Outpatient Treatment Settings
Which statements of a homeless person in the ED best meets the criteria for psychiatric inpatient admission? Select all that apply. "I'm hungry. Can I have something to eat?" "I got crucified today. Nothing can kill me now." "There's a devil in me, and I have to starve him out." "You have no right to keep me here. You'd better let me go!" "I ran out of my meds. I keep thinking that if I run in front of a car it would be over fast."
"I'm hungry. Can I have something to eat?" There is no indication of underlying mental illness in the homeless patient who asks for food. "I got crucified today. Nothing can kill me now." Delusional thinking, with potential result of self-harm, meets the criteria for admission. "There's a devil in me, and I have to starve him out." Delusional thinking indicative of mental illness, and the inability to access food due to that illness meets criteria for admission. "You have no right to keep me here. You'd better let me go!" The implied threat is vague and not enough to meet the danger to others criteria. "I ran out of my meds. I keep thinking that if I run in front of a car it would be over fast." An imminent danger to self with a high-risk suicide plan meets the criteria for admission.
Which patients are well suited for referral to PHP? Select all that apply. A homeless patient An acutely suicidal patient A patient who needs help improving coping skills A patient who needs more structure than day treatment A patient being discharged from an inpatient unit after a lengthy hospitalization
A homeless patient Patients in PHP must have a responsible adult to supervise them for safety after treatment hours. A homeless person does not have this type of support. An acutely suicidal patient Patients who pose a danger to self-meet criteria for inpatient admission, not PHP. A patient who needs help improving coping skills The treatment focus in PHP is improving coping skills. A patient who needs more structure than day treatment Patients needing a more intensive level of care than day treatment would benefit from PHP. A patient being discharged from an inpatient unit after a lengthy hospitalization Following a lengthy hospitalization, many patients need the transition step of PHP before being independent.
Which treatment strategies are often used in dual diagnosis/co-occurring disorders programs? Select all that apply. ACT Self-help groups Psychiatric home care Relapse prevention plans Couples and family therapy
ACT ACT is intensive case management used for those not in a structured program. Self-help groups Self-help groups provide education regarding mental illness and addiction. Psychiatric home care Psychiatric home care is for homebound patients. Relapse prevention plans Plans to address triggers for use of an addictive substance help the patient to stay clean and sober. Couples and family therapy Spouses and family members receive treatment in dual diagnosis programs.
Treatment in PHP is characterized by which factor? ACT Aftercare Psychiatric home care Intensive outpatient therapy
ACT ACT is used in intensive case management, not in PHP. Aftercare Aftercare occurs after completion of PHP and includes outpatient therapy or enrollment in a day treatment program. Psychiatric home care Psychiatric home care is for homebound psychiatric patients. Intensive outpatient therapy PHP is one level below inpatient hospitalization and provides intensive outpatient therapy.
Which is the major treatment challenge associated with community mental health? Access to health care Lack of adequate resources Availability of psychotherapy Adherence to medication regimen
Access to health care Patients who receive community mental health have access to adequate health care. Lack of adequate resources While many community mental health programs have inadequate financial resources, this is not the biggest challenge for community mental health care. Availability of psychotherapy Patients who receive community mental health have access to individual and group therapy. Adherence to medication regimen Even though community mental health patients have access to medication monitoring, many patients do not feel the need to continue with medication now that "normal life" has resumed outside of the hospital.
CASE STUDY QUESTION Which treatment might Michael Stern anticipate receiving in a PHP? Alcohol detoxification Medication management 24-hour access to therapists Strategies to improve coping skills Skilled nursing care to help reduce the need to return to an inpatient setting
Alcohol detoxification PHPs are ambulatory programs where the patient no longer needs acute medical care. Alcohol detoxification is an inpatient medical procedure. Medication management PHP offers patients medication management and monitoring. 24-hour access to therapists PHP is a day treatment program where the patient returns home in the evenings. Michael would not receive 24-hour care in a PHP program. Strategies to improve coping skills Patients in PHP receive therapy and other supportive measures for improving coping skills. Skilled nursing care to help reduce the need to return to an inpatient setting Patients in PHP receive skilled nursing care, both psychiatric and medical, interventions to help reduce the need to return to an inpatient setting.
Which patient admitted to the emergency department is most likely to be admitted to the inpatient psychiatric unit? An anxious patient who cannot sleep A depressed patient who lacks motivation A medicated patient with bipolar disorder who occasionally hallucinates A paranoid patient with schizophrenia who is aggressive toward the ED nurse
An anxious patient who cannot sleep The condition of a patient who is anxious and cannot sleep is not critical enough to be admitted on an inpatient basis. A depressed patient who lacks motivation A depressed patient who lacks motivation does not pose a risk to self or others and does not need inpatient care. A medicated patient with bipolar disorder who occasionally hallucinates A bipolar patient who adheres to a medication regimen and occasionally hallucinates is not in need of acute care. A paranoid patient with schizophrenia who is aggressive toward the ED nurse A paranoid patient with schizophrenia who is aggressive toward the ED nurse is dangerous and requires inpatient care.
At which point in PHP care is an aftercare treatment plan developed? At the end of PHP At the beginning of PHP When medication is decreased or discontinued After 90 consecutive days of PHP participation
At the end of PHP A referral to outpatient care or a day treatment program is planned upon completion of PHP to assist the patient to cope in a less structured setting. At the beginning of PHP A referral to outpatient care or a day treatment program is not planned at the beginning of PHP because the patient's needed level of care cannot be predicted at the beginning of the program. When medication is decreased or discontinued Patients may not experience a decrease or discontinuation of medication during PHP and this does not necessarily influence referral to aftercare. After 90 consecutive days of PHP participation Ninety consecutive days of PHP participation is not a benchmark for referral to an aftercare program.
Which conditions are examples of co-occurring or dual diagnoses? Depression and bipolar disorder Schizophrenia and multiple sclerosis Dementia and cardiovascular disease Borderline personality disorder and alcohol use disorder
Depression and bipolar disorder While depression and a personality disorder are both mental illnesses, they do not refer to dual diagnosis. Schizophrenia and multiple sclerosis Many psychiatric patients also have medical disorders, but they are not referred to as dual diagnosis. Dementia and cardiovascular disease Cognitive disorders and medical co-morbidities, such as cardiovascular disease, are common, but are not referred to as dual diagnosis. Borderline personality disorder and alcohol use disorder They interplay of mental illness and substance addiction requires a specialized, integrated approach to treat both problems concurrently. Mental illness and substance abuse are co-occurring disorders, or dual diagnoses.
What are possible reasons that a patient who has a mental illness discloses contradictory assessment information to different members of the emergency health care team? Select all that apply. Differences in gender Mental status changes Underlying mental illness Lack of motivation to improve health Lack of knowledge of the health care system
Differences in gender Some patients may feel a rapport with one gender over another and, therefore, may not be totally forthcoming with health care team member of the less-desired or less-trusted gender. Mental status changes Patients with mental illness can experience mental status changes during an assessment due to a change in location, time, or medication. Underlying mental illness The patient's underlying mental illness may make them manipulative or unreliable historians regarding their own health. Lack of motivation to improve health Patients with mental illness are often motivated to improve their health, but they lack the skills, insights, or resources to do so. Lack of knowledge of the health care system Although some mentally ill patients may not understand the health care system, this generally is not the reason for offering contradictory assessment data.
Which criteria must be met for a patient with mental illness to be admitted to the hospital on an inpatient status? Select all that apply. Extreme anxiety Intentional drug overdose Threat of danger to others Inability to provide shelter for self Disturbing hallucinations and delusions Admission of feelings of sadness, hopelessness, and lethargy
Extreme anxiety Extreme anxiety is not an admission criterion in and of itself. However, extreme anxiety can accompany other criteria, such as severe depression. Intentional drug overdose A suicide attempt or drug overdose demonstrates a patient's clear and imminent danger to self and meets inpatient admission criteria. Threat of danger to others A threat of danger to self or others meets inpatient admission criteria. Inability to provide shelter for self If the patient has a mental illness that prohibits the patient from providing basic personal safety needs, such as shelter and food, the patient may be admitted to the hospital. Disturbing hallucinations and delusions Exacerbation of a patient's psychotic symptoms is a reason for an inpatient admission and meets criteria. Admission of feelings of sadness, hopelessness, and lethargy Feelings of depression, such as sadness, hopelessness, and lethargy, are not enough for admission to the hospital. However, if these feelings accompanied suicidal ideation or past suicide attempts, the patient would meet the criteria for inpatient admission.
Assertive Community Treatment (ACT) addresses which issues for patients with chronic mental illness? Select all that apply. Family therapy Intensive therapy sessions Structured case management After hours and weekend problem-solving Medication management to avoid an ED visit
Family therapy ACT is focused on the individual patient; however, family therapy may be instituted with patient permission. Intensive therapy sessions ACT is a case management system and does not provide therapy services, but it can put the patient in contact with a therapist or organization that provides therapy. Structured case management The case worker visits the patient multiple times each week to address needs wherever the patient is located. After hours and weekend problem-solving ACT provides care and addresses patient issues 24 hours a day. Medication management to avoid an ED visit ACT assists patients in taking medications as prescribed and is important to helping patients remain out of the hospital.
Which services could a psychiatric patient receive at a community health center? Select all that apply. Housing assistance Alcohol detoxification Couple and family therapy Individual and group therapy Treatment for medical conditions
Housing assistance Psychiatric patients may receive intensive case management services to assist with housing needs. Alcohol detoxification Alcohol detoxification requires inpatient care and is not a service offered by community health centers. Couple and family therapy Couple and family-centered care is offered including therapy for these groups. Individual and group therapy Patients may attend individual and group therapy at community health centers. Treatment for medical conditions Community health centers do not provide treatment for medical conditions, but they do provide treatment programs for dual diagnosis.
What is the role of the psychiatric liaison who works in the ED? Implements the plan of care Determines patient disposition Evaluates patient odd behaviors Secures an inpatient psychiatric bed
Implements the plan of care The nurse implements the patient plan of care with collaboration from the health care team. Determines patient disposition The psychiatrist who diagnoses the patient's mental illness determines disposition. The psychiatric liaison may assist in determining and coordinating disposition. Evaluates patient odd behaviors Health care professionals, such as health care providers, health care provider assistants, and nurse practitioners evaluate patient behaviors. Secures an inpatient psychiatric bed The psychiatric liaison secures an inpatient psychiatric bed at a local facility for the patient.
Which are components of PHP aftercare? Select all that apply. Inpatient follow-up Outpatient therapy Psychiatric home care Day treatment program Medication management
Inpatient follow-up Aftercare is an outpatient program that does not involve inpatient follow-up. Outpatient therapy Outpatient therapy may provide support as the patient becomes more independent in a less structured environment than PHP. Psychiatric home care Only patients who are house-bound quality for psychiatric home care. If a patient attends PHP, he or she is not home-bound. Day treatment program The day treatment structure of 1 or 2 days per week may be just the transition the patient needs after the intensiveness of PHP. Medication management Medications are often an important support for patients transitioning to more independent environments.
A psychiatric nurse assesses which factors during a psychiatric home visit? Select all that apply. Medical illness Family dynamics Transportation issues Medication compliance Distance to community health center
Medical illness The nurse must provide an integrated approach to home care that includes treating the patient's medical illnesses. Family dynamics The nurse assesses family dynamics and establishes rapport with the family to facilitate care of the patient. Transportation issues Patients receiving psychiatric home care are homebound and do not require transportation. Medication compliance Older adult patients often forget to take their medications as ordered, or accidentally take multiple doses. It is important for the nurse to assess the patient's compliance to the medication regimen. Distance to community health center Patients receiving psychiatric home care are homebound and do not visit community health centers.
Which referral criteria is the primary consideration for a psychiatric patient transferring to PHP treatment level? Patient is no longer in crisis. Patient is stable on medications. Patient is safe to return home in the evening. Patient must be accompanied to treatment by a responsible adult.
Patient is no longer in crisis. Patients may be experiencing crisis at the PHP treatment level, as long as they do not meet criteria for inpatient admission. Patient is stable on medications. Medication adjustment and management is common at all levels of treatment and is not specific to the PHP treatment level. Patient is safe to return home in the evening. The patient must have a responsible adult supervising their safety after treatment hours. Patient must be accompanied to treatment by a responsible adult. Patients receiving PHP treatment do not need to be accompanied by a responsible adult, but they must have an adult vouch for their safety before and after the treatment day.
Which factors are characteristic of day treatment programs? Select all that apply. Patients attend 5 days a week. The programs usually lasts 4 weeks or less. The programs enhance patients' independence. The programs treat patients who are in acute crisis. Structured activities are usually less intense than those in PHP.
Patients attend 5 days a week. Patients usually attend 1 or 2 days a week for a duration of 4 weeks. The programs usually lasts 4 weeks or less. Day treatment programs provide short-term structure, usually 4 weeks or less, for the patient as they ready themselves to return to their usual life. The programs enhance patients' independence. The goal of a day treatment program is to assist the patient to transition to a more independent life. The programs treat patients who are in acute crisis. Patients in acute crisis are usually admitted to an inpatient unit or PHP and are not eligible for day treatment program care. Structured activities are usually less intense than those in PHP. Day treatment programs are a lower level of care than PHP and offer less intense structured activities.
Which group is the focus of ACT services? Patients who are in PHP Patients who are homeless Patients who are chronically ill Patients who are acutely suicidal
Patients who are in PHPPatients in PHP are already in treatment to meet their mental health needs. Patients who are homelessNot all homeless people need the intensive case management of ACT. Correct Patients who are chronically illACT case manages chronically ill psychiatric patients who would otherwise use the ED to address their mental health needs. Patients who are acutely suicidalAcutely suicidal individuals are admitted to the hospital.
Which is the primary treatment goal for patients in PHP? Reducing hospital readmission Stabilizing the home environment Providing multiple types of therapy Structuring the patient's time in treatment
Reducing hospital readmission Reducing patient readmission to the hospital or psychiatric facility is a primary goal of PHP. Stabilizing the home environment This can be a treatment goal for some, but not all patients in PHP need help with their home environment. Providing multiple types of therapy Although PHPs may provide different types of therapies, this is not a primary treatment goal of PHP. Structuring the patient's time in treatment Structuring the patient's time may be a strategy to help the patient, but it is not a treatment goal.
Which is a requirement for psychiatric home care? The patient must have dementia. The patient must have private insurance. The patient must be unable to leave home. The patient must be referred by an advanced practice psychiatric nurse.
The patient must have dementia. The patient may have any kind of mental illness in order to receive psychiatric home care. The patient must have private insurance. Private insurance is not required for psychiatric home care. Older adult patients on Medicare receive psychiatric home care. The patient must be unable to leave home. The patient must be home-bound due to a mental and/or physical condition and be in need of psychiatric care to receive psychiatric home health. The patient must be referred by an advanced practice psychiatric nurse. An independent licensed health care provider, not necessarily an advanced practice psychiatric nurse, can order the referral to psychiatric home health.
CASE STUDY QUESTION Which patient criteria suggests Michael Stern is a suitable candidate for a partial hospitalization program (PHP)? Unemployment Support of sibling History of suicide attempt Continued depression with substance abuse issues
Unemployment Employment issues alone are not sufficient to necessitate PHP treatment. Support of sibling PHP patients must have a responsible adult who will assure the patient's safety before and after treatment day. History of suicide attempt History of suicide attempt alone is not sufficient criteria for PHP treatment. Continued depression with substance abuse issues Dual diagnosis programs in an intensive outpatient setting would offer the greatest likelihood of success for Michael. These are not criteria for PHP.
When does disposition begin for psychiatric patients admitted to the emergency department (ED)? Upon entry to ED At discharge from ED Upon placement to a crisis house At acceptance to a day treatment program
Upon entry to ED Disposition for psychiatric patients begins upon entry to the ED and includes placing the patient at a lower level of care. At discharge from ED Disposition for psychiatric patients admitted to the ED occurs before discharge. Upon placement to a crisis house Psychiatric patients may be discharged to a crisis house, but this is decided prior to ED discharge. At acceptance to a day treatment program Psychiatric patients may be placed in a day treatment program, but this is decided before the patient leaves the hospital.
Which measures would the nurse expect to be taken in emergency departments (EDs) for the safety of patients with mental illness? Select all that apply. Use of private rooms Avoidance of sharp objects Use of special door handles Higher nurse-patient ratios Avoidance of the use of intravenous (IV) tubing
Use of private rooms Most EDs do not have the space to provide patients with private rooms. Avoidance of sharp objects Emergency departments are avoiding the use of sharp objects in the management of mentally ill patients, so the sharp objects cannot be used by the patient in self-harm or harm to others. Use of special door handles Emergency departments are using special door handles that prevent the patient from hanging. Higher nurse-patient ratios Most EDs are not fiscally able to provide additional staff to care for mentally ill patients. Avoidance of the use of intravenous (IV) tubing Emergency departments are no longer using IV tubing or other tubing in the treatment of mental health patients, since this may be used as a hanging device.
