1st week Chapter 1,3, and psychiatric setting Flashcards
mental health is ______________________
not the absence of sadness
traits of mental health
ability to
- think rationally
- communicate appropriately
- learn
- grow emotionally
- be resilient
- have a healthy self-esteem
Diathesis stress model
what is Diathesis?
what is stress?
- combination of genetic vulnerability and negative environmental stressors.*
- For example: if your mother had depression, you are more likely to have it too.*
Biological predisposition by nature
Environmental stress or trauma nurture
DSM-5
RN’S use DSM-5 to identify diagnosis and criteria, guide assessment, plan, implement and evaluate care
changed to 5 when we include cultural details
RNs in use of DSM-5
assessment
psychosocial history
culture and practices
perception of self-health, belief about illness. how patient passes time(leisure activities). substance use disorders and coping abilities.
stigma: less likely to reach for mental health support, spiritual and religious beliefs: for example, a catholic patient will hide any feelings of suicide to a friend.
NANDA - I
foundational to the care of mental health is the nursing process
what does it stand for?
what is it?
The North American Nursing Diagnosis Association International
describes a nursing diagnosis as a clinical judgment about individual, family, or community responses to actual or potential health problems and life processes.
Mental status examination (MSE)
level of consciousness
- alert
- lethargic
- stuporous
physical appearance - cold outside but the patient is wearing summer clothes
behavior
- voluntary and involuntary body movement
- eye contact
- mood (subjective)
- affect (objective)
lethargic- sleepy but easy to arouse
stuporous- coma
standardized screening tools
Mini-mental state examination (MMSE)
what is it used for?
Glasgow coma scale
mini-mental
- to rule out cognitive function decline, such as senile dementia
- orientation to time and place
- attention span and ability to calculate by counting backward by seven
- registration and recalling objects
- ability to follow commands
Glasgow
a score of 15 indicates that the patient is awake and responding appropriately
a score of 7 or less indicates that the client is in a coma
standardized screening tools for children and adolescents
- H
- E
- A
- D
- S
- S
- S
- home environment (relationship with parents)
- education/ employment( performance)
- activities (interaction with peers), drug and substance use, sexuality and suicide/ depression (risk), savagery (abuse at home or violence in his neighborhood
standardized screening tools for the older adult population
- geriatric depression scale (short term)
- Michigan alcoholism screening test (geriatric version)
- the McGill Pain questionnaire (MPQ)
- patient health questionnaire (PHQ-9/PHQ-2)
- general anxiety disorder (GAD-7)
the McGill Pain questionnaire (MPQ)
The McGill Pain Questionnaire (MPQ) measures the sensory, affective, evaluative, and miscellaneous components of pain
patient health questionnaire (PHQ-9)
diagnose depression
patient health questionnaire (PHQ-2)
provide a brief, initial screening for major depression.
patient self determination act
information about advance care documents should they become unable to make those decisions due to illness
questions on admission about having an advanced care document
information about rights to complete advance care documents
advance care directives in mental health
What’s durable power of attorney?
living will - a written statement detailing a person’s desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive.
continuing
what is competency?
the degree to which the client can understand and appreciate the information given during the consent process.
cognitive ability to process information at a specific time
different from rationality
competent client can refuse any aspect of the treatment plan
make sure the client is competent!!!!!!!!!!!!!!!
how can we assess competency?
communicate choices
understand relevant information
appreciate situation and consequences
use logical thought process to compare risks and benefits of treatment options
informed consent
legal procedure to ensure that client knows the benefits and costs of treatment
mandate of state laws
complicated in mental health treatment
- competency necessary to give consent
- decision- making ability often compromised in mental illness
least restrictive environment
can a person be restricted to an institution?
meds cannot be given unnecessarily
use of restraints last resort!!!!!!!!!!!!!!
no, person cannot be restricted to an institution when he or she can be successfully treated in the community
seclusion
what is it used for?
what does it have?
individual observed at all times
extremely negative client experience; many facilities have abandoned practice
outcomes may be worse if used
involuntary confinement in a room or area where the person is physically prevented from leaving
used for purposes of safety or behavioral management
contains mattress and blanket, usually padded walls, environmentally safe ( no hanging devices, electrical outlets, or accessible windows)
restraints # 1
- most restrictive safety intervention
- any manual (physical or mechanical) method which immobilizes or reduces ability to move
- must choose least restrictive type to keep client safe
what body areas to use?
wrist
walking or ankle
four-point
five-point
chemical
restraints #2
- last resort if client continues to be danger to self or others
- documentation must reflect careful assessment and all previously tried unsuccessful interventions
- promptly removed when client regains control over his or her behavior
- requires continued close observation after removal
- use can result in psychological harm and physical injury
trauma-informed care
- using restraints or seclusion can trigger and retraumatize client
- nurse must recognize connection between earlier trauma and adult mental health problems
- must follow medicare regulations if receiving medicare funding
- patients rights condition of participation
voluntary treatment
voluntary admission or commitment
- person retains full civil rights
- treatment strategies are recommended and agreed on by both provider and client
- free to leave at any time, even against medical advice
consider the DTO and DTS! always check the chart
involuntary treatment
involuntary commitment: court-ordered ; without persons consent
three common elements
- mentally disordered
- dangerous to self or others
- unable to provide for basic needs
right to receive treatment; possible right to refuse treatment
cannot leave against medical advice
what is breach of confidentiality?
release of client information without the clients consent in the absence of legal compulsion or authorization
mandates to inform
a legal obligation to breach of confidentiality
duty to warn
- judgment that the client has harmed someone or is about to injure someone
- based on tarasoff v. regents of the university of California
lawsuits
very common in this field especially clients that are suicidal or violent
nurses usually included in lawsuit filed against agency
so we have to document !!!!!!!!!!!!!!
what is sentinal event?
when patient kill himself or herself in institution
who is more important to watch over
manic
or
the alcoholic that is detoxing
alcoholic because he can die from detoxing
nursing documentation
clients have access to their records
legal documents
if the patient is suicidal or homicidal:
if that is the reason why he was admitted; PRN meds require separate entry to include the reason for administration, dosage, route, and response to medication
careful documentation!
social influences on psychiatric care settings
traditional medical health care vs. psychiatric mental health care
why are psychiatric illness often hidden?
stigma- shame and being flawed is associated with illness
outpatient psychiatric mental health care
specialty psychiatric care providers
patient-centered health/ medical homes
professionals who can prescribe meds, practice individual psychotherapy and or group therapy
the affordable care act ( health affairs 2010)
co-location of primary and specialty care in community based mental health settings
eliminates the stigma of seeking care for psychiatric disorders
community mental health centers
- created in the 1960’s
- mainstay for those who have no access to private mental health care
- provide emergency services, adult services, children services
treatments?
dual diagnosis treatment (meaning to the diagnosis)
treatments
medication administration
individual and group therapy
family therapy
community- based mental health programs
assertive community treatment (ACT)
partial hospitalization programs
- non traditional case management and treatment for clients who have severe mental illness and are noncompliant with traditional treatment
- reserve to those with repeated hospitalizations with severe symptoms
- ACT teams work intensively with patients in their homes, hospitals and clinics
- creative problem solving and interventions are the hallmarks of care provided by mobile teams
- intense short-term treatment for clients who are well enough to go home every night and who have a responsibility at home to provide a safe and supportive environment
- programs 5-6 hrs/day utilizing individual and group psychotherapy treatment
- primary goal
symptom improvement
safety
education on clinical condition and medication
coping strategies
other outpatient venues for psychiatric care
telephone crisis counseling
telephone outreach
internet
telepsychiatry
prevention in community care
primary
secondary
tertiary
occurs before any problem is manifested and seeks to reduce the incidence or rate of new cases (prevention) coping strategies and psychosocial support
reducing the prevalence of new and old cases at any point of time in psychiatric disorders. early identification, screening, prompt and effective treatment
treatment of disease with a focus on preventing the progression. encimpasses rehabilitation which aims to restore functional ability
psychiatric nursing in outpatient and community settings
strong problem-solving and clinical skills
cultural competence
flexibility
knowledge of community resources
autonomy
psychiatric nursing in outpatient and community settings continued…..
biopsychosocial assessment
case management
promoting continuation of treatment
teamwork and collaboration
nurse must have a comprehensive understanding of the patients ability to cope with the demands of living in the community
bridging the gap of all the patients medical and mental health needs
patient centered care
multidisciplinary treatment teams increase success, maybe a dietary because some meds require special diet
emergency care and crisis stabilization
comprehensive emergency service model
hospital-based consultant model
mobile crisis team model
crisis stabilization/ observation units
full service emergency department
incorporating triage and stabilization
stabilization “in the field’/goal to stabilize without ED
rapid stabilization and short length stay/ observation for 1-3 days
inpatient psychiatric care
admission reserved for individuals who are?
admission options
- direct admission
- hospital emergency department
criteria to justify admissions
- danger to self or others or unable to fulfill basic needs
voluntary or involuntary
- voluntary-agree to admission and treatment
- involuntary-admitted against their will due to safety concerns
- patient rights are maintained regardless of status
suicidal
homicidal
extremely disabled (unable to care for basic needs, gross impairment of judgement, and inability to protect oneself)
Therapeutic Milieu
surrounding and physical evironment
overall environment and interactions of environment
well managed milieu
- promotes healing
- inspires a sense of security
- structure
activities
unit rules
reality orientation practice
practice communication and coping skills
preparation for return for the community
