Chapter 2, 3, &4 Flashcards
What is mental health?
State of well-being where the person realizes their own abilities, can cope with stress, work productively, and contribute to society
To be considered healthy, what must be true?
You are mentally healthy.
What is cultural idiom of distress?
A linguistic term or way of talking about suffering among individuals of a cultural group (Susto)
What are the 8 dimensions of wellness?
Emotional Financial Social Spiritual Occupational Physical Intellectual Environmental
Dimension of wellness: emotional
Coping effectively and creating relationships
Dimension of wellness: financial
Satisfaction with present and future situations, basic human needs
Dimension of wellness: social
Developing connection, belonging, and support system
Dimension of wellness: spiritual
Sense of purpose and meaning in life
Dimension of wellness: occupational
Personal satisfaction and enrichment from work
Dimension of wellness: physical
Need for healthy food, sleep, and physical activity
Dimension of wellness: intellectual
Creative abilities and finding ways to expand knowledge and skills
Dimension of wellness environmental
Being in a pleasant and stimulating environment
What is wellness?
Having purpose in life, being happy, having satisfaction in work and play, joyful relationships. It is not the absence of disease or stress
Why are people with mental health problems more likely to die decades earlier than the general public from preventable diseases?
They face social, economics, and environment problems that lead them to have lack of health care, information, and linguistic competent care programs
Mental disorder/illness
A syndrome, or set of symptoms that cluster together that may have multiple causes and may represent several different disease states that have not yet been defined
How are mental illnesses/disorders diagnosed?
Through clusters of behaviors, thoughts, and feelings. NOT by biological pathways like blood work or scans
What mental illness is the leading disease burden in middle and high-income countries like the US?
Depression
Epidemiological research
Study of patterns or disease distribution and deft infants of health within populations. It does not determine the cause of illness, but examines associations.
Rate
Cases in population/ total population
Average rate is used for measures that are over specified time periods
Prevalence
Total number of people who have the disorder within a given population at a specified time with no regard of how long ago the disorder started
Point prevalence
Cases at T/ population at T
Who has a disorder at a specific time (ex: April 1, 2020)
What is the DSM-5?
Diagnostic and Statistical Manual of mental health disorders
It organizes and diagnoses mental disorders according to behavior and symptom patterns.
What is not included in the DSM-5?
Cultural syndromes don’t meet the criteria. If a behavior is outside of the social norms then it would be considered a mental disorder
What does The World Health Organization’s Disability Assessment Schedule 2.0 do?
It measures the amount of impairment a person experiences
_______ becomes difficult when the mental disorder impairs the persons ability to perform ADLs and self-care
Recovery
What is Ataque De Nervios?
It is a cultural syndrome
Frequent episodes of loss of control, uncontrollable crying, tremors, and severe anxiety with somatization symptoms like muscle/headaches, loss of appetite, or insomnia.
Who most commonly experiences Ataque De Nervios?
Women over 45 with little education and who have experienced a loss (divorce) or acute distress.
Define nervios
Idiom in Hispanic culture to describe a wide range of somatic and emotional symptoms like headache, irritability, nervousness, insomnia and difficulty concentrating
What is Susto?
A cultural idiom of distress
Fright characterized by symptoms of psychomotor agitation, anorexia, fever, diarrhea, confusion, apathy and depression following emotional trauma or witnessing a traumatic event.
It causes the soul to leave the body according to Central/South America
Cultural syndrome
Group of co-occurring symptoms that happen in 1 culture
What is a stigma?
It is a stereotype and offers major barriers to treatments, recovery, and social integration. These are often negative
Public stigma
A person is public ally “marked” as having a mental illness. These people are at risk for discrimination and prejudice. Common stereotypes are dangerous, unpredictable, etc.
Self-stigma
Occurs when negative stereotypes are internalized by people with mental illness. Patients become aware of the negative public view on mental illness and agree with pubic view. They develop low self-esteem
“I have mental illness, therefore, I am incompetent”
Label avoidance
Avoiding treatment or care to not be labeled as mentally ill and avoid the stigma.
Asian cultures often ignore mental illnesses
______ is the single most important goal of having a mental illness
Recovery
What is recovery?
Process of change through which individuals improve their health and wellness. It focuses on illnesses
What are the 4 requirements for recovery?
Health, home, purpose, community
Recovery-oriented treatment
Based on belief that mental illness and disturbances are treatable and recover is an expectation
T/F
Trauma is a universal experience for people with mental and substance abuse disorders
True
What are some guiding principles of recovery? (9 things)
Recovery is hope, person driven, holistic, supported by peers, supported by relationships, culturally based and influenced, based on respect, supported by addressing trauma, and involves individual/family/community
All cultural groups possess what 3 things?
They have the same beliefs, values, and patterns of accepted behavior
What is culture?
A way of life for people who identify with one another on the basis of some common purpose, need, or similar background as well as the learned socially transmitted beliefs, values, and behaviors. Culture is dynamic and includes race, ethnicity, age, gender, etc.
Cultural competence
The ability to interact effectively with people of different cultures which involves academic and interpersonal skills that are respectful to health beliefs/practices, and linguistic needs
Health literacy
Ability to use reading, writing, and verbal numerical skills in the context of health
What are the 4 domains for promoting health literacy?
Spoken communication
Written communication
Self-management and empowerment
Supportive systems
_____% of white people live below poverty level
12.3%
___% of blacks live below poverty level
26.4%
___% of Hispanic Americans live below poverty level
20.9%
____% of people below the poverty line is single moms and their kids
22.2%
Hispanic Americans have what view on mental health?
Use all other resources before going to a medical professional. They are the largest underrepresented group in the US.
Barriers: cost of care, availability of services, immigration status, and they believe facilities don’t accommodate their cultural needs
Blacks and African Americans have what viewpoint of mental health?
They believe that youth should be self-reliant and solve their own problems, they don’t trust their providers, and care is not affordable.
Often misdiagnosed with schizophrenia
Blacks and African Americans face what double stigma?
Double stigma from their culture and longtime racial discrimination
Asian Americans, Polynesians, and Pacific Islanders view on mental health
They deny or disguise their mental illness which can be characterized by fatigue, weakness, poor concentration, memory loss, irritability, and sleep disturbances.
What does hwa-byung mean in Korean culture?
Suppressed anger syndrome
Native Americans view on mental health
They view it as being out of balance with nature, so they look to the earth and nature to heal them. They use shamans or medicine men to perform healing rituals, feasts, or take herbal medicines.
In tribes that have little distinctions between physical and mental, there is little stigmatism with mental illnesses.
Arab Americans and their view on mental health
Seeking help is highly stigmatized so they are more likely to go to a health care provider for somatic problems. They have strong commitment to family, educational, and economic achievements. Men are discriminated against
How do women of underrepresented groups view mental health?
There is stress from acculturation, stigma towards mental illness, and lack of social support which contribute towards depression in immigrant women. They are reluctant towards health care due to the negative stereotypical attitude of healthcare workers
Spirituality has 5 parts, what are they?
Meaning, belief, connecting, self-transcendence, and value
This develops over time and is a dynamic and conscious process
Religiousness
Participation in a community of people who gather around common ways of worshipping
What is Buddhism?
It attempts to deal with problems of human existence like suffering and death. They believe that the cause of all human suffering is desire. This is why the emphasize following the middle path to avoid extremes of self-denial and self-indulgence. Good demos and compassion lead toward nirvana. Present behavior is a result of past greed
Lamaism
Buddhism blended with spiritual worship
Mantrayana
Intimate relationship with a guru and recitations of secret mantras; belief in sexual symbolism and demons
Ch’an Zen
Self-reliance and awareness through intuitive understandings are stressed
Satori
May come from sudden insight or enlightenment through self-discipline, meditation, and instruction
What is Christianity?
Gods love for all creatures is a basic belief. Salvation is gained by t hose who have faith and show humanity to God. Acts of charity, kindness, and forgiveness is important. Father, son, Holy Ghost
What is Confucianism?
System of this for living rather than a religion that teaches how people should act toward one another. People are born good and respect it shown for parents and authority figures. Improvement is gained through self-responsibility, introspection, and compassion for others. There is no God/s after death
What is Hinduism?
All people are assigned to castes. Brahmans (priests, intellectuals), kshatriyas (rulers and soldiers), vaisya (farmers, skilled workers), sudras (servants, laborers, peasants), untouchables (outcasts)
What does brahma mean?
Infinite being and creator that pervades all reality
What does Vishnu mean?
Preserver
What does shiva mean?
Destroyer
What does krishna mean?
Love
What is Islam?
God is just and merciful, humans are limited and sinful. God rewards the good and punishes the sinful. Mohammed teaches the truth and guides people. Peace is gained through submission to Allah, and a good Muslim obeys the 5 pillars of Islam
What is Judaism?
God is worshipped out of love and not fear. Obeying God’s law through ethical behavior and ritual obedience earns mercy of God
What is Shintoism?
Reverence for ancestors. Loyalty to places and locations where one lives/works.
What is Taoism?
Quiet and happy harmony with nature is the key belief. Peace and contentment are found from optimism, passivity, humility, and internal calmness. Humility is very important
Agnosticism
Belief that whether there is a god and spiritual world is unknown and probability unknowable
Atheism
Belief that no God or deity exists
Maoism
Faith is centered in communist party and all the people. The goal is to move away from individual and personal desires and ambitions and towards viewing and severing all people as a whole
Scientism
The belief that values and guidance for living come from scientific knowledge, principles and practices. Systematic study of life rather than superstition
Accreditation
Process by which a mental health agency is recognized/approved with establish standards to provide acceptable quality of care
Advance care directives
Treatment directives (living will) and appointment directives (POA) that apply only if the person is unable to make his/her own decisions because the pt is incapacitated, or in the opinion of 2 physicians, unable to make decisions for him/herself/ It doesn’t need to be written, reviewed, or signed by an attorney but must be witnessed by 2 people and notarized
Assault
Threat of unlawful forced to inflict bodily injury. Threat must be imminent and cause reasonable apprehension in the individual
Breach of confidentiality
Release of pt info without the patients consent in the absence of legal compulsion or authorization to release information
Chemical restraint
Use of meds to control patients or manage behaviors
Competence
Patient is able to understand and appreciate the info given during the consent process. Pts cognitive ability to process info at a specific time, ability to gather and interpret info to make reasonable judgements.
Confidentiality
Ethical duty of nondisclosure; pt has the right to disclose personal info without fear of it being revealed to others.
External advocacy system
Serve as advocates for treatment and rights of mental health pts. Operates independent of mental health agencies
Incompetent
A person is legally determined not able to understand and appreciate the info given during the consent process.
Informed consent
Mandated by state laws for a pt to determine what shall be done with ones own body and mind., pts must be given adequate info to base decisions about care and actively participate in the decision making process
Internal rights protection system
Pt protective measurements developed by the US mental health care system’s organizations to help combat any violation of mental health pts’ rights, including investigating incidents of abuse or neglect
Involuntary commitment
Confided hospitalization of a person without his/her consent but with a court order
Least restrictive environment
Pt has a right to be treated in the LRE possible for the exercise of free will. Can’t be restricted to an institution when he or she can be successfully treated in the community
Living will
Advance care directive that states what treatments should be omitted or refused in the event that a person is unable to make those decisions because of incapacitation
Medical battery
Intentional and unauthorized treatment threat is harmful or offensive. Failure to respect advance directives, false imprisonment, and not discharging voluntarily committed pts.
Negligence
Breach of duty of reasonable care for a pt that the nurse is responsible for and results in a personal injury. A clinician who does get consent but doesn’t disclose the nature and risks of procedures involved is subject to a negligence claim
Power of attorney
Advance care directive through with a proxy is appointed to make health care decisions on behalf of the person if they are incapacitated
Privacy
Part of persons life that is not giver enough by society’s laws and governmental intrusion
Restraint
The use of any manual, physical, or mechanical deceive that restricts movement when attached to the patient
Seclusion
Solitary confinement in a full protective environment for the purpose of safety or behavior management
Voluntary admission/commitment
The legal status of a pt that has consented to being admitted to the hospital for treatment and maintains all civil rights and is free to leave at any time, even if its against medical advice
What is self-determinism
It is based on a persons fundamental right to autonomy. Pts can choose to accept refuse, or terminate treatment without deceit, undue influence, duress, coercion, or prejudice. It’s a basically right established by title ii public law 99-139
What is the self-determination act?
Right to be provided with info regarding advance care documents
Right to be asked at admission whether they have and advance care document and that is be in the medical record
Right to be provided info on their rights to completed advance care documents and refuse medical care
What are PADs (psychiatric advance directives)?
Allows pts while competent to document their choices of treatment and care. They must be made in advance and physicians can override during times when a pt’s decision making is distorted. Pt must be informed first and an order made by the court if this happens
Americans with disabilities act and job discrimination protects against what?
It ensures that people with disabilities, mental illnesses, and addiction have legal protection against discrimination in the workplace, housing, public programs, transportation, and telecommunications. Law mandates that reasonable accommodations need to be made for a person in a workplace
Who sets patient rights standards for institution seeking Medicare and Medicaid funding?
Centers for Medicare and Medicaid services (CMS)
The nurse must be sure that _____ _____ was given before any treatment occurs
Informed consent
Where are 5 point restraints placed?
All extremities and 1 across the chest
Trauma-informed care
Being aware of and sensitive to doing no further harm to survivors of trauma
Requirements for restraints or seclusion
- can’t be used out of convenience, punishment, or means of coercion
- only used as last resort
- must be used for minimal amount of time necessary
- least amount of restraint points used
- must be checked up on frequently, or if in seclusion must be continuously monitored
Involuntary commitment
Mandated treatment without the persons consent but with court order. They have the right to refuse treatment, but must still remain in the facility
Emergency commitment allows the patient to be held for what amount of time with no court order?
48-72 hrs by a certified medical professional
What does HIPPA stand for?
Health insurance portability and accountability act of 1996
What does the American recovery and reinvestment act of 2009 do?
Maintains privacy of electronic transfer and storage of health info
What is a mandate to inform
May require a breach of confidentiality when a pt has harmed or is about to harm any individual or your duty to warn.
What does forensic mean?
Legal proceedings and mandated treatments of people with mental illness
Stigma of criminality
They suffer combined effects of the stigma or mental illness and criminality. There is often reluctance to treat these patients due to safety concerns for the staff
What is fitness?
Person is able to consult with a lawyer with a reasonable rational understanding of the facts of alleged crime and legal proceedings
Unfit to stand trial
Mental or physical condition, they are unable to understand the nature and purpose of the proceedings or to assist in defense. Hospitalization in a forensic facility follows. The goal is to get the person fit for trial, not to treat the disease.
Not guilty by reason of insanity (NGRI)
The accused is judged unable to distinguish right from wrong or unable to control their actions at the time of the crime. They get involuntary commitment in a secure setting and they are given a sentence equal to the time or sentence served if they had been guilty of the crime.
Guilty but mentally ill (GBMI)
Criminal conviction and is sent to the correctional system. Their mental illness was not to an extent of not knowing right from wrong. They are still treated for their mental illness in jail
Probation
Sentenced of conditional or revocable release under the supervision of a probation officer at a specified time. Charges can be dropped if this is successful
Is the insanity plea commonly used?
No, it is extremely difficult to use, even in cases of the severely ill.
Case of John Hinckley
Attempted to assassinate President Ronald Reagan in 1981 to gather attention of his love Jodie and was found NGRI. This case lead to multiple states changing their insanity defense to limit its’ use.
Case of Andrea Yates
Convicted of murder by drowning her 5 kids. She was sentence to life despite her previous and extensive mental health records. A retrial occurred and she was found NGRI. She was committed to a state mental hospital with period hearing for her release.
Brady Handgun Violence protection act of 1993 (Brady act/bill)
Requires a background check on people seeking ownership of a firearm. If you are mentally incompetent, have a severe mental illness, or have been in a mental institution, you can’t have a gun. This was seen as unfairly stigmatizing those with mental illnesses
Malpractice
Based on a set of torts; a civil wrong not based on contract committed by one person that causes injury to another
Battery
Intentional and unpermitted contact with another
5 elements to prove negligence
1) Duty
2) Breach of duty
3) Cause in fact
4) Cause in proximity
5) Damages
What is duty (related to negligence)?
Accepting assignment to care for pt
What is cause in fact (related to negligence)?
The injury wouldn’t have happened if the standards of care had been followed
What is cause in proximity (related to negligence)?
Harm actually occurred within the scope of foreseeable consequence
How can you protect yourself from lawsuit?
Maintaining and documenting standard of care
Pro re nata
Medications prescribed as needed
Is the pt record a legal document?
Yes
