Mental Health Disorder in Nursing

Psychiatric–Mental Health Nursing

Seventh Edition

SHEILA L. VIDEBECK, PhD, RN Professor Emeritus

Des Moines Area Community College Ankeny, Iowa

Illustrations by Cathy J. Miller

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7th edition Copyright © 2017 Wolters Kluwer

Copyright © 2014, 2011, 2008 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2006, 2004, 2001 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via e-mail at permissions@lww.com, or via our website at lww.com (products and services). Mental Health Disorder in Nursing

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Library of Congress Cataloging-in-Publication Data Names: Videbeck, Sheila L., author. | Miller, C. J. (Cathy J.), illustrator. Title: Psychiatric-mental health nursing / Sheila L. Videbeck ; illustrations by Cathy J. Miller. Description: Seventh edition. | Philadelphia, PA : Wolters Kluwer, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016018623 | eISBN 9781496355911 Subjects: | MESH: Psychiatric Nursing | Mental Disorders—nursing | Nurse-Patient Relations Classification: LCC RC440 | NLM WY 160 | DDC 616.89/0231—dc23 LC record available at https://lccn.loc.gov/2016018623

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

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This work is no substitute for individual patient assessment based upon health care professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data, and other factors unique to the patient. The publisher does not provide medical advice or guidance, and this work is merely a reference tool. Health care professionals, and not the publisher, are solely responsible for the use of this work, including all medical judgments and for any resulting diagnosis and treatments.

Given the continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and health care professionals should consult a variety of sources. When prescribing medication, health care professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used, or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law, or otherwise, or from any reference to or use by any person of this work.

LWW.com

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Reviewers

Josephine M. Britanico, MSN, RN, PNP, PhD(c) Assistant Professor of Nursing Borough of Manhattan Community College/CUNY New York, New York

Nicole Brodrick, DNP, RN, NP, CNS Assistant Professor University of Colorado Aurora, Colorado

Juliana DeHanes, MSN, RN, CCRN Nursing Faculty/Course Coordinator Middlesex County College Nursing Program Edison, New Jersey

Debbi Del Re, MSN, RN Mental Health Nursing Instructor University of St. Francis Joliet, Illinois

Kimberly Dever, MSN, RN Instructor University of Central Florida College of Nursing Orlando, Florida

Diane E. Friend, MSN, RN, CDONA/LTC Assistant Professor of Nursing Allegany College of Maryland Cumberland, Maryland

Melissa Garno, EdD, RN Professor, BSN Program Director Georgia Southern University Statesboro, Georgia

Barbara J. Goldberg, MS, RN, CNS Assistant Professor Onondaga Community College Syracuse, New York

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Judith E. Gunther, MSN, RN Associate Professor of Nursing Northern Virginia Community College Springfield, Virginia

Lois Harder, RN Senior Lecturer West Virginia University Morgantown, West Virginia

Tina L. Kinney, MSN, RNC, FNP-BC, WHNP-BC Nursing Instructor Lutheran School of Nursing St. Louis, Missouri

Lynne S. Mann, MN, RN, CNE Assistant Professor Charleston Southern University Charleston, South Carolina

J. Susan G. Van Wye, MSN, RN, ARNP, CPNP Adjunct Nursing Faculty Kirkwood Community College Cedar Rapids, Iowa

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Preface

The seventh edition of Psychiatric–Mental Health Nursing maintains a strong student focus, presenting sound nursing theory, therapeutic modalities, and clinical applications across the treatment continuum. The chapters are short, and the writing style is direct in order to facilitate reading comprehension and student learning.

This text uses the nursing process framework and emphasizes therapeutic communication with examples and pharmacology throughout. Interventions focus on all aspects of client care, including communication, client and family education, and community resources, as well as their practical application in various clinical settings.

In this edition, all DSM-5 content has been updated, as well as the Best Practice boxes, to highlight current evidence-based practice. New special features include Concept Mastery Alerts, which clarify important concepts that are essential to students’ learning, and Watch and Learn icons that alert students to important video content available on . Cultural and Elder Considerations have special headings to help call attention to this important content. The nursing process sections have a new design to help highlight this content as well.

ORGANIZATION OF THE TEXT Unit 1: Current Theories and Practice provides a strong foundation for students. It addresses current issues in psychiatric nursing as well as the many treatment settings in which nurses encounter clients. It thoroughly discusses neurobiologic theories, psychopharmacology, and psychosocial theories and therapy as a basis for understanding mental illness and its treatment.

Unit 2: Building the Nurse–Client Relationship presents the basic elements essential to the practice of mental health nursing. Chapters on therapeutic relationships and therapeutic communication prepare students to begin working with clients both in mental health settings and in all other areas of nursing practice. The chapter on the client’s response to illness provides a framework for understanding the individual client. An entire

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chapter is devoted to assessment, emphasizing its importance in nursing.

Unit 3: Current Social and Emotional Concerns covers topics that are not exclusive to mental health settings. These include legal and ethical issues; anger, aggression, and hostility; abuse and violence; and grief and loss. Nurses in all practice settings find themselves confronted with issues related to these topics. Additionally, many legal and ethical concerns are interwoven with issues of violence and loss.

Unit 4: Nursing Practice for Psychiatric Disorders covers all the major categories of mental disorders. This unit has been reorganized to reflect current concepts in mental disorders. New chapters include trauma and stressor-related disorders; obsessive–compulsive disorder and related disorders; somatic symptom disorders; disruptive disorders; and neurodevelopmental disorders. Each chapter provides current information on etiology, onset and clinical course, treatment, and nursing care. The chapters are compatible for use with any medical classification system for mental disorders.

PEDAGOGICAL FEATURES Psychiatric–Mental Health Nursing incorporates several pedagogical features designed to facilitate student learning:

• Learning Objectives focus on the students’ reading and study. • Key Terms identify new terms used in the chapter. Each term is

identified in bold and defined in the text. • Application of the Nursing Process sections, with a special design in

this edition, highlight the assessment framework presented in Chapter 8 to help students compare and contrast various disorders more easily.

• Critical Thinking Questions stimulate students’ thinking about current dilemmas and issues in mental health.

• Key Points summarize chapter content to reinforce important concepts. • Chapter Study Guides provide workbook-style questions for students

to test their knowledge and understanding of each chapter.

SPECIAL FEATURES • Clinical Vignettes, provided for each major disorder discussed in the

text, “paint a picture” of a client dealing with the disorder to enhance understanding.

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• Nursing Care Plans demonstrate a sample plan of care for a client with a specific disorder.

• Drug Alerts highlight essential points about psychotropic drugs. • Warning boxes are the FDA black box drug warnings for specific

medications. • Cultural Considerations sections highlight diversity in client care. • Elder Considerations sections highlight the key considerations for a

growing older adult population. • Therapeutic dialogues give specific examples of the nurse–client

interaction to promote therapeutic communication skills. • Client/Family Education boxes provide information that helps

strengthen students’ roles as educators. • Nursing Interventions provide a summary of key interventions for the

specific disorder. • DSM-5 Diagnostic Criteria boxes include specific diagnostic

information for the disorder. • Best Practices boxes highlight current evidence-based practice and

future directions for research on a wide variety of practice issues. • Self-Awareness features encourage students to reflect on themselves,

their emotions, and their attitudes as a way to foster both personal and professional development.

• Concept Mastery Alerts clarify important concepts that are essential to students’ learning and practice.

• Watch and Learn icons alert the reader to important resources available on to enhance student understanding of the topic.

ANCILLARY PACKAGE FOR THE SEVENTH EDITION

Instructor Resources The Instructor Resources are available online at http://thepoint.lww.com/Videbeck7e for instructors who adopt Psychiatric–Mental Health Nursing. Information and activities that will help you engage your students throughout the semester include:

• PowerPoint Slides • Image Bank • Test Generator

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• Pre-Lecture Quizzes • Discussion Topics • Written, Group, Clinical, and Web Assignments • Guided Lecture Notes • Case Studies

Student Resources Students who purchase a new copy of Psychiatric–Mental Health Nursing gain access to the following learning tools on using the access code in the front of their book:

• , highlighting films depicting individuals with mental health disorders, provide students the opportunity to approach nursing care related to mental health and illness in a novel way.

• NCLEX-Style Review Questions help students review important concepts and practice for the NCLEX examination.

• Journal Articles offer access to current research available in Wolters Kluwer journals.

• Online video series, Lippincott Theory to Practice Video Series includes videos of true-to-life clients displaying mental health disorders, allowing students to gain experience and a deeper understanding of these patients.

• Internet Resources provide relevant weblinks to further explore chapter content.

Practice Makes Perfect, and This Is the Perfect Practice. PrepU is an adaptive learning system designed to improve students’ competency and mastery and provide instructors with real-time analysis of their students’ knowledge at both a class and individual student level.

PrepU demonstrates formative assessment—it determines what students know as they are learning, and focuses them on what they are struggling with, so they don’t spend time on what they already know. Feedback is immediate and remediates students back to this specific text, so they know where to get help in understanding a concept.

Adaptive and Personalized

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No student has the same experience—PrepU recognizes when a student has reached “mastery” of a concept before moving him/her on to higher levels of learning. This will be a different experience for each student based on the number of questions he/she answers and whether he/she answers them correctly. Each question is also “normed” by all students in PrepU around the country—how every student answers a specific question generates the difficulty level of each question in the system. This adaptive experience allows students to practice at their own pace and study much more effectively. Mental Health Disorder in Nursing

Personalized Reports Students get individual feedback about their performance, and instructors can track class statistics to gauge the level of understanding. Both get a window into performance to help identify areas for remediation. Instructors can access the average mastery level of the class, students’ strengths and weaknesses, and how often students use PrepU. Students can see their own progress charts showing strengths and weaknesses—so they can continue quizzing in areas where they are weaker.

Mobile Optimized Students can study anytime, anywhere with PrepU, as it is mobile optimized. More convenience equals more quizzing and more practice for students!

There is a PrepU resource available with this book! For more information, visit http://thepoint.lww.com/PrepU.

This leading content is also incorporated into Lippincott CoursePoint, a dynamic learning solution that integrates this book’s curriculum, adaptive learning tools, real-time data reporting, and the latest evidence-based practice content into one powerful student learning solution. Lippincott CoursePoint improves the nursing students’ critical thinking and clinical reasoning skills to prepare them for practice. Learn more at www.NursingEducationSuccess.com/CoursePoint.

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Acknowledgments

Many years of teaching and practice have shaped my teaching efforts and this textbook.

Students provide feedback and ask ever-changing questions that guide me to keep this text useful, easy to read and understand, and focused on student learning. Students also help keep me up to date, so the text can stay relevant to their needs. I continue to work with students in simulation lab experiences as nursing education evolves with advances in technology.

I want to thank the people at Wolters Kluwer for their valuable assistance in making this textbook a reality. Their contributions to its success are greatly appreciated. I thank Natasha McIntyre, Dan Reilly, Zach Shapiro, Helen Kogut, and Cynthia Rudy for a job well done once again.

My friends continue to listen, support, and encourage my efforts in all endeavors. My brother and his family provide love and support in this endeavor, as well as in the journey of life. I am truly fortunate and grateful.

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Brief Contents

UNIT 1 Current Theories and Practice

1. Foundations of Psychiatric–Mental Health Nursing 2. Neurobiologic Theories and Psychopharmacology 3. Psychosocial Theories and Therapy 4. Treatment Settings and Therapeutic Programs

UNIT 2 Building the Nurse–Client Relationship

5. Therapeutic Relationships 6. Therapeutic Communication 7. Client’s Response to Illness 8. Assessment

UNIT 3 Current Social and Emotional Concerns

9. Legal and Ethical Issues 10. Grief and Loss 11. Anger, Hostility, and Aggression 12. Abuse and Violence

UNIT 4 Nursing Practice for Psychiatric Disorders 13. Trauma and Stressor-Related Disorders 14. Anxiety and Anxiety Disorders 15. Obsessive–Compulsive and Related Disorders 16. Schizophrenia 17. Mood Disorders and Suicide 18. Personality Disorders 19. Addiction 20. Eating Disorders 21. Somatic Symptom Illnesses 22. Neurodevelopmental Disorders

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23. Disruptive Behavior Disorders 24. Cognitive Disorders

Answers to Chapter Study Guides

Appendix A Disorders of Sleep and Wakefulness

Appendix B Sexual Dysfunctions and Gender Dysphoria

Appendix C Drug Classification Under the Controlled Substances Act

Appendix D Canadian Drug Trade Names

Appendix E Mexican Drug Trade Names Glossary of Key Terms Index

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Contents

UNIT 1 Current Theories and Practice

1. Foundations of Psychiatric–Mental Health Nursing Mental Health and Mental Illness Diagnostic and Statistical Manual of Mental Disorders Historical Perspectives of the Treatment of Mental Illness Mental Illness in the 21st Century Cultural Considerations Psychiatric Nursing Practice. Mental Health Disorder in Nursing

2. Neurobiologic Theories and Psychopharmacology The Nervous System and How it Works Brain Imaging Techniques Neurobiologic Causes of Mental Illness The Nurse’s Role in Research and Education Psychopharmacology Cultural Considerations

3. Psychosocial Theories and Therapy Psychosocial Theories Cultural Considerations Treatment Modalities The Nurse and Psychosocial Interventions

4. Treatment Settings and Therapeutic Programs Treatment Settings Psychiatric Rehabilitation and Recovery Special Populations of Clients with Mental Illness Interdisciplinary Team Psychosocial Nursing in Public Health and Home Care

UNIT 2 Building the Nurse–Client Relationship

5. Therapeutic Relationships Components of a Therapeutic Relationship Types of Relationships

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Establishing the Therapeutic Relationship Avoiding Behaviors that Diminish the Therapeutic Relationship Roles of the Nurse in a Therapeutic Relationship

6. Therapeutic Communication What is Therapeutic Communication? Verbal Communication Skills Nonverbal Communication Skills Understanding the Meaning of Communication Understanding Context Understanding Spirituality Cultural Considerations The Therapeutic Communication Session Assertive Communication Community-Based Care

7. Client’s Response to Illness Individual Factors Interpersonal Factors Cultural Factors

8. Assessment Factors Influencing Assessment How to Conduct the Interview Content of the Assessment Assessment of Suicide or Harm Toward Others Data Analysis

UNIT 3 Current Social and Emotional Concerns

9. Legal and Ethical Issues Legal Considerations Ethical Issues

10. Grief and Loss Types of Losses The Grieving Process Dimensions of Grieving Cultural Considerations Disenfranchised Grief Complicated Grieving Application of the Nursing Process

11. Anger, Hostility, and Aggression Onset and Clinical Course

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Related Disorders Etiology Cultural Considerations Treatment Application of the Nursing Process Workplace Hostility Community-Based Care

12. Abuse and Violence Clinical Picture of Abuse and Violence Characteristics of Violent Families Cultural Considerations Intimate Partner Violence Child Abuse Elder Abuse Rape and Sexual Assault Community Violence

UNIT 4 Nursing Practice for Psychiatric Disorders 13. Trauma and Stressor-Related Disorders

Posttraumatic Stress Disorder Etiology Cultural Considerations Treatment Elder Considerations Community-Based Care Mental Health Promotion Application of the Nursing Process

14. Anxiety and Anxiety Disorders Anxiety as a Response to Stress Overview of Anxiety Disorders Incidence Onset and Clinical Course Related Disorders Etiology Cultural Considerations Treatment Elder Considerations Community-Based Care Mental Health Promotion

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Panic Disorder Application of the Nursing Process: Panic Disorder Phobias Generalized Anxiety Disorder

15. Obsessive–Compulsive and Related Disorders Obsessive–Compulsive Disorder Cultural Considerations Application of the Nursing Process Elder Considerations. Mental Health Disorder in Nursing

16. Schizophrenia Clinical Course Related Disorders Etiology Cultural Considerations Treatment Application of the Nursing Process Elder Considerations Community-Based Care Mental Health Promotion

17. Mood Disorders and Suicide Categories of Mood Disorders Related Disorders Etiology Cultural Considerations Major Depressive Disorder Application of the Nursing Process: Depression Bipolar Disorder Application of the Nursing Process: Bipolar Disorder Suicide Elder Considerations Community-Based Care Mental Health Promotion

18. Personality Disorders Personality Disorders Onset and Clinical Course Etiology Cultural Considerations Treatment Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder