MIDTERM (JAY) Flashcards
What is stigma?
negative beliefs that impact the way we see the truth. Can prevent adequate care and seeking care
What is a stereotype?
A generalized belief about a group of people; expecting them to act in a certain way
What is discrimination?
Behavioural manifestation of prejudice
What is prejudice?
Hostile attitudes towards people belonging to a specific group
What are some common myths about mental illness?
- violent and dangerous
- caused by personal weakness
- less intelligent
- rare, untretable
What did Dorothea Dix do?
during 1840s
during 1840s, advocated for human tx, MH care, more hospitals. Advent of Nursing Care for the mentally ill was born (social reform)
What was the 1st antimanic med?
Lithium
What was the first antipsychotic?
Chlorpromazine
What were the first antidepressant meds?
MAOI and tricyclic
When was BC’s first asylum opened?
1872
What happened to Riverview? Empowerment and Deinstitutionalization
1909: construction begins on “Hospital for the Mind”; Essondale, later became Riverview
1913: opened, had 4,630 patients at peak
1970s/80s: patient advocacy groups emerged
1980s onwards: beginning of deinstitutionalization
1990s: Riverview began downsizing
2009: 256 active beds remain
2012: only 3 wards w/ less than 15 patients
2013: lights out
Brief hx of mental illness:
Prior to 1790: evil spirits, possession. Chains, shackles, and confinement as tx
1792: Pinel believed human were inhumanely tx; removal of chains
1835: first lunatic asylum
1836: insanity act formed, later became MHA
What is the period of institutionalization in Canada?
1845 (Quebec) to 2011 (BC)
What is the significance of veterans in MH care?
- MH tx became focus after WWI veterans were returning w/ shellshock (PTSD)
- led to the implementation of MH hospitals
- CNCMH formed in 1918
Define asylum:
peace, relief; we added the negative stigma
Define insanity:
not of a sound mind; made derogatory
What does psychotherapy do?
helps the patient to help themselves by asking strategic Q’s
Hx of MH tx:
1915: Malaria Fever Therapy
1920s: hyrdotherapy
1930-50s: Insulin Coma Therapy
1938 - present: ECT
1936-1970’s: Lobotomy
- all were aimed to ‘reset’ the brain
Explain choice community integration (MH care and reform):
- ongoing community involvement, enhanced understanding
- greater advocacy to protect rights and freedoms of MI ppl
- empowerment of client to help themselves; psych nurse acts as “facilitator”
- providing opportunities for people w/ MI to make their own decisions in tx
What is self awareness?
understanding one’s biases, beliefs, thoughts etc. and recognizing how they affect self and others
What is projection?
falsely attributing to other your own unacceptable thoughts/feelings
What is transference?
client unconsciously transfers aspects of past relationship onto nurse
What is ethics:
study of good conduct, character, motives. Accountability! Each practitioner has the responsibility to adhere to standards of ethical practice
RPN code of ethics:
Primary purpose: protect the public
- defines/provides RPN’s w/ practice standard
- governed by Health Professions Act
CRPNBC Professional standards
Therapeutic Relationships
Theory/knowledge base
Professional Accountability
Ethical Practice
Health care ethical principles:
Autonomy
Beneficence
Non-maleficence
Dignity
Justice
Truthfulness, informed consent & confidentiality
MH Care issues:
Behaviour control and restraint
- relational engagement and boundaries
- confidentiality
- ethical practice environments
- social justice
What is medical futility?
interventions unlikely to produce any significant benefit to patient
What are the 4 classifications of futility?
- not futile (beneficial)
- futile (not beneficial)
- futile from patient perspective
- futile from clinician perspective
Definition of critical thinking:
- art of analyzing and evaluating thinking w/ a view to improve
- encompasses both cognitive processes and attitudes
- consciously examining our own thinking processes
What is egocentric thinking?
Results form our tendency to be self-centered and to view situations/info from our own point of view with the assumption that it is “right”
What is sociocentric thinking?
Results from internalization of the dominant prejudices of our society or culture
It involves taking on group norms, beliefs, and to blindly conform to group standards without questioning them.
We begin to view situations from this lens and dont consider alternate perspectives/cultures
Elements of critical thinking:
-purpose
-question at issue
-information
-concepts
-assumptions
-inferences
-point of view
-implications
How do we measure the quality of our thinking?
Clarity, Accuracy, Precision, Relevance, Depth, Breadth, Logic
What is the problem solving process?
-Clarify the nature of a problem and suggests possible solutions
-Evaluate solutions and choose best one to implement
3 types of questions in problem solving:
- there is a correct answer: req. knowledge
- no ‘right’ answer: calls for subjective opinion/preference
- multi ‘right’ answers: clinical judgment
close-ended questions
Questions that can be answered in short or single word responses.
open-ended questions
questions that allow respondents to answer however they want
What is a complete health assessment?
non-emergent data collected at initial visit, or on hospital admission
What is an emergency assessment?
A quick focused assessment in an emergency situation to identify life-threatening problems
What is an episodic/problem centered assessment?
follow up assessment to a specific previously identified problem
What is a follow-up assessment?
analyzing previously implemented evaluation
What are the components of a health hx?
- biographical/demographic data (age, gender, address, etc.)
- chief concern/reason for visit (record verbatim: offers insight into experience)
- hx of present illness
- past health hx (including psych hx)
- family hx
- holistic assessment (physiological, psychological, sociocultural, developmental, spiritrual)
- perception of health
- MSE
What does the MSE assess?
- appearance and psychomotor behaviour
- mood/affect
- speech (nature of speech)
- thought form (how are they thinking?)
- though content (what are they thinking)
- perception (5 senses, hallucinations and delusions)
- cognition (memory, concentration, intelligence)
- insight/judgement
- risk assessment
Head to toe assessment:
- general survey
- vital signs
- head
- neck
- upper extremities
- chest/back
- abdomen
- anus and rectum
- lower extremities
What is the difference between insight and judgement?
insight: someone’s thoughts on their actions - do they understand their illness/know why they are there?
judgement: behavioural manifestation of insight - do they understand if their actions are good/bad?
What are the methods of physical assessment?
- inspection
- auscultation
- palpation
- percussion
- olfaction
What is the purpose of a conceptual framework?
- guide/organize assessment
- assist in identifying an dx health problems
- guide planning evaluation of care
- guides curriculum for education
- frame of reference to organize nursing research
4 Meta-paradigms of nursing (PEHN)
- person
- environment
- health
- nursing
What is recovery?
- represents return and maintenance of system stability following tx
- complete recovery may occur beyond baseline, may stabilize system to lower level, or return to level of wellness prior to illness
What falls under the psychological variable?
- emotions
- cognition
- perception of self
- self esteem
- body image
- self-ideal
- sexuality
- self-identity
What falls under the developmental variable?
- expected life events
- unexpected life events
- growth
- development
- transition
What falls under the sociocultural variable?
- language/communication patterns
- cultural roles and expectations
- social hx
- relationships/ SOs
- health beliefs
- habits/practices
- ethnicity and race
What falls under the spiritual variable?
- purpose and meaning
- interconnectedness
- faith
- religion
- forgiveness
- creativity
- transcendence
3 Components of Psychological Variable
- Emotions (Mood & Affect)
- Cognition & Perception (Thought Formation)
- Self Concept (Self-esteem, body image, sexuality and how you define yourself)
Influences on the development of Self Concept
Relations, environment, culture, genetics
What is a healthy self concept
Is stable, positive, meaningful, and helps an individual cope with stress
What does self identity comprise of
Ethnicity, religion, social class, age
What does self identity assessment comprise of
Determining a persons self awareness and their relationships with themselves and others
What is self ideal
Goals of who you want to be and evaluating who you are
What is body image
One’s relationship with their body
What is body dysmorphic disorder (BDD)
Linked with OCD, ones belief that their appearance is flawed when it is not
What is self esteem
One’s definition of their self worth
What is sexual identity
how people view themselves as a sexual being and is influenced by culture, ethnicity and religious beliefs and practices
What is gender identity
Do we identify ourselves as a male, female or other
What is gender dysphoria
A person who identifies with a different gender from which they were born (the distress resulting from it)
What is role performance
The way individuals perceive their ability to carry out significant roles
What are 5 social processes that influence role performance
Reinforcement-extinction
Inhibition
Substitution
Imitation
Identification
What is reinforcment-extinction
Certain behaviours become common
or are avoided, depending on whether they are approved and
reinforced or are discouraged and punished.
What is inhibition
An individual learns to refrain from certain
behaviours, even when tempted to engage in them.
What is substitution
An individual replaces one behaviour with another,
which provides the same personal gratification.
What is imitation
An individual acquires skills or behaviours by
observing and then imitating the skills and behaviours of other
members of the family or other social or cultural groups.
What is identification
An individual internalizes the beliefs, behaviours,
and values of role models into a personal, unique expression of
self.
What are some behavioural clues of altered self concept
Avoidance of eye contact Slumped posture
Poor grooming
Derogatory self talk “ I’m so fat/ ugly/ stupid”
Being overly apologetic Hesitancy in expressing views or opinions
Difficulty making decisions
MSE ASSESSMENT AREAS (10)
General Appearance (O) & Psychomotor Behavior (O)
Emotional State: Affect (O) and Mood (S)
Speech (O)
Thought Process/Form (O & S)
Thought Content (O & S)
Perception (O & S)
Cognitive Functioning/Sensorium (O & S)
Insight (O)
Judgment (O & S)
Risk assessment (O & S)
