Mental health nursing Flashcards
What are some historical treatments of mental health problems?
- drive out evil spirits
- Remove a piece of skull (so brain could relax?)
- Exorcism
- lobotomy (take out a piece of lobe)
- exclusion
- burnt at the stake
- locked up in an institution
What is the mission statement for Queenslands plan for mental health
“To provide a comprehensive, resilience and recovery-based mental health system across Queensland, with emphasis upon promotion, prevention and early intervention”
What are the principles for Queenslands plan for mental health?
- Consumer participation
- Resilience and recover
- Social inclusion
- Collaboration and partnerships
- Promotion prevention and early intervention
- Evidence
What is self awareness?
Knowing how you are going to respond to specific situations, knowing your values, attitudes and biases towards people and situations, and knowing how your human needs might manifest your work.
What are the core concepts of the effective nurse?
Empathy Autonomy Self-disclosure Confidentiality Advocacy Boundariesm
What is the role of the mental health nurse?
Mental state assessment Social/personal assessment Physical health assessment Counselling Monitoring, planning and evaluation Administration of medication Linking consumer with social activities Advocating for consumer and family Assisting with lifestyle choices Education - illness and treatment options Education for consumers,carers, family, other nurses, health professionals, members of the public. Linking with families Case management Member of the multi dis team Research Build therapeutic relationships with consumer, carers mad family
What is a therapeutic relationship?
A balance between the personal self, offering human closeness and professional distance.
An enabling relationship that supports the needs of the client
Based on rapport, establishing a connection with the person and developing trust
What is the consumer consultant, and how do they help the mental health service team?
People who have had a mental illness or are being treated with a mental illness.
Work in the facilities, congruent between the client and the staff help to assist the person to feel more part of the process, monitor how the service is working with the consumer. And give staff advice on what is best
How can the stigma of mental health be changed within the community?
Updated mental health act
Transportation via ambulance or mental Health care workers
Giving care in the least restrictive way for the client
Early interventions
Using GP
What is the role of the GP
Discussion and education of treatment
Deinstitutionalisation
Keeping the client in the community
What are the components of the psychosocial health assessment?
Identifying data Presenting problem History of presenting problem Family history Psychiatric history Occupational/educational history Spirituality/religion Mental state assessment Previous physical health Coping and stress Substance use and medications Other problems/issues
What are the components of the mental state assessment?
Appearance and behaviour Speech Mood and affect Form of thought Content of thought Sensorium and cognition Perception Insight
What is included in appearance and behaviour?
What do they look like Their clothes Where they clean Their hair Piercings Tattoos Clothes appropriate for the weather Motor behaviour Pacing, fiddling? Did they want to be here How do they feel about being here Make no judgements, only state what you see
What is included in speech for the Msa?
Rate
Volume
Quality of information
What is included in mood and affect for a MSA?
Mood - what they say they feel
Affect - how they appear to feel, your impression
Is the mood congruent with the affect?
What is included in form of thought for an MSA?
How the thinking is formed?
Amount of thought and rate of production
Continuity of ideas
Disturbance in language and meaning
What is included in content of thought for an MSA?
Delusions
Suicidal thoughts
What is included in perception for an MSA?
Hallucinations - auditory, visual, gustatory.
Voices - how many voices, what do they say, is it a make or female, do they have a name?
Perceptual disturbances eg. Derealisation, depersonalisation, dulled perception
What is included in sensorium and cognition for a MSA?
Level of consciousness Memory - immediate, recent, remote How did they get here? Orientation - time place and person Concentration - serial 7's Abstract thinking
What is included in insight for an MSA?
Extent of individual’s awareness of problem
I’m here because I’m drinking to much….
I’m here because the aliens have inserted probes into my head…
What is included in a risk assessment?
Suicidal/homicidal thoughts or ideas Do they have a plan? Do they have means? Sold property Given pets away Rope in car What is the intention? To not wake up in the morning Do they have a timeframe?
Give the definition of insight
The persons awareness of their situation or problem, including the existence of a mental health problem. Insight may exist in varying degrees ranging from no or little insight or awareness, through to a good level of insight. Assessment of insight is important in terms of the persons willingness to accept treatment - if they do not believe they have a problem for instance they are unlikely to accept help for it.
What is the definition of labile?
A term in relation to mood, where the person fluctuates between extremes of emotional states
What is the definition of thought disorder?
A disturbance of thought where expressions of thoughts is disrupted, resulting in illogical and awkward thinking and speech
What is the definition of thought form?
A component of the MSA that refers to the manner in which thoughts are expressed, as opposed to the content of thought.
What is autonomy?
Right to make own decisions, with ought violating the rights of another
What is beneficence?
Conduct that is good for the wellbeing of another
What is non-maleficence?
Above all, to do no harm and consider potential harm.
What are ethical violations?
Improve neglect of moral obligation (eg. Neglect of competent care provision)
What is an ethical dilemma?
Ethical reasons for and against a particular course of action - and one must be chosen.
What are some common ethical dilemmas?
Confidentiality violations Use of restraint Involuntary admission Informed consent Sexual attraction/relationship between professional and consumer
What elements are involved in the continuum of professional behaviour?
Disinterested neglectful-therapeutic relationship-boundary violations
Under involvement-zone of helpfulness-over involvement
How can you identify boundary violations?
Excessive self disclosure Secretive behaviour Super nurse Singled out treatment Selective communication Flirtations Sexual misconduct
What are some strategies to prevent boundary transgressions?
Reflective practice Peer support Clinical supervision Education Remaining current with professional groups
What are some ethico-legal issues in mental health nursing?
Right of a person to receive treatment may conflict with right to refuse
Right to refuse takes precedence unless person legally deemed a danger to self/others
Nurses have to make decisions balancing clients expressed wish vs. what is best interest
What is the purpose of the QLD MH act 2000?
Provides for the involuntary assessment and treatment, and protection, of persons while at the same time safeguarding their rights
Provides for the determination of a persons mental state when they have a mental illness and have been charged with a criminal offence
What is the definition of a mental illness in the QLD mental health act 2000?
A condition characterised by a clinically significant disturbance of thought, mood, perception or memory.
What are the principles of the QLD MH act 2000?
Respect for basic human rights
Persons particular needs and circumstances to be taken into account
Treatment under the act only to be given if it’s appropriate to maintain MH and wellbeing
Person has the right to confidentiality
Must be used if no less restrictive way to protect
What are the patients rights under the act?
Privacy and rights Least restrictive environment Individual treatment plans Informed consent Right to refuse, unless legally required Confidentiality Provision to info in a timely manner
What orders can be used for involuntary assessment?
JEO justice examination order
EEO emergency examination order
What is a JEO, justice examination order?
Can be made by a JP or magistrate
Person must reasonably believe that the person has a mental illness and that the person should be examined to determine whether a recommendation for assessment should be made and the examination cannot be carried out unless the order is made
Valid for up to 7 days and forwarded directly to AMHS
But person must be seen within 3 days
What is an EEO emergency examination order?
Can be made by a police officer or ambulance officer or psychiatrist
The person can be detained for up to 6hours
Examination by a doc or AMHP to decide if the assessment documents should be made
If documents are not made the person must be taken back to the place they were taken from or another place the person reasonably asked to be taken
In order be be assessed what criteria does the person need to meet?
Person appears to have a mental illness
Person requires immediate assessment
The assessment can be made at an authorised mental health service
There is a risk the the person may, cause harm to themselves, or someone else or suffer serious mental or physical deterioration
There is no less restrictive way of ensuring the person is assessed
The person lacks the capacity to consent or has refused to be assessed
What is the treatment criteria for a person under the mental health act?
The person has a mental illness
The persons illness requires immediate treatment
The treatment is available at the MH service
Because if their illness the person may cause harm to themselves or others
The person is likely to suffer deterioration
No less restrictive way
Person lacks the capacity to consent
Refuses treatment
What is psychosis?
Is a condition in which a person has impaired cognition, emotional, social and communicative responses and interpretation of reality
What is a hallucination?
A sensory perception that seems real but occurs without external stimulation. (Unlike an illusion, which is a misinterpretation of real phenomena)
Name the different types of hallucinations
Auditory - voices, inside head, outside, who are they, embrace them?
Visual- seeing things,
Olfactory- smells, querie organic?
Tactile- touch, feel something on my skin… Drug and alc withdrawal
Gustatory- taste, quierie organic?
Somatic-
Thought disorder - What is clanging?
Often person is elevated, coming up with puns and rhymes eg. Here’s a pen, my names Ben, I have 10
Thought disorder - What is circumtantiality?
Starts a story and goes off on a tangent then comes back, adding in so much detail
Thought disorder - What is derailment?
Often no connection in story, jumps from one part to another.
I grew up in Adelaide, I don’t like fish and chips I’m good at cooking
Thought disorder - What is tangentiality?
Off on tangent, the story continues but never finishes on the main point.
Thought disorder - What is incoherence?
Making no sense at all can not cohere what the person is telling
Thought disorder - What is thought blocking?
On the tip of the tongue, the person looses the thought entirely.
Thought disorder - What is word approximations?
Person finds it really difficult to explain things
Thought disorder - What is neologisms?
Making up new words
Thought disorder - What is a word salad?
Jumbled words coming together, eg. Cold battleship major cat phone flower wing rang
Expressive aphasia
What is a delusion?
A false belief based on incorrect inference about an external reality that is firmly sustained despite what almost everyone else believes and despite incontrovertible and obvious proof or evidence to the contrary
Can often sound like plausible things, need to be careful
Delusion - what does persecution mean?
I’m being watched all the time, sometimes I feel like I’m on camera and people are watching me and are stealing my thoughts
Delusion - what is somantic?
Feeling a snake moving within her stomach
Delusion - what is a religious delusion?
Believing they are the chosen one, I’m a bad person because I a previous life I did this and now I have to pay for my sins
Delusion - what is thought broadcasting?
When I think something you can all hear what I’m thinking and it’s really uncomfortable, your taking the thoughts out of my mind
Delusion - what is nihilistic?
Loosing hope and positivity, world is ending what’s the point.
Delusion - What is thought insertion?
You are putting thoughts into my mind there is a probe or a computer chip, people are controlling me through satellites
Delusion - what is erotomania?
Kyrie monouige wants to shag me, a sexual delusion
Delusion - what is grandiose?
I am king of the world! The reason I’m going to buy a porche is because I deserve a porche
Delusion - what is a control delusion?
The persons actions are being controlled the person has no independence
Delusion - what is a reference delusion?
When I watch family feud, the person is talking to me, the person is talking about me, they are telling me things passing me messages
Psychotic symptoms can also mean?
Neuro conditions Metabolic or endocrine disturbances Vitamin deficiencies Auto immune disorders Med or drug intoxication or withdrawal Dementia and or delirium
What is brief reactive psychosis?
Psychosis in reaction to an incredible stress
What is puerperal psychosis?
Immediate postpartum period of psychosis
