Viva Questions for Mental Health PDF

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REVISION FOCUS QUESTIONS MODULE 1 Question: Describe some activities/things you the nurse/midwife could share with your patient (psychoeducation) to promote their mental health and wellbeing. 

Increase knowledge about the illness

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Discuss treatment options

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Discuss medication

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Increase the insight to the illness

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Fresh air

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Healthy diet

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Exercise (improves circulation, and raises oxygen levels)

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Sleep (plays vital role in physical health)

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Good hygiene

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Express their feelings

Question: The patient in your care might have experienced stigma due to their mental illness when previously admitted to hospital. Part 1) How would you describe the term stigma associated with mental illness? Stigma is when a person or people have a mental illness but are associate with negative terms such as 'dangerous', 'crazy' or 'incompetent' rather than using the term unwell. Part 2) what could be some of the effects of stigma for ‘this person’ living with mental illness. It can lead to people with mental illness to be discriminated against which can lead to them missing out on opportunities such employment, housing, education, and social inclusion. Question: Describe some barriers to engagement from both the patient/consumer and nurse/midwife’s perspective regarding ‘the patient/consumer’ in your care. a lack of time a lack of dignity, compassion and respect insufficient staffing inadequate training environmental constraints unsupportive staff attitudes stigma Question: What can you do in your role as a nurse or midwife to help promote recovery for this ‘person/patient’ in your care?  

Keep hope alive even if the person has lost sight of it. Therapeutic optimism refers to the clinician’s expectation of a positive outcome for the consumer.

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Promote self-efficacy in the consumer’s capacity to recover from illness, set realistic goals & overcome obstacles. Self determination to maximise the persons autonomy, informed decisions and make sure they are involved in decisions concerning them. Personal agency is intrinsically motivated, fundamental in the belief to succeed, draws on strengths and sense of overcoming adversity. What do they need? Want? Not need or not want? Relationships are critical from a place of empathy, compassion and genuineness. Validation

REVISION FOCUS QUESTIONS MODULE 2 Question: Engaging with your patient/consumer is a key component when building the therapeutic relationship. Part 1) Identify some key personal and/or professional qualities that will assist you, in building rapport and subsequently the therapeutic relationship with the patient/consumer in your care. - Treat the patient with respect and build trust - Be genuine in my interactions - remember professional boundaries & standards - show empathy and unconditional acceptance Part 2) Identify barriers from the patient that may impact on your ability to engage with them. Professional boundaries invisible yet powerful lines that mark the territory of the nurse and midwife. They define a role and allow the nurse to say, “this is what I do, this is the purpose of my presence here”. - Resistance – may be resistance to treatment, starting new medication or therapy - Transference – feelings are often directed towards the nurses (when a patient redirects their feeling from a person in their life to the clinician *e.g. patient admires you and tells you how much they remind them of their BF, patient displace anger on nurse when talking about their partner - Countertransference – when a nurse transfers their feelings onto the patient *e.g. nurses talking about personal experience during session, nurse doesn’t have boundaries, offer advice vs listening) Question: You (the nurse/midwife) have observed transference/countertransference occurring on your ward with staff and the patient who is now in your care. Part 1) Why do you need to be mindful of transference / countertransference issues? *Can damage the therapeutic relationship Transference – do not take it personally Countertransference – potential for damage, or deterioration of relationship Part 2) What can you do to minimise the occurrence of this happening?

**Question: Explain what the biopsychosocial model is; and why this holistic approach is beneficial to the patient/consumer in mental health care. The biopsychosocial approach considers all factors such as biological (medication, genetics & illness), psychological (thoughts, feelings & emotions), and social factors (relationships, friends, work/education) . Biopsychosocial model of care can identify elements critical to the person’s physical, psychological health and safety as well as therapeutic elements which aid in assessment including;   

personal autonomy, identifying risk, enabling referral whist detailing clear rationale for interventions (actions) to take.

This approach is beneficial because…. -

Consumer is the centre of this model and approach

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Ensure patient to have the best opportunity to recover

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Gathers all info regarding persons world

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Considered best practice in MH

Question: Your patient says to you, “I think the medication I take for my mental disorder is making me feel worse, I’m going to stop taking it”. Describe your response in terms of: Part 1) What you would say or ask your patient/consumer in response to that statement? why do you think it makes you feel worst? How long have you felt like this?

Part 2) Outline interventions/strategies that might assist your patient/consumer with their concern (within the nurse/midwife scope of practice).

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Therapeutic communication - how does the person feels about medications and their illness?

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Discuss health behaviours - advocating and discussing with the treating team.

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Joint problem solving.

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Include family -provide information.

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Discuss side effects, recognise, refer, respond, & report.

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Education, administration of meds, decreasing dose safely.

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Encourage to seek help.

REVISION FOCUS QUESTIONS MODULE 3 Question: Discuss three (3) key assessments (included in the comprehensive mental health assessment) that would be undertaken on your patient/consumer with a mental health disorder in the clinical setting. Provide the rationale for you completing these assessments. 1) Physical Assessment 2) Mental State Exam (MSE) 3) Risk Assessment Theses assessment allows health professional to understand the patient’s needs, it will provide a framework for plan of care, a baseline and ongoing for future assessment’s, identify immediate risks to others, themselves and evaluates the patients current state of mine. Question: As a nurse or midwife, you will know that the population with severe mental illness is vulnerable for physical conditions due to the nature of their illness. Explain: Why is it essential for you (the nurse/midwife) to complete a thorough physical assessment (and clinical observations) on a person with mental illness. Provide your reasoning for this.

Question: You will be undertaking a Mental State Examination (MSE) on the person in your care. Explain what The MSE is, its purpose and major goals of the assessment. MSE is a semi-structure interview assess a person’s neurological and psychological functionary across several dimensions “at that point in time” Main purpose is to provide a framework for plan of care, gives baseline for future assessments, evaluate changes, identify immediate risk and evaluate state of mine. is can be affected by a number of factors: - time of day - the place of which it is performed - the gender of the assessor - if others are in the room **10 components of the MSE 1. Appearance 2. Behaviour (what are they doing?) 3. Mood (How are they feeling) 4. Affect (outwardly observable emotion response/states) 5. Speech (how the person says things) 6. Thought for (continuity & connection of ideas) 7. Thought content (description of what the person is talking about, e.g. suicide, delusions) 8. Perception (response of the sense, any hallucinations?) 9. Cognition (LOC, orientation, memory, concentration) 10. Insight and judgement (recognise a problem & understands it) Question: Risk in mental health contexts can take many forms. Explain potential risks associated with mental disorders - this could be associated with your patient/consumer in crisis, acutely unwell, or risks associated with the specific mental disorder itself. -

Danger to themselves and others

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Falls

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Financial/unemployment

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Sexual or physical exploitation

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Verbal or physical abuse

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Harassment and stalking

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Homelessness

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Not taking medications

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Substance use/abuse

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Social isolations

REVISION FOCUS QUESTIONS MODULE 4 Mental Illness Definition – Disturbance of thought, mood, volition, perception, orientation or memory, significantly impairs (temp or permanently) judgement of behaviour. Question: In consideration of your patient/consumers mental illness, give reasons as to why they may be unable to provide informed consent (incapacity). Incapacity: Physical or mental inability to do something or to manage one's affairs - due to cognitive deficit that impairs decision making abilities. Neurological disease due to mental illness (e.g. psychosis, delusions, delirium, sedation, fatigue, drugs/alcohol, intellectual disability, panic & fear, emotional shock, mediation’s and pain) Question: The Mental Health Act (2014) W.A. is legislation (the law) that governs current best practice in mental health in Western Australia. Briefly outline your understanding of the key principles and objectives of the Mental Health Act (2014) W.A. (2) Provide treatment in least restricted environment (e.g. community treatment)

Question: If the patient/consumer in your care was admitted to your ward under the Mental Health Act (2014) W.A., outline what ‘rights’ they would have under the Act.    

A person cannot be treated without consent under a treatment authority if the person has capacity; there must also be a risk of serious harm or deterioration. A person must be treated under an advance health directive, or with the consent of an attorney or guardian A patient has a right to receive accurate, timely and appropriate information about their healthcare. A patient must be given oral explanations and be involved in clinical decisions at key stages.

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A patient must be given written information for matters concerning them, such as the making of a treatment authority. A patient may seek an independent second opinion A patient may be visited by nominated support persons, family, carers, other support persons, unless specifically excluded under the Act. A patient may appoint one or two ‘nominated support people.

**Carers and family members also have rights. Question: If your patient/consumer was admitted to a mental health facility under the Mental Health Act (2014) W.A. as an involuntary patient, identify the five (5) criteria that the patient/consumer would need to meet for involuntary detention/admission status. *5 Criteria for inpatient treatment order

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the person has a mental illness requiring treatment;

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because of the mental illness there is a significant risk to the health or safety of the person or to the safety of another person, or a significant risk of serious harm to the person or to another person;

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the person does not demonstrate the capacity to make a treatment decision

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treatment in the community cannot reasonably be provided to the person; and

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there is no alternative that would be less restrictive to the person’s freedom of choice and movement.

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Patient must be assessed by medical doctor of mental health practitioner

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The practitioner considers if the person meets the criteria for involuntary treatment

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If (YES) referral to psychiatrist for exam

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Maybe detained or put on transport order

(THEY MUST MEET CRITERIA FOR THIS) A voluntary patient is someone who came into the care facility on their own volition. They chose to go there because they were feeling they were not coping well, or they needed help. An involuntary patient is someone who has been admitted not necessarily against their will, but meets the criteria of admission/detention

REVISION FOCUS QUESTIONS MODULE 5 Question: Your patient/consumer is experiencing anxiety. Part A: What is anxiety? Anxiety is your body’s natural response to stress, it’s a feeling of fear or apprehension about what’s to come ‘e.g.; first day of you, job interview’ Part B: How will you the nurse/midwife respond (what will you do) if your patient/consumer is showing signs of anxiety. Principles of Care – Show respect, show empathy, positive regard, validate their feelings, support the person, provide reassurance and comfort. LISTEN, and let the PATIENT talk. Question: Your patient/consumer is experiencing a ‘normal physiological response’ to anxiety. Describe the signs and symptoms/clinical observations of anxiety you might see across five body systems. Tip: 5 body systems (cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal). Signs & Symptoms - (CARDIVASCULAR) palpitations, chest pain, increased HR - (RESPIRATORY) hyperventilation’s, SOB - (NEUROLOGICAL) dizziness, light-headed, headache, tingling an numbness - (GASTROINTESTINAL) choking, dry mouth, nausea, vomiting and diarrhoea - (MUSCULOSKELETAL) muscles aches and pains, tremor, restlessness Your patient/consumer is to commence Cognitive Behavioural Therapy (CBT) as a therapeutic intervention to support the management of their mental disorder. How would you (the nurse/midwife) explain to your patient/consumer what Cognitive Behavioural Therapy (CBT) is?

CBT is a type of talking treatment that focusses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems. It combines cognitive therapy (examining the things you think) and behaviour therapy Question: Medication treatment. Your patient/consumer has been commenced on anxiolytic medications. Part A) What are anxiolytics? Low dose anti-depressant, prevent anxiety and treat anxiety related to several anxiety disorders - reduces the bodies response to adrenaline and noradrenaline” (“pam” diazepam, lorazepam, alprazolam ‘Xanax’ clonazepam) Part B) What are their primary aim? Relieve the symptoms of acute anxiety states Part C) What are some common side effects? Drowsiness, sedation, impaired memory and concentration, low mood, poor motor coordination, mood swings and irritability.

REVISION FOCUS QUESTIONS MODULE 6 Trauma or traumatic event: triggers psychological and emotional distress causes disruption in the persons physical and emotional wellbeing (illness, accident, relationship breakdown) Crisis: is a dangerous situation that requires attention (loss of job, relationship breakdown or divorce exam stress) Acute state of crisis: can become an emergency situation Stress: inevitable part of the human experience Question: Your patient/consumer is experiencing stress. This may/or may not be associated with their mental disorder. Part A: What are the long-term effects of stress on the body? - Mental health problems, such as depression, anxiety, and personality disorders - Cardiovascular disease, including heart disease, high blood pressure, abnormal heart rhythms, heart attacks, and stroke - Obesity and other eating disorders - Menstrual problems - Sexual dysfunction, such as impotence and premature ejaculation in men and loss of sexual desire in both men and women - Skin and hair problems, such as acne, psoriasis, and eczema, and permanent hair loss - Gastrointestinal problems, such as GERD, gastritis, ulcerative colitis, and irritable colon Part B: Identify health problems related to stress. -

Heart disease

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Asthma Obesity Diabetes Headaches Depression and anxiety Gastrointestinal issues

Question: Your patient/consumer may have experienced trauma and/or stress associated with their mental disorder. Identify what kind of experiences and situations might give rise to trauma/and or stress for the patient/consumer in your care.      

Having a mental illness before the trauma. Having experienced trauma in the past Experiencing a trauma that is severe. Experiencing physical assault. Using avoidant coping strategies (often drugs and alcohol). Being female

Question:The mental health patient in your care is more likely than not to have a history of trauma. Part A: What do you understand by the term ‘trauma-informed care’? Trauma Informed Care (TIC) approach - practices that promote a culture of safety, empowerment and healing.

Part B: What do the principles of trauma informed care include?

Question: Part A: Explain the Stress-Vulnerability Model and why it is useful for identifying and treating mental illness. Part B: As nurses and midwives you understand that individuals carry predisposing, perpetuating and precipitating factors to mental illness. Explain what these terms mean and provide examples of each.

Predisposi ng

(increase susceptibility to the development of mental condition) increase a person’s vulnerability to an issue and putting them at a higher risk

e.g.; genetic, trauma (birth), brain injury, physical illness, pain and mental illness, medications, culture, self-esteem.

Precipitatin g

(both increase susceptibility and contribute to the occurrence of mental condition) an event, situation or trigger - are factors that may have triggered the current issue

e.g.; drugs/alcohol, pain or trauma, grief and loss, relationships, work/finances, life events and stressors

Perpetuatin g:

(extend duration of condition & inhibit the recovery from the mental condition) what maintain problem once it has been established.

e.g.; any predisposing or precipitating factors which are ongoing.

REVISION FOCUS QUESTIONS MODULE 7 Question: Your patient/consumer has experienced periods of depressed state and/or elevated state (mania) throughout the course of their condition (disorder). Identify the key clinical features of both mania and depression. Question: You (the nurse/midwife) are completing a Mental State Examination (MSE) on your patient/consumer. Part A) Explain the difference between Mood and Affect. Part B) How will you determine/assess your patient’s mood? Question: You are conducting a risk assessment on your patient/consumer who may have been experiencing alterations in mood, or an unstable mood (lowered/decreased mood state and/or an elevated/agitated state).

What is your rationale for conducting the risk assessment? Question: Medication treatment. Drug treatment for disorders of mood (and other mental disorders) may include antidepressant medications. Part A) What are antidepressant medications? Part B) Discuss the purpose, action and reasons for commencing your patient/consumer on antidepressant medications. DISORDER REVISION – MAJOR DEPRESSIVE DISORDER (DEPRESSION) Outline the key presenting features (signs and symptoms /diagnostic criteria) for a diagnosis of major depre...