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Psychiatric mental health nursing : concepts of care in evidence-based practice / Mary C. Townsend.

By: Publication details: Philadelphia : F.A. Davis, c2009.Edition: 6th editionDescription: xxix, 896 p. : col. ill. ; 28 cm. + 1 CD-ROM (4 3/4 in.)ISBN:
  • 9780803619173
  • 0803619170
Subject(s): DDC classification:
  • WY 160 T749p 2009
Online resources:
Contents:
Contents UNIT ONE BASIC CONCEPTS IN PSYCHIATRIC/MENTAL HEALTH NURSING Chapter 1 The Concept of Stress Adaptation 2 STRESS AS A BIOLOGICAL RESPONSE 3 STRESS AS AN ENVIRONMENTAL EVENT 5 STRESS AS A TRANSACTION BETWEEN THE INDIVIDUAL AND THE ENVIRONMENT 5 Precipitating Event 5 The Individual's Perception of the Event 5 Predisposing Factors 6 STRESS MANAGEMENT 7 Adaptive Coping Strategies 7 SUMMARY AND KEY POINTS 8 REVIEW QUESTIONS 9 REFERENCES 10 CLASSICAL REFERENCES 10 Chapter 2 Mental Health/ Mental Illness: Historical and Theoretical Concepts 11 HISTORICAL OVERVIEW OF PSYCHIATRIC CARE 12 MENTAL HEALTH 13 MENTAL ILLNESS 14 PSYCHOLOGICAL ADAPTATION TO STRESS 15 Anxiety 15 Behavioral Adaptation Responses to Anxiety 17 Grief 20 MENTAL HEALTH/MENTAL ILLNESS CONTINUUM 22 THE DSM-IV-TR MULTIAXIAL EVALUATION SYSTEM 23 SUMMARY AND KEY POINTS 24 REVIEW QUESTIONS 25 REFERENCES 27 CLASSICAL REFERENCES 27 UNIT TWO FOUNDATIONS FOR PSYCHIATRIC/MENTAL HEALH NURSING Chapter 3 Theoretical Models of Personality Development 30 PSYCHOANALYTIC THEORY 31 Structure of the Personality 31 Topography of the Mind 31 Dynamics of the Personality 32 Freud's Stages of Personality Development 32 Relevance of Psychoanalytic Theory to Nursing Practice 34 INTERPERSONAL THEORY 34 Sullivan's Stages of Personality Development 34 Relevance of Interpersonal Theory to Nursing Practice 35 THEORY OF PSYCHOSOCIAL DEVELOPMENT 35 Erikson's Stages of Personality Development 35 Relevance of Psychosocial Development Theory to Nursing Practice 38 THEORY OF OBJECT RELATIONS 38 Phase I: The Autistic Phase (Birth to 1 Month) 38 Phase II: The Symbiotic Phase (1 to 5 Months) 38 Phase III: Separation-Individuation (5 to 36 months) 39 COGNITIVE DEVELOPMENT THEORY 39 Stage 1: Sensorimotor (Birth to 2 Years) 39 Stage 2: Preoperational (2 to 6 Years) 40 Stage 3: Concrete Operations (6 to 12 Years) 40 Stage 4: Formal Operations (12 to 15+ Years) 40 Relevance of Cognitive Development Theory to Nursing Practice 40 THEORY OF MORAL DEVELOPMENT 40 Level I: Preconventional Level (Prominent from Ages 4 to 10 Years) 41 Level II: Conventional Level (Prominent from Ages 10 to 13 Years and into Adulthood) 41 Level III: Postconventional Level (Can Occur from Adolescence Onward) 41 Relevance of Moral Development Theory to Nursing Practice 42 A NURSING MODEL-HILDEGARD E. PEPLAU 42 Peplau's Stages of Personality Development 42 Relevance of Peplau's Model to Nursing Practice 44 SUMMARY AND KEY POINTS 45 REVIEW QUESTIONS 46 REFERENCES 47 CLASSICAL REFERENCES 47 Chapter 4 Concepts of Psychobiology 48 THE NERVOUS SYSTEM: AN ANATOMICAL REVIEW 49 The Brain 49 Nerve Tissue 53 Autonomic Nervous System 53 Neurotransmitters 55 NEUROENDOCRINOLOGY 60 Pituitary Gland 60 Circadian Rhythms 63 Sleep 64 GENETICS 66 PSYCHOIMMUNOLOGY 66 Normal Immune Response 66 IMPLICATIONS FOR NURSING 68 SUMMARY AND KEY POINTS 69 REVIEW QUESTIONS 70 REFERENCES 71 Chapter 5 Ethical and Legal Issues in Psychiatric/ Mental Health Nursing 72 ETHICAL CONSIDERATIONS 73 Theoretical Perspectives 73 Ethical Dilemmas 74 Ethical Principles 74 A Model for Making Ethical Decisions 75 Ethical Issues in Psychiatric/Mental Health Nursing 76 LEGAL CONSIDERATIONS 76 Nurse Practice Acts 77 Types of Law 78 Classifications Within Statutory and Common Law 78 Legal Issues in Psychiatric/Mental Health Nursing 78 Commitment Issues 81 Nursing Liability 82 SUMMARY AND KEY POINTS 83 REVIEW QUESTIONS 85 REFERENCES 86 Chapter 6 Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health Nursing 87 CULTURAL CONCEPTS 88 HOW DO CULTURES DIFFER? 88 Communication 88 Space 89 Social Organization 89 Time 89 Environmental Control 89 Biological Variations 89 APPLICATION OF THE NURSING PROCESS 90 Background Assessment Data 90 Culture-Bound Syndromes 99 Diagnosis/Outcome Identification 99 Planning/Implementation 99 Evaluation 101 SPIRITUAL CONCEPTS 101 Spiritual Needs 101 Assessment of Spiritual and Religious Needs 103 Diagnoses/Outcome Identification/Evaluation 105 Planning/Implementation 105 Evaluation 105 SUMMARY AND KEY POINTS 107 REVIEW QUESTIONS 109 REFERENCES 110 CLASSICAL REFERENCES 111 UNIT THREE THERAPEUTIC APPROACHES IN PSYCHIATRIC NURSING CARE Chapter 7 Relationship Development 114 ROLE OF THE PSYCHIATRIC NURSE 115 DYNAMICS OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP 116 Therapeutic Use of Self 116 Gaining Self-Awareness 116 The Johari Window 117 CONDITIONS ESSENTIAL TO DEVELOPMENT OF A THERAPEUTIC RELATIONSHIP 119 Rapport 119 Trust 119 Respect 119 Genuineness 120 Empathy 120 PHASES OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP 121 The Preinteraction Phase 121 The Orientation (Introductory) Phase 121 The Working Phase 121 The Termination Phase 122 BOUNDARIES IN THE NURSE-CLIENT RELATIONSHIP 123 SUMMARY AND KEY POINTS 124 REVIEW QUESTIONS 125 REFERENCES 126 CLASSICAL REFERENCES 126 Chapter 8 Therapeutic Communication 127 WHAT IS COMMUNICATION? 128 THE IMPACT OF PREEXISTING CONDITIONS 128 Values, Attitudes, and Beliefs 128 Culture or Religion 128 Social Status 129 Gender 129 Age or Developmental Level 129 Environment in Which the Transaction Takes Place 129 NONVERBAL COMMUNICATION 130 Physical Appearance and Dress 130 Body Movement and Posture 130 Touch 130 Facial Expressions 131 Eye Behavior 131 Vocal Cues, or Paralanguage 131 THERAPEUTIC COMMUNICATION TECHNIQUES 132 NONTHERAPEUTIC COMMUNICATION TECHNIQUES 132 ACTIVE LISTENING 135 PROCESS RECORDINGS 135 FEEDBACK 135 SUMMARY AND KEY POINTS 137 REVIEW QUESTIONS 138 REFERENCES 139 CLASSICAL REFERENCES 139 Chapter 9 The Nursing Process in Psychiatric/Mental Health Nursing 140 THE NURSING PROCESS 141 Definition 141 Standards of Practice 141 WHY NURSING DIAGNOSIS? 149 NURSING CASE MANAGEMENT 149 Critical Pathways of Care 151 APPLYING THE NURSING PROCESS IN THE PSYCHIATRIC SETTING 151 CONCEPT MAPPING 153 DOCUMENTATION OF THE NURSING PROCESS 155 Problem-Oriented Recording 155 Focus Charting 156 The PIE Method 156 Electronic Documentation 157 SUMMARY AND KEY POINTS 158 REVIEW QUESTIONS 160 REFERENCES 160 Chapter 10 Therapeutic Groups 161 FUNCTIONS OF A GROUP 162 TYPES OF GROUPS 162 Task Groups 162 Teaching Groups 162 Supportive/Therapeutic Groups 162 Self-Help Groups 163 PHYSICAL CONDITIONS THAT INFLUENCE GROUP DYNAMICS 163 Seating 163 Size 163 Membership 163 CURATIVE FACTORS 164 PHASES OF GROUP DEVELOPMENT 164 Phase I. Initial or Orientation Phase 164 Phase II. Middle or Working Phase 164 Phase III. Final or Termination Phase 165 LEADERSHIP STYLES 165 Autocratic 165 Democratic 165 Laissez-Faire 165 MEMBER ROLES 166 PSYCHODRAMA 167 THE ROLE OF THE NURSE IN GROUP THERAPY 167 SUMMARY AND KEY POINTS 167 REVIEW QUESTIONS 169 REFERENCES 171 CLASSICAL REFERENCES 171 Chapter 11 Intervention with Families 172 STAGES OF FAMILY DEVELOPMENT 173 Stage I. The Single Young Adult 173 Stage II. The Newly Married Couple 173 Stage III. The Family with Young Children 173 Stage IV. The Family with Adolescents 173 Stage V. The Family Launching Grown Children 174 Stage VI. The Family in Later Life 175 MAJOR VARIATIONS 175 Divorce 175 Remarriage 175 Cultural Variations 175 FAMILY FUNCTIONING 176 Communication 177 Self-Concept Reinforcement 178 Family Members' Expectations 178 Handling Differences 179 Family Interactional Patterns 180 Family Climate 180 THERAPEUTIC MODALITIES WITH FAMILIES 181 The Family as a System 181 The Structural Model 183 The Strategic Model 184 The Evolution of Family Therapy 186 THE NURSING PROCESS-A CASE STUDY 187 Assessment 187 Diagnosis 190 Outcome Identification 190 Planning/Implementation 190 Evaluation 191 SUMMARY AND KEY POINTS 191 REVIEW QUESTIONS 193 REFERENCES 194 CLASSICAL REFERENCES 194 Chapter 12 Milieu Therapy-The Therapeutic Community 195 MILIEU, DEFINED 195 CURRENT STATUS OF THE THERAPEUTIC COMMUNITY 196 BASIC ASSUMPTIONS 196 CONDITIONS THAT PROMOTE A THERAPEUTIC COMMUNITY 197 THE PROGRAM OF THERAPEUTIC COMMUNITY 198 THE ROLE OF THE NURSE 199 SUMMARY AND KEY POINTS 201 REVIEW QUESTIONS 202 REFERENCES 203 CLASSICAL REFERENCES 203 Chapter 13 Crisis Intervention 204 CHARACTERISTICS OF A CRISIS 205 PHASES IN THE DEVELOPMENT OF A CRISIS 205 TYPES OF CRISES 206 Class 1: Dispositional Crises 206 Class 2: Crises of Anticipated Life Transitions 207 Class 3: Crises Resulting from Traumatic Stress 207 Class 4: Maturational/Developmental Crises 208 Class 5: Crises Reflecting Psychopathology 208 Class 6: Psychiatric Emergencies 208 CRISIS INTERVENTION 209 PHASES OF CRISIS INTERVENTION: THE ROLE OF THE NURSE 209 Phase 1. Assessment 209 Phase 2. Planning of Therapeutic Intervention 209 Phase 3. Intervention 210 Phase 4. Evaluation of Crisis Resolution and Anticipatory Planning 211 DISASTER NURSING 211 APPLICATION OF THE NURSING PROCESS TO DISASTER NURSING 211 Background Assessment Data 211 Nursing Diagnoses/Outcome Identification 211 Planning/Implementation 212 Evaluation 212 SUMMARY AND KEY POINTS 217 REVIEW QUESTIONS 218 REFERENCES 219 CLASSICAL REFERENCES 219 Chapter 14 Relaxation Therapy 220 THE STRESS EPIDEMIC 220 PHYSIOLOGICAL, COGNITIVE, AND BEHAVIORAL MANIFESTATIONS OF RELAXATION 221 METHODS OF ACHIEVING RELAXATION 223 Deep Breathing Exercises 223 Progressive Relaxation 223 Modified (or Passive) Progressive Relaxation 224 Meditation 225 Mental Imagery 225 Biofeedback 226 Physical Exercise 226 THE ROLE OF THE NURSE IN RELAXATION THERAPY 226 Assessment 227 Diagnosis 227 Outcome Identification/Implementation 227 Evaluation 228 SUMMARY AND KEY POINTS 228 REVIEW QUESTIONS 229 REFERENCES 229 Chapter 15 Assertiveness Training 230 ASSERTIVE COMMUNICATION 231 BASIC HUMAN RIGHTS 231 RESPONSE PATTERNS 231 Nonassertive Behavior 231 Assertive Behavior 232 Aggressive Behavior 232 Passive-Aggressive Behavior 232 BEHAVIORAL COMPONENTS OF ASSERTIVE BEHAVIOR 232 TECHNIQUES THAT PROMOTE ASSERTIVE BEHAVIOR 233 THOUGHT-STOPPING TECHNIQUES 234 Method 235 ROLE OF THE NURSE 235 Assessment 235 Diagnosis 236 Outcome Identification/Implementation 236 Evaluation 238 SUMMARY AND KEY POINTS 238 REVIEW QUESTIONS 239 REFERENCES 240 Chapter 16 Promoting Self-Esteem 241 COMPONENTS OF SELF-CONCEPT 242 Physical Self or Body Image 242 Personal Identity 242 Self -Esteem 242 DEVELOPMENT OF SELF-ESTEEM 242 Developmental Progression of Self-Esteem Through the Life Span 243 MANIFESTATIONS OF LOW SELF-ESTEEM 244 Focal Stimuli 244 Contextual Stimuli 244 Residual Stimuli 245 Symptoms of Low Self-Esteem 245 BOUNDARIES 245 Boundary Pliancy 246 Rigid Boundaries 246 Flexible Boundaries 246 Enmeshed Boundaries 247 Establishing Boundaries 247 THE NURSING PROCESS 247 Assessment 247 Diagnosis/Outcome Identification 247 Outcome Criteria 248 Planning/Implementation 248 Evaluation 250 SUMMARY AND KEY POINTS 250 REVIEW QUESTIONS 252 REFERENCES 253 CLASSICAL REFERENCES 253 Chapter 17 Anger/Aggression Management 254 ANGER AND AGGRESSION, DEFINED 255 PREDISPOSING FACTORS TO ANGER AND AGGRESSION 256 Modeling 256 Operant Conditioning 256 Neurophysiological Disorders 256 Biochemical Factors 256 Socioeconomic Factors 256 Environmental Factors 256 THE NURSING PROCESS 257 Assessment 257 Diagnosis/Outcome Identification 258 Planning/Implementation 258 Evaluation 261 SUMMARY AND KEY POINTS 261 REVIEW QUESTIONS 262 REFERENCES 263 Chapter 18 The Suicidal Client 264 HISTORICAL PERSPECTIVES 264 EPIDEMIOLOGICAL FACTORS 265 RISK FACTORS 265 Marital Status 265 Gender 265 Age 266 Religion 266 Socioeconomic Status 266 Ethnicity 266 Other Risk Factors 266 PREDISPOSING FACTORS: THEORIES OF SUICIDE 267 Psychological Theories 267 Sociological Theory 267 Biological Theories 268 APPLICATION OF THE NURSING PROCESS WITH THE SUICIDAL CLIENT 268 Assessment 268 Diagnosis/Outcome Identification 270 Planning/Implementation 270 Evaluation 275 SUMMARY AND KEY POINTS 275 REVIEW QUESTIONS 276 REFERENCES 277 CLASSICAL REFERENCES 278 Chapter 19 Behavior Therapy 279 CLASSICAL CONDITIONING 280 OPERANT CONDITIONING 281 TECHNIQUES FOR MODIFYING CLIENT BEHAVIOR 281 Shaping 281 Modeling 281 Premack Principle 282 Extinction 282 Contingency Contracting 282 Token Economy 282 Time Out 282 Reciprocal Inhibition 282 Overt Sensitization 283 Covert Sensitization 283 Systematic Desensitization 283 Flooding 283 ROLE OF THE NURSE IN BEHAVIOR THERAPY 283 SUMMARY AND KEY POINTS 285 REVIEW QUESTIONS 287 REFERENCES 288 CLASSICAL REFERENCES 288 Chapter 20 Cognitive Therapy 289 HISTORICAL BACKGROUND 290 INDICATIONS FOR COGNITIVE THERAPY 290 GOALS AND PRINCIPLES OF COGNITIVE THERAPY 290 BASIC CONCEPTS 291 Automatic Thoughts 291 Schemas (Core Beliefs) 292 TECHNIQUES OF COGNITIVE THERAPY 292 Didactic (Educational) Aspects 292 Cognitive Techniques 293 Behavioral Interventions 294 ROLE OF THE NURSE IN COGNITIVE THERAPY 295 SUMMARY AND KEY POINTS 298 REVIEW QUESTIONS 299 REFERENCES 300 CLASSICAL REFERENCES 300 Chapter 21 Psychopharmacology 301 HISTORICAL PERSPECTIVES 302 ROLE OF THE NURSE 302 Ethical and Legal Implications 302 Assessment 302 Medication Administration and Evaluation 302 Client Education 302 HOW DO PSYCHOTROPICS WORK? 304 APPLYING THE NURSING PROCESS IN PSYCHOPHARMACOLOGICAL THERAPY 306 Antianxiety Agents 306 Antidepressants 308 Mood-Stabilizing Agents 315 Antipsychotic Agents 321 Sedative-Hypnotics 327 Agents for Attention Deficit Hyperactivity Disorder (ADHD) 329 SUMMARY AND KEY POINTS 332 REVIEW QUESTIONS 334 REFERENCES 335 Chapter 22 Electroconvulsive Therapy 336 ELECTROCONVULSIVE THERAPY, DEFINED 337 HISTORICAL PERSPECTIVES 337 INDICATIONS 338 Major Depression 338 Mania 338 Schizophrenia 338 Other Conditions 338 CONTRAINDICATIONS 338 MECHANISM OF ACTION 338 SIDE EFFECTS 338 RISKS ASSOCIATED WITH ELECTROCONVULSIVE THERAPY 339 Mortality 339 Permanent Memory Loss 339 Brain Damage 339 THE ROLE OF THE NURSE IN ELECTROCONVULSIVE THERAPY 339 Assessment 339 Diagnosis/Outcome Identification 340 Planning/Implementation 340 Evaluation 341 SUMMARY AND KEY POINTS 341 REVIEW QUESTIONS 342 REFERENCES 343 Chapter 23 Complementary Therapies 344 COMMONALITIES AND CONTRASTS 347 TYPES OF COMPLEMENTARY THERAPIES 347 Herbal Medicine 347 Acupressure and Acupuncture 348 Diet and Nutrition 351 Chiropractic Medicine 355 Therapeutic Touch and Massage 356 Yoga 356 Pet Therapy 357 SUMMARY AND KEY POINTS 358 REVIEW QUESTIONS 359 REFERENCES 359 Chapter 24 Client Education 361 HISTORICAL PERSPECTIVES 362 THEORIES OF TEACHING AND LEARNING 363 Behaviorist Theory 363 Cognitive Theory 363 Humanistic Theory 363 DOMAINS OF LEARNING 364 Affective Domain 364 Cognitive Domain 364 Psychomotor Domain 364 AGE AND DEVELOPMENTAL CONSIDERATIONS 364 The Adult Learner 364 Teaching Children and Adolescents 365 Teaching the Elderly 365 THE NURSING PROCESS IN CLIENT EDUCATION 366 Assessment 366 Nursing Diagnosis 368 Outcome Identification 368 Planning/Implementation 368 Evaluation 370 DOCUMENTATION OF CLIENT EDUCATION 371 SUMMARY AND KEY POINTS 371 REVIEW QUESTIONS 373 REFERENCES 374 CLASSICAL REFERENCES 374 UNIT FOUR NURSING CARE OF CLIENTS WITH ALTERATIONS IN PSYCHOSOCIAL ADAPTATION Chapter 25 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence 376 MENTAL RETARDATION 377 Predisposing Factors 377 Application of the Nursing Process to Mental Retardation 378 AUTISTIC DISORDER 380 Clinical Findings 380 Epidemiology and Course 380 Predisposing Factors 381 Application of the Nursing Process to Autistic Disorder 381 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 384 Clinical Findings, Epidemiology, and Course 384 Predisposing Factors 385 Application of the Nursing Process to ADHD 387 Psychopharmacological Intervention for ADHD 390 CONDUCT DISORDER 393 Predisposing Factors 394 Application of the Nursing Process to Conduct Disorder 394 OPPOSITIONAL DEFIANT DISORDER 397 Clinical Findings, Epidemiology, and Course 397 Predisposing Factors 397 Application of the Nursing Process to ODD 398 TOURETTE'S DISORDER 401 Clinical Findings, Epidemiology, and Course 401 Predisposing Factors 401 Application of the Nursing Process to Tourette's Disorder 401 Psychopharmacological Intervention for Tourette's Disorder 404 SEPARATION ANXIETY DISORDER 404 Clinical Findings, Epidemiology, and Course 404 Predisposing Factors 404 Application of the Nursing Process to Separation Anxiety Disorder 405 GENERAL THERAPEUTIC APPROACHES 407 Behavior Therapy 407 Family Therapy 408 Group Therapy 408 Psychopharmacology 408 SUMMARY AND KEY POINTS 408 REVIEW QUESTIONS 410 REFERENCES 411 INTERNET REFERENCES 412 Chapter 26 Delirium, Dementia, and Amnestic Disorders 413 DELIRIUM 414 Clinical Findings and Course 414 Predisposing Factors 414 DEMENTIA 415 Clinical Findings, Epidemiology, and Course 415 Predisposing Factors 417 AMNESTIC DISORDERS 422 Predisposing Factors 422 APPLICATION OF THE NURSING PROCESS 422 Assessment 422 Nursing Diagnosis/Outcome Identification 426 Planning/Implementation 427 Concept Care Mapping 430 Client/Family Education 430 Evaluation 432 MEDICAL TREATMENT MODALITIES 432 Delirium 432 Dementia 432 SUMMARY AND KEY POINTS 437 REVIEW QUESTIONS 438 REFERENCES 439 INTERNET REFERENCES 440 Chapter 27 Substance-Related Disorders 441 SUBSTANCE-USE DISORDERS 442 Substance Abuse 442 DSM-IV-TR Criteria for Substance Abuse 442 Substance Dependence 442 DSM-IV-TR Criteria for Substance Dependence 443 SUBSTANCE-INDUCED DISORDERS 443 Substance Intoxication 443 DSM-IV-TR Criteria for Substance Intoxication 443 Substance Withdrawal 443 DSM-IV-TR Criteria for Substance Withdrawal 443 CLASSES OF PSYCHOACTIVE SUBSTANCES 444 PREDISPOSING FACTORS TO SUBSTANCE-RELATED DISORDERS 444 Biological Factors 444 Psychological Factors 444 Sociocultural Factors 444 THE DYNAMICS OF SUBSTANCE-RELATED DISORDERS 445 Alcohol Abuse and Dependence 445 Alcohol Intoxication 449 Alcohol Withdrawal 450 Sedative, Hynotic, or Anxiolytic Abuse and Dependence 450 Sedative, Hypnotic, or Anxiolytic Intoxication 452 Sedative, Hypnotic, or Anxiolytic Withdrawal 452 CNS Stimulant Abuse and Dependence 452 CNS Stimulant Intoxication 455 CNS Stimulant Withdrawal 455 Inhalant Abuse and Dependence 456 Inhalant Intoxication 456 Opioid Abuse and Dependence 456 Opioid Intoxication 458 Opioid Withdrawal 458 Hallucinogen Abuse and Dependence 459 Hallucinogen Intoxication 461 Cannabis Abuse and Dependence 461 Cannabis Intoxication 463 APPLICATION OF THE NURSING PROCESS 463 Assessment 463 Diagnosis/Outcome Identification 470 Planning/Implementation 471 Concept Care Mapping 474 Client/Family Education 474 Evaluation 474 THE CHEMICALLY IMPAIRED NURSE 476 CODEPENDENCY 477 The Codependent Nurse 477 Treating Codependence 478 TREATMENT MODALITIES FOR SUBSTANCE-RELATED DISORDERS 478 Alcoholics Anonymous 478 Pharmacotherapy 478 Counseling 480 Group Therapy 481 Psychopharmacology for Substance Intoxication and Substance Withdrawal 481 SUMMARY AND KEY POINTS 484 REVIEW QUESTIONS 485 REFERENCES 487 CLASSICAL REFERENCES 488 INTERNET REFERENCES 488 Chapter 28 Schizophrenia and Other Psychotic Disorders 489 NATURE OF THE DISORDER 490 Phase I: The Premorbid Phase 490 Phase II: The Prodromal Phase 491 Phase III: Schizophrenia 491 Phase IV: Residual Phase 491 Prognosis 491 PREDISPOSING FACTORS 492 Biological Influences 492 Psychological Influences 494 Environmental Influences 494 Stressful Life Events 494 The Transactional Model 494 TYPES OF SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS 496 Disorganized Schizophrenia 496 Catatonic Schizophrenia 496 Paranoid Schizophrenia 496 Undifferentiated Schizophrenia 496 Residual Schizophrenia 496 Schizoaffective Disorder 496 Brief Psychotic Disorder 497 Schizophreniform Disorder 497 Delusional Disorder 497 Shared Psychotic Disorder 497 Psychotic Disorder Due to a General Medical Condition 498 Substance-Induced Psychotic Disorder 498 APPLICATION OF THE NURSING PROCESS 498 Background Assessment Data 498 Diagnosis/Outcome Identification 502 Planning/Implementation 503 Concept Care Mapping 506 Client/Family Education 506 Evaluation 506 TREATMENT MODALITIES FOR SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS 508 Psychological Treatments 508 Social Treatment 509 Organic Treatment 510 SUMMARY AND KEY POINTS 514 REVIEW QUESTIONS 516 REFERENCES 517 INTERNET REFERENCES 518 Chapter 29 Mood Disorders 519 HISTORICAL PERSPECTIVE 520 EPIDEMIOLOGY 520 Gender 521 Age 521 Social Class 521 Race and Culture 521 Marital Status 522 Seasonality 522 TYPES OF MOOD DISORDERS 522 Depressive Disorders 522 Bipolar Disorders 524 Other Mood Disorders 525 DEPRESSIVE DISORDERS 525 Predisposing Factors 525 Developmental Implications 529 APPLICATION OF THE NURSING PROCESS TO DEPRESSIVE DISORDERS 532 Background Assessment Data 532 Diagnosis/Outcome Identification 534 Planning/Implementation 535 Concept Care Mapping 538 Client/Family Education 538 Evaluation of Care for the Depressed Client 538 BIPOLAR DISORDER (MANIA) 540 Predisposing Factors 540 Developmental Implications 542 APPLICATION OF THE NURSING PROCESS TO BIPOLAR DISORDER (MANIA) 543 Background Assessment Data 543 Diagnosis/Outcome Identification 544 Planning/Implementation 545 Concept Care Mapping 547 Client/Family Education 547 Evaluation of Care for the Manic Client 547 TREATMENT MODALITIES FOR MOOD DISORDERS 549 Individual Psychotherapy 549 Group Therapy for Depression and Mania 550 Family Therapy for Depression and Mania 550 Cognitive Therapy for Depression and Mania 550 Electroconvulsive Therapy for Depression and Mania 551 Transcranial Magnetic Stimulation 551 Light Therapy for Depression 551 Psychopharmacology 551 SUMMARY AND KEY POINTS 556 REVIEW QUESTIONS 557 REFERENCES 559 CLASSICAL REFERENCES 560 INTERNET REFERENCES 560 Chapter 30 Anxiety Disorders 561 HISTORICAL ASPECTS 562 EPIDEMIOLOGICAL STATISTICS 562 HOW MUCH IS TOO MUCH? 564 APPLICATION OF THE NURSING PROCESS 564 Panic Disorder 564 Generalized Anxiety Disorder 565 Phobias 566 Obsessive-Compulsive Disorder 571 Posttraumatic Stress Disorder 574 Anxiety Disorder Due to a General Medical Condition 576 Substance-Induced Anxiety Disorder 576 Diagnosis/Outcome Identification 576 Planning/Implementation 578 Concept Care Mapping 580 Client/Family Education 583 Evaluation 583 TREATMENT MODALITIES 583 Individual Psychotherapy 583 Cognitive Therapy 584 Behavior Therapy 584 Group/Family Therapy 585 Psychopharmacology 585 SUMMARY AND KEY POINTS 588 REVIEW QUESTIONS 589 REFERENCES 590 CLASSICAL REFERENCES 591 INTERNET REFERENCES 591 Chapter 31 Somatoform and Dissociative Disorders 592 HISTORICAL ASPECTS 593 EPIDEMIOLOGICAL STATISTICS 593 APPLICATION OF THE NURSING PROCESS 595 Background Assessment Data: Types of Somatoform Disorders 595 Predisposing Factors Associated with Somatoform Disorders 598 Background Assessment Data: Types of Dissociative Disorders 600 Predisposing Factors Associated with Dissociative Disorders 602 Diagnosis/Outcome Identification 604 Planning/Implementation 605 Concept Care Mapping 609 Evaluation 609 TREATMENT MODALITIES 609 Somatoform Disorders 609 Dissociative Amnesia 612 Dissociative Fugue 612 Dissociative Identity Disorder 612 Depersonalization Disorder 613 SUMMARY AND KEY POINTS 614 REVIEW QUESTIONS 616 REFERENCES 617 CLASSICAL REFERENCES 618 INTERNET REFERENCES 618 Chapter 32 Issues Related to Human Sexuality 619 DEVELOPMENT OF HUMAN SEXUALITY 620 Birth Through Age 12 620 Adolescence 620 Adulthood 621 SEXUAL DISORDERS 622 Paraphilias 622 Sexual Dysfunctions 626 Application of the Nursing Process to Sexual Disorders 630 Treatment Modalities for Sexual Dysfunctions 636 VARIATIONS IN SEXUAL ORIENTATION 638 Homosexuality 638 Transsexualism 640 Bisexuality 640 SEXUALLY TRANSMITTED DISEASES 641 SUMMARY AND KEY POINTS 643 REVIEW QUESTIONS 645 REFERENCES 646 CLASSICAL REFERENCES 646 INTERNET REFERENCES 646 Chapter 33 Eating Disorders 647 EPIDEMIOLOGICAL FACTORS 648 APPLICATION OF THE NURSING PROCESS 648 Background Assessment Data (Anorexia Nervosa) 648 Background Assessment Data (Bulimia Nervosa) 649 Background Assessment Data (Obesity) 650 Diagnosis/Outcome Identification 652 Planning/Implementation 652 Concept Care Mapping 657 Client/Family Education 658 Evaluation 658 TREATMENT MODALITIES 659 Behavior Modification 659 Individual Therapy 659 Family Therapy 660 Psychopharmacology 660 SUMMARY AND KEY POINTS 662 REVIEW QUESTIONS 663 REFERENCES 664 INTERNET REFERENCES 665 Chapter 34 Personality Disorders 666 HISTORICAL ASPECTS 668 TYPES OF PERSONALITY DISORDERS 668 Paranoid Personality Disorder 668 Schizoid Personality Disorder 669 Schizotypal Personality Disorder 670 Antisocial Personality Disorder 671 Borderline Personality Disorder 671 Histrionic Personality Disorder 671 Narcissistic Personality Disorder 672 Avoidant Personality Disorder 673 Dependent Personality Disorder 674 Obsessive-Compulsive Personality Disorder 675 Passive-Aggressive Personality Disorder 676 APPLICATION OF THE NURSING PROCESS 676 Borderline Personality Disorder (Background Assessment Data) 676 Predisposing Factors to Borderline Personality Disorder 678 Diagnosis/Outcome Identification 679 Planning/Implementation 679 Concept Care Mapping 683 Evaluation 683 Antisocial Personality Disorder (Background Assessment Data) 683 Diagnosis/Outcome Identification 686 Planning/Implementation 687 Concept Care Mapping 689 Evaluation 689 TREATMENT MODALITIES 690 Interpersonal Psychotherapy 690 Psychoanalytical Psychotherapy 690 Milieu or Group Therapy 690 Cognitive/Behavioral Therapy 690 Psychopharmacology 690 SUMMARY AND KEY POINTS 692 REVIEW QUESTIONS 693 REFERENCES 695 CLASSICAL REFERENCES 695 INTERNET REFERENCES 695 UNIT FIVE PSYCHIATRIC/MENTAL HEALTH NURSING OF SPECIAL POPULATIONS Chapter 35 The Aging Individual 698 HOW OLD IS OLD? 699 EPIDEMIOLOGICAL STATISTICS 699 The Population 699 Marital Status 699 Living Arrangements 700 Economic Status 700 Employment 700 Health Status 700 THEORIES OF AGING 700 Biological Theories 700 Psychosocial Theories 701 THE NORMAL AGING PROCESS 702 Biological Aspects of Aging 702 Psychological Aspects of Aging 705 Sociocultural Aspects of Aging 707 Sexual Aspects of Aging 707 SPECIAL CONCERNS OF THE ELDERLY POPULATION 708 Retirement 708 Long-Term Care 710 Elder Abuse 711 APPLICATION OF THE NURSING PROCESS 713 Assessment 713 Diagnosis/Outcome Identification 714 Planning/Implementation 715 Evaluation 715 SUMMARY AND KEY POINTS 720 REVIEW QUESTIONS 723 REFERENCES 724 CLASSICAL REFERENCES 725 INTERNET REFERENCES 725 Chapter 36 Victims of Abuse or Neglect 726 HISTORICAL PERSPECTIVES 727 PREDISPOSING FACTORS 727 Biological Theories 728 Psychological Theories 728 Sociocultural Theories 728 APPLICATION OF THE NURSING PROCESS 730 Background Assessment Data 730 Diagnosis/Outcome Identification 736 Planning/Implementation 736 Concept Care Mapping 739 Evaluation 739 TREATMENT MODALITIES 739 Crisis Intervention 739 The Safe House or Shelter 741 Family Therapy 741 SUMMARY AND KEY POINTS 742 REVIEW QUESTIONS 743 REFERENCES 745 CLASSICAL REFERENCES 745 INTERNET REFERENCES 745 Chapter 37 Community Mental Health Nursing 746 THE CHANGING FOCUS OF CARE 747 THE PUBLIC HEALTH MODEL 748 THE ROLE OF THE NURSE 749 The Psychiatric-Mental Health Registered Nurse (RN-PMH) 749 The Psychiatric-Mental Health Advanced Practice Registered Nurse (APRN-PMH) 750 CASE MANAGEMENT 750 THE COMMUNITY AS CLIENT 751 Primary Prevention 751 Secondary Prevention 757 Tertiary Prevention 758 SUMMARY AND KEY POINTS 772 REVIEW QUESTIONS 774 REFERENCES 775 CLASSICAL REFERENCES 776 Chapter 38 Forensic Nursing 777 WHAT IS FORENSIC NURSING? 777 HISTORICAL PERSPECTIVES 778 THE CONTEXT OF FORENSIC NURSING PRACTICE 778 FORENSIC NURSING SPECIALTIES 778 Clinical Forensic Nursing Specialty 778 The Sexual Assault Nurse Examiner (SANE) 779 Forensic Psychiatric Nursing Specialty 779 Correctional/Institutional Nursing Specialty 779 Nurses in General Practice 779 APPLICATION OF THE NURSING PROCESS IN CLINICAL FORENSIC NURSING IN TRAUMA CARE 780 Assessment 780 Nursing Diagnosis 781 Planning/Implementation 781 Evaluation 783 APPLICATION OF THE NURSING PROCESS IN FORENSIC PSYCHIATRIC NURSING IN CORRECTIONAL FACILITIES 783 Assessment 783 Nursing Diagnosis 786 Planning/Implementation 786 Evaluation 789 SUMMARY AND KEY POINTS 789 REVIEW QUESTIONS 790 REFERENCES 790 CLASSICAL REFERENCE 791 INTERNET REFERENCES 791 Chapter 39 The Bereaved Individual 792 THEORETICAL PERSPECTIVES ON LOSS AND BEREAVEMENT 793 Stages of Grief 793 LENGTH OF THE GRIEF PROCESS 796 ANTICIPATORY GRIEF 797 MALADAPTIVE RESPONSES TO LOSS 797 Delayed or Inhibited Grief 797 Distorted (Exaggerated) Grief Response 797 Chronic or Prolonged Grieving 797 Normal versus Maladaptive Grieving 798 APPLICATION OF THE NURSING PROCESS 798 Background Assessment Data: Concepts of Death-Developmental Issues 798 Background Assessment Data: Concepts of Death-Cultural Issues 799 Nursing Diagnosis/Outcome Identification 801 Planning/Implementation 801 Evaluation 801 ADDITIONAL ASSISTANCE 804 Hospice 804 Advance Directives 806 SUMMARY AND KEY POINTS 807 REVIEW QUESTIONS 809 REFERENCES 810 CLASSICAL REFERENCES 810 INTERNET REFERENCES 810
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Book Open Access Book Open Access Health Sciences Library WY 160 T749p 2009 (Browse shelf(Opens below)) 1 Available MBAL22031294
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Includes bibliographical references and index.

Contents

UNIT ONE
BASIC CONCEPTS IN PSYCHIATRIC/MENTAL HEALTH NURSING
Chapter 1
The Concept of Stress Adaptation 2
STRESS AS A BIOLOGICAL RESPONSE 3
STRESS AS AN ENVIRONMENTAL EVENT 5
STRESS AS A TRANSACTION BETWEEN THE INDIVIDUAL AND THE
ENVIRONMENT 5
Precipitating Event 5
The Individual's Perception of the Event 5
Predisposing Factors 6
STRESS MANAGEMENT 7
Adaptive Coping Strategies 7
SUMMARY AND KEY POINTS 8
REVIEW QUESTIONS 9

REFERENCES 10
CLASSICAL REFERENCES 10
Chapter 2
Mental Health/ Mental Illness: Historical and Theoretical Concepts 11
HISTORICAL OVERVIEW OF PSYCHIATRIC CARE 12

MENTAL HEALTH 13
MENTAL ILLNESS 14
PSYCHOLOGICAL ADAPTATION TO STRESS 15
Anxiety 15
Behavioral Adaptation Responses to Anxiety 17
Grief 20

MENTAL HEALTH/MENTAL ILLNESS CONTINUUM 22

THE DSM-IV-TR MULTIAXIAL EVALUATION SYSTEM 23
SUMMARY AND KEY POINTS 24
REVIEW QUESTIONS 25
REFERENCES 27
CLASSICAL REFERENCES 27

UNIT TWO
FOUNDATIONS FOR PSYCHIATRIC/MENTAL HEALH NURSING
Chapter 3
Theoretical Models of Personality Development 30
PSYCHOANALYTIC THEORY 31
Structure of the Personality 31
Topography of the Mind 31
Dynamics of the Personality 32
Freud's Stages of Personality Development 32
Relevance of Psychoanalytic Theory to Nursing Practice 34
INTERPERSONAL THEORY 34
Sullivan's Stages of Personality Development 34
Relevance of Interpersonal Theory to Nursing Practice 35
THEORY OF PSYCHOSOCIAL DEVELOPMENT 35
Erikson's Stages of Personality Development 35
Relevance of Psychosocial Development Theory to Nursing Practice 38
THEORY OF OBJECT RELATIONS 38
Phase I: The Autistic Phase (Birth to 1 Month) 38
Phase II: The Symbiotic Phase (1 to 5 Months) 38
Phase III: Separation-Individuation (5 to 36 months) 39

COGNITIVE DEVELOPMENT THEORY 39
Stage 1: Sensorimotor (Birth to 2 Years) 39
Stage 2: Preoperational (2 to 6 Years) 40
Stage 3: Concrete Operations (6 to 12 Years) 40
Stage 4: Formal Operations (12 to 15+ Years) 40
Relevance of Cognitive Development Theory to Nursing Practice 40
THEORY OF MORAL DEVELOPMENT 40
Level I: Preconventional Level (Prominent from Ages 4 to 10 Years) 41
Level II: Conventional Level (Prominent from Ages 10 to 13 Years and into
Adulthood) 41
Level III: Postconventional Level (Can Occur from Adolescence Onward) 41
Relevance of Moral Development Theory to Nursing Practice 42
A NURSING MODEL-HILDEGARD E. PEPLAU 42
Peplau's Stages of Personality Development 42
Relevance of Peplau's Model to Nursing Practice 44
SUMMARY AND KEY POINTS 45
REVIEW QUESTIONS 46
REFERENCES 47
CLASSICAL REFERENCES 47

Chapter 4
Concepts of Psychobiology 48
THE NERVOUS SYSTEM: AN ANATOMICAL REVIEW 49
The Brain 49
Nerve Tissue 53
Autonomic Nervous System 53
Neurotransmitters 55

NEUROENDOCRINOLOGY 60
Pituitary Gland 60
Circadian Rhythms 63
Sleep 64
GENETICS 66
PSYCHOIMMUNOLOGY 66
Normal Immune Response 66
IMPLICATIONS FOR NURSING 68
SUMMARY AND KEY POINTS 69
REVIEW QUESTIONS 70
REFERENCES 71

Chapter 5
Ethical and Legal Issues in Psychiatric/ Mental Health Nursing 72
ETHICAL CONSIDERATIONS 73
Theoretical Perspectives 73
Ethical Dilemmas 74
Ethical Principles 74
A Model for Making Ethical Decisions 75
Ethical Issues in Psychiatric/Mental Health Nursing 76
LEGAL CONSIDERATIONS 76
Nurse Practice Acts 77
Types of Law 78
Classifications Within Statutory and Common Law 78
Legal Issues in Psychiatric/Mental Health Nursing 78
Commitment Issues 81
Nursing Liability 82

SUMMARY AND KEY POINTS 83
REVIEW QUESTIONS 85
REFERENCES 86

Chapter 6
Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health
Nursing 87
CULTURAL CONCEPTS 88

HOW DO CULTURES DIFFER? 88
Communication 88
Space 89
Social Organization 89
Time 89
Environmental Control 89
Biological Variations 89
APPLICATION OF THE NURSING PROCESS 90
Background Assessment Data 90
Culture-Bound Syndromes 99
Diagnosis/Outcome Identification 99
Planning/Implementation 99
Evaluation 101
SPIRITUAL CONCEPTS 101
Spiritual Needs 101
Assessment of Spiritual and Religious Needs 103
Diagnoses/Outcome Identification/Evaluation 105
Planning/Implementation 105
Evaluation 105
SUMMARY AND KEY POINTS 107
REVIEW QUESTIONS 109
REFERENCES 110
CLASSICAL REFERENCES 111

UNIT THREE
THERAPEUTIC APPROACHES IN PSYCHIATRIC NURSING CARE
Chapter 7
Relationship Development 114
ROLE OF THE PSYCHIATRIC NURSE 115

DYNAMICS OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP 116
Therapeutic Use of Self 116
Gaining Self-Awareness 116
The Johari Window 117

CONDITIONS ESSENTIAL TO DEVELOPMENT OF A THERAPEUTIC
RELATIONSHIP 119
Rapport 119
Trust 119
Respect 119
Genuineness 120
Empathy 120

PHASES OF A THERAPEUTIC NURSE-CLIENT RELATIONSHIP 121
The Preinteraction Phase 121
The Orientation (Introductory) Phase 121
The Working Phase 121
The Termination Phase 122
BOUNDARIES IN THE NURSE-CLIENT RELATIONSHIP 123

SUMMARY AND KEY POINTS 124
REVIEW QUESTIONS 125
REFERENCES 126
CLASSICAL REFERENCES 126

Chapter 8
Therapeutic Communication 127
WHAT IS COMMUNICATION? 128
THE IMPACT OF PREEXISTING CONDITIONS 128
Values, Attitudes, and Beliefs 128
Culture or Religion 128
Social Status 129
Gender 129
Age or Developmental Level 129
Environment in Which the Transaction Takes Place 129

NONVERBAL COMMUNICATION 130
Physical Appearance and Dress 130
Body Movement and Posture 130
Touch 130
Facial Expressions 131
Eye Behavior 131
Vocal Cues, or Paralanguage 131
THERAPEUTIC COMMUNICATION TECHNIQUES 132

NONTHERAPEUTIC COMMUNICATION TECHNIQUES 132
ACTIVE LISTENING 135
PROCESS RECORDINGS 135
FEEDBACK 135
SUMMARY AND KEY POINTS 137
REVIEW QUESTIONS 138

REFERENCES 139
CLASSICAL REFERENCES 139

Chapter 9
The Nursing Process in Psychiatric/Mental Health Nursing 140
THE NURSING PROCESS 141
Definition 141
Standards of Practice 141

WHY NURSING DIAGNOSIS? 149

NURSING CASE MANAGEMENT 149
Critical Pathways of Care 151
APPLYING THE NURSING PROCESS IN THE PSYCHIATRIC SETTING 151
CONCEPT MAPPING 153
DOCUMENTATION OF THE NURSING PROCESS 155
Problem-Oriented Recording 155
Focus Charting 156
The PIE Method 156
Electronic Documentation 157

SUMMARY AND KEY POINTS 158
REVIEW QUESTIONS 160

REFERENCES 160
Chapter 10
Therapeutic Groups 161
FUNCTIONS OF A GROUP 162

TYPES OF GROUPS 162
Task Groups 162
Teaching Groups 162
Supportive/Therapeutic Groups 162
Self-Help Groups 163

PHYSICAL CONDITIONS THAT INFLUENCE GROUP DYNAMICS 163
Seating 163
Size 163
Membership 163

CURATIVE FACTORS 164
PHASES OF GROUP DEVELOPMENT 164
Phase I. Initial or Orientation Phase 164
Phase II. Middle or Working Phase 164
Phase III. Final or Termination Phase 165
LEADERSHIP STYLES 165
Autocratic 165
Democratic 165
Laissez-Faire 165
MEMBER ROLES 166

PSYCHODRAMA 167
THE ROLE OF THE NURSE IN GROUP THERAPY 167
SUMMARY AND KEY POINTS 167
REVIEW QUESTIONS 169

REFERENCES 171
CLASSICAL REFERENCES 171
Chapter 11
Intervention with Families 172
STAGES OF FAMILY DEVELOPMENT 173
Stage I. The Single Young Adult 173
Stage II. The Newly Married Couple 173
Stage III. The Family with Young Children 173
Stage IV. The Family with Adolescents 173
Stage V. The Family Launching Grown Children 174
Stage VI. The Family in Later Life 175
MAJOR VARIATIONS 175
Divorce 175
Remarriage 175
Cultural Variations 175
FAMILY FUNCTIONING 176
Communication 177
Self-Concept Reinforcement 178
Family Members' Expectations 178
Handling Differences 179
Family Interactional Patterns 180
Family Climate 180
THERAPEUTIC MODALITIES WITH FAMILIES 181
The Family as a System 181
The Structural Model 183
The Strategic Model 184
The Evolution of Family Therapy 186
THE NURSING PROCESS-A CASE STUDY 187
Assessment 187
Diagnosis 190
Outcome Identification 190
Planning/Implementation 190
Evaluation 191

SUMMARY AND KEY POINTS 191
REVIEW QUESTIONS 193

REFERENCES 194
CLASSICAL REFERENCES 194
Chapter 12
Milieu Therapy-The Therapeutic Community 195
MILIEU, DEFINED 195

CURRENT STATUS OF THE THERAPEUTIC COMMUNITY 196
BASIC ASSUMPTIONS 196

CONDITIONS THAT PROMOTE A THERAPEUTIC COMMUNITY 197
THE PROGRAM OF THERAPEUTIC COMMUNITY 198
THE ROLE OF THE NURSE 199
SUMMARY AND KEY POINTS 201
REVIEW QUESTIONS 202

REFERENCES 203
CLASSICAL REFERENCES 203
Chapter 13
Crisis Intervention 204
CHARACTERISTICS OF A CRISIS 205

PHASES IN THE DEVELOPMENT OF A CRISIS 205
TYPES OF CRISES 206
Class 1: Dispositional Crises 206
Class 2: Crises of Anticipated Life Transitions 207
Class 3: Crises Resulting from Traumatic Stress 207
Class 4: Maturational/Developmental Crises 208
Class 5: Crises Reflecting Psychopathology 208
Class 6: Psychiatric Emergencies 208

CRISIS INTERVENTION 209
PHASES OF CRISIS INTERVENTION: THE ROLE OF THE NURSE 209
Phase 1. Assessment 209
Phase 2. Planning of Therapeutic Intervention 209
Phase 3. Intervention 210
Phase 4. Evaluation of Crisis Resolution and Anticipatory Planning 211

DISASTER NURSING 211

APPLICATION OF THE NURSING PROCESS TO DISASTER NURSING 211
Background Assessment Data 211
Nursing Diagnoses/Outcome Identification 211
Planning/Implementation 212
Evaluation 212
SUMMARY AND KEY POINTS 217
REVIEW QUESTIONS 218

REFERENCES 219
CLASSICAL REFERENCES 219
Chapter 14
Relaxation Therapy 220
THE STRESS EPIDEMIC 220
PHYSIOLOGICAL, COGNITIVE, AND BEHAVIORAL MANIFESTATIONS OF RELAXATION
221
METHODS OF ACHIEVING RELAXATION 223
Deep Breathing Exercises 223
Progressive Relaxation 223
Modified (or Passive) Progressive Relaxation 224
Meditation 225
Mental Imagery 225
Biofeedback 226
Physical Exercise 226

THE ROLE OF THE NURSE IN RELAXATION THERAPY 226
Assessment 227
Diagnosis 227
Outcome Identification/Implementation 227
Evaluation 228
SUMMARY AND KEY POINTS 228
REVIEW QUESTIONS 229

REFERENCES 229

Chapter 15
Assertiveness Training 230
ASSERTIVE COMMUNICATION 231
BASIC HUMAN RIGHTS 231
RESPONSE PATTERNS 231
Nonassertive Behavior 231
Assertive Behavior 232
Aggressive Behavior 232
Passive-Aggressive Behavior 232

BEHAVIORAL COMPONENTS OF ASSERTIVE BEHAVIOR 232

TECHNIQUES THAT PROMOTE ASSERTIVE BEHAVIOR 233
THOUGHT-STOPPING TECHNIQUES 234
Method 235
ROLE OF THE NURSE 235
Assessment 235
Diagnosis 236
Outcome Identification/Implementation 236
Evaluation 238
SUMMARY AND KEY POINTS 238
REVIEW QUESTIONS 239

REFERENCES 240
Chapter 16
Promoting Self-Esteem 241
COMPONENTS OF SELF-CONCEPT 242
Physical Self or Body Image 242
Personal Identity 242
Self -Esteem 242

DEVELOPMENT OF SELF-ESTEEM 242
Developmental Progression of Self-Esteem Through the Life Span 243

MANIFESTATIONS OF LOW SELF-ESTEEM 244
Focal Stimuli 244
Contextual Stimuli 244
Residual Stimuli 245
Symptoms of Low Self-Esteem 245
BOUNDARIES 245
Boundary Pliancy 246
Rigid Boundaries 246
Flexible Boundaries 246
Enmeshed Boundaries 247
Establishing Boundaries 247
THE NURSING PROCESS 247
Assessment 247
Diagnosis/Outcome Identification 247
Outcome Criteria 248
Planning/Implementation 248
Evaluation 250

SUMMARY AND KEY POINTS 250
REVIEW QUESTIONS 252

REFERENCES 253
CLASSICAL REFERENCES 253

Chapter 17
Anger/Aggression Management 254
ANGER AND AGGRESSION, DEFINED 255
PREDISPOSING FACTORS TO ANGER AND AGGRESSION 256
Modeling 256
Operant Conditioning 256
Neurophysiological Disorders 256
Biochemical Factors 256
Socioeconomic Factors 256
Environmental Factors 256

THE NURSING PROCESS 257
Assessment 257
Diagnosis/Outcome Identification 258
Planning/Implementation 258
Evaluation 261

SUMMARY AND KEY POINTS 261
REVIEW QUESTIONS 262

REFERENCES 263
Chapter 18
The Suicidal Client 264
HISTORICAL PERSPECTIVES 264
EPIDEMIOLOGICAL FACTORS 265
RISK FACTORS 265
Marital Status 265
Gender 265
Age 266
Religion 266
Socioeconomic Status 266
Ethnicity 266
Other Risk Factors 266

PREDISPOSING FACTORS: THEORIES OF SUICIDE 267
Psychological Theories 267
Sociological Theory 267
Biological Theories 268

APPLICATION OF THE NURSING PROCESS WITH THE SUICIDAL CLIENT 268
Assessment 268
Diagnosis/Outcome Identification 270
Planning/Implementation 270
Evaluation 275
SUMMARY AND KEY POINTS 275
REVIEW QUESTIONS 276

REFERENCES 277
CLASSICAL REFERENCES 278
Chapter 19
Behavior Therapy 279
CLASSICAL CONDITIONING 280
OPERANT CONDITIONING 281
TECHNIQUES FOR MODIFYING CLIENT BEHAVIOR 281
Shaping 281
Modeling 281
Premack Principle 282
Extinction 282
Contingency Contracting 282
Token Economy 282
Time Out 282
Reciprocal Inhibition 282
Overt Sensitization 283
Covert Sensitization 283
Systematic Desensitization 283
Flooding 283

ROLE OF THE NURSE IN BEHAVIOR THERAPY 283
SUMMARY AND KEY POINTS 285
REVIEW QUESTIONS 287

REFERENCES 288
CLASSICAL REFERENCES 288
Chapter 20
Cognitive Therapy 289
HISTORICAL BACKGROUND 290
INDICATIONS FOR COGNITIVE THERAPY 290
GOALS AND PRINCIPLES OF COGNITIVE THERAPY 290
BASIC CONCEPTS 291
Automatic Thoughts 291
Schemas (Core Beliefs) 292

TECHNIQUES OF COGNITIVE THERAPY 292
Didactic (Educational) Aspects 292
Cognitive Techniques 293
Behavioral Interventions 294

ROLE OF THE NURSE IN COGNITIVE THERAPY 295

SUMMARY AND KEY POINTS 298
REVIEW QUESTIONS 299

REFERENCES 300
CLASSICAL REFERENCES 300

Chapter 21
Psychopharmacology 301
HISTORICAL PERSPECTIVES 302
ROLE OF THE NURSE 302
Ethical and Legal Implications 302
Assessment 302
Medication Administration and Evaluation 302
Client Education 302

HOW DO PSYCHOTROPICS WORK? 304
APPLYING THE NURSING PROCESS IN PSYCHOPHARMACOLOGICAL THERAPY 306
Antianxiety Agents 306
Antidepressants 308
Mood-Stabilizing Agents 315
Antipsychotic Agents 321
Sedative-Hypnotics 327
Agents for Attention Deficit Hyperactivity Disorder (ADHD) 329

SUMMARY AND KEY POINTS 332
REVIEW QUESTIONS 334

REFERENCES 335
Chapter 22
Electroconvulsive Therapy 336
ELECTROCONVULSIVE THERAPY, DEFINED 337
HISTORICAL PERSPECTIVES 337
INDICATIONS 338
Major Depression 338
Mania 338
Schizophrenia 338
Other Conditions 338
CONTRAINDICATIONS 338
MECHANISM OF ACTION 338
SIDE EFFECTS 338
RISKS ASSOCIATED WITH ELECTROCONVULSIVE THERAPY 339
Mortality 339
Permanent Memory Loss 339
Brain Damage 339

THE ROLE OF THE NURSE IN ELECTROCONVULSIVE THERAPY 339
Assessment 339
Diagnosis/Outcome Identification 340
Planning/Implementation 340
Evaluation 341

SUMMARY AND KEY POINTS 341
REVIEW QUESTIONS 342

REFERENCES 343
Chapter 23
Complementary Therapies 344
COMMONALITIES AND CONTRASTS 347
TYPES OF COMPLEMENTARY THERAPIES 347
Herbal Medicine 347
Acupressure and Acupuncture 348
Diet and Nutrition 351
Chiropractic Medicine 355
Therapeutic Touch and Massage 356
Yoga 356
Pet Therapy 357

SUMMARY AND KEY POINTS 358
REVIEW QUESTIONS 359

REFERENCES 359
Chapter 24
Client Education 361
HISTORICAL PERSPECTIVES 362
THEORIES OF TEACHING AND LEARNING 363
Behaviorist Theory 363
Cognitive Theory 363
Humanistic Theory 363

DOMAINS OF LEARNING 364
Affective Domain 364
Cognitive Domain 364
Psychomotor Domain 364

AGE AND DEVELOPMENTAL CONSIDERATIONS 364
The Adult Learner 364
Teaching Children and Adolescents 365
Teaching the Elderly 365

THE NURSING PROCESS IN CLIENT EDUCATION 366
Assessment 366
Nursing Diagnosis 368
Outcome Identification 368
Planning/Implementation 368
Evaluation 370

DOCUMENTATION OF CLIENT EDUCATION 371

SUMMARY AND KEY POINTS 371
REVIEW QUESTIONS 373

REFERENCES 374
CLASSICAL REFERENCES 374

UNIT FOUR
NURSING CARE OF CLIENTS WITH ALTERATIONS IN
PSYCHOSOCIAL ADAPTATION
Chapter 25
Disorders Usually First Diagnosed in Infancy, Childhood, or
Adolescence 376
MENTAL RETARDATION 377
Predisposing Factors 377
Application of the Nursing Process to Mental Retardation 378

AUTISTIC DISORDER 380
Clinical Findings 380
Epidemiology and Course 380
Predisposing Factors 381
Application of the Nursing Process to Autistic Disorder 381
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 384
Clinical Findings, Epidemiology, and Course 384
Predisposing Factors 385
Application of the Nursing Process to ADHD 387
Psychopharmacological Intervention for ADHD 390

CONDUCT DISORDER 393
Predisposing Factors 394
Application of the Nursing Process to Conduct Disorder 394

OPPOSITIONAL DEFIANT DISORDER 397
Clinical Findings, Epidemiology, and Course 397
Predisposing Factors 397
Application of the Nursing Process to ODD 398

TOURETTE'S DISORDER 401
Clinical Findings, Epidemiology, and Course 401
Predisposing Factors 401
Application of the Nursing Process to Tourette's Disorder 401
Psychopharmacological Intervention for Tourette's Disorder 404

SEPARATION ANXIETY DISORDER 404
Clinical Findings, Epidemiology, and Course 404
Predisposing Factors 404
Application of the Nursing Process to Separation Anxiety Disorder 405
GENERAL THERAPEUTIC APPROACHES 407
Behavior Therapy 407
Family Therapy 408
Group Therapy 408
Psychopharmacology 408

SUMMARY AND KEY POINTS 408
REVIEW QUESTIONS 410

REFERENCES 411
INTERNET REFERENCES 412

Chapter 26
Delirium, Dementia, and Amnestic Disorders 413
DELIRIUM 414
Clinical Findings and Course 414
Predisposing Factors 414
DEMENTIA 415
Clinical Findings, Epidemiology, and Course 415
Predisposing Factors 417

AMNESTIC DISORDERS 422
Predisposing Factors 422
APPLICATION OF THE NURSING PROCESS 422
Assessment 422
Nursing Diagnosis/Outcome Identification 426
Planning/Implementation 427
Concept Care Mapping 430
Client/Family Education 430
Evaluation 432

MEDICAL TREATMENT MODALITIES 432
Delirium 432
Dementia 432

SUMMARY AND KEY POINTS 437
REVIEW QUESTIONS 438

REFERENCES 439
INTERNET REFERENCES 440

Chapter 27
Substance-Related Disorders 441
SUBSTANCE-USE DISORDERS 442
Substance Abuse 442
DSM-IV-TR Criteria for Substance Abuse 442
Substance Dependence 442
DSM-IV-TR Criteria for Substance Dependence 443

SUBSTANCE-INDUCED DISORDERS 443
Substance Intoxication 443
DSM-IV-TR Criteria for Substance Intoxication 443
Substance Withdrawal 443
DSM-IV-TR Criteria for Substance Withdrawal 443

CLASSES OF PSYCHOACTIVE SUBSTANCES 444

PREDISPOSING FACTORS TO SUBSTANCE-RELATED DISORDERS 444
Biological Factors 444
Psychological Factors 444
Sociocultural Factors 444

THE DYNAMICS OF SUBSTANCE-RELATED DISORDERS 445
Alcohol Abuse and Dependence 445
Alcohol Intoxication 449
Alcohol Withdrawal 450
Sedative, Hynotic, or Anxiolytic Abuse and Dependence 450
Sedative, Hypnotic, or Anxiolytic Intoxication 452
Sedative, Hypnotic, or Anxiolytic Withdrawal 452
CNS Stimulant Abuse and Dependence 452
CNS Stimulant Intoxication 455
CNS Stimulant Withdrawal 455
Inhalant Abuse and Dependence 456
Inhalant Intoxication 456
Opioid Abuse and Dependence 456
Opioid Intoxication 458
Opioid Withdrawal 458
Hallucinogen Abuse and Dependence 459
Hallucinogen Intoxication 461
Cannabis Abuse and Dependence 461
Cannabis Intoxication 463

APPLICATION OF THE NURSING PROCESS 463
Assessment 463
Diagnosis/Outcome Identification 470
Planning/Implementation 471
Concept Care Mapping 474
Client/Family Education 474
Evaluation 474

THE CHEMICALLY IMPAIRED NURSE 476

CODEPENDENCY 477
The Codependent Nurse 477
Treating Codependence 478

TREATMENT MODALITIES FOR SUBSTANCE-RELATED DISORDERS 478
Alcoholics Anonymous 478
Pharmacotherapy 478
Counseling 480
Group Therapy 481
Psychopharmacology for Substance Intoxication and Substance Withdrawal
481

SUMMARY AND KEY POINTS 484
REVIEW QUESTIONS 485

REFERENCES 487
CLASSICAL REFERENCES 488
INTERNET REFERENCES 488

Chapter 28
Schizophrenia and Other Psychotic Disorders 489
NATURE OF THE DISORDER 490
Phase I: The Premorbid Phase 490
Phase II: The Prodromal Phase 491
Phase III: Schizophrenia 491
Phase IV: Residual Phase 491
Prognosis 491

PREDISPOSING FACTORS 492
Biological Influences 492
Psychological Influences 494
Environmental Influences 494
Stressful Life Events 494
The Transactional Model 494

TYPES OF SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS 496
Disorganized Schizophrenia 496
Catatonic Schizophrenia 496
Paranoid Schizophrenia 496
Undifferentiated Schizophrenia 496
Residual Schizophrenia 496
Schizoaffective Disorder 496
Brief Psychotic Disorder 497
Schizophreniform Disorder 497
Delusional Disorder 497
Shared Psychotic Disorder 497
Psychotic Disorder Due to a General Medical Condition 498
Substance-Induced Psychotic Disorder 498

APPLICATION OF THE NURSING PROCESS 498
Background Assessment Data 498
Diagnosis/Outcome Identification 502
Planning/Implementation 503
Concept Care Mapping 506
Client/Family Education 506
Evaluation 506

TREATMENT MODALITIES FOR SCHIZOPHRENIA AND OTHER PSYCHOTIC
DISORDERS 508
Psychological Treatments 508
Social Treatment 509
Organic Treatment 510

SUMMARY AND KEY POINTS 514
REVIEW QUESTIONS 516

REFERENCES 517
INTERNET REFERENCES 518

Chapter 29
Mood Disorders 519

HISTORICAL PERSPECTIVE 520
EPIDEMIOLOGY 520
Gender 521
Age 521
Social Class 521
Race and Culture 521
Marital Status 522
Seasonality 522

TYPES OF MOOD DISORDERS 522
Depressive Disorders 522
Bipolar Disorders 524
Other Mood Disorders 525

DEPRESSIVE DISORDERS 525
Predisposing Factors 525
Developmental Implications 529

APPLICATION OF THE NURSING PROCESS TO DEPRESSIVE DISORDERS 532
Background Assessment Data 532
Diagnosis/Outcome Identification 534
Planning/Implementation 535
Concept Care Mapping 538
Client/Family Education 538
Evaluation of Care for the Depressed Client 538

BIPOLAR DISORDER (MANIA) 540
Predisposing Factors 540
Developmental Implications 542

APPLICATION OF THE NURSING PROCESS TO BIPOLAR DISORDER (MANIA) 543
Background Assessment Data 543
Diagnosis/Outcome Identification 544
Planning/Implementation 545
Concept Care Mapping 547
Client/Family Education 547
Evaluation of Care for the Manic Client 547

TREATMENT MODALITIES FOR MOOD DISORDERS 549
Individual Psychotherapy 549
Group Therapy for Depression and Mania 550
Family Therapy for Depression and Mania 550
Cognitive Therapy for Depression and Mania 550
Electroconvulsive Therapy for Depression and Mania 551
Transcranial Magnetic Stimulation 551
Light Therapy for Depression 551
Psychopharmacology 551

SUMMARY AND KEY POINTS 556
REVIEW QUESTIONS 557

REFERENCES 559
CLASSICAL REFERENCES 560
INTERNET REFERENCES 560

Chapter 30
Anxiety Disorders 561
HISTORICAL ASPECTS 562
EPIDEMIOLOGICAL STATISTICS 562

HOW MUCH IS TOO MUCH? 564
APPLICATION OF THE NURSING PROCESS 564
Panic Disorder 564
Generalized Anxiety Disorder 565
Phobias 566
Obsessive-Compulsive Disorder 571
Posttraumatic Stress Disorder 574
Anxiety Disorder Due to a General Medical Condition 576
Substance-Induced Anxiety Disorder 576
Diagnosis/Outcome Identification 576
Planning/Implementation 578
Concept Care Mapping 580
Client/Family Education 583
Evaluation 583

TREATMENT MODALITIES 583
Individual Psychotherapy 583
Cognitive Therapy 584
Behavior Therapy 584
Group/Family Therapy 585
Psychopharmacology 585

SUMMARY AND KEY POINTS 588
REVIEW QUESTIONS 589

REFERENCES 590
CLASSICAL REFERENCES 591
INTERNET REFERENCES 591

Chapter 31
Somatoform and Dissociative Disorders 592

HISTORICAL ASPECTS 593

EPIDEMIOLOGICAL STATISTICS 593
APPLICATION OF THE NURSING PROCESS 595
Background Assessment Data: Types of Somatoform Disorders 595
Predisposing Factors Associated with Somatoform Disorders 598
Background Assessment Data: Types of Dissociative Disorders 600
Predisposing Factors Associated with Dissociative Disorders 602
Diagnosis/Outcome Identification 604
Planning/Implementation 605
Concept Care Mapping 609
Evaluation 609

TREATMENT MODALITIES 609
Somatoform Disorders 609
Dissociative Amnesia 612
Dissociative Fugue 612
Dissociative Identity Disorder 612
Depersonalization Disorder 613

SUMMARY AND KEY POINTS 614
REVIEW QUESTIONS 616

REFERENCES 617
CLASSICAL REFERENCES 618
INTERNET REFERENCES 618

Chapter 32
Issues Related to Human Sexuality 619
DEVELOPMENT OF HUMAN SEXUALITY 620
Birth Through Age 12 620
Adolescence 620
Adulthood 621

SEXUAL DISORDERS 622
Paraphilias 622
Sexual Dysfunctions 626
Application of the Nursing Process to Sexual Disorders 630
Treatment Modalities for Sexual Dysfunctions 636

VARIATIONS IN SEXUAL ORIENTATION 638
Homosexuality 638
Transsexualism 640
Bisexuality 640

SEXUALLY TRANSMITTED DISEASES 641

SUMMARY AND KEY POINTS 643
REVIEW QUESTIONS 645

REFERENCES 646
CLASSICAL REFERENCES 646
INTERNET REFERENCES 646
Chapter 33
Eating Disorders 647
EPIDEMIOLOGICAL FACTORS 648
APPLICATION OF THE NURSING PROCESS 648
Background Assessment Data (Anorexia Nervosa) 648
Background Assessment Data (Bulimia Nervosa) 649
Background Assessment Data (Obesity) 650
Diagnosis/Outcome Identification 652
Planning/Implementation 652
Concept Care Mapping 657
Client/Family Education 658
Evaluation 658

TREATMENT MODALITIES 659
Behavior Modification 659
Individual Therapy 659
Family Therapy 660
Psychopharmacology 660

SUMMARY AND KEY POINTS 662
REVIEW QUESTIONS 663

REFERENCES 664
INTERNET REFERENCES 665

Chapter 34
Personality Disorders 666

HISTORICAL ASPECTS 668

TYPES OF PERSONALITY DISORDERS 668
Paranoid Personality Disorder 668
Schizoid Personality Disorder 669
Schizotypal Personality Disorder 670
Antisocial Personality Disorder 671
Borderline Personality Disorder 671
Histrionic Personality Disorder 671
Narcissistic Personality Disorder 672
Avoidant Personality Disorder 673
Dependent Personality Disorder 674
Obsessive-Compulsive Personality Disorder 675
Passive-Aggressive Personality Disorder 676

APPLICATION OF THE NURSING PROCESS 676
Borderline Personality Disorder (Background Assessment Data) 676
Predisposing Factors to Borderline Personality Disorder 678
Diagnosis/Outcome Identification 679
Planning/Implementation 679
Concept Care Mapping 683
Evaluation 683
Antisocial Personality Disorder (Background Assessment Data) 683
Diagnosis/Outcome Identification 686
Planning/Implementation 687
Concept Care Mapping 689
Evaluation 689

TREATMENT MODALITIES 690
Interpersonal Psychotherapy 690
Psychoanalytical Psychotherapy 690
Milieu or Group Therapy 690
Cognitive/Behavioral Therapy 690
Psychopharmacology 690

SUMMARY AND KEY POINTS 692
REVIEW QUESTIONS 693
REFERENCES 695
CLASSICAL REFERENCES 695
INTERNET REFERENCES 695


UNIT FIVE
PSYCHIATRIC/MENTAL HEALTH NURSING OF SPECIAL
POPULATIONS
Chapter 35
The Aging Individual 698
HOW OLD IS OLD? 699

EPIDEMIOLOGICAL STATISTICS 699
The Population 699
Marital Status 699
Living Arrangements 700
Economic Status 700
Employment 700
Health Status 700
THEORIES OF AGING 700
Biological Theories 700
Psychosocial Theories 701

THE NORMAL AGING PROCESS 702
Biological Aspects of Aging 702
Psychological Aspects of Aging 705
Sociocultural Aspects of Aging 707
Sexual Aspects of Aging 707

SPECIAL CONCERNS OF THE ELDERLY POPULATION 708
Retirement 708
Long-Term Care 710
Elder Abuse 711

APPLICATION OF THE NURSING PROCESS 713
Assessment 713
Diagnosis/Outcome Identification 714
Planning/Implementation 715
Evaluation 715

SUMMARY AND KEY POINTS 720
REVIEW QUESTIONS 723

REFERENCES 724
CLASSICAL REFERENCES 725
INTERNET REFERENCES 725

Chapter 36
Victims of Abuse or Neglect 726
HISTORICAL PERSPECTIVES 727
PREDISPOSING FACTORS 727
Biological Theories 728
Psychological Theories 728
Sociocultural Theories 728

APPLICATION OF THE NURSING PROCESS 730
Background Assessment Data 730
Diagnosis/Outcome Identification 736
Planning/Implementation 736
Concept Care Mapping 739
Evaluation 739
TREATMENT MODALITIES 739
Crisis Intervention 739
The Safe House or Shelter 741
Family Therapy 741

SUMMARY AND KEY POINTS 742
REVIEW QUESTIONS 743

REFERENCES 745
CLASSICAL REFERENCES 745
INTERNET REFERENCES 745

Chapter 37
Community Mental Health Nursing 746
THE CHANGING FOCUS OF CARE 747

THE PUBLIC HEALTH MODEL 748
THE ROLE OF THE NURSE 749
The Psychiatric-Mental Health Registered Nurse (RN-PMH) 749
The Psychiatric-Mental Health Advanced Practice Registered Nurse (APRN-PMH) 750

CASE MANAGEMENT 750
THE COMMUNITY AS CLIENT 751
Primary Prevention 751
Secondary Prevention 757
Tertiary Prevention 758

SUMMARY AND KEY POINTS 772
REVIEW QUESTIONS 774

REFERENCES 775
CLASSICAL REFERENCES 776
Chapter 38
Forensic Nursing 777
WHAT IS FORENSIC NURSING? 777

HISTORICAL PERSPECTIVES 778
THE CONTEXT OF FORENSIC NURSING PRACTICE 778

FORENSIC NURSING SPECIALTIES 778
Clinical Forensic Nursing Specialty 778
The Sexual Assault Nurse Examiner (SANE) 779
Forensic Psychiatric Nursing Specialty 779
Correctional/Institutional Nursing Specialty 779
Nurses in General Practice 779

APPLICATION OF THE NURSING PROCESS IN CLINICAL FORENSIC NURSING IN
TRAUMA CARE 780
Assessment 780
Nursing Diagnosis 781
Planning/Implementation 781
Evaluation 783

APPLICATION OF THE NURSING PROCESS IN FORENSIC PSYCHIATRIC NURSING IN
CORRECTIONAL FACILITIES 783
Assessment 783
Nursing Diagnosis 786
Planning/Implementation 786
Evaluation 789
SUMMARY AND KEY POINTS 789
REVIEW QUESTIONS 790

REFERENCES 790
CLASSICAL REFERENCE 791
INTERNET REFERENCES 791
Chapter 39
The Bereaved Individual 792
THEORETICAL PERSPECTIVES ON LOSS AND BEREAVEMENT 793
Stages of Grief 793

LENGTH OF THE GRIEF PROCESS 796
ANTICIPATORY GRIEF 797
MALADAPTIVE RESPONSES TO LOSS 797
Delayed or Inhibited Grief 797
Distorted (Exaggerated) Grief Response 797
Chronic or Prolonged Grieving 797
Normal versus Maladaptive Grieving 798

APPLICATION OF THE NURSING PROCESS 798
Background Assessment Data: Concepts of Death-Developmental Issues 798
Background Assessment Data: Concepts of Death-Cultural Issues 799
Nursing Diagnosis/Outcome Identification 801
Planning/Implementation 801
Evaluation 801
ADDITIONAL ASSISTANCE 804
Hospice 804
Advance Directives 806

SUMMARY AND KEY POINTS 807
REVIEW QUESTIONS 809
REFERENCES 810
CLASSICAL REFERENCES 810
INTERNET REFERENCES 810

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