Exam 1 Flashcards
successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity
mental health
a clinical significant behavioral or psychological syndrome experienced by a person and marked by distress, disability, or the risk of suffering disability or loss of freedom
mental illness
fact or myth: mentally healthy people are always logical, rational, and in control
myth. even mentally healthy people have off days
is there a line that separates mental illness and mental health?
no, no obvious consistent line exists between mental illness and mental health. mental health is a continuum in which all behavior falls on a line between mental health and mental illness.
what are the three types of influences on mental health?
biological influences, psychological influences, and sociocultural influences
influences on mental health that come from the perinatal period, are anatomical, could include injuries to the brain
biological influences
influences on mental health that include self concept, developmental stages, relationships in childhood and adulthood, and traumatic events
psychological influences
influences on mental health that include drugs, home-environment, housing, school, religion, poverty, etc
sociocultural influences
what is the most accepted explanation for mental illness?
the diathesis stress model
what is the diathesis-stress model?
diathesis - biological predisposition
stress - environmental stress or trauma
says that there is a combination of genetic vulnerability and negative environmental stressors for everyone.
someone may always carry the trait for a mental illness, but never encounter the stressors in life that would cause that mental illness to come out
what is our number one priority when treating patients?
the patient’s safety
are people always incapacitated by their mental illnesses?
no, they may have a diagnosis but not be incapacitated by it. it may be no different than a physical illness in terms of the need for coping strategies
what are some problems with treating mental illness?
cost, stigma, revolving door treatment, lack of parity (equality with health care), limited access to services
why is stigma a major barrier to mental health treatment and recovery?
because the stigmatizing attitude toward individuals who are mentally ill has bad effects on the person who is being treated
what is a stigma?
a collection of negative attitudes, beliefs, thoughts, and behaviors that influence the individual and general public
what are some of the psychosocial processes that lead to stigmatization?
stereotyping, labeling, separating, and status loss or discrimination in a context of power imbalance, social isolation, and reduced opportunities.
what are the responsibilities of an RN with the treatment of a mental illness?
assessment of functioning, case management, medication design and management, medication administration and teaching, crisis intervention, supportive counseling
leader that takes control. ‘my way or the highway’ leader.
autocratic leader
leader who likes the group to reach a consensus. focuses on collaborative processes
democratic leader
hands-off leader. allows the group to reach a consensus with little input
laissez-faire leader
manifest communication
what is actually said; verbal communication
latent communication
emotional undercurrent of things being said. body language and tone
what are the phases of group development?
orientation, working, termination
what types of groups can a basic-level RN lead?
psychoeducational groups, medication-education groups, health education groups, symptom management groups, stress management groups, support and self help groups. As a RN leader, if someone wants to get some feelings off their chest you can let them, but you are not their to delve into their past
how do you deal with a monopolizing member of a group?
recognize what they have said, but redirect them back to the topic. remind them that other people need a chance to talk
what should you do with a demoralizing member of a group?
you may need to pull them out in the middle of the group and talk to them individually, and if that doesn’t work, they may need a different group or group therapy may not be for them
what should you do with the silent member of a group?
try to give them an opening where they can talk, but realize that they may not want to speak. some people benefit more by just listening to someone else talk.
a fundamental goal of psychiatric care is to strike a balance between…
the rights of the individual patient and the rights of society at large
is it okay to allow ethical guidelines to override laws?
no
personal beliefs about the worth of a given idea, attitude, custom, or object that set standards that influence behavior
values
study of philosophical beliefs about what is considered right or wrong in society
ethics
ethical questions arising in health care
bioethics
what four things do the professional nursing code of ethics include?
advocacy, responsibility, accountability, and confidentiality
what are the principles of bioethics?
beneficence, autonomy, justice, fidelity, veracity
beneficence
doing good for the patient
autonomy
respecting the rights of others to make their own decisions
justice
distributing care equally
fidelity
faithfulness, maintaining loyalty to the patient
veracity
maintaining truthfulness
where do the three sources of legal guidelines that set the limits of nursing come from?
statutory law, regulatory law, and common law
laws that come from nurses - Nurse Practice Act
statutory law
laws that come from cases that have occurred before
common law (judicial law)
laws that come from government agencies
regulatory law (administrative law)
legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care
standards of care
where does the best known standards of care come from?
the american nurses association
what are the civil rights mental health laws
people with mental illness are guaranteed the same rights under federal/state laws as any other citizen
In most states, a patient can be admitted against their will for a period of how many hours?
72
can a person be made to stay involuntarily after they have been in a facility for longer than 72 hours?
yes, if there is an order from a judge. otherwise, we have to let them go
can a patient repeal if they are made to stay in a facility involuntarily?
yes, they have the right to get representation and appear before the judge
can people voluntarily admit themselves?
yes
what are due processes in civil commitment?
the courts have recognized involuntary commitment to mental hospital is “massive curtailment of liberty” requiring due process protection
when a patient is released from the hospital, but they still have to come back for some sort of treatment or make follow-up appointments
conditional release
when a patient is free to leave the facility and no further treatment is required
unconditional release
what are the rights of the patient?
right to treatment, right to refuse treatment, right to informed consent (based on right to self-determination), implied consent, rights regarding restraints and seclusions
what are the patients rights regarding restraints and seclusions?
they have a right to the least restrictive means of restraint for the shortest time. legislation provides strict guidelines on this.
what does the “duty to warn” do?
protects people when there is a breach in patient confidentiality because it keeps the patient or others safe. it states that if a patient has threatened to harm someone, you must warn the person that the patient has threatened
what should you do after you have warned someone during your “duty to warn”
document that you have done so
an act or an omission to act that breaches the duty of due care and results in or is responsible for a patient’s injuries
negligence/malpractice
what are the elements necessary to prove malpractice?
you must have a duty to that patient, there must be a breach in duty, you have to prove that the patient would be okay if it wasn’t for what you did or didn’t do
how are the standards of care of nurses determined?
nurses are held to standards of care provided by other nurses possessing the same degree of skill or knowledge in same or similar circumstances
do we want to solve a patient’s problems for them?
no, we are there ot help them solve their problems, not solve them for them
what are the goals of groups?
facilitate communication of distressing thoughts and feelings, assist patients with problem-solving, help patient examine self-defeating behaviors and test alternatives, promote self-care and independence
are social relationships appropriate for nurse-patient relationships?
no, they are initiated for the purpose of friendship or meeting a goal. we want to focus on therapeutic relationships. focus on the patient, not the nurse.
what things are done during a therapeutic relationship?
problem-solving approaches are taken, new coping skill are developed, behavioral change is encouraged
what are the necessary behaviors for nurses to maintain a therapeutic relationship?
accountable for your actions and what you say, focus on patient’s needs, if you say you are competent you need to make sure that you are, delay judgement
should you try to please your patient in a therapeutic relationship?
no, that is blurring the boundaries of a therapeutic relationship. if you feel like you are, you might need to step back and reevaluate
what is the difference between transference and counter transference?
transference is when the patient uncousciously displaces onto the nurse feelings and behaviors related to significant figures in the patient’s past. counter transference is the opposite, when the nurse puts feelings of significant figures in the nurse’s past onto the patient.
state of complete physical, mental, and social well-being
health
what is the therapeutic use of self?
the idea that you can use yourself as a tool because of your vialues and beliefs
what things occur in the orientation phase of the nurse-patient relationship?
establish rapport and the parameters of the relationship. you let them know what is expected of them while they are on the unit and what they can expect. confidentiality. terms of termination - when their possible discharge time will be. during this time, you are establishing a structure for them.
what things occur during the working phase of a nurse-patient relationship?
maintain a relationship. you gather further data. promote patient problem-solving skills and self esteem. explore problems and guide them to identify and solve those problems. patients may test you at first. facilitate behavioral change. overcome resistant behaviors. evaluate problems and goals. promote practice and expression of alternative adaptive behaviors.
what occurs during the termination phase of the nurse-patient relationship?
when the patient is leaving. summarize goals and objectives achieved. discuss ways for the patient to incorporate new coping strategies learned. exchange memories. formal discarge. if a patient has become dependent they may act out so they don’t have to leave.
what are some factors that can aid in the nurse-patient relationship?
consistency, setting a neutral pace (you want an eb and flow with the discussion), listening, go in with a neutral attitude and try to make a good impression on the patient, promote patient comfort and balance control (don’t let them dominate the conversation, but allow them to speak some-what freely)
when we are trying to understand what the patient is feeling and where they are coming from we are displaying…
empathy
when we are feeling sorry for our patients we are displaying…
sympathy. we don’t want to do this. we want to have empathy, not sympathy.
what is the best way to start an interview with a new patient?
ask them an open-ended question like what brought them to the hospital.
what are the three types of factors that affect communication?
personal factors, environmental factosrs, and relationship factors
factors that affect communication that include beliefs, mood, attitudes, cognitive factors, intellectual ability, previous experiences, cultural background, etc
personal factos
what type of expression should you have on your face when conversing with a patient?
a neutral expression
what are double-bind messages?
saying one thing when you really mean something else
how does using silence help communication?
it can allow the patient to gather their thoughts and think about things
what does reflecting do?
it redirects he patients thoughts and feelings and emotions back to them
what should you do when a patient is experiencing altered reality?
present reality to the patient. try to tell them that you don’t hear/see what they do, but let them know that you know it is real to them. orient them and address the emotion. do not argue with the patient.
is excessive questioning helpful?
no
should you give approval or disapproval to the patient?
no. if you give approval, you are saying that what they think or feel is good and that the opposite is bad. disapproval causes the patient to become defensive and shut down?
what is anxiety?
a feeling of apprehension, uneasiness, uncertainty, or dread which results from a real or a percieved threat
do people with anxiety calm down after the threat resolves?
no, they stay in a constant state of arousal and don’t calm down even after the threat resolves.
a reaction to a real, specific threat that usually resolves after the situation resolves
fear
anxiety that is temporarily raised because of some sort of outside factor.
acute or state anxiety. can be a good thing like when it drives you to study.
anxiety that is a normal thing for some patients. anxiety disorders tend to develop in patients that have this.
chronic or trait anxiety
what is the difference between normal and abnormal anxiety?
normal is a healthy reaction needed for survival because it motivates us. abnormal is pathological anxiety because it affects the person’s function in daily life.
level of anxiety in which the person has a hightened perception and sensory awareness. they are able to see, hear, and grasp more informatoin.
mild anxiety
level of anxiety in which a person’s perception field will narrow. they will not be able to see, hear, or grasp as much information.
moderate anxiety
anxiety level in which the patient has improved concentration and problem-solving abilities. there will be no changes in verbal ability, but they may have some fidgeting.
mild anxiety
level of anxiety in which the patient will block out unwanted stimuli so that they can focus on things that are worrying them. the patient cannot think as clearly, and are able to problem-solve, but not optimally. they may have tremors in their voice or a change in vocal pitch.
moderate anxiety
you are about to take a test. you begin to get a headache and notice that you have been clenching your jaw while you wait for the test to start. you can feel your heart pounding and you seem to be breathing faster than normal. what level of anxiety are you feeling?
moderate anxiety
level of anxiety in which a person’s perception is greatly reduced. they have trouble processing what is going on around them and learning and problem solving are pretty well impossible. they have loud, rapid speech. they may get light headed or start to hyperventilate and are tachycardic.
severe anxiety
level of anxiety in which the person cannot perceive or process anything and they may start to lose touch with reality and start to hallucinate. cognition is impossible. if they can speak, it is usually unintelligible and they are usually frozen or they are unable to stop moving
panic
why is it good to know what level of anxiety a patient is experiencing?
because then you know how to better treat the patient
what can you do to drain tension on someone with severe to panic mode anxiety?
you can try gross motor activity. if they can’t sit still maybe have them walk up and down the hallway. be careful not to let them get exhausted though
how should you address someone with severe or panic mode anxiety?
be more simple and direct. use close-ended questions
group of conditions in which the affected person experiences persistent anxiety that he/she cannot dismiss and that interferes with daily activities
anxiety disorders
how do people with anxiety disorders feel?
like the core of their personality is being threatened, even when no actual danger exists
what is the most common type of mental health disorder?
anxiety disorders
how do people with anxiety disorders control their anxiety?
with rigid, repetitive, and ineffective behaviors
chronic excessive worry that lasts for more days than for not (6+ months)
generalized anxiety disorder
what things can continued high anxiety cause?
restlessness, iritability, fatigue, depression, poor concentration, sleep disturbances, helplessness
persistent, irrational fear of an object, activity or situation that does not pose a significant danger. contact with the object (or thought of)can cause severe anxiety
phobia
fear of being trapped into an unbearable situation in which the person cannot escape
agoraphobia
discrete period of intense anxiety/terror without a real, accompanying danger
panic attack
what are some of the symptoms of a panic attack?
palpitations, tachycardia, sweating, shaking, shortness of air, choking sensation, upset stomach/nausea, light headed/dizziness, chest pain or discomfort, tingly/faint feeling, derealization, depersonalization, feeling of losing control or dying, chills or hot flashes
how long do panic attacks usually last?
5-20 minutes
what is a panic attack often mistaken for?
a heart attack
recurrent panic attacks with no cause, and a month or more concern about future attacks and consequences
panic disorder
what can the constant worry of having another panic attack lead to?
behavioral changes and another attack
what might accompany panic disorder?
agoraphobia
recurrent intrusive ideas, thoughts, and impulses
obsessions
do people with OCD realize that there thoughts are irrational?
yes, but they cannot control it
ritualistic behaviors that people participate in to control their thoughts
compulsions
what are the three stages of Freud’s personality structure?
ID, ego, and superego
Freudian theory: focuses on something that gratifies us (on getting what we want), natural way to respond, reflex action, primary process, most primitive personality structure
ID
Freudian theory: problem solver, reality tester, this is usually what we project as our personality
ego
moral component of Freud’s personality structure
superego
what are the three levels of awareness and what is each?
conscious - things that are in our current awareness
preconscious - things that we can bring to the surface pretty easily
unconscious - things that are buried deep within our awareness
what are Erikson’s 8 stages of development?
trust vs mistrust; autonomy vs shame/doubt; initiative vs guilt; industry vs inferiority; identity vs role confusion; intamacy and solidarity vs isolation; generativity vs self-absorption; integrity vs despair
says that early interpersonal relationships are crucial for personality development - anxiety is an interpersonal phenomenon - and that all behavior is aimed at avoiding anxiety and threats to self esteem
interpersonal theory - Sullivan
what is the goal of interpersonal therapy?
to guide and challenge maladaptive behavior with emphasis on relationship issues. the therapist is the “participant observer”.
what is the concept of interpersonal therapy?
awareness of dysfunctional patterns leads to changes in behavior
what does Peplau say is the art of nursing?
providing care, compassion, and advocacy. Enhancing comfort and well-being
what does Peplau say the science of nursing is?
apply knowledge to understand the broad range of human problems and psychosocial phenomena and to intervene in relieving patient’s suffering and promote growth
“the mother of psychiatric nursing’
Hildegard Peplau
what are the general principles of behavior therapy?
conditioning, reinforcement, punishment, generalization and discrimination, modeling and shaping, appplied behavior analysis, lots of empirical evidence
what is the difference between generalization and discrimination?
generalization is learning from a broad category based on one event while discrimination is learning from one specific category based on one event. (the dog example)
what is the difference between modeling and shaping?
as the nurse, we try to model good behavior to the patient. we try to teach the patient little by little and shape their behavior.
systematic desensitization
expose patients slowly, overtime, to what they are afraid of and pair that with some sort of relaxation excercise to slowly make them less afraid
aversion therapy
more aggressive behavioral therapy that is more focused on keeping a patient from doing something because it has negative consequences
