Islamic University of Gaza

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Islamic University of Gaza Faculty of nursing
Community Mental Health Nursing
Placement Semester 2 Credits 3
crds Lecturer Dr. Ashraf El-Jedi RN, DrPH
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Course Description -

• This module aims to provide students with an
  opportunity to explore the role and position of
  the community mental health nurse within a broad
  social, political and ethical context.  Community
  mental health is a key feature of this course
  with specific reference made to the use of
  cognitive behavioral therapy in the treatment of
  mental health problems. Dealing with the human
  mind and behaviours is not an exact science. The
  job of helping people back to mental health is
  every bit as valuable and satisfying as caring
  for those with a physical. It also focuses on
  investigating cultural perspectives of mental
  health/ illness, stigma, stereotyping and
  labeling. A range of material will be drawn upon
  in the module  from empirical and theoretical
  sources to service-user perspectives and
  accounts, which will offer the student insights
  and challenges to mental health nursing practice.

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Course objectives

• On completion of this course the student will be
  able to
• Understand the community mental health nursing,
  with specific reference to the increasing use of
  cognitive behavioral therapy.
• Apply case management and promoting recovery.
• Explore the role of community mental health nurse
  within a broad social, political and ethical
  context.
• Focus on theoretical issues related to negative
  cultural practices.
• Utilize effective communication process to
  collaborate with patients, staff, and families to
  promote and maintain mental health.
• Provide sensitive nursing care to culturally
  disadvantaged population of women, children, and
  aged population.
• Utilize theories focusing on occupational health.
• Promote healthy attitudes toward mental health
  and illness.

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Teaching Methods

• You will experience a variety of teaching and
  learning methods such as lectures, seminars,
  reflective practice, debates, simulation
  exercises, role-play, problem based learning and
  independent study. You will learn practical
  skills in a clinical environment where you will
  be fully supported by experienced qualified
  nurses. You will use a fully equipped skills
  centre to develop your clinical skills.

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Course Contents

1. Person, environment, mental health and nursing
2. Community-based psychiatric nursing care
3. Purpose of community mental health.
4. Prevention and mental health promotion
5. Families as resources, caregivers and
   collaborators
6. Family intervention
7. Crisis intervention
8. Recovery and psychiatric rehabilitation
9. Care of survivors of abuse and violence
10. Implementing the nursing process standards of
    practice and professional performance

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• Social factors and mental illness.
• Rehabilitation and mental illness.
• Stress and mental illness.
• Suicide and attempted suicide.
• The practice use of social services in mental
  health work.
• Social policy and mental illness.
• Alternatives in mental health care.

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Course Evaluation

• 30 Mid-Term
• 10 presentation
• 10 Case study
• 10 family assessment report
• 40 final Exam

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References

• Stuart, G. (2005). Principles and Practice of
  Psychiatric Nursing. 9th editin. Mosby.
• Sheila forster (2005). The role of the mental
  health nurse. londonnelson thornes ltd 2005
• Puckett A (1993). community mental health. W.B.
  Saunders. Sydney
• Mental Health Work in the Community Theory and
  Practice in Social Work and Community Psychiatric
  Nursing by Michael Sheppard (Paperback - 30 May
  1991)
• A Handbook for the Study of Mental Health Social
  Contexts, Theories, and Systems by Allan V.
  Horwitz and Teresa L. Scheid (Paperback).

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The Domains of Psychiatric Nursing
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• Nursing is and exciting, challenging, dynamic
  profession embedded in a stressed,
  underdeveloped, and rather chaotic health care
  system whatever nurses may say about their work,
  boredom and superficiality are rarely mentioned.
  The intensity of the emotion, the challenge of
  engaging a client in pursuit of health, and the
  knowledge that nursing is a vital service all
  serve to give meaning to even the most difficult
  workdays. Because of the importance of the work,
  nurses must learn and use nursing theories and
  concepts (the knowledge domain) to effect
  specific outcomes for the clients. The how of
  nursing is the nursing process (the practice
  domain)

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Person

• Person is defined as a living being with
  physical, cognitive, affective, behavioral, and
  social dimensions, who interacts with the
  environment to achieve a chosen life purpose.
  Three aspects of the definition are explored.

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Dimensions of the Person

• a person is thought to consist of five
  dimensions physical, cognitive, affective,
  behavioral, and social. The physical dimension
  includes neurobiologic, neurophysiologic, and
  biochemical aspects of the person.

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• However, persons do not function in the physical
  dimensions. The cognitive dimension is involved
  in the persons ability to formulate thoughts,
  process information, and solve problems. The
  affective dimension is involved the persons
  actions in the integration of the physical,
  cognitive, and affective dimensions. A persons
  behavior is an expression of individuality and is
  reflective of the uniqueness of both the
  dimensions and the patterns of interaction the
  person develops with the environment. The social
  dimension involves the persons skills in living
  as a member of a family and community.

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Interaction with the Environment

• People interact, or engage in mutual, ongoing,
  patterned relationships with other people and
  with objects in the environment. Patterns of
  interaction are identifiable, rhythmic,
  measurable, and changing over rhythmic they can
  also be described.
• For a person who has well-established patterns,
  life becomes predictable and comfortable. A
  healthy person is able to balance the need for
  predictability with the need for change.
• Behavior patterns are useful to the person
  because they are reliable, flexible ways to
  interact with the environment in a variety of
  situations.

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Chosen life purpose

• A life purpose is an integrative spiritual
  function that gives meaning to each persons
  existence. Behavior patterns are developed to
  achieve a chosen life purpose. The need for a
  purpose in life is a uniquely human
  characteristic. This need and the capacity to
  choose combine so that each person actively
  chooses a life purpose.
• Purposes are chosen early in life as an outgrowth
  of interaction with the environment. The quality
  of the choice is and important focus for nurses
  working with clients with mental or emotional
  problems.

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Environment

• Environment is defined as everything outside a
  person. It includes the physical and social
  elements that are external to and interactive
  with the client. As the nurse assesses the
  clients determine together which aspects of the
  environment need to be included in the focus of
  treatment. Many aspects of the physical
  environment, such as light, heat, and sound may
  influence the client and need to be addressed in
  the nursing care plan.

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• The nurse is part of the environment of the
  client in the treatment setting. The nursing
  staff can help make the interaction with the
  hospital system healthy and constructive for the
  client. The client may have developed unhealthy
  patterns of interaction with aspects of the
  social environment, that is, family and
  community. The opportunity for healthy
  interaction with people in the hospital
  environment creates the possibility that the
  client will interact in more healthy ways after
  discharge. Therefore, the hospital environment,
  or milieu, is thought to be a major treatment
  opportunity for which nurses are responsible.

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Family

• The family is the basic unit of society,
  transmits cultural norms and values, and is the
  most influential socializing agent for learning
  how to relate to people, groups, and community.
  Subsystems within a family may be the married
  couple, the sibling group, and the extended
  family. The family with a mentally ill member
  struggles to maintain a normal household and
  healthy relationships with friends and community
  groups. However, many of the familys resources
  are consumed in the care and treatment of its ill
  members. Often the family ends up isolated,
  impoverished in resources and relationships, and
  dysfunctional in intrafamily relationships. The
  family is usually the strongest, most reliable
  support system the mentally ill person has.
  Building on family strengths while decreasing
  dysfunctional, energy draining interactions
  assists both the ill person and the other family
  members

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Community

• Community is defined as a group of people with
  common characteristics, location, or interests. A
  community is not just a mixture or assembly of
  people. Rather, community implies organization,
  roles, growth, development, and relationships
  among people. Relationships in a community may be
  related to
• Common characteristics such as ethnicity or
  social status, which bind people together
• Geographic location
• And common interests.

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• For instance, the nursing profession may be
  considered a community. It has organization,
  roles, growth and development as a profession,
  and common interests at the heart of its
  identity.
• The community that is the environment for
  individuals and families is itself part of a
  larger environment, society. A community
  influences and is influenced by society. Growth
  and development, resources, and attainment of
  goals are influenced and somewhat determined by
  the larger society, the community interacts as a
  whole with the society, whether the community be
  a city, hospital, ideologic group, or group with
  common characteristics.

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• The community is composed of many subsystems. The
  client determines relevant subsystems, which may
  include the neighborhood, school, church,
  employment office, public assistance office,
  visiting nurse, or child protection unit.
  Organized groups such as adult education classes,
  Alcoholics Anonymous, parent effectiveness
  training groups, and state nurses associations
  are also subsystems.

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Health

• Health is defined as a synthesis of the clients
  internal patterns with those of the environment
  it is measured on a continuum from functional to
  dysfunctional patterns of interaction. Health is
  a dynamic , changing state determined by changing
  patterns of interaction. It may be described and
  measured.

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• Health exists on a a continuum from functional to
  dysfunctional. Health implies the ability to
  function, and illness implies the disability to
  function, that is , dysfunction.
• A persons health status varies considerably over
  time because of the dynamic nature of patterns of
  interaction. Nurses seek to improve a clients
  health by influencing patterns of interaction
  between the client and the environment.

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Mental Health

• Mental health is defined as a dynamic process in
  which a persons physical, cognitive, affective,
  behavioral, and social dimensions interact
  functionally with one another and with the
  environment. Mentally healthy patterns reflect
  and ability to perceive reality accurately
  modulate the way emotions are experienced and
  expressed think clearly and logically
  communicate thoughts, emotions, feelings, needs,
  and desires effectively anticipate events and
  solve problems initiate and maintain meaningful
  relationships

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• establish and maintain boundaries use resources
  appropriately develop a positive self-concept
  and , in general, behave in ways that facilitate
  personal growth and development. Mental health
  permits persons to pursue life goals in a way
  that affirms other people, facilitates the growth
  and quests of others, and culminates in the
  fulfillment of their own life purpose.

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Mental Illness

• Mental illness is defined as physical, cognitive,
  affective, behavioral, and social patterns that
  interact dysfunctionally with the environment.
  Dysfunctional patterns of interaction make it
  difficult to satisfy needs, develop and maintain
  social relationships, address growth and
  developmental tasks, and pursue a productive an d
  gratifying life. Patterns of interaction within
  the person and among the person, the persons
  family, and the community significantly influence
  the development and maintenance of mental
  illness.

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Nursing

• The American Nurses Association (ANA) defines
  nursing as the diagnosis and treatment of human
  responses to actual or potential health problems
  (ANA, 1980). Human responses are the synthesis of
  physical, cognitive, affective, behavioral, and
  social dimensions of the person expressed in
  interaction with the environment. Nursing for
  the purposes of this text, is defined as a
  goal-directed process that promotes functional
  patterns of interaction between client and
  environment. Functional patterns of interaction
  is synonymous with health therefore, nursing is
  a goal-directed process that promotes health.

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• ANA has defined psychiatric and mental health
  nursing g as a specialized area of nursing
  practice that employs theories of human behavior
  as its science and purposeful use for self as its
  art ( ANA, 1976). It is directed toward both
  preventive and corrective effects upon mental
  disorders and their sequel and is concerned with
  the promotion of optimal mental health for
  society, the community and individuals (ANA,
  1976).

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The Nursing Process

• The nursing process in other areas of practice is
  also used in psychiatric mental health nursing.
  It is composed of assessment, nursing diagnosis,
  client outcomes, nursing interventions, and
  evaluation of outcomes. The process is ongoing,
  an evaluation is part of the assessment once the
  process is established.

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Collaboration with other disciplines

• Nursing practice can be thought of as occurring
  in two contexts within particular settings, and
  within a multidisciplinary team.

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Mental Health Disciplines

• The four mental health disciplines that have
  traditionally provide services to psychiatric
  clients are nursing, medicine, social work, and
  psychology. In addition to the four traditional
  disciplines, occupational therapy and therapeutic
  recreation are offered in almost every inpatient
  unit. Disciplines to whom referrals for
  psychiatric clients are made include dietary,
  physical therapy, pharmacy, and others.

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Teamwork

• Working together is a challenge for my two
  people, no matter what the task. Increasing the
  number of people with different educational
  backgrounds, vocabulary, priorities, methods of
  problem solving goals, and communication styles
  adds to the challenge of working together. The
  multidisciplinary team comes together for a
  common purpose planning and evaluating the
  treatment of individuals clients. The client is
  considered a member of the team. Each person on
  the team is treated with mutual respect, because
  everyone on the team has a vital contribution to
  make.

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• Thought team members may overlap in some areas of
  knowledge and responsibility, each team member
  also has a unique contribution to make that must
  be communicated for effective treatment planning
  to occur. Decision making usually occurs by
  consensus, and all members specify the activities
  they will pursue. Any team member could
  coordinate the clients care, but the nurse
  usually provides this service because members of
  the nursing staff are always present in the
  inpatient environment.
• Inherent in this view of teamwork are several
  principles.
• Teamwork focuses on client outcomes to which all
  team members make a contribution.
• The client is a member of the team, creating a
  climate of cooperation among all members.
• Each mental health discipline makes a unique
  contribution, and there is overlapping among
  disciplines as well.