PMHNP exam Flashcards
Definition:
- The client’s right to assume that information given to the healthcare provider will not be disclosed
- Protected under federal statute through the Medical Record Confidentiality Act of 1995
- Pertains to verbal and written client information
- Requires that the provider discuss confidentiality issues with clients, establish consent, and clarify and any questions about disclosure of information.
- Requires that provider obtain a signed medical authorization and consent form to release medical records and information when requested by the client or another healthcare provider.
Confidentiality
Definition:
- The first national comprehensive privacy protection act
- Guarantees clients four fundamental rights: 1. To be educated about HIPAA privacy protection, 2. To have access to their own medical records, 3. To request amendment of their health information to which they object, and 4. To require their permission for disclosure of their personal information.
HIPAA
Definition:
- When appropriate persons or organizations determine that the need for information outweighs the principle of confidentiality
- If a client reveals an intent to harm self or others
- Information given to attorneys involved in litigation
- Releasing records to insurance companies.
- Answering court orders, subpoenas, or summonses
- Meeting state requirements for mandatory reporting of disease or conditions
- Tarasoff principle: duty to warn potential victim of imminent danger of homicidal clients
- In cases of child or elder abuse.
Exceptions to guaranteed confidentiality
Definition:
1. Persons younger than 18 years old who are married, parents, or self-sufficiently living away from the family domicile
Emancipated minors
Definition:
- Duty: the NP had a duty to exercise reasonable care when undertaking and providing treatment to the client
- Breah of duty: the NP violated the applicable standard of care in treating the client’s condition.
- Proximate cause: There is a causal relationship between the breach in the standard of care and the client’s injuries.
- Damages: The client experiences permanent and substantial damages as a result of the breach in the standard of care.
Four Elements of negligence that must be established to prove malpractice.
Definition:
- Person has a diagnosed psychiatric disorder
- Person is harmful to self or others as a consequence of the disorder
- Person is unaware or unwilling to accept the nature and severity of the disorder
- Treatment is likely to improve function
Commitment basic criteria
Developmental Stage for:
Trust vs. mistrust
Ability to form meaningful relationships, hope about the future, trust in others
Developmental failure: poor relationships, lack of future hope, suspicious of others
Infancy Birth-1 year
Developmental Stage for:
Autonomy vs shame and doubt
Self-control, self esteem, willpower
Developmental failure: poor self control, low self esteem, self doubt, lack of independence
Early childhood 1-3 years
Developmental Stage for:
Initiative vs guilt
Self-directed behavior, goal formation, sense of purpose
Developmental failure: Lack of self initiated behavior, lack of goal orientation
Late childhood 3-6 years
Developmental Stage for:
Industry vs inferiority
Ability to work; sense of competency and achievement
Developmental failure: Sense of inferiority; difficulty with working, learning
School-age 6-12 years
Developmental Stage for
Identity vs. role confusion
Personal sense of identity
Developmental failure: Identity confusion, poor self-identification in group settings
Adolescence 12-20 years
Developmental Stage for
Intimacy vs isolation
Committed relationships, capacity to love
Developmental failure: Emotional isolation, egocentrism
Early adulthood 20-35 years
Developmental Stage for
Generativity vs self-absorption or stagnation
ability to give time and talents to others, ability to care for others
Developmental failure: self-absorption, inability to grow and change as a person, inability to care for others
Middle adulthood 35-65 years
Developmental Stage for
Integrity vs despair
Fulfillment and comfort with life, willingness to face death, insight and balanced perspective on life’s event
Developmental failure: Bitterness, sense of dissatisfaction with life, despair over impending death
Late adulthood greater then 65 years of age
Typical age of onset for intellectual disability
infancy-usually evident at birth
Typical age of attention deficit hyperactivity disorder
Early childhood per DSM 5 by age 12
Typical age of schziophrenia
18 to 25 years for men
25 to 35 years for women
Typical age of major depression
Late adolescence to young adulthood
Typical age of dementia
most common after age 85
Three primary psychic structures make up the mind and personality and are responsible for mental functioning:
Contains primary drives or instincts, urges, or fantasies
Drives are largely unconscious, sexual, or aggressive in content, and infantile in nature
Operates on the pleasure principle; seeks immediate satisfaction
Is present at birth and motivates early infantile actions
The Id
Three primary psychic structures make up the mind and personality and are responsible for mental functioning:
Contains the concept of external reality
Rational mind; responsible for logical and abstract thinking
Functions in adaptation
Mediates between the demands of drives and environmental realities
Operates on the reality principle
Begins to develop at birth as infant struggles to deal with environment
Responsible for use of defense mechanisms
The go says, “I think, I evaluate”
The Ego
Three primary psychic structures make up the mind and personality and are responsible for mental functioning:
Is the ego-ideal
Contains sense of conscience or right versus wrong
Also contains aspirations, ideals, and moral values
Regulated by guilt and shame
Begins to fully develop around age six as a child comes into contact with external authority figures such as other parents, schoolteachers, coaches, or religious figures
The superego says “I should or outght”
The Superego
Freud’s psychosexual stages of development:
Primary means of discharging drives and achieving gratification:
Stage and Age:
Sucking, chewing, feeding, crying
Psychiatric disorders linked to failure of stage: schizophrenia, substance abuse, paranoia
Oral stage 0-18 months
Freud’s psychosexual stages of development:
Primary means of discharging drives and achieving gratification:
Stage and Age:
Sphincter control, activities of expulsion and retention
Psychiatric disorders linked to failure of stage:
Depressive disorders
Anal Stage 18 months-3 years
Freud’s psychosexual stages of development:
Primary means of discharging drives and achieving gratification:
Stage and Age:
Exhibitionism, masturbation with focus on Oedipal conflict, castration anxiety, and female fear of lost maternal love
Psychiatric disorders linked to failure of stage: Sexual identity disorders
Phallic stage 3-6 years
Freud’s psychosexual stages of development:
Primary means of discharging drives and achieving gratification:
Stage and Age:
Peer relationships, learning, motor skills development, socialization
Psychiatric disorders linked to failure of stage: Inability to form social relationships
Latency stage 6 years to puberty
Freud’s psychosexual stages of development:
Primary means of discharging drives and achieving gratification:
Stage and Age:
Integration and synthesis of behaviors from early stages, primary genital-based sexuality
Psychiatric disorders linked to failure of stage: Sexual perversion disorder
Genital stage Puberty forward
Which Theory?
Human development evolves through cognition, learning, and comprehending
Factors such as native endowment and biological and environmental factors set the course for a child’s development.
Cognitive theory: Jean Piaget ( 1896-1980)
What are these?
Denial, Projection, Regression, Repression, Reaction formation, Rationalization, Undoing, Intellectualization, Suppression, Sublimation, Altruism
Defense Mechanisms
Avoidance of unpleasant realities by unconsciously ignoring their existence
Denial
Unconscious rejection of emotionally unacceptable personal attributes, beliefs, or actions by attributing them to other people, situations, or events
Projection
Return to more comfortable thoughts, behaviors, or feelings used in earlier stages of development in response to current conflict, stress, or threat
Regression
Often called overcompensation; unacceptable feelings, thoughts, or behaviors are pushed from conscious awareness by displaying and acting on the opposite feeling, thought, or behavior
Reaction formation
Justification of illogical, unreasonable ideas, feelings, or actions by developing an acceptable explanation that satisfies the person
Rationalization
Behaviors that attempt to make up for or undo an unacceptable action, feelings, or impulse
Undoing
Attempts to master current stressors or conflict by expansion of knowledge, explanation, or understanding
Intellectualization
Conscious analog of repression; conscious denial of a disturbing situation, feeling, or event
Suppression
Unconscious process of substitution of socially acceptable, constructive activity for strong unacceptable impulse
Sublimation
Meeting the needs of others in order to discharge drives, conflicts, or stressors
Altruism
- Sensorimotor (birth to 2 years): the critical achievement of this stage is object permanence
- Preoperational (2-7 years): more extensive use of language and symbolism; magical thinking
- Concrete Operations (7-12 years): Child begins to use logic; develops concepts of reversibility and conservation
- Formal Operations (12 years to adult): Ability to think abstractly; thinking operates in a formal, logical manner
Four stages of cognitive development in Jean Piaget Cognitive Theory
What theory?
Behavior occurs because of interpersonal dynamics
Interpersonal relationships and experiences influence one’s personality development, which is called the self-system (the total components of personality traits).
Understanding behavior: the drive for satisfaction (basic human drives such as sleep, sex, hunger) and the drive for security (conforming to social norms of a person’s reference group).
When the person’s need for satisfaction and security is interfered with by the self-system, mental illness occurs.
Humans experience anxiety and behavior is directed toward relieving the anxiety, which then results in interpersonal security.
Interpersonal theory (Harry Stack Sullivan, 1892-1949)
What theory?
Health model rather than illness model
A hierarchical organization of needs
Hypothesizes that certain needs are more important to than others
States that a person will attempt to meet more important needs first before satisfying other needs
Hierarchy of Needs Theory (Abraham Maslow, 1908-1970)
What theory? Survival Safety and security needs Love and belonging Self-esteem Self-actualizations
Hierarchy of Needs Theory (Abraham Maslow)
Developmental Task: Oral gratification; anxiety occurs for the first time
Infancy Birth to 18 months
Developmental Task: Delayed gratification
Childhood 18 months to 6 years
Developmental Task: Forming of peer relationships
Juvenile 6 to 9 years
Developmental Task: Same sex relationships
Preadolescence 9-12 years
Developmental Task: Opposite-sex relationships
Early adolescence 12-14 years
Developmental Task: Self-identity developed
Late adolescence 14-21 years
What model? Explains that healthy people do not always take advantage of screening or preventative programs because of the following certain variables: 1. Perception of susceptibility 2. Seriousness of illness 3. Perceived benefits of treatment 4. Perceived barriers to change 5. Expectations of efficacy
Health Belief Model (Marshall Becker, 1940-1993)
What model?
States that change such as in health behaviors occurs in sex predictable stages:
1. Precontemplation: the person has no intention to change
2. Contemplation: The person is thinking about changing; is aware that there is a problem but not committed to changing.
3. Preparation The person has made the decision to change; is ready for action
4. Action: The person is engaging in specific, overt actions to change.
5. Maintenance: The person is engaging in behaviors to prevent relapse
Transtheoretical Model of Change
Components of what?
- Focused, goal directive therapy
- Builds on the Transtheoretical Model of Change
- Motivation is elicited from the client
- Nonconfrontational, nonadversarial
Motivational Interviewing (Miller & Rollnick, 1991)
What Theory?
- Behavior is the result of cognitive and environmental factors
- People learn by observing others, relying on role-modeling
- Self efficacy is the perception of one’s ability to perform a certain task at a certain level of accomplishment.
- Behavioral change and maintenance are functions of outcome expectations and efficacy expectations.
Self-efficacy and social learning theory (Albert Andura, born 1925)
Nursing Theory:
Regardless of the culture, care is the unifying focus and the essence of nursing
Health and well-being can be predicted through cultural care
Theory of cultural care (Madeline Leininger, born 1925)
Nursing Theory:
Self-care: Activities that maintain life, health, and well-being
Theory of Self-Care (Dorothy Orem, 1914-2007)
Nursing Theory:
First significant psychiatric nursing theory
Based in part on interpersonal theory
Sees nursing as an interpersonal process in which all interventions occur within the context of the nurse-client relationship
The therapeutic nurse-client relationship is central to nursing
Includes phases of the nurse-client relationship: orientation phase, working phase, and termination phase.
Promoting adaptive responses is the goal of nursing
Behavior represents the person trying to adapt to internal or environmental forces.
Therapeutic Nurse-Client relationship theory or interpersonal theory (hildegard peplau, 1909-1999)
Nursing theory:
Caring is an essential component of nursing
“Carative factors” guide the core of nursing and should be implemented in health care.
Carative factors are those aspects of care that potentiate therapeutic healing and relationships.
Caring Theory (Jean Watson, born 1940)
Term:
Process in which a third party reviews evidence from both sides and makes a decision to settle the case
Arbitration
What is?
The basic cellular unit of the nervous system
The microprocessor of the brain responsible for conducting impulses from one part of the body to another
Cell body: also known as soma; made up of the nucleus and cytoplasm within cell membrane
Stem or axon: transmits signals away from the neuron’s cell body to connect with other neurons and cells
Dendrites: collect incoming signals from other neurons and send the signal toward the neuron’s cell body
Neuron
What is?
Composed of two separate, interconnected divisions:
Central nervous system: spinal cord and brain
Peripheral nervous system: connect the CNS to receptors, muscles, and glands. Includes the cranial nerves just outside the brain stem. Comprises the somatic nervous system and the autonomic nervous system.
Nervous System
What is?
Conveys information from the CNS to skeletal muscles; responsible for voluntary movements
Somatic nervous system
