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Prentice Hall
Mental Health Nursing / Edition 5

Mental Health Nursing / Edition 5

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Product Details

ISBN-13: 9780130979926
Publisher: Prentice Hall
Publication date: 01/28/2003
Edition description: 5TH BK&CDR
Pages: 752
Product dimensions: 8.26(w) x 10.06(h) x 1.30(d)

About 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.

Table of Contents

About the Authorxix
Part IFoundations of Mental Health Nursing1
Chapter 1Introduction to Mental Health Nursing3
Mental Health and Mental Illness5
Significance of Mental Disorders7
Theories of Mental Disorders7
The Therapeutic Relationship27
Nursing Process in Mental Health Nursing32
Meeting the Challenges of the Twenty-First Century43
Chapter 2Relating, Communicating, and Educating49
Chapter 3The Family in Mental Health Nursing79
Family Systems80
Psychiatric Disability and the Family System84
Mental Disorders Across the Life Span86
Death and the Family System88
Family Nursing Practice92
Assessment of Vulnerability to Relapse93
Cultural Assessment93
Chapter 4The Community in Mental Health Nursing99
Treatment Settings and Services101
Community Services103
Community-Based Nursing Practice104
Community-Based Nursing Interventions108
Chapter 5The Role of Cultural Diversity in Mental Health Nursing115
Culture and Mental Health117
Caring for a Diverse Population126
Diversity Within the Profession132
Chapter 6Legal and Ethical Issues137
Types of Admission138
Informed Consent140
Client Rights140
Reporting Laws141
Duty to Disclose/Protect141
Leaving Against Medical Advice (LAMA)142
Omnibus Mental Illness Recovery Act143
Clients with Legal Charges143
The Mentally III in Correctional Settings143
Caring: A Prerequisite to Ethical Behavior144
Nursing Ethics144
Part IIFoundations of Neurology151
Chapter 7Neurobiology and Behavior153
Development of the Brain154
Functions of the Brain172
Nutritional Neuroscience177
Chapter 8Psychopharmacology183
Introductory Concepts184
Psychotropic Medications185
Antipsychotic Medications185
Adjunctive Medications for EPSs190
Antidepressant Medications190
Mood-Stabilizing Medications194
Antianxiety Medications197
Central Nervous System Stimulants199
Special Populations and Psychopharmacological Treatment201
Nursing Interventions204
Client and Family Participation206
Part IIITherapeutic Approaches213
Chapter 9Cross-Diagnosis Behaviors215
Clients Experiencing Hallucinations216
Clients Experiencing Delusions219
Clients Who Self-Mutilate221
Clients Who Are Aggressive223
Chapter 10Treatment Modalities233
Mental Health Care Consumers234
Mental Health Care Professionals235
Milieu Therapy237
Individual Psychotherapy238
Crisis Intervention239
Family Therapy245
Behavioral Therapy247
Play Therapy248
Art Therapy249
Biological Therapies249
Psychosocial Nursing Interventions252
Complementary/Alternative Therapies255
Part IVMental Disorders267
Chapter 11Anxiety Disorders269
Knowledge Base271
Nursing Process298
Chapter 12Eating Disorders315
Anorexia Nervosa and Bulimia Nervosa316
Knowledge Base319
Nursing Process333
Chapter 13Mood Disorders345
Knowledge Base350
Nursing Process371
Chapter 14Schizophrenic Disorders395
Knowledge Base397
Nursing Process412
Chapter 15Substance-Related Disorders427
Knowledge Base431
Nursing Process458
Chapter 16Personality Disorders477
Knowledge Base479
Nursing Process494
Chapter 17Spectrum Disorders507
Knowledge Base509
Nursing Process524
Part VNeurobehavioral Brain Disorders539
Chapter 18Cognitive Impairment Disorders541
Knowledge Base: Dementia543
Knowledge Base: Delirium554
Nursing Process558
Chapter 19Neuropsychiatric Problems573
Knowledge Base574
Nursing Process581
Part VIDysinhibition Syndromes589
Chapter 20Suicide591
Knowledge Base593
Nursing Process601
Chapter 21Domestic Violence611
Sibling Abuse613
Child Abuse614
Partner Abuse--Heterosexual616
Partner Abuse--Homosexual616
Elder Abuse617
Emotional Abuse617
Abuse of Pregnant Women617
Knowledge Base619
Nursing Process627
Chapter 22Sexual Violence639
Sexual Harassment640
Childhood Sexual Abuse643
Knowledge Base: Rape644
Nursing Process649
Knowledge Base: Childhood Sexual Abuse654
Nursing Process661
Chapter 23Community Violence675
Types of Violence677
Types of Homicide678
Settings of Community Violence679
Knowledge Base681
Nursing Process685
DSM-IV-TR Classification697


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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