Mhtest1

Front 1

____ determines what is “right” or “good” within a society.

Back 1

Legislation

Front 2

Many of the state laws revised after this Act
After this, the funding was cut off
Promoted de-institutionalization
Positive and negative outcomes:
Negative: homelessness, mass shootings
Positive: less abuse, pt become part of society

Back 2

Community MH Centers Act (1963) - JFK

Front 3

: moving people out of state hospital into community

Back 3

Promoted de-institutionalization

Front 4

(JFK’s sister had____. She had a lobotomy, JFK decided institutions were wrong

Back 4

down syndrome

Front 5

At times it is necessary to ____ rights for the protection of patients or of others and for therapeutic purposes.

Back 5

suspend

Front 6

Suspension of a patient’s rights requires the nurse to clearly document _____

Ie: take away phone privilege (for threatening, 911, causing others distress)
However, you cant assume things (ie: flight risk is not adequate reason)

Back 6

reasons to withdraw these rights

Front 7

Persons with mental illness _____ the same rights under federal and state laws as any other citizen

Back 7

are guaranteed

Front 8

Patient Rights: Right to Treatment
Treatment must include:4

Back 8

A humane environment
Qualified staff
Sufficient staff
Individualized care plan

Front 9

Patient Rights: Right to_____

Patients may withhold consent or withdraw consent at any time
This is true of voluntary or involuntary committed to treatment

However if the pt refuses, they may not be allowed to leave
Cannot force medication until there is a court hearing about it

Back 9

Refuse Treatment

Front 10

Patient Rights: Right to _____

For consent to be effective legally, it must be informed
Informed consent is situated on the patient’s competence
Pt must be competent

Back 10

Informed Consent

Front 11

: the capacity to understand the consequences of one’s decisions

Back 11

Competence

Front 12

Patient Rights: _____
Seclusion: The involuntary confinement of a patient alone in a room, or area from which the patient is physically prevented from leaving
Restraint: Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely

Back 12

Seclusion and Restraints

Front 13

: The involuntary confinement of a patient alone in a room, or area from which the patient is physically prevented from leaving

Back 13

Seclusion

Front 14

: Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely

Back 14

Restraint

Front 15

Use of Seclusion and Restraints
Legally, behavioral restraint and seclusion are authorized as an intervention:

5

Back 15

When particular behavior is physically harmful to the patient or a third party
When disruptive behavior presents a danger to the facility
When alternative or less restrictive means are insufficient in protecting the patient or others from harm
When a decrease in sensory over-stimulation is needed
When the patient anticipates that a controlled environment would be helpful and requests seclusion

Front 16

Contraindications to Seclusion and Restraints

5

Back 16

Extremely unstable medical and psychiatric conditions
Delirium or dementia leading to inability to tolerate decreased stimulation
Severe suicidal tendencies
Severe drug reactions or overdoses or need for close monitoring of drug overdoses
Desire for punishment of patient or convenience of staff

Front 17

: It is the duty of the nurse to protect confidential patient information.

Back 17

ANA Code of Ethics (2001)

Front 18

Seclusion and restraints have been marked by __2__. This country has been working to move away from this. It is monitored by the Joint Commission.

Back 18

overuse and abuse

Front 19

____ is a good idea, it helps the pt to find their own parameter and triggers.
Could be misused to avoid

Back 19

Voluntary seclusion

Front 20

One should consider if there is a _____2____ before applying any restraints.

Back 20

less restrictive setting and less restrictive alternative

Front 21

Legally, behavioral restraint and seclusion are authorized as an intervention:
______ can do this and make this determination (physician will later write order)

Back 21

Nurses

Front 22

____ is the most liberal, least restrictive method of observation
Nurses have the ability to initiate ^ this into practice

Back 22

Therapeutic observation (TO)

Front 23

____ CANNOT decrease level of observation (only physician can do this)

Back 23

Nurses

Front 24

____ is the level of observation that is constantly being watched

Back 24

Constant observation

Front 25

The highest level of observation is _____

Back 25

special constant/ suicide constant observation (SCO)

Front 26

special constant/ suicide constant observation (SCO)

Back 26

This is within arms-length and is only for pt for very untrustworthy (acutely ill) pts

Front 27

Chemical Restraints are never ____, though the physician can prescribe it PRN for each pt

Back 27

a standing order

Front 28

exceptions to Confidentiality → These are mandated to be reported

4

Back 28

Harm to self
Harm to others
Elder abuse
Child abuse

Front 29

exception to confidentiality

The healthcare provider has an obligation to warn identified individuals if a client has made a credible threat to harm them

Must communicate this information to other professionals
Must take steps to protect the potential recipient(s) of harm

Back 29

Duty to Warn

Front 30

Tarasoff was going to kill a teacher. Admitted it before to psychologist.
Now this has become a requirement to warn individual of threats (must be credible)

Back 30

Tarasoff vs. Regents of University of CA, 1974

Front 31

“_____ ends where the public peril begins”

Back 31

Protective privilege

Front 32

May carry criminal penalties

Punitive damages may be awarded

Not covered by malpractice insurance

Voluntary acts intended to bring a physical or mental consequence

Purposeful acts

Recklessness

Not obtaining patient consent

Back 32

Intentional torts

Front 33

__2__ may serve as a defense to charges of an intentional tort.

Back 33

Self-defense or protection of others

Front 34

Carelessness

Foreseeability of harm

Back 34

Negligence/malpractice

Front 35

Person apprehensive (____) of harmful/offensive touching (____)

Threat to use force (words alone are not enough) with opportunity and ability

Treatment without patient’s consent

Back 35

assault

battery

Front 36

Intent to confine to a specific area

Indefensible use of seclusion or restraints

Detention of voluntarily admitted patient, with no agency or legal policies to support detaining

Back 36

False imprisonment

Front 37

____are unintended acts against another person that produce injury or harm.

ie: negligence, failure to warn

Back 37

Unintentional torts

Front 38

3 steps

The proper procedure for dealing with escalated (especially dangerous) behavior is to:

Back 38

Attempt to calm patient verbally

Offer pharmacologic (PRN) intervention

Seclude or restrain patient if other options have been unsuccessful, or the patient is acting in a dangerous manner
Get some help before doing this
Can jump right to this if there is a risk to self or others

Front 39

Involuntary commitments – has to show harm yourself or someone else to accomplish this

4

Back 39

Emergency commitments –
The mentally ill person in need of treatment
Involuntary outpatient commitment
The gravely disabled client

Front 40

avoiding liability8

Back 40

Respond to the client
Educate the client
Comply with the standard of care
Supervise care
Adhere to the nursing process
Document carefully
Follow up as required
Develop and maintain a good interpersonal relationship with client and family

Front 41

Milieu characteristics conducive to violence:
5

Back 41

Overcrowding
Staff inexperience
Provocative or controlling staff
Poor limit setting: must be comfortable setting limits
Arbitrary revocation of privileges

Front 42

De-Escalation Principles

Back 42

Maintain patient’s self-esteem and dignity
Maintain calm
Assess the patient and the situation
Identify stressors and stress indicators
Respond as early as possible
Calm, clear tone of voice
Invest time
Remain honest
Establish the patient’s need
Maintain a large personal space
Avoid verbal struggles
Give several options
Attempt to be confidently aware
Assess for personal safety

Front 43

Feelings that May Precipitate Anger

Back 43

Discounted
Embarrassed
Frightened
Found Out
Guilty
Humiliated
Hurt
Ignored
Inadequate
Insecure
Unheard
Out of control of the situation
Rejected
Threatened
Tired
Vulnerable

Front 44

Signs and symptoms that usually (but not always) precede violence:

• ____: most important predictor of imminent violence (e.g., pacing, restlessness)

• _____: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self (patient may have shortness of breath, sweating, and rapid pulse)

• ______: profanity, argumentativeness

• Loud voice, change of pitch; or very soft voice, forcing others to strain to hear

• Intense eye contact or avoidance of eye contact

Back 44

Hyperactivity

Increasing anxiety and tension

Verbal abuse

Front 45

The right to vote

• The right to civil service ranking

• The right to receive, forfeit, or deny a driver’s license

• The right to make purchases and enter contractual relationships (unless the patient has lost legal capacity by being adjudicated incompetent)

• The right to press charges against another person

• The right to humane care and treatment (medical, dental, and psychiatric needs must be met in accordance with the prevailing standards of these professions)

• The right to religious freedom and practice

• The right to social interaction

• The right to exercise and participate in recreational opportunities

Back 45

Rights of those with mental illness

Front 46

_____ is the termination of a patient-institution relationship. This release may be court-ordered or administratively ordered by the institution’s officials. Generally, the administrative officer of an institution has the discretion to discharge patients.

Back 46

Unconditional release

Front 47

_____ usually requires outpatient treatment for a specified period to determine the patient’s adherence with medication protocols, ability to meet basic needs, and ability to reintegrate into the community. Generally, a voluntarily admitted patient who is conditionally released can only be involuntarily admitted through the usual methods described above; however, an involuntarily admitted patient who is conditionally released may be reinstitutionalized, although the commitment is still in effect without recommencement of formal admission procedures.

Back 47

Conditional release

Front 48

Does commitment mean that a person will be forced to take medication?

Back 48

No, people who have been committed retain their right to refuse treatment.

Front 49

Under what circumstances can someone be medicated against his or her will?

Back 49

In an emergency to prevent a person from causing serious and imminent harm to self or others, a person may be medicated without a court hearing.

Front 50

is the capacity to understand the consequences of one’s decisions.

Back 50

Competency