Psych Ch. 1
Which branch of epidemiology is the nurse involved in when seeking outcomes for clients whose depression was treated with electroconvulsive therapy (ECT)? Descriptive Analytic Clinical Experimental
Clinical Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms. None of the other options accurately identify the field that is associated with clinical practice.
A nursing diagnosis for a client with a psychiatric disorder serves what purpose with considering the plan of care? Justifying the use of certain psychotropic medication. Providing data essential for insurance reimbursement. Establishing a framework for selecting appropriate interventions. Completing the medical diagnostic statement.
Establishing a framework for selecting appropriate interventions. Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing. While the nursing diagnosis may contribute to the other options, none describe the purpose of the nursing diagnosis.
How can a nurse best differentiate whether an Asian client is demonstrating a mental illness after having attempted suicide? Explain that suicide is often regarded as a desperate act. Assess the client for other examples of depressive behaviors. Identify the client's culture's view regarding suicide. Ask the client whether he views himself as being depressed.
Identify the client's culture's view regarding suicide. One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable. In this view, the mentally ill are those who violate social norms and thus threaten (or make anxious) those observing them. For example, traditional Japanese may consider suicide to be an act of honor, and Middle Eastern "suicide bombers" are considered holy warriors or martyrs. Contrast these viewpoints with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill. While the remaining options are appropriate interventions, they fail to address the possible cultural component of the client's behavior.
The mental health status of a particular client can best be assessed by considering which factor? The degree to which an individual is logical and rational Rate of demonstrated intellectual and emotional growth Position placement on a continuum from health to illness The degree of conformity of the individual to society's norms
Position placement on a continuum from health to illness Many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore, these disorders can be regarded as "diseases." Visualizing these disorders along the mental health continuum is helpful.
Prevalence of Mental Illness (HHS, 2014)
Suicide was (is still) in the world the 10th leading cause of death in the United States. Suicide age 18-35 years old
Resilience
•Ability and capacity to secure resources needed to support well-being •Characterized by: •Optimism •Sense of mastery •Competence •Essential to recovery
Levels of PsychiatricNursing Practice
•Basic Level •Psychiatric mental health registered nurse (PMH-RN) •2 years full-time work, 2000 clinical hours, 30 hours continuing education, followed by certification exam to add "BC" to the RN title (RN-BC) •Advanced Practice Psychiatric mental health advanced practice registered nurse (PMH-APRN) Master of Science or Doctorate
A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" Keeping in mind the diagnosis of the client, how should the nurse respond to this question? "We have the specialized skills needed to care for those with mental illnesses." "Don't be afraid; it means I'm here to help, not hurt, you." "Psychiatric mental health nurses care for people with mental illnesses." "The nurses who work in mental health facilities have that title."
We have the specialized skills needed to care for those with mental illnesses." A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. The remaining options either do not effectively answer the client's question or assume that the question is the result of the client's paranoia.
Which nursing statement illustrates the concept of client advocacy? "I'd like you tell me more about your depression and your suicide attempt?" "Dr. Raye, during the admissions interview the client stated that there is a family history of three other suicide attempts in the past." "Dr. Raye, during the admission interview, the client stated they will refuse fluoxetine because of adverse effects they experienced previously." "I will take you on a tour of the unit and orient you to the rules so you can get adjusted here."
"Dr. Raye, during the admission interview, the client stated they will refuse fluoxetine because of adverse effects they experienced previously." By letting the provider know that the client does not want the treatment the provider is prescribing, you have advocated for the client and her right to make decisions regarding her treatment. The other selections do not describe client advocacy since they do not represent actions by the nurse that the client is incapable of on their own.
The nurse being aware that certain mental illnesses have a prevalence among a specific gender, will suspect which statement was made by a female client? (Select all that apply.) "I'm so anxious, about everything." "There is no way I could make a presentation to a group of people." "I freeze in panic when I see a spider." "I've been depressed most of my adult life." "I've been arrested 6 times in the last 15 years."
"I've been depressed most of my adult life." "I've been arrested 6 times in the last 15 years."
Which client statement demonstrates the mental health concept of resilience? "My kids, happiness is worth any sacrifice I have to make." "My mother made decisions about my husband's funeral when I just couldn't do that." "Losing my job was hard but my skills will help me get another one." "In spite of all the treatment, I know I'll never be really healthy."
"Losing my job was hard but my skills will help me get another one." Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as relying on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself.
What client assessment data demonstrates parity related to mental health care? Advance practice nurse can be certified as psychiatric nurse specialist. The client is admitted for a 72-hour mental hygiene evaluation. A client who has attempted suicide is hospitalized for a mental health evaluation. A client's mental health coverage is equal to his/her medical/surgical coverage.
A client's mental health coverage is equal to his/her medical/surgical coverage. Parity refers to equivalence that requires insurers who provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage. None of the other options are associated with mental health insurance coverage.
Epidemiology of mental disorders
A disease with a short duration, such as the common cold, tends to have a high incidence (many new cases in a given year), and a low prevalence (not many people suffering from a cold at any given time). Conversely, a chronic disease such as diabetes will have a low incidence because the person will be dropped from the list of new cases after the first year (or whatever time increment is being used).
The scope of practiced for an advanced nurse practitioner would include which intervention? a. Conducting a mental health assessment. b. Prescribing psychotropic medication. c. Establishing a therapeutic relationship. d. Individualizing a nursing care plan.
ANS: B In most states, prescriptive privileges are granted to master's-prepared nurse practitioners and clinical nurse specialists who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning.
When a new bill introduced in Congress reduces funding for care of persons diagnosed with mental illness, a group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Recovery b. Attending c. Advocacy d. Evidence-based practice
ANS: C An advocate defends or asserts another's cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping clients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter-writing campaign
A family has a long history of conflicted relationships among the members. Which family member's comment best reflects a mentally healthy perspective? a. "I've made mistakes but everyone else in this family has also." b. "I remember joy and mutual respect from our early years together." c. "I will make some changes in my behavior for the good of the family." d. "It's best for me to move away from my family. Things will never change."
ANS: C The correct response demonstrates the best evidence of a healthy recognition of the importance of relationships. Mental health includes rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier in life may be healthy, but the correct response shows a higher level of mental health. The other incorrect responses show blaming and avoidance.
Traits of Mental Health
Ability to •Think rationally •Communicate appropriately •Learn •Grow emotionally •Be resilient •Have a healthy self-esteem/coping skills •Realistic goals and reasonable function within the individual's role
According to current information what factor is associated with the most disabling mental disorders? Biological influences Learned ways of behaving Faulty patterns of early nurturance Psychological trauma
Biological influences Biological and genetic factors influence mental health. The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress disorder, and autism. Therefore many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders.
The nurse planning care for a mentally ill client bases interventions on which concept? There are universal fears that are shared by all mentally healthy individuals. Every client comes with experiences that contribute to their problem. It is a client right to be treated respectfully. Every client has a certain degree of resilience.
Every client has a certain degree of resilience. Nurses are expected to evaluate clients with mental health issues for their strengths and their areas of high functioning. You will find many attributes of mental health in some of your clients with mental health issues. These strengths should be built upon and encouraged. Resilience is the ability and capacity for people to secure the resources they need to support their well-being. None of the remaining options describe concepts that are the foundation for the actual creation of individualized care plans.
Which statement best describes the Diagnostic and Statistical Manual, fifth edition (DSM-5) DSM-5? It suggests common interventions for mental disorders. It is a compendium of treatment modalities. It is a medical psychiatric assessment system. It offers a complete list of nursing diagnoses.
It is a medical psychiatric assessment system. The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses. None of the other options are accurate descriptions.
Which severe mental illness has a prevalence of over 6% among the populace of the United States? (Select all that apply.) Major depressive disorder A personality disorder Generalized anxiety disorder Social phobia Alzheimer's Disease
Major depressive disorder A personality disorder Social phobia Alzheimer's Disease Data suggests that prevalence among the US populace is: Alzheimer's disease 10% (65 years and older), any personality disorder 9.1%, Social phobia 6.8%, Major depressive disorder 6.7% . The prevalence of Bipolar disorder is 2.6% while Generalized anxiety disorder is 3.1
A client tells the mental health nurse "I am terribly frightened! I hear whispering in my head that someone is going to kill me." Which criteria of mental health can the nurse assess as lacking? Positive self-concept Rational thinking Learning and productivity Self-control
Rational thinking The ability to think rationally is lacking for this client. The client does not have an accurate picture of what is happening that is based on reliable cognitive thinking. The statement fails to meet the criteria for any of the other options.
An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports what conclusion about this client? The client is not conforming with social norms. The client is engaging in egocentric behaviors. The client is demonstrating symptoms of bipolar disorder. The client is demonstrating socially deviant behavior.
The client is not conforming with social norms. Behavior that deviates from socially accepted norms does not indicate a mental illness unless there is significant disturbance in mental functioning.
DSM-V
•The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
A registered nurse has accepted a position as staff nurse on a psychiatric unit. Which statement made by the nurse requires additional instructions regarding the therapies provided on the unit? "You will attend a psychotherapy group that I lead that will help you care for yourself." "You will be given a schedule daily of the groups we would like you to attend." "You will see your provider daily in a one-to-one session." "You will participate in unit activities and groups daily."
"You will attend a psychotherapy group that I lead that will help you care for yourself." Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a client's schedule on a psychiatric unit.
CHAPTER 1 MENTAL HEALTH AND MENTAL ILLNESS
CHAPTER 1 MENTAL HEALTH AND MENTAL ILLNESS
Risk and Protective Factors
Medina talking: There are risk factors that push ppl towards mental illness and factors that prevent Environmental- Access and lack of access to basic needs and commodities such as healthcare, water, safety services, and a strong highway system have a profound effect on community mental health.
Diagnosis of Mental Illness
Medina talking: "bible of psychology" •Mental disorders are organized and diagnosed according to the criteria published in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5; APA, 2013). •DSM-5 system contains subtypes and other specifiers that further classify disorders.
Dimensions of Wellness
Mental health is an important part of total wellness. The concept of wellness includes being in good physical and mental health. Problems in one area impact the other area. Wellness is not the absence of disease or stress; it involves having a purpose in life, being actively involved in satisfying work and play, having joyful relationships, having a healthy body and living environment, and being happy. It includes the mental, emotional, physical, occupational, intellectual, and spiritual aspects of a person's life Mental health problems significantly impact the process of wellness. Individuals with mental health problems are more likely to die decades earlier than the general public from preventable diseases (Heiberg et al., 2018). People with serious mental health problems often face social, economic, and/or environmental disadvantages that result in lack of access to health care, lack of information, and lack of culturally and linguistically competent care and programs (U.S. DHHS, SAMHSA, 2018b).
Mental Illness
•Disorders with definable diagnosis •Significant dysfunction in mental functioning related to •Developmental •Biological •Physiological disturbances •Culturally defined -alterations in behaviors, thoughts, and feelings are unexpected and are outside normal, culturally defined limits. •If a behavior is considered normal within a specific culture, it is not viewed as a psychiatric symptom. For example, members of some religious groups "speak in tongues." To an observer, it appears that the individuals are hallucinating but this behavior is normal for this group within a particular setting. Ex: Medina was cramming for exam and got epigastric pain. Grandma believed she has an evil being and brought her a healer for a exorcism.
Social Influences on Mental Health Care
•National Alliance on Mental Illness (NAMI) 1979- NAMI began to resist the traditional arrangement of mental healthcare providers dictating treatment without the input of the patient. This paternalistic relationship was demoralizing, and it also implied that patients were not competent to make their own decisions. Consumers demanded increased involvement in decisions concerning their treatment. The consumer movement also promoted the concept of recovery, a new and an old idea. On one hand, it represents a concept that has been around a long time: that some people—even those with the most serious illnesses such as schizophrenia—recover The first Surgeon General's report on the topic of mental health was published in 1999 •Human Genome Project •New Freedom Commission on Mental Health •Institute of Health •Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative •Research Diagnostic Criteria (RDoC) Initiative
Epidemiology of mental disorders 2
•Prevalence (Examples): •Major depressive disorder: Leading cause of disability in U.S. at 6.7% prevalence over 12 months •Schizophrenia: 1.1% prevalence over 12 months; affects men and women equally •Panic disorder: 2.7% prevalence over 12 months; typically begins in adolescence; 1 in 3 develop agoraphobia •Generalized anxiety: 3.1% prevalence over 12 months; risk is highest between childhood and middle age
Psychiatric Mental Health Nurses
•Promoting mental health through assessment, diagnosis, and treatment of behavioral and mental disorders ▶️SCHIZO NEUROTRANSMITTER} DOPAMINE ▶️DEPRESSION} serotonin ▶️Bipolar} mood stabilizers} like lithium
NANDA-I NOC and NIC
•The North American Nursing Diagnosis Association International (NANDA-I) •Provides standardized nursing diagnoses •Nursing Outcomes Classification (NOC) •Source of standardized outcomes, definitions of these outcomes, and measuring scales •Nursing Interventions Classification (NIC) •Identifies seven domains of nursing intervention
Mental Health
•emotional and psychological well-being of an individual who has the capacity to interact with others, deal with ordinary stress, and perceive one's surroundings realistically.
Legislation and Mental Health Funding
➡️ Mental Health Parity Act (1996) •Parity = Equivalence •Required insurance companies to provide equal treatment coverage for psychiatric disorders Too often, insurance companies: • Did not cover mental healthcare at all • Identified yearly or lifetime limits on mental health coverage • Limited hospital days or outpatient treatment sessions • Assigned higher copayments or deductibles ➡️ Patient Protection and Affordable Care Act •Coverage for most uninsured Americans through expanded Medicaid eligibility (for very poor) •Created health insurance exchanges to offer more choices •"Insurance mandate" for coverage
KEY POINTS
➡️ Mental illness refers to all psychiatric disorders with definable diagnoses that cause significant dysfunction in developmental, biological, or psychological disturbances ➡️ Risk factors such as inborn vulnerability, a poor social environment, economic hardship, and poor health policy may increase the risk of adverse mental health outcomes. ➡️ Protective factors - improve a person's ability to respond to stress, trauma, and loss. Its is characterized by optimism, sense of mastery, and competence. ▶️ Resiliency - a person's ability and capacity to secure resources needed to support well-being. ➡️ The distinction between mental and physical illness is artificial. Mental illness is brain-based and is therefore a physical illness. ➡️ Psychiatric disorders are generally the result of nature and nurture. A diathesis-stress model—in which diathesis represents biological predisposition and stress represents environmental stress or trauma—is the most accepted explanation for mental illness. ➡️ The recovery movement has shifted the focus of decision-making from a paternalistic system, where compliance is emphasized, to a focus on self-determination and self-direction. ➡️ Government programs and initiatives such as the Decade of the Brain, the Human Genome Project, Brain Research through Advancing Innovative Neurotechnology, and Research Domain Criteria are expanding our knowledge of the brain and will provide the basis for future treatments. ➡️ Mental health parity refers to equality in funding. ➡️ The DSM-5 provides criteria for psychiatric disorders and a basis for the development of comprehensive and appropriate interventions. ➡️ Standardized nursing classification systems (NANDA-I, NOC, NIC) are used to form and communicate patient problems, outcomes, and interventions specific to nursing care. ➡️ Psychiatric-mental health nurses function at a basic or advanced level of practice with clearly defined roles. ➡️ Promoting mental health through assessment, diagnosis, and treatment of behavioral and mental disorders