Week 1 Flashcards
Traits of Balance in Mental Health
Ability to
- Think rationally
- Communicate appropriately
- Learn
- Grow emotionally
- Be resilient
-Have a healthy self-esteem
- Realistic goals and reasonable function within the individual’s role
Ability to
- Think rationally
- Communicate appropriately
- Learn
- Grow emotionally
- Be resilient
-Have a healthy self-esteem
- Realistic goals and reasonable function within the individual’s role
If a patient does not sleep and has a MH illness, it can-
exacerbate their condition highly
Epidemiology of Mental Disorders
Prevalence (Examples)
- Major depressive disorder: Leading cause of disability in U.S. at 6.7% prevalence over 12 months
- Schizophrenia: 1.1% prevalence over 12 months; affects men and women equally
- Panic disorder: 2.7% prevalence over 12 months; typically begins in adolescence; 1 in 3 develop agoraphobia
- Generalized anxiety: 3.1% prevalence over 12 months; risk is highest between childhood and middle age
Prevalence (Examples)
- Major depressive disorder: Leading cause of disability in U.S. at 6.7% prevalence over 12 months
- Schizophrenia: 1.1% prevalence over 12 months; affects men and women equally
- Panic disorder: 2.7% prevalence over 12 months; typically begins in adolescence; 1 in 3 develop agoraphobia
- Generalized anxiety: 3.1% prevalence over 12 months; risk is highest between childhood and middle age
DSM-V
- The Diagnostic and __________ Manual of ______________, 5th Edition
- Official medical guidelines of the American Psychiatric Association for diagnosing
psychiatric disorders - Based on specific criteria influenced by multi-professional clinical field trials
- The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
- Official medical guidelines of the American Psychiatric Association for diagnosing
psychiatric disorders - Based on specific criteria influenced by multi-professional clinical field trials
What Does a Psychiatric Mental Health Nurse Do?
- Promoting ______________ through assessment, diagnosis, and treatment of behavioral and
mental disorders - Use nursing, psychosocial, neurobiological theories and __________
- Work with people throughout the __________
- Employed in a variety of settings and among varied populations
- Promoting mental health through assessment, diagnosis, and treatment of behavioral and
mental disorders - Use nursing, psychosocial, neurobiological theories and research
- Work with people throughout the life span
- Employed in a variety of settings and among varied populations
Multiaxial Assessment
Axis 1 Mental Health _________ Disorders
(ie: Schizophrenia, Bipolar, Depression, Anxiety, Substance Abuse, Eating…)
Axis 2 __________ Disorders
Antisocial, Borderline, Histrionic, Narcissistic, Dependent, Schizoid, Schizotypal, Paranoid, Avoidant and Obsessive Compulsive Personality Disorders
Axis 3 General _________ Disorders (ie: HTN, PE, COPD, MI, DM…)
Axis 4 ___________ Stressors & Environmental Factors
(ie: family conflicts, loss of job, recent divorce, financial concerns…)
Axis 1 Mental Health Clinical Disorders
(ie: Schizophrenia, Bipolar, Depression, Anxiety, Substance Abuse, Eating…)
Axis 2 Personality Disorders
Antisocial, Borderline, Histrionic, Narcissistic, Dependent, Schizoid, Schizotypal, Paranoid, Avoidant and Obsessive Compulsive Personality Disorders
Axis 3 General Medical Disorders (ie: HTN, PE, COPD, MI, DM…)
Axis 4 Psychosocial Stressors & Environmental Factors
(ie: family conflicts, loss of job, recent divorce, financial concerns…)
Treatment Settings -Background
- 1860s: Asylums have roots in Civil War era
- 1950s: First antipsychotic medication
- 1960s: Medicare and Medicaid with no funding for psychiatric care
- 1999: Olmstead Decision: Deinstitutionalization
- 2016: Drop in state psychiatric hospitals from 322 in 1950 to 195 in 2016
- Current system: Outpatient and inpatient settings
- 1860s: Asylums have roots in Civil War era
- 1950s: First antipsychotic medication
- 1960s: Medicare and Medicaid with no funding for psychiatric care
- 1999: Olmstead Decision: Deinstitutionalization
- 2016: Drop in state psychiatric hospitals from 322 in 1950 to 195 in 2016
- Current system: Outpatient and inpatient settings
Continuum of Care
Determination of the appropriate level of care is based on:
- Safety
- Intensity of supervision needed
- Severity of symptoms
- Level of functioning
- Type of treatment needed
Determination of the appropriate level of care is based on:
- Safety
- Intensity of supervision needed
- Severity of symptoms
- Level of functioning
- Type of treatment needed
Entry to Acute Inpatient Care
- Direct admission on referral
- Emergency department or crisis service
- Voluntary or involuntary
- Length of stay is around _____ days.
- Emphasis includes ______ intervention and safety.
- Staffing considerations are required to be cost-effective to provide safe care.
- Patients are acutely symptomatic.
- Discharge planning begins upon ________.
- Provides care for individuals experiencing toxic reactions to meds or other substances
- Provides safe detoxification from substances
- Provides care for someone with a medical illness that may present with behavioral symptoms or complicates an existing psychiatric illness
- Direct admission on referral
- Emergency department or crisis service
- Voluntary or involuntary
- Length of stay is around 3 to 5 days.
- Emphasis includes crisis intervention and safety.
- Staffing considerations are required to be cost-effective to provide safe care.
- Patients are acutely symptomatic.
- Discharge planning begins upon admission.
- Provides care for individuals experiencing toxic reactions to meds or other substances
- Provides safe detoxification from substances
- Provides care for someone with a medical illness that may present with behavioral symptoms or complicates an existing psychiatric illness
Long-Term Care: Residential Services
Long-term, state-run facilities
- Extended-care facilities, _______ homes
- Group homes
- Half-way homes
- Supervised apartment living
- Foster care
- ________: homeless or individuals who need safety because of domestic violence
Long-term, state-run facilities
- Extended-care facilities, nursing homes
- Group homes
- Half-way homes
- Supervised apartment living
- Foster care
- Shelters: homeless or individuals who need safety because of domestic violence
Outpatient Psychiatric Mental Health Care
- Primary care providers
- Clinic or private practice
- Appointments determined by individual need
- Staff can consist of psychiatrist, psychologist, NP, nurse, social worker, licensed mental health counselor, and case manager.
- Specialty psychiatric care providers
- Patient-centered health/medical homes
-Community clinics - Psychiatric home care
- ACT
- Intensive outpatient programs and partial hospitalization
- Other outpatient venues for psychiatric care
– Telephone crisis counseling
– Telephone outreach
– Internet
– Telepsychiatry
- Primary care providers
- Clinic or private practice
- Appointments determined by individual need
- Staff can consist of psychiatrist, psychologist, NP, nurse, social worker, licensed mental health counselor, and case manager.
- Specialty psychiatric care providers
- Patient-centered health/medical homes
-Community clinics - Psychiatric home care
- ACT
- Intensive outpatient programs and partial hospitalization
- Other outpatient venues for psychiatric care
– Telephone crisis counseling
– Telephone outreach
– Internet
– Telepsychiatry
Day Treatment Program
-Minimal __________
- Ongoing treatment that is structured
- May provide care _____ hours daily for 1 to 5 days a week
- Population may be adult, child, or adolescent.
- May specialize in specific ___________, such as care for substance abuse
-Minimal supervision
- Ongoing treatment that is structured
- May provide care 4 to 8 hours daily for 1 to 5 days a week
- Population may be adult, child, or adolescent.
- May specialize in specific populations, such as care for substance abuse
Specialty Treatment Settings
- Pediatric psychiatric care
- Geriatric psychiatric care
- Veterans administration centers
- Forensic psychiatric care
- Alcohol and drug abuse treatment
- Self-help options
- Pediatric psychiatric care
- Geriatric psychiatric care
- Veterans administration centers
- Forensic psychiatric care
- Alcohol and drug abuse treatment
- Self-help options
Patients’ Rights
- Hospitalized patients retain their rights as citizens
- Patient’s need for ______ must be balanced against patient’s rights as a citizen
- Mental health facilities have ________ statements of patient’s rights and applicable state laws
Patient Rights Poster-Dept of Health Care Services CA https://www.dhcs.ca.gov/services/Documents/EnglishPoster.pdf
Patient Rights Handbook https://www.dhcs.ca.gov/services/Documents/English_HB.pdf
- Hospitalized patients retain their rights as citizens
- Patient’s need for safety must be balanced against patient’s rights as a citizen
- Mental health facilities have written statements of patient’s rights and applicable state laws
Patient Rights Poster-Dept of Health Care Services CA https://www.dhcs.ca.gov/services/Documents/EnglishPoster.pdf
Patient Rights Handbook https://www.dhcs.ca.gov/services/Documents/English_HB.pdf
Patients’ Rights Under the Law
- Right to _________
- Right to ______ treatment
Right to informed _________
- Indicates that the patient has been provided with basic understanding of risks, benefits, and alternatives
- Person must voluntarily accept treatment
- To be effective legally, it must be informed and in general a physician or advanced practice provider must obtain the consent.
- Rights regarding involuntary commitment and psychiatric advance directives
- Rights regarding restraint and seclusion
- Right to confidentiality
- Right to treatment
- Right to refuse treatment
Right to informed consent
- Indicates that the patient has been provided with basic understanding of risks, benefits, and alternatives
- Person must voluntarily accept treatment
- To be effective legally, it must be informed and in general a physician or advanced practice provider must obtain the consent.
- Rights regarding involuntary commitment and psychiatric advance directives
- Rights regarding restraint and seclusion
- Right to confidentiality
Inpatient Psychiatric Nursing Care
- Completing comprehensive data collection that includes the patient, family, and other health care workers
- Developing, implementing, and evaluating plans of care
- Assisting or supervising mental health care workers
- Maintaining a safe and therapeutic environment
- Facilitating health promotion through teaching
- Monitoring behavior, affect, and mood
- Maintaining oversight of restraint and seclusion
- Coordinating care by the treatment team
- Therapeutic Milieu
- Completing comprehensive data collection that includes the patient, family, and other health care workers
- Developing, implementing, and evaluating plans of care
- Assisting or supervising mental health care workers
- Maintaining a safe and therapeutic environment
- Facilitating health promotion through teaching
- Monitoring behavior, affect, and mood
- Maintaining oversight of restraint and seclusion
- Coordinating care by the treatment team
- Therapeutic Milieu
Therapeutic Milieu
- Safety
- Structure
- Norms
- Limit setting
- Balance
- Environmental modifications
- Workflow of the unit
- Safety
- Structure
- Norms
- Limit setting
- Balance
- Environmental modifications
- Workflow of the unit
Five Principles of Bioethics
- Beneficence: The duty to promote ______
- Autonomy: Respecting the _____ of others to make their own decisions
- Justice: Distribute resources or care _______
- Fidelity (nonmaleficence): Maintaining loyalty and commitment; doing ___________ to a patient
- Veracity: One’s duty to always communicate ___________
- Beneficence: The duty to promote good
- Autonomy: Respecting the rights of others to make their own decisions
- Justice: Distribute resources or care equally
- Fidelity (nonmaleficence): Maintaining loyalty and commitment; doing no wrong to a patient
- Veracity: One’s duty to always communicate truthfully
Admission Procedures
- Informal admission—sought by __________
- Voluntary admission—sought by ________ or _________
Involuntary commitment—without patient’s consent
- Mentally ill
- Danger to self or others
- Unable to acquire basic necessities-gravely disabled
- Informal admission—sought by patient
- Voluntary admission—sought by patient or guardian
Involuntary commitment—without patient’s consent
- Mentally ill
- Danger to self or others
- Unable to acquire basic necessities-gravely disabled
Due Process in Involuntary Commitment
- Writ of habeas corpus hearing
It is an informal hearing held at the hospital to determine if there is ___________ to keep someone in the hospital. At the hearing, a hearing officer will determine whether or not the patient is still a danger to themselves, others, or gravely disabled as a result of a mental illness. If there is no good cause determined to keep the person in the hospital, the hearing officer can discharge the person from the hospital immediately. If there is good cause, the hearing officer will allow the psychiatrist to keep the patient in the hospital. - Least restrictive alternative doctrine
- Reise Hearing
- Writ of habeas corpus hearing
It is an informal hearing held at the hospital to determine if there is “good cause” to keep someone in the hospital. At the hearing, a hearing officer will determine whether or not the patient is still a danger to themselves, others, or gravely disabled as a result of a mental illness. If there is no good cause determined to keep the person in the hospital, the hearing officer can discharge the person from the hospital immediately. If there is good cause, the hearing officer will allow the psychiatrist to keep the patient in the hospital. - Least restrictive alternative doctrine
- Reise Hearing
Discharge Procedures
- Conditional release
- Unconditional release
- Release against medical advice (AMA)
- Conditional release
- Unconditional release
- Release against medical advice (AMA)
Patient Confidentiality
- Exceptions to the rule
- Duty to warn and protect third parties: ________
- Follow the hospital policy to inform
Tarasoff Story
- Child abuse reporting statutes
- Elder abuse reporting statutes
- Exceptions to the rule
- Duty to warn and protect third parties: Tarasoff
- Follow the hospital policy to inform
Tarasoff Story - Child abuse reporting statutes
- Elder abuse reporting statutes
Documentation of Care
- A record’s usefulness is determined by evaluating—when the record is read later—how accurately and completely it portrays the patient’s behavioral status at the time it was written.
- Used for quality of care
- Used as evidence
- A record’s usefulness is determined by evaluating—when the record is read later—how accurately and completely it portrays the patient’s behavioral status at the time it was written.
- Used for quality of care
- Used as evidence
Violence in the Psychiatric Setting
- Employers are not typically responsible for employee ________ from violent patients.
- Nurses must participate in setting policies that create and maintain a safe environment
- Always _________ patient’s potential for violence
- Communicate observations to colleagues
- Employers are not typically responsible for employee injuries from violent patients.
- Nurses must participate in setting policies that create and maintain a safe environment
- Always document patient’s potential for violence
- Communicate observations to colleagues
Therapeutic Toolbox
- Safety FIRST
- Support
- Strengths
- Silence
- Stressors
- Feelings
- Insights
- Goals
- Coping Skills
- Triggers
- Empowerment
- Culture
- Balance
- Safety FIRST
- Support
- Strengths
- Silence
- Stressors
- Feelings
- Insights
- Goals
- Coping Skills
- Triggers
- Empowerment
- Culture
- Balance
