INTRO TO PSYCH Flashcards
How is mental health conceptualized by the World Health Organization?
The state of well being in which the individual realizes his or her own abilities, can cope with life’s normal stressors, can work productively and can make a contribution to society
Mental health is the successful performance of mental functions resulting in…
results in productivity
fulfilling relationships
ability to adapt to change
ability to cope with adversity, life’s events
what does mental health provide the capacity for?
for rational thinking, learning, emotional growth, resilience and self-esteem
7 elements of mental health
Self-governance ability to act independently, dependently or interdependently without losing autonomy
Progress toward growth or self-realization
Tolerance of the unknown
Self-esteem
Reality orientation
Mastery of environment
Stress management
Areas that influence mental health
biological influences
psychological influences
sociocultural influences
biological influences
prenatal, perinatal and neonatal events physical health status nutrition history of injuries neuroanatomy physiology
psychological influences
interactions intelligence quotient self concept skills creativity emotional developmental level
sociocultural influences
family stability ethnicity housing child-rearing patterns economic level religion values and beliefs
Mental Disorders
significant disturbances in cognition, emotional regulation or behavior that reflects a dysfunction in the physiological, biological, or developmental processes underlying mental dysfunction.
what are mental health disorders usually associated with?
distress or impaired functioning
mental health/illness continuum
physical level, personal level, interpersonal level, societal level
mental health and illness cannot be defined completely in terms of one another. individuals and families are complex
Incidence and prevalence
MENTAL HEALTH IS NON DISCRIMINATORY
At any given time 57.7 million Americans could be diagnosed with a mental illness; about 26% 18 years or older– 1 in 4 adults
½ of those never seek treatment
15% adults with M.I. have co-occurring substance abuse problems – DUAL DIAGNOSIS.
25% homeless people have schizophrenia or bipolar disorder
Depression most often mis & under diagnosed esp. older pop. 65 or older highest suicide rate.
Etiology
Causes of Mental Illness largely unidentified.
Complex interactions among genetics and environmental influences
Combination of biological and environmental factors
Precise definitions of mental illness are elusive
The experience and consequences of mental illness are much more complicated than a list of symptoms
Stress in and of itself is not sufficient to produce a mental illness
Two main diagnostic tools
ICD - WHO classification of mental and behavioral disorders
APA developed Diagnostic and Statistical Manual of Mental Disorders (DSM)
ICD
WHO’s Classification of Mental and Behavioral Disorders, ICD-10 international diagnostic standard for general epidemiological and many health management purposes monitoring and analysis of the general health of a population and the incidence and prevalence of diseases.
APA
developed Diagnostic and Statistical Manual of Mental Disorders ( DSM ) multi-axial classification system groups disorders by symptom clusters and differentiates between normality and psychopathology based on duration and severity of symptoms. In 2013, DSM V moved away from the multi-axial system to a more unified approach aimed at improving diagnosis & care.
Five AXES of DSM
Axis I- Clinical Disorder
Axis II- Personality Disorders and Mental Retardation
Axis III- General Medical Conditions
Axis IV- Psychosocial and Environmental Problems
Axis V- GAF- Global Assessment Scale # system meaning current functioning/ highest level of functioning in the past year.
Each disorder has criteria that describes behaviors, symptoms, or signs; duration and other qualifiers, the criteria does NOT determine diagnosis. Many clients have more than one dx on the first 3 axes
does criteria determine diagnosis?
NO!
many clients have more than one dx on the first 3 axes
AXIS 1 criteria
Includes most of the psychiatric disorders except for personality disorders and issues of developmental disorders
If person has more than one axis I disorder, list them all with the chief complaint listed first
AXIS 2 criteria
Personality disorders
Intellectual development disorder
Other prominent maladaptive and defense mechanisms
AXIS 3 criteria
General medical conditions that may be relevant to understanding and/or managing the mental disorder.
Does not include medical disorders that are thought to be a direct cause for a mental disorder—these are coded on axis 1
AXIS 4 criteria
Problems with primary support group
Problems related to social environment
Educational, Occupational, Housing or Economic problems
Problems with access to health care services
Problems with legal system
AXIS 5 criteria
Clinician makes a judgment about person’s overall level of functioning
GAF Scale: 0-100
The lower the number, the lower the level of function
Limits of DSM system
Categories are descriptions not explanations & labeling
Nurses must avoid expecting a person’s behavior based on a diagnostic label –tautology
Divides normal and abnormal
Clients can suffer from the same disorder and manifestations and personal experience differ for each client
Inflexibility of duration
Criterion utilized for adults and children
Cultural discrepancies
changes to multi-axial system
In 2013, the APA moved to a single axis system to avoid issues created with the multi-axial approach. The previous approach created an arbitrary hierarchy of mental disorders between the first two axes. It also implied a separation of mental disorders from physical disorders, when in fact mental disorders are physical disorders.
This current approach still uses all of the same mental, physical and social considerations as the multi-axial system but does it in a more unified manner aimed at improving diagnosis and care, informing new research and allowing for global information sharing.
DSM V Single Axis Approach
The first three axes are combined containing all mental and other medical diagnoses. This change removes artificial distinctions among conditions, benefiting both clinical practice and research use.
The forth axis still represents contributing stressors, but now uses ICD codes which allows providers to better indicate other problems, such as relationship problems, which need clinical attention.
The GAF of Axis V is no longer used due to lack of clarity and was replaced by the WHO’s Disability Assessment Schedule. This change brings the DSM tool into better alignment with other medical disciplines.
WHO disability assessment schedule
Measures disorders and their associated disabilities which are shown as conceptually distinct and are assessed separately.
Prevention and treatment
Health promotion and illness prevention
Attention to medically underserved populations
Involvement of managed care in behavioral health
Quality management, including client outcomes
Expanded practice of advanced clinical providers PNP
Community based primary care
Influence of consumer and family advocacy
Decreased benefits for Medicare, Medicaid, disability programs
Issues related to treatment (5)
Nearly 2/3rd of people with mental illness fail to seek treatment
Leading to increase expenses r/t loss productivity, increase in criminal justice system and social service
COST inpatient care, medications
STIGMA misconceptions, discrimination, stereotyping
REVOLVING DOOR TREATMENT decreasing length of stay, Managed Care mandates, deinstitutionalization, lack of community supports
LACK OF PARITY inequality of coverage most effective vs. what received
LIMITED ACCESS TO CARE inadequate, inappropriate, no care difficult for families to determine appropriate care
Goals for improving care (6)
Increase the number of Mental Health Professionals caring for children and adolescents
Expand Mental Health Services
Cultural understanding
Improve understanding
Redesign rehabilitation services to meet client needs- social, physical, cultural needs
Integration and collaboration in services
goals for improving care (7)
Reintegration into Society- family involvement, employment, continued education, social and recreational activities, community participation
Legislation to improve coverage
Culturally competent care
Medication Adherence
Self-Help and Advocacy
National Alliance for the Mentally Ill
Psychiatric Advanced Directives- treatment wishes
Medication compliance
Education on medication is critical
Compliance is a huge issue with this population
Education around medication side effects is critical
Psychiatric Nursing
what will you do?
Work with individuals and families who have psychiatric problems and disorders, such as depression, schizophrenia, bipolar disorder, psychosis or dementia. In this role you’ll perform the following tasks:
Assess mental health and physical needs and provide interventions based on individual needs
Develop and evaluate nursing care plans to ensure positive outcomes
Crisis intervention and counseling
Help patients regain or improve their coping abilities
Manage and work with a team to ensure and enhance the therapeutic environment
Assist patients with self-care activities
Administer and monitor treatment regimens
Psychiatric nursing role
Participation in the interdisciplinary mental health team Advocacy Health promotion and maintenance Case management Screening Milieu therapy Health teaching Psychobiologic interventions
Psychiatric nursing (3 TGE)
Therapeutic use of self
Forms a trusting relationship that provides comfort, safety, and acceptance
Genuineness and warmth
Openness, realness, and lack of defenses
Empathy
Able to “walk a mile in the client’s shoes”
Crucial to therapeutic relationship
Psychiatric nursing (3 LAM)
Leadership
Ability to empower, direct, and manage client care
Acceptance
Suggests neither approval nor disapproval but tolerance and appreciation of the client
Maturity and self-awareness
Major role in nurse’s ability to tolerate differences
Safety with psychiatric nursing
Here are some general tips to ensure safety while working on a psychiatric unit:
Never be alone with a patient in an isolated spot. Alert staff of your whereabouts at all times
Always have an exit plan, do not put yourself in a position where your back is to a closed in area
Avoid provocative clothing and avoid having too much skin exposed
Additional safety with psych nursing
Psychotic patients generally experience three delusional themes: 1.) Religious, 2.) Political, and 3.) Sexual. Avoid these topics unless you are experienced in managing them
Avoid wearing necklaces or other items that can be used as a weapon to strangle. Do not wear loop earrings
Always remember safety first. Always listen to your primary or gut instinct
differences in nursing process
The manner and focus of the nurse’s observations. Observations are extremely important
The particulars of interviewing during data collection
The types of interventions used for identified problems
issues influencing the nursing process
Therapeutic nurse-client relationship
Self awareness needed to reduce barriers to effective data collection and assessment
Nurse’s personal feelings, values, beliefs, and perceptions that may interfere with accurate data collection
Communication skills, developmental stage of client, culture, spirituality and religion
nursing process assessment
Physical examination Review of systems Diagnostic testing Vital signs Neurological status Changes in sleep patterns, appetite, libido, concentration Elimination Activity & exercise Hydration Self-care
nursing process assessment (MS)
*** psych nursing, nurse collects health data *** Mental status examination components: General appearance Orientation Mood and affect Quality of speech Thought process Cognitive Intellectual Performance Insight & Judgement
Psychosocial components of nursing process
Psychosocial components Recent stressors Strengths Current medications History or psychiatric treatment Substance abuse history Quality of support systems Family definition of problem
Psychosocial components (BSBSP)
Behavior Self-concept Body image Self- esteem Personal identity
Psychosocial components (S/H,C,S/C,L/O,E,Q)
Suicidal/homicidal ideation Coping patterns Spiritual and cultural needs Legal and occupational history Economic status Quality of life
Life span considerations
Child and Adolescents - Growth and development - Family dynamics - Parenting styles Older adults - Avoid ageism - Determine how to address (e.g. surname)
Nursing process
Diagnosis
Analyze assessment data to determine diagnoses
Develop according to NANDA classification system http://www.nanda.org
nursing process
outcome identification care plan goals
Psychiatric nurse identifies expected outcomes that are individualized to the client and measurable
nursing process - planning
Psychiatric nurse develops a plan of care that prescribes interventions to attain expected outcomes. Safety needs often a priority. Patient involvement is critical once they are well enough to be involved.
nursing process - interventions
Psychiatric nurse implements the interventions identified in the plan of care. RN assumes many roles while assisting patient: Advocate Teacher Socializing agent Role model
interventions
biological
psychological
social
biological interventions
Promote self care Encourage physical activity Sleep intervention Encourage proper nutrition Relaxation techniques Medication management
Psychological interventions
Cognitive interventions Counseling Conflict resolution Bibliotherapy Reminiscence Behavior therapy Psychoeducation
Social interventions
Milieu therapy Containment Validation Structured interventions Open communication Patient Safety
nursing process - evaluation
Psychiatric nurse evaluates the client’s progress in attaining expected outcomes
Dynamic process changes as client’s condition changes
key components of documentation
It becomes part of the client’s permanent record
Objective and subjective data are documented
Written documentation should be clear and legible
Nurses should avoid using inferences or judgments
Nurses should use concrete and specific terms
