NCM113 LECTURE: CARE OF CLIENTS WITH MALADAPTIVE PATTERNS

I. Standards of Psychiatric Mental Health Nursing Practice

Standards of Care
Standard 1: Assessment
 The psychiatric–mental health registered nurse synthesizes and collects comprehensive
health data that is pertinent to the patient’s health or situation.
 Nurses do a holistic approach of care
 Collects comprehensive data using therapeutic techniques employing evidenced based
assessment skills 
 Coordinates with psychiatrist, social worker, dieticians, and other members of healthcare
team
 Document relevant data, it must be in a retrievable form
 Involve the patient, his family, other healthcare providers and other support systems in
holistic data collection
1. Consider the age
a. 1 in 10 children suffer from a mental illness
b. Adolescents - concerned with confidentiality, share with other members if it’s
about substance abuse, suicide, homicide, and other life threatening substances
c. Older adults - needs special attention (physical limitation)
2. Language Barriers
 Complex spiritual and social factors (procedures contraindicated to religion)
 Need an interpreter
3. Using Rating Scales
Ex. Depression - Beck inventory, Patient health questionnaire 
Standard 2: Diagnosis
 The psychiatric–mental health registered nurse analyzes the assessment data to
determine diagnoses of problems, make diagnosis, what is the focus of care, including
level of risk.
 When formulating nursing diagnosis, we can make a standard diagnosis, risk diagnosis
or health promotion diagnosis
Standard 3: Outcome identification (long or short term goals)
 The psychiatric–mental health registered nurse identifies expected outcomes for a plan
individualized to the patient or the situation.
Standard 4: Planning -  patient centered, evidenced based, client oriented 
 The psychiatric–mental health registered nurse develops a plan that prescribes
strategies and alternatives to attain expected outcomes.
Standard 5: Implementation 
 The psychiatric–mental health registered nurse implements the identified plan.
(5.1) Standards of  Interventions
1. Counseling - used to assist patients in improving their previous coping abilities,
fostering mental health, prevent mental health, done only by trained nurses
2. Milieu Therapy - The psychiatric–mental health registered nurse provides, structures,
and maintains a safe and therapeutic environment in collaboration with patients, families,
and other health-care clinicians.
3. Self care activities - activities of daily living of client, promote independence, structure
activities for mental being within the schedule of client
 4. Psychological intervention - could be psychological, biological, pharmacologic
(medications indications, side effects, drug actions and interactions, safe level usage),
use knowledge in order to restore patient’s health and prevent further disability, look into
current research findings, consider dietary restrictions
5. Health teaching -  use strategies in order to keep our patients safe, promote health and
recovery, look special needs considering age, culture, ability to learn, and readiness to
accept treatment
 health teaching includes needs of clients, coping skills, stress management,
problem solving skills, conflict management, interpersonal relationship
6. Case Management (vf) - nurse must coordinates for the comprehensive healthcare to
the client in coordination with other health care team to ensure safety
6. Health Promotion (vf) - The psychiatric–mental health registered nurse employs
strategies and interventions to promote health, prevent illness and a safe environment.
6. Psychotherapy (vh) - The psychiatric–mental health advanced practice registered
nurse conducts individual, couple, group, and family psychotherapy using evidence-
based psychotherapeutic frameworks and nurse–patient therapeutic relationships.
6. Prescription authority and treatment (vi) - The psychiatric–mental health advanced
practice registered nurse uses prescriptive authority, procedures, referrals, treatments,
and therapies in accordance with state and federal laws and regulations.
6. Consultation (vj) - The psychiatric–mental health advanced practice registered nurse
provides consultation to influence the identified plan, enhance the abilities of other
clinicians to provide services for patients, and effect change.
(Note: Standards 5D are advanced practice interventions –G and may be performed only
by the psychiatric–mental health advanced practice registered nurse.)
11. Evaluation (vi) - The psychiatric–mental health registered nurse evaluates progress
toward attainment of expected outcomes. 

How to become a Psychiatric Nurse 

Step 1: Complete a Nursing PRogram
Step 2: Earn RN license
Step 3: Earn Certificate in Psychiatric Nursing 

Basic Level Functions of the Nurse

1. Counseling - done which is directed toward resolution of a health related problem
 Interventions and communication techniques, Problem-solving, Crisis
intervention, Stress management, Behavior modification
2. Milieu Therapy - Maintain therapeutic environment, Teach skills, Encourage
communication between clients and others, Promote growth through role modeling
 Attends to physical individual needs and physical environment programing, social
structure and interventions
3. Self care activities - Encourage independence (hygiene, grooming, eating), Increase
self-esteem, Improve function and health
3. Psychobiological interventions - Administer medications, observations (side effects,
effectiveness), Teach, implementing nutrition and rest
3. Health teaching - teaching in relation to promoting health or treating mental illness
3. Care management - nursing care in coordination with other members of healthcare
team, done inpatient or outpatient giving highest level of functioning to promote self
sufficiency, involves referrals to the community

Advanced Level Functions

 Health promotion - health maintenance, prevent complications that may arise after
giving medication, educate clients 
1. Psychotherapy - done by advanced practical nurse, includes individual, family,
group, community
2. Prescription - medication
3. Consultation - clinic

Standards of Professional Performance

Standard 1: Quality of care - The psychiatric–mental health registered nurse systematically
enhances the quality and effectiveness of psychiatric nursing practice.
Standard 2: Performance appraisal - The psychiatric–mental health registered nurse evaluates
one’s own practice in relation to the professional practice standards and guidelines, relevant
statues, rules, and regulations
Standard 3: Education - The psychiatric–mental health registered nurse attains knowledge and
competency that reflects current nursing practice.
Standard 4: Collegiality - The psychiatric–mental health registered nurse interacts with and
contributes to the professional development of peers, health care clinicians and colleagues
Standard 5: Ethics - The psychiatric–mental health registered nurse integrates ethical
provisions in all areas of practice.
Standard 6: Collaboration - The psychiatric–mental health registered nurse collaborates with
patients, family, and others in the conduct of nursing practice.
Standard 7: Research - The psychiatric–mental health registered nurse integrates research
findings into practice.
Standard 8: Resource Utilization - The psychiatric–mental health registered nurse considers
factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery
of nursing services.

Where do they work?

 Psychiatric hospitals
 Doctor’s offices
 Assisted living facilities (Nursing homes)
 Long term care centers
 Rehabilitation Centers 
 Behavioral care companies
 Private homes
 Correctional facilities
 Community mental health centers
 Private clinics 
 Schools
 Military care hospitals

Whom do they work with?

1. Children
2. Adolescents
3. Adults
4. Older persons
5. People with substance abuse disorders
6. People with eating disorders
7. Forensics
8. Consultant   
II. Related Laws in Mental Health
 RA No. 11036 -  Mental Health Act
 Patient’s Bill of Rights
 Magna Carta - women
 Magna Carta - Disabled Person
 Magna Carta - Health workers
 Ethico-legal considerations
 Torts - Civil Law
 Commitment issue - Client’s Health Care Rights

1. RA No. 11036 - Philippine Mental Health Act 

The state affirms the basic right of all Filipinos to mental health as well as the fundamental right
of people who require mental health services.

Objectives
1. Effective leadership and governance for mental health
2. National mental health care system
3. Protect rights of patients - with psychiatric, neurologic and psychosocial health needs
4. Strengthen information systems, evidence based research for mental health
5. Integrate mental health care in the basic health services
6. Integrate strategies promoting mental health in educational institutions, workplace and in
communities 

Rights of Service Users

 Freedom from discrimination (social, political, economic, religious, culture)
 Respect political, civil, economic, social, religious, educational and cultural rights
 Access to evidence based treatment - on the same standards such as cultural, ethnic,
and economic
 Affordable (social and mental health services)
 Humane treatment  -  free from solitary confinement or harmful acts
 Accessible - they should be free to all facilities
 Confidentiality 
 Informed consent - include family members

Patients Rights and Responsibilities

1. Right to appropriate medical care & humane treatment - good quality medical care
2. Informed consent - clear, truthful and substantial information; in emergency cases may
not need consent; minors (parents) and legally incompetent (spouse, son, daughter)
needs guardian 
3. Privacy & confidentiality - we should not exposed to the public the information of the
client it should be at least in the court of law
4. Information - patient has the right to know his disease, procedures to be done and
medications
5. Choose health care provider & facility - a patient can choose her/his doctor and the
hospital
6. Self determination - patient has the right to avail for himself any recommended
diagnostics/procedure; include a guardian if needed
7. Religious belief -  a patient has a right to refuse as long as it is against to their beliefs
 8. Medical records - patient has right to view his summary medication and hospitalization
9. To leave - if the patient wants to leave he has the right to leave, and know her medical
condition and consequences.
10. To refuse participation in Medical Research - patient can refuse to be a part of the
research even though he is a vital element
11. To receive visitors- right to communicate to his/her family, relatives, and friends
12. To express grievance - if he want to complain or express without any discrimination
13. To be informed of his rights and obligations as a patient - DOH and other healthcare
team must allow patient to be given information

2. Magna Carta for Women (RA No. 9710)

A comprehensive women’s human rights law that seeks to eliminate discrimination through the
recognition, protection, fulfillment, and promotion of the rights of Filipino women.

Salient features
 Third level positions in government
 Leave benefit of two (2) months with full pay
 Employment in the field of military, police and other similar services
 Equal access - Education, scholarship, training
 Women in media and film
 Equal status given to men & women

3. Republic Act 7277 - Magna Carta for Disabled Persons (PWD)

 Disabled persons are part of Philippine  society - we must look into overall well-being of
the person
 Same rights as other persons in society 
 More meaningful, productive and satisfying life - government responsibility
 Promote welfare of the disabled persons - encourage partnership in programs that could
address their needs
 Respect for disabled persons - if they join society we should remove all social,cultural
economic, prejudicial treatment
 Remove all prejudice 

RIGHTS OF DISABLED PERSONS (PWD)

 Employment
 Education
 Health
 Social services
 Telecommunication (sign language, free postal charges) 
 Accessibility - PWD ramps, vehicles
 Political & civil rights - right to vote, assemble
 Housing program 

5. Republic Act 7305 - Magna Carta of Public Health Workers 

a. Promote and improve social and economic well being of the health workers
b. Develop their skills and capabilities
c. Join and remain in government service - usually rural areas blocked public workers
  Married public health workers - should be in the same municipality but not  the same
office
 Security of tenure - regular employment when they have been in service for a long time
 Discrimination prohibited - religion, social status
 No understaffing/overloading of health staff - so that there will be quality of care,
because if nurses are overworked they can’t not render good quality of care to the client.
 Normal hours of work - 8 hours/40 hours a week according to labor law
 Night shift differential - increase 10% of his wage for each hour
 Salary & additional compensation - transportation allowance, medical allowance, laundry
allowance

6. Ethico-Legal Considerations
Physicians' Top 20 Ethical Dilemmas - Survey Results Slideshow (medscape.com) 

Legal and Ethical Concepts

1. Ethics
Study of philosophical beliefs about what is considered right or wrong in society
2. Bioethics
a. Ethical questions arising in health care
1. Principles of bioethics
a. Beneficence: duty to act to benefit others - no harm
b. Autonomy: respecting the rights of others to make decisions - don’t make decisions for
them or the family.
c. Justice: duty to distribute resources equally 
d. Fidelity: maintaining loyalty and commitment to patient - continuity of care should be
there especially if you are taking care of the patient for a long time
e. Veracity: duty to communicate truthfully 

Mental Health Laws: Civil Rights and Due Process

Civil rights: people with mental illness are guaranteed same rights under federal/state laws as
any other citizen

1. Due process in civil commitment: courts have recognized involuntary commitment to

mental hospital is “massive curtailment of liberty” requiring due process protection,
including:
a. Writ of habeas corpus: procedural mechanism used to challenge unlawful detention
b. Least restrictive alternative doctrine: mandates least drastic means be taken to
achieve specific purpose

Mental Health Laws: Admission to the Hospital

1. Voluntary: sought by patient or guardian 
a. Patients have right to demand and obtain release
b. Many states require patient submit written release notice to staff
2. Involuntary admission (commitment): made without patient’s consent
a. Necessary when person is danger to self or others, and/or unable to meet basic needs
as result of psychiatric condition - emergency involuntary admission
3. Emergency involuntary hospitalization
a. Commitment for specified period (1-10 days) to prevent dangerous behavior to
self/others
4. Observational or temporary involuntary hospitalization
a. Longer duration than emergency commitment
b. Purpose: observation, diagnosis, and treatment for mental illness for patients posing
danger to self/others

Issue of Legal Competence

1. All patients must be considered legally competent until they have been declared
incompetent through legal proceeding (court has announced legally)
a. Determination made by courts 
b. If found incompetent, court-appointed legal guardian, who is then responsible for giving
or refusing consent
2. Implied consent
a. Many procedures nurse performs has element of implied consent (e.g., giving
medications) 
b. Some institutions require informed consent for every medication given

Rights Regarding Restraint and Seclusion

1. Doctrine of least restrictive means of restraint for shortest time always the rule
2. Legislation provides strict guidelines for use
a. When behavior is physically harmful to patient/others
b. When least restrictive measures are insufficient
c. When decrease in sensory overstimulation (seclusion only is needed)
d. When patient anticipates that controlled environment would be helpful and requests
seclusion
3. Recent legislative changes have further restricted use of these means and some facilities
have instituted “restraint free” policies

Patient Confidentiality
1. Ethical considerations
a. Confidentiality is right of all patients - privacy and confidentiality, information should be
consented by the patient; doctor-patient confidentiality  
b. ANA Code of Ethics for Nurses (2001) asserts duty of nurse to protect confidentiality of
patients
2. Legal considerations
a. Health Insurance Portability and Accountability Act (HIPAA), 2003
 Health information may not be released without patient’s consent, except to
those people for whom it is necessary in order to implement the treatment plan
3. Exceptions
a. Duty to Warn and Protect Third Parties 
 Tarasoff v. Regents of University of California (1974) ruled that psychotherapist
has duty to warn patient’s potential victim of potential harm
b. Most states have similar laws regarding duty to warn third parties of potential life threats
b. Staff nurse reports threats by patient to the treatment team

Child and Elder Abuse Reporting Statutes

1. All states have enacted child abuse reporting statutes
a. Many states specifically require nurses to report suspected abuse
2. Numerous states have also enacted elder abuse reporting statutes
a. Agencies receiving federal funding (i.e., Medicare/Medicaid) must follow strict guidelines
for reporting abuse of older adults
Tort Law Applied to Psychiatric Settings
1. Protection of patients: legal issues common in psychiatric nursing are related to failure to
protect safety of patients
2. Protection of self
a. Nurses must protect themselves in both institutional and community settings
b. Important for nurses to participate in setting policies that create safe environment

(59) What is Tort Law? – YouTube

(59) Tort Law: The Rules of Medical Malpractice – YouTube 

Negligence/Malpractice
1. Negligence or malpractice - is an act or an omission to act that breaches the duty of
due care and results in or is responsible for a person’s injuries; unintentional negligence
can still cause damage to the patient
2. Elements necessary to prove negligence
 Duty
 Breach of duty
 Cause in fact
 Proximate cause
3. Damages Cause in fact
 Evaluated by asking “except for what the nurse did, would this injury have occurred?”
4. Proximate cause or legal cause
 Evaluated by determining whether there were any intervening actions or individuals that
were in fact the causes of harm to patient
5. Damages
 Include actual damages as well as pain and suffering
6. Foreseeability of harm
 Evaluates likelihood of outcome under circumstances

Nursing Intervention: Suspected Negligence

1. Most states require legal duty to report risks of harm to patient
2. Nurse has obligation to report peer suspected of being chemically impaired
 Report to supervisor is requirement 
3. If nurse knows physician’s orders need to be clarified or changed, it is nurse’s duty to
intervene and protect patient - correct the physician politely
3. Abandonment - never leave patient alone, endorse after shift
a. Legal concept may arise when nurse does not leave patient safely back in hands of
another health care professional before discontinuing treatment
Avoiding Liability
 Respond to the client 
 Educate the client
 Comply with the standard of care - Nursing Process
 Supervise care - monitor side effects
 Adhere to the nursing process
 Document carefully- no document, no evidence, no action to patient (could give more
than the prescribed medicine)
 Follow up and evaluate
 Maintain a good interpersonal relationship with client and  family
DOCUMENTATION and REPORTING

Documentation
Serves as a permanent record of client information and care
 ISBARR
Identify, situation, background, assessment, recommendation, read back
 OTHERS
Change of shift
Incident report
Referral system
Health care electronic database
 RECORDING

Reporting
Takes place when two or more people share information about client care, either face to face or
by telephone 

Purposes of client’s record/chart

1. communication
2. legal documentation - can't be tampered and no erasures. 
3. Research -  name should not be included
4. Statistic -  city health to get the statistics, statistics in the client’s chart is also applicable.
That's why we need to make sure that all of the information is reliable.
5. education
6. audit and quality assurance - completeness and accuracy, insurance cases can look into
patient's chart but they can’t look into psych patient’s chart
7. planning client care
8. reimbursement

Types of records

Traditional client record

1. Admission sheet 
2. Physician’s order sheet
3. Medical history
4.  Nurses’ notes
5. Special records/reports

SOAPIE
S – subjective data
O – objective data
A – assessment 
P – planning
I – Intervention
E - Evaluation

Narrative
Descriptive statement  of patient status written in chronological order throughout the shift 

Example - narrative
Patient was agitated in the morning & pacing in the hallway.
Blinked eyes, muttered to self & looked off to the side.
Stated heard voices.
Verbally hostile to another patient.
Offered 2 mg haloperidol (Haldol) prn and sat with staff in   quiet area for 20 minutes
Patient returned to community lounge and was able to sit and watch television

SOAPIE
Problem oriented charting 
  Problem identification
 Process
  Outcome 

ADVANTAGES
Uses a common form of expression
Can address any event or behavior
Explained flow sheet findings
provides multidisciplinary ease of use 

DISADVANTAGES
Unstructured
May result in a different organization of information from note to note
Makes it difficult to retrieve quality assurance and utilization management data
Frequently leads to omission of elements in the nursing process
Commonly results in inclusion of unnecessary and subjective information 

Problem-oriented charting: soapie

S : “I’m so stupid. Get away.”  “I hear the devil telling me bad things”
O: Patient paced the hall, mumbling to self and looking to the side.  Shouted derogatory 
comments when approached by another patient .  Watched walls and ceilings closely.
A: Patient was having auditory hallucinations and increased agitations
P: offered haloperidol PRN.  Redirected patient to less stimulating environment
 I: Patient received 2 mg of haloperidol PO PRN.  Sat with patient in the quiet room for 20
minutes
E: Patient calmer. Returned to community lounge, sat, and watched television 

ADVANTAGES
Structured
Provides consistent organization of data
Facilitates retrieval of data for QA and utilization management 
Contains all elements of the Nursing Process
Minimizes inclusion of unnecessary data
Provides multidisciplinary ease of use

DISADVANTAGES
Requires time and effort to structure information 
Limits entries to problems
May result to loss of data about progress
Not chronological 
Carries negative connotation 
FDAR
F – focus
D – data
A – action
R - response

EHR - Electronic health records

Huge volume of information 
All client information in one record
Client database – add new data
 create & revise care plan
 document client progress

Pomr – problem oriented medical record

ISBARR
Identify
Situation
Background
Assessment
Recommendations
Read back

SBAR
SITUATION – state name, unit and client name
Briefly state the problem
BACKGROUND – client admission diagnosis
Date of admission, medical history
Brief summary of treatment
ASSESSMENT – vital signs, pain scale, any change?
RECOMMENDATION – state what you would like  to see done 
HCP – orders or tests or medications
If no improvement, call HCP?
Types of reporting

1. Change of shift
For continuity of care

2. Telephone reports
When the call was made
Who made the call
Who was called
To whom was the information given
What information was given
What information was received

3. Transfer reports
Transfer of patient from one unit to another

OTHERS
 Change of shift
 Incident report - violent encounter between nurse and patient
 Referral system - if client is referred to a specific clinic
 Health care Electronic Databases

Recording
Characteristics of a good recording
1. Brevity - entries are concise
2. INK - avoid pencil evidence legal court
3. Accuracy -  fact, no opinions allowed
4. Appropriateness - information pertaining to the client only
5. Completeness  - Chronology, organization, sequencing and timing (if 2 problems, write
2 different nurses notes)
6. Standard terms - Correct spelling & grammar, Approved abbreviations
7. Signed- Affix signature at the end of charting  (SN, RN, CI)
8. In case of error - Draw a single line through the error (do not use white out)
9. Confidentiality - Only health personnel are allowed to read the chart 
10. Legal awareness - Chart only what you have done, observed, heard &  felt
11. Legible - Writing must be clear and easily read by others. If not legible, then PRINT
12. Do not use patient or PT in the chart - The word “patient” is not used in the chart. All
information in the chart pertains to the patient 

Legal consideration for documentation of care 

Don’t:
Chart opinions
Defame patient 
Chart before an event occurs
Chart generalizations
Obliterate, erase, alter, or destroy a record
Leave blank spaces

Health information privacy

1. ETHICAL CONSIDERATIONS 
Confidentiality of care and treatment is an important right for all patients particularly
psychiatric patients
Any discussion or consultation involving a patient should be conducted discreetly and only with
individuals who have a need and a right to know this privileged information
2. CODE OF ETHICS FOR NURSES
nurse’s legal duty to maintain confidentiality  is to protect the patients privacy 
You may NOT , without the patients consent, disclose information obtained from the patient or
information in the medical record to anyone
 Not even to employer
 Not even after death  

Interdisciplinary Mental Health Team Collaboration

MENTAL HEALTH TEAM

 MENTAL HEALTH NURSE - HEALTH TEAM
 TEAM APPROACH - IN NURSING CARE
 COLLABORATION - MULTIDISCIPLINARY & SECTORAL TEAMS
 REFERRALS/TRANSPORT - SAFETY AND SECURITY

HEALTH TEAM
It is defined as “group of persons who share a common objectives determined by community
needs and toward the achievement of which each member of the team contributes in
accordance with her/his competence and skills, and respecting  the functions of the other.”

Members of the Mental Health Team

PHYSICIAN: 
A physician is a person who is legally authorised to practice medicine. In a hospital setting, the
physician is responsible for the medical diagnosis and for determining the therapy required by a
person who is ill or injured.

Psychiatrist
Admit clients
Prescribe pharmacologic agents
Administer therapy
Conduct individual & family therapy
Team meetings

Psychiatric Nurse
manage client care
Administer & monitor medications
Assist in psychiatric & physical treatment
Teach client & family
Client records
Client advocate
Interact with significant others of the client
SOCIAL WORKER
Social worker provide assistance to the family and patient. He provide assistance in the
problems such as finances, counselling or marital problems, adoption of children etc.

Psychiatric Social Worker

Intervention with the client in the social environment where he/she will live 

Psychiatric Technician
 reports to the Psychiatric nurse
 has direct client contact
 Observe and record symptoms
 Intervene with supervision 

Mental Health Technician

 Also called Mental health counselor
 Assists in ADL
 Maintain the schedule
 Provide general support
 Do NOT administer medications
 Minimal education in Psychiatry

Psychologist 
 Licensed individual
 Do NOT prescribe nor administer medications
 Administer psychometric tests that aid in diagnosis of disorders

Marriage, Family, Child Counselor

 Work with individuals, families, couples and groups
 Emphasize the interpersonal aspects of achieving and maintaining relationships 

PHARMACISTS
 Pharmacists dispense drugs and medications prescribed by physicians, physician
assistants, nurse practitioners, and dentists.

OCCUPATIONAL THERAPIST
 The occupational therapist assists patients with some impairment of function to gain
skills as they relate to activities of daily living and help with a skill that is therapeutic.

COMMUNITY HEALTH WORKER 

 The CHW is a member of the community and plays an important role in identifying a
community's problems and in developing solutions.

LABORATORY TECHNICIAN
 Examine and study specimens such as urine, faeces, blood and discharge from wounds.

RADIOLOGIC TECHNOLOGIST
Assists with a wide variety of X-Ray procedures.

Other members
Recreational therapist
Vocational rehabilitation specialist 
Art therapist
Physical therapist
Pastoral counselors
Peer specialist

Interdisciplinary Team
Core skill
Interpersonal skills
Humanity
Knowledge
Communication skills
Personal qualities
Teamwork skills
Risk assessment & risk management skills

Collaboration
Nurse 
Collaborates
Patient
And
Significant others
Health care clinicians
Provide care

Referrals
Family dysfunction
Psychotic symptoms
Diagnostic questions 
Substance abuse/addiction
Impotence 
Psychopharmacology assessment
Suicidality
Sleep problems
Signs of dementia
Sexual dysfunction

Developmental problems
Abnormal bereavement
Anger

Interpersonal relationships with other members of the mental health team 

In the Philippines, areas of coordination 
1. Provision of basic social services 
DSWD – food, clothing, shelter, camp management
PRC – family tracing and community
DepEd – school
DOH – military, service providers, media
OCD and other Agencies – search and rescue
2. Provision of community and family support
LGU, NGO, Academe, religious organizations
3. Provision of focused non-specialized services - Mental health  workers
4. Provision of specialized services 
 psychiatrists, psychologists, other mental health professionals
 Mental health facilities  

Inter-professional collaboration: 
1. reduces “silos” in health care 
Si lo
verb
To isolate from others. When certain departments or sectors aren't able to, or don't know how to
share information, systems or processes with others in the same company.

Inter-professional collaboration 
2. Defining roles and expectations among care providers and team members
3. Improving teamwork
4. Fostering open, honest, and respectful communication between care providers, team
members, patients and families 
5. Developing collaboration and coordinated care plans within and between organizations
6. Promoting understanding or inter-professional perspectives

Safety measures
Suicide and self-harming behavior
Violence and aggression behavior
Seclusion and restraint use
Absconding 

Culture of Filipinos
Filipino People
 109, 581, 078 (2020)
 Most filipinos are of Malay descent (like malaysians and Indonesians)
 With a sprinkling of Chinese, Spanish, American and Arab blood
Characteristics of a Filipino
1. Resilient
2. Take pride in their families  
 3. Religious 
4. Respectful - “mano po”, takes advice of Filipino elder, lives will be better if we follow our
parents/elderly
5. Help one another - “bayanihan”
6.  Value tradition and culture - educational system is patterned like in the Americans
7. Love  to party 
8. Longest Christmas -Starting ber months
9. Love to eat
10. Love to sing
11. Love art
12. Festivals

Edit lang guys😆

Evolution of psychiatric and mental health in the Philippines

Pres spanish time and Era

And american regime 

8th most populated in asia

And 12 in the world

Pre spanish era:

Filipino folklores
Manananggal -target the pregnant women
Kapre -trees,
batibat-bangungot (medically caused by Pancreatitis)
Dwendi- step on their house we will suffer, use of tabi tabi in warning them

Spanish era:
Religious factors and supernatural forces
Dietist
Mangkukulam or witch
Mangangaway or devil men(by praying ti dark forces, healers and instill fear to px)
Exorcism-prayer rallies to the person possessed
Folk healers or herbolarios (Albularyo)- used of different herbs, uses candles, white cloth etc.
Like wrap in a math and vagiliated a tail of a fish. Drinking potions. Massage (hilot).

Hospicio de San Jose 1782- first ever to care for mentally ill

American regime
San lazaro hospital (november 1904)- Insane department . Pennsylvania a filipino student. 

Hospital and trainings

1918-  City sanitarium, San Juan Del Monte
1928- Insular Psychopathic hospital (now its national Psychopathic Hospital)
1910- Philippine general hospital (also UST)

Japanese Occupation
Used of medicinal herbs

1.National mental health association

-1959 to promote mental health …
2.The philippine society of psychiatry and neurology - 1972
3. Philippine Mental Act

Filipino seeking for mental health problems

Module VI. Leadership Management

 The leader and manager
 Qualities of a leader and manager 
 Leadership Styles
 Organizational structure of a mental health facility
 Services
 Attributes and core values of the nurse 

Leadership - an interpersonal process influencing an individual toward goal attainment in a

given situation
 Focus on goals, sell it, take risks, encourage, go against the grain, motivate, break the
rules, inspire trust, foster ideas
Management - manipulation of people in the environment, money, time, and other resources to
reach organizational goals 
 Focus on taste, tell it

Leadership and Management qualities 

 Ability to gain respect of others
 Expertise in communication skills
 Capability to motivate others
Nursing Leadership

5  Leadership Styles for Nurses

1. Autocratic or Authoritarian Leader - given the power to make decisions alone, having
total authority
 Closely supervises and controls people when they perform certain tasks
2. Democratic or Participative Leader - includes one or more people in the making
process of determining what to do and how to do it.
 Maintains the final decision making authority. 
3. The Laissez-faire or Delegative Leader
* Allows people to make  their own decisions.
• Leader is still responsible for the decisions that are 
made. 
• This style allows greater freedom and responsibility 
for people. 
• However, you need competent people around you, or nothing will get done
4. Charismatic Leader
* Leads by creating energy and eagerness in people. 
• Leader is well liked and inspires people.
• Appeals to people’s emotional sider a subtitle here if you need it
5. The Servant Leader
* The highest priority of this leader is to encourage, support and enable people to fulfill
their full potential and abilities.
• Helps people achieve
their goals.
• Works for the people. 

Organizational Structure of a Mental Health Facility 

Attributes and Core Values of a Nurse 
Qualities  of an Effective Psychiatric Nurse 
 Self awareness
 Self acceptance
 Accepting the patient
 Being sincerely interested in patient care
 Make own choice
 Aware of his Likes and dislikes
 Honest 
 Active listening 
 Being available
 Empathizing  with the client 
 Reliability Professionalism
 Accountability
 The ability to think critically
 Genuineness
 Respect 
 Concreteness - involves terminologies instead of abstract thinking, avoids ambiguity 
SKILLS
 Problem solving
 Good judgment
 Offering advice
 Observational
 Interpersonal communication
 Psychosocial
 Values and behaviors
  Right values

Psychiatric Nurses’ Role as Member of the Research Team

Role of nurses in research
1. Principal investigator
2. Member of the research team
3. Evaluator of findings
4. User of research findings
5. Client advocate during a research study 
6. Subject in a research study 

Nursing  Times
Role of the Research Nurse
5 key points
1. Clinical research is vital for finding new treatments and improving patient care
2. Research nurses are at the forefront of this process
3. The nurses play a key role as patient advocate, ensuring patients safety and protection
and the patients are well supported throughout the research study 
4. Research nurses need a wide range of skills including management  and organizational
skills, teaching and mentoring communication and IT
5. Collaboration and cooperation with other researchers and members of the
multidisciplinary team is crucial for successful research 

Northern Care Alliance NHS Group  

Research Nurses – Our Role
 complex
 Exciting 
 Interesting 
 Responsibilities 
 Identifying and screening potential patients 
 Making sure that patients have necessary information to allow them to make a fully
informed decision about whether they want to participate in the study
 Ensuring that patients give fully informed consent before they are enrolled in the study
 Supporting the Principal Investigator (PI) by coordinating the day to day management of
research studies 
 Providing ongoing support to patients throughout the time as a participant  

Continuing Professional Development Program 

1. . Formal Education 
Schools – Masters’ Degree Psychiatric and Mental Health   
 Philippine Women’s University 
 UST
 UPCN
 UERMMMC
2. Continuing Education 
3. Online Learning 
4. Health Advocacy Programs
Entrepreneur Opportunities in Psychiatric Mental Health Practice
Why start a mental health business?
1. Sleep technician
2. Biosimilar or biological drugs
3. psychiatric hospital
 4. Travel agency
5. Media hub
6. Wellness clinic
7. Concierge doctor
8. Corporate wellness
9. Mental health and wellness podcast
10.  Yoga studio
11.  psychologist
12. Counseling service
13. Mental health and wellness blog
14. Medical records management
15. Develop a health app
16. Clinical health worker
17. Mental health magazine
18. Software to support wellpreneurs
19.  Retreat center
20. Drug treatment and rehabilitation center 
21. Alcohol  and drug  abuse counselor
22. Drug testing business 
23. natural remedy supplier
24. Start a mental health program on TV
25. Organize mental health fairs
26. Organize mental health fairs
27. Medical transcription services
28. Home health care agency
29. Medical insurance selling 
30. Medical billing services