Varcarolis's Canadian Psychiatric Mental Health Nursing: A Clinical Approach

Front cover
Brief TOC
Half title page
Evolve page
Varcarolis's Canadian Psychiatric Mental Health Nursing, Canadian Edition
Copyright page
Dedication
Table of Contents
Acknowledgements
Canadian Contributors
U.S. Contributors
Canadian Reviewers
To the Instructor
	Content New to This Edition
	Organization of the Text
	Teaching and Learning Resources
		For Instructors
		For Students
To the Student
	Reading and Review Tools
	Additional Learning Resources
	Chapter Features
Unit 1 Foundations in Theory
	1 Mental Health and Mental Illness
		Objectives
		Key Terms and Concepts
		Mental Health and Mental Illness
			Two Conceptualizations of Mental Health  and Mental Illness
			Contributing Factors
				Resilience
					Mental health recovery.
				Culture
			Perceptions of Mental Health and Mental Illness
				Mental Illness Versus Physical Illness
				Nature Versus Nurture
			Social Influences on Mental Health Care
				Self-Help Movement
				Decade of the Brain
				Mental Health for Canadians: Striking a Balance
				Human Genome Project
			Changing Directions, Changing Lives: The Mental Health Strategy for Canada
		Epidemiology of Mental Disorders
		Classification of Mental Disorders
			The Diagnostic and Statistical Manual
				The DSM-5 Organizational Structure
			The ICD-10-CA
		Psychiatric Mental Health Nursing
			What Is Psychiatric Mental Health Nursing?
			Classification of Nursing Diagnoses, Outcomes,  and Interventions
				DSM-5– and NANDA-I–Approved Nursing Diagnoses
				Nursing Outcomes Classification (NOC)
				Nursing Interventions Classification (NIC)
			Evidence-Informed Practice
			Levels of Psychiatric Mental Health Clinical  Nursing Practice
			Future Challenges and Roles for Psychiatric  Mental Health Nurses
				Aging Population
				Increasing Cultural Diversity
				Expanding Technology
				Twelve Key Social Determinants of Health
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	2 Historical Overview of Psychiatric Mental Health Nursing
		Objectives
		Key Terms and Concepts
		Early Mental Illness Care
			Early Canadian Asylums
		Early Psychiatric Treatments
		The Introduction of Nurses to  Asylum Care
		Shifts in Control Over Nursing
			Eastern and Atlantic Canada
			Western Canada
		Deinstitutionalization and the Nursing Role in Psychiatric Mental Health Care
		University-Based Nursing Curriculum
		National Organizations for Psychiatric Mental Health Nursing and Canadian Nurses Association Certification
		Advanced-Practice Nursing in Psychiatric Mental Health Care
		The Future of Psychiatric Mental  Health Nursing
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	3 Relevant Theories and Therapies for Nursing Practice
		Objectives
		Key Terms and Concepts
		Psychoanalytic Theories and Therapies
			Sigmund Freud’s Psychoanalytic Theory
				Levels of Awareness
					Conscious.
					Preconscious.
					Unconscious.
				Personality Structure
					Id.
					Ego.
					Superego.
				Defence Mechanisms and Anxiety
				Psychosexual Stages of Development
				Implications for Psychiatric Mental Health Nursing
			Classical Psychoanalysis
			Psychodynamic Therapy
			Erik Erikson’s Ego Theory
				Implications for Psychiatric Mental Health Nursing
		Interpersonal Theories and Therapies
			Harry Stack Sullivan’s Interpersonal Theory
				Implications for Psychiatric Mental Health Nursing
			Interpersonal Psychotherapy
			Hildegard Peplau’s Theory of Interpersonal Relationships in Nursing
				Implications for Psychiatric Mental Health Nursing
		Behavioural Theories and Therapies
			Ivan Pavlov’s Classical Conditioning Theory
			John B. Watson’s Behaviourism Theory
			B.F. Skinner’s Operant Conditioning Theory
				Implications for Psychiatric Mental Health Nursing
			Behavioural Therapy
				Modelling
				Operant Conditioning
				Systematic Desensitization
				Aversion Therapy
				Biofeedback
		Cognitive Theories and Therapies
			Rational-Emotive Behaviour Therapy
			Cognitive-Behavioural Therapy (CBT)
				Implications for Psychiatric Mental Health Nursing
		Humanistic Theories
			Abraham Maslow’s Humanistic Psychology Theory
				Hierarchy of Needs
				Implications for Psychiatric Mental Health Nursing
		Biological Theories and Therapies
			The Advent of Psychopharmacology
			The Biological Model
				Implications for Psychiatric Mental Health Nursing
		Additional Therapies
			Milieu Therapy
				Implications for Psychiatric Mental Health Nursing
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	4 Psychotropic Drugs
		Objectives
		Key Terms and Concepts
		Structure and Function of the Brain
			Functions and Activities of the Brain
				Maintenance of Homeostasis
				Regulation of the Autonomic Nervous System and Hormones
				Control of Biological Drives and Behaviour
					Cycle of sleep and wakefulness.
					Circadian rhythms.
				Conscious Mental Activity
				Memory
				Social Skills
			Cellular Composition of the Brain
			Organization of the Brain
				Brain Stem
				Cerebellum
				Cerebrum
			Visualizing the Brain
			Disturbances of Mental Function
		Mechanisms of Action of  Psychotropic Drugs
			Antianxiety and Hypnotic Drugs
				Benzodiazepines
				Short-Acting Sedative–Hypnotic Sleep Drugs
				Buspirone Hydrochloride
				Treating Anxiety Disorders With Antidepressants
			Antidepressant Drugs
				Tricyclic Antidepressants
				Selective Serotonin Reuptake Inhibitors
				Serotonin–Norepinephrine Reuptake Inhibitors
				Serotonin and Norepinephrine Disinhibitors
				Monoamine Oxidase Inhibitors
				Other Antidepressants
			Mood Stabilizers
				Lithium Carbonate
			Anticonvulsant Drugs
				Valproate
				Carbamazepine
				Lamotrigine
				Other Anticonvulsants
			Antipsychotic Drugs
				Conventional Antipsychotics
				Atypical Antipsychotics
					Clozapine.
					Risperidone.
					Quetiapine fumarate.
					Other atypical antipsychotics.
			Drug Treatment for Attention Deficit  Hyperactivity Disorder
			Drug Treatment for Alzheimer’s Disease
			Natural Health Products
		Key Points
		Critical Thinking
		Chapter Review
		References
Unit 2 Foundations for Practice
	5 Psychiatric Mental Health Nursing in Acute Care Settings
		Objectives
		Key Terms and Concepts
		Funding Psychiatric Mental Health Care
		Inpatient Psychiatric Mental Health Care
			Entry to Inpatient Care
			Rights of the Hospitalized Patient
			Multidisciplinary Treatment Team
			Nursing Care
				Admission Assessment
				Ensuring Safety
				Physical Health Assessment
				Milieu Management
				Structured Group Activities
				Documentation
				Medication Administration
					Medication adherence.
					Pain management.
				Crisis Management
					Medical crises.
					Behavioural crises.
				Preparation for Discharge to the Community
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	6 Psychiatric Mental Health Nursing in Community Settings
		Objectives
		Key Terms and Concepts
		The Evolution of Psychiatric Care  in the Community
		Community Psychiatric Mental  Health Nursing
			Roles and Functions
				Biopsychosocial Assessment
				Treatment Goals and Interventions
				Interprofessional Team Member
				Biopsychosocial Care Manager
				Promoting Continuation of Treatment
			Evolving Venues of Practice
		Community Settings
			Partial Hospitalization Programs
			Crisis Intervention Team
			Assertive Community Treatment
			Community Mental Health Centres
		Disaster Preparedness
		Ethical Issues
		Future Issues
			Barriers to Treatment
			Nursing Education
			Meeting Changing Demands
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	7 Cultural Implications for Psychiatric Mental Health Nursing
		Objectives
		Key Terms and Concepts
		Cultural Competence in Psychiatric Mental Health Nursing
			Culture, Race, Ethnicity, and the Social  Determinants of Health
		Demographic Shifts in Canada
		World Views and Psychiatric Mental Health Nursing
		Culture, Mental Health, and  Mental Illness
		Barriers to Quality Mental  Health Services
			Communication Barriers
			Stigma and Discrimination
			Misdiagnosis
			Ethnic Variation in Pharmacodynamics
		Populations at Risk for Mental Health Problems and Compromised Care
			Aboriginal Peoples
			Immigrants
			Refugees
			Culture of Poverty
		Culturally Competent Care
			Cultural Awareness
			Cultural Knowledge
			Cultural Encounters
			Cultural Skill
			Cultural Desire
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	8 Ethical Responsibilities and Legal Obligations for Psychiatric Mental Health Nursing Practice
		Objectives
		Key Terms and Concepts
		Ethical Concepts
		Mental Health Legislation
			Establishing Best Practice
				Standards of Practice
				Standards of Care
				Policies and Procedures
				Traditional Practice Knowledge
		Guidelines for Ensuring Adherence to Standards of Care
			Negligence, Irresponsibility, or Impairment
			Unethical or Illegal Practices
			Self-Determination
				Consent
				Advance Directives
				Guardianship
				The Nurse’s Role in Decision Making
				Involuntary Admission Criteria
		Patients’ Rights Under the Law
			The Right to Refuse Treatment
			Authorization of Treatment
			Provision of the Least Restrictive Type of Mental  Health Care
			Rights Regarding Confidentiality
				Duty to Warn and Protect Third Parties
					Risk-of-violence assessment findings.
				Reporting of Abuse
				Confidentiality and Communicable Diseases
				Confidentiality After Death
				Protection of Patients
			Legal Duties and Responsibilities
			Tort Law
				Intentional Torts
				Unintentional Torts
					Duty.
			Breach of duty.
			Cause in fact, proximate cause, damages, and foreseeability.
		Documentation of Care
			Facility Use of Medical Records
				Medical Records as Evidence
				Guidelines for Electronic Documentation
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
Unit 3 Psychosocial Nursing Techniques
	9 The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing
		Objectives
		Key Terms and Concepts
		Assessment
			Age Considerations
				Assessment of Children
				Assessment of Adolescents
				Assessment of Older Adults
			Language Barriers
			Psychiatric Mental Health Nursing Assessment
				Gathering Data
					Review of systems.
					Laboratory data.
					Mental status examination.
					Psychosocial assessment.
					Spiritual or religious assessment.
					Cultural and social assessment.
				Validating the Assessment
				Using Rating Scales
		Nursing Diagnosis
		Outcomes Identification
		Planning
		Implementation
			Basic-Level Interventions
				Coordination of Care
				Health Teaching and Health Promotion
				Milieu Therapy
				Pharmacological, Biological, and Integrative Therapies
			Advanced-Practice Interventions
		Evaluation
		Documentation
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	10 Therapeutic Relationships
		Objectives
		Key Terms and Concepts
		Concepts of the Nurse–Patient Relationship
			Goals and Functions
			Social Versus Therapeutic
				Social Relationships
				Therapeutic Relationships
			Relationship Boundaries and Roles
				Establishing Boundaries
				Blurring of Boundaries
				Blurring of Roles
					Transference.
					Counter-transference.
				Self-Check on Boundaries
		Values, Beliefs, and Self-Awareness
		Peplau’s Model of the Nurse–Patient Relationship
			Preorientation Phase
			Orientation Phase
				Establishing Rapport
				Parameters of the Relationship
				Formal or Informal Contract
				Confidentiality
				Planning for Terms of Termination
			Working Phase
			Termination Phase
		What Hinders and What Helps  the Nurse–Patient Relationship
		Factors That Encourage and Promote Patients’ Growth
			Genuineness
			Empathy
				Empathy Versus Sympathy
			Positive Regard
				Attitudes
				Actions
					Attending.
					Suspending value judgements.
					Helping patients develop resources.
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	11 Communication and the Clinical Interview
		Objectives
		Key Terms and Concepts
		The Communication Process
		Factors That Affect Communication
			Personal Factors
			Environmental Factors
			Relationship Factors
		Verbal and Nonverbal Communication
			Verbal Communication
			Nonverbal Communication
			Interaction of Verbal and Nonverbal Communication
		Communication Skills for Nurses
			Therapeutic Communication Strategies
				Silence
				Active Listening
					Listening with empathy.
				Clarifying Techniques
					Paraphrasing.
					Restating.
					Reflecting.
					Exploring.
				Asking Questions and Eliciting Patient Responses
					Open-ended questions.
					Closed-ended questions.
			Nontherapeutic Communication Techniques
				Excessive Questioning
				Giving Approval or Disapproval
				Giving Advice
				Asking “Why” Questions
			Cultural Considerations
				Communication Style
				Eye Contact
				Touch
				Cultural Filters
			Evaluation of Communication Skills
		The Clinical Interview
			Preparing for the Interview
				Pace
				Setting
				Seating
			Introductions
			Initiating the Interview
			Tactics to Avoid
			Helpful Guidelines
			Attending Behaviours: The Foundation of Interviewing
				Eye Contact
				Body Language
				Vocal Quality
				Verbal Tracking
			Clinical Supervision
			Process Recordings
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	12 Understanding Responses to Stress
		Objectives
		Key Terms and Concepts
		Responses to and Effects of Stress
			Early Stress Response Theories
			Neurotransmitter Stress Responses
			Immune Stress Responses
		Mediators of the Stress Response
			Stressors
			Perception
			Personality
			Social Support
				Self-Help Groups
				Low- and High-Quality Support
			Culture
			Spirituality and Religious Beliefs
		Nursing Management of Stress Responses
			Measuring Stress
			Assessing Coping Styles
			Managing Stress Through Relaxation Techniques
				Relaxation Exercises
				Meditation
				Guided Imagery
				Breathing Exercises
				Physical Exercise
				Biofeedback
				Cognitive Reframing
				Mindfulness
				Journaling
				Humour
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
Unit 4 Psychobiological Disorders
	13 Anxiety, Obsessive-Compulsive, and Related Disorders
		Objectives
		Key Terms and Concepts
		Anxiety
			Levels of Anxiety
				Mild Anxiety
				Moderate Anxiety
				Severe Anxiety
				Panic
			Defences Against Anxiety
		Anxiety Disorders
			Clinical Picture
				Panic Disorders
					Panic Disorder With Agoraphobia
					Simple Agoraphobia
				Phobias
				Obsessive-Compulsive Disorder (OCD)  and Related Disorders
				Generalized Anxiety Disorder
				Post-Traumatic Stress Disorder
				Acute Stress Disorder
				Substance-Induced Anxiety Disorder
				Anxiety Due to Medical Conditions
				Anxiety Disorder Not Otherwise Specified
				Attention Deficit Hyperactivity Disorder (ADHD)
			Epidemiology
			Co-Morbidity
			Etiology
				Biological Factors
					Genetic
					Neurobiological
				Traumatic Life Events
				Psychological Factors
				Sociocultural Factors
					Culture-Bound Syndromes
		Application of the Nursing Process
			Assessment
				General Assessment
				Other Rating Scales for Specific Anxiety Disorders
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Determining Levels of Anxiety
					Mild to Moderate Levels of Anxiety
					Severe to Panic Levels of Anxiety
				Counselling
				Milieu Therapy
				Promotion of Self-Care Activities
					Nutrition and Fluid Intake
					Personal Hygiene and Grooming
					Elimination
					Sleep
				Pharmacological Interventions
					Antidepressants
					Antianxiety Drugs
					Other Classes of Medications
				Integrative Therapy
				Health Teaching
				Advanced Interventions
					Cognitive Therapy
					Behavioural Therapy
					Cognitive-Behavioural Therapy
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	14 Depressive Disorders
		Objectives
		Key Terms and Concepts
		Clinical Picture
			Major Depressive Disorder
				Subtypes
			Premenstrual Dysphoric Disorder
				Other Specified Depressive Disorders
			Dysthymic Disorder
		Epidemiology
			Children and Adolescents
			Older Adults
		Co-Morbidity
		Etiology
			Biological Factors
				Genetic
				Biochemical
				Alterations in Hormonal Regulation
				Diathesis–Stress Model
			Psychological Factors
				Cognitive Theory
				Learned Helplessness
		Application of the Nursing Process
			Assessment
				General Assessment
					Assessment Tools
				Assessment of Suicide Potential
				Key Assessment Findings
				Areas to Assess
					Affect
					Thought Processes
					Mood
					Feelings
					Physical Behaviour
					Communication
					Religious Beliefs and Spirituality
				Age Considerations
					Assessment of Children and Adolescents
					Assessment of Older Adults
				Self-Assessment
					Unrealistic Expectations of Self
					Feeling What the Patient Is Feeling
			Diagnosis
			Outcomes Identification
				The Recovery Model
			Planning
			Implementation
				Counselling and Communication Techniques
				Health Teaching and Health Promotion
				Promotion of Self-Care Activities
				Milieu Management
				Pharmacological Interventions
					Antidepressant Drugs
						Choosing an antidepressant.
						Selective serotonin reuptake inhibitors.
							Indications.
							Common adverse reactions.
							Potential toxic effects.
						Tricyclic antidepressants.
							Indications.
							Common adverse reactions.
							Potential toxic effects.
							Adverse drug interactions.
							Contraindications.
							Patient and family teaching.
						Monoamine oxidase inhibitors.
							Indications.
							Common adverse reactions.
							Potential toxic effects.
							Contraindications.
						Use of antidepressants by pregnant women.
						Use of antidepressants by children and adolescents.
						Use of antidepressants by older adults.
				Electroconvulsive Therapy
					Indications
				Transcranial Magnetic Stimulation
					Indications
				Nerve Stimulation
					Indications
				Advanced-Practice Interventions
					Psychotherapy
					Group Therapy
				Future of Treatment
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	15 Bipolar Disorders
		Objectives
		Key Terms and Concepts
		Clinical Picture
		Epidemiology
		Co-Morbidity
		Etiology
			Biological Factors
				Genetic
				Neurobiological
				Neuroendocrine
				Gender
			Psychological Factors
				Environmental Factors
		Application of the Nursing Process
			Assessment
				General Assessment
					Mood
					Behaviour
					Thought Processes and Speech Patterns
					Cognitive Function
				Self-Assessment
			Nursing Diagnosis
			Outcomes Identification
				Acute Phase
				Continuation Phase
				Maintenance Phase
			Planning
				Acute Phase
				Continuation Phase
				Maintenance Phase
			Implementation
				Acute Phase
					Depressive Episodes
					Manic Episodes
				Continuation Phase
				Maintenance Phase
				Pharmacological Interventions
					Lithium Carbonate
						Indications.
						Therapeutic and toxic levels.
						Maintenance therapy.
						Contraindications.
					Anticonvulsant Drugs
						Divalproex sodium (Epival).
						Carbamazepine.
						Lamotrigine.
					Antianxiety Drugs
						Clonazepam and lorazepam.
					Atypical Antipsychotics
				Electroconvulsive Therapy
				Milieu Management
				Support Groups
				Health Teaching and Health Promotion
				Psychotherapy
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	16 Schizophrenia Spectrum and Other Psychotic Disorders
		Objectives
		Key Terms and Concepts
		Clinical Picture
		Epidemiology
		Co-Morbidity
		Etiology
			Biological Factors
				Genetic Factors
				Neurobiological Factors
					Dopamine theory.
					Other neurochemical hypotheses.
				Brain Structure Abnormalities
			Psychological and Environmental Factors
				Prenatal Stressors
				Psychological Stressors
				Environmental Stressors
			Course of the Disorder
			Prognosis
			Phases of Schizophrenia
		Application of the Nursing Process
			Assessment
				During the Prepsychotic Phase
				General Assessment
					Positive Symptoms
						Alterations in thinking.
						Alterations in speech.
						Alterations in perception.
						Alterations in behaviour.
					Negative Symptoms
					Cognitive Symptoms
					Affective Symptoms
				Self-Assessment
			Diagnosis
			Outcomes Identification
				Phase I—Acute
				Phase II—Stabilization
				Phase III—Maintenance
			Planning
				Phase I—Acute
				Phase II—Stabilization/Phase III—Maintenance
			Implementation
				Phase I—Acute
					Settings
					Interventions
				Phase II——Stabilization/Phase III—Maintenance
				Milieu Management
					Activities and Groups
					Safety
				Counselling and Communication Techniques
					Hallucinations
					Delusions
					Associative Looseness
				Health Teaching and Health Promotion
				Pharmacological Interventions
					Atypical Antipsychotics
					Conventional Antipsychotics
					Potentially Dangerous Responses to Antipsychotics
					Adjuncts to Antipsychotic Drug Therapy
					When to Change an Antipsychotic Regimen
				Specific Interventions for Paranoia, Catatonia,  and Disorganization
					Paranoia
						Communication guidelines.
						Self-care needs.
						Milieu needs.
					Catatonia: Withdrawn Phase
						Communication guidelines.
						Self-care needs.
						Milieu needs.
					Catatonia: Excited Phase
						Communication guidelines.
						Self-care needs.
					Disorganization
						Communication guidelines.
						Self-care needs.
						Milieu needs.
				Advanced-Practice Interventions
					Family Therapy
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	17 Eating Disorders
		Objectives
		Key Terms and Concepts
		Clinical Picture
		Epidemiology
		Co-Morbidity
		Etiology
			Biological Factors
				Genetic
				Neurobiological
			Psychological Factors
			Environmental Factors
		Anorexia Nervosa
			Application of the Nursing Process
				Assessment
					General Assessment
					Self-Assessment
				Diagnosis
				Outcomes Identification
				Planning
				Implementation
					Acute Care
					Psychosocial Interventions
					Pharmacological Interventions
					Health Teaching and Health Promotion
					Milieu Management
					Advanced-Practice Interventions
						Psychotherapy
				Evaluation
					Bulimia Nervosa
		Application of the Nursing Process
			Assessment
				General Assessment
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Acute Care
				Milieu Management
				Pharmacological Interventions
				Counselling
				Health Teaching and Health Promotion
				Advanced-Practice Interventions
					Psychotherapy
			Evaluation
				Binge Eating Disorder
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	18 Cognitive Disorders
		Objectives
		Key Terms and Concepts
		Delirium
			Clinical Picture
			Epidemiology
			Co-Morbidity and Etiology
		Application of the Nursing Process
			Assessment
				General Assessment
					Cognitive and Perceptual Disturbances
					Physical Needs
					Moods and Physical Behaviours
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Implementation
			Evaluation
		Dementia
			Clinical Picture
			Epidemiology
			Etiology
				Biological Factors
					Alzheimer’s Tangles
					Genetic
					Head Injury and Traumatic Brain Injury
					Cardiovascular Disease
					Modifiable Factors
		Application of the Nursing Process
			Assessment
				General Assessment
				Diagnostic Tests
				Stages of Alzheimer’s Disease
					Mild Cognitive Impairment due to AD
					Dementia due to AD
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Counselling and Communication Techniques
				Health Teaching and Health Promotion
					Referral to Community Supports
				Pharmacological Interventions
					An Overview of Drugs Approved for Treatment of AD
						Donepezil (Aricept).
						Rivastigmine (Exelon).
						Galantamine (Reminyl).
						Memantine (Ebixa).
					The Future of Drug Therapy
				Integrative Therapy
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	19 Substance Use and Addictive Disorders
		Objectives
		Key Terms and Concepts
		Clinical Picture
			No Use
			Use
			Misuse
			Abuse
			Dependency
				Flashbacks
				Synergistic Effects
				Antagonistic Effects
				Codependence
		Epidemiology
		Co-Morbidity
			Psychiatric Co-Morbidity
			Medical Co-Morbidity
		Etiology
			Biological Factors
			Psychological Factors
			Sociocultural Factors
		Application of the Nursing Process
			Assessment
				Assessment of Substance Use and  Substance-Induced Disorders
				Assessment of Acute Intoxication and of Active and Historical Substance Use or Behavioural Addiction
				Signs of Intoxication and Withdrawal
					Central Nervous System Depressants
						Alcohol poisoning.
						Alcohol withdrawal.
						Alcohol intoxication.
						Alcohol withdrawal delirium.
					Central Nervous System Stimulants
						Cocaine and crack.
						Caffeine and nicotine.
					Opioids
					Marijuana
					Hallucinogens
						Lysergic acid diethylamide (LSD) and LSD-like drugs.
						Phencyclidine piperidine (PCP).
					Inhalants
					Club Drugs
					Date Rape Drugs
				Psychological Changes
				Assessment of Readiness for Change
				Self-Assessment and Self-Awareness
					Nurses and Addiction in the Workplace
				Communication Techniques for  Assessment and Interventions
			Diagnosis
			Outcomes Identification
				Withdrawal
				Initial and Active Substance Abuse Treatment
				Health Maintenance
			Planning
			Implementation
				Substance Abuse Interventions
				Motivational Interviewing
				Pharmacological Interventions
					Detoxification or Alcohol Withdrawal Treatment
						Naltrexone.
						Acamprosate.
						Topiramate.
					Biological Treatment of Opioid Addiction
						Methadone.
						Naltrexone.
						Clonidine.
						Buprenorphine.
					Biological Treatment of Nicotine Addiction
				Implementation at Primary, Secondary, and Tertiary Levels of Prevention
					Primary Prevention
					Secondary Prevention
						Harm-reduction approaches.
						Relapse prevention.
						Self-help groups for patient and family or friends.
						Twelve-step programs.
					Tertiary Prevention
						Residential treatment programs.
						Intensive outpatient programs.
						Outpatient treatment programs and employee assistance programs.
				Advanced-Practice Interventions
					Psychotherapy
			Evaluation
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	20 Personality Disorders
		Objectives
		Key Terms and Concepts
		Clinical Picture
			Cluster A Personality Disorders
				Schizotypal Personality Disorder
			Cluster B Personality Disorders
				Antisocial Personality Disorder
				Borderline Personality Disorder
				Narcissistic Personality Disorder
			Cluster C Personality Disorders
				Avoidant Personality Disorder
				Obsessive-Compulsive Personality Disorder
		Epidemiology
		Co-Morbidity
		Etiology
			Biological Factors
				Genetics
				Neurobiology and Neurochemistry
			Psychosocial Factors
				Psychological Factors
				Environmental Factors
			Diathesis–Stress Model
		Application of the Nursing Process
			Assessment
				Assessment Tools
				Patient History
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Safety and Teamwork
				Pharmacological Interventions
				Case Management
				Advanced-Practice Interventions
					Psychotherapy
			Evaluation
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	21 Sleep–Wake Disorders
		Objectives
		Key Terms and Concepts
		Sleep
			Consequences of Sleep Loss
			Normal Sleep Cycle
			Regulation of Sleep
			Functions of Sleep
			Sleep Requirements
			Sleep Patterns
		Sleep–Wake Disorders
			Clinical Picture
				Insomnia Disorders
				Hypersomnia Disorders
					Hypersomnia
					Narcolepsy
				Confusional Arousal Disorders
					Sleepwalking
					Sleep Terrors
					Nightmare Disorder
					Sleep Paralysis
					Rapid Eye Movement Behaviour Disorder
				Kleine–Levin Syndrome
				Sleep–Wake Disorders Related to Breathing
					Obstructive Sleep Apnea Hypopnea Syndrome
					Primary Central Sleep Apnea
					Primary Alveolar Hypoventilation
				Circadian Rhythm Sleep Disorder
				Restless Legs Syndrome (Willis-Ekbom Disease)
			Epidemiology
			Co-Morbidity
				Sleep–Wake Disorders and Mental Illness
				Sleep and General Health
		Application of the Nursing Process
			Assessment
				General Assessment
					Sleep Patterns
					Identifying Sleep–Wake Disorders
					Functioning and Safety
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Counselling
				Health Teaching and Health Promotion
				Pharmacological Interventions
				Cognitive-Behavioural Therapy for Insomnia
				Advanced-Practice Interventions
			Evaluation
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	22 Sexual Dysfunction, Gender Dysphoria, and Paraphilias
		Objectives
		Key Terms and Concepts
		Sexuality
		Sexual Dysfunction
			Clinical Picture
				Sexual Desire Disorders
				Sexual Arousal Disorders
				Orgasm Disorders
					Female Orgasmic Disorder
					Male Orgasmic Disorder
					Premature Ejaculation
				Sexual Pain Disorders
					Dyspareunia
					Vaginismus
				Other Sexual Dysfunctions and Problems
			Epidemiology
			Co-Morbidity
			Etiology
		Application of the Nursing Process
			Assessment
				Self-Assessment
				General Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Pharmacological Interventions
				Health Teaching and Health Promotion
				Advanced-Practice Interventions
			Evaluation
		Sexual Disorders
			Clinical Picture
				Gender Dysphoria
				Paraphilias
					Fetishism
					Pedophilia
					Exhibitionism
					Voyeurism
					Transvestic Fetishism
					Sexual Sadism
					Frotteurism
					Paraphilia Not Otherwise Specified
			Epidemiology
			Co-Morbidity
			Etiology
				Biological Factors
				Psychosocial Factors
		Application of the Nursing Process
			Assessment
				Self-Assessment
				General Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Health Teaching and Health Promotion
				Milieu Management
				Pharmacological Interventions
				Advanced-Practice Interventions
					Psychotherapy
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	23 Somatic Symptom Disorders and Dissociative Disorders
		Objectives
		Key Terms and Concepts
		Somatic Symptom Disorders
			Clinical Picture
				Somatic Symptom Disorder
				Illness Anxiety Disorder
				Conversion Disorder
			Epidemiology
			Co-Morbidity
			Etiology
				Biological Factors
					Genetic Factors
				Psychological Factors
					Psychodynamic Theories
					Behavioural Theory
					Cognitive Theory
				Environmental Factors
				Cultural Factors
		Application of the Nursing Process
			Assessment
				Physical Symptoms
				Psychosocial Factors
					Coping Skills
					Spirituality and Religion
					Secondary Gains
					Cognitive Style
					Ability to Communicate Feelings and Emotional Needs
					Dependence on Medication
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Psychosocial Interventions
				Pharmacological Interventions
				Health Teaching and Health Promotion
				Case Management
				Advanced-Practice Interventions
			Evaluation
		Factitious Disorders
			Clinical Picture
				Malingering
			Epidemiology
			Co-Morbidity
			Etiology
				Biological Factors
				Psychological Factors
		Application of the Nursing Process
			Assessment
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
			Evaluation
		Dissociative Disorders
			Clinical Picture
				Depersonalization/Derealization Disorder
				Dissociative Amnesia
				Dissociative Identity Disorder
			Epidemiology
			Co-Morbidity
			Etiology
				Biological Factors
					Genetics
				Psychological Factors
				Environmental Factors
				Cultural Factors
		Application of the Nursing Process
			Assessment
				General Assessment
					Identity and Memory
					History
					Mood and Anxiety
					Impact on Patient and Family
					Suicide Risk
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Milieu Management
				Health Teaching and Health Promotion
				Pharmacological Interventions
				Advanced-Practice Interventions
					Somatic Therapy
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
Unit 5 Trauma Interventions
	24 Crisis and Disaster
		Objectives
		Key Terms and Concepts
		The Development of Crisis Theory
			Types of Crisis
				Maturational Crisis
				Situational Crisis
				Adventitious Crisis
			Phases of Crisis
				Phase 1
				Phase 2
				Phase 3
				Phase 4
		Application of the Nursing Process
			Assessment
				General Assessment
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Counselling
					Primary Care
					Secondary Care
					Tertiary Care
						Critical incident stress debriefing.
			Evaluation
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	25 Suicide
		Objectives
		Key Terms and Concepts
		Epidemiology
			Racial and Ethnic Statistics
			Risk Factors
		Etiology
			Biological Factors
			Psychosocial Factors
			Cultural Factors
			Societal Factors
		Application of the Nursing Process
			Assessment
				Verbal and Nonverbal Clues
				Lethality of Suicide Plan
				Assessment Tools
				Self-Assessment
			Implementation
				Primary Intervention
				Secondary Intervention
				Tertiary Intervention
				Milieu Management
					Suicide Precautions
				Counselling
				Health Teaching and Health Promotion
				Case Management
				Pharmacological Interventions
				Postvention for Survivors of Suicide
			Evaluation
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	26 Anger, Aggression, and Violence
		Objectives
		Key Terms and Concepts
		Clinical Picture
		Epidemiology
		Co-Morbidity
		Etiology
			Biological Factors
			Psychological Factors
			Sociological Factors
		Application of the Nursing Process
			Assessment
				General Assessment
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Psychosocial Interventions
					Staff Safety
					Considerations for Engaging the Angry or Aggressive Patient
				Pharmacological Interventions
				Health Teaching and Health Promotion
				Case Management
				Milieu Management
					Use of Restraints or Seclusion
				Caring for Patients in General Hospital Settings
					Patients With High Anxiety Related to Hospitalization
					Patients With Healthy Coping Skills Who Are Overwhelmed
					Patients With Marginal Coping Skills
				Caring for Patients in Inpatient Psychiatric Settings
					Patients Who Are Acutely Psychotic
				Caring for Patients With Cognitive Deficits in  Long-Term Residential Care Settings
					Patients With Cognitive Deficits
			Evaluation
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	27 Interpersonal Violence:
		Objectives
		Key Terms and Concepts
		Clinical Picture
			Types of Abuse
				Physical Abuse
				Sexual Abuse
				Emotional Abuse
				Neglect
				Economic Abuse
			Cycle of Violence
		Epidemiology
			Child Abuse
			Intimate Partner Abuse
			Older Adult Abuse
		Co-Morbidity
		Etiology
			The Ecological Model
			Environmental Factors
				Perpetrator
				Vulnerable Person
					Women.
					Children.
					Older adults.
				Crisis Situation
		Application of the Nursing Process
			Assessment
				General Assessment
					Interview Process and Setting
					Maintaining Accurate Records
				Self-Assessment
				Level of Anxiety and Coping Responses
				Family Coping Patterns
				Support Systems
				Suicide Potential
				Homicide Potential
				Drug and Alcohol Use
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Reporting Abuse
				Counselling
				Case Management
				Milieu Management
				Promotion of Self-Care Activities
				Health Teaching and Health Promotion
				Prevention of Abuse
					Primary Prevention
					Secondary Prevention
					Tertiary Prevention
				Advanced-Practice Interventions
					Individual Psychotherapy
					Family Psychotherapy
					Group Psychotherapy
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	28 Sexual Assault
		Objectives
		Key Terms and Concepts
		Epidemiology
			Profile of Sexual Perpetrators
		Clinical Picture
			Relationships Between Victims and Perpetrators
			Psychological Effects of Sexual Assault
			Rape-Trauma Syndrome
				Acute Phase
				Long-Term Reorganization Phase
		Application of the Nursing Process
			A Trauma-Informed Approach
			Assessment
				General Assessment
					Level of Anxiety
					Coping Mechanisms
					Available Support Systems
					Signs and Symptoms of Emotional Trauma
					Signs and Symptoms of Physical Trauma
				Self-Assessment
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Counselling
				Promotion of Self-Care Activities
				Follow-Up Care
				Advanced-Practice Interventions
					Sexual Assault Nurse Examiners
						Survivors.
						Perpetrators.
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
Unit 6 Interventions for Distinct Populations
	29 Disorders of Children and Adolescents
		Objectives
		Key Terms and Concepts
		Epidemiology
		Co-Morbidity
		Risk Factors
		Etiology
			Biological Factors
				Genetic
				Brain Development and Biochemicals
				Temperament
				Resilience
			Environmental Factors
				Cultural Factors
		Child and Adolescent Psychiatric Mental Health Nursing
			Assessing Development and Functioning
				Data Collection
				Assessment Data
					Developmental Assessment.
					Mental Status Examination.
						Risk Assessment.
					Cultural Factors.
			General Interventions
				Family Therapy
				Group Therapy
				Behavioural Therapy
				Cognitive-Behavioural Therapy
				Milieu Management
					Seclusion and Restraint.
						Quiet Room.
						Time Out.
				Mind–Body Therapies
				Play Therapy
					Mutual Storytelling.
					Therapeutic Games.
					Bibliotherapy.
					Therapeutic Drawing.
				Psychopharmacology
		Neurodevelopmental Disorders
			Intellectual Disabilities
			Communication Disorders
			Autism Spectrum Disorder
			Attention Deficit–Hyperactivity Disorder
			Specific Learning Disorder (SLD)
			Motor Disorders
		Application of the Nursing Process
			Assessment
			Diagnosis
			Outcomes Identification
			Implementation
		Disruptive, Impulse-Control,  and Conduct Disorders
			Oppositional Defiant Disorder
			Conduct Disorder
				Bullying
		Application of the Nursing Process
			Assessment
			Diagnosis
			Outcomes Identification
			Implementation
		Anxiety Disorders
			Separation Anxiety Disorder
			Generalized Anxiety Disorder (GAD)
		Application of the Nursing Process
			Assessment
			Diagnosis
			Outcomes Identification
			Implementation
		Other Disorders of Children and Adolescents
			Depressive Disorders and Bipolar and Related Disorders
			Post-Traumatic Stress Disorder
			Feeding and Eating Disorders
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	30 Psychosocial Needs of the Older Adult
		Objectives
		Key Terms and Concepts
		Mental Health Issues Related to Aging
			Late-Life Mental Illness
				Depression
					Depression and suicide risk.
				Anxiety Disorders
				Substance Abuse
			Trauma
		Health Care Concerns of Older Adults
			Pain
				Principles of Pain Management
					Assessment tools.
					Barriers to accurate pain assessment.
					Pain treatment.
						Pharmacological pain treatments.
						Nonpharmacological pain treatments.
			Caregiver Burden
			Access to Care
			Ageism
				Ageism and Public Policy
				Ageism and Drug Testing
		Nursing Care of Older Adults
			Assessment Strategies
			Intervention Strategies
				Psychosocial Interventions
				Pharmacological Interventions
				Health Teaching and Health Promotion
				Promotion of Self-Care Activities
				Milieu Management
			Care Settings
				Skilled Nursing Facilities
				Residential Care Settings
				Partial Hospitalization
				Day Treatment Programs
				Behavioural Health Home Care
				Community-Based Programs
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	31 Living With Recurrent and  Persistent Mental Illness
		Objectives
		Key Terms and Concepts
		Serious Mental Illness Across  the Lifespan
			Older Adults
			Younger Adults
		Development of Serious Mental Illness
		Rehabilitation Versus Recovery:  Two Models of Care
		Issues Confronting Those With Serious Mental Illness
			Establishing a Meaningful Life
			Co-Morbid Conditions
				Physical Disorders
				Depression and Suicide
				Substance Abuse
			Social Problems
				Stigma
				Isolation and Loneliness
				Victimization
			Economic Challenges
				Unemployment and Poverty
				Housing Instability
				Caregiver Burden
			Treatment Issues
				Nonadherence
				Anosognosia
				Medication Adverse Effects
				Treatment Inadequacy
				Residual Symptoms
				Relapse, Chronicity, and Loss
		Resources for People With Serious  Mental Illness
			Comprehensive Community Treatment
				Community Services and Programs
			Substance Abuse Treatment
		Evidence-Informed Treatment Approaches
			Assertive Community Treatment
			Cognitive-Behavioural Therapy
			Cognitive Enhancement Therapy
			Family Support and Partnerships
			Social Skills Training
			Supportive Psychotherapy
			Vocational Rehabilitation and Related Services
		Other Potentially Beneficial Services or Treatment Approaches
			Consumer-Run Programs
			Wellness and Recovery Action Plans
			Exercise
		Nursing Care of Patients With Serious Mental Illness
			Assessment Strategies
			Intervention Strategies
			Evaluation
		Current Issues
			Involuntary Treatment
			Criminal Offences and Incarceration
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	32 Psychological Needs of Patients With Medical Conditions
		Objectives
		Key Terms and Concepts
		Psychological Factors Affecting  Medical Conditions
		Psychological Responses to Serious Medical Conditions
			Depression
			Anxiety
			Substance Abuse
			Grief and Loss
			Denial
			Fear of Dependency
		Nursing Care of Patients With  Medical Conditions
			Psychosocial Assessment
				Quality of Life
				Coping Skills
				Spirituality and Religion
				Social Support
			General Interventions
		Human Rights Abuses of Stigmatized Persons With Medical Conditions
		Psychiatric Consultation Liaison Nurse
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	33 Care for the Dying and for  Those Who Grieve
		Objectives
		Key Terms and Concepts
		Hospice Palliative Care
		Nursing Care at the End of Life
			Hospice Palliative Care Nursing
			The Art, Presence, and Caring of Nursing
			Assessment for Spiritual Issues
			Awareness and Sensitivity of Cultural Contexts
			Palliative Symptom Management
			The Importance of Effective Communication
				Anticipatory Grief
				The Four Gifts of Resolving Relationships
					Forgiveness.
					Love.
					Gratitude.
					Farewell.
			Self-Care
		Nursing Care for Those Who Grieve
		Grief Reactions, Bereavement,  and Mourning
			Types of Grief
			Theories
				Dual Process Model of Coping With Bereavement
				Four Tasks of Mourning
			Helping People Cope With Loss
			Palliative Care for Patients With Dementia
		Implications for Further Study
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	34 Forensic Psychiatric Nursing
		Objectives
		Key Terms and Concepts
		Forensic Nursing
			Education
			Roles and Functions
				Nurse Examiner/Sexual Assault Nurse Examiner
				Nurse Coroner or Death Investigator
			The Forensic Mental Health System in Canada
		Forensic Psychiatric Nursing
			Roles and Functions
				Correctional Nursing in Canada
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
Unit 7 Advanced Intervention Modalities
	35 Therapeutic Groups
		Objectives
		Key Terms and Concepts
		Therapeutic Factors Common to  All Groups
		Planning a Group
		Phases of Group Development
		Group Member Roles
		Group Leadership
			Responsibilities
			Styles of Leadership
			Clinical Supervision
			Group Observation
		Nurse as Group Leader
			Basic Groups
				Psychoeducational Groups
					Medication Education.
					Health Education.
					Family Education.
					Concurrent Disorders.
					Symptom Management.
					Stress Management.
					Support and Self-Help Groups.
			Advanced-Practice Nurse or Nurse Therapist
				Group Psychotherapy
					Psychodrama Groups.
					Dialectical Behaviour Treatment.
					Integrative Groups.
			Dealing With Challenging Member Behaviours
				Monopolizing Member
					Complaining Member Who Rejects Help.
				Demoralizing Member
				Silent Member
		Expected Outcomes
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
	36 Family Interventions
		Objectives
		Key Terms and Concepts
		Family
			Family Functions
			Families and Mental Illness
		Canadian Models of Family Nursing Care and Assessment
			McGill Model of Nursing
			Calgary Family Assessment Model (CFAM) and Calgary Family Intervention Model (CFIM)
		Family Therapy
			Issues Associated With Family Therapies
				Communication
				Emotional Support
				Socialization
			Family Life Cycle
			Working With the Family
				The Identified Patient
				Family Triangles
					The Nurse’s Response to Triangulation.
				The Nuclear Family Emotional System
		Family Therapy Theory
			The Family as a System
		Application of the Nursing Process
			Assessment
				Sociocultural Context
				Intergenerational Issues
					Constructing a Genogram
				Self-Awareness
			Diagnosis
			Outcomes Identification
			Planning
			Implementation
				Counselling and Communication Techniques
				Family Therapy
					Traditional Family Therapy
					Psychoeducational Family Therapy
					Self-Help Groups
				Case Management
				Pharmacological Interventions
			Evaluation
			Key Points to Remember
			Critical Thinking
		Chapter Review
		References
	37 Integrative Care
		Objectives
		Key Terms and Concepts
		Integrative Health Care in Canada
			Research
		Patients and Integrative Care
			Safety and Efficacy
			Cost
			Reimbursement
			Placebo Effect
		Integrative Nursing Care
		Classification of Integrative Care
			Whole Medical Systems
				Traditional Aboriginal Medicine
				Ayurvedic Medicine
				Traditional Chinese Medicine
					Acupuncture.
				Homeopathy and Naturopathy
			Mind–Body–Spirit Approaches
				Guided Imagery
				Biofeedback
				Hypnosis and Therapeutic Suggestion
				Meditation
				Rhythmic Breathing
				Spirituality
			Biologically Based Therapies
				Diet and Nutrition
				Herbal Therapy
				Aromatherapy
			Manipulative Practices
				Chiropractic Medicine
				Massage Therapy
				Reflexology
			Energy Therapies
				Therapeutic Touch
				Healing Touch
				Reiki
				Thought Field Therapy and Emotional Freedom Technique
				Bioelectromagnetic-Based Therapies
		Key Points to Remember
		Critical Thinking
		Chapter Review
		References
Appendix A Psychiatric Mental Health Nursing Standards of Practice, Code of Ethics, Beliefs, and Values
	Canadian Federation Of Mental Health Nurses Standards of Practice
		Standard I:
		Standard II:
		Standard III:
		Standard IV:
		Standard V:
		Standard VI:
		Standard VII:
			Beliefs/Values
	Registered Psychiatric Nurses Of Canada Standards of Psychiatric Nursing Practice Psychiatric nursing, as a distinct profession, provides service to individuals whose care needs relate to mental, physical, and developmental health. Registered psychiatric nurses engage in various roles providing health services to individuals, families, groups, and communities. The practice of psychiatric nursing occurs within the domains of direct practice, education, administration, and research.
		Standards of Psychiatric Nursing Practice
		Standard 1: Therapeutic Interpersonal Relationships
		Standard 2: Application and Integration of  Theory-Based Knowledge
		Standard 3: Professional Responsibility
		Standard 4: Professional Ethics
			The Code of Ethics
Appendix B NANDA-I Nursing Diagnoses 2012–2014
	Domain 1: Health Promotion
	Domain 2: Nutrition
	Domain 3: Elimination and Exchange
	Domain 4: Activity/Rest
	Domain 5: Perception/Cognition
	Domain 6: Self-Perception
	Domain 7: Role Relationships
	Domain 8: Sexuality
	Domain 9: Coping/Stress Tolerance
	Domain 10: Life Principles
	Domain 11: Safety/Protection
	Domain 12: Comfort
	Domain 13: Growth/Development
Glossary
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	L
	M
	N
	O
	P
	R
	S
	T
	U
	V
	W
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	Y
	Z
Answers to Chapter  Review Questions
	Chapter 1
	Chapter 2
	Chapter 3
	Chapter 4
	Chapter 5
	Chapter 6
	Chapter 7
	Chapter 8
	Chapter 9
	Chapter 10
	Chapter 11
	Chapter 12
	Chapter 13
	Chapter 14
	Chapter 15
	Chapter 16
	Chapter 17
	Chapter 18
	Chapter 19
	Chapter 20
	Chapter 21
	Chapter 22
	Chapter 23
	Chapter 24
	Chapter 25
	Chapter 26
	Chapter 27
	Chapter 28
	Chapter 29
	Chapter 30
	Chapter 31
	Chapter 32
	Chapter 33
	Chapter 34
	Chapter 35
	Chapter 36
	Chapter 37