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Chapter 4 - Treatment Settings

This chapter discusses various treatment settings for mental health care including outpatient, emergency, inpatient, and specialty settings. Outpatient settings include primary care, community clinics, intensive outpatient programs, and assertive community treatment. The role of the nurse in outpatient settings involves strong clinical skills, cultural competence, flexibility, and knowledge of community resources. When moving from inpatient to outpatient care, factors like medication adherence, family support, housing stability, and substance use can affect treatment success. Inpatient settings include crisis stabilization units, general hospitals, and state hospitals. Nurses play an important role in data collection, care planning, and maintaining a therapeutic environment in inpatient settings.

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134 views3 pages

Chapter 4 - Treatment Settings

This chapter discusses various treatment settings for mental health care including outpatient, emergency, inpatient, and specialty settings. Outpatient settings include primary care, community clinics, intensive outpatient programs, and assertive community treatment. The role of the nurse in outpatient settings involves strong clinical skills, cultural competence, flexibility, and knowledge of community resources. When moving from inpatient to outpatient care, factors like medication adherence, family support, housing stability, and substance use can affect treatment success. Inpatient settings include crisis stabilization units, general hospitals, and state hospitals. Nurses play an important role in data collection, care planning, and maintaining a therapeutic environment in inpatient settings.

Uploaded by

SUNKISSED HONEY
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Chapter 4

Treatment Settings
Background:
- 1860s: Asylums have roots in Civil War era
- 1950s: First antipsychotic medication
o Haldol, stella zine (hearing voices, psychosis)
- 1960s: Medicare and Medicaid with no funding for psychiatric care
- 1999: Olmstead Decision: Deinstitutionalization
- 2016: Drop in state psychiatric hospitals from 322 in 1950 to 195 in 2016
- Current system: Outpatient and inpatient settings

Outpatient Psychiatric Mental Health Care:


-primary care providers -community clinics
-specialty psychiatric care providers -psychiatric home care
-pt centered health/medical homes -ACT (assertive community treatment)
-intensive outpatient programs & visit @ home, talk about support groups
partial hospitalization Goal: keep home & OUT of hospital

Other outpatient venues:


- Telephone crisis counseling
- Telephone outreach
- Internet
- Telepsychiatry

Emergency Care:
- Comprehensive emergency service model
- Hospital-based consultant model
- Mobile crisis team model

Prevention Strategies:
1. Primary
a. Prevent/ identify
2. Secondary
a. Assessment tools for diagnoses
3. Tertiary
a. Already have it, getting treated for illness

Role of the Nurse in Outpatient Settings:


- Strong problem-solving & clinical skills
- Cultural competence
- Flexibility
- Knowledge of community resources
- Autonomy
- Promoting recovery & continuation of treatment

What are some problems that may affect the success of treatment when working with a patient that is moving from
inpatient to outpatient community?
- Changing the environment
- Family support
- Have not taken medication*

Housing adequacy and stability: If a patient faces daily fears of homelessness, it is not possible to focus on other treatment
issues.
Income and source of income: A patient must have a basic income—whether from an entitlement, a relative, or other
sources—to obtain necessary medication and meet daily needs for food and clothing.
Family and support system: The presence of a family member, friend, or neighbor supports the patient's recovery and gives
the nurse a contact person, with the patient's consent.
Substance abuse history and current use: Often hidden or minimized during hospitalization, substance abuse can be a
destructive force, undermining medication effectiveness and interfering with community acceptance and procurement of
housing.
Physical well-being: Factors that increase health risks and decrease life span for individuals with mental illnesses include
decreased physical activity, smoking, medication side effects, and lack of routine health exams.

Settings for INPATIENT Care:


- Crisis stabilization/observational units
- General hospital & private hospital
- State hospital

Entry to Acute Inpatient Care:


- Direct admission on referral
- Emergency department or crisis service
- Voluntary or involuntary
*are they suicidal or homicidal? A risk to themselves or others?

Patient’s Rights:
- Hospitalized patients retain their rights as citizens
- Patients need for safety must be balance against patient’s rights as a citizen
- Mental health facilities have written statements of patient’s rights & appliable state laws

Teamwork & Collaboration:


- Members of each discipline are responsible for gathering data & participating in the planning of care
- Treatment plan or clinical pathway provides a guideline for patients care during hospital stay
- Nurses role is often to lead planning meetings
- For standardization in treatment & improve outcomes, inpatient unites use clinical pathways
Therapeutic Milieu:
- Surroundings and physical environment
o Managing behavioral crises
o Safety
o Unit design

Inpatient Psychiatric Nursing Care:


- Completing comprehensive data collection that includes the patient, family, and other health care workers
- Developing, implementing, and evaluating plans of care
- Assisting or supervising mental health care workers
- Maintaining a safe and therapeutic environment
- Facilitating health promotion through teaching
- Monitoring behavior, affect, and mood
- Maintaining oversight of restraint and seclusion
- Coordinating care by the treatment team

Specialty Treatment Settings:


- Pediatric psychiatric care
- Geriatric psychiatric care
- Veterans administration centers
- Forensic psychiatric care
o State hospital
- Alcohol and drug abuse treatment
- Self-help options

*always educate how treatment can help them!

Major depression: chronic illness


- Need follow up care
- Need medication

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