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FUNDAMENTAL OF PSYCHIATRIC NURSING
1.1 DEFINITION
Mental Health is a healthy and happy feelings and able to cope with the challenges of life, can accept others as they are and have a positive attitude toward self and others.
Include mental health
· How do you feel about yourself
· How do your feelings toward others
· How does your ability to overcome your life a day - day.
Some human understanding:
· Individuals who are holistic: consists of physical and 'spiritual'.
· Consists of parts of body, mind, soul and the heart (spirit)
· The structure of the human soul consists of the id (instinctual satisfaction principles), the ego (awareness of the reality-principle of reality), super ego / moral principles of morality (Freud's theory)
1.2 CRITERIA BY MENTAL HEALTH YAHODA
· Grow, develop and actualize
· Integration: The past and present
· Autonomy in satisfied decision
· Perception as reality
· Controlling the environment: to adapt
1.3 RANGE MENTAL HEALTH
1. Dynamic rather than static point
2. The range starts from optimal health - dies
3. There are stages
4. Individual variation
5. Describes the ability of adaptation
6. Function effectively: a healthy
1.4 DEFINITION MENTAL HEALTH NURSING
a. According to the American Nurses Associations (ANA)
Psychiatric Nursing is a special area of nursing practice that uses the science of human behavior as a basis and using self teraupetik in improving, maintaining, restoring the client's mental health and mental health communities where clients are (American Nurses Associations).
b. According to WHO
Psychiatric is not just a state of mental ill, but contains many characteristics of reply is a direct care, communication and management, wrote describing the positive nature of harmony and spiritual balance reflects the maturity of personality horse's mouth.
c. According to the Act Health NO 03 1966
Conditions that enable the development of physical, emotional intellectual optimally from someone and this development in harmony with others.
Psychiatric nursing is a professional nursing service based on behavioral science, nursing in the human spirit throughout the life cycle in response to psycho-social maladaptif disruption caused by the bio-psycho-social, by using self and soul of nursing therapy (therapeutic communication and therapeutic modalities mental health nursing) through the nursing process approach to improve, prevent, maintain and restore clients' mental health problems (individuals, families, community groups).
Psychiatric nursing is the interpersonal process of trying to improve and maintain the behavior so that the client can function fully as a human being.
The principle of psychiatric nursing consists of four components of the human, environmental, health and nursing.
• Human
Function as being a holistic person is to act, interact and react with the environment as a whole. Every individual has the same basic needs and important. Every individual has self-esteem and dignity. Individual goals are to grow, healthy, independent and self-actualization achieved. Every individual has the ability to change and the desire to pursue personal goals. Every individual has a varying köping capacity. Every individual has the right to participate in decision keputuasan. All significant individual behavior, where behavior include perceptions, thoughts, feelings and actions.
• Environment
Human beings are influenced by the environment holistically from within and outside environment, both families, groups, communities. In dealing with the environment, humans must develop effective strategies to köping can adapt. Interpersonal relationships developed can produce changes in individual self.
• Health
Health is one of basic human needs which shows one aspect of the quality of human life, therefore, every individual has the right to receive the same health through adequate treatment.
• Nursing
In the spirit of nursing, the nurse looked at people holistically and use of therapeutic self.
Methodology psychiatric of nursing is to use a self-therapeutic and interpersonal interactions with self aware, the environment, and interaction with the environment. This awareness is the basis for change. Clients grow aware of themselves and the situation, so more accurately identify needs and problems and choosing a healthy way to cope. Nurses provide a constructive stimulus so that eventually the client learn how to handle problems that are the basis of capital in the face of various problems.
Mental Health Nursing Process Providing nursing care is a therapeutic process involving the cooperative relationship between the nurse with clients, and communities to achieve optimal health levels (Carpenito, 1989 quoted by Keliat, 1991).
Nurses need the scientific method in the therapeutic process, the nursing process. The use of nursing process to assist nurses in nursing practice, nursing clients solve problems or meet client needs in a scientific, logical, systematic, and organized. Basically, the process of nursing is one of the troubleshooting techniques (problem solving).
Nursing process aims to provide nursing care in accordance with clients' needs and problems so that the quality of nursing service to be optimal. Clients' needs and problems can be identified, prioritized to be filled, and resolved. By using the nursing process, nurses can avoid nursing actions that are routine, intuisis, and not unique to the individual client. Nursing process is characterized by dynamic, cyclic, interdependent, flexible, and open. Each stage can be updated if circumstances change client clients.
Stage by stage is cyclical and interdependent. Nursing diagnosis could not be formulated if there has been no assessment data. Nursing process is a tool / vehicle for cooperation nurses and clients. Generally, in the early stages of the nurse's role is greater than the client's role, but the process till the end client expected otherwise greater role than nurses, so the client can be achieved independence. Independence client self care can also be used as a criterion needs are met and / or the issue is resolved.
Benefits for Nurses Nursing Process.
a. Increased autonomy, confidence in providing nursing care.
b. Paradigm available / work logical, scientific, systematic, and organized.
c. Documenting the nursing process showed that nurses are responsible and accountable.
d. Increased job satisfaction.
e. Facility / vehicle desimasi nursing science and technology.
f. Career development, through research mindset.
For Clients
a. Received the care quality and scientifically justified.
b. Increased participation in self-care to (independent care).
c. Protected from malpractice.
Psychiatric nursing is a specialized field of nursing practice is to apply the theory of human behavior as their knowledge and use of therapeutic self as tricks. Mental nursing practice occurs in a social context and environment. Nurses use knowledge from the soul sciences psychosocial, biophysical, theories of personality and human behavior to derive a theoretical framework which underlies nursing practice.
Mental health conditions that facilitate an optimal and in harmony with others, thus achieved the ability to adjust to yourself, others, society and environment, harmony soul function, which is able to face common problems and feel happy. Intact healthy aspects include physical, mental, social, and personal which can be explained As with the physical, the process of physical function and physiological functions and efficiency.
Indicators of physical health is not the least there dysfunction, with other indicators (eg blood pressure, cholesterol, pulse and heart, and levels of carbon monoxide) is used to assess the various degrees/ psychological / mental, which is primary of a subjective feeling of well-being, a self-assessment of one's feelings, covering areas such as self-concept about one's ability, fitness and energy, feelings of well-being, and internal self-control ability, an indicator of the state of mental health / psychological / soul is not at least feel stress / depression.
So it can be concluded that mental health is an integral part of health and is a condition that allows the development of physical, social and individual optimally, and in harmony with the development with others.
Social health, which is one's social activities. Person's ability to complete the task, role, and learn various skills for adaptive functioning in society. Indicators of social health status of the minimum is the ability to perform basic tasks and skills appropriate to the role of a person.
Personal health is a state that goes beyond functioning effectively and adequate of the three aspects mentioned above, emphasizes the possibility of capacity, resources, gifts and talents a person's internal, that might not be / will be displayed in an atmosphere of daily life as usual.
According to the guidelines for the soul of nursing care public hospitals or community health center (Puskesmas) personal health means that a person inside there is the potential and ability to meet and resolve the other dimensions of itself, it is not instrumental, and which enables the development of an optimal one. Minimum indicator of personal health is no real interest in the activities and experiences that allow a person to penetrate the state, Äústatus quo, Au.
Psychiatry and mental health using Indonesia elektik-holistic approach which sees man and his behavior both in good health or sickness, as a coherent whole of the elements of organo-biological (bio-system), psycho educational / psychodynamic (psychoanalytic system), and socio-cultural (socio-system).
This approach means that we must be able to see the human condition and behavior, both in good health or ill, in detail, Äúdetail, Au in the three aspects mentioned above (eclectic), but realized that these three aspects are interrelated and are a unified whole as one system (holistic).
So obviously with this approach we consider the psychological and social factors or psychosocial in addition to biological factors in implementing health measures.
Nursing process to clients with mental health problems is a unique challenge because mental problems may not be seen directly, saperti on physical health problems show various symptoms and caused a variety of things. Past events similar to the current events, but may appear different symptoms and contradictions. Their ability to participate in solving the problem also varies.
Relationship of trust between nurses and clients is the main basis to the client's nursing care of mental disorders. This is important because the role of nurses in nursing care of souls is to help clients to be able to solve problems in accordance with the capabilities they have. The client may avoid or refuse to participate and nurses may tend to leave, especially for clients that do not cause trouble and do no harm.
This must be avoided because:
· Learn to solve the problem would be more effective if the client is participating.
· The clients include the recovery of the client's ability to control their lives are more likely to be achieved.
· By participating the client learn to be responsible for the perpetrator.
Role and Functions of Mental Nurse Nursing definition and description of psychiatric
Nursing is the interpersonal process that seeks to improve and maintain the patient's behavior that contribute to the integrated function. Patient or client system may be individuals, families, groups, organizations or communities. ANA mendefiniskan mental health nursing as a specialized field of nursing practice is to apply the theory of human behavior as self-knowledge and the beneficial use of the tricks. The soul of contemporary nursing practice occurs in a social context and environment.
The role of nursing professional lives in the complex evolved from the original historical elements. That role now includes the dimensions of clinical competence, patient-family advocacy, fiscal responsibility, interdisciplinary collaboration, social accountability, and legal-ethical parameters.
Center for Mental Health Services officially recognized mental health nursing as one of the five core mental health disciplines. Nurses use knowledge from the soul psychosocial sciences, biophysics,, personality theory, and human behavior to obtain a theoretical framework of thinking that underlies nursing practice.
Here are two levels of clinical nursing practice mental health that have been identified.
1. Psychiatric-mental health registered nurses (RN)
Is a licensed registered nurses who demonstrate clinical skills in mental health nursing skills than new nurses in the field. Certification is a formal process to recognize the field of clinical nursing expertise.
2. Advanced practice registered nurse is Psychiatric-mental health (APRN-PMH)
is a licensed registered nurse educated to at least a master's degree, have a thorough knowledge of nursing theory of the soul, to guide clinical practice, and has a mental competency advanced nursing skills. Mental health nurses in advanced practice prepared to have a master's degree and doctorate in nursing or other related fields.
3. Range of Traditional Farm Order
To nurse the soul include psychiatric facilities, community mental health centers, psikitari units in general hospitals, residential facilities, and private practice. However, with the health care reform, there is an alternative structure throughout the range of nursing care for the soul.
Many hospitals specifically transformed into an integrated clinical system that provides inpatient care, partial or hospitalisasi daily therapy, residetial care, home care, and outpatient care.
Order of treatment in the community currently developing a foster care or group home, Hospice, home health agencies, visiting nurse association, emergency units, shelter, nursing home, primary care clinics, schools, prisons, industry, managed care facilities, and health maintenance organizations .
Three domains of nursing practice in contemporary life include:
(1) direct care activity
(2) communication activities
(3) management activity
Counseling functions, coordination, delegation, and collaboration on the role of nurses is shown in the domain of practice that overlap ini.Berbagai mental nurse activity within each domain name explained further. Activity remained reflect the nature and scope of the latest from the competent care by nurses soul although not all nurses to participate in all activities.
In addition, nurses are able to do this soul-the following:
1. Creating biopsikososial health assessment that is sensitive to the culture.
2. Designing and implementing action plans for patients and families experiencing complex health problems and conditions that can cause illness.
3. Participate in case management activities, such as organizing, accessing, negotiating, mengordinasi, and integrate repair services for individuals and families.
4. Providing health care guidelines to individuals, families, and groups to use mental health resources available in the community including the provision of care, institutional, technological, and social systems of the most appropriate.
5. Improve and maintain mental health and mental disorders cope with the effects through counseling and counseling.
6. Providing care to patients who experienced physical illness psiokologis problems and mental patients who have physical problems.
7. Managing and mengordinasi care system that integrates the needs of patients, families, staff, and policy makers.
1.5 PRINCIPLES OF MENTAL HEALTH NURSING
- Roles and functions of psychiatric nurse : competent
- Therapeutic Nurse patient relationship
- Conceptual models of psychiatric nursing
- Stress adaptation model of psychiatric nursing
- Biological context of psychiatric nursing care
- Psychological context of psychiatric nursing care
- Sociocultural context of psychiatric nursing care
- Environmental context of psychiatric nursing care
- Legal ethical context of psychiatric nursing care
- Implementing the nursing process : standards of care
- Actualizing the Psychiatric Nursing Role
1.6 DEVELOPMENT OF MENTAL HEALTH NURSING
Handle clients that have attitude problems, feelings and conflicts
↓
Primary prevention
↓
Handling multidisciplinary
↓
Nursing specialization soul
FIRST:
Mental Disorder Patients are considered garbage, put in the stocks embarrassing
NOW:
- Improving Science
- Knowledge of community mental disorders increased
- Need understanding of human rights
- It is important to improve the quality of service and consumer protection.
1.7 CONCEPTUAL MODEL MENTAL HEALTH NURSING
| Model | View of behavioral deviation | | Therapeutic process | Roles of a patient & therapist |
| Psychoanalytical (freud, Erickson) | The ego is not able to control anxiety, conflict is not over | | Free association dream & analysis | Client: express all the thoughts & dreams |
| Interpersonal (Sullivan, peplau) | Anxiety arising & experienced in interpersonal, basic fear is fear of rejection | | Build feeling security Trusting relationship & interpersonal satisfaction | Patient: share anxieties Therapist : use empathy & relationship |
| Social (caplan,szasz) | Social & environmental factors create stress, which cause anxiety &symptom | | Environment manipulation & social support | Patient: submit problems using existing resources in the community |
| Existensial (Ellis, Rogers) | Individuals fail to find and accept yourself | | Experience in relationship, conducted in group Encouraged to accept self & control behavior | Client: participate in meaningful experiences to learn self - |
| Supportive Therapy (Wermon,Rockland) | Factors biopsikososial & current maladaptive response | | Strengthening the adaptive response köping | Client: involved in the identification of coping |
| Medical (Meyer,Kreaplin) | Combination from physiological, genetic, environmental & social | | Diagnostic examination, somatic therapy, interpersonal farmakologik & techniques | Client: undergo diagnostic procedures & long-term therapy |
Based on the above conceptual model of nursing, it can be categorized into the 6 models are:
1. Psycoanalytical (Freud, Erickson)
This model explains that mental disorders occur in a person dapt when the ego (mind) is not functioning in controlling the id (the will and desires or instincts). The inability of a person in using his mind (ego) to comply with the regulations, rules, norms, religion (super ego / uber das ich), will encourage the behavior deviation (deviation of Behavioral).
Other causal factors of mental disorders in this theory is the existence of intrapsychic conflict, especially in childhood. For example during oral dissatisfaction where children do not get the perfect milk, not the stimulus for learning to speak, is prohibited by violence to enter the body at its mouth on the oral phase and so on. This will lead to a lasting traumatic in adulthood.
The process of therapy in this model is to use the method of free association and dream analysis, to improve transferen traumatic past. For example the client made in a very sleepy state. In a helpless situation subconscious experience dengamn explored questions to explore the traumatic past. This is better known as hypnotic methods that require expertise and specialized training.
In this way, clients will express all thoughts and dreams, while the therapist attempts to interpret the patient's thoughts and dreams.
Role of the nurse is trying to make assessment or study of traumatic circumstances or that are considered significant stressor in the past, for example (the parents had been tortured, been sodomized, ririskiky treated harshly, neglected, brought up with violence, rape in childhood), using the approach therapeutic communication after the trust is established (mutual trust).
2. Interpersonal (Sullivan, peplau)
According to this model concept, a mental bias arising from the threat. The threat is causing anxiety (Anxiety). Anxiety arises and experienced person as a result of the conflict when dealing with others (interpersonal). According to this concept of fear fear of someone based adnya rejected or not accepted by the surroundings.
The process of therapy according to this concept Feeling adalh Build Security (trying to build a sense of security on the client), Trusting Relationship and Interpersonal Satisfaction (a relationship of mutual trust) and nurturing of satisfaction in getting along with others so that clients feel valued and respected.
Role of nurses in the share anxieties therapy (attempting to share about what the client feels, what he used to worry about the client when dealing with others), Empathy and use therapist relationship (the nurse to be trying to feel empathy and share what is perceived by the client). Nurse memberiakan verbal response that encourages a sense of security clients in dealing with others.
3. Social (Caplan, Szasz)
According to this concept of a person will experience a mental disorder or behavioral deviations when the number of social factors and environmental factors that will trigger the emergence of stress on one's (social and environmental factors create stress, which cause anxiety and symptoms).
The principle of therapy process is very important in this model is the concept of environment manipulation and social support (the importance of environmental modification and the presence of social support)
Role of nurses in providing therapy according to this model is the patient must communicate problems using existing resources in the community involving peers, superiors, family or husband and wife. While working therapist: exploring the social system clients such as the atmosphere at home, at work, at school, in society or the workplace.
4. Existensial (Ellis, Rogers)
According to the theory of behavioral disorders ekistensial model or a mental disorder occurs when individuals fail to find his true identity and purpose of life. Individuals do not have the pride of her. Hating myself and susceptible to interference in Body-image of his
Principles in the therapy process are: seeking an experienced individual to get along with others, understand the history of the lives of others who are considered successful or may be regarded as a role model (experience in relationship), to expand self-awareness by way of introspection (self assessment), along with social groups and humanity (conducted in group), encouraged to accept their own identity and accept criticism or feedback about the behavior of others (encouraged to accept self and control behavior).
Nursing principles are: clients are encouraged to participate in a meaningful experience To learn himself and get feed back from others, eg through group activity therapy. Therapist seeks to expand the client's self-awareness through feedback, criticism, suggestions or reward & punishment.
5. Supportive Therapy (Wermon, Rockland)
Causes of mental disorders in this concept are: biopsikososial factor and respo maladaptive today. Biological aspects of an issue such as: frequent stomach ulcers, migraine and coughing. Psychological aspects of having a lot of complaints such as nervous, lacking confidence, feelings of guilt, doubt, ill-tempered. Social aspects have problems such as: hard to get along, pull away, not liked, hostile, unable to get a job, and so on. All these things accumulated to cause mental disorders. These phenomena arise due ketidakmamupan in adapting to the problems that arise now and has nothing to do with the past.
The principle of the therapy process is to strengthen copinh adaptive response, the individual first sought to know telebih forces what is in itself; power which can be used alternative solution.
Nurses need to assist individuals in coping identify who owned and used by the client. Therapist seeks a warm relationship and empathetic with the client to prepare clients adaptive coping.
6. Medica (Meyer, Kraeplin)
According to this concept of mental disorders tend to emerge from a complex multifactor include: physical aspects, genetic, environmental and social factors. So the focus should be complete Rx through diagnostic tests, somatic therapy, farmakologik and interpersonal techniques. The nurse role in collaborating with the medical team in conducting diagnostic procedures and long-term therapy, therapist role in therapy, report on the impact of therapy, determining the diagnosis, and determine the type of treatment approach used.
1.8 THE ROLE OF MENTAL HEALTH NURSING
· Assessment to consider cultural
· Designing and implementing an action plan
· Participate in the management of cases
· Improving and maintaining mental health, to overcome the effects of mental illness - counseling and counseling
· Manage and coordinate service systems that integrate the needs of patients, families of staff and policy makers
· Provide guidelines for health services
1.9 COMPONENT OF CARING
· Assessment sensitive biopsikososial culture.
· Designing and implementation of action plans for clients and families.
· Participation in case management: organize, review, negotiation, coordination of services for individuals and families.
· Provide guidance services for individuals, families, groups, to use the resources available in the mental health community, including related services, technology and social systems of the most appropriate.
· Improve and maintain kesehatanmental and overcoming the effects of mental illness through education and counseling.
· Provide askep on physical illness and psychological problems of mental illness with physical problems.
· Manage and coordinate service systems that integrate the needs of clients, families, staff, and policy makers.
Keliat, Budi Anna;Panjaitan;Helena. 2005. Proses Keperawatan Kesehatan Jiwa. Ed.2. Jakarta: EGC.
Stuart, Gail W.2007.Buku Saku Keperawatan Jiwa. Jakarta : EGC.
Suliswati, 2005. Konsep Dasar Keperawatan Kesehatan Jiwa. Jakarta : EGC
Videbeck, Sheila L.(2004). Psychiatric Mental Health Nursing 2nd Edition. Philadelphia : Lippincot Williams & Wilkin.
Yosep,Iyus.2007. Keperawatan Jiwa. Jakarta: PT. Refika Aditama.
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