Chapter 4: Foundations for Practice Flashcards
How did the creation of Medicare/Medicaid change medical care for the mentally ill?
Changed from publicly owned asylums (later known as state hospitals) and private psychiatrists offices to general hospital psychiatric units and nursing homes. The Great Social reform in the 1960s began to pay for short-term hospitalization in general hospitals and medical centers which spurred the creation of psych units. It did not cover care in asylums. Geriatric psych patients were moved to nursing homes bemuse Medicare reimburses the homes 100% of cost.
In 1999 the Olmstead Decision decreed that asylums are crazy and suck. Money would be granted to develop community and state care systems to complement hospital visits/nursing homes.
Now theres barely any asylums and our current mental health system is comprised of out and inpatient treatment.
Examples of Specialty psychiatric care providers
Psychiatrist, psychiatric mental health advanced practice registered nurses, psychologists, social workers, counselors, other licensed therapists
What is a PCMH
Patient centered medical home: Homes that give a patient a wholistic mental health support expereince. It is:
Patient centered
Comprehensive care
Coordination care
Improved access
System approach
What is a community mental health center?
Started in the 1960s for people that couldn’t be put in a state hospital. Today helps low income mentally ill. Medciatiosn Rx, administration, therapy, rehab, social work
What four elements must be met in order for psychiatric home care to be reimbursed by Medicare?
pt is homebound, has a psychiatric Dx, needs the skills of a psychiatric nurse, a plan of care developed by a MD or NP
What is an ACT?
Assertive Community Treatment. An intensive type of case management developed in the 70s that targets pts with severe psychiatric symptoms (will not participate in traditional forms of treatment). Characterized by unnecessary repeat visits to the ER, in-patient care.
ACT teams are interdisciplinary and go to their homes, hospitals, and clinics to organize pt’s life. Often the nurse coordinates everything and has to visit a pt 3-5 times a week.
What are Intensive outpatient programs and partial
hospitalization?
steps between inpatient and outpatient care. PHPs are Monday-Friday. IOPs meet 3-5 times a week for 3 hours
provide structured activities. Pts admitted to PHPs/IOPs are monitored in case they need to be readmitted
Define primary, secondary, and tertiary prevention
Primary: before an problem manifest and seeks to reduce the incidence/rate of new cases. CBT in highschool.
Secondary: Early identification/screening
Tertiary: treatment of disease with a focus on preventing progression to a severe course.
what is the difference between comprehensive emergency service model and hospital based consultant model
often affiliated with a full-service emergency department in a hospital or medical center setting. there is a dedicated clinical space with specialty staffing.
hospital based consultant model utilizes the concepts of the comprehensive model by incorporating triage and stabilization but usually there is no dedicated clinical space or comprehensive separate staffing.
what is the mobile crisis team model
is considered stabilization in the field. while the team vary in design, psychiatric mental health nurses, social workers and counselors in collaboration with a psychiatrist or an advanced practice nurse often make up the care team.
What is the difference between a locked and unlocked unit?
Locked units provide privacy and prevents leaving before being discharged (elopement)
what is the admission criteria for an entry to acute inpatient care?
imminent danger of harming self
imminent danger of harming others
unable to care for basic needs and or gross impairment of judgment, placing an individual at imminent risk based on inability to protect oneself.
what is milieu
refers to surroundings and physical environment emotional climate how it affects mental health
