violence, Chapter 23, focuses on the perpetrators and victims of violence in American culture, including the effects of terrorism. The emphasis is on children and adolescents as they are the largest demographic group involved in and affected by violent behavior.

Chapter 1, Introduction to Mental Health Nursing, includes new material on the human genome, diathesis-stress model, nature versus nurture, genetic anticipation, and behavioral genetics.

The fifth edition of the text increases emphasis on family and community mental health by expanding it to two chapters. Chapter 3, The Family in Mental Health Nursing, focuses on the competency model of mental health nursing. New or expanded material includes boundaries, family burden, family pain, family recovery, expressed emotion, and cultural assessment of families. Chapter 4, The Community in Mental Health Nursing, reflects today's changing health care environment. New or expanded material includes the Americans with Disabilities Act, Individual with Disabilities Education Act, least restrictive environment, homeless populations, crisis response services, recovery-oriented nursing interventions, and community-based nursing practice.

Chapter 7 on Neurobiology and Behavior has been extensively revised, including new artwork illustrating structures of the brain, pathways of fear, and ligands and neurotransmission. New or expanded content includes neuroplasticity, free radicals and antioxidants, executive functions, reward deficiency syndrome, feedback and feedforward, working memory versus long-term memory, emotions, language and self-talk, motivation, and psychoneuroimmunology.

Chapter 10, Treatment Modalities, has been extensively revised and includes the negative impact of seclusion and restraints. Suggestions are provided to prevent the use of these aversive "interventions." New or expanded content includes civil rights protection, crisis intervention, 12step programs, online support groups, social skills training, self-esteem interventions, physical exercise, group therapy, and play and art therapy. An overview of the major alternative therapies is provided, with a focus on how these are used in mental health settings.

Most chapters have been revised to include new information from the neurobiological sciences, DSMIV-TR boxes, community resources, and suggested books for clients and families. Age-Specific Characteristics are integrated into each chapter, appearing as a distinct head in the chapter content and replacing the chapters on children and adolescents and older adults from the fourth edition. This is a separate chapter feature apart from the childhood disorders presented in Chapter 17, Spectrum Disorders.

About the Artwork and Poetry

All of the artwork and corresponding descriptions at the opening of each unit and chapter are creative expressions of psychiatric patients involved in the Expressive Therapy program at Four Winds-Saratoga, Saratoga Springs, New York. In the Expressive Therapy groups, patients are encouraged to utilize a range of art media to depict and explore their internal landscapes, clarify and communicate their struggles, and identify obstacles, as well as discover their strengths and create the ways to more effectively direct the journey toward a more gratifying life. Giving shape, form, and color to feelings promotes an increased sense of mastery over even the most painful affect. The communication through art then promotes the sharing of experiences in a safe and nonthreatening manner. The transformation of overwhelming feelings into the constructive communication embodied in the art object nurtures the patients' spontaneity and problem-solving skills in life, thereby promoting increased understanding of self and connection to others.

Submission of work for this book was voluntary and offered to patients at the end of each Expressive Therapy group over a period of six weeks. Once submitted, the appropriate legal releases of the work were secured from the individuals or their guardians, if under age 18. Many patients submitted work and were enthusiastic and appreciative of the invitation to contribute to the further education of professionals. By sharing their use of the modality of Expressive Therapy, they are sharing a very intimate dynamic expression of their search for direction, connection, strength, and hope in their individual healing process. Expressive Therapy makes manifest our belief that each individual is unique, as is his or her vision of life experience. To share that vision sparks our recognition of our common human experience. With that recognition comes the possibility of a society of greater benevolence, human dignity, and respect (Catherine Sanderson, Expressive Arts Therapist, Four Winds-Saratoga).

All New Comprehensive Teaching and Learning Package

To enhance the teaching and learning process, the following supplements have been developed in close correlation with the new edition of Mental Health Nursing. The full complement of supplemental teaching materials is available to all qualified instructors from your Prentice Hall Health Sales Representative.

Student CD-ROM. A new addition to this package, the Student CD-ROM includes NCLEX-style multiple-choice questions that emphasize the application of nursing care. Students can test their knowledge and gain immediate feedback through rationales for right and wrong answers. The CD-ROM also provides several animations to help students understand and visualize more difficult concepts in mental health nursing care. Answers to the critical thinking exercises from the textbook NOC and NIC classifications, and the glossary are provided on the CD-ROM, with complete discussions of these topics. Finally, the CDROM allows access to the Companion Web site described below. This CD-ROM is packaged free with every copy of the textbook.

Clinical Companion. This clinical companion serves as a portable, quick reference to psychiatric-mental health nursing. Topics include DSMIV TR classifications, common diagnostic studies, over 20 clinical applications for mental health disorders, medications, and much more. This handbook will allow students to bring the information they learn from class into any clinical setting.

Instructor's Resource Manual. This manual contains a wealth of material to help faculty plan and manage the mental health nursing course. It includes chapter overviews, detailed lecture suggestions and outlines, learning objectives, a complete test bank, answers to the textbook critical thinking exercises, teaching tips, and more for each chapter. The IRM also guides faculty on how to assign and use the text-specific Companion Web site, www.prenhall.com/fontaine, and the CD-ROM that accompany the textbook.

Instructor's Resource CD-ROM. New to this package, the Instructor's Resource CD-ROM provides many resources in an electronic format. First, the CD-ROM includes the complete test bank in Test-Gen format. Second, it includes a comprehensive collection of images from the textbook in PowerPoint format, so faculty can easily import these photographs and illustrations into their own classroom lecture presentations. Finally, the CDROM provides instructors with access to the same animations that appear on the Student CD-ROM, so faculty can incorporate these visual accents into their lectures.

Companion Web Site and Syllabus ManagerĀ®. New to this package is a free Companion Web site at www.prenhall.com/fontaine. This Web site serves as a text-specific, interactive online workbook to Mental Health Nursing, Fifth Edition. The Companion Web site includes modules for Learning Objectives, Audio Glossary, Chapter Summary for lecture notes, NCLEX Review Questions, Case Studies, Care Plan activities, Message Board discussion questions, Web Links, and Nursing Tools, such as Standards of Practice, NANDA Nursing Diagnoses, and more. Instructors adopting this textbook for their courses have free access to an online Syllabus Manager with a whole host of features that facilitate the students' use of this Companion Web site and allow faculty to post their syllabi online for their students. For more information or a demonstration of Syllabus Manager, please contact your Prentice Hall Health Sales Representative or go online to www.prenhall.com/demo.

Online Course Management Systems. Also new to this package are online course companions available for schools using Blackboard, WebCT or Course Compass course management systems. For more information about adopting an online course management system to accompany Mental Health Nursing, Fifth Edition, please contact your Prentice Hall Health Sales Representative or go online to www.prenhall.com/demo.

Karen Lee Fontaine

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Introduction

Goals of Mental Health Nursing

Mental, behavioral, and social health problems are increasing throughout the world. According to recent world studies, four of the ten leading causes of disability worldwide are mental illnesses. In the United States, mental illnesses are the nation's second leading cause of disability, and mental illness has been classified as a public health crisis.

My goal is that nursing students and nurses in all professional practice specialties incorporate psychiatric nursing skills as they work with a variety of clients to improve the quality of life and achieve the highest possible level of functioning. Strong interpersonal and communication skills are critical to every area of practice. In addition, nurses encounter people with mental illnesses in inpatient, outpatient, and community sites including medical-surgical settings, intensive care units, emergency departments, obstetrics, and pediatrics. Thus, wherever you practice nursing, your mental health nursing skills will help you think critically and creatively.

The fifth edition of Mental Health Nursing is designed to appeal to both traditional and nontraditional nursing students. The text is written in a user-friendly style for undergraduate students with the understanding that students and clients encompass a wide range of ages and ethnic groups, both genders, and a variety of sexual identities. This diversity is reflected throughout the text.

This text is based on the belief that the practice of mental health nursing means taking time to be with clients and their families in deeply caring ways. To that end, nursing students are encouraged to engage inself-analysis in order to increase their self-understanding and self-acceptance. This is important because nurses who are able to clarify their own beliefs and values are less likely to be judgmental or to impose their own values and beliefs on clients.

Language is a powerful tool that reflects our beliefs and values. When we refer to someone with a disability by a label, we profess a belief that the disability is the most important feature about that person. This attitude is reflected when we label people as alcoholics, schizophrenics, or quadriplegics. In contrast, I use "people-first" language. I acknowledge the person first by saying, "a person with schizophrenia" or "a person who has a substance abuse problem." In the same spirit, I use the words "client" and "consumer" interchangeably. I believe these terms reflect people with options and choices who have the right to determine their own direction in life.

Philosophical and Theoretical Frameworks

Many theories and models are relevant to the practice of mental health nursing. It is the integration of these theories that creates the unique domain of mental health nursing as we respond to the social, cultural, environmental, and biological components of mental illness. It is important that we maintain the art of nursing, which is being there, with another person or persons, in a context of caring. It involves compassion and sensitivity to each person within the context of her or his entire life.

The model basic to this text is one of competency. This is based on the belief that individuals and families are resourceful and have the capacity to grow and change. The competency model does not ignore pathology and dysfunction but emphasizes strengths and adaptation. The role of nursing is to empower people to respond and adapt to life circumstances. In this spirit, nurses develop collaborative partnerships with clients and families. The overall goal is to provide the support, education, coping skills training, and advocacy necessary for successful living, learning, and working in the community. Consumer-sensitive nursing care helps people assume personal responsibility for where they are in their lives and for where they are going.

Traditional Strengths of Mental Health Nursing

In the fifth edition, Mental Health Nursing retains many of the strengths that have made it a popular "user-friendly" text for nursing students.

There is a heavy emphasis throughout the text on the development of effective communication skills. Chapter 2, Relating, Communicating, and Teaching, includes a new example of a student-client interaction and an analysis thereof in the form of a process recording. Each chapter in Part IV, Mental Disorders, features Clinical Interactions, illustrating a therapeutic interaction between a nurse and client.

The nursing process is the organizing framework for Chapters 11 through 23. This organizational consistency is extremely effective in helping students begin to assess, analyze, plan, implement, and evaluate in a systematic manner. The Focused Nursing Assessment feature aids students in learning the type and range of assessment questions to ask particular clients. NANDA diagnoses are correlated with Nursing Outcomes Classification (NOC) and with Nursing Interventions Classification (NIC) in tables. These taxonomies model a systematic use of the nursing process. At the same time, students are not limited to these taxonomies as the information flows well within other internal models of the nursing process.

Clinical Interactions present a brief patient history and then provide clinical interactions between client and nurse to promote effective therapeutic communication skills.

Vignettes give insights into brief client scenarios and their applications relevant to chapter topics.

Key Concepts are listed at the end of each chapter. Students who read these concepts before reading the chapter will find this helpful in focusing their attention. Key concepts are also a useful tool to quickly review the chapter content.

Culture-Specific Content continues to be a feature of Chapters 11 through 23. In addition to Chapter 5, The Role of Cultural Diversity in Mental Health Nursing, culture-specific characteristics are highlighted throughout these chapters to show students the importance of cultural considerations when caring for a variety of clients.

New Features in the Fifth Edition

While retaining many of the strengths of the previous edition, this new fifth edition of Mental Health Nursing includes much new and significantly updated material, new pedagogical features, and new emphases.

Learning Objectives and Key Terms introduce each chapter. Page numbers are included with each key term to identify the place where the term first appears in the chapter, in bold blue type. In addition, other important terms are bolded within the chapter content. The glossary on the student CD-ROM, is expanded to twice the previous size.

Critical Thinking Exercises are integrated in every chapter in the text. Answers to these exercises are found on the accompanying Student CD-ROM and the Instructor's Resource CD-ROM and Instructor's Resource Manual.

Complementary/Alternative Therapies describe the use of and "how to" apply complementary therapy as an adjunct to traditional psychiatric care. Books for Clients & Families provide a listing of useful books for clients and their families.

Community Resources include names and addresses of agencies and organizations that may provide additional information to students about a variety of topics.

Lengthy clinical pathways have been eliminated with the expansion of the nursing process section. A sample of a clinical pathway is provided in Chapter 11, Anxiety Disorders. Evaluation is linked to outcome criteria, enabling the student to see the ongoing process of professional nursing practice. Interactive Care Plan activities on the Companion Web site allow students to develop their own care plans based on a specific client scenario. Students can e-mail these custom care plans to their instructors as homework assignments.

A new feature, MediaLink, introduces each chapter of the text and lists additional specific content, animations, NCLEX Review, tools, and other interactive exercises that appear on the accompanying Student CDROM and the Companion Web site. MediaLink icons appear throughout the chapter to indicate topics in the textbook that are further explained on the accompanying media supplements. Finally, at the end of each chapter, the section entitled EXPLORE MediaLink encourages students to use the CD-ROM and the Companion Web site to apply what they have learned from the text in case studies, practice NCLEX questions, and use additional resources. The purpose of the MediaLink feature is to further enhance the student experience, build on knowledge gained from the text book, prepare students for the NCLEX, and foster critical thinking.

Chapter 17, a new chapter on Spectrum Disorders, focuses on attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, Tourette's disorder, bipolar disorder, Asperger's syndrome, and autistic disorder. These disorders are grouped together not only because they begin in childhood but also because they are linked by overlapping signs and symptoms and genetic similarities.

Chapter 19 is a new chapter on Neuropsychiatric Problems. While these are not mental disorders per se, the disorders covered in this chapter have significant psychiatric symptoms as part of the clinical picture. This chapter is designed to help students see the application of psychiatric nursing principles to medical conditions.

A new chapter on Community Violence, Chapter 23, focuses on the perpetrators and victims of violence in American culture, including the effects of terrorism. The emphasis is on children and adolescents as they are the largest demographic group involved in and affected by violent behavior.

Chapter 1, Introduction to Mental Health Nursing, includes new material on the human genome, diathesis-stress model, nature versus nurture, genetic anticipation, and behavioral genetics.

The fifth edition of the text increases emphasis on family and community mental health by expanding it to two chapters. Chapter 3, The Family in Mental Health Nursing, focuses on the competency model of mental health nursing. New or expanded material includes boundaries, family burden, family pain, family recovery, expressed emotion, and cultural assessment of families. Chapter 4, The Community in Mental Health Nursing, reflects today's changing health care environment. New or expanded material includes the Americans with Disabilities Act, Individual with Disabilities Education Act, least restrictive environment, homeless populations, crisis response services, recovery-oriented nursing interventions, and community-based nursing practice.

Chapter 7 on Neurobiology and Behavior has been extensively revised, including new artwork illustrating structures of the brain, pathways of fear, and ligands and neurotransmission. New or expanded content includes neuroplasticity, free radicals and antioxidants, executive functions, reward deficiency syndrome, feedback and feedforward, working memory versus long-term memory, emotions, language and self-talk, motivation, and psychoneuroimmunology.

Chapter 10, Treatment Modalities, has been extensively revised and includes the negative impact of seclusion and restraints. Suggestions are provided to prevent the use of these aversive "interventions." New or expanded content includes civil rights protection, crisis intervention, 12step programs, online support groups, social skills training, self-esteem interventions, physical exercise, group therapy, and play and art therapy. An overview of the major alternative therapies is provided, with a focus on how these are used in mental health settings.

Most chapters have been revised to include new information from the neurobiological sciences, DSMIV-TR boxes, community resources, and suggested books for clients and families. Age-Specific Characteristics are integrated into each chapter, appearing as a distinct head in the chapter content and replacing the chapters on children and adolescents and older adults from the fourth edition. This is a separate chapter feature apart from the childhood disorders presented in Chapter 17, Spectrum Disorders.

About the Artwork and Poetry

All of the artwork and corresponding descriptions at the opening of each unit and chapter are creative expressions of psychiatric patients involved in the Expressive Therapy program at Four Winds-Saratoga, Saratoga Springs, New York. In the Expressive Therapy groups, patients are encouraged to utilize a range of art media to depict and explore their internal landscapes, clarify and communicate their struggles, and identify obstacles, as well as discover their strengths and create the ways to more effectively direct the journey toward a more gratifying life. Giving shape, form, and color to feelings promotes an increased sense of mastery over even the most painful affect. The communication through art then promotes the sharing of experiences in a safe and nonthreatening manner. The transformation of overwhelming feelings into the constructive communication embodied in the art object nurtures the patients' spontaneity and problem-solving skills in life, thereby promoting increased understanding of self and connection to others.

Submission of work for this book was voluntary and offered to patients at the end of each Expressive Therapy group over a period of six weeks. Once submitted, the appropriate legal releases of the work were secured from the individuals or their guardians, if under age 18. Many patients submitted work and were enthusiastic and appreciative of the invitation to contribute to the further education of professionals. By sharing their use of the modality of Expressive Therapy, they are sharing a very intimate dynamic expression of their search for direction, connection, strength, and hope in their individual healing process. Expressive Therapy makes manifest our belief that each individual is unique, as is his or her vision of life experience. To share that vision sparks our recognition of our common human experience. With that recognition comes the possibility of a society of greater benevolence, human dignity, and respect (Catherine Sanderson, Expressive Arts Therapist, Four Winds-Saratoga).

All New Comprehensive Teaching and Learning Package

To enhance the teaching and learning process, the following supplements have been developed in close correlation with the new edition of Mental Health Nursing. The full complement of supplemental teaching materials is available to all qualified instructors from your Prentice Hall Health Sales Representative.

Student CD-ROM. A new addition to this package, the Student CD-ROM includes NCLEX-style multiple-choice questions that emphasize the application of nursing care. Students can test their knowledge and gain immediate feedback through rationales for right and wrong answers. The CD-ROM also provides several animations to help students understand and visualize more difficult concepts in mental health nursing care. Answers to the critical thinking exercises from the textbook NOC and NIC classifications, and the glossary are provided on the CD-ROM, with complete discussions of these topics. Finally, the CDROM allows access to the Companion Web site described below. This CD-ROM is packaged free with every copy of the textbook.

Clinical Companion. This clinical companion serves as a portable, quick reference to psychiatric-mental health nursing. Topics include DSMIV TR classifications, common diagnostic studies, over 20 clinical applications for mental health disorders, medications, and much more. This handbook will allow students to bring the information they learn from class into any clinical setting.

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