PSYCH EXAM 1 Flashcards
Privacy Receive mail, phone calls, visits Confidentiality Individualized treatments Right to receive or refuse treatment No verbal or physical abuse Chemical or physical restraints are considered abusive (policies must be in place)
RIGHTS of Persons with Mental Illness
When can medications be forced on a patient?
- Behaviors dangerous to self or others
- Medication prescribed has a reasonable chance to provide help
- Judged incompetent to evaluate benefits of treatment
Patients have a right to ______ treatment
least restrictive
When are seclusion and restraints used?
When less restrictive measures have failed
“1 Hour Rule”
Requires a face to face evaluation by a licensed independent practitioner within 1 hour of restraint
must report suspected child or elder abuse or incompetent adult (MR)
Informed consent (esp ECT)
1 hour rule (Q4 adult Q2 kids)
False imprisonment
Mandatory NC State Statutes
Voluntary Commitment
may institute 72 hour hold to determine change to involuntary
Requirements for IVC
danger to self or others
hearing by judge within 7 days unless converted/dropped by health professional
Most critical cultural and spiritual concerns
Communication and Space
Culture
Comprises the shared beliefs, values, and practice that guide a group’s members in patterned thinking and acting
blueprint for guiding actions that impact care, health, and well being
Is the focus culture or race?
race
Should we classify culture according to a racial-ethnic system?
NO
Should we take into account cultural beliefs about mental illness & treatment?
YES
Individuality; mind and body seen as two separate entities
Western Tradition (Science)
family as basis for one’s identity; Body-mind-spirit are seen as single entity
Eastern Tradition (Balance)
Western, Eastern, or Indigenous: disease is considered to have specific, measurable, and observable cause and is aimed at eliminating the cause; Time-focus is on the future; Based on individual rights
Value - right to decide, right to be informed
WESTERN
Western, Eastern, or Indigenous: family is starting point for identity; time is circular; based on promoting positive relationships
EASTERN
Western, Eastern, or Indigenous: those who have inhabited a country for thousands of years; significance on the place of humans in the natural world; deep relationship with nature; mind, body, spirit considered one entity; time is focused on present
INDIGENOUS
to develop a therapeutic plan that is mutually agreeable, culturally acceptable, and productive of positive outcomes
Goal of Cultural Assessment
human quality that gives meaning and sense of purpose to an individual’s existence
Spiritual
FICA
An example of a spiritual assessment nurses can use F = Faith I = Importance C = Community A = Address
Factors influencing Mental Health
Stress ("positive" and "negative")
Disease (esp chronic)
Trauma
Drug Abuse
Cultural Factors
Environmental IssuesWhat is the primary burden of mental illness?
The illness itself
What is the secondary burden of mental illness?
the stigma attached to mental disorders
Developed by APA for evaluation of the client’s mental status and standardization of symptomology to develop diagnoses of mental illness
For clinicians to have a common language to communicate characteristics of mental disorders presented by patients
DSM-V
“the ability to use one’s personality consciously & in full awareness in an attempt to establish relatedness & structure nursing interventions”
Therapeutic Use of Self
WHO: mother of psychiatric nursing
identified counseling as major subrole of psychiatric nursing
Hildegard Peplau
Theory of Interpersonal Relationships in Nursing
First nurse theorist to describe nurse-patient relationship as the foundation of nursing practice
what nurses do together WITH patients
Hildegard Peplau
“care for the person as well as the illness”
“think exclusively of patients as persons”
Hildegard Peplau
Primary task of therapeutic relationship
getting acquainted and establishing rapport
6 Therapeutic Relationship Conditions
Rapport Trust Confidentiality Respect Genuineness Empathy
Focus is on the Patients' Needs ** Goal Directed/Mutually Formulated Objective vs Subjective Time limited/ Not Open Ended (crisis resolution) Nurturing Environment Boundaries Respected Judgment is delayed Accountability
Characteristics of a Therapeutic Relationship
nurse as counselor
listens to patient and facilitates process or helping the client solve problems
nurse as teacher
identifies learning needs
nurse as leader
directs interactions to ensure goals are met
nurse as technical expert
possesses the clinical skills necessary to perform the interventions that are best interest of the client
Phase of Therapeutic Relationship: explore self-perceptions
Preinteraction
Phase of Therapeutic Relationship: establish trust & formulate contract for interaction
Orientation/ Introductory Phase
Phase of Therapeutic Relationship: promote client change in problem solving
Working Phase
Phase of Therapeutic Relationship: evaluate goal attainment & ensure therapeutic closure
Termination Phase
Transference
occurs when client unconsciously attributes or transfers feelings TOWARD the nurse from previous relationships
Countertransference
refers to the nurse’s behavioral & emotional response to the client
Professional Boundaries
such as self disclosure, gift giving, touch, & role crossing (friendship, romantic)
Hyperthyroidism
may cause or mimic anxiety symptoms
Hypothyroidism
may mimic depression
Neurotransmitters
Two Important Facts:
Responsible for essential function of human emotion and behavior
Target for the mechanism of action of many psychotropic medications
Psychotropic Medication: Potentiates Gaba
Benzodiazepines
Psychotropic Medication: Increases Serotonin
Selected Serotonin Reuptake Inhibitors (SSRI)
Psychotropic Medication: Increases both Serotonin & Norepinephrine
Selected Norepinephrine Reuptake Inhibitors (SNRI)
Psychotropic Medication: Increases norepinephrine & serotonin, and also some increase of acetylcholine and histamine
Tricyclic Antidepressants
Psychotropic Medication: Increases monoamines
Monoamine Oxidase Inhibitor (MAOI)
Psychotropic Medication: Decrease Dopamine
Antipsychotics
Where is the master clock that controls circadian rhythms located?
In the hypothalamus
Instillation of Hope Universality Imparting of Information Altruism Corrective recapitulation of the primary family group Development of socializing techniques Imitative behavior Group cohesiveness Catharsis Existential Resolution
Yalom’s Curative Factors
process of learning by involuntary behaviors
Classical Conditioning
relationship between voluntary behavior & environment … influenced by the consequences of an action
Operant Conditioning
