Psychiatric-Mental Health Nursing, 5th Edition

546 Pages·2012·11.98 MB·English

by  Sheila L. Videbeck

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Psychiatric–Mental
Health Nursing
FIFTH EDITION
SHEILA L. VIDEBECK, PhD, RN
Professor, Nursing
Des Moines Area Community College
Ankeny, Iowa
Illustrations by Cathy J. Miller
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Acquisitions Editor: Jean Rodenberger
Product Manager: Katherine Burland
Editorial Assistant: Laura Scott
Design Coordinator: Holly McLaughlin
Vendor Manager: Cynthia Rudy
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: MPS Limited, A Macmillan Company
Fifth Edition
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Copyright © 2008 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2006, 2004, 2001
by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book
may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other
electronic copies, or utilized by any information storage and retrieval system without written permission from the
copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this
book prepared by individuals as part of their official duties as U.S. government employees are not covered by the
above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut
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9 8 7 6 5 4 3 2 1
Printed in China
Library of Congress Cataloging-in-Publication Data
Videbeck, Sheila L.
Psychiatric-mental health nursing / Sheila L. Videbeck; [illustrations by Cathy J. Miller]. — 5th ed.
p.; cm.
Includes bibliographical references and index.
ISBN 978-1-60547-861-6 (alk. paper)
1. Psychiatric nursing. I. Title.
[DNLM: 1. Psychiatric Nursing. 2. Mental Disorders—nursing. WY 160 V652p 2011]
RC440.V536 2011
616.89’0231—dc22
2009045890
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted prac-
tices. However, the author, editors, and publisher are not responsible for errors or omissions or for any consequences
from application of the information in this book and make no warranty, expressed or implied, with respect to the cur-
rency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situ-
ation remains the professional responsibility of the practitioner; the clinical treatments described and recommended
may not be considered absolute and universal recommendations.
The author, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in
this text are in accordance with the current recommendations and practice at the time of publication. However, in
view of ongoing research, changes in government regulations, and the constant flow of information relating to drug
therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications
and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a
new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance
for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA
status of each drug or device planned for use in his or her clinical practice.
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Reviewers
MARGE BLONDELL, MS, RN KARREN BROWN LIEBERT, BSN, RN, MSN
Assistant Professor of Nursing (doctoral candidate)
Genesee Community College Assistant Professor
Batavia, New York Long Island University School of Nursing
Brooklyn, New York
MARTHA M. COLVIN, PhD, RN, APRN-PMHN
Associate Dean, College of Health Sciences and Professor
SUSAN MADSON, MSN, RN
Georgia College & State University, School of Nursing
Professor of Nursing
Milledgeville, Georgia
Horry Georgetown Technical College
Myrtle Beach, South Carolina
KAREN CUMMINS, CRNP-BC, MSN, CNE
Professor of Nursing
JOAN C. MASTERS, EdD, MBA, RN
Community College of Allegheny County
Associate Professor of Nursing
Pittsburgh, Pennsylvania
Bellarmine University
Nursing Instructor
Louisville, Kentucky
Slippery Rock University
Slippery Rock, Pennsylvania
KIMBERLEY R. MEYER, RN, BAN, MSN, EdD
PATRICIA H. DAVIS, RN, BSN, MN Associate Professor of Nursing
Professor of Nursing Bethel University
Lake City Community College St. Paul, Minnesota
Lake City, Florida
MAGDALENA MORRIS, RN, MSN
MARIAN T. DOYLE, RN, MSN, MS Faculty, LPN and ASN Programs
Associate Professor of Nursing Apollo College (DeVry)
Northampton Community College Boise, Idaho
Bethlehem, Pennsylvania
PENNY R. PAK, RN, MSN
ROSEMARY GATES, RN, MS Assistant Professor Nursing
Professor Pasco Hernando Community College
Crouse Hospital School of Nursing Dade City, Florida
Syracuse, New York
COLLEEN PRUNIER, MS, APRN, CARN
BARBARA J. GOLDBERG, APRN, BC
Assistant Professor of Nursing
Adjunct Professor of Nursing
Suffolk County Community College, School of Nursing
Onondaga Community College
Brentwood Campus, New York
Syracuse, New York
CARLA E. RANDALL, RN, PhD
DEBORAH A. GREENAWALD, RN, MSN, PhD(c)
University of Southern Maine, Lewiston-Auburn
Assistant Professor of Nursing
Campus
Alvernia University
Lewiston, Maine
Reading, Pennsylvania
ELLEN STUART, MSN, RN
ALICE P. JENSEN, MS, RN
Professor of Nursing
Associate Professor of Nursing
Grand Rapids Community College
Maryville University
Grand Rapids, Michigan
St. Louis, Missouri
PAMELA WEAVER, MSN, PMHCNS, BC
SOPHIE KNAB, MS (Psychiatric Clinical Nurse Specialist)
Professor, Nursing Division Nursing Instructor I
Niagara County Community College UPMC Shadyside School of Nursing
Sanborn, New York Pittsburgh, Pennsylvania
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Preface
The fifth edition of Psychiatric–Mental Health Nursing PEDAGOGICAL FEATURES
maintains a strong student focus, presenting sound nurs-
Psychiatric–Mental Health Nursing incorporates several ped-
ing theory, therapeutic modalities, and clinical applica-
agogical features designed to facilitate student learning:
tions across the treatment continuum. The chapters are
short and the writing style is direct in order to facilitate (cid:129) Learning Objectives focus the students’ reading and
reading comprehension and student learning. study.
This text uses the nursing process framework and em-
(cid:129) Key Terms identify new terms used in the chapter. Each
phasizes assessment, therapeutic communication, neurobi-
term is identified in bold and defined in the text.
ologic theory, and pharmacology throughout. Interventions
focus on all aspects of client care, including communica- (cid:129) Application of the Nursing Process sections use the as-
tion, client and family education, and community resources, sessment framework presented in Chapter 8, so students
as well as their practical application in various clinical can compare and contrast various disorders more easily.
settings.
(cid:129) Critical Thinking Questions stimulate students’ thinking
This new edition is supported with an ancillary package
about current dilemmas and issues in mental health.
designed to assist instructors with course planning and ex-
ecution, and student evaluation, and to assist students (cid:129) Key Points summarize chapter content to reinforce im-
with comprehensive knowledge synthesis. portant concepts.
(cid:129) Chapter Study Guides provide workbook-style ques-
ORGANIZATION OF THE TEXT tions for students to test their knowledge and under-
standing of each chapter.
Unit 1: Current Theories and Practice provides a strong
foundation for students. It addresses current issues in psy-
SPECIAL FEATURES
chiatric nursing as well as the many treatment settings in
which nurses encounter clients. It discusses thoroughly
(cid:129) Clinical Vignettes are provided for each major disorder
neurobiologic theories, psychopharmacology, and psycho-
discussed in the text to “paint a picture” for better
social theories and therapy as a basis for understanding
understanding.
mental illness and its treatment.
(cid:129) Drug Alerts highlight essential points about psycho-
Unit 2: Building the Nurse–Client Relationship pres-
tropic drugs.
ents the basic elements essential to the practice of mental
health nursing. Chapters on therapeutic relationships (cid:129) Cultural Considerations sections appear in each chap-
and therapeutic communication prepare students to ter, as a response to increasing diversity.
begin working with clients both in mental health settings
(cid:129) Therapeutic dialogues give specific examples of nurse–
and in all other areas of nursing practice. The chapter on
client interaction to promote therapeutic communica-
the client’s response to illness provides a framework for
tion skills.
understanding the individual client. An entire chapter is
devoted to assessment, emphasizing its importance in (cid:129) Internet Resources to further enhance study are located
nursing. at the end of each chapter.
Unit 3: Current Social and Emotional Concerns covers (cid:129) Client/Family Teaching boxes provide information that
topics that are not exclusive to mental health settings, in- help strengthen students’ roles as educators.
cluding legal and ethical issues; anger, aggression, and
(cid:129) Symptoms and Interventions are highlighted for chap-
hostility; abuse and violence; and grief and loss. Nurses in
ters in Units 3 and 4.
all practice settings find themselves confronted with issues
related to these topics. Additionally, many legal and ethical (cid:129) Sample Nursing Care Plans are provided for chapters in
concerns are interwoven with issues of violence and loss. Units 3 and 4.
Unit 4: Nursing Practice for Psychiatric Disorders covers (cid:129) Self-Awareness features appear at the end of each chap-
all the major categories identified in the DSM-IV-TR. Each ter, which encourage students to reflect on themselves,
chapter provides current information on etiology, onset their emotions, and their attitudes as a way to foster
and clinical course, treatment, and nursing care. both personal and professional development.
iv
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PREFACE v
ANCILLARY PACKAGE FOR (cid:129) Guided Lecture Notes
THE FIFTH EDITION
(cid:129) Online eBook
(cid:129) Journal Articles
Faculty
This fifth edition comes with a collection of ancillary ma-
Students
terials designed to help you plan class and clinical learning
Free and bound in the book, the fifth edition DVD-ROM
activities and evaluate students’ learning. The Instructor
supplies the following learning tools:
Resource DVD-ROM contains information and activities
that will help you engage your students throughout the (cid:129) Movie-Viewing Guides highlighting films depicting in-
semester, including dividuals with mental health disorders and providing
students the opportunity to approach nursing care re-
(cid:129) PowerPoint Slides
lated to mental health and illness in a novel way.
(cid:129) Image Bank
(cid:129) Clinical Simulations on Schizophrenia, Depression,
(cid:129) Test Generator and the Acutely Manic Phase that walk students through
case studies and put them in real-life situations.
Additional content and technology resources are avail-
able online at ThePoinnntt —http://thepoint.lww.com—allowing (cid:129) Drug Monographs of commonly prescribed psycho-
instructors easy access to an extensive selection of materials tropic drugs.
for each chapter, including
These and other valuable student resources, including
(cid:129) Pre-lecture Quizzes NCLEX-style psychiatric nursing questions designed to
help students prepare to face exams armed with confidence
(cid:129) Discussion Topics
and knowledge, are also available on ThePoinnntt —http://
(cid:129) Written, Group, Clinical, and Web Assignments thepoint.lww.com.
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Acknowledgments
As always, I am grateful to all the nursing students who appreciated. I thank Jean Rodenberger, Katherine Burland,
contribute to this book in more ways than they might Laura Scott, and Cynthia Rudy for a job well done once
imagine. Their continued questions and feedback guide again.
me to keep this text useful, easy to read and understand, My friends, Sheri and Beth, continue to listen, support,
and focused on student learning. and encourage me in all that I do while keeping me from
I want to thank the people at Lippincott Williams & taking myself too seriously. And the women in my neigh-
Wilkins for their valuable assistance in making this text- borhood who help me to laugh and enjoy life––their sup-
book a reality. Their contributions to its success are greatly port is greatly appreciated.
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Contents
UNIT 1 (cid:129) CURRENT THEORIES AND PRACTICE 1
Chapter 1 Foundations of Psychiatric-Mental Health Nursing 2
Mental Health and Mental Illness 2
Diagnostic and Statistical Manual of Mental Disorders 3
Historical Perspectives of the Treatment of Mental Illness 4
Mental Illness in the 21st Century 5
Psychiatric Nursing Practice 8
Chapter 2 Neurobiologic Theories and Psychopharmacology 17
The Nervous System and How It Works 18
Brain Imaging Techniques 21
Neurobiologic Causes of Mental Illness 23
The Nurse’s Role in Research and Education 24
Psychopharmacology 24
Cultural Considerations 37
Chapter 3 Psychosocial Theories and Therapy 43
Psychosocial Theories 44
Cultural Considerations 56
Treatment Modalities 56
The Nurse and Psychosocial Interventions 60
Chapter 4 Treatment Settings and Therapeutic Programs 65
Treatment Settings 66
Psychiatric Rehabilitation Programs 69
Special Populations of Clients with Mental Illness 71
Interdisciplinary Team 72
Psychosocial Nursing in Public Health and Home Care 73
UNIT 2 (cid:129) BUILDING THE NURSE–CLIENT RELATIONSHIP 79
Chapter 5 Therapeutic Relationships 80
Components of a Therapeutic Relationship 81
Types of Relationships 86
Establishing the Therapeutic Relationship 87
Avoiding Behaviors That Diminish the Therapeutic Relationship 91
Roles of the Nurse in a Therapeutic Relationship 93
Chapter 6 Therapeutic Communication 98
What Is Therapeutic Communication? 99
Verbal Communication Skills 101
Nonverbal Communication Skills 107
Understanding the Meaning of Communication 109
Understanding Context 110
Understanding Spirituality 110
Cultural Considerations 110
The Therapeutic Communication Session 111
Assertive Communication 114
Community-Based Care 115
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viii CONTENTS
Chapter 7 Client’s Response to Illness 119
Individual Factors 120
Interpersonal Factors 123
Cultural Factors 124
Chapter 8 Assessment 138
Factors Influencing Assessment 139
How to Conduct the Interview 140
Content of the Assessment 140
Assessment of Suicide or Harm Toward Others 143
Data Analysis 145
UNIT 3 (cid:129) CURRENT SOCIAL AND EMOTIONAL CONCERNS 155
Chapter 9 Legal and Ethical Issues 156
Legal Considerations 156
Ethical Issues 161
Chapter 10 Anger, Hostility, and Aggression 166
Onset and Clinical Course 167
Related Disorders 168
Etiology 168
Cultural Considerations 169
Treatment 169
Applying the Nursing Process 170
Workplace Hostility 176
Community-Based Care 176
Chapter 11 Abuse and Violence 180
Clinical Picture of Abuse and Violence 181
Characteristics of Violent Families 181
Cultural Considerations 182
Intimate Partner Violence 182
Child Abuse 185
Elder Abuse 188
Rape and Sexual Assault 190
Community Violence 193
Psychiatric Disorders Related to Abuse and Violence 194
Application of the Nursing Process 196
Chapter 12 Grief and Loss 205
Types of Losses 206
The Grieving Process 206
Dimensions of Grieving 208
Cultural Considerations 211
Disenfranchised Grief 213
Complicated Grieving 213
Application of the Nursing Process 215
UNIT 4 (cid:129) NURSING PRACTICE FOR PSYCHIATRIC DISORDERS 225
Chapter 13 Anxiety, Anxiety Disorders, and Stress-Related Illness 226
Anxiety as a Response to Stress 227
Incidence 232
Onset and Clinical Course 232
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