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Nursing 326 Mental Health Nursing Clinical Dr. K Spencer ACNP-BC WEEK 1 CLINICAL ASSIGNMENT: Nursing is precision. The ability to read and follow directions is key. -Dr. SpencerPlease read the following and answer the questions. If the question indicates a sentence minimum, that sentence minimum must be met. Include the question with your answer. Group 1, I realize you have not had lecture yet, so this will help prepare you for that. Group 2, this will serve as a review. If you fail to complete the assignment as directed, you will be asked to repeat it. Failure to complete all clinical assignments in a away that is satisfactory or that meets a C per rubric can cause you to fail clinical. Not passing clinical means you do not pass the course. All clinical assignments are due by the Wednesday after your clinical. Late assignments are not accepted. You have the time after we leave the Webex that is intended for use to complete this. Do not use it for other classes. The focus for this week in addition to your coursework is adjusting to a Mental Health milieu. 1. What was your first thoughts when you were assigned to this course? 5 sentence minimum. My first thought when assigned to this course was that I was finally going to expand on all those psychology classes I had to take at NOVA. I took a psych class in high school, and two at NOVA. I had already started to go over the general development of mental illnesses, but never really had the chance to dive into details with it. We mainly learned about people affected by different disorders, and what to expect from them. Now I have the opportunity to learn the pathophysiology and treatments of a lot of mental conditions that had already caught my attention. 2. What difficulties do you anticipate? Why? How can I assist you with this? In the past I have had issues differentiating between diseases with similar manifestations. I feel like in mental health I will also encounter many conditions with very similar signs and symptoms. Remembering what makes each condition unique is the biggest difficulty I expect to encounter. I feel like you can help Professor by assigning work that helps us compare and contrast different conditions with a lot of similarities. This is what I have found most useful in the past. 3. What are your expectations of this course? 5 sentence minimum

My expectations for this course are fairly simple. I do not think we can learn everything about every single mental disorder, but I do think after this course we should be able to recognize manifestations of mental illness and be able to connect it to a specific disorder. We should also be able to associate certain medications or treatments associated with specific disorders. But most importantly we should learn how to approach patients going through these mental health issues, and how to communicate with them effectively. I believe therapeutic communication is the most important skill needed when treating a patient suffering from mental illness. 4. What are your expectations of me as your clinical instructor? 5 sentence minimum My expectations for you as a clinical instructor are for you to be understanding but fair. Last session I was having a lot of computer issues, and my instructors were very understanding of last minute issues. But I always made up any time or work missed. I also hope to get good feedback from you. I feel like lately everything we do gets awarded with a good job even though it may not have been. I want the criticism and detailed feedback in order to better myself as a nurse and learn from my mistakes. 5. List at least five things you’d like to experience during this course. Five things I would like to experience during this course include using therapeutic communication to talk to a manic patient. Using therapeutic communication to talk to a severely depressed patient. Learning how to guide a patient to seek help if I suspect they need to speak to someone who specializes in mental illness. Learning how to include the family in the care plan of a patient suffering from mental illness. Lastly, I would love to teach a client suffering from mental illness how to cope with their condition. 6. List at least five goals for yourself for this course? Five goals I have for myself in this course include getting an A because its been a few classes since I’ve seen one of those. Turning every assignment in on time. Not only learning how to test on the material but truly mastering it. Being able to apply what I learn from this course to my own personal life. Also I would like to simply grow as a nurse and feel like I truly have the knowledge I need to be out in the field dealing with patients. 7. Where would you like to practice nursing when you graduate? When I graduate I have yet to consider where I would work. But I know I have to work with kids. More specifically babies, but If I can not become a neonatal ICU nurse, then I would not mind being a pediatric nurse. 8. After our discussion how have your impressions of the mental heath population changed? 15 sentence minimum.

My impressions on the mental health community honestly haven’t differed much from what I’ve experienced at my workplace. I am a patient sitter with Inova Fairfax, and they have a few mental health units. We have an acute facility and a more long term behavioral unit. We also have another floor for teenagers that is also separated into two units. I have worked with kids and adults suffering from many different disorders. Some are minor cases of OCD and depression, while others are cases of extreme schizophrenia and hallucinations. My approach to each patient always changes through the shift because every patient reacts differently to specific interventions. A lot of patients seem completely normal most of the time, but once they begin speaking on their thoughts, I get an insight on the battle they are fighting in their heads. The only thing that has changed on my thoughts on the mental health community is the impact of the word crazy. I never used that word at work to maintain professionalism and I have never referred to a patient suffering from mental health issues as crazy. But I have used that word in my daily life carelessly. Thinking back to it, I have never used that word meaning a negative connotation but that does not mean I haven’t offended someone with my use of that word. We never truly know what is going on in another persons head. Somebody close to me may be suffering from a mental health condition, and I may not even be aware of it. What if my use of the word crazy might have one day unintentionally scared someone into seeking help in fear of being labeled as crazy. After our discussion I have learned that my words may be having an impact on others unintentionally, and that the best solution is to attempt eliminate this word from my vocabulary. For others it may be just a word but for some people it is a label that prevents them from feeling normal. 9. Mr. M threatened to kill Mr. H. Mr. M has been hospitalized for two weeks, is stable and on medications. The plan is to discharge him tomorrow. In no less than ten sentences, discuss Duty to Warn and tie it to HIPPA. HIPAA protects Mr. M from having any of his medical records or spoken intents released to people outside of his care team. The only exception to HIPAA is a health care providers duty to warn. Duty to warn means that a healthcare provider feels that a patient is a danger to either themselves or another. In order for this to fall under the required criteria of Duty to Warn the healthcare provider must feel that by warning Mr. M they are potentially saving his life or preventing a tragedy. This scenario is tricky because one could argue that Mr. M is not yet fully stable because psych meds typically take 4-6 weeks to work. But another could argue that there is not immediate threat to Mr. H because Mr. M is stable enough to be released. I believe that if Mr. M expressed that he intended to kill Mr. H in the past than HIPAA can not be violated. But if Mr. M is now stable and taking his medications, but still has not expressed regret in his intention to kill Mr. H than Mr. H might still be in danger. HIPAA must be broken because of the healthcare providers duty to Warn in order to prevent a foreseeable death. HIPAA does prevent healthcare providers from speaking about a patient without their consent unless the healthcare provider is protecting a life.

10. Compare and contrast False Imprisonment to Involuntary Commitment. 15 sentence minimum.

False Imprisonment is the intentional and unauthorized confinement of a patient against their will. If a patient came to the hospital voluntarily they have the right to refuse treatment. They have the right to choose when they want to leave. They can however decompensate to the point that they may need restraints or to be secluded in order to protect them from either themselves or others. If this happens the court must intervene and they are the ones that determine competency and if the patient becomes involuntarily committed against their will. This is done in order to protect patients and their right to freedom and privacy. Involuntary Commitment is the process conducted to forcefully keep a patient in the hospital against their will. This is done as a last result because being committed involuntarily restricts the rights of the individual. In order to be involuntarily committed a patient must meet specific criteria. They can be imminently dangerous to themselves. They can be perceived dangerous to others by being physically aggressive, violent, or homicidal. Or a patient can be unable to take care of their own basic personal needs. This is the criteria that must be met in order to meet the federal laws requirements needed to temporarily restrict a patient of certain rights. The difference between false imprisonment and involuntarily commitment is simply authorization. A healthcare provider can be charged for keeping someone against their will without having the authority to do so. But in involuntary commitment the court gives permission to restrict patients of certain freedoms in order to maintain safety. 11. Compare and contrast Involuntary Inpatient and Involuntary Outpatient commitment. 10 sentence minimum. Involuntary Inpatient must be done under the probable cause that a patient is dangerous to themselves or others, is mentally ill, and in need of treatment or disabled. Patients are either kept in a hospital or mental institution or unit. This is done until the patient no longer needs medical treatment. Also if the patient is kept with the intention of providing mental health treatment they may be kept longer. In cases where the patient is mentally ill, they must remain inpatient until stabilized, or a drug therapy regimen has shown to be helping the patient. Involuntary outpatient is a court ordered tool to push a person with mental illness to submit to treatment for their illness. Criteria for outpatient differs from inpatient. Patients may be court ordered outpatient for having a history of decompensation and involuntary commitment. Having a severe mental illness that limits their awareness and is in need of treatment. Having mental illness that causes the patient to repeatedly become homeless, incarcerated, violent, or attempt suicide. Or if the patient is at risk for relapse and hospitalization related to noncompliance with treatment. As long as the patients life or the life of others are not immediately at risk, the court may order the patient to receive outpatient treatment versus keeping them in an institution full time. 12. Select two Therapeutic techniques you feel you are at risk for using too often and explain why for each. 5 sentence max for each. One therapeutic technique that I feel at risk for using too often is using silence. In some cases it's useful not to speak at all, in order for patient to be able to fully vent, and process what they said. Also it gives nurses a chance to think through their responses and where they intend on

going with the conversation. I feel like I am the type of person who thinks through every response and attempts to think of possible outcomes. This is something I’ve relied on in the past but feel like it may not always be helpful. I believe sometimes giving patients too much time to think may lead to them spiraling. Another therapeutic technique I am at risk for using too often is offering self. Offering up my time to spend with a patient may lead to them opening up, and trusting their healthcare team more. This may be beneficial to them successfully accepting their mental health treatment. The downside of this is nurses always have multiple patients. Spending too much time with one patient may reduce the time with another patient who is in just as much need. Or may cause a nurse to fall behind on tasks and leave more room for errors to occur when a nurse is rushing. 13. Review and select two Non-Therapeutic techniques and discuss how you’ve used them in the past. 15 sentence minimum. One non-therapeutic technique that I have fallen victim too in the past is focussing on self. I have had a lot of life experiences that very often make me feel like I can relate to my patients. It has happened on several occasions especially dealing with teenagers, that I find myself comparing their experiences to my own. When this happens in order to relate to them I begin story telling, which often leads to me spending too much time on my own stories. This takes the attention away from them. Although my intent is to gain their trust, they may feel like they are not the priority. I need to learn to limit how much I share, and when it would be appropriate if ever to speak on y own experiences. Another non-therapeutic technique I have done is given advice. In order to want the best for my patients I have always attempted to lead them to what I consider a better path. This may be more damaging than good. My patients do not have my life, what is best for me, may not be best for them. I would use sentences like “if I were you, I would..” In order to put myself in my patients shoes. This is wrong because it may make the patient feel like I believe they can’t handle their own life choices. It is are jobs to give patients the tools they need to be able to make decisions on their own, not tell them what they need. 14. Discuss ways you can build trust and rapport with a patient. Give specific examples. 15 sentence minimum. I think the most important thing to remember when attempting to build trust and rapport with a patient is to always be kind and friendly. These patients are going through a lot, whether they're there on their own accords or forced. They are there to seek mental health treatments and be able to go and provide themselves with stable healthy lives. Showing them that you truly have an interest in their lives is and want them to better themselves is a great way to gain their trust. You can do this by trying to make the experience as comfortable as possible. Maybe the patient has a favorite book you can find for them. Maybe they have a movie they find comforting or even a desert. Going out of your way to do little things for them, that do not break any protocols your facility has in place, may lead your patient to understand that you truly care.

Another thing nurses need to keep in mind is that a lot of these patients issues may be stemmed from betrayals, manipulations, or prior traumas. We must always be honest with our patients in order to avoid causing further damage and distrust within these patients. We must do our best to keep our promises with these patients as well. For example if a patient asks for her melatonin at 10, and the nurse forgets. This may cause resentment from the patient....