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230 Cards in this Set
- Front
- Back
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Identify 5 signs of mental health
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1. Happiness
2. Control over behavior 3. Effectiveness at work 4. Healthy self-concept 5. Perception of reality |
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Describe the continuum of mental health and mental illness.
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People can experience a temporary mental health issue and still be healthy, However when problems persist can cause impairment in work and social life this can indicate mental illness
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Summarize the factors that can affect the severity and progression of a mental illness.
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ability to adapt to stress- resilience, degree of stressors (how many, how severe), support system- is one available- makes it easier to cope, genetic & biological influences, spiritual influences- spiritual connections make coping easier
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Compare and contrast the parts of the DSM-IV-TR multiaxial system
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Axis 1- current psych FOC, Axis 2- long term (ongoing) mental dists, Axis 3- phys med conds, Axis 4- psychosocial and environ stress, Axis 5- Assess of overall functioning
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APRN – psychiatric mental health
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Advanced practice RN, in the psych and mental health department, can prescribe meds, lead psychotherapy, and consultation
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RN – psychiatric mental health
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Basic Level:
Coordinator of care Health teaching Milieu therapy Medication therapies |
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DSM-IV-TR
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"The Bible" contains a list of all the accepted psychiatric diagnoses
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Diathesis-stress model
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most psychiatric disorders result from a combination of genetic vulnerability and environmental stressors. If there is an underlying genetic vulnerability environmental stressors can turn the disease "on"
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APNA
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Psychiatric mental health nurses use the purposeful use of self as its art and a wide range of theories and research evidence as its science.
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Psychiatric diagnoses are more ____ than medical diagnoses. Psychiatry uses a list of 5 areas to make a complete diagnosis. This is called the ___ ____
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global
Axis System |
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Axis I
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Current focus of psychiatric care. This is the main priority.
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Axis II
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Long-term mental disturbances ie. mental retardation or personality disorders.
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Axis III
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Medical conditions ie. diabetes or hypertension.
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Axis IV
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Psychosocial and environmental stress.
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Axis V
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Assessment of overall functioning. Sometimes both the current and the past year are listed to indicate the amount of change the current illness has caused
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Nursing diagnoses differ from ______ diagnoses
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psychiatric
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Nursing diagnoses are
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statements about an actual or potential problem based on the patient’s response to illness or stressors. They focus on functioning rather than on naming a disease.
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Which part of the axis system is essential to know for your daily FOC?
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Axis I because it represents the current focus of psychiatric care. This is the main priority.
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2What do you think are the advantages of having the multiaxial system?
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The person as a whole is addressed and each aspect of that person can be evaluated. It is less general/global and more specific.
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LCU
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Life Change Units - ways to quantify stress - part of Axis IV
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GAF
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Global Assessment of Functioning- a scale that uses numerical values to determine level of functioning. Part of Axis V
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Elopement
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Patient leaving unit- AWOL
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Mental health parity
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recognition by health insurance companies that mental illnesses are as debilitating and in need of proper treatment as physical illnesses
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Occupational therapist
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health professionals that use treatments to develop, recover, or maintain the daily living and work skills of their patients
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Recreational therapist
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uses treatment, education and recreation services to help people with illnesses, disabilities and other conditions to develop and use their leisure in ways that enhance their health, functional abilities, independence and quality of life."
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Psychosocial rehabilitation
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The development of the skills necessary for a person with chronic mental illnesses to live independently
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Managed behavioral health care
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managed care plans that developed separately from medical services to provide mental health and substance abuse programs
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Multidisciplinary treatment plan
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A plan developed with input from a diverse group of heath care professionals
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Psychiatric case management
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A program that coordinates services for individual patient care
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Social worker
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Social workers in the area of mental health may assess, treat, develop treatment plans, provide case management and/or rights advocacy to individuals with mental health problems.
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Milieu
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The physical and social ENVIRONMENT of an individual
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Explain how the mental health team collaborates to plan and implement care for the hospitalized patient.
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The medical Drs, Psychiatric Drs, nurses, Social workers, etc. all work together in establishing and carrying out individual treatment plans for patients. Multidisciplinary care needs much communication
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Compare and contrast the role of the psychiatric nurse with the other members of the team.
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The nurse cannot make medical dx as the dr. can, she instead makes nsg dx, the nurse focuses on the care and symptoms of the patient rather than the treatment of the disease. The social worker works with planning for the pts environment outside of the hospital and the nurse works with the environment inside the hospital
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Explain the most common criteria for admission for psychiatric care.
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Common criteria= DTS/SI, DTO/HI, GD,
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first drug that actually treated mental illness introduced
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1950’s- Thorazine
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How was Thorazine first used?
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Surgeon experimented with it to decrease the amount of anesthesia needed for surgery. Patients were very calm...might have a use in psychiatry
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Thorazine brought to America as what kind of drug?
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anti-emetic drug
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1963 Federal Community Mental Health Centers Act
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mandated that mental health patients be treated in their community- led to Community Based Care
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5 ways pt safety is ensured?
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1. measures to prevent Elopement
2. “Head checks” q 15 min 3. Contraband monitored for (visitors) 4. Sexual activity not allowed (cannot ensure it is consentual) 5. Aggression is monitored for |
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Nursing responsibilities in the Mental Health unit?
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Milieu mgmt,
Group activities Documentation Medication therapy – assess for effectiveness Crisis management – codes Prepare patient for discharge. |
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What populations have a hard time with getting coverage for mental health?
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homeless
self employed illegal citizens people that do not qualify for medical and cannot afford their own HC ins |
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Assault
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An intentional threat designed to make the victim fearful; produces reasonable apprehension of harm
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Battery
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The harmful of offensive touching of another person
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Fidelity
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doing no wrong to the patient
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Involuntary commitment
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Admission to a psychiatric facility without the patient's consent
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Justice
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duty to distribute resources/care equally
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Veracity
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duty to communicate truthfully.
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Duty to protect
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Ethical and legal obligations of health care workers to protect patients from physically harming themselves or others
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Malpractice
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An act or omission to act that breaches the duty of care and results in or is responsible for a person's injuries
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Beneficence
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duty to promote the good of others
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Least restrictive alternate doctrine
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Mandates that the least restrictive and least disruptive means be used to achieve a specific purpose
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Writ of Habeas Corpus
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A "formal written order" to "free the person"
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Duty to warn
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An obligation that may result in the beach of confidentiality on the part of the health care worker to warn third parties when they may be in danger from a patient
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Reise
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Sued for being forced to take meds wile in hospital. Led to pts right not to take meds (unless emergency) and pts must sign a consent form
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When the court orders a patient to take medication, common terminology is that the patient has been _____
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"Riesed"
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Tarasoff
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1974 = therapist has the duty to warn potential victims
1976 = therapist has a duty to both warn and protect potential victims – |
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Describe at least 5 client rights that relate to the mental health client’s bill of rights.
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1. Right to refuse treatment and need informed consent
2. ...communicate within and w/ outside world 3. ... freedom from harm 4. ...Dignity and respect 5. ...confidentiality/privacy |
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Autonomy
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respecting the rights of others
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Lanterman-Petris-Short Act of 1968 landmark legislation in California...
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defines the conditions under which a person may be ADMITTED INVOLUNTARILY to a mental health hospital.
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DTS
DTO GD |
Danger to Self (SI- suicidal ideations)
Danger to others (HI- homicidal ideations) GD- Gravely disabled |
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5150
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72 hr hold
DTS, DTO, and/or GD |
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5250
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14 day hold
continued DTS, DTO, or GD after initial 72 hour hold |
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What is required after client is put on a 14 day hold?
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A Probable Cause (PC) hearing is required within 7 days of INITIAL confinement.
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5260
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A second 14 day hold
continued DTS 2 affidavits stating the need |
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What is the requirement for the second 14 day hold?
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continued DTS (SI)
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30 day hold
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GD after first 14 day hold
PC hearing w/in 4 days |
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5300
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180 day hold
still DTO after first 14 day hold Rarely done, need D.A. involved |
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LPS Conservatorship
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This establishes a conservator, guardian, for an adult client who evidences grave disability.
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How long does an LPS Conservatorship last for?
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1 year
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When must an LPS Conservatorship be initiated?
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can only be initiated during a 14 day or a second 14 day hold. It cannot be started during a 30 day hold.
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Generally clients on conservatorship are placed in...
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long term locked facilities.
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When a person is deemed a DTO, DTS, and/or GD as a result of a mental disorder, they may be ...
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involuntarily admitted to a hospital for observation and evaluation for a 72 hour period
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If the client continues to be a DTO, DTS, and/or GD after the initial 72 hour hold, they may placed...
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On a 14 day hold, A Probable Cause (PC) hearing is required within 7 days of initial confinement.
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If a client continues to be a danger to ___ after the first 14 day hold, he/she may be placed on...
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self (suicidal)
a second 14 day hold for further treatment. No PC hearing required |
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If the person remains ________ after the first 14 day hold, they may be placed on a 30 day hold
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gravely disabled
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A PC hearing must be held within __ days of being placed on the 30 day hold.
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4 days
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PC hearings: Clients are informed at the time of the first hold that their case will automatically be reviewed within __ days of admission or within __ days of the first 14 day hold.
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7
4 |
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At a PC hearing, The client is represented by a ____ _____
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patient’s advocate.
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Can a client can waive his/her right to a PC hearing?
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Yes
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If the client is dissatisfied with the PC process, he/she may bypass it and request a...
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Writ of Habeas Corpus.
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Once a writ has been requested, the client must be given a court date within...
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2 working court days.
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In case of a 14 day hold, who must call and notify the court to arrange for PC hearing?
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The nurse
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Outcome of Reise case?
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Cannot force pts to take meds and informed consent
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Outcome of Tarasoff case?
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Duty to warn and Duty to protect
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Restraints
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generally the goal is the least restrictive environment to protect the client and others.
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What should be used first before restraints or seclusion?
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Always attempt verbal and then chemical interventions first.
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Restraints require...
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physician orders in a specified time and for a specified amount of time
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What must be documented in the case of restraints and/or seclusion?
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Every detail of event, attempts by staff, meds, etc. EVERYTHING
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What must be charted when client in restraints?
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chart q 15min and meet needs for comfort measures, ROM, nutrition, elimination, etc.
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How must a pt in restraints be monitored?
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By a staff member nearby- not on camera/monitor
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Reasons for restraints (5)?
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1. Behavior may harm self or other
2. Danger to the facility 3. Decrease in sensory stimulation is needed 4. When the client requests it 5. Never as a form of punishment or for staff convenience |
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Abstract thinking
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The ability to conceptualize ideas ie. finding meaning in proverbs
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Affect
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The external manifestation of feeling or emotion which is manifested in facial expression, tone of voice, and body language
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Blunted affect
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severe reduction in the intensity of affect
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Broad affect
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normal range of affect
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Circumstantial thinking/speech
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A pattern of speech characterized by indirectness and delay before the parson gets to the point or answers a question; the person gets caught ip in countless details and explanations
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Concrete thinking
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Thinking grounded in immediate experience rather than abstraction. There is an overemphasis on specific detail as opposed to general and abstract concepts
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Delusions
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A false belief held to be true even with evidence to the contrary
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Flat affect
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the absence or near absence of emotional response to a situation that normally elicits emotion.
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Flight of ideas
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Continuous flow of speech, person jumps rapidly from one topic to another. Sometimes necessary to listen for themes in the incessant talking.
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Hallucinations
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A false sense of perception (auditory, visual, etc.)
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Ideas of reference
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The false impression that outside events have special meaning for oneself
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Tangential thinking
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Someone gets off track onto other topics and never gets back to the original point.
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Thought broadcasting
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the feeling that one's thoughts are being broadcast to the environment.
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Thought insertion
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the delusion that thoughts that are not one's own are being inserted into one's mind.
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Thought withdrawal
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the delusion that someone or something is removing thoughts from one's mind.
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Word salad
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A mixture of words meaningless to the listener and to the speaker as well
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MSE
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Mental Status Examination- a formal assessment of cognitive functions such as intelligence, thought processes, and capacity for insight
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What type of charting is used for the MSE?
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narrative charting
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psychomotor retardation
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extreme slowness of and difficulty in movements that in the extreme can entail complete inactivity
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tremulous
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Marked by trembling, quivering, or shaking.
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What is psychomotor retardation a sign of?
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neuro damage
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poverty of content
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Speech that lacks meaning, or where speech quantity is far greater than necessary for the message conveyed.
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Poverty of speech
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brief and empty replies to questions
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Speech Quantity
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normal, voluminous, poverty of content/speech
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Speech quality
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clear, pressured, slurred
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Speech Rate
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slow, normal, rapid
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Voluminous speech
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"talky talky talky!"
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Labile
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Characterized by rapid shifts in mood which may be as dramatic as laughing one minute and crying the next; unstable
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FOI
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Part of patients thought process- Flight of Ideas- there are threads that connect their thoughts or ideas... but very minimal connections.
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LOA
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Looseness of Association- part of pts thought process- phrases not connected to one another, disorganized.
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Example of LOA
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"Mary went swimming. I like turkey."
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Example of FOI
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I like the color blue. Do you ever feel blue? Feeling can change from say to day. The days are getting longer."
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Blocking
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sudden obstruction/interruption in the flow of thinking or speaking- it is perceived as an absence or deprivation of thought. Part of pts thought process.
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tangentiality
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pattern of speech characterized by oblique, digressive, or irrelevant replies to questions; the responses never approach the point of the questions.
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circumstantiality
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pattern of speech characterized by delay in getting to the point due to interpolation of unnecessary details and irrelevant remarks. Eventually may get to the point.
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Concrete thinking
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Thought process that is grounded in immediate experience rather than abstraction. Over emphasis on specific detail rather than abstract or general concepts.
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What is the "normal" person's thought process?
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Relevant and logical
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Example of concrete thinking?
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How did you come to be in the hospital? I came in a car.
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The client being assessed is illiterate. What areas of assessment will be affected and/or inaccurate?
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The patients fund of knowledge and understanding of proverbs may be affected.
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Congruence
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consistency between a patient's symptoms and their mood or mental disorder
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Countertransference
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helping professional responds emotionally to patient as if patient were significant other
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Orientation phase
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The phase of the nurse-pt relationship in which the nurse and pt meet, and the nurse conducts an initial interview
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Termination phase
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The final. integral phase of the nurse-pt relationship
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Therapeutic relationship
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A relationship requiring that the nurse maximize her communication skills, understanding of human behavior, and personal strengths in order to enhance personal growth in the patient.
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Transference
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unconscious process, react as if helping person is a significant other from past
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Working phase
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The phase of the nurse/pt relationship during which the nurse and pt identify and explore areas that are causing problems in the patient's life.
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What factors are important to keep in mind when performing an assessment?
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Consider physical, psychosocial, cultural, and spiritual factors
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Why is it important to keep pt's spiritual factors in mind when doing assessment?
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5. Spiritual may be awkward & sensitive but evidence shows that religious involvement is associated with better physical & mental health as well as longer life.
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All clients deserve positive _____ no matter what the situation.
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positive regard
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Why is pacing important to keep in mind when working with clients?
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All relationships will develop at different rates, be patient with the time it takes for each pt.
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What type of listening do we use with clients?
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Active listening- pay attention to body language.
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Nursing Diagnosis with 3 parts?
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Actual problem
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Nursing Diagnosis with 2 parts?
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Risk for Problem
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Patient outcomes need to be...
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Patient centered, attainable, measurable, times
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Implementation – 4 areas of basic care
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1. Coordination of care
2. Health teaching & promotion 3. Milieu therapy 4. Pharmacological, biological, integrative therapies |
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The _____ relationship is the basis of all psychiatric nursing care. It is also vital to all other areas of nursing
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therapeutic
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“___- therapy” is extremely effective way to help patients work through many of the emotional and functional issues accompanying their disease
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Talk
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Developing a caring relationship with patients is the ______ of psychiatric nursing.
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art...It is also the key to all nursing.
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An intimate relationship involves...
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emotional commitment
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An social relationship involves...
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friendship, socialization, tasks
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Genuine
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what is displayed on the outside is what is felt on the inside
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Factors that promote therapeutic relationships
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Genuine
Empathetic Positive regard Develop strengths Consistency Pacing Listening |
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Factors that hinder therapeutic relationships
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Inconsistency
Unavailable |
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The following are steps taking during which phase of the nurse/pt relationship?
Parameters of the relationship Contract, Confidentiality, Termination Testing behaviors to see if nurse really “cares” about patient |
Orientation Phase
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The following are steps taking during which phase of the nurse/pt relationship?
Problems identified, explored, resolved Intense emotions – anger, denial, lowered self-esteem |
Working phase
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The following are steps taken during which phase of the nurse/pt relationship?
Patient may exhibit defensive behaviors Avoid delaying termination due to guilt |
Termination
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What is the best technique to use when initiating an interview?
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Broad openings
ex: “Tell me about what’s been going on with you.” |
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Raymond introduces himself to his patient and explains how long he will be on the unit. What phase of the nurse-patient relationship is this?
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Orientation Phase
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Signs of countertransference?
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Boredom, rescuing, overinvolvement, overidentification, misuse of honesty, anger, and helplessness/hopelessness
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BOREDOM
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inattentive, frequently ask client to repeat information, give inappropriate responses
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RESCUING
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reaching for unattainable goals, resisting peer feedback
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OVERINVOLVEMENT
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coming to work early and leaving late, keeping secrets, calling family/client when off duty.
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OVERIDENTIFICATION
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physical attraction, special agendas/secrets with client, revealing too much personal information
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MISUSE OF HONESTY
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lying to clients, withholding information from clients
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ANGER
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withdrawal, using profanity, asking to be taken off the case
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HELPLESSNESS/HOPELESSNESS
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sadness
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Solution to boredom?
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Focus on directing interviews in productive directions, leave personal concerns at home.
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Solution to rescuing?
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reaching for unattainable goals, resisting peer feedback
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Solution to overinvolvement?
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Avoid too much self-disclosure, don’t call the client/family when not working
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Solution to overidentification?
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Allow patient to direct goals, encourage patient to solve problems
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Solution to misuse of honesty?
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Be truthful, if you cannot provide information tell the patient
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Solution to anger?
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Analyze the reasons for the anger and take steps to resolve
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Solution to helplessness/hopelessness?
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Focus on the patient’s concerns, not your feelings
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Acculturation
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adapting to the beliefs, values, and practices of a new cultural setting
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Indigenous Tradition
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HARMONY, NATURE, mind/body/spirit one entity-no separation, identity is COMMUNITY- self does not exist, time focus on present,
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Assimilation
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the incorporation of new ideas, objects, and experiences in to the framework of one's thoughts
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Bias
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Prejudice in favor of or against one thing, person, or group compared with another, usually in a way considered to be unfair.
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Enculturation
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the process in which a culture's world view, beliefs, values, and practices are transmitted to it's members
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Ethnopharmacology
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a relatively new field of medicine that investigates the genetic and ethnic variations in drug pharmacokinetics
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Culturally competent
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the nurse's act of adjusting her practices to meet the patient's cultural beliefs, practices, needs, and preferences
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Egocentrism
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self-centered
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Ethnocentrism
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the universal tendency of humans to think their way of thinking and behaving is the only correct and natural way
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Eastern Tradition
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BALANCE, Identity starts with FAMILY, interdependence, group decision making, mind/body/spirit unity, time is circular and recurring, yin and yang/ unbalance causes disease, fate unchangeable
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Racism
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a belief that inherent differences between races determine people's achievement and that one;s own race is superior
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Stereotyping
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the assumption that all people in a similar cultural, racial, or ethnic group think and act alike
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Western Tradition
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SCIENCE, focus on INDIVIDUALITY- values autonomy, independence, and self-reliance, mind and body 2 separate entities, disease has scientific cause, time is linear moving forward
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Culture bound Syndromes
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sets of signs and symptoms common in a limited number of cultures but virtually non-exist in most other cultural groups
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World View
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a system for thinking about how the world works and how people should behave in it and in relationships with one another
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Describe 3 different biases and how they affect psychiatric health care.
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Think ageism, sexism, and racism
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Discuss the influences of intrapersonal, interpersonal, and extrapersonal factors on a client’s response to illness.
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Intrapersonal- stress can bring on or intensify illness, interperpersonal- people of eastern traditions may need their families presence in order to feel that they can heal, extrapersonal- the client may not be in a helpful or healing environment
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Do our western psych theories work cross culturally?
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no
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medical culture
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defines appropriate behavior, language, and roles. Sometimes health care providers are so involved with this culture they are unable to relate to others outside it.
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Active listening
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Being aware of the patients verbal and nonverbal communications while monitoring personal verbal and nonverbal communications
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Body language
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Communication is 90% body language, and is a major part of how we receive a message.
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Clarifying
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Helps clients clarify their own thoughts and maximize mutual understanding between nurse and client "I'm not sure I follow you"
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Checking perceptions
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Perception checking refers to a process also known as "echoing," where one person repeats back what they understand the other to have meant.
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Broad openings
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"What would you like to talk about today?" Letting the client take initiative to introduce a topic
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Making observations
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Calla attention to the persons behavior, "You appear tense."
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Exploring
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a technique that enables the nurse to examine important ideas, experiences, or relationships more fully. "Tell me more about that."
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Focusing
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Concentrates attention to a single point, "You've mentioned many things, let's go back to your thinking of 'ending it all."
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Formulating a plan
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Allows the pt to identify alternative actions for interpersonal situations the pt finds disturbing, "If this were to happen again, what could you do differently?"
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Presenting reality (Reality orientation)
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Indicates what is real, "Your mother is not here, I am a nurse."
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Using Silence
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Gives the person time to collect thoughts or think through a point.
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Accepting
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Indicates that the person has been understood, "I follow what you say."
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Offering self
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Offers presence, interest, and a desire to understand. "I would like to spend time with you."
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Reflecting
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Directs questions, feelings, and ideas back to the patient. P: "What should I do about..." N: "What do you think you should do?"
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Encouraging comparisons
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Bring out recurring themes in experiences or interpersonal relationship. Helps the person clarify similarities and differences.
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Encouraging evaluation
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Aids the patient in considering people and events from the perspective of the patients own set of values, "How do you feel about...?"
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Summarizing
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brings together important points of discussion to enhance understanding, "During the past hour, you and I have discussed..."
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Example of comparisons
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"Is this how you felt when..."
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What are some ways in which message transmission can be affected?
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electronic mistakes, environment, culture...
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_____ can help refocus clients in manic states
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focusing
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When seeking clarification, the nurse is taking ______ for not understanding
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responsibility
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What 2 things do we do at the end of the interview?
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Summarize and formulate a plan
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When active listening, listen to remember what they said to see if they _____ themselves
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contradict
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Giving advice
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Assumes the nurse knows best and the patient can't think for themselves. Inhibits problem solving ability and fosters dependency.
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Example of Giving advice
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"Get out of this situation immediately."
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Minimizing feelings
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Indicates that the nurse is unable to understand or empathize with the patient. PTs feeling are being belittled causing pt to feel small or insignificant.
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Example of Minimizing feelings
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P: "I wish I were dead."
N: "Everyone gets down in the dumps." or "I know what you mean" |
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Falsely reassuring
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Underrates a person's feelings and belittles a person's concerns. May cause the pt to stop sharing feeling if the patient thinks he or she will be ridiculed or not taking seriously
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Example of Falsely reassuring
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"Everything will be fine, you'll see."
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Making value judgements
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Prevents problem solving. Can make the patient feel guilty, angry, misunderstood, not supported, or anxious to leave.
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Example of Making value judgements
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"How come you still smoke when your wife has lung cancer?"
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Asking "why" questions
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Implies criticism; often has the effect of making the patient feel defensive. "Why did you stop taking your medication?"
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Asking excessive questions
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Results in the pts not knowing which question is to answer and possibly being confused about what is being asked
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Giving approval, agreeing
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Implies the pt is doing the RIGHT thing- ant that not doing it is wrong. May lead the pt to focus on pleasing the nurse, and denies the pt the opportunity to change his or her mind
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Example of Giving approval, agreeing
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"I'm proud of you for applying for that job."
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Disapproving; disagreeing
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Can make person defensive. "You really should have shown up for that medication group."
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Changing the subject
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May invalidate the pts feelings and needs. Leads to feelings of being alienated, isolated, hopeless
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