Using the Manual
The Manual of Psychiatric Nursing Care Plans is designed for both educational and clinical nursing situations. Because the care plans are organized according to the nursing process within each nursing diagnosis addressed, the Manual can effectively complement any psychiatric nursing text and can be used within any theoretical framework. Because the plans are based on psychiatric disorders, client behaviors, and clinical problems, the Manual is appropriate for both undergraduate and graduate levels of nursing education.
In the clinical realm, the Manual is useful in any nursing setting. The Manual can be used to help formulate individual nursing care plans in inpatient, partial hospitalization, and outpatient situations; in psychiatric settings, including residential and acute care units, locked and open units, and with adolescent and adult client populations; in community-based programs, including individual and group situations; in general medical settings, for work with clients who have psychiatric diagnoses as well as those whose behavior or problems are addressed in the Manual; and in skilled nursing facilities and long-term residential, day treatment, and outpatient settings.
NURSING STUDENTS AND INSTRUCTORS
Development of Psychiatric Nursing Skills in Students
For a student, developing nursing skills and comfort with clients with psychiatric problems is a complex process of integrating knowledge of human development, psychiatric problems, human relationships, self-awareness, behavior and communication techniques, and the nursing process with clinical experiences in psychiatric nursing situations. This process can be fascinating, stimulating, and satisfying for both students and instructors, or it may be seen as arduous, frustrating, and frightening. We hope that the former is the common experience and that this Manual can be used to add to the students’ knowledge base, guide their use of the nursing process, and suggest ways to interact with clients that result in positive, effective nursing care and increased confidence and comfort with psychiatric nursing.
Good interaction skills are essential in all types of nursing, and they enhance the student’s nursing care in any setting. In addition, skillful communications enhance the enjoyment of working with clients and help avoid burnout later in a nurse’s career. Efficient use of the nursing process and skills in writing and using care plans also help avoid burnout by decreasing frustration and repetition and increasing effective communication among the staff.
An important part of psychiatric nursing skill is conscious awareness of interactions, both verbal and nonverbal. In psychiatric nursing, interactions are primary tools of intervention. Awareness of these interactions is necessary to ensure therapeutic, not social, interactions and requires thinking on several levels while the nurse is planning for and engaged in the interaction:
The nurse must be knowledgeable about the client’s present behaviors and problems.
The interaction should be goal directed: What is the purpose of the interaction in view of the client’s nursing diagnosis and expected outcomes?
The skills or techniques of communication must be identified and the structure of the interaction planned.
During the interaction itself, the nurse must continually monitor the responses of the client, evaluate the effectiveness of the interaction, and make changes as indicated.
Techniques for Developing Interaction Skills
The Manual can be used to facilitate the development of interaction skills and awareness in classes, group clinical settings, and individual faculty-student interaction in conjunction with various teaching methods. Effective techniques include the following:
Case studies: presentation of a case (an actual client, hypothetical example, or paradigm case) by the instructor or student. The case may be written, presented by roleplaying, or verbally described. Students (individually or in groups) can perform an assessment, write a care plan for the client, and discuss interventions and related skills, using the Manual as a resource.
Role-play and feedback: used in conjunction with a case study or to develop specific communication skills. Interactions with actual clients can be reenacted or the instructor may portray a client with certain behaviors to identify, practice, and evaluate communication techniques; students and instructors can give feedback regarding the interactions.
Videotaped interactions: for case presentations and roleplay situations to help the student develop awareness by seeing his or her own behavior and the interaction as a whole from a different, “outside observer” perspective.
Review of the video by both the instructor and the student (and in groups, as students’ comfort levels increase) allows feedback, discussion, and identification of alternative techniques.
Review of the video by both the instructor and the student (and in groups, as students’ comfort levels increase) allows feedback, discussion, and identification of alternative techniques.
Written process recordings: used with brief interactions or portions of interactions with or without videotaping. Recalling the interaction in detail sufficient for a written process recording helps the student to develop awareness during the interaction itself and to develop memory skills that are useful in documentation. Process recordings can include identification of goals, evaluation of the effectiveness of skills and techniques or of the client’s responses to a statement or behavior, and ways to change the interaction (i.e., as if it could be redone), in addition to the recording of actual words and behaviors of the client and the student.
Written care plans: developed for each client, based on the student’s assessment of the client. Before an interaction with the client, the instructor can review the plan with the student, and the student can identify expected outcomes, nursing interventions, and interactions he or she plans to use, and so forth. After the interaction, both the care plan and the specific interaction can be evaluated and revised.
Using the Manual in Teaching Psychiatric Nursing
Instructors may find the Manual useful in organizing material for teaching classes and for discussion points. The “Key Considerations in Mental Health Nursing” section examines a number of issues germane to the general practice of psychiatric nursing and the delivery of nonjudgmental nursing care. Each group of care plans deals with a set of related problems that students may encounter in the psychiatric setting. These care plans represent the usual assessments and interventions the student or nurse will use in the planning and delivery of care to clients and families. The information in the “Key Considerations in Mental Health Nursing” section regarding sexuality, culture, aging, and so forth provides the context for the student to individualize the planning and delivery of care for each client. A small group of students could be responsible for the presentation of a client’s care plan that illustrates one of these topics (e.g., loss or chemical dependence) to the entire class, with subsequent discussion of specific behaviors, problems, nursing diagnoses, interventions, and so forth.
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