Psychotherapeutic

Management in the
Continuum of Care
Nina Anne Bernadette M.
Pajas, RN, MSN

Psychotherapeutic
Management
What do psychiatric nurses do
that is different from that of other
mental health practitioners?

Standards of Care
Authoritative statements by
professional
organizations
that
describe
the
responsibilities
for
which
nurses are accountable.

Five Categories of Psychiatric

Treatment
1. Use of WORDSEmphasis of
2. Use of DRUGS

Psychotherapeutic

3. Use of ENVIRONMENT Management

4. Somatic Therapy
5. Behavioral Conditioning

Therefore, We have the THREE

intervention TOOLS

1.Self
2.Drugs
3.Environment (MILIEU)

 Each component is used within

the continuum of Care
Less than optimal outcomes are
expected when a component is
not provided to patient

Example.
A Client diagnosed with depression
being treated in an Inpatient
setting
Situation 1: Supportive and caring
Nurses
Antidepressants are being
provided
Safety and other environmental
concerns being addressed

What if.
Situation 2: Non-therapeutic
relationship
Antidepressants being provided
Safety ensured
Outcome: Patient is safe but recovery
is prolonged

 Situation 3: Therapeutic relationship

No antidepressant being
provided
Safety ensured
Outcome: Patient is safe but without
antidepressant, patient suffers the
manifestations of depression.

Psychopathology
Foundation of Psychotherapeutic
Management
One Size does not Fit All
Every Psyche patient is UNIQUE.

Therapeutic Nurse-Patient
Relationship
Therapy
VS
Therapeutic
Goal of Graduate Level Domain of
Psychiatric Training
undergraduate
Level
So at the end of this subject you are
expected to become therapeutic.

Self Awareness
Process by which a nurse
gains recognition of his or her
own feelings, beliefs and
attitudes.

Psychopharmacology
What Is your knowledge of the
drugs?
What are your interventions BEFORE,
DURING, and AFTER drug
administration?
Assessment of patient response to
drug, its side effects and adverse
effects.

Milieu Management
The use of environment in the management of
clients therapy
6 environmental elements:
1. Safety
2. Structure
3. Norms
4. Limit Setting
5. Balance
6. Environmental Modification

Therapeutic NursePatient Relationship

Communication skills
Respect and a Desire
to help
Understanding of the
patient case

Psychoth
erapy

Pharmacology
Responsibilities in
administering the
medication

Milieu Management
Safety and comfort

The Continuum of Care

(DIAGRAM)

Treatment
Options

1. Hospital-Based Care
Reasons for hospitalization
1. Safety for self and others
2. With risk of accidental harm
3. Confused, disoriented who cannot
sustain their basic needs
4. Individuals experiencing toxic
reactions to medications and other
substances

2. Traditional Outpatient Services

a. Partial Programs and day treatment
b. Psychiatric Home Care
c. Community Outreach programs
d. Residential Services

3. Intensive Outpatient
Programs
Designed to assist the recovery of
the patients and stabilize them in the
community

4. Self Help Groups

Addiction Based
Alcoholic Anonymous, Narcotic
Anonymous
Survivor Based
Survivors of suicide, adult children of
alcoholics
Disorder Based
Eating disorder, Bipolar disorder

Managed Care
Concept designed to purposely
control the balance between the
quality of care provided and the cost
of care
People received care based on their
need than on their request

Case Management
Care on a case-by-case basis represented an
effort to necessary care while containing the cost
Patient is assigned to a Case Manager who
coordinates all types of care for the patient
It decreases fragmented care from a variety of
sources, eliminate unneeded overlap services,
provide less restrictive care and decreased the
expences.