FINAL (JAY) Flashcards
What does spiritual health refer to?
Spiritual Health is a feeling of
being generally alive, purposeful, and fulfilled
Spiritual Variable Assessment categories (7)
Purpose
Interconnectedness
Faith
Religion
Forgiveness
Creativity
Transcendence
What is purpose?
When individual client is in search for insight and expression of underlying feelings regarding
one’s philosophy of life, values and beliefs about health and health challenges is explored.
ASK: u What do you see as your purpose in life? What in life is important to you?
What is interconnectedness?
an individual’s sense of love, belonging and
connection to self, others, a higher power, nature and the cosmos.
ASK: Tell me what place you go to in order to feel a sense of peace
and comfort. How satisfied are you with your relationships with other people?
What is faith?
A belief in the unseen or unknown. Faith is a firm belief in the ability to draw on spiritual resources with certainty despite any evidence or proof
ASK: Tell me about any faith practices / rituals important to you?
What is religion?
Defined as a system of organized worship ascribing to a set of doctrines which the person practices. The practice of religion is only one way an individual may express their spirituality
ASK: What is your religion / religious preference? How do you express your religious beliefs?
What is forgiveness?
- may not have meaning to all client groups. Clients will describe situations where either they cannot forgive themselves,
others can’t forgive them, or they can’t forgive others. Explore with your client their ability to forgive others and / or their openness to accept forgiveness from others as a starting point
of “letting go” of past feelings of being hurt, angry, resentful, betrayed, and / or devastated.
ASK: What do you believe interferes with your ability to forgive?
What is creativity?
Any activity producing a sense of peace, comfort, and soulfullness for the individual.
ASK: What does creativity mean to you?
What is transcendence?
a process / experience
beyond the usual sensory
phenomena. Transcendence is often associated with classical mystic experiences of God. It is not reserved for religious experience alone, but may be related to aesthetic reactions to art and music or the response to the majesty of creation (regarding a feeling of wonder or
awe)
ASK: What does the word “transcendence” mean to you?
What is spiritual distress?
disturbance in the person’s core
value system, which provides strength, hope
and meaning to life
How can nurses support spiritual practice?
Holy Days
Sacred Writings
Spiritual Symbols
Prayer/Meditation
Beliefs:
Diet Nutrition
Dress
Birth & death
Medical procedures
What is culture? & examples
patterns of learned values and behaviours
that are transmitted over time and that distinguish the members of one group from another.
ex. language, ethnicity, spiritual and
religious beliefs, socioeconomic c lass, gender, sexual orientation, age, group history, geographic origin, and education, as well as childhood and life experiences
What are examples of cultural groups? (6)
Homeless
Aging families
LBGTQ+ community
Students
People with mental illness
Nurses
What is ethnicity and race?
Ethnicity: groups whose members share a social and cultural heritage. Members feel a sense of common identity. May share common
values, language, history, physic al characteristics, and geography -> COMMON IDENTITY
Examples: Irish, Japanese, Filipino
Race: biological attributes shared by group (skin colour)
What is cultural safety?
the redistribution of power and resources in a relationship. culture is used to apply to any person or group of people
who may differ from the nurse/midwife because of socio-economic status, age, gender, sexual orientation, ethnic origin, migrant/refugee status, religious belief or disability
BCCNM Code of Ethics and Cultural Safety
B 4: Recognizes and respects diversity and that a person’s culture may influence health practices and decision making.
C 5: Recognizes the role of culture and spirituality in health promotion, illness prevention, and in recovery.
6 core concepts and principles of anti-racism and cultural safety
SELF-REFLECTIVE PRACTICE (IT STARTS WITH ME)
BUILDING KNOWLEDGE THROUGH EDUCATION
ANTI-RACIST PRACTICE (TAKING ACTION)
CREATING SAFE HEALTH CARE EXPERIENCES
PERSON-LED CARE (RELATIONAL CARE)
STRENGTHS-BASED AND TRAUMA-INFORMED PRACTICE (LOOKING BELOW
THE SURFACE)
How to convey cultural sensitivity? (8)
Address by last name (unless permission given)
Introduce yourself, explain your role
Use appropriate eye contact
Be genuine and honest (about lac k of knowledge)
Respectful language (based on client’s preference and/ or acceptable norms)
Do not make assumptions
Respect the client’s values, beliefs and practices
Show respect for client’s supports/ family
What is the sociocultural theory?
Looks at interaction between people, their social structure, relationships, and the “culture” in which they live, work and play.
Suggests human learning is largely a social process
Lev Vysotsky: argued the learning is based in interacting with other people. Once this has occurred, information is integrated on the individual level.
Sociocultural assessment variables? (6)
Language and Communication Patterns: Verbal/ Nonverbal
Cultural Roles and Expectations
Social History: Family, Education and Work/ Finances
Relationships/ Significant Others
Health Beliefs, Habits and Practices
Ethnicity and Race
What does language and communication patterns consider?
Verbal and non-verbal
What are cultural roles and expectations?
What roles does the person occupy? Are these roles satisfying/ dissatisfying?
What community groups does the person belong to? What is their role in these
groups?
What sex or gender roles does the person occupy?
How does the person express his/ her identity in relationships with others?
Does the person feel they fit into their community?
What special practices does the person consider essential to their lifestyle and
role expression?
What subjects cause the most disagreement between the person and
significant others?
Perceived roles in family? Society? Significant others?
Social History: Family, Education, Occupation
Family: What is the person’s marital status? Who are the person’s significant others
and family? How close is the family? What is the family make-up?
Education: What is the person’s highest level of education and at what age did they
achieve this?
Occupation: What work has the person done?
Considerations of relationships/others?
How does the person express feelings of caring for others?
Does the person form relationships with other people? Who are important people to the
person? Significant others?
Health Beliefs, Habits and Practices considerations?
What are your beliefs about health, illness, birth, death, time, and health care
providers?
Which cultural group do you identify with?
Ethnicity and race considerations?
Have you experienced discrimination because of your ethnic background? If so, how?
What type of cultural stereotyping have you experienced?
What does social identity include?
Social Status (age, sex, family status, occupation)
Membership in groups (cultural, membership)
Social labels (i.e. mentally ill, unemployed)
Derived statuses (war veteran, rec overing alcoholic)
Social types (perceptions, attitudes as self defined).
Personality identity (nickname, preferred name, title)
What is an ecomap?
visual assessment tool depicting the various systems in an individual’s life. These include relationships, communities, work,
education
What is a genogram?
concise visual depiction of the family structure and
relevant situational information used in nursing assessments.
What are the 7 universal experiences in the DCPNCF?
CRISIS* (Stress, Anxiety)
COMFORT* (pain)
HOPE* (hopelessness)
LOSS (grief)
POWER* (powerlessness)
RESILIENCY* (coping, strengths)
INTEGRITY (death, dying, acceptance)
What are the 3 components to response to stress?
1) Physiological
Component
2) Cognitive Component
3) Emotional
Component
What is the physiological response to stress?
Fight or flight response.
What are the 3 stages in the physiological response to stress?
Stage 1: Alarm reaction
Stage 2: Resistance stage
Stage 3: Exhaustion stage
6 examples of physiological responses?
Cardiovascular
Respiratory
Gastrointestinal
Musculoskeletal Genitourinary
Dermatologic
What is the cognitive appraisal theory? (Lazarus & Folkman)
Primary VS Secondary Appraisal?
The person is under stress only if they perceive themselves to be.
* Primary appraisal: what does this situation mean to me?
* Secondary appraisal: can I cope with it
What is involved in the emotional component of stress response?
The cognitive triangle: thoughts, behavior, emotions
What are 3 levels of anxiety?
Mild: Slight arousal that enhances perception, learning and productivity. (what most people have)
Moderate: Increased arousal with tension, nervousness and perception is
narrowed.
Severe/Panic: It is consuming, poor focus,
very uncomfortable and
requires intervention. overpowering and frightening.
What are adaptive coping methods to stress?
Strategies that
minimize/reduce or eliminate
the stress response.
Strategies can be short
term/immediate, or longer
term adaptations.
What are maladaptive coping methods to stress?
May temporarily be “effective”, but cause
longer term negative consequences and
results in worsening distress.
Defense mechanisms- denial, projection, regression.
What does “power” consider?
gaining or maintaining
control or influence over aspects on one’s
environment.
A client receiving mental health treatment can at
times feel powerless.
Recognize & minimize the power differential inherent in our therapeutic relationships
and our practices as RPN’s.
The goal is to empower our clients by mobilizing
their strengths
What are 2 types of crisis? + examples
Developmental: puberty, empty nest, retirement
Situational: illness, job loss, traumatic experience
What are 5 means of crisis intervention?
Early intervention
Stabilization
Facilitate understanding
Problem solving
Encourage self reliance
4 concepts of loss?
Grief: The emotional response (subjective) to the perception of loss
Actual Loss: A loss of a person or object that can no longer be felt, heard, known or experienced
Perceived Loss: A loss that can’t be seen by others
Bereavement: The response to the loss or death of a loved one
Common symptoms of grief?
Feel physically drained
Can’t sleep
Forgetful, can’t think clearly
Appetite changes
What are cultural humility, safety, and sensitivity?
- knowledge, skills, and personal attributes req. by nurses to provide appropriate care and services in relation to cultural characteristics of their clients
- ask relevant Q’s, be curious, don’t fall for stereotypes
What is cultural safety?
- involves considering the redistribution of power and resources in a relationship
- can refer to any people that differ from the nurse bc of SE status, age, etc.
BCCNM code of ethics cultural safety:
B4: recognizes and respects diversity and that a person’s cultural may influence health practices and decision making
C5: recognizes the role of culture and spirituality in health promotion, illness prevention, and in recovery
BCCNM professional standards cultural safety:
Standard 3 - Professional Responsibility: integrates cultural safety into psychiatric nursing practice
BCCNM Indigenous cultural safety, cultural humility, and anti-racism:
- new practice standard; 2022
- be aware of indigenous specific racism
- can lead to lower life expectancy, higher infant mortality, and increased presence of chronic health conditions
- purpose: set clear expectations for how BCCNM registrants are to provide culturally safe care for indigenous clients; organized into 6 core concepts
6 core concepts of In Plain Sight BCCNM
- self reflective practice
- building knowledge through education
- anti-racist practice
- creating safe health care experiences
- person-led care
- strengths based and trauma informed practice
Culturally sensitive care (Potter et al.): (7)
- be culturally knowledgeable
- being client centered
- being self reflective
- recognizing conflict of client/nurse values
- facilitating client choice
- incorporating client’s cultural preferences
- accommodating client’s belief and practices
Ways to convey cultural sensitivity: (8)
- address by last name
- introduce self, explain role
- use appropriate eye contact
- be genuine and honest about lack of knowledge
- respectful language based on preference or norms
- don’t make assumptions
- respect client’s values, beliefs, practices
- show respect for client’s supports/family
Social cultural assessment (PNUR Variable Guide): (6)
- language and communication patterns
- cultural roles and expectations
- social history
- relationships/SOs
- health beliefs, habits, practices
- ethnicity and race
Components of the developmental variable: (6)
- growth
- development
- lifespan
- expected life events
- unexpected life events
- transition
Factors influencing growth and development:
- genetics
- disease
- injury
- traumatic events
Factors that impact grieving?
Personality
Culture
The circumstance of the loss
Support Systems
Is the grieving process a continuum?
NO
How is normal grief different from clinical depression? (explain normal grief)
self esteem is intact
good days and bad day
feeling of hope and able to experience pleasure
How is clinical depression different from normal grief? (explain clinical depression)
self esteem is disturbed
hopeless feelings
no perception of pleasure
What is complicated grief?
Stuck in the grieving process.
at least 6 months of unhealthy morning:
daily living impacted
recurrent intrusive images
What is anticipatory grief?
the emotional experience of the norm al
grief response before the loss actually occurs
What is the role of the RPN when a patient is grieving?
Assess the client’s stage in the grief process (gather an
accurate baseline)
— Develop trust. Show empathy and unconditional positive regard.
— Provide ongoing support (friends, support groups…)
What is the concept of integrity?
The quality of having an inner sense of ‘wholeness’ and
consistency of character.
Demonstrate a consistency in your values, beliefs and actions in all areas of your life.
Developmental stages (age groups)
- adolescence: 12-18 yrs
- young adult: 19-39 years
- middle adult: 40-64 years
- older adult: 65+
Normal developmental characteristics in adolescence (physical, psycho, risks)
- physical changes: increase in bone and muscle growth, puberty
- massive brain growth and pruning, poor impulse control
- self identity: gender identity, peer relationships, sexuality, independence
- health risks: MVA accidents, violence, suicide, substance abuse, EDs, STIs, depression
Normal developmental characteristics in young adulthood (physical, psycho, risks)
- physical changes: growth completed at 2- yrs, at physical peak, tend to avoid seeking help
- psychosocial changes: choosing occupation, pursing education, developing intimate mature relationships, achieving financial independence, parenthood, body image issues
- health risks: lifestyle habits, accidents, substance abuse, fertility issues, stress, pregnancy, MI
Normal developmental characteristics in middle adulthood (physical, psycho, risks)
- physical changes: grey hair, wrinkles, metabolic changes, hearing and vision loss, hormone fluctuations
- psychosocial changes: assisting w/ children as they leave the nest, dealing with separation/divorce, death
- health risks: stress, anxiety, depression, obesity, long term effects of poor lifestyle choices
Normal developmental characteristics in older adults (physical, psycho, risks)
- physical changes: occur in most body systems
- psychosocial changes: retirement, role change, social isolation, maintaining sexual identity
- health risks: cancer, heart disease, delirium, dementia, arthritis, falls
Concept of Erikson’s 8 Stages of Social and Emotional Development
- Erikson believed personality developed in a series of stages
- in each stage, each person needs to accomplish tasks to move onto the next
- each stage builds upon the success of previous challenges
- unsuccessful resolution of one stage will result in the chronic inability to master these tasks
Erikson’s theory of adolescence
- teens into early 20s
- identity vs. role confusion: teens work at refining a sense of self by testing roles and then integrating them to form a single identity, or they become confused about who they are
Erikson’s theory: young adult
- 20’s to early 40’s
- intimacy vs isolation: struggle to form close relationships and to gain capacity for intimacy, or they feel socially isolated
Erikson’s theory: middle adult
- 40s to 60s
- generativity vs stagnation
- middle aged discover a sense of contributing to the world, usually through family and work, or they feel a lack of purpose
Erikson’s theory: late adult
- late 60s and up
- integrity vs despair
- when reflecting on their life the older adult may feel satisfaction or failure
Overview of what the MSE is
- a structured approach to assessing psychological, emotional, social, and neurological functioning
- an attempt to objectively describe the behaviours, thoughts, feelings, and perceptions of the pt throughout the interview
- provides an overall pic of current MH status
How is the MSE done?
- woven throughout the interview
- sensitive q’s should be asked after more general, less sensitive topics are addressed
When is the MSE done?
- during initial assessment
- throughout the tx process
- behavioural changes are evident
- event or injury that may impact mental states
- all the time!
Components of MSE: (9)
- appearance/behaviour
- mood/affect
- speech
- thought form
- thought content
- perception
- cognition
- insight and judgement
- risk assessment
Appearance: (MSE)
- objective characteristics such as age, weight, race, hygiene, distinguishing features
- gives insight into mental status
- helps in case you need to file a police report
Behaviour: (MSE)
- objective data
- psychomotor retardation or agitation
- hyperactivity, restlessness, repetitive movements
- eye contact
- attentiveness
- mannerisms, gestures
- general attitude/attitude towards interviewer
Mood: (MSE)
- subjective data
- how the client is feeling
- ex; happy, neutral, depressed, nervous
Affect: (MSE)
- objective data
- physical manifestation of mood
- ex; bright, flat, labile, euthymic
- note range, appropriateness to context/situation, congruency
Speech: (MSE)
- objective data
- rate, volume/tone, spontaneity/hesitant, characteristics, response time, speech production
Thought form/process: (MSE)
- objective and subjective
- process is determined by flow of conversation and quality of thoughts; how the person is thinking
- can only be determined through the pts speech and how they describe thinking
- ex; logical/organized, disorganized, loose associations, racing thoughts, thought blocking, neologisms
Thought content: (MSE)
- objective and subjective
- what the client is thinking
- what the client spends their time thinking about
- looking for bothersome thoughts, preoccupations, sx of psychosis (delusions) and phobias or obsessions
Perception: (MSE)
- objective and subjective
- hallucinations
- illusions
- assess content of hallucinations, client’s interpretation/extent of belief, client’s reaction
Cognitive functioning: (MSE)
- objective and subjective
- level of arousal
- orientation
- concentration and attention
- memory
- intellectual capacity/knowledge
- abstraction/concrete
Insight: (MSE)
- awareness of situation, context
- recognition of illness, need for help
- understanding of factors contributing to illness
- motivation to work on problems
- “full, partial, limited, impaired, no”
Judgement: (MSE)
- behavioural manifestation of insight
- process one uses to reach a decision or take action
- ability to consider pros and cons of choices
Risk assessment: risk to self
assess for both self harm and suicide
- ask routinely during initial assessment and periodically throughout tx process
- assess when a change in behaviour occurs that might indicate risk
- following a major stressor
- when we get clues that the client may be feeling hopeless
- consider: suicidal thoughts, plan, intent, means, impulsivity, risk, and protective factors
Suicide risk factors:
- age
- sex
- hx of psychiatric disorders
- current dx
- characteristic sx
- hx of suicidal behaviour
- hx of abuse, trauma
- substance use
- situational risk factors
- family hx of suicide and MI
- living alone
- social relationship problems
- access to lethal means
- physical health issues
Suicide protective factors:
- family factors: sense of responsibility to family, relationships characterized by warmth and belonging
- community: opportunities to participate, affordable/accessible supportive resources, hope for the future, community self-determination and solidarity
Suicide levels of risk:
Non-existent
Mild
Moderate
High
Imminent
Risk assessment: risk to others:
Thoughts of harming or killing others
Plan/intent to harm others
Means to harm others
Previous history of violence
Substance abuse
Psychotic processes
common MSE mistakes:
- avoid judgement terms
- use proper sentence structure
- be clear and concise
- avoid qualifiers
- don’t use too many adjectives
- do not repeat data; use headings
- do not include personal impressions: stick to data
- avoid terms like appears, seems
- avoid pt did, pt had, pt said, pt was
- use “client” in community settings, “patient” in hospital settings
- never use normal
What is Psychosocial Rehabilitation (PSR)
- psychosocial rehabilitation
- a MH tx philosophy or approach that promotes reslience, personal recovery, full community integration and a sense of purpose and meaning for those who have been dx with a MH condition/addiction issue
Principles of PSR (12)
- PSR practitioners convey hope and respect
- PSR practitioners recognize that culture and diversity are ventral to recovery and strive to ensure all services are culturally relevant
- PSR practitioners engage in informed and shared decision. making and facilitate partnerships with people the client identifies
- PSR practitioners build on strengths of clients
- PSR practices are person-centered
- PSR practices support full integration of people in recovery into their communities
- PSR practices promote self-determination and empowerment
- facilitate development of personal support networks
- strive to help clients improve the quality of all aspects of their lives (variables)
- promote health and wellness
- emphasize evidence-based practices congruent with personal recovery
- must be readily accessible to all ppl when they need them and integrated with other tx
PSR overlap w/ recovery movement:
- PSR is a recovery approach; harm reduction
- recover: living a satisfying life despite illness
- recovery is a process, not an outcome
- it is individually defined
- recovery is possible and expected
- considered a grassroots movement w/ a focus on advocacy
Principles of recovery:
- hope
- dignity
- self determination
- responsibility
What does MPA stand for? Who is the director?
- motivation, power, and achievement
- Nick Blackman
What does MPA do?
- implements semi-independent living programs
- uses housing first
- court services
- helps ppl get support workers that align w/ their goals
- has licensed, enhanced, supportive housing
Goals of the MPA
- providing information and education
- providing a sense of community and humour
- informed risk taking
What is the health professions act? (HPA)
- umbrella legislation that provides a common regulatory framework for health professions in BC
- gives BCCNM mandate and power
- each health profession under the Act has its own regulatory body
- each regulatory body has its own bylaws; details of the operation, responsibilities, qualifications, regulation of conduct
Relevant legislation for RPNs: (6)
- Access to Information Act (federal)
- E-Health Act (provincial)
- FOIPPA (provincial)
- Personal Information Protection and Electronics Act (federal)
- Privacy Act (provincial)
- Mental Health Act (provincial)
What does FOIPPA do?
- main purpose: make public bodies more accountable to the public and to protect personal information
- dictates how public bodies collect, store, and share information
- confidentiality
- continuity of care
What information can we share and with whom can we share it with? (FOIPPA)
- Consistent purpose (continuity of care): we can share info w/ others if it is being shared for the same reason it was collected: to offer health care
- consider implications for sharing information with family; try your best to get consent
FOIPPA Exceptions:
- disclosure harmful to individual or public safety
- disclosure harmful to personal privacy
- information must be disclosed if in the public interest
What does the E-Health act do:
Attempts to balance the goal of giving citizens access to their health records and medical information, while protecting privacy, through electronic health records.
WHat is the most used piece of legislation and why?
- BC Mental Health Act because psychiatric care is usually involuntary; many MI ppl don’t have the ability or knowledge to get help
- it is a useful guide to figure out obligations and restrictions for each situation
- it outlines rights of pts and responsibilities of personnel
Voluntary hospitalization under MHA:
- S. 20
- an adult may voluntarily seek admission to a designated facility for tx of a mental disorder under either the Hospital Act or the MHA
- req. person to req. admission using Form I: Request for Admission (Voluntary Patient)
- a physician and director just agree and sign Form 2: Consent for Treatment (Voluntary Patient)
- voluntary pts may discharge themselves at any time
What is a designated facility?
A place that accepts involuntary admins ; needs a psych unit
What are the 3 methods of voluntary admission:
- Medical Certification (Section 22; Form 4)
- Police Intervention (Section 28 (I))
- Judge’s Order (Section 28 (3); Forms 9 and 10)
Method I: Medical Certificate:
- Section 22
- one medical certification (Form 4) detains someone for 48 hours
- a second Form 4 must be completed by a different physician within 48 hrs of admission to continue and is valid for a month
Method 2: Police Intervention:
- Section 28 (I)
- gives police the authority to apprehend a person and take them to a physician for examination
- criteria used by police is different from physicians
- an officer must be satisfied that the person has a mental disorder and is acting in a manner that is likely to endanger their own safety or the safety of others
- it is a higher standard to meet than section 22
Method 3: Order by a Judge
- Section 28 (3)
- anyone who has reason to believe a person has a mental disorder and meets the criteria for involuntary admission according to S. 22 can apply to a provincial court judge or justice of the peace to have a person apprehended for assessment by a physician
- Form 9: Application for Warrant is completed by friend/family member or someone else and submitted to judge
- if the judge is satisfied that the conditions are met, the judge may issue a warrant under S. 28 (4) Form 10, giving police authority to apprehend
Pt’s rights under the MHA:
- Form 13
- to know the name and location of the facility
- to know the reason why they are there
- to contact a lawyer
- to be examined regularly by a medical doctor to see if you should be discharged
- to apply to the Review Panel for a hearing ‘’
- to apply to the court to ask a judge if your medical certificates are in order
- to appeal to the court your medical dr’s decision to keep you in the facility
- to request a second medical opinion on the appropriateness of your tx
