Week 12 Flashcards
Phases of the journey of life
- Honeymoon phase: excitement, enthusiasm, high energy
- Shock phase: the realization that nursing is not what you expected; anger, frustration, disappointment, fatigue, being critical, having a negative life view
- Recovery phase: a realization that there is more than one perspective in the work situation, returning sense of humour
- Resolution phase: choosing a way to resolve the conflicts between the subcultures of school and work, with different values and emphasis
Indications for assessment (urgent vs stable)
- behaviour changes: depressed or illogical, withdrawn
- changes in mood
- anxiety
- self- harm or suicide ideation
- hallucinations
- delusions (particularly paranoid delusions)
- alterations in cognition (orientation, memory, problem-solving)
Questions for an acute assessment
- Have you ever tried to harm or kill yourself?
- Do you have a plan for how you might kill yourself?
- Do you have the things you need to carry out this plan
- Have you made preparations for your death
Core principles of risk assessment
- Is unique for each person
- Is complex and challenging
- Is not static
- Errs on the side of caution
- Is collaborative and relies on effective communication
- Relies on clinical judgement
- Tales all threats, warning signs, and risk factors seriously
- Asks the tough questions
- Is treatment and occurs in the context of a therapeudic relationship
- Tries to uncover the underlying message
- Is done in a cultural context
- Is documented
SAD PERSONAS screening tool
S: sex
A: age
D: depression
P: previous attempt
E: ethanol abuse
R: rational thinking loss
S: social supports lacking
O: organized plan
N: no spouse
A: access to lethal means
S: sickness
Guidelines for action with the SAD PERSONAS scale
0-2 —> send home with follow up
3-4 —> close follow up; consider hospitalization
5-6 —> strongly consider hospitalization depending on confidence in the follow up arrangement
7-10 —> hospitalize or commit
Key Factors to monitor
- disconnection, social isolation and loneliness
- real or perceived barriers to health
- pre-existing mental illness (substance abuse)
- vulnerable roles (nurses, physicians, etc)
- impact of media coverage
Collecting Data for mental health
Subjective
- what the pt says directly to the nurse
- is overheard telling someone else
- what family and friends have said
- important to establish rapport first
- pt may use divergent tactics to avoid answering questions
Objective
- obtain objective data by observing the pt and the pt behaviour
- physical presentation may be the first indication of toxicity, underlying medical problem or psychosis
General Survey for mental health
Appearance
- posture
- facial expression
- body movement
- Dress
- grooming and hygiene
Behaviour
- LOC
- facial expression
- mood
- affect
- speech
Cognition
- orientation
- immediate/ recent/ remote memory
- attention and concentration
- comprehension and abstract reasoning
Thinking
- perception
- content
- process
- insight
- judgement
What is a mini- mental state examination (MMSE)
- most common used test for complaints of cognitive and memory problems
- it can be used by clinicians to help assess dementia: its progress and severity
- the MMSE is a series of questions and tests, each of which scores points if answered correctly
- if every answer is correct, a maximum score of 30 points id possible
- the MMSE tests a number of different mental abilities, including a persons memory, attention and language
What is the Montreal cognitive assessment (MoCA)
- quick to administer
- good for detecting dementia and delirium and differentiating these from psychiatric mental illness
- a brief 30 question test that takes around 10-12 minutes to complete and help assess people for dementia
- assess orientation, memory, language ability, clock - drawing test
What if grief
- experience sorrow
- emotional response to loss
- can feel overwhelming
What are the stages of grief
- Denial/ shock
- avoidance, confusion, elation, shock, fear - Anger
- frustration, irritation, anxiety, pain, guilt - Bargaining
- overwhelmed, hopelessness, hostility, flight - depression
- struggling to find meaning, reaching out to others, telling ones story - Acceptance
- exploring options, new plans, moving on
Other perspectives to guilt
Anticipatory: grieving before the death happens
Disenfranchised: hidden grief that may not be readily resolved because it is not recognized by others
Complicated: grief that is so debilitating and enduring that the individual appears to be headed for catastrophe
