Mental Health

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Informs nurse and society of profession’s ethical expectations and requirements
Provides framework for ethical decision making

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Code of Ethics for Nurses

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Basic questions to ask

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1st What do I know about this patient situation? Essential step.
• What do I know about the patient’s values and moral preferences?
• What assumptions am I making that need more data to clarify?
• What are my own feelings (and values) about the situation, and how might they be influencing how I view and respond to this situation?
• Are my own values in conflict with those of the patient?
• What else do I need to know about this case, and where can I obtain this information?
• What can I never know about this case?
• Given my primary obligation to the patient, what should I do to be ethical?

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each person has the fundamental

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Autonomy

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(decision for your own path in life).

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right of self-determination

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the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential.

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Beneficence-

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is the duty to treat all fairly, distributing the risks and benefits equally

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Justice

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example of INJUSTICE-

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mental health limited access to health care)

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Duty to cause no harm, both individual and for all.

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Nonmaleficence:

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Belief that knowledge and education authorize professionals to make decisions for the good of the patient.

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Paternalism:

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an example of paternalism.

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Mandatory use of seat belts and motorcycle helmets

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The duty to tell the truth.

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Veracity:

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Faithfulness to obligations and duties
It is keeping promises.

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Fidelity:

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Fidelity is important in

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establishing trusting relationships.

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Assessment
Diagnosis
Outcome identification
Planning
Implementation
Evaluation

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Six components of
Standards of Practice

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Organized around the nursing process (ADPIE). Mental Health nurses adhering to the standards of practice use the

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nursing process as a foundation to engage in clinical decision making.

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Collection of comprehensive health data

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Assessment-

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Analyze data to identify relevant nursing diagnosis

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Diagnosis-

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Individualize outcomes to the patient

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Outcome identification-

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Plan with reasonable strategies and alternatives if they are needed.

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Planning-

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Sub-standards
Staff RN- Coordination, Health teaching and promotion, milieu therapy, Pharmacological, biological and integrative therapies, Advanced Practice- prescriptive authority, psychotherapy, and consultation

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Implementation-

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Evaluate progress.

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Evaluation-

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Focus- PATIENT

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Assessment
Diagnosis
Outcome identification
Planning
Implementation
Evaluation

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Quality of practice
Education
Professional practice evaluation
Collegiality
Collaboration
Ethics
Research
Resource utilization
Leadership

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Standards of Professional Performance

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Systematically enhances the quality and effectiveness of nursing practice.

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Standard 7 Quality of Practice-

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Attains knowledge and competency that reflect current nursing practice.

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Standard 8 Education-

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Evaluates one’s own practice in relation to the professional practice standards and guide-lines, relevant statures, rules, and regulations.

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Standard 9 Professional Practice Evaluation-

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Interacts with and contributes to the professional development of peers and colleagues.

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Standard 10 Collegiality-

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Collaborates with patients, family, and others in the conduct of nursing practice.

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Standard 11 Collaboration-

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Integrates ethical provisions in all areas of practice.

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Standard 12 Ethics-

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Integrates research findings into practice.

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Standard 13 Research-

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Considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services.

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Standard 14 Resource Utilization-

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Provides leadership in the professional practice setting and the profession.

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Standard 15 Leadership-

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Basic
Advanced practice

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Levels of Practice

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RN with baccalaureate education; credentialed by American Nurses Credentialing Center (ANCC)
Use of nursing process to treat actual or potential mental health problems or psychiatric disorders
Promote and foster health and safety
Assess dysfunction; assist to regain or improve coping abilities
Maximize strengths; prevent further disability

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Basic

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Master’s level preparation; nationally certified by the ANCC
Clinical nurse specialist
Nurse practitioner in psychiatric nursing
Doctorate in nursing science (DNS, DNSc)
Doctor of philosophy (PhD)
Doctorate of nursing practice (DNP) in psychiatric nursing

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Advanced:

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American Nurses Association (ANA)
American Psychiatric Nurses Association (APNA)
International Society of Psychiatric–Mental Health Nurses (ISPN)

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Psychiatric–Mental Health Nursing Organizations

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Supports through liaison activities

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American Nurses Association (ANA)

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Advances psychiatric–mental health nursing practice
Improves mental health care for culturally diverse individuals, families, groups, and communities
Shapes health policy for the delivery of mental health services

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American Psychiatric Nurses Association (APNA)

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Four specialist divisions
Purpose: unite and strengthen the presence and the voice of psychiatric–mental health nurses and promote quality care for individuals and families with mental health problems

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International Society of Psychiatric–Mental Health Nurses (ISPN)

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Biologic domain
Psychological domain
Social domain

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3 domains of The Biopsychosocial Model in Psychiatric–Mental Health Nursing

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The biopsychosocial model consists of three separate but interdependent domains:

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biologic, psychological, and social.

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Each domain has an

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independent knowledge and treatment focus

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Each domain can interact and be mutually interdependent with the other domains. T or F

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true

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, all biological activities, and functional health patterns (sleep, eat, rest, exercise)

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Biologic- biological and neuro-biological theories

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based in the psychological process of thoughts, feelings and behaviors that impact emotion, cognition, and behavior.

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Psychological-

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account for social forces- family and community- culture/ethnicity is included.

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Social –

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Exercise, sleep, adequate nutrition are examples of

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Biologic- biological and neuro-biological theories Domain

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Thought, feelings, and behavior are examples of

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Psychological Domain

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Self
Clinical reasoning and reflection
Interdisciplinary care
Plan of care

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Tools of Psychiatric Nursing Practice

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Most important tool- relationships matter!

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Self-

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uses of sound critical thinking and reflection- (self- evaluation)

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Clinical reasoning-

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working as a team, common approach in Mental Health Care.

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Interdisciplinary care-

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Step by step process of how their care will be approached. Patients do not always follow the script

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Plan of care-

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Knowledge development, dissemination, and application
Overcoming stigma
Health care delivery system challenges
Impact of technology and electronic health records

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Challenges of Psychiatric Nursing

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readily understood by all nurses to describe care, It provides a common means of communication.

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Standardized nursing language

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Psychoanalytic theories (see Table 7.1)
Two groups
Neo-Freudian models
Humanistic theories

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Psychodynamic Theories

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Sigmund Freud:

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psychoanalytic theory
Study of the unconscious
Personality development
Object relations and identification
Anxiety and defense mechanisms
Sexuality
Psychoanalysis
Transference and countertransference

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Id-
Ego-
Superego-

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Three parts of a persons personality- all formed in early childhood

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unconscious desires- sexual and aggressive tendency occur from here.

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Id-

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mental mechanisms- controls movements, perceptions, and reality- allows people to form relationships

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Ego-

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ethics, standards, and self- criticisms- influential people help form this in a child

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Superego-

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Object relations-
Anxiety-
Sexuality-
Psychoanalysis-

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Themes of their research

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psychological attachment to another person or object.

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Object relations-

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leads to defense mechanisms

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Anxiety-

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oral, anal, and genital zones all relate to stages of early childhood development

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Sexuality-

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therapeutic process for accessing the unconscious conflicts that originate in childhood

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Psychoanalysis-

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displacement of thoughts, feelings, and behaviors originally associated with significant others from childhood onto a person in a current therapeutic relationship.

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Transference-

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the direction of all of the therapist’s feelings and attitudes toward the patient.

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Countertransference-

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Neo-Freudian Models

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Alfred Adler: inferiority
Carl Jung: Introversion and extroversion
Karen Horney: situational neurosis/women
Otto Rank: birth trauma
Erich Fromm: relationship of society and individual
Melanie Klein: play therapy techniques
Harry Stack Sullivan: interpersonal forces

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individual psychology
Motivating force in life results from an intolerable sense of inferiority
Principles of mutual respect, choice, responsibility

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Alfred Adler:

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analytical psychology
Extroverted vs. introverted personalities

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Carl Jung:

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feminine psychology
Rejection of traditional psychoanalytic belief that women felt disadvantaged because of their genital organs
Women are at a disadvantage because of authoritarian culture

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Karen Horney:

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birth trauma

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Otto Rank:

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Erich Fromm: relationship of society and individual (inter-woven)

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Erich Fromm:

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play therapy techniques

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Melanie Klein:

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interpersonal forces
Importance of human relationships; instincts and drives are less important
Interpersonal relations as the basis for human development and behavior

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Harry Stack Sullivan:

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Carl Rogers: empathy and positive regard
Frederick S. (Fritz) Perls: Gestalt therapy
Abraham Maslow: hierarchy of needs

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Humanistic Theories

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empathy and positive regard
client-centered therapy
Empathy, unconditional positive regard (non-judgmental caring), genuineness, Highly important in developing rapport with mental health clients.

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Carl Rogers:

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Gestalt therapy
Anxiety resulting from inability to express natural biological and psychological desires; repression  anxiety
Focused on personal responsibility and how patients understand themselves in the context of their life experiences and surroundings.
Empty chair technique- patient pretends someone or even themselves is in the chair and they are talking to themselves (Clint Eastwood and Barack Obama).

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Frederick S. (Fritz) Perls:

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hierarchy of needs
Hierarchy of needs ranging from basic food, shelter, and warmth to a high-level requirement for self-actualization

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Abraham Maslow:

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Important concepts:
Interpersonal relationships
Defense mechanisms
Transference
Countertransference
Internal objects

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Applicability to Nursing: Psychodynamic Theories

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core of psychiatric–mental health nursing intervention

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A therapeutic interpersonal relationship:

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Stimulus–response theories (see Table 7.2)
Reinforcement theories
Cognitive theories

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Cognitive Behavioral Theories

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Pavlovian theory: classical conditioning, with training you can get a response (balloon- popping)
John B. Watson: behaviorism the more often (frequency) and more recently (recency) a stimuli is experienced, the more likely the person is to repeat it.

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Stimulus–response theories (see Table 7.2)

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Edward L. Thorndike: “stamping in” (reinforcement of positive behavior)
B.F. Skinner: Operant conditioning- conditioning from a focus on the consequences of a behavioral response, not stimuli.

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Reinforcement theories

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links internal thought process with human behavior.
Albert Bandura: social cognitive theory; self-efficacy (a person’s sense of his or her ability to be deal efficiently with the environment)
Aaron Beck: thinking and feeling; cognitions

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Cognitive theories-

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Widespread use of behavioral theories in practice
Patient education interventions
Changing an entrenched habit
Privilege systems and token economies

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Applicability to Nursing: Cognitive Behavioral Theories

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The cognitive theories attempt to

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link internal thought processes with behavior.

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Erik Erikson: psychosocial development
Jean Piaget: learning in children
Carol Gilligan: gender differentiation
Jean Baker Miller: sense of connection

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Developmental Theories

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Eight stages- Should know these from General Psych
Identity and adolescence- turbulent times for teens and may lead to conflict (self and society)

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Erik Erikson: psychosocial development

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cognition development evolves as they age and allows greater capcity to learn or seek new knowledge. Studied his own children. Not formally tested.

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Piaget: learning in children cognition

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gender influence who and how children develop relationships (parents first, others later).

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Carol Gilligan:

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sense of connection
Connections  mutual engagement, empathy, and empowerment

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Jean Baker Miller:

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Infant
Toddler
Pre-school
School-aged child
Adolescence
Young adult
Adulthood
Maturity

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Eight Ages of Man

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Basic Trust Vs. Mistrust

Driev and hope

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Infant

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Autonomy vs. shame and doubt

Self Control and willpower

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Toddler

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Initiative vs. guilt

Direction and purpose

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Preschool-aged child

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Industry vs.inferiority

Method and competence

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School-aged child

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Identity vs role diffusion

Devotion and fidelity

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Adolescence

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Intimacy vs. isolation

Affilitation and love

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Young adult

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Generativity vs stagnation

Production and care

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Adulthood

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Ego integrity vs. despair

Renunciation and wisdom

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Maturity

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Useful in understanding childhood and adolescent experiences and manifestations as adult problems
Applicability limited because of assumption of stages progressing in a linear fashion
Lack of accounting for gender differences and diverse lifestyles and cultures

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Applicability to Nursing: Developmental Theories

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Family dynamics: patterned interpersonal and social interactions; based on systems theory
Formal and informal social support; social distance
Role theories: emphasis on social interaction
Sociocultural perspectives:
Mead: culture and gender
Leininger: transcultural health care

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Social Theories

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are large organizations, such as hospitals and nursing homes that provide care to individuals.

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Formal support systems-

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are family, friends, and neighbors.
Individuals with strong informal support networks actually live longer than those without this type of support.

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Informal support systems-

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Emphasize the importance of social interaction in either the individual’s choice of a particular role or society’s recognition of it. Psychiatric–mental health nursing uses role concepts in understanding group interaction and the role of the patient in the family and community.

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Role theories-

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Goal is to discover culturally based healthcare

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Transcultural Healthcare-

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Important to consider the role of the individual within the family and society
Interventions based on understanding and significance of family and cultural norms
Design of inpatient unit’s social environment
Basis for many group interventions

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Applicability to Nursing: Social Theories

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Interpersonal Relations Model
Existential and Humanistic Theories
Systems Model

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Nursing Theories:

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Hildegarde Peplau: the power of empathy
Ida Jean Orlando: dynamic nurse–patient relationship

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Interpersonal Relations Model

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Rosemarie Rizzo Parse: theory of human becoming
Jean Watson: Transpersonal Caring

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Existential and Humanistic Theories

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Imogene King: theory of goal attainment
Betty Neuman: client system interacting with the environment
Dorothea Orem: self-care deficit nursing theory

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Systems Model

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model of unitary human beings

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Martha Rogers:

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adaptation model

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Calista Roy:

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theory of goal attainment
Personal, interpersonal, and social systems- focuses on relationship between the nurse and the patient through each system

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Imogene King:

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client system interacting with the environment
stressors impact on nursing

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Betty Neuman:

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self-care deficit nursing theory
Theory of self-care- activities performed by the client independently to maintain personal well being
Theory of self-care deficit- how people can be helped by nursing
Theory of nursing systems- series of actions a nurse takes to meet the patient’s self-care deficits

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Dorothea Orem:

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model of unitary human beings

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Martha Rogers:

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adaptation model

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Calista Roy:

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Useful in understanding childhood and adolescent experiences and manifestations as adult problems
Applicability limited because of assumption of stages progressing in a linear fashion
Lack of accounting for gender differences and diverse lifestyles and cultures

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Applicability to Nursing: Developmental Theories

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Family dynamics: patterned interpersonal and social interactions; based on systems theory
Formal and informal social support; social distance
Role theories: emphasis on social interaction
Sociocultural perspectives:
Mead: culture and gender
Leininger: transcultural health care

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Social Theories

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Hildegarde Peplau: the power of empathy
Ida Jean Orlando: dynamic nurse–patient relationship

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Interpersonal Relations Model

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Rosemarie Rizzo Parse: theory of human becoming
Jean Watson: Transpersonal Caring

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Existential and Humanistic Theories

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the power of empathy
Empathic linkage- the ability to feel in one’s self the feelings experienced by another person.
Self-system
Anxiety – Energy that arises with expectations are not met- if not addressed becomes panic.

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Hildegarde Peplau:

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Rosemarie Rizzo Parse: theory of humanbecoming- Themes: meaning, rhythmicity, transcendence
Jean Watson: Transpersonal Caring- caring is the foundation of nursing - Transpersonal caring-healing relations

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Existential and Humanistic Theories

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Cerebrum
Subcortical structures
Limbic system
Other CNS structures
Autonomic nervous system

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Neuroanatomy of the CNS

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Psychiatric–mental health nurses must be able to make the connection between

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Patients’ psychiatric symptoms
The probable alterations in brain functioning linked to those symptoms
The rationale for treatment and care practices.

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Working memory (Judgement, reasoning, critical thinking), personality, ; Includes areas: pre-central gyrus (damage causes spasticity) and Broca’s area (motor function of speech→ expressive aphasia)

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Frontal-

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largest part of brain (cortex- outer covering=gray matter- these ridges are known as “gyrus”),
Two halves- opposite sides of control, left- verbal, right- interpretation of experience (emotion, intonation, etc)

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Cerebrum

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Frontal
Parietal
Temporal
Occipital

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Lobes of the brain

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damage= sensory function impairment (discriminatory- not lack of sensory) object recognition, spatial relations, writing (function of writing), math ext.

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Parietal-

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auditory and olfactory areas, Wernicke’s area- receptive speech, visual information that aides in writing and written language skills, houses the hippocampus

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Temporal-

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visual integration of information (not a function of the eye organ)

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Occipital –

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Helps cortex integrate with each area.

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Association cortex-

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Subdivisions: putamen, globus pallidus, and caudate
Motor functions
Associations in both learning and programming behavior or activities that are repetitive and done become automatic

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Basal ganglia

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layers under the cortex that aide in emotions and behaviors.

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Subcortical structures (white matter)-

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Basal ganglia are in

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both hemispheres that serve to retain how to make repetitive movements.

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Hippocampus (see Figure 8.3)
Thalamus
Hypothalamus
Amygdala
Limbic midbrain nuclei

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Limbic System

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Sophisticated system of organs that work together to manage emotions and behavior. Linked strongly to psychiatric D/O

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Limbic system-

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stores the emotions that are attached to memories

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Hippocampus-

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switching station for sensory information from PNS (not smell)

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Thalamus-

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regulates sleep, appetite, body temperature, sex drive. Dysfunction from injury or disorder causes common sleep/appetite issues.

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Hypothalamus-

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sensory input for smell, primitive source of primal behaviors- sex and aggression. Focus of Bipolar mood d/o research.

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Amygdala-

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collection of neurons that play a role in addition. “pleasure center”

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Limbic Midbrain Nuclei-

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Muscle tone, common reflexes, and automatic voluntary motor functioning (e.g., walking) are controlled by this nerve track. Dysfunction of this motor track can produce hypertonicity in muscle groups. Parkinson’s disease has this area significantly affected. Area affected by many antipsychotic drugs.

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Extrapyramidal motor system-

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Contains secretory cells that emit the neurohormone melatonin and other substances (regulatory functions-endocrine system.) Information received from light–dark sources controls release of melatonin, which has been associated with sleep and emotional disorders.

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Pineal body-

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Very small, because of its wide-ranging neuronal connections throughout cortex- influence in the regulation of attention, time perception, sleep–rest cycles, arousal, learning, pain, and mood, involved with information processing of new, unexpected, and novel experiences. Dysfunction may explain why individuals become addicted to substances and seek out risky behaviors despite awareness of negative consequences

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Locus ceruleus-

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Mediating symptoms of emotional dysfunction. These nuclei are also the primary source of several neurochemicals, such as serotonin, that are commonly associated with psychiatric disorders.

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Brain stem-

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posture and balance. Information through out the PNS and CNS

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Cerebellum-

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Efferent or motor system (nerves moving away from CNS)
Afferent or sensory (nerves moving toward CNS; see Figure 8.4)
Sympathetic nervous system
Parasympathetic nervous system

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Neurons of ANS

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(nerves moving away from CNS)

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Efferent or motor system

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(nerves moving toward CNS; see Figure 8.4)

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Afferent or sensory

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mostly norepinephrine, quick response in the body, flight or fight reaction

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Sympathetic nervous system-

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mostly Acetylcholine , activities that occur at a slow pace (rest) digestions, defecations, and urination

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Parasympathetic nervous system-

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Ability of the brain to change
Compensates for loss of function in specific area
Nerve signals may be rerouted
Cells learn a new function
Nerve tissues may be regenerated

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Neuroplasticity

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Examples:
Gabby Gifford and Christopher Reeves- regain use of injured brain after time and supportive therapies.

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Neuroplasticity

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As people age there is a _______ .

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decrease in neuroplasticity.

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Decrease in neuroplasticity can be

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mitigated (to some extent) with cognitive exercises that engage the brain.

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receive, organize, and transmit information

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Neurons-

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For information to be transmitted (process is called- synaptic transmission) -

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the electrical charge to a neuron must be changed to a chemical communication (via chemical messenger or neurotransmitters) at the synaptic cleft.

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are the chemical messengers that are used as portals to the membrane to make it more receptive to the primary neurotransmitters (open and close the ion channels).

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Neuromodulators

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Directly or indirectly control opening or closing of ion channels
Excitatory or inhibitory
Types
Cholinergic
Biogenic amines
Amino acid
Neuropeptides

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Neurotransmitters

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reduce the membrane potential and enhance the transmission of the signal between neurons.

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Excitatory neurotransmitters:

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have the opposite effect and slow down nerve impulses.

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Inhibitory neurotransmitters-

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Acetylcholine (ACh)

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Excitatory neurotransmitter
Greatest concentration in the peripheral nervous system

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Excitatory neurotransmitter
Primary cholinergic neurotransmitter that is found in the greatest concentration in the PNS (peripheral nervous system)
Synaptic communication for the parasympathetic neurons and part of the sympathetic neurons, which send information to the CNS.
Aides in higher intellectual functioning and memory.
May contribute to their memory difficulties and other cognitive deficits.
Some role in communicating one’s emotional state to the cerebral cortex.

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Acetylcholine (ACh)

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Synthesized from tyrosine

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Dopamine (excitatory; cognition, motor and neuroendocrine functions; see Figure 8.9)
Norepinephrine

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Synthesized from tryptophan

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Serotonin (excitatory; emotions, cognition, sensory perceptions, and essential biologic functions, such as sleep and appetite;

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provides body the “feel good” emotion- related to addiction disorders

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Dopamine-

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1a. Mesocortical- cognition, including such functions as judgment, reasoning, insight, social conscience, motivation, the ability to generalize learning, and reward systems in the human brain.
1b. Mesolimbic- strongly influences emotions and has projections that affect memory and auditory reception.
Abnormalities in these pathways have been associated with schizophrenia.
2. Nigrostriatal pathway . This influences the extrapyramidal motor system, which serves the voluntary motor system and allows involuntary motor movements. Destruction associated with Parkinson’s disease.
3. Tuberoinfundibular pathway Impact on endocrine function and other functions, such as metabolism, hunger, thirst, sexual function, circadian rhythms, digestion, and temperature control.

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Dopamine-Three pathways:

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maintenance of mood, decreased amounts leads to depression, involved in sleep and wakefulness.
Because of its close relationship with the fight or flight reaction (resulting in increased sweating and gooseflesh), it is thought to play a part in chronic anxiety disorders

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Norepinephrineine-Excitatory-

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Histamine (derived from amino acid histadine)
Gamma-aminobutyric acid (GABA): inhibitory
Glutamate: excitatory

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Amino Acids

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(derived from amino acid histadine)→Hypothalmus→ when blocked sedation, weight gain, and hypotension

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Histamine

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inhibitory → CNS → general dysrhythmia= anxiety disorders, when low- development of seizure disorder.

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Gamma-aminobutyric acid (GABA):

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excitatory → Mainly in cortex→ excitotoxicity (over activity of the glutamate receptors) → chronic excitotoxicity- it will injury CNS and may cause dementias (including Alzheimer's),

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Glutamate:

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Opioid neuropeptides
Endorphins, enkephalins, and dynorphins (endocrine functioning and pain suppression)
Nonopioid neuropeptides

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Neuropeptides

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Endorphins, enkephalins, and dynorphins (endocrine functioning and pain suppression)

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Opioid neuropeptides

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Substance P and somatostatin (pain transmission and endocrine functioning)
Found throughout the CNS, but not in the thalamus

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Nonopioid neuropeptides

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Receptors with capacity to change
Changes in sensitivity of receptors most commonly caused by:
The effect of a drug on a receptor site
Disease that affects the normal functioning of a receptor site

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Receptor sensitivity

Front 181

the electrical-chemical action occurs and allows the function of that receptor.
Same neurotransmitter, many different receptors.

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As receptors capture the neurotransmitter

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• Family studies analyze the occurrence of a disorder in first-degree relatives (biologic parents, siblings, and children), second-degree relatives (grandparents, uncles, aunts, nieces, nephews, and grandchildren), and so on.
• Twin studies analyze the presence or absence of the disorder in pairs of twins. The concordance rate is the measure of similarity of occurrence in individuals with a similar genetic makeup.
• Adoption studies compare the risk for the illness developing in offspring raised in different environments. The strongest inferences may be drawn from studies that involve children separated from their parents at birth.
Molecular genetics: genetic contribution to development of psychiatric disorders
Genetic susceptibility
Identification of increased risk for psychiatric disorders- genetic risk does not make it happen (think about Breast Cancer)

There is some contribution in genetics with mental illness, causality has NOT been identified.

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Population genetics - following principle epidemiologic methods:

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Psychoneuroimmunology (PNI)
Chronobiology

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Emerging Fields of Study

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Examines the relationships among the immune system, nervous system, and endocrine system and our behaviors, thoughts, and feelings

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Psychoneuroimmunology (PNI)

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Study and measure of time structures or biologic rhythms
Zeitgebers such as light

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Chronobiology

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Diagnostic Approaches: Biologic Markers

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Laboratory tests and neurophysiologic procedures
Electrophysiologic tests: EEG, polysomnography
Structural and functional imaging: MRI, fMRI, PET
Other neurophysiologic methods

Front 187

Levels of neurotransmitters and other CNS substances in the bloodstream
Challenge tests

Back 187

Laboratory tests and neurophysiologic procedures

Front 188

Evoked potentials (EPs)
Brain electrical activity mapping (BEAM) studies

Back 188

Other neurophysiologic methods

Front 189

are diagnostic test findings that occur only in the presence of the psychiatric disorder. Mental health nurses need to be aware of the current trend in tests.

Back 189

Biologic markers

Front 190

are used to rule out medical diagnosis, which may be a step in the actual diagnosis of a mental illness.

Back 190

Labs tests

Front 191

EEG, polysomnography- most abnormalities appear during sleep.

Back 191

Electrophysiologic tests:

Front 192

Withholding phase- nurse is not supportive
Avoiding and ignoring phase- nurse and client avoid each other.
Struggling and making sense of phase- patient is feeling hopeless, and hope is the essential factor for healing.

Back 192

Deteriorating relationship

Front 193

nurse is not supportive

Back 193

Withholding phase-

Front 194

nurse and client avoid each other.

Back 194

Avoiding and ignoring phase-

Front 195

patient is feeling hopeless, and hope is the essential factor for healing.

Back 195

Struggling and making sense of phase-

Front 196

Providing 8 ounces of water every two hours would be a ,

Back 196

Biologic domain

Front 197

where offer grief support would be in a .

Back 197

psychological domain, unless you involved family and then it would be psychological and social

Front 198

State the purpose
Use open-ended questions to allow observation of patient’s verbal and nonverbal responses
Use closed-ended questions to elicit specific information
Clarify when words do not have the same meaning
Summarize to allow the patient to correct the nurse’s interpretation

Back 198

Patient Interviews

Front 199

Current and past health status
Most recent medical evaluation
Past hospitalizations and surgical operations
Cardiac problems
Respiratory problems
Neurologic problems
Endocrine disorders
Immune disorders
Use, exposure, abuse, or dependence on substances

Back 199

Assessment: Biologic Domain

Front 200

Physical examination
Body systems review
Neurologic status
Laboratory results (see Table 10.1)
Pharmacologic assessment
Physical functions
Elimination
Activity and exercise
Sleep
Appetite and nutrition
Hydration
Sexuality
Self-care

Back 200

Assessment: Biologic Domain

Front 201

Identify meaning of life changes to the patient and family members
Identify current strategies or behaviors in dealing with the disorder

Back 201

Responses to mental health problems

Front 202

Responses to mental health problems
Mental status examination (see Box 10.4)
Behavior
Self-concept
Stress and coping patterns
Risk assessment

Back 202

Assessment: Psychological Domain

Front 203

Body image
Self-esteem
Personal identity

Back 203

Self-concept

Front 204

Suicidal ideation
Assaultive or homicidal ideation

Back 204

Risk assessment

Front 205

General observations
Orientation
Mood and affect
Speech
Thought processes
Cognition and intellectual performance
Attention and concentration
Abstract reasoning and comprehension
Memory: recall, short term, recent, and remote
Insight and judgment

Back 205

Mental Status Examination (MSE)

Front 206

Have you ever tried to harm or kill yourself?
Do you have thoughts of suicide at this time? If yes, do you have a plan? If yes, can you tell me the details of the plan?
Do you have the means to carry out this plan? (If the plan requires a weapon, does the patient have it available?)
Have you made preparations for your death (e.g., writing a note to loved ones, putting finances in order, giving away possessions)?
Has a significant episode in your life caused you to think this way (e.g., recent loss of spouse or job)?

Back 206

Risk Assessment: Suicidal Ideation

Front 207

Do you intend to harm someone? If yes, who?
Do you have a plan? If yes, what are the details of the plan?
Do you have the means to carry out the plan? (If the plan requires a weapon, is it readily available?)

Back 207

Risk Assessment: Assaultive or Homicidal Ideation

Front 208

Functional status
Social systems
Family assessment
Cultural assessment
Community support and resources
Spiritual assessment
Occupational status
Economic status
Legal status
Quality of life

Back 208

Assessment: Social Domain

Front 209

Mutually agreed-upon goals
Measurement of outcomes
Demonstrates clinical effectiveness
Promotes rational clinical decision making
Reflects nursing interventions

Back 209

Plan for Patient Outcomes

Front 210

Nursing actions or treatments
Direct or indirect
Nursing interventions systems
Nursing Interventions Classification (NIC)
Clinical Care Classification system
Omaha nursing model

Back 210

Nursing Interventions

Front 211

Promotion of self-care activities
Activity and exercise interventions
Sleep interventions
Nutrition interventions
Relaxation interventions
Hydration interventions
Thermoregulation interventions
Pain management
Medication management

Back 211

Nursing Interventions: Biologic Domain

Front 212

Simple relaxation
Distraction- focused of attention away from s/s
Guided Imagery- use of pleasant imagination to relax (good for anxiety and stress management

Back 212

Relaxation interventions

Front 213

Counseling interventions
Conflict resolution and cultural brokering
Bibliotherapy and Webotherapy
Reminiscence (see Box 10.7)
Behavior therapy
Behavior modification
Token economy
Psychoeducation
Health teaching (see Figure 10.3)
Spiritual interventions

Back 213

Nursing Interventions: Psychologic Domain

Front 214

short term focus on coping and promotion of positive behaviors (communication and interactions)

Back 214

Counseling-

Front 215

: the reading of selected written materials to express feelings or gain insight under the guidance of a health care provider.
Webotherapy has the same function, just uses the WWW for information. Use cautiously- junk science out there.

Back 215

Bibliotherapy

Front 216

The thinking about or relating of past experiences
Encourages client to discuss their past and review their lives, identify past coping strategies that can support them in current stressful situations, maintain self-esteem, stimulate thinking, and support the natural healing process of life review.

Back 216

Reminiscence:

Front 217

- Reinforce desired behaviors (with positive incentives) and extinguish undesired ones.

Back 217

Behavior modification

Front 218

patients are rewarded with tokens for selected desired behaviors. (common in child and adolescence)

Back 218

Token economy-

Front 219

- Educational strategies to teach patients the skills they lack because of a psychiatric disorder.
Goal- Change in knowledge and behavior

Back 219

Psychoeducation

Front 220

Spiritual interventions- Assisting patients to feel balance and connection within their relationships, involves listening to expressions of loneliness, using empathy, and providing patients with desired spiritual articles.

Back 220

Spiritual interventions-

Front 221

Social behavior and privilege systems
Milieu therapy
Containment
Validation
Structured interaction
Open communication
Promotion of patient safety
Observation
De-escalation
Seclusion
Restraints
Home visits
Community action

Back 221

Nursing Interventions: Social Domain

Front 222

provides a stable and coherent social organization to facilitate an individual’s treatment.

Back 222

Milieu therapy (therapeutic environment )

Front 223

Process of providing safety and security and involves the patient’s access to food and shelter.

Back 223

Containment-

Front 224

The process reaffirming the patient’s humanity and human rights, interactions reflect respect and kindness

Back 224

Validation-

Front 225

Purposeful interaction that allows patients to interact with others in a useful way.

Back 225

Structured interaction-

Front 226

: Staff and patient willingly share information. Tenant of therapeutic relationship.

Back 226

Open communication

Front 227

Patient observation- The ongoing assessment of the patient’s mental status to identify and subvert any potential problem
De-escalation-
Seclusion
Restraint-

Back 227

Safety Interventions

Front 228

Interactive process of calming and redirecting a patient who has an immediate potential for violence directed toward self or others.

Back 228

De-escalation-

Front 229

is the involuntary confinement of a person in a room or an area where the person is physically prevented from leaving

Back 229

Seclusion

Front 230

Any manual method, physical or mechanical, that immobilizes or reduces the ability of the patient to move.

Back 230

Restraint-

Front 231

Cost effectiveness of the intervention
Patient benefits
Patient’s level of satisfaction
Outcome diagnosis specific or nonspecific

Back 231

Evaluating Outcomes

Front 232

Important: When determining the efficacy of the intervention you need to evaluate objective and subjective data. The patient’s perspective is important in measuring the results.

Back 232

Evaluating Outcomes