Seek and Find Flashcards
What is the foundation of the Standards of Practice for Psychiatric –Mental Health Nursing?
nursing process
What are the 6 QSEN competencies?
Patient –centered care, quality improvement, safety, informatics, teamwork and collaboration, evidenced-based practice (EBP)
What is the purpose of the Mental Status Exam (MSE)?
To evaluate an individual’s current cognitive processes
What are the 4 aspects or considerations that every nurse needs to know when administering psychotropic medications?
Intended action, therapeutic dosage, adverse reactions, and safe blood levels
What are the 4 basic principles in planning nursing interventions?
Safe, appropriate, individualized, evidenced-based
Describe what the new technology “telehealth” refers to:
The use of electronic information and telecommunication technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration
Define therapeutic communication:
professional, goal-directed, and scientifically based communication
Give 9 common “cues” or examples of nonverbal communication:
Physical appearance, facial expressions, body posture, amount of eye contact, eye cast, hand gestures, sighs, fidgeting, and yawning
When communicating with a patient in a mental health setting what are the 4 goals to help the patient?
Feel understood and comfortable, identify and explore problems relating to others, discover healthy ways of meeting emotional needs, and experience satisfying interpersonal relationships
There are many communication techniques that nurses can use to enhance their nursing practice. Name at least 10:
using silence, offering self, giving board openings, restating, reflecting, focusing, exploring, making observations, seeking clarification, voicing doubt, summarizing
Define countertransference:
the nurse unconsciously transfers feelings onto the patient that are related to people in their past
Define transference:
a patient unconsciously transfers feelings onto the nurse that are related to someone from their childhood/past
Describe the phases of the nurse-patient relationship:
pre- orientation, orientation, working, termination
Define empathy and sympathy:
empathy understands the feelings of others and sympathy is feeling the feelings of others
There are many tactics to avoid when interviewing a patient. Describe at least 3:
not argue with, minimize or challenge the patient. Do not give false reassurance. Do not question or probe
What is psychiatric mental health nursing and its main focus?
A core mental health profession that employs a purposeful use of self as its art and a wide range of nursing, psychosocial, and neurobiological theories and research evidence as its science. Its focus is the treatment of human responses to mental health problems and psychiatric disorders.
Recovering from a mental illness is viewed as a personal journey of healing. What is the goal of recovery?
empower those with mental illness to find meaning and satisfaction in their lives, realize personal potential, and function at their optimal level of independence
Describe the difference between the nurse-patient relationship and the nurse-patient partnership:
nurse-patient relationship suggests an unequal status with the nurse/health care worker as the person in authority. The nurse-patient partnership is more in line with the emphasis on “relationships” in the recovery model
In a survey on caring in 1998, emerged 3 themes. Explain all 3:
Caring is evidenced by empathic understanding, actions, and patience on another’s behalf. Caring for one another by actions, words, and being there leads to happiness and touches the heart. Caring is giving of self while preserving the importance of self.
What is a patient advocate? And what is not?
Someone who speaks up for another’s cause, who helps others by defending and comforting them, especially when the other person lacks knowledge, skills, ability, or status to speak for himself/herself. It is NOT a legal role but rather an ethical one
What is the DSM-5?
Diagnostic and Statistical Manual of Mental Disorders. 5th addition was released in May 2013
What is mental illness?
It is medical conditions that affect a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. It includes flawed biological, psychological, social, and cultural processes
Describe 1 myth and 1 misconception that plague mental illness:
one myth is that to be mentally ill is to be different and odd. A misconception about mental illness is that to be mentally health, a person must be logical and rational
Describe the outdated concept for the term mental disorder:
a mental disorder implies a distinction between “mental” disorder and “physical” disorder, and stresses mind-body dualism. There is just as much physical in mental disorders
Define stigma:
an attribute that is deeply discrediting where a person is reduced from a whole unusual person to a tainted, discounted one
What does elopement and AWOL mean?
-elopement (leaving before being discharged) “Absent without leave”
What are some attributes of mental health?
Accurate appraisal of reality; ability to love and experience joy; capacity to deal with conflicting emotions; ability to live without (undue) fear, guilt, or anxiety; ability to take responsibility for one’s own actions; ability to control one’s own behavior; think clearly-problem solve and use good judgment; relate to others and form close loving relationships; attain self-defined spirituality; negotiate each developmental task; ability to work and be productive; maintain a healthy self-concept and self-value; ability to play and laugh
What are some influences that can have an effect on a person’s mental health?
Available supports systems (friends, family, community); spirituality/religious influences; family influences, developmental events, personality traits; demographic and geographic locations; negative environmental influences (poverty, psychosocial stressors, poor parenting); cultural/subcultural beliefs, values; health practices and beliefs; hormonal influences; biological influences; inherited factors; other environmental experiences (drugs/toxins)
The role of the staff RN may include?
didactic education in groups such as medication education.
The Advanced Practice Nurse can provide?
therapy and prescribe medications which the staff nurse is not licensed to do
What are some safety measures taken in an inpatient setting? ons
- Hanging is a common way patient’s on an inpatient setting will harm self so rooms are designed with safety in mind.
- Nurses must ensure the milieu is safe by ensuring assigned staff are making Q15 minute checks to know where all patients are at, check if they are breathing when appearing to be asleep and that measures are taken to prevent injury (locked windows, platform beds, heavy furniture that cannot be lifted to be thrown or dismantled, no cords or strings longer than 12 inches and all belongings that are not allowed on unit locked in nursing area and not given back to patients until discharge.
- Nurses giving medications must check to see if patients are “cheeking” and ensure they are swallowing their medications
Critical Thinking Question: How would a nurse assess for a patient “cheeking” medications and what can be done to prevent this?
Have them stick out their tongue and move from side to side after swallowing and an oral check. Sometimes patients are asked to sit at nursing station for observed for 15-20 minutes to ensure medication has dissolved if cheeking is suspected as some patients are still able to hide the pill in their cheek/gums. Other options would be asking prescriber to order liquids, sprinkles, disk melt meds, or possibly IM injectable medications
Psychoanalytical
Freud – theory and nursing
ID, EGO, SUPEREGO –
Transference and Countertransference
Stages for psychosexual personality development/tasks
Behavioral theorists – know theory and behavioral methods
Pavlov –
Skinner –
Pavlov – Classical Conditioning
Skinner – Operant Conditioning
Systemic desensitization, Aversion therapy, Biofeedback
Pre-orientation:
Orientation:
Working phase:
Resolution:
1) Pre-orientation: Nurse preps; Client accepts help from nursing professional.
2) Orientation: Build rapport; rules and unit daily activities are reviewed, The dos and don’ts, nurse role is clarified, confidentiality is discussed, terms of termination, and the client’s problems are articulated with goals established.
3) Working phase: Gathering more information/using professional assistance for problem solving (working partnership) with behavioral changes made, resistant behaviors overcome, and adaptive behaviors promoted.
4) Resolution: Termination of professional relationship with summarized goal achieved and new coping strategies identified. Client may realize they have unresolved issues and they may have desperate feelings and want to stay in treatment; nurse express feelings too in order to normalize feelings.
Legal & Ethical concepts related to behavioral health
- Mental health laws
- Ethical principles – beneficence, veracity, justice, fidelity
- Confidentiality
- Civil rights, torts
- Duty to warn/duty to protect
- Duty to report – elder, child and vulnerable persons reporting of abuse
- Forensic nursing – what is the role of the forensic nurse?
Process of communication
- Verbal
- Non-verbal
- Para-verbal (how you say what you say – tone, volume, cadence)
The psychiatric client’s right to receive treatment and to have confidential medical records is legally protected through this law. The law passed in 1996 and established national standards for the protection of electronic medical records. Privacy breaches could lead to harm to the nurse-patient relationship; harm to the client’s well-being; grounds for corrective action; and liabilities for the hospital and health care workers
Health Insurance Portability and Accountability Act/ HIPAA
This legal term is based on the client’s right to self- determination. Each adult of sound mind has the right to determine what shall be done with his or her own body when a basic understanding of risks, benefits, and options has been achieved
Informed consent
A category of civil law that commonly applies to health care practice. It is a civil wrong for which monetary compensation may be collected by the injured party (the plaintiff) from the wrongdoer (the defendant)
Tort
An act, or failure to act, that breaches the duty of due care, and results in or is responsible for another person’s injuries
Negligence
An obligation that may result in a breach of confidentiality on the part of the health care worker to warn third parties when they may be in danger from a client
Duty to warn
Respecting the rights of other to make their own decisions (e.g. the right to refuse a specific medication or treatment)
Autonomy
Admission to a psychiatric facility without the client’s consent
Involuntary Commitment
The rights of personal liberty guaranteed under two U.S. constitutional amendments (e.g. the right to vote, the right to religious freedom and practice, the right to humane care and treatment, the right to exercise, the right to press charges against another person)
Civil Rights
The client or guardian seeks psychiatric inpatient care and treatment through written application to the facility. The client also has the right to a written application to demand and obtain release from the hospital whereby the facility staff reevaluate the client’s condition for possible conversion to involuntary status if needed according to criteria established by state law
Voluntary commitment
A specific term that refers to the ethical questions that arise in healthcare
Bioethics
The duty to act so as to benefit or promote the good of others
Beneficence
An intentional threat designed to make the victim fearful. It produces reasonable apprehension of harm
Assault
The least drastic means be taken to achieve a specific purpose. For example, if someone can safely be treated for depression in an outpatient setting, acute care inpatient hospitalization would be too restrictive and unnecessarily disruptive to the individual. Another example is restraints – time-out and seclusion must be attempted and failed before violent behavior restraints can be implemented, which is the most restrictive environment for clients
Least Restrictive Doctrine/least restrictive environment
The duty to distribute resources or care equally, regardless of personal attributes such as socioeconomic class, race, sexual orientation, etc.
Justice/distributive justice
The landmark 1970s case against University of California that viewed public safety to be more important than privacy in narrowly defined circumstances
Tarasoff v. Regents of University of California
Designed for the intention of protecting children and can be found in all 50 states and the District of Columbia
Child abuse reporting statutes
Designed for the intention of protecting adults over the age of 65 years
Elder abuse reporting statutes
Results when there is a conflict between two or more courses of action, each carrying with them favorable or unfavorable consequences. Health care workers respond based on their morals, beliefs, and values
Ethical Dilemma
Maintaining loyalty and commitment to the client and doing no wrong for the client. For example, maintaining expertise in nursing skill through certification demonstrates fidelity to client care
Fidelity
One’s duty to communicate truthfully. For example describing the side effects of antipsychotic medication in a truthful and non-misleading way
Veracity
The harmful or offensive touching of another person
Battery
The right to reject forced treatment or withhold consent at any time. This right takes into consideration the client’s right for choice or autonomy, and beneficence, actions which benefit others. Retraction of consent previously given must be honored, whether it is verbal or written.
Right to refuse treatment
Most states provide civil commitment for a specified limited period of time to prevent dangerous behavior that is likely to cause harm to self or others when a client is in need of emergency psychiatric treatment or when the client is unable to meet his or her own basic needs
Emergency involuntary hospitalization
Intent to confine to a specific area. For example, unwarranted or indefensible use of seclusion and restraints
False imprisonment
Conduct that exposes a client to an unreasonable risk of harm
Breach of Duty
One of the main functions of this type of nursing expert is to establish competency and fitness of a psychiatric patient to stand trial in a court of law
Forensic Nurse Examiner/ Forensic Nurse
