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Context Final > Environments: Acute Care/Inpatient Psych > Flashcards

Environments: Acute Care/Inpatient Psych Flashcards

1
Q

Acute Care

A
  • generalist
  • fast paced, short length of stay
  • – limited opportunity to get to know patient
  • understanding medical conditions is important
  • safety is important
  • skilled observation over standardized assessment
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2
Q

Acute Care: Intervention Methods

A
  • Preparatory methods
  • Rehabilitative/restorative approaches
  • Compensatory approaches
  • Use of activities, education, training – occupation can be a challenge
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3
Q

Acute Care: Patient Navigator for ASD

A
  • Collaborate with multi-disciplinary team
  • Educate staff
  • Coordination in continuity of care (acute –> inpatient –> outpatient)
  • Examine and streamline current hospital processes
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4
Q

Inpatient Psychiatry: Goals for Patient

A
  • Safety
  • Clarify diagnosis
  • Symptom management
  • Coordination of outpatient treatment
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5
Q

Inpatient Psychiatry: OT Assesses for

A
  • Cognitive impairments that affect function
  • Coping skills (stressors, symptoms, coping strategies, values, routines)
  • Sensory processing challenges that affect function
  • Social and communication skills
  • Patient’s goals for hospitalization
  • Use the COPM
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6
Q

Inpatient Psychiatry: Groups vs 1:1

A
  • need to maximize use of time, cannot see everyone one on one
    Prioritize people for 1:1 sessions:
  • Identified as high risk for seclusion or restraint
  • Actively experiencing distressing symptoms such as urges to self-injure, PTSD symptoms such as flashbacks, hallucinations, agitation, suicidal thoughts, panic attacks
  • Assessment of home safety indicated
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7
Q

Inpatient Psychiatry: OT Assessment and Intervention

A
  1. Home Safety Evaluation: MET, EFPT, skilled observation of ADLs
  2. Sensory Modulation: educate on strategies to use in and out of the hospital
  3. Health and Wellness: coping, communication, reconnect with meaningful occupations, organize and establish routines, wellness recovery action plan/crisis management plan
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8
Q

Client Process Through Mental Health System

A
  1. Emergency dept, urgent care center
  2. acute inpatient psychiatric unit, crisis stabilization unit
  3. residential program, state hospital
  4. partial hospitalization program, intensive outpatient program, psychiatric vna, homeless shelter, supportive housing
    - group homes: supervised, partially supervised
    - outpatient supports: psychiatrist, therapist, psychologist, CBFS worker, rehabilitation
    - peer supports: clubhouse, support groups, recovery learning community
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9
Q

CBFS workers

A
  • community based flexible support

- i think this is a massachusetts thing

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10
Q

Legal Status

A
  • Conditional Voluntary Admission
  • Involuntary Admission
  • Commitment
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11
Q

Being Committed means…

A
  • assisted outpatient treatment
  • – lots of support services given outside of the hospital
  • home, supported housing to transition between residences, shelter
  • does not always mean going to a state hospital
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12
Q

Case Study: Sue is a 32 y/o young woman with acquired brain injury & h/o depression, admitted from MGH neurology service for ongoing electroconvulsive therapy to treat catatonia. She presents with cognitive impairments (attention, memory, problem solving, sequencing/organization) , self injurious behaviors (biting self, scratching self with objects) and suicidal thoughts (stating she wants to die).
Interests: Sue has a BS in elementary education and previously enjoyed working as a teacher in a preschool. She enjoys volunteering in her community, crafts (crochet, artwork), and spending time with her nephews (ages 3 & 5) and family.

A
  • IDK
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13
Q

Case Study: Sally is a 65 y/o woman with schizoaffective disorder and multiple prior admissions who was brought in by staff at the shelter where she resides on a section 12 due to symptoms of decompensation, including being verbally aggressive/threatening, dressing provocatively, using racial slurs, and making false accusations about staff. She was offered a conditional voluntary, but refused to sign. She reports a history of PTSD due to trauma. She presents with aggressive behaviors including yelling, spitting, and throwing objects, resulting in her being restrained.
Interests: Sally previously worked as a hairdresser, and is interested in fashion and makeup. She loves listening to music (KISS 108, Musicals) and dreams of traveling. She has a granddaughter whom she loves dearly.

A
  • IDK
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14
Q

Restraint

A
  • is any manual method, physical or mechanical device, or medication that immobilizes or reduces the ability of a person to move his or her arms, legs, body, or head freely.
  • Mechanical: using a device
  • Physical: holding the person
  • Restraints can result psychological and physical harm to staff and patient, re-traumatizing
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15
Q

Seclusion

A
  • is the involuntary confinement of a person alone in a room or area from which the person is physically prevented from leaving.
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16
Q

Core Strategies to Reduce Restraint and Seclusion

A

(1) Leadership toward organizational change
(2) Use of data to inform practice
(3) Workforce development
(4) Full including of individuals and their families
(5) Use of seclusion and restraint reduction tools, including environment of care and the use of sensory modulation
(6) Rigorous debriefing after events in which seclusion and restraint might have been used

17
Q

(A) Trauma Informed vs. (B) Non-Trauma Informed Care

  1. Recognition
  2. Assessment
  3. Hospital Culture
A
  1. Recognition: A - high prevalence of trauma. B - ignorance
  2. Assessment: A - find out if history of trauma. B- don’t ask
  3. Hospital Culture: A - recognize practices that retraumatize people. B- tradition of toughness
18
Q

(A) Trauma Informed vs. (B) Non-Trauma Informed Care

  1. Power/Control
  2. Role of Staff
  3. Blame
A
  1. Power/Control: A - minimized. B - keys, security, staff demeanor and tone of voice
  2. Role of Staff: A - caregivers/supporters = collaboration. B - rule enforcers = compliance
  3. Blame: A - violence/conflict arise from situational factors. B - patient blaming is the norm
19
Q

(A) Trauma Informed vs. (B) Non-Trauma Informed Care

  1. Behavior
  2. Language
  3. Center of Treatment
A
  1. Behavior: A - all behavior has meaning. B - behavior seen as intentionally provocative
  2. Language: A - neutral language. B - labeling language as manipulative, attention-seeking, needy
  3. Center: A - consumer, focus on education, self-management. B - lack of self-directed care, over-reliance on medication
20
Q

Trauma Informed Care - Intervention

A
  • Identify Triggers
  • Identify Early Warning Signs of Distress
  • Identify Calming Strategies
  • – Distraction (I.e. puzzle, art)
  • – Sensory (I.e. weighted blanket, listen to music, cold)
  • – Support (I.e. talk to RN)
  • – Environment
  • Ensure understanding by all members of treatment team
21
Q

Understanding Episodes of Distress

A

Trigger –> Warning Signs of Distress –> Crisis Behaviors

22
Q

Universal Triggers

A
  • enforcing a rule

- being told no

23
Q

Understanding Episodes of Distress:

  1. Proactive Approach
  2. Reactive Approach
A
  1. preventing triggers, or intervening when you see warning signs
    - understanding and recognizing warning signs allows you to intervene early and prevent a crisis
  2. intervening after challenging behaviors occur during a crisis
24
Q

Crisis Intervention and Safety Plan

A
  • make a plan of what to do to prevent crisis before it occurs
  • staff is prepared with strategies and knows what to do
  • individualized
25
Q

Case Study: Gary is a 33 y/o man with Asperger’s Syndrome, OCD, and depression who was brought in by ambulance. He had been discharged from a state hospital ~10 days prior, and had left his group home after becoming upset about rules and restrictions. He had called 9-1-1 in distress because he was stranded in the cold and had no money to return to his group home. He felt EMS was angry and mistreated him, and so he threw himself in front of the ambulance, which resulted in him being restrained on the way to the hospital. He also presents with self injurious behaviors including head banging, aggressive behavior with objects, threatening posture when in distress, and h/o self injury by cutting. He has a h/o of jail time due to aggressive behavior.
Interests: Gary identified exercise as his primary leisure (push-ups, sit-ups, basketball). One of his goals and values is to have a romantic relationship and a family.

A
  • Lower adrenaline levels –> sensory modulation, coping strategies –> de-escalate, bring back to a calm state where he can think clearly –> give time for the adrenaline to leave his system
  • — use exercise since that is something he enjoys
  • Work on developing a plan of coping strategies with him
  • – help him to identify triggers and warning signs
  • – write out what he can do to prevent crisis
  • Communication - what is a better way to communicate frustration/hurt than throwing yourself in front of the ambulance?
  • Refer to outpatient services who can provide further assistance on a regular basis since not everything can be hashed out in the hospital and coping strategies plan will need adjusting as life changes

Context Final (5 decks)

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