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84 Cards in this Set

  • Front
  • Back
Doing what is fair in all aspects of Care
Justice
Doing No Harm
Nonmalfeasance
Doing good and promoting well being
Beneficence
Doing for self
Autonomy
Treating everyone with equal respect
Respect
Being loyal and true
Fidelity
Telling the truth
Veracity
Ethical Rights
--To preserve client's dignity, autonomy, rights and confidentiality.
--Client's must be involved in decision
making to the full extent of their capacity (Mutual Decision Making).
--Client's have a right to treatment in the least restrictive setting.
--Clients' have a right to refuse treatment unless a legal process resulting in a mandatory court order for treatment has been obtained.
Ethical Dilemma
--Occurs in situations where there are two or more justifiable alternatives.

--Occurs when the choice is made to promote good.

--Which option sacrifices the fewest high-priority values (a harm-reduction approach)
Action is judged as good or bad based on the act itself regardless of the consequences.
Deontological Theory
Actions are chosen based on the moral virtues (honesty, courage, compassion, wisdom, gratitude, self respect) or the character of the person making the decision.
Virtue Ethics
Action is judged as good or bad based on the consequences or outcome.
Teleological Theory
Malpractice Insurance
--Coverage for negligent professional acts.
--Coverage for highly technical or professional skills required by health professionals, NP's.
--No protection for practicing outside legal scope of practice.
4 Elements to Prove Negligence:
--Duty: To exercise reasonable care when undertaking and providing treatment to the client.
--Breach of Duty: NP violated the applicable standard of care in treating the client's condition.
--Proximate Cause: There's a causal relationship between the breach in the standard of care and the client's condition.
--Damages: Are permanent and substantial damages to the client as a result of the breach in the standard of care.
Determination that a client can make reasonable judgements and decisions regarding treatments and other health concerns.
--Determined by a court.
Competency

(If incompetent, a court-appointed legal guardian will make health-related decisions for the individual.)
Scholarly Activities
Publishing, Lecturing, Preceptorship, Continuing Education
Client Advocacy
--Standing up for patient's rights and empowering them to become their own advocate.
--Participating in professional organizations.
--Helping patients receive available services.
System of controlled oversight and authorization of services and benefits provided to clients.
--Coordinating Care, Ensuring Quality Outcomes, Monitoring Plan of Care, and Advocacy.
--Promote Quality Cost-Effective Outcomes.
Case Management
Health Promotion/Disease Prevention Education:
--Preventive Care & Screening Practices.
--Screening for physical Health Problems-Psych Client.
--Usually Guided by Healthy People 2010, which identifies national health objectives, incl. behavioral health.
Mental Health Promotion and Education Includes:
--Teaching about Ways to Cope with Specific Stressors.
--Validating "normalcy" of feelings; ensuring clients they are not "crazy".
--Helping clients recognize and identify their feelings or behaviors.
--Helping clients identify resources in the community.
PUBLIC HEALTH PRINCIPLES

Primary Prevention:
Aimed at decreasing incidence (number of new cases) of mental disorders. ie: by helping people avoid stressors or cope with them more adaptively (Stress Management Classes, Smoking Prevention Classes, Drug Abuse Resistance Education, DARE)
PUBLIC HEALTH PRINCIPLES

Secondary Prevention
Aimed at reducing prevalence or number of existing cases of mental disorders.
--Early Case Finding
--Screening
--Prompt and effective treatment (Hotlines, Crisis Intervention, Disaster Responses)
PUBLIC HEALTH PRINCIPLES

Tertiary Prevention
Aimed at reducing disability and severity of a mental disorder.
--Rehabilitative Services
--Avoidance or postponement of complications (day treatment programs, Case management for physical, housing, or vocational needs; social skills training.)
Risk Factors for developing a psychiatric disorder:
--BIOLOGICAL: History of mental illness in family, poor nutritional status, and poor general health.
--PSYCHOLOGICAL: Poor self concept, external locus of control, poor ego defenses.
--SOCIAL: Stressful occupation, low socioeconomic status, poor level of social integration.
Preventive Factors that facilitate a healthy response to stress:
--BIOLOGICAL: No history of mental illness in the family, health nutritional status, good health.
--PSYCHOLOGICAL: Good self esteem or self concept, internal locus of control, healthy ego defenses.
--SOCIAL: Low stress occupation, higher socioeconomic status, higher level of education.
--The continuous monitoring for high-risk situations.

--Assessing individuals for non-healthy behaviors.
Risk Assessment
Risk Management
--Activities or systems designed to recognize and intervene to decrease the risk of injury to clients.
--Appropriate interventions that are implemented to reduce unhealthy behaviors in clients and high-risk situations.
--Functions to recognize and intervene to decrease subsequent claims against health care providers.
Client gives specific instructions while mentally competent that providers must follow if client becomes incompetent or terminally ill.
Living Will
--Designates an agent to act on behalf of the client if they become unable to make health care decisions.
--Not limited to terminal illness; covers other aspects of illness such as making financial decisions during an individuals illness.
--Should be considered as an aspect of relapse planning for clients with chronic psych disorders.
Durable Power of Attorney (Health care proxy")
Living Will

Durable POA
Advance Directives (Binding in all 50 states)
Learned beliefs and behaviors or the socially inherited characteristics common among all member of a group--may be racial, social, ethnic or religious grouping.
Culture
Culture-Bound Syndrome
--Specific behaviors related to a person-s culture and not linked to a psychiatric disorder
--Be cognizant of inaccurately judging a client's behavior as psychopathology when it is really related to his culture.
Ethnicity
Self-identified race, tribe, or nation with which a person or group identifies and which greatly influences beliefs and behavior.
Family
--Group of adults and children who are usually related and whose adults participate in carrying out the essential functions of providing food, clothing, shelter, safety, and education of children.
--Initially teaches the belief patterns, religion, culture, and mores of a society.
--Concept broadened beyond the traditional husband-wife-children pattern.
Community
A group of families often sharing the same race, tribe, or culture and who have beliefs or behavior not shared by others.
Environment
Includes both physical and psychosocial factors; the general circumstances of an individual's life:
Social contacts, housing, climate, altitude, pollution, fluoride in water, crime, poverty, transportation, water contamination.
Homeless Persons
--People who do not have stable or consistent nighttime housing or who maintain permanent residence at shelters, hotels, transitional housing, or public places in which it is not appropriate for human beings to live.
--Persons intended to be institutionalized who are in institutions for transitory residence.
Homeless Families
--Majority are headed by a single parent, usually a woman.
Risk Factors for Homelessness:
--Female-headed households: limited education or employment skills; low-paying employment with little or no benefits and limited access to affordable housing.
--Teen mothers: lack of education and incomes that older parents possess.
Other Reasons:
Mental Illness
Addictive Disorders
Poverty
Unemployment
Inadequate Public Assistance
Domestic Violence
Lifestyle Choice
Facts Regarding the Homeless Pop:
--50% have co-occurring substance use disorders and serious mental illness.
--Schizophrenia accounts for 15-45% of the US homeless pop.
--Symptoms are often active and untreated.
--This results in paranoia, hallucinations, mania, anxiety, and depression, making it difficult to maintain employment, relationships, and other ADL's.
--These people are at greater risk for violence, medication noncompliance, and treatment resistance.
Strategies for Reducing Homelessness
--Outreach Services: in various settings; building an empathetic, consistent, and caring relationship to provide treatment.
--Integrated Care: Combining mental health and medical care to improve overall functioning in the community; also may include access to dental care and pharmacy services with co-location.
--Supporting services to people in housing: effective in moving homeless individuals with serious mental illness directly to independent housing with support and intensive attention.
--Prevention: Beginning with discharge planning in inpatient settings, provide resources for mental health care, housing, transitioning service, and follow-up.
Migrant Farm Workers

(Men, women, and children of all cultures)
People who leave their permanent residences to take agricultural jobs in different locations.
Seasonal Farm Workers

(Men, women, and children of all cultures)
Workers who travel from their permanent residences seasonally for agricultural employment.
Migrant & Seasonal Farm Workers
--Estimated between 3 and 5 million in the US (difficult to estimate because they are moving around)
--High incidence of depression, anxiety and substance abuse.
--Poor working conditions, problems with the process of acculturation, isolation, discrimination, and impaired access to health care play a role in the high prevalence of mental illness among this population.
--Physical and emotional abuse of women is harder to address because of frequent changes of location.
--Displaying an empathetic, understanding, and culturally sensitive attitude is imperative when promoting care due to the ways specific cultures perceive mental illness.
How people identify psychologically on a continuum between female and male and to whom they are sexually and/or affectionately attracted.
Sexual Identity
An individual's identity along a continuum between normative constructs of masculinity and femininity
Gender Identity
Gender Identity
--Influences may consist of biological and social factors.
--Biological factors may include pre and postnatal hormone levels and gene expression.
--Social factors may include gender messages from family, mass media, and cultural attitudes.
--Gender Identity Disorder (GID) is the formal diagnosis to describe persons who experience significant gender dysphoria (discontent with their biological sex). It is a psychiatric classification in the DSM-IV.
The direction of sexual attraction, and does not always relate to gender identity.
Sexual Orientation (Preferred over "sexual preference" or lifestyle.)
Transgender
Individuals whose gender identity does not conform to gender norms associated with the sex they were assigned at birth; does not imply a particular sexual orientation.
Transsexual
Individuals who identify as the opposite gender from the one they were assigned at birth; some change their bodies hormonally and surgically to conform to their gender identity.
Gay, lesbian, bisexual, transgender, and queer
GLBTQ
Manner in which humans experience and express their sexuality; includes attracting partners, sexual interactions, and social interactions between individuals.
Sexual Behavior
US Prisoners
--15 to 24% have severe mental illness
--Lack of synchronized care with criminal justice, mental and public health systems results in repeat incarcerations.
Forensic Nursing
--Practice of nursing when health and legal systems intersect; the forensic nurse provides direct services to individual clients; consultation services to nursing, medical, and legal agencies; and expert court testimony in areas dealing with trauma and/or investigations of questioned deaths, adequacy of services delivery, and specialized diagnoses of specific conditions as related to nursing.
Forensic vs. Correctional

Forensic:
Nurse-Patient relationship based on crime committed and investigational aspect of the interaction.
Providers have an ethical responsibility:
--To disclose medical errors, accidents, injuries, and negative results to patients.
--As a result of these disclosures, a patient may have a legal right to compensation for harm suffered due to medical misadventures.
Americans with Disabilities Act:
--Works to prevent discrimination by employers with 15 or more employees against qualified individuals in hiring, firing, advancement, job training, compensation, and workplace conditions.
Risk of Disclosure under the Americans with Disabilities Act:
--Employers may find ways to avoid hiring people known to have a disability
--Coworkers may harass or discriminate against people with psych illness.
--Assumption that people with psych illnesses may be less productive.
--May limit an employee's chance for advancement in career.
--Feedback for improvement may not be given to employee because others may attribute the persons behavior to the psych illness.
--Labeling oneself as "disabled" may affect one's beliefs or self-image.
Benefits of Disclosure under the Americans with Disabilities Act:
--Able to request reasonable accommodations.
--Opportunity to have a job coach come to the work site and communicate directly with employer.
--Employee can involve an employment service provider, employee assistance program, or other third party in the development of accommodations.
--Easier for employee to come to work during an exacerbation of symptoms.
--May help with the recovery process.
--Allows coworker to offer personal support.
--May empower another employee to disclose.
The most commonly procedure coding manual used in the US.
AMA's Physicians' Current Procedural Terminology (CPT)

--Continuous errors can trigger audits, payment refund requests, fraud and abuse charges, and the provider being dropped from managed care networks.
Aid the provider in documenting and selecting the correct code and correct level of service
Evaluation and Management (E/M) Codes
Evaluation and Management Code has three components:
--History
--Examination
--Medical Decision-Making

A combination of various levels of these three components determines the code to be used.
Comprehensive: Chief complaint, extended HPI, complete ROS; past, family, and social histories; and mental status exam; may also include communication with family, as well as lab or other diagnostic studies.
--Initial E/M: Performance and documentation of all three components
--Follow-up E/M: performance and documentation of two of the three components.
--Face-to-face time is a key factor for particular E/M codes.
--Evaluating for medication only is coded as a medication management appointment.
--Documentation must support the level of service billed.
--Medical Necessity is used in addition to the CPT code for payment.
Psychotherapy: Two broad categories
--Interactive Psychotherapy
--Insight-Oriented, Behavior-Modifying, and/or Supportive Psychotherapy.

--Coded by type of therapy provided and the amount of time spent with client.
Medicare
--Health Insurance for those age 65 and older.
--Those with certain disabilities
--Those with end-stage renal disease
Medicare Part A Covers:
Hospitalization, Rehabilitation, Skilled Nursing, Hospice, and Home Health, usually without a premium.
Medicare Part B Covers:
--Doctors' services, outpatient care, and preventive services for a monthly premium
-- penalty for not signing up promptly upon reaching age 65
-- providers who are Medicare-approved "accept assignment", meaning that they accept the Medicare-approved amount as full payment.
Medicare Part C:
Medicare Advantage Plans provide Medicare-covered hospitalization (Part A) and medical (Part B) services through private companies.
Medicare Part D:
Prescription Drug Coverage; run by private companies and vary in medications covered
--person must join a plan for a monthly premium, with penalty for not signing up promptly at age 65.
--Some Medicare Advantage companies include Part D coverage.
Personal Health Records
--May be managed by Medicare provider or can be set up by the individual so the patient controls the information.
--The PHR is not public information and is not subject to HIPAA.
EMR
Electronic Medical Record is a health record that the doctor or hospital agency controls.
--It is confidential information as limited by the HIPAA act.
Medicaid
--Helps pay medical costs for eligible persons.
--Federal and state program of CMS
--Administered by the state.
--Needs-based; each state determines eligibility and services
--Eligibility depends on income, assets, and resources.
--For low-income pregnant women, children under age 19, people 65 and older, blind, disabled, or in need of and unable to pay for nursing home care.
--Applied for at the state Medicaid agency.
--Medicaid-managed behavioral health care reimburses public and private care for eligible persons.
Joint Commission
--Is recognized by most state gov's as criterion for licensure and receipt of Medicaid reimbursement.
--Subject to the accrediting standards of the Centers for Medicare and Medicaid Services as of July 2010. (CMS)
--Evaluates behavioral healthcare organizations that provide mental health, chemical dependency, mental retardation/dev. disabilities, and other psychosocial services.
--Standards are published in Comprehensive Accreditation Manual for Behavioral Health Care (CAMBHD)
Joint Commission
Recommends using Evidence-based practice sources such as the Cochrance Review, National Patient Safety Goals, and other scientific research when developing quality measures.
The integration of best research evidence with clinical expertise and patient values and needs.
Evidence-Based Practice
Process of synthesizing, disseminating, and using research-generated knowledge to make a change in practice; a subset of the broader evidence-based practice.
Research Utilization
Research Utilization Process:
--Critique Research
--Synthesize the Findings
--Apply the Findings
--Measure the Outcomes
Develop the Clinical Question:
P = Patient, population of patients, problem
I = Intervention
C = Comparison (Another treatment or therapy, placebo)
O = Outcome.
--Search for relevant research evidence
--Critique the research evidence
--Make an evidence-based decision regarding implementation.
--Implement the change, depending on the above decision.
--Evaluate the change.
Internal Validity
When the Independent Variable (treatment) caused a change in the dependent variable (the outcome).
External Validity
When the sample is representative of the population, and the results can be generalized.
Descriptive Statistics
Describes the basic features of the data in the study; numerical values that summarize, organize, and describe observations; can be generated by either qualitative or quantitative studies.
--Mean: Average of scores
--Standard Deviation: Indication of the possible deviations from the mean.
--Variance: How the values are dispersed around the mean; the larger the variance, the larger the dispersion of scores.
Inferential Statistics:
Numerical values that enable one to reach conclusions that extend beyond the immediate data alone; generated by quantitative research designs.
--t test: Assesses whether the means of two groups are statistically different from each other.
--Analysis of variance (ANOVA): Tests the diference among three or more groups.
--Pearson's r correlation: Tests the relationship between two variables.
--Probability: Likelihood of an event occurring; lies between 0 and 1; an impossible event has a probability of 0, and a certain event has a probability of 1.
--p value: Also known as level of significance; describes the probability of a particular result occurring by chance alone (if p = .01, there is a 1% probabiity of obtaining a result by chance alone).
Research Ethics

Institutional Review Boards (IRB's)
--Ensures that risks to participants are minimized.
--Participant selection is equitable.
--Averse events are reported and risks/benefits are reevaluated.
--Informed consent is obtained and documented.
--Data and safety monitoring plans are implemented when indicated.
--Overall, the IRB protects the rights and welfare of human research participants and has the authority to approve, require modifications, or disapprove of any research activities.
--All investigators or persons involved in research must take and pass a test on protection of human participants--The Belmont Report
Critical Thinking
--Acquisition of knowledge with an attitude of deliberate inquiry.
--Making clinical decisions based on evidence-based practice
--Decreases the difficulty of choosing from conflicting or multiple recommendations when diagnosing and treating clients.