Mental Health Exam 1 - Test notes PDF

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Exam 1 — Mental Health

Me, Meds, Milieu1 Chapter ME: nurse-patient relationship > “How should I talk to the patient?” MEDS: medication skills > “What kind of medications should she or he be taking?” MILIEU: creating a safe therapeutic > “What environmental issues will promote health & safety?”

Psychotherapeutic!management:!3!interventions! -Therapy is provided by nurses who have a graduate degree -Nurses are taught how to be therapeutic >communication >respect >understanding of mental mechanisms, adaptation styles, & coping strategies >mastering therapeutic intervention skills

-Knowledge of psychiatric meds -Application of nursing process: How are the meds assisting the pt? -Determining when drug related problems are occuring & what to do next -When to provide PRN meds -Providing patient teaching about meds

-A proactive approach to care that forges therapeutic benefits from patient’s surroundings, whether in the hospital, outpatient setting, or home -The 5 environmental elements the nurse must consider in creating a therapeutic miliieu: 1. Safety: keeping the patient free from danger or harm 2. Structure: the physical environment, regulations, & schedules 3. Norms: specific expectations of behavior (acceptance, non-violence, privacy) 4. Limit setting: clear & enforceable limitations on behaviors 5. Balance: negotiating the line between dependence & independence

Continuum!of!Care:!All!the!places!to!implement!me,!meds, &!milieu -Continuum of care provides individuals with a. Wide range of treatment options **The first step after a mental health problem is to confirm its existence** >Next: ask “Does this person need hospitalization?” ~~RISK ASSESSMENT~~ 1. Is the person dangerous to self or others? 2. Is the person gravely disabled? 3. Is the person acutely psychotic? 4. Is the person suicidal or homicidal? If necessary, dx planning is started at Residential services, outpatient services, self-help resources admission -The role of nurses is to assess the individual’s current level of functioning & direct the individual to appropriate resources >Multidisciplinary team collaboration coordinates care >Includes professionals, patient, families, representatives from insurance companies, nursing homes, group homes, or medical clinical -Determination of appropriate level of care is based on: >Safety >Intensity of supervision needed >Level of functioning >Type of tx needed

-Currently, average length of hospital stay is 3 to 5 days; largely driven by economic decisions >Goals are crisis intervention & safety >Staffing must be cost effective while maintaining quality of service >Acuity of patients has increased >Discharge planning begins immediately after admission -The highest priority for admission to hospital based care is safety for self & others -Provdies care for individuals who are experiencing toxic reactions to meds of 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

-Available to help individuals who need long term care -NURSING HOMES are available for people who require 24 hour supervision & medical nursing care; often required for individuals with severe developmental disabilities, dementia, or acute & chronic medical illnesses -GROUP HOMES might provide temporary or permanent housing for individuals with chronic mental disorders -HALFWAY HOUSES were traditionally available for individuals recovering from chemical dependency; residents were expected to seek employment & participate in cooking and cleaning chores; residents also attended self-help groups that met on site, such as AA -APARTMENT LIVING provides varying degrees of supervision & programming; staff might be on site on a daily basis offering group sessions & activities, or they might visit periodically to provide medication assistance and facilitate attendance at various appointments -FOSTER CARE & BOARDING HOMES are generally staffed by non professionals but have professional supervision available on an intermittent basis -SHELTERS provide room & board to homeless people -JAIL is also a major facility “housing” the mentally ill

-Traditionally occurs in mental helath clinics & private offices -Person providing counseling may be a psychiatrist, psychologist, social worker, psychiatric NP, nurse, or other professional -Number of visits per week or month depend on the individual’s needs

-For individuals who need minimal supervision, structured activities, & ongoing treatment may benefit -Vary in length 4 to 8 hours per day & 1 to 5 day per week -Depending on community, these programs might provide treatment for specific populations based on age or type of problem

-Meetings are conducted by members, not professionals & may take place on a weekly basis -Can be addiction based, survivor based, disorder based, loss based, medical based, or prevention based

Addiction based - alcoholics anonymous, narcotics anonymous, over eaters anonymous . Survivor based - suicide survivor, incest survivors anonymous, adult children of alcoholics Disorder based - eating disorders, bipolar disorder Loss based - divorce, grief, bereavement Medically based - lupus, cancer. AIDS Prevention based - parenting, relationship boundaries

Primary!Care -Individuals with mental health problems such as anxiety, depression, & other mental health issues seek help for these problems in primary care offices >3 reasons for this: 1. Stigma of mental health care (no one will know) 2. Lack of knowledge about who to see & where to get help 3. Reduced access to care

Nursing!process! -Apply nursing process to provide comprehensive nursing care -Effective use in the areas of psychiatric rehab, crisis intervention, home care, therapy, consultation & liaison, resource linkage, & advocacy enhances these services

Chapter Historical Issues 2 Epidemiology! -25% of American adults over 17 meet the criteria for a mental disorder during any 12-month period, with about 18% having a diagnosable mental illness at an given time -Major mental disorders that cause disability include major depression, schizophrenia, bipolar disorder, & alcohol abuse -One half of all mental disorders begin in the teen years

Benchmarks!in!psychiatric!history -In the 18th century, mentally ill people were confined & often chained; thought to be immune to normal biological stressors; often placed on display for the amusement of their caretaker and paying the public

-Preenlightenment period: ~1790s >Assistance, banishment, confinement -2 meanings of the word asylum: 1. Protection, social support, or sanctuary from the stresses of life 2. Mistreatment & neglect -Proponents: >Tuke: ensured moral treatment >Pinel: unchained & clothed the patients, providing food & abolishing abuse

-Personified by Freud -Mental illness needed not be suffered but might be alleviated -Freud: described human behavior in psychological terms -Kraepelin: classified mental disorders -Bleuler: coined the term schizophrenia & added understanding to the treatment of the illness

-Began around the 1950s with the discovery of psychotropic drugs >chlorpromazine: antipsychotic drugs >lithium: antimanic, mood stabilizer >imipramine: antidepressant

Chapter 3 Legal issues Sources!of!law -3 basic sources -Derived from judicial decisions -A body of legal principles applied to ever new case based on evolving reasons, opinions, & precedents cited in previous cases

-M’Naghten Rule states that individuals who do not understand the nature & implications of murderous actions because of insanity cannot be help legally accountable for murder

-Wyatt v. Stricken confirmed a right to treatment -The court rules that the Alabama Mental health system must: >stop using patitents for hospital labor needs >ensure a humane environment >develop & maintain minimal staffing standards >establish institutional human right committees >provide the least restrictive environment for pt.

-Roger v. Okin determined the right to refuse treatment -Nonviolent patietns cannot be forced to take medications against their will; the court based this decision on the right to privacy -This required patients or guardians to give consent before drug treatment could begin -Nurses cannot force patients to take medications “for their own good”

-Written law developed from a legislative body -Created by state & federal legislatures

-Tarasoff v. The Regents of the University of California established mental health professionals “duty to warn” of threats of harm to others -Currently a national standard of practice -Know your law in your geographic area of practice; some jurisdictions still hold that any disclosure of confidential information is a violation of patient rights

-Public law issued by administrative or government agencies authorized by statute to administer the enacted laws of federal & state governments -Controls the administrative operations of the government & regulates social, political, & economic domains of human collaboration

-Keep all patient records secure -Carefully consider all written entries -Release info only with written consent -Disguise clinical material for education purposes -Share info only with people who need to know -Guard written material outside the clinical area -Do not access written or electronic information out of curiosity -Know to whom you are talking when relating patient info on the phone -Not that fax transmission to unsecured areas in which a receipt error is a possibility

Torts!(Civil!Law) -Personal wrongdoing that is distinguished from a criminal law violation -Described as the failure to perform care that is ethically expected or what a reasonably careful person would do under the same circumstances -4 elements must be present for a plaintiff to recover damages: 1. Duty to care 2. An obligation of reasonable care 3. Breach of duty 4. Injury proximately caused by breach of duty -Professional negligence -Claims usually arise form the nurse’s failure to prevent harm to patients & failure to -The deliberate threat coupled with the apparent ability maintain the standard of care to do physical harm to another -Areas that can lead to suits: illegal confinement, -Verbally threatening a patient that you are going to failure to obtain consent for medication & force them to take medication against their will other treatments, inadequate treatment, is an assault medication errors, & the breach of duty to warn of threatened suicide of harm to others -Employer is responsible for the acts of the -An intentional touching of another person, in a socially employee as long as the employee is acting impermissible manner, without the persons consent within the scope & authority of employment -The reciever of the battery does not have to be aware that a battery has occured

-Unlawful restraint of an individual’s personal liberty or the unlawful confinement of an individual -Examples: >excessive force used to restrain a patient >preventing a patient from leaving a health care facility >wrongfully committing a patient to a psychiatric facility

Commitment!Issues! -Most people are voluntary patietns -After individuals are assessed & stabilized (usually over 28-72 hours) they check themselves out

-Involuntary treatment means that an individual who has the legal capacity to consent to mental health treatment refuses to do so -Individuals who are considered dangerous to self or others because of a mental disorder can be involuntary treated for that mental disorder -Involuntary treatment is divided into 3 common categories -Individuals who meet any of the criteria (dangerous to self, dangerous to others, or gravely disabled) can be detained involuntarily for evaluation and emergency treatment in most states

-Each state has different laws -These laws authorize a qualified expert to determine whether a person has a treatable mental disorder >physician, psychiatrist, psychiatric NP, social workers psychologist

-Reserved for people requiring prolonged psychiatric care but refuse to seek help voluntarily -Can last from ~90 days to longer & usually conducted at state hospitals -Determined by a hearing officer

-Risk of harm through self neglect, grave disability, or failure to meet basic needs -Risk that a person might physically injure or kill themselves -Risk that a person might physically harm other persons

-Risk of psychical deterioration without commitment -Potential danger to property -Risk of relapse or mental deterioration

-Probable cause statement indicates that a person is a danger to self or others or is gravely disabled -4th amendment of the constitution requires the probable cause statement -If probable cause exists, the person is detained fo observation & treatment -Patients must be released when no legal basis exists for continued confinement to the hospital

-In most states a procedure is required for establishing a conservator or guardian for a gravely disabled person because adults are presumed competent before the law -Once judged incompetent, the individual loses the right to marry, vote, drive a car, & enter into contracts -Gravely disabled is defined as the inability to provide food, clothing, & shelter for oneself because of a mental illness -The appointment of a conservator or guardian is a serious legal matter, and full legal protection is provided for people being evaluated for conservatee status -Conservators are legally obligated to act in the best interests of conservatees

Patient!Rights!

5 rights that patients have under HIPPA: 1. Right to be educated about HIPPA privacy regulations 2. Right to access their own medical records 3. Right to correct or add to their medical records 4. Right to demand their authorization before their medical records are disclosed to others & right to request an accounting of everyone their information has been disclosed to 5. Right to request a preferred method of communication -Staff must receive special training & demonstrate competency -Use alternative interventions before using restraint or seclusion -A physicians order is required within 1 hour of restraint -Use the least restrictive method to assist the patient -Document the events leading to the intervention & justification for use -Orders must contain type of restraint/seclusion, rationale for use, & time limitations -PRN orders are not permitted -Used for the least amount of time; patients must know what behaviors are expected for release -Reevaluate the patient every 2 hours for continued need -Constantly observe the patient; document safety & comfort interventions every 15 minutes -Debrief patient after restrictive interventions -Death of a patient in restraints must be reported to FDA -The court decides whether a person is incompetent and medication can be imposed on the patient -Never hide medications in food or liquid when a patient refuses; this is forcing a patient against their will

-A nurse must document clearly that allowing the patient to continue to exercise specific right might result in harm to self or others -Concern & suspicious of their right must be documented by nurse

Psychiatric!Advance!Directives! -Most states have recognized the rights of individuals to choose the type of medical treatment they receive in case of a life-threatening medical condition >living wills >power of attorney >health care directives -In advance of a mental health crisis, individuals can issue directives about treatment in many areas; some include: 1. Use of specific medications, including dose & route 2. Use of specific treatment options, such as ECT 3. Use of behavior management including restraint, seclusion, sedation 4. A list of the individuals who are to be notified & allowed to visit 5. Consent to contact HCP and obtain treatment records 6. Willingness to participate in research studies Mental!illness!&!the!justice!system! -ABout 20%-64% of local prisoners, 15%-56% of state prisoners, & 12%-45% of federal prisoners are reported to have mental health problems -The justice system is unable to meet the needs of prisoners with mental illness >the justice system was not designed to treat mental illness >large numbers of inmates pretend to have mental illness to receive medications & be in a more safer or comfortable environment >mentally ill individuals who need treatment frequently are fearful of taking medications because some have the potential to render them less able to defend themselves from fellow inmates >risk that therapeutic medications will be abused by the patient or by selling the drugs to others, or by having the drug taken from them by a stronger inmate

Chapter Cultural Issues 5 -Culture is a critical component of patients’ lives that affect their health care attitudes & actions as well as their ability to understand and used the interventions that psychiatric nurses develop -Culture is the internal & external manifestation of learned & shared values, beliefs, & norms of a person, group, or community used to help individuals function in life & understand and interpret life occurrences

Basic!Concepts! -Cultural competence is the process whereby the nurse shows proficiency in developing cultural awareness, knowledge, & skill to promote effective health care -A culturally competent psych nurse incorporates cultural competence into interactions with peers, students, patients, families, and communities -Key to patients recover process

-Culture diversity includes age, gender, socioeconomic status, religion, race, ethnicity, mental illness, physically changing conditions.

-The most common barrier to the delivery of culturally competent nursing care involves miscommunication between nurses & patients -Might lack knowledge and sensitivity regarding a patients cultural beliefs and practices; might not recognize the importance and value of these beliefs to the patient as they relate to health care practices -To facilitate successful relationships with patients, nurses must understand their own cultural beliefs and values and how they influence patients care -Another barrier results from failure to assess the patients cultural perspective -Patients unaware of the nurses cultural perspectives therefore misinterpreting health care recommendations from the nurse -Barriers are primarily grounded in differences between nurses and patient cultural world views

-Nurses & patient health care actions & beliefs are generally formulated by 3 factors: 1. Their definition of health 2. Their perception of how illness occurs 3. Their cultural worldview -Natural causes: a person believes that everyone and everything in the world is interrelated & that a disruption of this connectedness causes an illness or disease -Unnatural/outside causes: outside forces create illness and disease -Scientific: specific, concrete explanations of the illness -For primary worldview: 1. Analytic 2. Relational 3. Community 4. Ecologic >many individuals have a mix of primary worldview

-Analytic: values detail to time, individuality, & possessions; prefers learning through written, hands-on, & visual resources -Relational: grounded in a brief in spirituality and the significance of relationships and interactions between and among individuals; verbal communication is preferred learning style -Community: believed that Community needs and concerns are more important than individual ones; learning style Includes quiet, respectful communication as well as meditation and reading -Ecologic: based on a belief that a form of interconnected Ed’s exists between human beings and the earth and that individuals have a responsibility to take care of the earth; learning accomplished through quiet observation and contemplation

Culture-bound!mental!health!issues -Recurring patterns of behavior that create disturbing experiences for individuals >these symptoms may or ma...