Quiz 1 Study Guide - Lecture notes 1 PDF

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Chapter 1 and 4 1.

What are some of the traits for Mental Health?  Ability to: o Think rationally o Communicate appropriately o Learn o Grow emotionally o Be resilient o Have a healthy self-esteem o Positive self-concept o Self care o Learning and productivity  Mental Health – a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively and contribute to the community. -provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem -music, exercise, diet etc. to keep/promote mental health

2.

a. How is mental illness diagnosed?  A medical professional determines a diagnosis by interviewing you about your history of symptoms. Sometimes a doctor will require a couple of medical tests to rule out possible physical ailments, but we cannot evaluate mental health itself through blood tests or other biometric data. b. What are the manifestation of mental illness?  These disorders are manifested in significant dysfunctions that may be related to developmental, biological, or psychological disturbances in mental function. o Excessive fears or worries, or extreme feelings of guilt. o Extreme mood changes of highs and lows. o Withdrawal from friends and activities. o Significant tiredness, low energy or problems sleeping.

 Diathesis-stress model – most accepted explanation for mental illness -where diathesis represents biological predisposition and stress represents environmental stress or trauma – is the most accepted explanation for mental illness. ex. trauma or stress can damage the brain c. How are Mental Disorders classified? o They are identified based on specific criteria o Chronic or long-term impairments that range from moderate to disabling. o 2 major classification systems exist  Diagnostic and Statistical Manual, Fifth Edition (DSM-5)  International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) 3.

a. What are the influences on Mental Healthcare?

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Individual characteristics and attributes influence health and well being Several factors have been linked to mental health, including race and ethnicity, gender, age, income level, education level, sexual orientation, and geographic location. Environmental experiences →inherited factors→biological influences, hormonal influences, health practices and beliefs, cultural beliefs, family influences

4. a. What is Psychiatric Mental Health Nursing?  Nursing specialty that is dedicated to promoting mental health through assessment, diagnosis, and treatment of behavioral problems, mental disorders, and comorbid conditions across the lifespan o Employ purposeful use of self o Use nursing, psychosocial, neurobiological theories and research o Work with people throughout the life span o Employed in a variety of settings 4.

b. Which treatment settings do they practice?  Basic Level o Coordination of care o Health teaching and health maintenance o Milieu therapy o Pharmacological, biological and integrative therapy  Advanced Practice o Medication prescription o Psychotherapy o Consultation

5.

Identify scope of practice of the multidisciplinary team.  Members of each discipline are responsible for gathering data and participating in the planning of care o MD: Psychiatrist o Nurses: RN, LVN, LPT, UAP (CNA / MHW) o Therapist: LCSW, LMFT, Psychologist o Occupational / Recreational Therapist o Registered Dietician o Pharmacist o Housekeeping  Treatment plan or clinical pathway provides a guideline for patient’s care during hospital stay

Chapter 2 1.

Review Freud Psychoanalytic Theory. What are the implications of psychoanalytic theory in nursing?  Methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events.  Behavior is modified by subconscious thoughts and feelings ❖ Conscious: awareness of thought and emotion ❖ Preconscious: Not current emotion but can remember the emotion from

past experience. ❖ Unconscious: Thoughts that motivate a person when they are unaware of the thought or emotion. This also includes repression as a defense mechanism.  The ego is considered the “reality principle” and begins to develop between 4 and 6 months of age. The ego experiences the outside world and then adapts and responds to it. The ego’s main goal is to maintain harmony between the id and the superego. E.g. The ability to assert oneself without anger or aggression is an example of healthy ego development.  The id is the locus of instinctual drives—the “pleasure principle.”  The superego internalizes values and morals set forth by the primary caregivers. This is considered the “perfection principle.”

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Freud’s theory of the unconscious mind is particularly valuable as a baseline for considering the complexity of human behavior. By considering conscious and unconscious influences, a nurse can identify and begin to think about the root causes of patient suffering Freudian Theory and Nursing o Formation of personality o Conscious and unconscious influences o Importance of individual talk sessions o Attentive listening o Transference  occurs when the client displaces onto the therapist attitudes and feelings that the client experienced. Transference patterns are automatic and unconscious in the therapeutic relationship. For example, an adolescent female client working with a nurse who is about the same age as the teen’s parents might react to the nurse like she reacts to her parents. She might experience intense feelings of

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rebellion or make sarcastic remarks; these reactions are actually based on her experiences with her parents not the nurse. Countertransference  occurs when the therapist displaces onto the client attitudes or feelings from his or her past. For example, a female nurse who has teenage children and who is experiencing extreme frustration with an adolescent client may respond by adopting a parental or chastising tone. The nurse is countertransference her own attitudes and feelings toward her children onto the client. Nurses can deal with countertransference by examining their own feelings and responses, using self-awareness, and talking with colleagues. Stages of Psychosexual Development Oral—0 to 1 year: weaning Anal—1 to 3 years: toilet training Phallic—3 to 6 years: oedipal conflict Latency—6 to 12 years: hides sexuality from disapproving adults Genital—12 to 20 years: genital sexuality

2.

What is the interpersonal theory? What are the implications of interpersonal theory in nursing?  Interpersonal theory states that individual behavior and personality development are the direct result of interpersonal relationships. The identification of a positive relationship is an intervention that reflects interpersonal theory  TEST-TAKING HINT: Understanding the basic concepts of interpersonal theory assists the test taker in answering this question correctly. Remember interpersonal theory by thinking “inter” and “personal,” or “between people.” It often gets confused with intrapersonal theory. Think “intra” and “personal,” meaning “within oneself.”  Purpose of all behavior is to get needs met through interpersonal interactions and to reduce or avoid anxiety o Anxiety o Security operations  Milieu Therapy - surrounding o The concept of milieu therapy, originally developed by Sullivan, involved clients’ interactions with one another, including practicing interpersonal relationship skills, giving one another feedback about behavior, and working cooperatively as a group to solve day-to-day problems. o Orienting the client to the physical setting o Identifying rules and boundaries of the setting o Ensuring a safe environment for the client o Assisting the client to participate in appropriate activities

3.

What are the behavioral and cognitive theories and therapies? What are the implications of cognitive theory in nursing?  Substituting rational beliefs for irrational beliefs and eliminating self-defeating behaviors are goals of cognitive-behavioral theory subscribed to by Beck and Ellis  Behavioral therapy is based on the assumption that changes in maladaptive behavior can occur without insight into the underlying cause

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Cognitive theory is based on the principle that thoughts affect feelings and behaviors. 4 types of behavioral therapy: o Modeling – learning occurs through observation o Operant conditioning - is a method of learning that employs rewards and punishments for behavior. o Systematic desensitization - This therapy aims to remove the fear response of a phobia, and substitute a relaxation response to the conditional stimulus gradually using counter conditioning. o Aversion therapy - designed to cause a patient to reduce or avoid an undesirable behaviour pattern by conditioning the person to associate the behaviour with an undesirable stimulus o Biofeedback - a mind-body technique that involves using visual or auditory feedback to gain control over involuntary bodily functions such as blood flow, blood pressure, and heart rate. examples include: learning disorders, eating disorders, bedwetting, and muscles spasms

What is the humanistic theory? What are the implications of humanistic theory in nursing?  Attempts to support personal growth by helping people gain self-awareness, and self-acceptance  “Client-centered therapy” is Carl Roger’s name for his style of humanistic therapy  Focus on human potential and free will to choose life patterns supportive of personal growth o Such as Maslow’s hierarchy of needs:  Maslow hypothesized that the basic needs at the bottom of the pyramid would dominate the person’s behavior until those needs were met, at which time the next level of needs would become dominant

Implications of Motivation theory:

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First, an emphasis on human potential and the patient’s strengths is key to successful nurse-patient relationships. Second, the model helps establish what is most important in the sequencing of nursing actions.

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What is the biological theory and therapies? What are the implications of biological theory in nursing?  Biological theories focuses on neurological, chemical, biological, and genetic issues o E.g: Psychopharmacology therapy, Brain stimulation therapies  Implications: o Physical needs and physical care in psychiatric nursing are provided as part of a holistic approach to healthcare

6.

What are the developmental theories? What are the implications of developmental theory in nursing?  Our mental representations of the world, or schemata, depend on the cognitive stage we have reached o Eg. Jean Piaget:

o 1. During Piaget’s stage 1 of cognitive development (birth to 2 years), object permanence is developed. 2. According to Piaget, egocentrism occurs during the stage of preoperational thought (2 to 6 years) 3. During Piaget’s stage 3 of cognitive development (6 to 12 years), reversibility and spatiality are developed. 4. Formal operations (12 to 15 years) is the fourth stage of Piaget’s theory of cognitive development. At this stage, the individual is able to think and reason in abstract terms

7.

Provide examples with each theory.

Psychoanalytic: Freud - Id, Ego, Superego Interpersonal: Hildegard Peplau – the nurse helps patients make positive changes in their healthcare status - short-term therapy – good for depression Behavioral: Pavlov – Classical conditioning, operant Cognitive: based on both psychology & behavioral – CBT (cognitive-behavioral therapy) e.g. Jean Piaget

E.g. of CBT - Substituting rational for irrational beliefs and eliminating self-defeating behaviors. Humanism: Maslow hierarchy and Carl Roger’s Client-centered therapy Biological: Psychopharmacology therapy 

Chapter 6 1.

Describe and give examples of the 5 ethical principles central to bioethics.  Beneficence: The duty to act to benefit or promote the good of others (e.g., spending extra time to help calm an anxious patient).  Autonomy: Respecting the rights of others to make their own decisions (e.g., acknowledging the patient’s right to refuse medication supports autonomy).  Justice: The duty to distribute resources or care equally, regardless of personal attributes (e.g., an intensive care unit nurse devotes equal attention to someone who has attempted suicide as to someone who suffered a brain aneurysm).  Fidelity (nonmaleficence): Maintaining loyalty and commitment to the patient and doing no wrong to the patient (e.g., maintaining expertise in nursing skill through continuing nurse education). o Fidelity is the duty to keep one's promises or word. Keeping an appointment the nurse has made with the client is an example of fidelity.  Veracity: The duty to communicate truthfully (e.g., describing the purpose and side effects of psychotropic medications in a truthful and non-misleading way).

2.

Describe the legal process for admission to a psychiatric hospital. Describe Voluntary Admission and Identify the three criteria for Involuntary Hold according California’s Welfare and Institutions Code.  Neither voluntary admission nor involuntary commitment determines a patient’s ability to make informed decisions about personal healthcare.  Care providers must establish a well-defined psych problem based on DMS5  There must be a reasonable expectation that the hospitalization and treatment will improve the presenting problem  Voluntary admission: o Informal admission:  Least restrictive of all admissions.  Similar to any general admission; the pt. is free to stay or leave, even against medical advice o Voluntary admission:  Pts. Apply in writing for admission to the facility  Involuntary Commitment o Aka assisted inpatient psychiatric treatment; a court ordered admission to a facility without the patient’s consent 1. Mentally ill 2. Posing a danger to self or others 3. Gravely disabled

 Criteria for Involuntary Commitment; Welfare and Institution Code (WIC) o 5150 – 72 hr. hold for (DTS/DTO/GD) --> 5585 – 72 hr. hold for minors o 5250 – 14 day hold for (DTS/DTO/GD)

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5260 – consecutive 14 hold for DTS 5300 – 180 day hold for DTO 5270 – 30 day hold for GD Temporary Conservatorship – GD LPS Conservatorship – GD

Explain the importance of confidentiality in psychiatric care. Provide explanations for situations in which health care professionals have a duty to break patient confidentiality.  It is an ethical responsibility of healthcare professionals that prohibits the disclosure of privileged information without the patient’s consent  Paperwork should never contain the full patient identifiers Explanations to Break the confidentiality code: o Duty to warn and protect third parties o Statutes for reporting child and elder abuse

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Identify the following legal terminology (e.g., torts, negligence, and malpractice) applicable to psychiatric nursing, and explain the significance of each term.

5.

Describe patient’s rights to treatment, right to refuse treatment and the right to informed consent. RIGHTS TO TREATMENT: right to quality care  The right to be free from excessive or unnecessary medication  The right to privacy and dignity  The right to the least restrictive environment  The right to an attorney, clergy and private care providers  The right to not be subjected to lobotomies, electroconvulsive treatments and other treatments without fully informed consent RIGHT TO REFUSE:  In an emergency to prevent a person from causing serious and imminent harm to self or others, institutions can medicate a person without a court hearing.  After a court hearing, a person can be medicated if all of the following criteria are met: 1. The person has a serious mental illness 2. The person’s ability to function is deteriorating or he or she is suffering or exhibiting threatening behavior 3. The benefits of treatment outweigh the harm 4. The person lacks the capacity to make a reasoned decision about the treatment 5. Less-restrictive services have been found inappropriate RIGHT TO INFORMED CONSENT: Informed consent is a legal term that means the patient has been provided with basic information regarding risks, benefits, and alternatives of treatment. The person must be voluntarily accepting the treatments. While registered nurses may provide education about treatment, typically, it is the prescriber who is legally responsible for securing informed consent.  Consent must be secured for surgery, electroconvulsive treatment, or the use of experimental drugs or procedures. Some state institutions require consent for each medication addition or change. Patients have the right to refuse participation in experimental treatments or research and the right to voice grievances and recommend changes in policies or services offered by the facility, without fear of punishment or reprisal.

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For an individual to provide informed consent, as previously mentioned, he or she must have the capacity to understand. Like the phrase, “Innocent until proven guilty,” patients are considered competent until they have been declared incompetent. If found incompetent through a formal legal proceeding, the patient may be appointed a legal guardian or representative who is responsible for giving or refusing consent for the patient, while always considering the patient’s wishes. Guardians are typically selected from among family members. The order of selection is usually (1) spouse, (2) adult children or grandchildren, (3) parents, (4) adult siblings, and (5) adult nieces and nephews. In the event a family member is either unavailable or unwilling to serve as in this role, the court may also appoint a court-trained volunteer guardian.

Discuss a patient’s civil rights and how they pertain to restraint and seclusion in adults, adolescence and children. What is the criteria to place a person in restraints / seclusion?  Once restraints are removed- a new order is required to reinstitute.  Chemical restraints are medications or doses that are not used for the patients’ condition.  Seclusion is confining a patient in a room when they are a threat to themselves or others in using a self destructive behavior.  Can place patient in restraints and then call physician for order in emergency situation, but need written order within 15-30 minutes.  Restraints are only used as a last resort when other least restrictive measures have been tried.  Assess circulation of patient at least every 15 min while patient is in restraints.  Assess for safety and physical needs and document client’s behavior.  Ensure patient receives fluids, range of motion, and toileting while in restraints.  Assess vital signs and presence of pain.  Release patient when exhibiting safe and quieter behavior and enter time released. o New order needed before initiating restraints again.  Time limit for seclusion and restraints: o 18+- 4 hours o 9-17- 2 hours o 8 and younger- 1 hour

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Describe the purpose of documentation of care. Medical records provide accurate and complete info about the care and treatment of patients and to give healthcare personnel a means of communicating with one another They help determine: o The extent of the pt. damages and pain and suffering in personal injury cases such as when a psychiatric pt. attempts suicide while under the protective care of a hospital o The nature and extent of injuries in child abuse or elder abuse o The nature and extent of physical or mental disability in disability cases o The nature and extent of injury and rehabilitative potential in workers’ compensation cases

Chapter 8 1.

Review concepts of therapeutic nurse client relationship....