Exam 1 SG Flashcards
Mental Health Promotion
Increasing public knowledge and awareness
Access to healthcare
Supporting persons, families, communities, and organizations
Support organizations that help with daily livings of others and that facilitate healthy socializations
Providing education
Mentoring
Supporting patients with defining and achieving life goals.
Reducing stigma
Mental Health Risk Factors
Biologic: genetic predisposition, age, and gender
Psychologic: difficult personality style
Sociocultural: absence of parents, abuse/neglect
Environment: exposure to toxins
Primary Prevention
Aims to prevent disease or injury before it ever occurs
Helps reduce the incidence of mental disorder (measure taken to prevent onset of illness)
i.e. stress reduction technique
Secondary Prevention
Aims to reduce the impact of a disease or injury that has already occurred.
Helps reduce the prevalence (measures that lead to early diagnosis and prompt treatment)
i.e. screening for mental illness
Tertiary Prevention
Aims to soften the impact of an ongoing illness or injury that has lasting effects.
helps reduce the residual effects of the disorder and promotes rehabilitation (measures following significant illness)
i.e. outpatient groups and family therapy.
Fundamental Objectives of Mental Health
Promotion and protection of mental health
Prevention of Mental Disorders
Treatment of Mental Disorders
Recovery and Rehabilitation
Gravely Disabled Adult
Unable to provide or use food, clothing, or shelter for themselves on the basis of mental disorder.
When the patient’s mental disorder causes harm to themselves or to others.
Therapeutic Alliance with patient
Professional bond that exists between nurse and patient.
It’s focus on patient’s need, issues, and goals
Therapeutic Alliance Goals
Allow open discussion of needs and problems free from judgment and criticism
Assist with insight into problems, expectations, abilities, and support systems
Learn and practice new skills in a safe environment
Effect life changes
Heal mental and emotional wounds
Promote growth
Principles of the nurse-patient relationship
Relationship is therapeutic rather than social (consider boundaries)
Focus on patient’s needs and problems
Relationship is purposeful and goal directed
Objective rather than subjective- When nurse act subjectively, they lose effectiveness
Time-limited versus open-ended
Objective vs Subjective
Objective remains free of bias, prejudice and personal identification during patient interactions.
Subjective places emphasis on one’s own feelings, attitudes, and opinions during patient interaction.
Empathy vs Sympathy
Empathy is ability to be genuinely aware of the patient’s emotions.
Sympathy allows nurses to act on their emotions and loses objectivity.
Reducing fear while working with the psychotic patient
Identify fear, over come it through increased insight and understanding, and to take action toward becoming effective communicators
Avoid stereotyping
Stages of nurse-client relationship
Preorientation
Orientation
Working
Termination
Preorientation Stage
Prior to meeting the patient
Gather data about the patient: condition/present situation
Autodiagnosis: addressing his or her thoughts, feelings, perceptions, and attitude about this particular patient
Orientation
Nurse and patient become acquainted, build trust and rapport.
Explain the purpose of the meeting
Dependability is important
Working Stage
Patient takes responsibility and actively engages in his or her own plan of care
Nurse must Prioritize patient’s needs
Termination Stage
Naturally occurs when the patient has improved and is discharged
Hildegard Peplau’s theoretic framework
Regarded nurse-patient relationship as central framework for therapeutic interventions.
Nurse assists patient to identify difficulties; express feelings and thoughts; explore options; and reinforce healthy coping.
Transferance
Occurs when a client projects feelings about someone else, particularly someone encountered in childhood, onto her nurse or therapist.
Countertransferance
Nurse or therapist begins to project his own unresolved conflicts onto the client.
Electroconvulsive therapy (ECT) Education
Brief electrical stimulus is applied to the brain of an unconscious patient to produce a seizure.
Useful treatment for pharmacotherapy-resistant clients with major psychotic disorder
Treatment for major depression
Informed consent required
Side effects: headache, temporary loss of recent memory.
Behavioral Therapy
Based on the premise that distorted or dysfunctional thinking causes psychological disturbances in mood and behavior.
Behavioral Therapy Goals
Help clients begin to identify automatic thoughts and their connection to feelings.
Cognitive Appraisal
Cognitive appraisal
Way in which an individual responds to and interprets stressors in life
Nursing role in therapeutic activities
Provide more availability for patient activities.
Trained professional observer that represents safety and comfort
Allows multiple disciplines to view different patient problems from different perspectives.
Boundaries with the patient
Clearly outlining the roles of the staff and the patient,
Meeting responsibilities for the achievement of treatment goals, and
Maintaining the integrity of the therapeutic milieu (social environment).
Maslow’s Hierarchy of Needs (Top to Bottom)
Self-Actualization- morality, creativity, spontaneity, fact acceptance, lack of prejudice, problem solving
Self-Esteem- confidence, achievements, respect of others, need for individuality
Love and Belonging-friendship, family, relationships,
Safety and Security - home, employment, stability,
Basic Physiologic Needs - food, water, rest, warmth, things to keep you alive everyday
Nursing Diagnosis
Statements that describe a person’s health state and responses to actual or potential problems.
Uses NANDA-I diagnosis
Actual Nursing Diagnosis
Problem or need
Etiology
Defining characteristics
Potential Nursing Diagnosis
Risk diagnosis
Risk factors as supporting factors; no etiology
Nursing Outcome
Specific, measurable indicators Derived from nursing diagnoses Projections of expected influence of nursing interventions Opposite of defining characteristics Often put in patient’s own words
Nursing Outcome Behavioral Goals (JEROM)
Justify reimbursement Ensure quality care Realistic Observable Measurable
Outcome Identification Examples
Verbalize the absence of suicidal thoughts and plans in 24 hours.
Display an absence of self-mutilating behaviors in 24 hours.
Interpret environmental stimuli accurately in 36 hours.
Contact staff when experiencing troubling thoughts and feelings in 24 hours.
Interact socially with patients and staff in 36 hours.
Bathe and dress self by 8:00 AM each day in 72 hours.
SMART goal
SPECIFIC - goals are specific and narrow for more effective planning.
MEASURABLE - define what evidence will prove you’re making progress and reevaluate when necessary
ATTAINABLE- make sure you can reasonably accomplish your goal within a certain timeframe
RELEVANT- goals should align with values and long-term objectives
TIME-BASED - set a realistic, ambitious end-date for task prioritization and motivation
Traits of Therapeutic Communication and describe each one (GET CRAP)
GENUINESS: consistent with both verbal and nonverbal behavior
EMPATHY: nurse’s ability to see things from pt’s viewpoint and to communicate this understanding to the pt.
TRUSTWORTHINESS: responsible and dependable; keep commitments and promises & consistent in approaching and responding to pt.
CLARITY nurses communicate clearly with pt who often have difficulty processing info or thinking clearly as a result of mental disorders.
RESPONSIBILITY: accountable for the outcome of professional interactions; nurse is responsible for her part in the interaction
ASSERTIVENESS: ability to express thoughts and feelings comfortable and confidently in a positive, honest, and open manner that demonstrates respect for one’s self while respecting others
POSITIVE REGARD: respect and acceptance
Therapeutic communication vs barriers to therapeutic communication
Resistance
Transference
Countertransference
Boundary Violations
Resistance as a barrier to communication
Occurs in patients who consciously or unconsciously maintain a lack of awareness of their problems to avoid anxiety.
Teach patients to overcome resistance by pointing out their progress and strengths
Boundary Violations as barrier to communication
Nurses go beyond the established therapeutic relationship standards and enter into a social or personal relationship with the patient.
Unethical and considered abuse
Nonverbal communication
Most important part of any message and composes 93% of communication.
Has to be congruent and consistent with verbal messages.
Body language
Paralinguistics
Space
Touch
Appearance
Communicating with patient with psychotic symptoms
Do not use figures of speech, jokes, cliches, colloquialisms, and other terms or special phrases also have different meanings for different groups, especially with schizophrenic patients and patients with psychosis who has loose associations.
Professional boundaries
Uses collegial communication to coworkers and therapeutic communication to patients.
Stand or position yourself at a respectful distance from the patient.
Wear appropriate clothing in a professional setting
Locus of control
Based on how different people perform a task with regard to their own sense of goal attainment.
Includes: person’s thoughts, beliefs, behaviors, aptitudes, culture and value system.
Internal Locus of Control
Something they can contribute to their success.
Tend to have better outcomes, becomes more motivated and less likely to conform to social influences.
External Locus of Control
Task completion beyond their control.
More likely to conform to social influences
Distress vs Eustress
Distress if stress that’s damaging to the individual and can be impairing.
Eustress occurs as a result of a positive event. It usually allows people to be concentrated and focus.
Physiologic response to GAS: Alarm stage
When stressor is detected, ANS tells medulla oblongata to increase blood flow to organs which increases awareness and ability to think and respond to stressors.
Blood in brain has an increase in glucose, epinephrine, and norepinephrine to assist with individual’s reaction to stressor.
Reticular formation supports coordination between sensory and motor tract.
Brain will alert the limbic-hypothalamic-pituitary-adrenal axis.
Limbic-hypothalamic-pituitary-adrenal axis
Limbic area of the brain communicates with hypothalamus that stress is occurring
Hypothalamus secretes corticotropin-releasing factor which alerts pituitary gland.
Pituitary gland secretes adrenocorticotropic hormone that lets the adrenal cortex release cortisol.
Cortisol mobilizes energy response
Resistance Stage in GAS
Body stabilizes and returns to normal.
Hormone levels return to normal
PNS activity
Adaptation to stressors.
Exhaustion Stage
Individual’s body does not adapt to stress.
Continues in alarm-stage format until body becomes exhausted and cannot sustain the changes.
Compartmentalization
Healthy defense mechanism where the person learns to leave the stressor in the designated space.
This is used a lot in patient teaching
Coping skills
Is the adaptation to internal and external stressors, the use of functional and adaptive coping mechanisms and techniques, the management of daily living and ability to solve problems associated with daily lives.
Appropriate nursing interventions for exhaustion phase of GAS
In the exhaustion phase, the body becomes exhausted keeping up with the alarm-stage format.
Manifests itself in the forms of illnesses like infections, headaches, hypertension, asthma attacks, chronic fatigue syndrome, depression, anxiety disorders and other chronic conditions. It can also cause death.
Assess the individual’s stress and the factors leading up to it.
Assess chronic conditions
Teach patients to conserve their energy and relaxing techniques.
Provide pain medications and reassess for headaches.
Ensure patients are compliant with their medications such as BP meds.
Ensure patients are getting the appropriate interventions for their infections, chronic fatigue syndrome, depression, anxiety, etc.
Disorders that could benefit from cognitive behavioral therapy.
Anxiety, Depression, Eating disorders, Panic attacks, Addictions, Anger and Phobias.
Cognitive Behavioral Therapy: Thinking Patterns Strategies
Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.
Gaining a better understanding of the behavior and motivation of others.
Using problem-solving skills to cope with difficult situations.
Learning to develop a greater sense of confidence is one’s own abilities.
Cognitive Behavioral Therapy: Behavioral Patterns Strategies
Facing one’s fears instead of avoiding them.
Using role playing to prepare for potentially problematic interactions with others.
Learning to calm one’s mind and relax one’s body.
Cognitive Behavioral Therapy Interventions
Humor Compartmentalization Regular exercise Healthy diet Sufficient sleep Cognitive interventions Stop, Divert, and Reframe
Stop, Divert and Reframe
Stop: interrupt negative train of thought
Divert: think about something to reduce stress
Reframe: what can you do to reduce the stressor.
Mindfulness-Based Stress Reduction
based on traditional practices of Asian religions that helps individuals learn a generic method of relaxation by concentrating on the rhythm of breathing…focusing on inhalation and exhalation provides focus for meditation.
Cultural Awareness
Understanding and valuing all aspects of another person’s culture.
Awareness of one’s own culture.
Cultural competence
Respect for diversity and understanding of other culture’s and their languages.
Establishing trust between patient and health care professionals is the key to an effective relationship
Guidelines for communicating with Non-English Speaking Patients
Personal Space Touch Time Orientation Biologic Characteristics Translation Services
Xenophobia
The morbid fear of strangers and those who are not of one’s own ethic group
Nursing Diagnosis: Spiritual Distress
Nursing diagnosis defined as a disruption in value and belief system that pervades the person’s state of being and that transcends the physical and psychosocial self.
Therapeutic communication about spirituality
Listening to the patient; aware of body gestures, body positions, facial expressions, eye movements and tone of voice
Be supportive and find out if pt wish to have healer, pastor to visit, pray, or do anything for pt such as baptism, communion, and anointing
Remain neutral and unbiased
LEARN model
L-E-A-R-N Model for Cross-Cultural Health Care
Listen to the patient and the family’s concepts of the illness, their reactions to the Western health care system approaches, and their desires for therapy.
Explain your assessment with the use of drawings, videotapes, and test results.
Acknowledge differences and similarities between a person from a different culture and the health care system perspective; emphasize the similarities.
Recommend the diagnostic and therapeutic approaches, and listen to the patient and the family’s responses.
Negotiate all areas of care to accommodate the patient and the family’s cultural beliefs and practices.
Patient Rights
Vote Manage financial affairs Make contracts Seek advice of attorney Send and receive unopened mail Wear own clothes Receive visitors Make phone calls Have Informed consent regarding treatment and research participation
Patient’s right to treatment
A non-dangerous individual cannot be hospitalized without being provided with some form of treatment
Patient’s Right to refuse treatment
Medications
Voluntary and involuntary patients can refuse medication.
In emergency situations, if potential danger is present, patient can be medicated against his or her will.
Electroconvulsive Therapy (ECT)
- Requires informed consent.
- State laws vary regarding refusal.
Riese Hearing
Riese v. St. Mary’s Hospital & Medical Center
Index Topic: Medication (Right to Refuse)
The issue before the California Supreme Court was whether a patient involuntarily committed to a mental health facility could be administered antipsychotic medication over his objection and absent a judicial determination of incompetence.
The ruling allowed patients committed for three or 14 days to exercise informed consent to antipsychotic medications with two exceptions: (a) in an emergency, or (b) following a court determination of the patient’s legal incompetence to make a treatment decision regarding the drugs.
Tarasoff
A treating mental health professional has a duty to warn potential identifiable victims.
Tarasoff v. Regents of the University of California
Supreme Court of California held that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient.
California Supreme Court called for a “duty to protect” the intended victim. The professional may discharge the duty in several ways, including notifying police, warning the intended victim, and/or taking other reasonable steps to protect the threatened individual.
1799
Medical Hold
5150
72-hour observation as a result of mental disorder, a danger to others, or to himself or herself, or gravely disabled.”
5250
14-day additional hold, it is extended at the end of the 72 hours the person continues to meet one of the three criteria (DTS/DTO/GD)
5260
14-day additional hold for who threatened or attempted to take his own life or who was detained for evaluation and treatment
5270
Additional 30-day hold after 5150 and 5250 hold. A patient must meet the criteria of: Gravely disabled (GD)
LPS Act
- To end the inappropriate, indefinite, and involuntary commitment of mentally disordered persons, people with developmental disabilities, and persons impaired by chronic alcoholism, and to eliminate legal disabilities;
- To provide prompt evaluation and treatment of persons with serious mental disorders or impaired by chronic alcoholism;
- To guarantee and protect public safety;
- To safeguard individual rights through judicial review;
- To provide individualized treatment, supervision, and placement services by a conservatorship program for gravely disabled persons;
- To encourage the full use of all existing agencies, professional personnel and public funds to accomplish these objectives and to prevent duplication of services and unnecessary expenditures;
- To protect mentally disordered persons and developmentally disabled persons from criminal acts.
Right to be restraint free
Seclusion and Restraint
CMS standards:
- Client right to be restraint free is paramount
- Use only when less restrictive alternatives fail
- One-hour rule: evaluation from independent LIP within 1 hour of the initiation of restraint
Healthcare disparities
Access to host’s healthcare system
Health literacy
Requires a respect for diversity
Have understandings of attitudes, beliefs, behaviors, practices, and communication patterns of multiple cultures and their languages
Recognize individual and cultural difference, seek advice from diverse group
Health literacy
Ability to understand basic health information and the services available to assist them with making of appropriate health decisions.
