3876_FM_i-xxx 15/07/13 4:17 PM Page i Essentials of Psychiatric A guide to… Mental Health Nursing Get the most out of your textbook and resources online at to prepare for class, clinical, and professional success. Gain access to your complete text online with the Davis Digital Version. Quickly search for the content you need and add notes, highlights, and bookmarks. Redeem your Plus Code to access your Premium resource. Step 1. Preview what you’ll learn Chapter Outline, Key Terms, & Core Concepts Take a look at the Chapter Outline and Key Terms sections at the beginning of every chapter to see what you will be learning and what Core Concepts to focus on. Objectives Read the Objectives now to see exactly what you’ll be learning in each chapter. Then, after you read the chapter, revisit the section and assess your progress. Can you correctly define and explain all of the key points? Homework Assignment Take a few moments to review the Homework Assignment before you begin the chapter. When you’ve finished reading the chapter, complete the assignment to reinforce what you’ve learned. 3876_FM_i-xxx 15/07/13 4:17 PM Page ii Step 2. Prepare for the real world of nursing practice Quality and Safety Education for Nurses (QSEN) Activities Stay up to date—attain the knowledge, skills, and attitudes you need to fulfill the initiative’s most current quality and safety competencies. NEW! Communication Exercises Boxes Practice your communication skills with clinical scenarios to prepare for the real world of nursing practice. Therapeutic Communication Icon Find helpful interventions and guidance on how to speak to your patients—just look for this icon in the Care Plan sections. Interactive Clinical Scenarios Online at * Work through the nursing process with client summaries, multiple-choice questions with rationales, drag-and-drop activities, and much more! *A Plus Code in the front of each new book unlocks DavisPlus Premium Content. (Access can also be purchased at DavisPlus.FADavis.com.) 3876_FM_i-xxx 15/07/13 4:17 PM Page iii Summary and Key Points Too busy to take notes? Refer to the Summary and Key Points section at the end of every chapter for a recap of the most important concepts. Step 3. Build your confidence NCLEX-Style Test Bank Online at * Practice makes perfect! Quiz yourself and assess your progress with a wealth of questions, including alternate-item-format questions. Client Teaching Guide Online at Review the crucial information your patients need to know, including possible side effects and what to do before, during, and after taking medication. *A Plus Code in the front of each new book unlocks DavisPlus Premium Content. (Access can also be purchased at DavisPlus.FADavis.com.) 3876_FM_i-xxx 15/07/13 4:17 PM Page iv Step 4. Expand your knowledge NEW! Lists of Movies Take a visual approach—watch the movies listed in every chapter to better understand the conditions and behaviors you may not encounter in clinical. Psychotropic Drug Monographs Online at Attach these handy, printable monographs to your care plans or take them into clinical rotations. Patient safety information, classifications, indications, actions, and nursing implications are easy to find on each psychotropic drug monograph from the trusted Davis’s Drug Guide for Nurses® database. More resources for SUCCESS! Curtis, Fegley, & Tuzo Visit www.FADavis.com for details. Psychiatric Mental Health Nursing Success Pedersen A Q&A Review Applying Psych Notes Critical Thinking to Test Clinical Pocket Guide Taking Includes DSM-5 Content! Quickly find crucial, yet succinct information on all aspects of 2 books in 1—Course Review & NCLEX Prep! Looking for psychiatric mental health nursing—from basic more Q&A review to prepare for classroom exams? Multiple- behavioral theories to psychiatric and crisis choice and alternate-item-format questions help assure your interventions—in a waterproof, spiral-bound mastery of psychiatric mental health nursing knowledge while pocket guide. honing your critical-thinking and test-taking skills. Perfect for classroom exams and the NCLEX, too. 3876_FM_i-xxx 15/07/13 4:17 PM Page v SIXTH EDITION Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice MARY C. TOWNSEND, DSN, PMHCNS-BC Clinical Specialist/Nurse Consultant Adult Psychiatric Mental Health Nursing Former Assistant Professor and Coordinator, Mental Health Nursing Kramer School of Nursing Oklahoma City University Oklahoma City, Oklahoma 3876_FM_i-xxx 15/07/13 4:17 PM Page vi F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2014 by F. A. Davis Company Copyright © 2014 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be repro- duced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Robert G. Martone Director of Content Development: Darlene D. Pedersen Project Editor: Jacalyn C. Clay Electronic Project Editor: Katherine E. Crowley Cover Design: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Townsend, Mary C., 1941- Essentials of psychiatric mental health nursing : concepts of care in evidence-based practice/Mary C. Townsend. — 6th ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-8036-3876-1 ISBN-10: 0-8036-3876-0 I. Title. [DNLM: 1. Psychiatric Nursing—methods. 2. Evidence-Based Nursing. 3. Mental Disorders—nursing. WY 160] RC440 616.89’0231—dc23 2013005234 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-3876-1/14 0 + $.25. 3876_FM_i-xxx 15/07/13 4:17 PM Page vii To my best friend, Jimmy 3876_FM_i-xxx 15/07/13 4:17 PM Page viii CONTRIBUTORS Lois Angelo, MSN, APRN, BC Karyn I. Morgan, RN, MSN, CNS Assistant Professor Senior Instructor, Mental Health Nursing Massachusetts College of Pharmacy and Health The University of Akron Sciences Akron, Ohio and CNS, Intensive Outpatient Boston, Massachusetts Psychiatry Summa Health System Cathy Melfi Curtis, MSN, RN-BC Akron, Ohio Nursing Educator Consultant Charleston, South Carolina Carol Norton Tuzo, MSN, RN-BC Nursing Educator Consultant Tona Leiker, PhD, APRN-CNS, CNE Charleston, South Carolina Clinical Nurse Specialist Wesley Medical Center Wichita, Kansas viii 3876_FM_i-xxx 15/07/13 4:17 PM Page ix REVIEWERS Lois Angelo, MSN, APRN, BC Jennifer E. Herrold, RN, MSN, CRNP Assistant Professor Instuctor MA College of Pharmacy and Health Sciences Thomas Jefferson University Boston, Massachusetts Danville, Pennsylvania Linda Blair, BSN, RN Beverly J. Howard, MSN, RN, FNP Nursing Instructor Instructor Central Carolina Community College Alvin Community College Sanford, North Carolina Alvin, Texas Debra DeVoe, RN, MSN, NE-BC Katherine M. Howard, MS, RN-BC Nursing Instructor Nursing Instructor Our Lady of Lourdes Middlesex County College Nursing Program, Camden, New Jersey Raritan Bay Medical Center Edison, New Jersey Donna A. Enrico, MBS, BSN, RN Clinical Instructor Janet K. Johnson, MBA, MSN, RN College of Southern Nevada Nursing Coordinator Las Vegas, Nevada Fort Berthold Community College New Town, North Dakota Elizabeth Fife, MSN, RN, CNS, CPN Associate Professor Rebecca King, RN, MSN, PMHCNS-BC Louisiana Tech University Division Chair for Nursing and Allied Health Ruston, Louisiana University of Arkansas, Community College of Batesville Wanda Golden, RN, MSN, CCRN, PhD(c) Batesville, Arkansas Dean and Associate Professor of Nursing Abraham Baldwin Agricultural College Brenda Kucirka, PhD(c), RN, PMHCNS-BC, CNE Tifton, Georgia Clinical Instructor Widener University Patricia J. Hefner, MSN, RN-BC Chester, Pennsylvania Faculty; Course Coordinator of Psychiatric Mental Health Nursing Jan E. Lawrenz Blasi, MSN, RN Heritage Valley Sewickley Nursing Instructor Moon, Pennsylvania Chandler School of Nursing and Allied Health, Pratt Community College Sharon A. Henle, Ed.D, ANP, RHIA, CNE Pratt, Kansas Assistant Professor of Nursing Farmingdale State College Farmingdale, New York ix