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Mental Health Nursing > Mental Health Nursing History and Scope of Practice > Flashcards

Mental Health Nursing History and Scope of Practice Flashcards

1
Q

Peplau’s 3 core elements of mental health nursing

A
  1. the patient
  2. the nurse
  3. interaction between patient and nurse
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2
Q

Peplau’s 4 phases of the mental health nursing interpersonal theory negotiated relationship

A
  1. orientation
  2. identification
  3. exploitation
  4. resolution
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3
Q

What does ‘recovery’ mean in a mental health context?

A

Recovery is being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms. It is about having control over and input into your own life. Each individual’s recovery, like his or her experience of the mental health problems or illness, is a unique and deeply personal process.

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4
Q

Common mental illnesses

A
  • anxiety
  • bipolar disorder
  • delirium
  • dementia
  • depression
  • schizophrenia
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5
Q

3 types of personality disorders

A
  • cluster A: odd/eccentric
  • cluster B: dramatic, erratic and emotional
  • cluster C: anxious and fearful
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6
Q

4 tiers of mental health services

A

tier 1 - mild
tier 2 - moderate
tier 3 - severe
tier 4 - enduring

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7
Q

how are mental disorders classified?

A

1- International Classification of Diseases (ICD-11) produced by the World Health Organization (WHO)

2- Diagnostic and Statistical Manual of Mental Disorders (DSM-V) produced by the American Psychiatric Association (APA)

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8
Q

What are the classifications of the IDC-11?

A

F1 Organic, including symptomatic, mental disorders (e.g. alzheimer’s, dementia)
F2 Mental and behavioural disorders due to use of psychoactive substances
F3 Schizophrenia, schizotypal and delusional disorders
F4 Mood (affective) disorders
F5 Neurotic, stress-related and somatoform disorders
F6 Behavioural syndromes associated with physiological disturbances and physical factors
F7 Disorders of personality and behaviour in adult persons
F8 Mental retardation
F9 Disorders of psychological development
F10 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence

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9
Q

Substance abuse key terms

A
  • addiction
  • dependence
  • harmful use
  • hazardous use
  • intoxication
  • tolerance
  • withdrawal
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10
Q

What is the role of nursing in mental health assessment?

A
  • listen
  • validate and explore concerns
  • ask key questions about the person’s problems
  • observe
  • offer an interpretation
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11
Q

What are the focuses of assessment in mental health nursing?

A
  • the client’s presenting problems
  • clinical symptoms
  • mental health history
  • current mental state
  • risk
  • strengths and protective factors
  • physical health strengths and protective factors
  • other aspects of psychosocial functioning
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12
Q

different tools and models of mental health assessment?

A
  • conversational interview
  • history-taking
  • systems review
  • validated assessment instruments
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13
Q

validated assessment instruments?

A
  • Alcohol Use Disorders Identification Test (AUDIT) for assessment of alcohol use
  • Mini-Mental State Examination (MMSE) for assessment of cognitive function
  • Beck Depression Inventory (BDI) for assessment of mood
  • Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) for assessment of side effects of medication
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14
Q

Mental state assessment using BATOMI mnemonic

A
  • Behaviour and appearance
  • Affect and mood
  • Thought and speech
  • Orientation
  • Memory
  • Insight and Judgement
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15
Q

Steps for mental state assessment

A
  1. Determine the need to assess mental state of patient.
  2. Focused mental health history
  3. Assess mental state
    a. appearance
    b. behaviour
    c. affect and mood
    d. thought and speech
    e. orientation
    f. memory
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16
Q

Mental State Assessment - conducting a focused mental health history

A

a. Consider the patient’s usual mental state, and how mental state may be affected by illness.
b. Consider the presence of factors that may affect mental state:
• pain/discomfort
• sedative or other effects of medication
• tiredness
• anxiety about health/hospitalisation
• sensory loss or impairment
• nausea or other symptoms
• any history of mental illness
• alcohol or drug use.

Procedure

(1) Initiate communication by introductions, clarification of the patient’s immediate needs and problems.
(2) Consider positioning of nurse and patient to assist communication, that is, by enabling eye contact.
(3) Ideally sit at the same level as the patient.
(4) Continue with assessment using guidelines below to assess mental state.

17
Q

Mental State Assessment - assessment of appearance

A

includes both expected and unusual aspects of appearance. Observe for:

(1) Gross appearance (stature, state of dress, appropriateness of dress for current situation).
(2) Patient’s apparent age compared with recorded age.
(3) Position during assessment (sitting, lying).
(4) Grooming and evidence of self-care or neglect.
(5) Jewellery, make-up.
(6) Distinguishing features (complexion, marks on skin, any observable disabilities).
(7) Facial expressions.

18
Q

Mental Statement Assessment - assessment of behaviour

A

includes all observable behaviour. Observe for:

(1) Physical signs of anxiety or distress (handwringing, nervous mannerisms, plucking at clothes/hair, clutching objects such as purse or personal items).
(2) Changes in behaviour in response to assessment.
(3) Any tremor or involuntary movements.
(4) Gestures with hands, eyes, head.
(5) Crying, laughing or other behavioural indicators of mood.
(6) Eye contact with interviewer (observe for constant, intermittent, intense or absent eye contact).
(7) Motor activity (settled/relaxed, changes of position, restlessness).

19
Q

Mental Statement Assessment - assessment of affect and mood

A

includes direct and indirect observations of emotional state

(1) Emotional responsiveness (warm, engaging, distant, aloof).
(2) Responses to topics of discussion.
(3) Crying, smiling, laughing and other behavioural indicators of emotional state.
(4) Conversational triggers to emotional responses.
(5) Congruence between emotional response and content of conversation.
(6) Irritability/anger.
(7) Indications of anxiety.
(8) Patient’s self-rating of mood (1 = lowest ever; 10 = best ever).

20
Q

Mental Statement Assessment - assessment of thought and speech

A

includes directly observed speech and underlying thought processes.
Make allowances for age, culture, language. Observe for:
(1) Rate of speech (slowed, normal, accelerated, pressured).
(2) Themes of thought and speech (preoccupations, guilt, depressive themes, dominant concerns).
(3) Reduced/absent speech.
(4) Organisation of speech (coherent, logical, complete sentences, goal-oriented).
5) Evidence of ideas that are out of context (i.e. paranoid ideas, delusions).
(6) Evidence of unexplained perceptions (voices, visual hallucinations).
Patients can also be asked to describe their thoughts.

21
Q

Mental Statement Assessment - assessment of orientation

A 
(1) Aspects of orientation are:
• Time
• Place
• Person
(2) Orientation is assessed by asking specific questions or interpreting conversational cues to orientation (e.g. names, time, place of assessment).
22
Q

Mental Statement Assessment - assessment of memory

A

includes all retention of information, whether short or long term.
(1) Observe for:
• attention/concentration/registration
• short-term memory loss
• long-term memory loss.
(2) Ask specific questions if you need to test different aspects of memory, that is, can the patient remember:
• events that just occurred (registration)
• events that occurred 5 minutes ago (short-term memory)
• events that occurred on the previous day (long-term memory).
Memory can be further tested by giving the names of three unrelated items (ball, flag, tree) and asking the patient to repeat (registration) and then recall after 5 minutes’ conversation.

23
Q

Mental Statement Assessment - assessment of insight and judgement

A

assesses and records the patient’s understanding of their current:

(1) realistic perception of current health problems
(2) realistic perception of any need for treatment
(3) awareness of consequences of own choices.

Mental Health Nursing (9 decks)

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