Exam 1 Flashcards
Mental Health is a state of ____________ in which each individual is able to realize his or her own _________, cope with the normal ________ of ________, work _________, and make a _________ to the _________.
Well-being, potential, stressors, life, productively, contribution, community
A state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community
Mental Health
Refers to all mental disorders with definable diagnosis.
Mental Illness
Mental illnesses are manifested in significant dysfunction that may be related to ______, ________, or _______ disturbances in mental functioning.
Developmental, biological, psychological
The ability and capacity for people to secure the resources they need to support their well-being.
Resilience
_________ is essential to the recovery process.
Resilience.
Behavior that deviates from socially accepted norms does not indicate mental illness unless there is significant ______ in _________ ________.
Disturbance in mental functioning.
Recognizing feelings of stress, readily dealing with them, and earning from the experience rather than falling victim to negative emotions.
Resilience
______ defines mental health as going against a norm decided by that particular group.
Culture
Drug found to have a calming effect on agitated, out of control patients that was a breakthrough in viewing mental illness as having physical symptoms.
Thorazine (chlorpromazine)
NAMI
National Alliance on Mental Illness, a group for people with mental illness and their families
Diathesis-stress model
The most accepted explanation for mental illness
Diathesis represents biological disposition
Stress represents environmental stress or trauma
_____ % of all Americans will suffer from some type of mental disorder during their lifetime.
46
More than ___% of disability is due to ________.
30, Depression
QSEN Competencies:
- Patient centered care
- Teamwork and collaboration
- Evidence based practice
- Quality improvement
- Safety
- Informatics
The quantitative study of the distribution of mental disorders in human populations
Epidemiology
Refers to the number of NEW CASES of mental disorder in a healthy population in a given period of time.
Incidence
Describes the TOTAL NUMBER OF CASES, new and existing, in a given population during a specific period of time (regardless of when they became ill).
Prevalence
Diseases with short duration (common cold) have a high ____ and low _____.
Incidence, prevalence
Chronic diseases have a low ____, and a high____.
Incidence, prevalence.
A broad field that examines health and illness at the population level.
Clinical epidemiology
DSM-5
Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
Official medical guidelines for diagnosing psychiatric disorders
*classifies disorders not people!
ICD-9-CM
International Classification of Diseases
Clinical descriptions of mental and behavior disorders
Psychiatric mental health nursing employs a purposeful ___ of ______ as its art and a wide range of nursing, psychosocial, and neurobiological _______ and research ______ as its science, work with people throughout the _____ ______, and employed in a _____ of settings.
use of self, theories, evidence, life span, variety
Promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders.
Psychiatric mental health nursing
Nurses work in various supervised settings and perform roles such as staff nurse, case manager, home care nurse.
Basic Level
Nurse specialists trained to provide individual therapy, group therapy, and provide training for other staff. Have diagnostic privileges, prescriptive authority, and permission to engage in psychotherapy.
Advanced Practice
Sensitivity to different cultural view regarding health, illness, and response to treatment
Cultural competence
Future challenges and roles for psychiatric mental health nurses: (5)
Educational Aging population Cultural diversity Science, technology and Electronic health care Legislative involvement
Freud believed that a vast majority of mental disorders were due to unresolved issues that originated in ______.
Childhood
Cathartic method
Talk therapy developed by freud. Includes free association (full disclosure and honesty)
All material a person is aware of at any one time including perceptions, memories, thoughts, fantasies, and feelings.
Conscious
Material that can be retrieved rather easily through conscious effort.
Preconscious
All repressed memories, passions, and unacceptable urges lying deep below the surface. May be placed here because individuals find the memories to painful to deal with.
Unconscious
The source of all drives, instincts, reflexes, needs, genetic inheritance, and the capacity to respond.
Id
Lacks the ability to problem solve, is not logical, and operates according to the pleasure principle.
id
The problem solver ad reality tester.
Ego
Able to differentiate subjective experiences, memory images, and objective reality and attempts to negotiate the outside world.
Ego
Represents the moral component of personality
Superego
Represents the ideal rather than the real, seeks perfection as opposed to seeking pleasure or engaging in reason
Superego
Developed by the go to ward off anxiety by preventing conscious awareness of threatening feelings.
Defense mechanisms
Two common features of defense mechanisms
- They all (except suppression) operate on an unconscious level
- Deny, falsify, or distort reality to make it less threatening
Freud’s psychosexual Stages of development
Oral (0-1) Anal (1-3) Phallic (3-6) Latency (6- 12) Genital (12+)
This model helps determine which types of interventions will be effective in nursing.
Erikson’s developmental theory
Erikson’s developmental stage- Age 0-1.5 yrs:
Trust vs. Mistrust
Erikson’s developmental stage- 1.5- 3yrs:
Autonomy vs. Shame/Doubt
Erikson’s developmental stage- 3- 6yrs:
Initiative vs. guilt
Erikson’s developmental stage- 6-12yrs:
Industry vs Inferiority
Erikson’s developmental stage- 12- 20yrs:
Identity vs. Role confusion
Erikson’s developmental stage- 20- 35yrs:
Intimacy vs isolation
Erikson’s developmental stage- 35- 65yrs:
Generatively vs. Self-absorption
Erikson’s developmental stage- 65yrs+:
Integrity vs. Despair
This theorist stated that the purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety.
Henry Sullivan
Measures the individual employs to reduce anxiety and enhance security
Security Operations (coined by Henry Sullivan)
Term which states that a professional helper cannot be isolated from the therapeutic situation if they are to be effective.
Participant observer
Established the foundation for the professional practice of psychiatric nursing.
Peplau
Therapy used to reduce or eliminate psychiatric symptoms (depression) by improving interpersonal functioning and satisfaction with social relationships. Includes Identifying the Nature of the problem
Interpersonal psychotherapy
Four types of problem areas (nature of problems) in Interpersonal psychotherapy:
Grief
Role disputes
Role transition
Interpersonal deficit
Peplau stated self-awareness is part of nursing and that nursing had two parts: the ____ component consisting of care, compassion, and advocacy and the _____ that involves application of knowledge.
art, science
______ described three levels of anxiety: _______, _______, and _____.
Peplau, Mild, moderate, panic
Pavlov described ______ ________ by using dogs and food and stated that this behavior was _______.
Classic conditioning, Involuntary
Involves pairing a behavior with a condition that reinforces or diminishes the behaviors occurrence.
Conditioning
Watson developed a school of thought called ______ using an experiment with Little Albert and stated that one could control the ______ to mold behavior.
behaviorism, environment
Skinner researched ______ ________ and stated ________ behaviors are learned through ________, either positive or negative.
operant conditioning, voluntary, reinforcement.
Modeling, Operant conditioning, systemic desensitization, aversion therapy, and biofeedback are all types of _____ therapy and work best when directed at a ____ _____ and when _____ are well defined.
Behavior, specific problem, goals
Operant conditioning is a type of behavior therapy taht uses positive reinforcement to elicit desired behaviors such as in the reward system known as _______ ________.
Token Economy
Involves the development of behavior tasks customized to the patient’s specific fears. Integrates learned relaxation techniques.
Systematic Desensitization
This behavior therapy is akin to bunishement.
Aversion therapy
Proposes a dynamic interplay between individuals and the environment, that thoughts come before feelings and actions, and thoughts about the world are based on ones own perspective despite reality.
Cognitive Theories (Beck, Ellis)
Developed by Ellis, aim to eradicate core irrational beliefs by helping people recognize thoughts that are not accurate, sensible or useful.
REBT- Rational-Emotive Behavior Therapy
A therapeutic tool used to change the way individuals think and therefore change behaviors and reduce symptoms
CBT- Cognitive-behavioral therapy (Beck)
Unique assumptions that a person has about oneself. Can be negative or positive.
Schemas (Beck)
Theory of self-actualization
Maslow’s Hierarchy of needs
Maslow’s hierarchy of needs:
Physiological Safety Belonging/Love Esteem Self-actualization
Emphasized on the human potential and the patient’s strength as the key to a successful nurse-patient relationship.
Maslow
Model that focuses on neurological, chemical, biological, and genetic issues and seeks to understand how the body and brain interact to create emotions, memories and perceptual experiences.
Biological Model
Use of the total environment to treat patients.
Milieu therapy
Milieu recognizes the ____, the _____, the _____, and the ______ climate as important to healing.
people, setting, structure, emotional
Sense of responsibility, shame, and being flawed associated with a disorder.
Stigma
Deterioration of mental health
Decompensation
Outpatient or Inpatient: Primary Care Community Clinic Assertive Community Treatment (ACT) Milieu Psychosocial rehabilitation Patient-centered health/Medical homes
All but Milieu are outpatient
When selecting a facility in which to obtain treatment, the ____ _____ _____, or setting that provides the necessary care allowing the greatest personal freedom is very important.
Least restrictive environment
Type of prevention that screens for predisposal to mental illness and taking action to prevent it. Helps “at risk” individuals from developing an illness.
Primary
Type of prevention that identifies and treats illness promptly to prevent worsening of illness.
Secondary prevention
Type of prevention such as rehabilitation that prevents serious complications of established illnesses
Tertiary prevention
Admission criteria for Impatient psychiatric care:
1-Imminent danger of harming self
2-Imminent danger of harming others
3-Unable to care for basic needs and/or gross impairment of judgement that places the individual at imminent risk based on inability to protect oneself.
Moves the individual beyond stabilization toward recovery and a higher quality of life
Psychosocial rehabilitation (community-based program)
Comprises of the shared beliefs, values and practices that guide a group’s members in patterned ways of thinking and acting.
Culture
Connected with economic and social standing in society more than with cultural identity.
Minority status
Groups that have a common heritage and history.
Ethnicity
A system for thinking about how the world works and how people should act.
Worldview
In Psychiatric mental health nursing we should focus on _____ rather than _____.
Culture, race
In Western tradition, one’s identity is found in one’s _______, which inspires the valuing of _____, independence, and self-reliance. ____ and _____ are seen as two separate entities.
Individuality, autonomy, Mind, Body
In Eastern tradition, ______ is the basis of one’s identity, leading to interdependence and group decision making. ____-______-______ are seen as a single entity.
Family, Body, Mind, Spirit
Places significance on humans in the natural world.
Indigenous culture
The culture’s worldview, beliefs, values, and practices transmitted to its members.
Enculturation
Differences outside the range of normal in a culture are viewed as….
Mental illness
The universal tendency of humans to think their way of thinking and behaving is the only correct and natural way.
Ethnocentrism
Imposing cultural norms on members of other cultural groups.
Cultural imposition
Populations at risk of mental illness and inadequate care:
Immigrants
Refugees
Cultural minorities.
Five steps to becoming culturally competent:
Cultural awareness Cultural knowledge Cultural encounters Cultural skill Cultural desire
Involves examining beliefs, values, and practices of one’s own culture.
Cultural awareness
Three cultures that intersect during a cultural encounter:
Culture of patient
Culture of nurse
Culture of setting
Learning by attending cultural events and programs, forging friendships with diverse cultural groups, and studying to help establish rapport, ask culturally relevant questions, and identify cultural variables to be considered.
Cultural knowledge
Deters nurses form stereotyping, helps nurses gain confidence in cross-cultural interactions, and helps nurses avoid or reduce cultural pain.
Cultural encounters
Ability to perform a cultural assessment in a sensitive way to achieve a mutually agreeable plan of care.
Cultural skill
Cultural skill involves three outcomes for planning:
Cultural preservation/maintenance
Cultural accommodation/negotiation
cultural re patterning/restructuring
Genuine concern for a patient’s welfare, willingness to listen until a patient’s viewpoint is understood, and utilizing patience, consideration and empathy.
Cultural desire
The study of philosophical beliefs about what is considered right or wrong in society.
Ethics
The duty to act to benefit or promote the good of others.
Beneficence
Respecting the rights of others to make their own decisions
Autonomy
The duty to distribute resources or care equally, regardless of personal attributes
Justice
Maintaining loyalty and commitment to the patienta nd doing no wrong to the patient
Fidelity/nonmaleficence
One’s duty to communicate truthfully
Veracity
Conflict between two or more courses of action, each with favorable and unfavorable consequences
Ethical dilemma
Temporary admission is used for 2 reasons:
- People who are confused or demented and cannot make decisions on their own
- People who are so ill they need emergency admission
When a patient (or guardian) applies in writing for admission to the facility
Voluntary
Admission to a facility without the patient’s consent.
Involuntary admission
Usually requires outpatient treatment for a specified period to determine the patient’s adherence with medication protocols, ability to meet basic needs, and ability to reintegrate into the community.
Conditional release
The termination of a patient-institution relationship
Unconditional release
Treatment seems beneficial but there is no compelling reason to seek an involuntary continuance of stay.
Release against medical advice (AMA)
Confining a patient alone in an area or rom and preventing the patient from leaving.
Seclusion
Is this seclusion:
Person restrained in an open room?
Patient in unlocked room but will be punished if they leave?
No, Yes
Exceptions to confidentiality:
Duty to warn and protect third parties
Child and elder abuse reporting
Injury to a person, property, or reputation.
Tort
Intentional torts:
Assault (Threats to physically injure) Battery (Physically injuring) False imprisonment Invasion of Privacy Defamation of character: Slander (verbal) Libel (printed)
Unintentional Torts:
Negligence
Malpractice
Five requirements of malpractice:
- Duty
- Breach of duty
- Cause in fact (Absence or presence of opposite action would have prevented harm)
- Proximate cause (actions/lack of action that caused harm)
- Damages
Primary sources for assessment
Patient
Secondary sources for assessment
Family, friends, neighbors, police, health care workers, medical records
Includes caretaker, interview and observation, acting, anatomically correct dolls, story telling, picture drawing, or games.
Child Assessment
Involves disclosing confidentiality, as it is important to this age group, and use of HEADSSS interview technique.
Adolescent assessment
Takes into consideration any physical limitations, sensory conditions, motor conditions, or medical conditions and accommodates to them.
Older Adult assessment
Interpreter vs Translator:
Interpreter interprets patients words and inserts his/her own understanding while a translator avoids this.
Gives subjective data that focuses on the patient’s perceptions and recollections of current lifestyle and life in general
Psychosocial Assessment
Aids in collecting objective data such as a patient’s behavior, nonverbal communication, appearance, speech patterns, mood, thought content, perceptions, and cognitive ability.
MSE- Mental Status Examination
Refers to memory from years ago
Remote memory
Refers to memories recently such as yesterday or last week.
Recent memory
Refers to memories from now such as 5 minutes ago or 20 minutes ago
Immediate
Three dimensions of spirituality:
Cognitive
Experiential
Behavioral
Standardized outcomes that provide a mechanism for communicating the effect of nursing interventions on the well-being of patients, families, and communities. Has an associated group of indicators used to determine patient status in relation to the outcome
NOC- Nursing Outcomes Classification
Principles when planning care: (4)
Safe
Compatible/Appropriate
Realistic/Individualized
Evidence-based
Research-based standardized listing of interventions reflective of current clinical practices the nurse can use to plan care.
NIC- Nursing Interventions Classification
5 Basic Level Interventions:
Coordination of Care Health teaching and promotion Milieu therapy Pharmacological, biological, and integrative therapies Use of therapeutic relationship
Advanced Practice Interventions:
Prescriptive authority and treatment
Psychotherapy
Consultation
Use of personality consciously and i full awareness to attempt to establish relatedness and to structure nursing interventions is the ______ ____ ___ ______
Therapeutic use of self.
Social relationships meet ______ needs and communication is _______.
Mutual, Superficial
Therapeutic relationship meet ______ needs, _____ are established, _______-______ approaches are taken, ______ change is encouraged, and new _____ _____ are developed.
patient’s, boundaries, problem-solving, behavioral, coping skills
Nursing behaviors at the foundation of a therapeutic nurse-patient relationship include: (5)
Accountability (Responsibility) Focus on patient's needs (Advocate) Clinical competence (EBP) Delayed judgement (avoiding ethnocentrism) Supervision (to develop competence)
A brief relationship that may be substantial, useful, and important for the patient.
Therapeutic Encounter
Three types of boundaries:
Physical
Contract
Personal space
Two circumstances in which boundaries are blurred:
- When the relationship slips into social context
2. When nurse’s needs are met at the expense of the patient’s needs
Patient unconsciously and inappropriately displaces feelings and behaviors on the nurse.
Transference
Nurse displaces feelings on the patient.
Countertransference
Four phases of the nurse-patient relationship:
- Pre-orientation phase
- Orientation phase
- Working phase
- Termination phase
Our values and beliefs are: (3)
- Reflect our own culture/subculture
- Derived from a range of choices
- Chosen for ourselves from a variety of influences and role models
Phase in nurse-patient relationship- Happens before the nurse and patient meet
Pre-orientation phase
The first time the nurse and patient meet where the nurse conducts the initial interview
Orientation phase
Includes establishing rapport, parameters of the relationship, formal/informal contract, confidentiality, and terms of termination
Orientation phase
Involves maintaining a relationship, gathering further data, promoting that patient’s problem-solving skills, self-esteem, and use of language.
Working phase
Phase in which the nurse and patient together identify and explore areas that cause problems in the patient’s life.
Working phase
Discussed during the first interview, working phase, and where the patient is discharged (or clinical ends).
Termination phase
Involves summarizing goals and objectives achieved, discussing ways for patient to incorporate new skills, and review of relationship and memories.
Termination phase
Factors that help the nurse-patient relationship (6)
Consistency Pacing Listening Initial impressions Promoting comfort Trust/participation (patient factors)
_____ is understanding the feelings of others where as ______ is feeling the feelings of others.
Empathy, Sympathy
Implies respect, Ability to view another person as being worthy of caring about and as someone who has strengths and achievement potential
Positive regard
Factors that promote patient growth
Genuineness
Empathy
Positive regard (attitudes and actions)
actions of positive regard (3):
Attending
Suspending judgements
Helping patient’s develop resources
A special kind of listening that refers to an intensity of presence or just being with the patient. Includes being there, posture, eye contact, and body language.
Attending
