Psychiatric and Mental Health Nursing

Transcription

1 Psychiatric and Mental Health Nursing

2 Psychiatric and Mental Health Nursing Theory and practice William Reynolds Senior Tutor, Highland College of Nursing and Midwifery Raigmore Hospital, Inverness and Desmond Cormack Honorary Reader in Health and Nursing Queen Margaret College, Edinburgh SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.

3 First edition 1990 Springer Science+ Business Media Dordrecht 1990 Originally published by Chapman and Hall in 1990 Typeset in 10112pt Palatino by Best-set Typesetter Ltd ISBN DOI / ISBN (ebook) All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, or stored in any retrieval system of any nature, without the written permission of the copyright holder and the publisher, application for which shall be made to the publisher. British Library Cataloguing in Publication Data Reynolds, William Psychiatric and mental health nursing. 1. Mentally disordered patients. Nursing I. Title II. Cormack, Desmond Library of Congress Cataloging-in-Publication Data Psychiatric and mental health nursing: theory and practice / [edited by] William Reynolds and Desmond Cormack. -1st ed. p. cm. Includes bibliographical references. 1. Psychiatric nursing. I. Reynolds, William, II. Cormack, Desmond. [DNLM: 1. Models, Psychological. 2. Psychiatric Nursingmethods. WY 160 P9715] RC440.P '68-dc20 DNLMIDLC for Library of Congress CIP

4 Contents Contributors vii Preface ix Part One THE ROLE OF THE PSYCHIATRIC NURSE 1 1 Psychiatric and mental health nursing: theory and practice 3 W. Reynolds and D. Cormack 2 Classifying human responses in psychiatric and mental health 23 nursing A. O'Toole and M. Loomis Part Two THEORETICAL MODELS: PRINCIPLES 41 AND GENERAL APPLICATIONS 3 Cognitive therapy model: principles and general applications 43 P. Barker 4 Behaviour therapy model: principles and general applications 63 A. Hume 5 Interpersonal relations model: principles and 87 general applications H. E. Peplau 6 General systems model: theoretical constructs, principles 133 and general applications S. A. Smoyak 7 Rogers' client-centred model: principles and general 153 a pp lica tions W. Reynolds 8 Orem's self-care model: principles and general applications 175 P. R. Underwood 9 Roy's adaptation model: principles and general applications 188 K. Dorsey and S. Purcell 10 The eclectic approach: principles and general applications 197 P. Schroder and B. Benfer

5 vi Contents Part Three THEORETICAL MODELS: SPECIFIC CLINICAL 221 APPLICATIONS 11 Cognitive therapy model: clinical applications 223 P. Barker 12 Behaviour therapy model: clinical applications 242 A. Hume 13 Peplau's interpersonal model: clinical applications 261 P. Martin 14 General systems model: clinical applications 279 S. A. Smoyak 15 The Rogerian client-centred model: clinical applications 304 D. A. Bertin 16 Orem's self-care model: clinical app!ications 319 P. R. Underwood and S. Meuser 17 Roy's adaptation model: clinical applications 346 S. Purcell and K. Dorsey 18 The eclectic approach: clinical applications 354 B. Benfer and P. Schroder PartFour ISSUES RELATED TO TEACHING, LEARNING 371 PSYCHIATRIC AND MENTAL HEALTH NURSING, AND THE SCOPE OF PSYCHIATRIC NURSING RESEARCH 19 Teaching psychiatric and mental health nursing: a teaching 373 perspective W. Reynolds 20 Psychiatric and mental health nursing: learning in the clinical 396 environment M. Chambers 21 Research and psychiatric nursing 434 B.D.Davis Index 468

6 Con tribu tors Philip Barker, RNMH, PhD, Honorary Lecturer, Department of Psychiatry, University of Dundee, Scotland. Beverly Benfer, RN, MA, FAAN, Consultant in Administrative and Psychiatric Nursing, Marion, la, USA. David A. Bertin, RMN, RGN, Cert Behaviour Therapy Nursing, Clinical Nurse Specialist, Argyll and Bute Hospital, Lochgilphead, Argyll, Scotland. Mary Chambers, RGN, RMN, Dip Nurs (Lond), RNT, BEd (Hons), Senior Lecturer in Psychiatric Nursing, Department of Nursing and Health Visiting, University of Ulster, Coleraine, Londonderry, Northern Ireland. Desmond F. S. Cormack, RMN, RGN, MPhil, Dip Ed, Dip Nurs, PhD, Honorary Reader in Health and Nursing, Queen Margaret College, Clerwood Terrace, Edinburgh, Scotland. Bryn Davis, BD, SRN, RMN, RNT, BSc, PhD, Principal Lecturer, Department of Community Studies, Brighton Polytechnic, Brighton, England. Katherine Dorsey, RN, MS, BSN, Nursing Home Care Unit, Veterans Administration Medical Center, Roseburg, OR, USA. Anne Hume, RGN, RMN, Cert Behaviour Therapy Nursing, Senior Nurse Therapist, The Montgomery Clinic, Edinburgh, Scotland. Maxine E. Loomis, RN, CS, PhD, FAAN, Professor and Director (PhD Program), University of South Carolina, College of Nursing, Columbia, SC, USA. Peggy Martin, RGN, RMN, Dip N (Lond), RCNT, RNT, Senior Tutor, Sussex Downs School of Nursing, Hellingly Hospital, Harlsham, England.

7 viii Contributors Shelagh Meuser, RN, BS, Lieutenant Commander, The Naval Hospital, Portsmouth, VA, USA. Anita O'Toole, RN, PhD, CS, Professor and Graduate Program Director (Psychiatric Mental Health Nursing), School of Nursing, Kent State University, Kent, OH, USA. Hildegard Peplau, RN, EdD, FAAN, Professor Emerita, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA. Shirley Purcell, RN, MN, Associate Chief, Veterans Administration Medical Center, Roseburg, OR, USA. William Reynolds, RMN, RNT, RGN, MPhil, Senior Tutor, Highland College of Nursing and Midwifery, Raigmore Hospital, Inverness, Scotland. Patricia Schroder, RN, MA, CS, Consultant in Psychiatric Nursing, Marion, la, USA. Shirley Smoyak, RN, PhD, FAAN, Professor of Doctoral Nursing Studies, Faculty of Planning, Institute of Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA. Patricia Underwood, RN, DNSc, FAAN, Professor of Clinical Nursing and Vice Chair, Department of Mental Health, Community and Administrative Nursing, School of Nursing, University of California, San Francisco, CA, USA.

8 Preface Psychiatric and Mental Health Nursing: Theory and practice was conceived as a result of three major premises which, in the view of the editors, relate to the practice of psychiatric and mental health nursing. First, that high-quality psychiatric and mental health nursing can be practised only if it is underpinned by appropriate nursing theory. Secondly, that there exists a body of theory which can and should be applied to psychiatric and mental health nursing. Thirdly, that there is a need for a text which will assist teachers, students and clinicians to apply available nursing and borrowed theory to clinical practice. The general aim of this book is to introduce nursing students to a theorybased approach to caring for people with psychiatric and mental health problems. The phrase psychiatric and mental health problems indicates that the text relates to clients with a psychiatric diagnosis, and also to those who have mental health problems but who do not necessarily have such a diagnosis. The client group to which the material in this text applies will include those who are, or have been, hospitalized and those in the community who have not been, and may never be, hospitalized. The intended readership is all students of psychiatric and mental health nursing issues, for example basic and post-basic nurses, and their teachers. Established clinicians who are seeking to develop skills in applying psychiatric and mental health nursing theory to practice will, we hope, also find the content of value. While the book is primarily intended for nurses, it should also be of interest to all other groups of psychiatric and mental health workers such as social work, clinical psychology and occupational therapy students. The special features of this book are that it is essentially a nursing book which seeks to identify problems which nurses can treat, and the means by which that can be done. Selected theoretical models are discussed in relation to general principles and applications, then applied to examples of

9 x Preface specific psychiatric and mental health problems. It is intended to rectify the relative weakness of many texts on nursing theory which do not blly address nursing practice, and many relating to nursing practice which do not fully address nursing theory. By addressing both nursing theory and practice via the application of theory, the text will introduce readers to the rationale underpinning a variety of nursing treatment strategies. Part One of the text (Chapters 1 and 2) introduces the role of nurse in terms of using theory-based strategies in order to personally influence the mental health of clients. Chapter 1 traces the development of the nurse's role from that of providing custodial care, to the identification and treatment of human responses to psychiatric and mental health problems, via the application of nursing theory. The application of theory to practice is dependent on making one or more nursing diagnoses as a means of focusing nursing care on one or more specific patient needs/problems. Chapter 2 gives a classification of human responses which, we believe, provides an appropriate framework from which to make nursing diagnoses. Many of these responses are dealt with in practical terms in the subsequent two parts of the text (Chapters 3 to 18) and provide demonstrations of how diagnoses were made, and the application of theory to practice in order to effect desired change through appropriate nursing intervention. Part Two (Chapters 3 to 10) provides insight into the rationale, content and general principles of a number of selected major nursing and borrowed theories, and demonstrates the general application of these in relation to psychiatric and mental health nursing. Readers may wish to use Part Two in one of two ways. First, Chapters 3 to 10 might be read independently of the remainder of the text in order to study the principles and general applications of a number of major theories. Alternatively, readers may wish to study an individual chapter on principles and general applications, then move on to the corresponding chapter in Part Three which deals with clinical applications. Because of the common origins of some of the theories presented in this book, and because of similarities in the way in which some are interpreted and applied, there is inevitably a degree of overlap in the chapters in this and the subsequent part of the text. We make no apology for this overlap and view it as a demonstration of the need for nurses to be familiar with and, when appropriate, make use of more than one theory. This approach to nursing is reflected in our decision to include Chapters 10 and 18 which view psychiatric and mental health nursing from an eclectic perspective. Part Three (Chapters 11 to 18) demonstrates how each of the selected theories can be applied in particular clinical situations. Authors present a brief case-study of a client with specific needs/problems and describe how nursing care based on relevant theory can be delivered. These chapters enable readers to consider why clients behave in a certain way, guide them

10 Preface xi to an appropriate nursing diagnosis and intervention, and assist in the prediction and assessment of outcome. Part Four (Chapters 19 to 21) focuses on issues relating to teaching and learning psychiatric and mental health nursing, and on the nature and scope of psychiatric nursing research. The first two chapters in this part (Chapters 19 and 20) indicate our belief that teaching and learning this subject requires special insights, innovative and special teaching/learning approaches, and the development of a teacher-learner relationship which is not unlike the client-patient relationship. Finally, Chapter 21 reviews the contributions to, and limitations of, existing psychiatric and mental health nursing research. As with any textbook, Psychiatric and Mental Health Nursing: Theory and practice has its limitations. It does not deal with the pathology or aetiology of mental illness, with the contributions of other professionals, or with the structure and organization of psychiatric and mental health care generally, or nursing in particular, for example. However, these limitations are deliberate in that the general aim of the text is to demonstrate how nursing theory can be applied to clinical practice, and to place that application in the context of how the subject is being, and can be, taught, learned and researched. w. J. Reynolds (Inverness) and D. F. s. Cormack (Edinburgh), 1990