MH part 1
Providing a safe environment for patients with impaired cognition, referring an abused spouse to a "safe house" and conducting a community meeting are nursing interventions that address aspects of: 1. milieu therapy 2. cognitive therapy 3. behavioral therapy 4. interpersonal psychotherapy
1 pg 43
Which of the following contributions to modern psychiatric nursing practice was made by Freud? 1. The theory of personality structure and levels of awareness 2. The concept of "self-actualized personality" 3. The thesis that culture and society exert significant influence on personality 4. Provision of a developmental model that includes the entire life span
1 pg 43
According to Maslow's Hierarchy of Needs, the most basic needs for psychiatric mental health nursing are: 1. Physiological 2. Safety 3. Love and belonging 4. Self-actualization
1 pg43
seclusion and restraint is permitted only under the following circumstances
1 one the written order of a physician 2 when orders are confined to specific time-limited periods 3 when the patient's condition is reviewed and documented regularly 4 when the original order is extended after review and reauthorization and specifies the type of restraint pg 84
EBP depends on a combination of which of the following sources of information and knowledge? SATA 1. Clinical expertise 2. Randomized controlled trials 3. Theories of ethical decision-making 4. Patient preferences
1,2 and 4
Factors that affect a person's meant health are: (SATA) 1. support system 2. developmental events 3. socioeconomic status 4. cultural beliefs
1,2, 4 pg 22
What can the ADN/BSN do in Mental Health Nursing Practices/Roles? name all 7
1. Counseling 2. Milieu therapy 3. Self-care activities 4. Psychobiological interventions 5. Health teaching 6. Case management 7. Health promotion and maintenance
Factors that hinder the nurse-patient relationship
1. Lack of nurse availability or lack of contact 2. Lack of nurse self-awareness 3. Nurse's negative feelings about client Don't tell them, "I'll come back" and don't come back SIDE
Working Phase
1. Maintain the relationship 2. gather further data 3. promote the patient's problem-solving skills, self-esteem, and use of language 4. overcome resistance behaviors 5. evaluate problems and goals, and redefine them as necessary 6. promote practice and expression of alternative adaptive behaviors during the working phase, the nurse and patient together identify and explore areas in the patient's life that are causing problems. pg 144 and SLIDE
Communication Techniques
1. Use of silence 2. Active listening 3. Clarifying techniques a. paraphrasing b. restating c. restating d. reflecting e. sharing observation, exploring 4. Focusing 5. Information-giving 6. Open-ended 7. Suggesting slide
cultural considerations: negotiating barriers
1. communication styles 2. use of eye contact 3. perception of touch 4. cultural filters pg 128
Attending Behaviors
1. eye contact 2. body language 3. vocal qualities (not what you say, but how you say) 4. Verbal tracking (what the patient is saying) pg 149
Factors that enhance growth
1. genuineness (self-awareness of feelings, and the ability to communicate them appropriately) 2. empathy (understand the feelings) 3. positive regard (respect) -attitudes -actions
signs of mental health
1. happiness 2. control over behavior 3. appraisal of reality 4. effectiveness in work 5. healthy self-concept 6. satisfying relationships 7. effective coping strategies pg 12
signs of mental illness
1. major depressive episode 2. control disorder: undersocialized, aggressive (repetative and persistent pattern) 3. Schizophrenic and Other disorders (bizarre delusions, like being controlled - Big Brother) 4. Adjustment Disorder with work (or Academic) Inhibition (where previous no problem) 5. Dependent personality Disorder (they can't do anything for themselves) 6. Borderline Personality Disorder (patterns of unstable and intense interpersonal relationships. Lacks self-confidence) 7. Substance Dependencies pg 12
Goals of therapeutic communication
1. promote insight 2 promote problem solving 3 promotes patient making choices 4. keeping patient focused 5. directed at "just facts" slide
A nurse is working with a couple and their two children. The 14-year-old son has been in trouble at school because of truancy and poor grades. The 16-year-old daughter is quiet and withdrawn and refuses to talk to her parents. The parents have had severe marital problems for the past 10 years. The priority nursing concern at this time is how the: 1 Parents can set limits on their children's behavior 2 Couple's marital problems are affecting their children 3 Son's behavior in school will impair his relationships with peers 4 Daughter's withdrawn behavior limits her ability to talk with her friends
2 The parents' ongoing marital problems appear to have interfered with their parental roles, resulting in their children's behavioral problems. At this time the children need support, not limits. The son's and daughter's behaviors are not the priority nursing concern because there are no data to support these assumptions.
A student nurse receives her final course evaluation for her clinical practicum in psychiatry, which took place at an urban mental health clinic. Her professor reported that she demonstrated competent and knowledgeable practice but gave her a grade of "C" The student is disbelieving and confused. Which of the following is the most likely rationale of the professor? 1. the student was reported to be anxious about patients' reactions during the first week 2. the student was reported to lack a compassionate attitude toward patients. 3. the student was unable to delineate the difference between symptoms of bipolar disorder and manic depression 4. the student did not conduct a comprehensive review of psychiatric nursing literature during her semester
2
When working with clients who use manipulative socially acting-out behaviors, the nurse should be: 1 Strict, punishing, and restrictive 2 Sincere, cautious, and consistent 3 Supportive, accepting, and friendly 4 Sympathetic, nurturing, and encouraging
2 A sincere, cautious, and consistent attitude limits this individual's ability to manipulate both situations and staff members. A strict, punishing, and restrictive approach may create a power struggle and limit the development of a therapeutic nurse-client relationship. When accepting the person, the nurse should not support negative behavior; a friendly attitude may encourage further problem behavior. A sympathetic, nurturing, and encouraging approach may encourage the client to continue in her lifestyle rather than learn appropriate ways to relate to others.
Cognitive Theory Who and what
Beck Cognitive-Behavioral Therapy *Automatic thoughts *Cognitive disorders (negative thoughts, anxiety)
Biological Who and what
Biological Therapy Psychopharmacology Nonpharmacological
Considerations communication style posture Eye-contact touch cultural filters
Considerations communication style posture Eye-contact touch cultural filters slide
Theory of Psychosocial Development
Erik Erikson his 8 stages to pass through
TRUE OR FALSE DSM classifies a person with a disorder for example: it defines an alcoholic
FALSE The DSM classifies disorders that people have and not the person. for example: "an individual who with alcohol dependency" pg 18
Goals of Therapeutic Nurse-Patient relationship
Facilitate: communication of distressing thoughts and feelings Assisting: patients with problem-solving to help facilitate activities of daily living Helping: patients examine self-defeating behaviors and test alternatives Promoting: self-care and independence SLIDE pg 137
Psychoanalytic Theory who and what
Freud therapy type: *Psychoanalysis *Psychodynamic -Transference -Countertransference
mental health continuum
IS A DYNAMIC AND EVER-SHIFTING, RANGING FROM MILD TO MODERATE TO SEVERE TO PSYCHOSIS
_____________________ is acknowledged to be a barrier to proper or appropriate mental health/recovery and medical services as well.
Stigmatizing pg 21
TRUE or FALSE The influence of culture on behavior and the way in which symptoms present may reflect a person's cultural patterns
TRUE therefore; symptoms need to be understood in terms of a person's cultural background pg 21
what is stigma
a mark of infamy, disgrace or reproach. one of the biggest reasons people do not go to get treatment
Cognitive distortions
are irrational because people make false assumptions and misinterpretations. same as automatic thoughts pg 32
Confidentiality
care and treatment is an important right for all patients! discussions need to be done discretely there are some situations when disclosure is needed EXAMPLE: 3rd party harm
bioethics
is a more specific term that refers to the ethical fusions that arise in health care pg 80
complementary relationship
like teacher and student
Ethics of Care Theory
pg 35
eye contact
presence or absence of eye contact should not be used to assess attentiveness to judge truthfulness or to make assumptions on the degree of engagement
Restating
the nurse mirrors the patient's overt and covert message echo feelings don't misuse this tool, don't want to be a parrot pg 122
Boundaries
the very first connections between nurse and patient are to establish an understanding that the nurse is safe, confidential, reliable, consistent and that the relationship is conducted within appropriate and clear boundaries. pg 136
The single most important action nurses can take to protect the rights of a psychiatric patient is to 1. be aware of the state's laws regarding care and treatment of mentally ill 2. refuse to participate in imposing restraint or seclusion 3. document concerns about unit short staffing 4. practice the five principles of bioethics
1
While assessing your patient, Simon, a 63-year-old man in the psychiatric unit with a diagnosis of generalized anxiety disorder, he asks you, "Can you tell me why my family thinks that I am just acting sick to get attention?" Drawing from your knowledge of the impact of mental illness on families, which of the following would you include in your discussion to help Simon see his illness as a real illness? (Select all that apply.) ALL OF THESE APPLY 1. Mental health is fundamental to health. 2. Mental disorders are real health conditions that have an immense impact on individuals and families. 3. The efficacy of mental health treatment is well documented. 4. A range of treatments exists for most mental disorders.
1,2,3,4 yep all four
Which of the following interventions will assist in creating and maintaining a therapeutic environment on an acute care mental health unit? Select all that apply. 1 Reorienting clients to the rules of the unit whenever necessary 2 Providing a posted schedule of unit activities 3 Monitoring each client for the potential of aggressive behavior 4 Assuring the clients that they will have unlimited access to the telephone 5 Encouraging the clients to take an active role in planning the unit's activities
1,2,3,5 Safety, structure, balance, and limit setting are elements that the nurse addresses when providing a therapeutic milieu. Privileges, such as telephone access, cannot be assured because they are earned and often are factors that are affected by the client's needs and behaviors.
ETHICAL PRINCIPLES list 5
1. Beneficence: benefit or promote the good of others 2. autonomy: respecting the rights of others to make their own decisions. 3. Justice: duty to distribute resources/care equally 4. Fidelity (nonmaleficence): maintaining loyalty and commitment of the patient and doing no wrong to the patient 5. veracity: one's duty to communicate truthfully pg 80
Non therapeutic Communication
1. asking excessive questions 2. minimizing feelings 3. falsely reassuring 4. giving premature advice 5. making value judgments 6. asking "why" questions 7. Giving approval; agreeing 8. Disapproving : disagreeing 9. Changing the subject slide
Non threatening environment for nurse-patient
1. assuming the same height, either both sitting or both standing 2. avoiding a face-to-face stance when possible; a 90- to 120-degree angle or side-by-side position may be less intense and the patient and nurse can look away fro each other without discomfort 3. Providing safety and psychological comfort in terms of exiting the room. The patient should not be positioned between the nurse and the door, nor should the nurse be positioned in such a way that the patient feels trapped in the room. 4. avoiding a desk barrier between the nurse and the patient. pg 148
Factors that help the nurse-patient relationship
1. consistency: make sure nurse is always assigned to the same patient and that the patient has a regular routine for activities. 2 being honest and consistent in what is said 3. Pacing: let the patient set the pace. 4. Listening to patient's concerns 5. Initial impressions and preconceptions 6. promoting patient comfort and balancing control 7. Enhancing growth in patients via genuineness, empathy, respect pg 145-146 SLIDE
Contraindications to seclusion and restraint
1. extremely unstable medical and psychiatric condition 2. delirium or dementia leading to inability to tolerate decreased stimulation 3. severe suicidal tendencies 4. severe drug reactions or overdoses or need for close monitoring of drug dosages 5. desire for punishment of patient or convenience of staff pg 85
EXAMPLES OF COMMON LIABILITY ISSUES
1. false imprisonment 2. assault/battery 3. breach of confidentiality 4 failure to notify of third party harm 5. failure to report abuse, negligence, exploitation SLIDE
Social relationship
1. initiated for the purpose of friendship or meeting a goal 2. Mutual needs are met 3. communication to give advice, give or ask for help 4. content of communication superficial slide
FACILITATIVE SKILLS CHECKLIST so how are you doing?
1. maintain good eye contact 2. most of my verbal comments follow the lead of the other person 3. I encourage others to talk about feelings 4. I am able to ask open-ended questions 5. I can restate and clarify a person's ideas 6. I can summarize in a few words the basic ideas of a long statement made by a person 7. I can make statements that reflect the person's feelings 8. I can share my feelings relevant to the discussion when appropriate to do so 9. I am able to give feedback 10. At least 75% or more of my responses help enhance and facilitate communication 11. I can assist the person to list some alternatives available 12. I can assist the person to identify some goals that are specific and observable. 13. I can assist the person to specify at least one next step that might be taken toward the goal.. pg 131
active listening
1. observe the patient's nonverbal behaviors 2 listening to an understanding the patient's verbal message 3. listening to the understanding the person in the context of the social setting of his or her life 4. listening for "false notes" 5. providing the patient with feedback about himself or herself of which the patient might be unaware pg 122
what are some obstacles
1. stigma 2. self medication 3. economics 4 education 5 culture slide
Influences affecting mental health
1. support system 2. family influences 3. developmental events 4. cultural beliefs and values 5. health practices 6. negative influences (poverty, disasters) slide
principles important to active listening
1. the answer is always inside the patient 2. objective truth is never as simple as it seems 3. everything you hear is modified by the patient's filters 4. everything you hear is modified by your own filters. 5. it is okay to feel confused and uncertain 6. listen to yourself too active listening helps strengthen the patient's ability to use critical thinking in order to solve problems pg 122
General Principes what you need to understand
1. the facilities policies and procedures 2. the rights of the patients (civil rights) regarding mental health services a. right to vote. b. service ranking c. driver's license d. purchases or contractual agreements e. press charges on another person f. humane care/treatment g. religious freedom h. social interaction 3. State mental health statutes (mental health laws) 4. the nurses' scope of practice 5. nurses' obligation to report 6. HIPPA slide don't forget the other RIGHTS: right to treatment right to refuse treatment right to informed consent least restrictive environment (seclusion, physical & chemical restraints)
Behaviors that have relevance to healthcare workers, including nurses are
Accountability: nurses assume responsibility for their conduct and the consequences of their actions Focus o patient needs: the interest of the patient rather than the nurse, other health care workers, or the institution is given first consideration. The nurse's role is that of patient advocate pg 138
EXAMPLE OF ABCs OF IRRATIONAL BELIEFS this is a good exercise
Activating event: Tim has been in counseling for depression. His therapist's secretary called and canceled this weeks's appointment. Belief: My therapist is disgusted with me and wants to avoid me Consequence: Sadness, rejection, and hopelessness. Decides to call off work and return to bed Reframing There is no evidence to believe that I disgust my therapist. Why would he have rescheduled if he really didn't want to see me? pg 33
Examples of Cognitive disorders
All-or-nothing thinking Overgeneralization Labeling Mental filter Disqualifying the positive Jumping to conclusions a. mind-reading b. fortune telling Magnification or minimization a. catastrophizing Emotional reasoning "should" and "must" statements Personalization -assuming responsibility for an external event or situation that was likely out of personal control pg 32
The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety? A. "I guess you're worried about something, aren't you? b. "Can I get you some medication to help calm you?" c. "Have you been pacing for a long time?" d. "I notice that you're pacing. How are you feeling?"
Answer: D. "I notice that you're pacing. How are you feeling?" By acknowledging the observed behavior and asking the client to express his feelings the nurse can best assist the client to become aware of his anxiety. In option A, the nurse is offering an interpretation that may or may not be accurate; the nurse is also asking a question that may be answered by a "yes" or "no" response, which is not therapeutic. In option B, the nurse is intervening before accurately assessing the problem. Option C, which also encourages a "yes" or "no" response, avoids focusing on the client's anxiety, which is the reason for his pacing.
The nurse explains to a mental health care technician that a client's obsessive-compulsive behaviors are related to unconscious conflict between id impulses and the superego (or conscience). On which of the following theories does the nurse base this statement? A. Behavioral theory B. Cognitive theory C. Interpersonal theory D. Psychoanalytic theory
Answer: D. Psychoanalytic theory Psychoanalytic is based on Freud's beliefs regarding the importance of unconscious motivation for behavior and the role of the id and superego in opposition to each other. Behavioral cognitive and interpersonal theories do not emphasize unconscious conflicts as the basis for symptomatic behavior.
Which nursing intervention is best for facilitating communication with a psychiatric client who speaks a foreign language? A. Rely on nonverbal communication. B. Select symbolic pictures as aids. C. Speak in universal phrases. D. Use the services of an interpreter.
Answer: D. Use the services of an interpreter. An interpreter will enable the nurse to better assess the client's problems and concerns. Nonverbal communication is important; however for the nurse to fully determine the client's problems and concerns, the assistance of an interpreter is essential. The use of symbolic pictures and universal phrases may assist the nurse in understanding the basic needs of the client; however these are insufficient to assess the client with a psychiatric problem.
Pre-orientation:
Before Clinical Address concerns Know safety ground rules Discuss feelings Trust your instincts Identify signs of escalating anxiety trust your instincts, don't turn your back pg 141
Pavlov, Watson-Skinner theory tenets therapeutic model
Behavioral Behavior is learned through conditioning Behavioral modification addresses maladaptive behaviors by rewarding adaptive behavior pg 25 FROM LECTURE: behavioral. learned through conditioning: addresses by "rewarding" adaptive behavior
Many theory tenets therapeutic model
Biological Psychiatric disorders are the result of physical (brain) alterations Neurochemical imbalances are corrected through medication and talk therapy pg 25 FROM LECTURE and slides: Biological. Psychiatric disorders are the result of physical (brain) alterations. Neurochemical imbalances are corrected through medication and talk therapy
Establishing Relationships Communication
Chapter 8 communication skills pg 117
Beck theory tenets therapeutic model
Cognitive Negative and self-critical thinking causes depression Cognitive behavioral therapists assist in identifying negative thoughts patterns and replacing them with rational ones pg 25 FROM LECTURE: Cognition. Negative and self-critical thinking causes depression: assist in identifying negative thought patterns and replacing them with rational ones
Clinical Interview
Content & Direction are determined by the patient If the patient is not comfortable... STOP goals: 1. to feel understood and comfortable 2. to identify and explore problems relating to others 3. to discuss healthy ways of meeting emotional needs 4. to experience a satisfying interpersonal relationship pg 147
The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety? A. "I guess you're worried about something, aren't you? b. "Can I get you some medication to help calm you?" c. "Have you been pacing for a long time?" d. "I notice that you're pacing. How are you feeling?"
D By acknowledging the observed behavior and asking the client to express his feelings the nurse can best assist the client to become aware of his anxiety. In option A, the nurse is offering an interpretation that may or may not be accurate; the nurse is also asking a question that may be answered by a "yes" or "no" response, which is not therapeutic. In option B, the nurse is intervening before accurately assessing the problem. Option C, which also encourages a "yes" or "no" response, avoids focusing on the client's anxiety, which is the reason for his pacing.
The nurse explains to a mental health care technician that a client's obsessive-compulsive behaviors are related to unconscious conflict between id impulses and the superego (or conscience). On which of the following theories does the nurse base this statement? A. Behavioral theory B. Cognitive theory C. Interpersonal theory D. Psychoanalytic theory
D Psychoanalytic is based on Freud's beliefs regarding the importance of unconscious motivation for behavior and the role of the id and superego in opposition to each other. Behavioral cognitive and interpersonal theories do not emphasize unconscious conflicts as the basis for symptomatic behavior.
tactics to avoid
DO NOT argue minimize or challenge the patient give false reassurance interpret to the patient or speculate on the dynamics instead: *keep focus on facts and the patients perceptions *Make observations of the patients' behavior "change is always possible" *Listen attentively, use silence, and try to clarify the patient's problem pg 148
LESSON OBJECTIVES
Differentiate between social and therapeutic relationship Identify boundaries in a therapeutic relationship define transference & counter-transference (remember - in the theories) describe the phases of therapeutic relationship discuss common behaviors and nurse responses in the mental health setting discuss the clinical interview Describe clinical supervision and process recordings
Effective communication skills for nurses
Gold is to help the patient: 1. feel understood and comfortable 2. identify and explore problems relating to others 3 discover healthy ways of meeting emotional needs 4. experience satisfying interpersonal relationships. want the patient to feel safe pg 121
What can the Advanced Practice Nurse do in Mental Health Nursing Practices/Roles? List the additional to the ADN/BSN roles
IN ADDITION TO THE 7 that the ADN/BSN They can conduct 1. Psychotherapy 2. Prescription of pharmacological agents 3. Consultation (ex: evaluation in ED)
Inter-related "There is much 'physical' in 'mental' disorders and much 'mental' in 'physical' disorders *APA Great quote
Inter-related "You will never be free until you free yourself from the prison of your own false thoughts" *Philip Arnold Great quote
Sullivan theory tenets therapeutic model
Interpersonal Relationships as basis for mental health or illness therapy focuses on here and now and emphasizes relationships; therapist is an active participant pg 25 FROM LECTURE: interpersonal, relationships as basis for mental health or illness: therapy focuses on "here and now" and has an active role
Boundaries of the nurse-patient relationship
Nurse tries to get his/her own needs met at expense of patient's (the nurse need is being met.. like buying the burrito) Relationship becomes social or physical Nurse takes the role of a friend or family member of the client These are warning signals that indicate a nurse may be blurring boundaries Overhelping: doing for patients what they are able to do themselves or going beyond the wishes or needs of patients Controlling: asserting authority and assuming control of patients "for their own good" Narcissism: Having to find weakness, helplessness, and/or disease in patients to feel helpful, at the expense of recognizing and supporting patients' healthier, stronger, and more competent features SLIDE pg 138
Behavioral Theory Who and what
Pavlov: believed "conditioned" (dogs trained with bell, and crying baby and milk letdown) Watson: believed "learned"(9 mos old boy to be terrified of white fur bunny) Skinner: behavior learned by reward (good) or punishment (bad) Behavioral Therapy *Behavioral Modification *Systematic Desensitization (phobias) *Aversion Therapy *Biofeedback
Nursing Models
Peplau (mother of nursing) the nurse-patient relationship she broke down anxiety. Mild, moderate, severe and panic pg 37
theories of moral development what are those stages
Pre-Conventional Level (caring for self) 1. Obedience and punishment (rules, listening) 2. Individualism and exchange. (not everyone thinks alike) Conventional level (caring for others) 3. Good interpersonal relationships. (right/wrong) 4. Maintaining the social order (rules are rules) Post-conventional level (Balancing) 5. Social contract and individual rights (social order is important, but must be good - otherwise change the rules to fit) 6. Universal ethical principles (actions should create justice for everyone involved) pg 35
Biological Model
Psychiatric care is DOMINATED by this model mental disorders are believed to have physical causes; therefore mental disorders will respond to physical treatment. psychopharmacology is the primary biological treatment for mental disorders pg 35
Rights regarding restraint & Seclusion
Seclusion Physical restraints Chemical restraints 1. when particular behavior is physically harmful to the patient or a third party 2. when alternative or less restrictive measures are insufficient in protecting the patient or others from harm 3. when a decrease in sensory overstimulation (seclusion only) is needed 4. when the patient anticipates that a controlled environment would be helpful and requests seclusion pg 84
Defamation of character
Slander (spoken) Libel (written) Supervisory liability (vicarious liability) --Inappropriate delegation of duties Lad of supervision of those supervising Intentional torts *may carry criminal penalties *punitive damages may be awarded *Not covered by malpractice insurance pg 88
but the policies suck where I work
Substandard institutional policies do NOT absolve the individual nurse of responsibility to practice on the basis of professional standards of nursing care. pg 89
THERAPEUTIC RELATIONSHIPS AND THE CLINICAL INTERVIEW CHAPTER 9
THERAPEUTIC RELATIONSHIPS AND THE CLINICAL INTERVIEW CHAPTER 9
TRUE OR FALSE some disorders occur in some cultures, but are absent in others
TRUE culture-related syndromes appear to be more influenced by culture alone and are not seen in all areas of the world EXAMPLE: running amok someone (usually male) runs around engaging in furious, almost indiscriminate violent behavior Pibloktoq: uncontrollable desire to take off clothes and jump into ice water.. crazy people in Alaska anorexia nervosa: starvation (refuse to eat) in North America
Phrases practice saying...
Tell me more tell me about what are your thoughts go on what are you feeling it seems as if are you saying that what i hear you saying slide
Values Beliefs Self-awareness
Values are abstract standards and represent an ideal, either positive or negative Usually culturally oriented and influenced in a variety of ways through parents, teachers, religious institutions, workplaces, peers, etc *modeling: role model* understand your own values and beliefs. this will matter when dealing with your patients abortion refusal of medication, surgery or blood because of religious patient puts material gain above family patient is extremely religious (nurse not) patient is atheist (nurse not) life-style, drugs, prositution, murderer, abuser pg140
Group Therapy
a gathering of two or more individuals who share a common purpose and meet over a substantial time period in face-to-face interaction to achieve an identifiable goal some say 6-10 no desks, keep it open, less barriers free interaction among individuals pg 37
Reflecting
a means of assisting people to better understand their own thoughts and feelings. "you sound as if you have had many disappointments" Pg 122
rights after death
a person's reputation can be damaged even after death. DO N OT divulge any information after a person's death that could not have been legally shared BEFORE the death. pg 86
social relationship
a relationship that is primarily initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task. mutual needs are met
giving approval
a value comment might be misinterpreted more therapeutic: I noticed that you spoke up to John in group yesterday about his rude behavior. How did if feel to be more assertive? see that, neither approved or disapproved his actions
The "art" of psychiatric mental health nursing, according to Benner, includes (SATA) a. caring b. attending c. patient advocacy d. ethics
a, b, c pg 6
Caring is (SATA) a. an attitude that one communicate b. a way of being with the patient c. intensity of presence d. giving of self
a, b, d pg 7
The core concepts of Patient-and family-centered care consist of
a. dignity and respect b. information sharing c. patient and family participation d. collaboration in policy and program development pg 136 also called the nurse-patient partnership
purpose of medical records
allows for continuity of care, provides accurate and complete information about the care and treatment of patients. the patient has the right to see the chart, BUT the chat belongs to the institute. The patient must follow appropriate protocol to view his/her records. they may also be used for legal reasons pg 91
mental illnesses
are medical conditions that affect a person's thinking, feeling, mood, ability to relate to others, and daily functioning. A chain of events.... Are treatable, patients can find relief from tehri symptoms with treatment and support may not be a cure, recovery is always possible pg 13
Duty to intervene and duty to report
as the patient's advocate you have a duty to intern one to protect the patient; at the same time, you do NOT ha e the right to interfere with the physician-patient relationship. got an issue? talk to the supervisor follow agency policies if you FAIL to intervene and the patient is injured, you may be partly liable for the injuries that result because of failure to use safe nursing practice an good professional judgment
Initiating the interview
ask how they would like to be addressed where should we start tell me a little about what has been going on with you tell me about your difficulties
Patient advocacy a. is a legal role b requires courage c. is an optional aspect of nursing d. was developed in 2007
b pg 8
When an experienced psychiatric nurse listens carefully to a patient's detailed recounting of a traumatic emotional experience, the nurse is: a. acting as a patient advocate b. using an attending behavior c. interpreting "best evidence" d. using a systematic approach to care.
b pg 8
The "science" of psychiatric mental health nursing includes: SATA a. sense of tradition b. nursing theory c. psychosocial theory d. neurobiological theory
b,c,d,e pg 6
physical factors affect communication
background noise, lack of privacy, uncomfortable accommodations pg 119
aversion therapy
based on both classical and operant conditioning used to eradicate unwanted habits by associating unpleasant consequences with them. example in class: antibuse someone takes this then drinks alcohol becomes extremely ill. also: sex offenders receive electric shock in response to arousal from child porn pg 30
Systematic desensitization
based on classical conditioning. Gradual process facing a particular anxiety. like the example of flying pg 30
therapeutic relationship
basis of all psychiatric nursing treatment approaches 1. relationship consistently focused on the patient's problems and needs 2. synonymous with a professional helping relationship 3. alternative problem-solving approaches are taken --have patient take charge of their goals 4. new coping skills may develop 5. behavioral change encouraged SLIDE
nonverbal behaviors
body movements , how a person listens, uses silence, touch, etc nonverbal behavior is called the process of the messages pg 220
LEGAL & ETHICAL BASIS OF PRACTICE Goal: Balance between right of the individual and society
chapter 6 Dynamic & evolving (always changing, based on court designs) Statute regulation court decisions example: right to notify when harm can come to a 3rd party
DRUG ALERT
clonazepam (Klonopin) = benzodiazepine, anxiolytic, used to treat seizures, and panic attacks clozapine (Clozaril)= atypical antipsychotic; agranulocytosis (<500 neutrophils) is a potentially life-threatening side effect affecting a small percentage of patients
double messages
conflicting messages, mixed messages
Verbal Communication
consists of all words a person speaks we gain only 10% of this usually culturally perceived important to be clear and to understand what each other actually mean pg 119
attending behavior
crucial element! PAY ATTENTION TO YOUR PATIENT in culturally and individually appropriate ways body posture, eye contact, body language
abandonment
do not leave a patient without safely assigning to another health care professional
Patient-centered therapy
emphasis is on self-awareness and on the present, because the past has already occurred and the future has not yet occurred. MUST HAVE THESE 3: congruence (genuineness) empathy respect otherwise there is little chance that therapy will be successful pg 31
Theory of Object relations
emphasize past relationships in influencing a person's sense of self as well as the nature and quality of relationships in the present. Object refers to another person, particularly a significant person pg 34
exploring
enables the nurse to examine important ideas, experiences, or relationships more fully tell me more...
common liability issues protection of patients
failure to protect the safety of the patients 1. if a suicidal pt is left alone 2. miscommunications and med errors 3. abuse of the therapist-patient relationship 4. sexual misconduct 5. misdiagnosis
Cultural filters
form of cultural bias or cultural prejudice that determines what we notice and what we ignore if cultural filters are strong, the likelihood for bias is increased pg 129
Mental health is
from early childhood until death "the springboard of thinking and communication skills, learning, emotional growth, resilience, and self-esteem"
communicate relevant information
from police, relatives, or the patient's old records might also be deemed negligent. pg 87
sharing observations
helps make the patient away of inner feelings and encourages the patient to own them
projective questions: the What if.. questions
if you had 3 wishes what would you wish fore... can help people articulate, explore, and identify thoughts and feelings pg 123
what about the employer
if you release any information about the patient's condition you are in breach of confidentiality. you are subject to liability for the tort of invasion of privacy as well as a HIPAA violation pg 86
what hampers the development of positive relationships?
inconsistency and unavailability pg 146
Biofeedback what the heck is this
individuals learn to control physiological responses like breathing rates, heart rate, BP, brain waves, and skin temperature. deep breathing, relaxation, slow breathing, meditation
Consumer Providers CP huh.. what?
individuals with serious mental illness who are trained to use their experiences to provide recovery-oriented services and to support others with mental illness in mental health delivery setting focus on hope and recovery role models to encourage goal setting, problem-solving, symptom management skills, they facilitate or lead groups pg 37
behaviors expected during working phase
intense emotions such as anxiety, anger, self-hatred, hopelessness, helplessness may surface. defense mechanisms, such as acting out anger inappropriately, withdrawing, intellectualizing, manipulating and denying are to be expected pg 144
negligence/Malpractice
is an act or an omission to act that breaches the duty of due care and results in or is responsible for a person's injuries 5 elements to prove 1. duty 2. breach of duty 3. cause in fact 4. proximate cause 5. damages Foreseeability or likelihood of harm is also evaluated pg 89
Duty
is measured by the standard of care understand theory of care medication held to higher standard safe pg 89
disapproving
is moralizing and implies that the nurse has the right to judge the patient's thoughts or feelings example: you really should not cheat, even if you think everyone else is doing it more therapeutic can you give me two examples of how cheating could negatively affect your goal of graduating pg 127
Use of silence
is not the absence of communication; it is a specific channel for transmitting and receiving messages. a significant means o f influencing and being influenced by others can be a powerful listening tool
Voluntary Admission
is sought by the patient or guardian through a written application have
Resiliency (define)
is the ability to recover from or adjust easily to misfortune and change pg 15
breach of duty
is the conduct that exposes the patient to an unreasonable risk of harm, through either commission or omission of acts by the nurse
Termination Phase
is the final, integral phase of the nurse-patient relationship. It is discussed from the work phase on. It is patient is discharge or the end of clinical rotation 1. Deal with intense feelings regarding the experience 2 summarizing the goals and objectives achieved in the relationship 3. discussing ways for the patient to incorporate into daily life and new coping strategies learned during the time spent with the nurse 4. reviewing situations that occurred during the time spent together 5. exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship pg 145 SLIDE
Ethics
is the study of philosophical beliefs about what is considered right or wrong in a society pg 80
DSM-5 what the heck is this? it's not a disease....
is to provide clinicians, researchers, psychiatric drug regulation agencies, health insurance companies..etc, with a common language and standard criteria for the classification of mental disorders. it focuses on research and clinical observations when constructing diagnostic categories for a discrete mental disorder pg 14
Behavioral therapy or Behavior Modification works how??
it attempts to correct or eliminate maladaptive behaviors or responses by rewarding and reinforcing adaptive behavior. pg 30
Recovery Model
it increases individual and family roles in recovery *advocate for self-admin of meds when possible, with appropriate supports in the community *encourage the development of med records to schedule dosing and to share with other HCP *Develop a personal relapse prevention program by knowing the symptoms of relapse *recommend supported employment *Utilize psychiatric directives: prep in the event of crisis if the patient becomes incompetent pg 33
child abuse reporting statutes
it is required to report any child abuse. each state may have a different definition of abuse. so know your state. failure to do so may result in civil penalties pg 87
Orientation (get involved in relationships)
it is the first tie the nurse and the patient meet Trust & Understanding (rapport) nurses roles is clarified Parameters of the relationship formal or informal contract confidentiality mutually agreed goals termination begins (on admission) SLIDE pg 141
asking WHY
it's criticism... just don't do it ask what is happening not why
symmetrical relationship
like friends, colleagues, where two participants are equal
telehealth
live interactive mechanism, to track clinical information and provide access to people who otherwise might not receive good medical or psychosocial help. great for rural areas or for individuals who can't travel, schools, prisons, etc pg 129 video conferencing, internet, streaming, etc people who are afraid of stigma may use this form of help, because of privacy in home (this has helped with suicide hotlines)
Involuntary admission (commitment)
made without the patient's consent. necessary when a person is in need of psychiatric treatment, present a danger to self or others, or is unable to meet his or her own basic needs. Still have right to informed consent free from unreasonable restraint right to refuse treatment, including meds pg 81/SLIDE
double-bind messages
messages are sent to create meaning but also can be used defensively to hide what is actually occurring, create confusion, and attack relatedness. its a mix of content. damned if you do, damned if you don't actions speak loader than words, watch while your patient talks
excessive questioning
more therapeutic approach: Tell me about the situation between you and your wife remember knowing all the facts may not be what is important. you need to know the person! pg 123
Clarifying techniques
must request feedback on accuracy of the message received from verbal as well as nonverbal cues. this will help correct misinterpretations and promote mutual understanding
transference
occurs as the patient projects intense feelings onto.. the therapist, nurse, doctor related to unfinished work from previous relationships a safe expression of these feelings is crucial to successful therapy. pg 26 is the process whereby a person unconsciously and inappropriately displaces (transfers) onto individuals in his or her current life those patterns of behavior and emotional reactions that originated in relation to significant figures in childhood **you remind me of....** Patient: "oh you are so high and mighty. did anyone ever tell you that you are a cold, unfeeling machine, just like others I know?" Nurse: "tell me about one person who is cold and unfeeling toward you." transferential feelings may include: hostility, jealousy, competitiveness, love Transference phenomena to gain something like cigaretts, water, extra time in session pg 139
What is an ECT Electroconvulsive therapy
proven to be an effective treatment for severe depression and the psychiatric conditions electrical current to induce a seizure and is thought to work by affecting neurotransmitters and neuroreceptors pg 36
Freud theory tenets therapeutic model
psychoanalytic unconscious thoughts; psychosexual development psychoanalysis to learn unconscious thoughts; therapist is nondirective and interprets meaning pg 25 from lecture: psychoanalytic, unconscious thoughts, psychosexual development. not used much today... long term *Psychoanalysis *Psychodynamic -Transference -Countertransference
automatic thoughts tell me about this
rapid, unthinking responses based on these schemata they are intense, and frequent in psychiatric disorders such as depression and anxiety
Paraphrasing
restating in different words pg 122
ethical dilemma
results when there is a conflict between two or more courses of action, each carrying with them favorable and unfavorable consequences. how we respond is based on self-morals and values pg 80
psychoanalytic theory (IPT) is
rooted in what occurs in the mind it is a hands-on system in which therapists actively guide and challenge maladaptive behaviors and distorted views. the focus is the "here and now" pg 26
Mental health recovery model
shifts the responsibility for care from the provider to the individual. it emphasizes hope, social connection, empowerment, coping strategies, and meaning in life. It has been embraced by the US Dept of Health and Human Services as a guide to federal and state initiatives. In hopes to reduce mental illness stigma pg 33
societal determinants affect communication
sociopolitical, historical, economic factors; the presence of others; the expectations of others pg 119
touch
some cultures touch is normally perceived as a gesture of warmth and friendship. and some cultures touch can be perceived as an invasion of privacy or an invasion of intimacy may be considered patronizing, intrusive, aggressive, or sexually inviting some facilities have a no touch policy... I think of how Romaine said she air touches
Helpful Guidlenise
speak briefly when you do not know what to say, say nothing when in doubt, focus on feelings avoid advice avoid relying on questions pay attention to nonverbal cues keep the focus on the patient pg 149
elder abuse reporting statutes
state laws vary.. know your state
Mental Health defined by Surgeon General
successful performance of mental functions, resulting in the ability to engage in productive activities, enjoy fulfilling relationships and adapt to change and cope with adversity pg 13
Presupposition question: the miracle question
suppose you woke up in the morning and a miracle happened and this problem had gone away. what would be different? how would it change your life? can reveal a lot about a person, some motivation to pursue
using a well conceived nursing diagnoses helps
target the symptoms and needs of patients so that ideally they may achieve a higher le vel of functioning and a better quality of life pg 21
what is the difference between DSM diagnosis and nursing diagnosis
the DSM diagnosis distinguishes a person's specific psychiatric disorder, whereas a nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing. pg 22
Clinical Supervison
the focus is on the nurse's behavior in the nurse-patient relationship. The nurse and the supervisor examine and analyze the nurse's feelings and reactions to the patient and the way they affect the relations is a necessary professional activity that fosters professional growth and helps minimize the development of nontherapeutic nurse-patient relationships. process recordings are written records of a segment of the nurse-patient session that reflect as closely as possible the verbal and nonverbal behaviors of both patient and nurse. pg 150
advising
this is rarely helpful, it can undermine their sense of competence and adequacy. try: what do you see as some possible actions you can take
Psychotherapy... tell me about it
this is talk therapy it focuses on the complexity and inner workings of the mind and emphasizing environmental influences on its development and its stability pg 25
Nonverbal communication
tone pitch of a person's voice and the manner in which a person paces speech 90% of what we understand is nonverbal watch your cues physical appearance, facial expression, body posture, among of eye contact, eye cast, sighs, hand gestures, fidgeting, and yawning pg 119
True or false many individuals have more than one mental disorder at a time
true pg 15
Countertransference
unconscious emotional responses to the patient must be scrutinized in order to prevent damage to the therapeutic relationship pg 26 when we fail to recognize our countertransference toward our patients, the therapeutic relationship stalls, and we disempower our patients... they are not individuals, but inner projections common sign is overidentification with the patient. pg 138
schemata
unique assumptions about ourselves, others, and the world around us SO: if someone has a schema that no one can be trusted but them self, then this person will question everyone else's motives and expect deception and eventual pain from the relationships with others. NEGATIVE schemata include: incompetence, abandonment, evilness, and vulnerability pg 31
Suspending value judments
we will have personal opinions, guard agains using your own value system to judge patients thoughts, feelings, or behaviors don't label focus on exploring the behavior 1. recognize their presence 2. identify how or where you learned these responses to the patient's behavior 3. construct alternative ways to view the patient's thinking and behavior pg 147
interpersonal theory focuses on
what occurs between people
mutual avoidance
when nurse and patient are reluctant to spend time together and meeting times become sporadic or superficial pg 146
Relationship Factors affect communication
whether the participants are equal or unequal. symmetrical or complementary pg 119
what are the 2 most important concepts applicable to civic commitment cases
writ of habeas corpus "formal written order" how a patient challenges commitment least restrictive alternative doctrine: mandates that the least drastic means be taken to achieve a specific purpose EX: if someone can safely be treated for depression on an outpatient basis, hospitalization would be too restrictive and unnecessarily disruptive pg 81
Phrases avoid
you should you can't let's why don't you i think you everyone why i know slide
Maslow's hierarchy
you should know this by now pg 31
Which statement about mental illness is true? 1. Mental illness is a matter individual nonconformity with societal norms. 2. Mental illness is present when individual irrational and illogical behavior occurs 3. Mental illness is defined in relation to the culture, time in history, political system, and group in which it occurs 4. Mental illness is evaluated solely by considering individual control over behavior and appraisal of reality.
3 pg 22
The nurse is teaching a client who is receiving a monoamine oxidase inhibitor about dietary restrictions. The nurse plans to caution the client to avoid: 1 Pork, spinach, and fresh oysters 2 Milk, grapes, and meat tenderizers 3 Cheese, beer, and products with chocolate 4 Leafy green vegetables, fresh apples, and ice cream
3 Cheese, beer, and products with chocolate are high in tyramine, which in the presence of a monoamine oxidase inhibitor can cause an excessive epinephrine-type response that can result in a hypertensive crisis. There is no relationship between the other foods and this medication.
The premise that an individuals behavior and affect are largely determined by the attitudes and assumptions the person has developed about the world underlies: 1. modeling 2. milieu therapy 3. cognitive behavioral therapy 4. psychoanalytic psychotherapy
3 pg 43