Psychiatric Rehabilitation
Psychiatric rehabilitationinvolves providing ser-
vices to people with severe and persistent mental
illness to help them to live in the community. These
programs are often called community support services
or community support programs.Psychiatric reha-
bilitation focuses on the client’s strengths, not just on
his or her illness. The client actively participates in
program planning. The programs are designed to help
the client manage the illness and symptoms, gain
access to needed services, and live successfully in the
community.
These programs assist clients with activities of
daily living such as transportation, shopping, food
preparation, money management, and hygiene. So-
cial support and interpersonal relationships are rec-
ognized as a primary need for successful community
living. Psychiatric rehabilitation programs provide
opportunities for socialization such as drop-in cen-
ters and places where clients can go to be with others
in a safe, supportive environment. Vocational refer-
ral, training, job coaching, and support are available
for clients who want to seek and maintain employ-
ment. Community support programs also provide
education about the client’s illness and treatment and
help the client to obtain health care when needed.THE NURSE AND PSYCHOSOCIAL
INTERVENTIONS
Intervention is a crucial component of the nursing
process. Psychosocial interventionsare nursing
activities that enhance the client’s social and psycho-
logical functioning and improve social skills, inter-
personal relationships, and communication. Nurses
often use psychosocial interventions to help meet
clients’ needs and achieve outcomes in all practice set-
tings, not just mental health. For example, a medical-
surgical nurse might need to use interventions that
incorporate behavioral principles such as setting lim-
its with manipulative behavior or giving positive
feedback.
For example, a client with diabetes tells the
nurse, “I promise to have just one bite of cake. Please!
It’s my grandson’s birthday cake”(manipulative be-
havior). The nurse might use behavioral limit-setting
by saying, “I can’t give you permission to eat the cake.
Your blood glucose level will go up if you do, and your
insulin can’t be adjusted properly.”When a client
first attempts to change a colostomy bag but needs
some assistance, the nurse might say, “You gave it a
good effort. You were able to complete the task with a
little assistance”(giving positive feedback).
Understanding the theories and treatment modal-
ities presented in this chapter can help the nurse se-
lect appropriate and effective intervention strategies.
In later chapters that present particular mental disor-
ders or problems, specific psychosocial interventions
that the nurse might use are described.SELF-AWARENESS ISSUES
The nurse must examine his or her be-
liefs about the theories of psychosocial development
and realize that a variety of treatment approaches
are available. Different treatments may work for dif-
ferent clients: no one approach works for everyone.
Sometimes the nurse’s personal opinions may not
agree with those of the client, but the nurse must
make sure that those beliefs do not inadvertently af-
fect the therapeutic process. For example, an over-
weight client may be working on accepting herself as
being overweight rather than trying to lose weight,
but the nurse thinks the client really just needs to
lose weight. The nurse’s responsibility is to support
the client’s needs and goals not to promote the nurse’s
own ideas about what the client should do. Hence the
nurse must support the client’s decision to work on
self-acceptance. For the nurse who believes that being
overweight is simply a lack of will power, it might be
difficult to support a client’s participation in a self-help
weight-loss group, such as Overeaters Anonymous,
that emphasizes overeating as a disease and accept-
ing oneself.Points to Consider When Working
on Self-Awareness
Points to consider regarding psychosocial theories
and treatment:- No one theory explains all human behavior.
No one approach will work with all clients. - Becoming familiar with the variety of psy-
chosocial approaches for working with clients
will increase the nurse’s effectiveness in pro-
moting the client’s health and well-being. - The client’s feelings and perceptions about
his or her situation are the most influential
factors in determining his or her response to
therapeutic interventions, rather than what
the nurse believes the client should do.
➤ KEY POINTS
- Psychosocial theories help to explain human
behavior—both mental health and mental ill-
ness. There are several types of psychosocial
theories including psychoanalytic theories,
interpersonal theories, humanistic theories,
behavioral theories, and existential theories. - Freud believed that human behavior is
motivated by repressed sexual impulses
and desires and that childhood development
66 Unit 1 CURRENTTHEORIES ANDPRACTICE