Intro to Psych Flashcards
Mental Health Overview
- lifelong process of successful adaptation to an ever-changing internal and external environment
- positive/adaptive coping mechanisms
- individual is in contact with reality and the environment
Resilience
-ability to function with healthy responses even when experiencing significant stress and adversity
What is resilience influenced by?
- optimism, or belief that a positive outcome is possible in the situation they are currently facing
- self efficancy, or belief that they have the ability to complete the tasks needed to take control of situations which influence their life
Coping
- can be emotion focused or problem focused
- problem focused is use of more problem solving and finding meaning
Ability to function
- within occupational or school environment
- within a family system
Cognitive Coping
emotional: oh its not that bad
problem: what are my odds of surviving
Behavioral Coping
emotional: physical activity to avoid thinking about the stressful event
problem: adhereing to a health care plan
Affective Coping
emotional: hoping for a miracle
problem: keeping feelings from interfering
Erikson’s Stage: Young Adulthood
18-25 years (intimacy vs. Isolation)
successful: developing healthy romantic relationships without losing personal identity
unsuccessful: isolation, avoidance of intimacy, fear of commitment
Erikson’s Stage: Adulthood
25-65 years (generativity vs. stagnation)
successful: productivity and creativity. Desire to care for and guide offspring
(if no kids, guide next generation)
unsuccessful: self-preoccupation, primary attainment of pleasure through self indulgence, stagnation
Erikson’s Stage: Maturity
65-death (integrity vs. despair)
successful: sense of peace concerning life experiences, life choices framed within meaningful context, development of wisdom
unsuccessful: life experiences framed by bitterness/regret, may progress to hopelessness/depression
Mental Illness
- loss of the ability to respond to the environment in ways that are in accord with one’s own or society’s expectations
- characterized by thoughts, feelings, or behavior patterns that impair functioning and cause the individual (or others!) distress
Adaptations to Stress with mental illness
- feels out of control with self and with the environment
- has a negative perception of the environment/life in general
- has ineffective coping mechanisms
Personality Characteristics of mental illness
- non-accepting of self and dislikes self
- unrealistic perception of strengths and weaknesses
- thoughts and perceptions may not be reality based
- unable to find meaning and purpose in life
- lacks direction and productivity in life
- has difficulty in meeting own needs
- adapative vs maladaptive responses/behaviors/coping skills
Interpersonal Relationships with mental illness
- unable to love and care for others (with appropriate and healthy boundaries)
- unable to feel loved by others or accept feelings from others
Historical timeline of mental illness treatment
1793: released from chains in Paris Hospital
Mid 19th century: continued belief in moral causes of mental illness
1847-1851: Hope Retreat
1937: Electric Shock Therapy
1946: National Institute of Mental Health
1950: Intro of Psychotropic drugs
1963: Community Mental Health Centers Act of 1963 (De-institutionalization of care)
2008: mental health parity
2010: Affordable care act
Psychiatric/Mental Health Nursing
- diagnosis and treatment of human responses to actual or potential mental health problems
- specialized area of nursing practice
Psych nursing draws from multiple theoretical models
- biological
- counseling
- Hildegard Peplau’s
- Therapeutic use of self
- QSEN
Influence of Hildegard Peplau
- introduced the concept of a therapeutic relationship
- different from social relationship
- requires therapeutic use of self
- important for nurse to have self awareness/understanding of own philospohies about life, death and human condition
conditions that promote development of a therapeutic relationship
- trust
- genuineness
- empathy
- rapport
- respect
Stages of Therapeutic relationship
- preinteraction
- orientation
- working
4 termination
the focus of a therapeutic relationship
-promotion of mental health and prevention of mental illness in individuals, families, and groups in the communities
Collaborative Inpatient care
-physician, nurse, social services, occupational therapy and mental health counselors, peer specialists
The physician creates a diagnosis based on…
- assessment
- data gathered by other disciplines
- DSM 5
Social services…
helps the patient find placement
DSM 5
is short for the diagnostic and statistical Manual of Mental Illness version 5
- lists psychiatric diagnoses
- lists criteria patients need to meet to be diagnosed with a disorder
Role of the nurse
- safe milieu
- therapeutic milieu
- safe practice
- ethical and legal guidelines
Safety
- focus on maintaining safety of patients and staff
- accomplished through prevention
- monitoring patients
- assessing patients: implementing safety precautions prn
- controlling contraband
- milieu management strategies
- culture of safety implemented at some hospitals includes evidence based interventions
Milieu Therapy
Basic Assumptions:
- all patients have strengths as well as limitations
- every interaction is an opportunity for therapeutic intervention
- patients participate in making decisions and solving problems on the units
- personal responsibility is encouraged
- peer pressure used to give feedback
- inappropriate behaviors processed
- no restrictions or punishments: use group discussion first
Safe Practice
- knowledge of medication purpose, dosage range, primary side effects
- self awareness: insight into how individual communication is affecting patient
- therapeutic communication to help patient identify thoughts and feelings
- collaboration with interdisciplinary team to maintain safety
- requires knowledge of mental health disorders, how to assess mental status and identify mental status changes
Legal guidelines: Two categories of admission
- voluntary status
- involuntary status
Involuntary Admission
- after initial 72 hrs, client may be asked to sign voluntary admission to further tx/stabilization
- judicial process required to extend original baker act
Who can initiate Baker Act in Florida?
- any physician
- psychiatrist
- psychologist
- psych ARNP
- LCSW/LMHC
- Police offices
- court order, ex-parte order
Ethical considerations for baker act
- the right to treatment
- confidentiality
- only those involved in client’s care should have access to the information divulged by the client
Confidentiality
client needs to know that his/her info will be shared with the tx team and that there are limits to what can be kept secret
-beware of agreeing to keep info secret
Duty to Warn
- Tarasoff Case
- failure to warn a potential victim that he/she is in danger
Rights of the Mentally Ill
- clients have all the civil rights of any citizen, except the right to leave the hospital in the care of involuntary commitment
- can refuse treatment (except under life threatening conditions or emergency tx orders)
Any restrictions of the client’s freedom….
must be made by MDs or with a court order with a verifiable, documented reason
Restraints
direct application of physical force to a person without his/her permission to restrict freedom of movement.
Force can be human, mechanical or a combo
Restraints used only to…
prevent injury to client or someone else
Reason for restraints…
must be justified and documented and have physician order
Strict guidelines for use are…
spelled out in policies and procedures
If restraints not documented….
agency can lose license and nurse sued for battery
Seclusion
involuntary confinement of a person in a specially constructed, locked room (usually has a window or camera for visual monitoring)
-provides decreased stimulation, protecting of others from the client, prevention of property destruction, and privacy for the client
Goal to seclusion
give the client the opportunity to regain physical and emotional self-control
-must be closely monitored
Nurse’s documentation for seclusion
-must justify seclusion as well we document the occurence
Release from seclusion
-as soon as possible, the client is informed of the behavioral criteria for release from seclusion
Informed consent
-client must receive enough information to make a decision about treatment and to communicate that decision to others
Least Restrictive Environment
-clients have the right to treatment in the least restrictive environment that is appropriate for their needs while maintaining their safety and that of others
EBP for mental health
- 6 core strategies to reduce use of seclusion and restraints
- leadership toward organizational change
- use of data to inform practice
- workforce development
- use of S/R reduction tools
- consumer roles in inpatient settings
- debriefing techniques
