quiz 3-mental health

Suicide

Frequent reason for in-patient admission is risk of suicide. Goal of psychiatric admission: provide safe environment for client. Assess client's suicide risk. Inform staff of client's suicide risk. Ensure protective environment. Intervene to protect client from harm. Eliminate all dangerous objects that could be used for suicide. Initiating appropriate observation by staff. Address issues making client want to end his or her life. Document client's status (behaviors observed and therapeutic interventions initiated); document actions taken in medical record.

roles for nurses

Identify and refer to groups Liaison Resource person Education Development

false imprisonment

If theyre not a danger to themselves or others and theyre hospitalized against their will-false imprisonment 2PC-2 physicians need to sign that the pt has to be hospitalized. If not 2PC- false imprisonment.

Privileged Communication

Information shared between certain individuals protected by law. Physician and client. Attorney and client. Priest and parishioner. Husband and wife. except fir child abuse and threat to self/others

Growth of Online Self-Help Networks

Internet access allows participation in thousands of online self-help groups. Virtual social networks offer both greater access and less privacy. Potential for noninteractive lurking and obscuring of identity. Removes barriers that prevented people from participating in self-help group. Website message boards or forums. E-mail discussion groups. Electronic mailing lists. Live chat room meetings. Provide mutual support, information, sense of belonging, medical and resource referrals.

therapeutic factors of groups: Instillation of hope Universality Self-understanding Identification Catharsis Altruism Corrective recapitulation of the primary family group Socializing techniques Imitative behavior Existential factors Cohesiveness Guidance or imparting information Interpersonal learning Self-understanding

- Instillation of hope - Universality: recognizing that others share the same experiences and feelings reduces sense of isolation. - Self-understanding: develop understanding of communication and relationships through feedback and information provided in the group. - Identification: recognizing similarities in traits or experiences shared with others - Catharsis: relief provided by expression of emotions seen in context of sharing within the group and receiving feedback and recognition. - Altruism: members learn that they can be useful to others and benefit from helping others. - Corrective recapitulation of the primary family group: with the use of transference and countertransference of relationships within the group, they may allow to experience new ways of perspective on relationships that were originally experienced within the family setting. - Socializing techniques: development of relationships within the group that are nonjudgmental and empathetic. - Imitative behavior: imitate or mirror the behavior, communication style, or interactions of the leader or other members. - Existential factors: acknowledgement of basic themes of the human condition and individual responsibility. - Cohesiveness: the sense of acceptance and belonging to the group - Guidance or imparting information: sharing of knowledge and experience both by the leader and other group members. - Interpersonal learning: focused upon the present- what happens in the here and now; group is seen as a microcosm of the social environment. - Self-understanding: may lead to a willingness to develop new skills or to change; an awareness or insight into one's own behavior and interaction with others.

Mind-Body Practices

Interventions for pre- or postprocedure fear, sleep difficulty, anxiety, restlessness, stress, pain relief. Deep breathing Progressive muscle relaxation Autogenic training Biofeedback training Neurofeedback Imagery Meditation Hypnosis

Group process is ongoing and takes place on several levels.

Latent content underlying feeling content. Manifest content spoken or observable content of communication.

group member

Makes commitment to attend group and to participate; active within group. Attends regularly. Actively listens to other participants. Shares thoughts and feelings. Treats group members with respect. Maintains confidentiality.

Manipulative and Body-Based Practices

Massage Reflexology Yoga

working stage of therapy group

Members develop trust and relationship with others as well as identity as group or team. Acceptance between members strengthened; bonds develop within group. Emphasis on helping each other achieve their individual and group goals.

Duty to Warn

Must report information to authorities and/or other parties if evidence client may inflict danger on himself, herself, another individual. Provide care for client; protect others in process. Nurses mandated by law to report suspected child abuse; in some states, elder and spousal abuse.

Characteristics of Self-Help Groups

Mutual-help Member run Composed of peers Nonprofit

accessiblity of groups

No fees; groups financially accessible. Geographically accessible in community. Convenient meeting times. Psychologically accessible. Alternative solutions.

children in research

Not attained legal age for consent to treatments or procedures. Person under 18 years old a child; emancipated minor. Children can be used as subjects as long as dissent of children from and assent of children to research carefully safeguarded.

The Right to the Least Restrictive Environment

Not to restrict one's civil rights more than needed to protect individual. Care decided based on individual needs. Mentally ill individuals have right to refuse treatment as long as they are not endangering themselves or others. False imprisonment: detaining without legal authority to confine individual. Document behaviors/reasons leading to decision to hospitalize client involuntarily. Clients have legal right to request for discharge if they disagree with involuntary hospitalization.

violence

Nurses ethically responsible for protecting clients from being harmed by others. Protecting themselves and other psychiatric personnel. Duty to protect from harm applies to violence. Assault: any action that places another person in apprehension of being touched in manner that is offensive, insulting, or physically injurious without consent or authority. Battery: harmful or unwarranted contact. Laws being passed to protect nurses from violent acts committed by clients.

Standards of Professional Practice

Nurses judged according to national professional standards. Standards of practice. Standards of professional performance. Authoritative sources for nursing practice. Not legal documents.

nutrient supplemtns

Omega-3 fatty acids Grape seed extract-venous insufficiency S-Adenosyl-L-Methionine (SAMe)=osteoarthiritis, depression. increase serotonin

therapy group membership

Open: allowing members to self-select or join at different points of group experience. Stability, continuity, sense of safety. Closed: allowing only members selected by leader, meeting certain criteria, or joining at same time. Many experience therapy without long-term commitment.

beginnings ot therapy groups

Outgrowth of psychoanalytic, interpersonal, and systems theories. First utilized for dealing with large population of institutionalized patients. Deinstitutionalization and managed care popularized treatments in outpatient settings and groups. Hildegard Peplau stressed importance of nurse-patient relationship. Nursing roles: Teacher Leader Resource person Counselor

how groups help

People comforted by knowing their experiences and feelings are not unusual. Enhances social ties and connections. Buffer to stress and adversity. Encourages members to take responsibility. Helping others personally satisfying and rewarding.

Conㅁfidentiality

Psychiatric nurses must keep client's information confidential. It is ethical and legal responsibility. Pertains to health records/photographs. Family members: refrain from discussing information client has shared. Clients have right to refuse to allow nurse to speak with others. Health Insurance Portability and Accountability Act (HIPAA): first federal law mandating individuals' right to privacy of their personal health information.

4 concepts of professional boundaries

1. Professional boundaries are spaces between nurse's power and client's vulnerability 2. Boundary violations can result when there is confusion between needs of the nurse and those of client. 3. Boundary crossings are brief excursions across that may be thoughtless, inadvertent. 4. Professional sexual misconduct is an extreme form of boundary violation and include any behavior that is seductive, demeaning, harassing.

eg of boudnaries violated

1. Using first names 2. Ongoing conversations about nurse's personal life 3. Body contact 4. Accepting/receiving gifts 5. Wearing clothing inappropriate 6. Meeting at appropriate times and place 7. Physical contact that can be misinterpreted.

- Imagery

: can be felt, sensed, heard, visualized, intuited, tasted, and smelled; improving immune function, in reducing pain and anxiety, and in working with insight.

- Meditation

: two popular are transcendental and mindfulness medication; both involve learning to be present in the moment, focusing attention on one thing, letting go of everyday problems and distractions, and developing a caring, nonjudgmental attitude. Mindful medication teaches a person to recognize early signs of muscle tension. Effective in lowering BP and in reducing stress and anxiety-induced illnesses.

psychotic member

: usually not selected because of disorganized thinking and behavior.

helper therapy

A client who has same disorder helps with therapy Helper experiences increased sense of self-worth and self-esteem. Helpers develop understanding of own recovery process and goals when helping others. Most groups turn what society considers liability into asset.

group therapy

Psychotherapeutic process: individuals or members meet at regular intervals (sessions) with group leaders for common purpose. Purpose: intrapsychic or interpersonal change. Boundaries: defined and limited. Theoretical frameworks: interpersonal or cognitive behavioral psychology, psychoanalytic therapy, systems or family therapy. Transference and countertransference. Manifest content / Latent content. Unconscious meanings. Verbal and non-verbal meanings of communications. Willingness or resistance to deal with issues. Goals: discussion and development of relationships and alliances within group and development of skills used outside of group.

Psychopharmacology

Psychotropic medication effectively treats many mental illnesses and disorders. Benefits and risks of treatment discussed with individual before initiating treatment. Clients monitored for expected and unexpected side effects and adverse reactions. Abnormal Involuntary Movement Scale (AIMS): measures presence of tardive dyskinesia (TD). Extrapyramidal Symptom Rating Scale: parkinsonism, akathisia, dystonia, tardive dyskinesia.

possible researches with children

Research not involving greater than minimal risk to children. Research involving greater than minimal risk but presenting prospect of direct benefit to individual children involved in research. Research greater than minimal risk and no prospect of direct benefit to children involved in research; likely to yield knowledge about disorder or condition. Research IRB believes does not meet regulatory conditions; does present reasonable opportunity to understanding, prevention, alleviation of serious problem affecting health or welfare of children.

group therapy leader

Responsible for group orientation and development. Role model and educator; modeling appropriate communication and behavior. Direct group and to outline expectations. Coleaders need to work as team learning each other's styles.

leader

Responsible for summarizing what happens in the present; interpreting how influencing group. Identifies purpose of group. And group members responsible for developing group norms and culture. Responsible for attributing meaning to communication process and interactions.

informed consent 4 areas of focus

STATE, UNDERSTAND, APPRECIATE AND REASON Ability to state choice. Understand relevant information. Appreciate nature of situation. To reason.

seclusion vs restraint

Seclusion: placing client in safe, contained environment separate from other clients. Restraints: mechanical or manual devices used to limit client's physical mobility. Restraint- every 4 hr for adults. Every 2 hr for children 9-18 years. Nurse can make the call but doctor has to write the order later. Take off the restraints when pt is ready to talk.

client assessment holistic nursing

Sense of well-being and inner strengths. Support systems available. Traditional or cultural rituals appropriate for client's experience. Explore client's purpose in life. Include client in planning of care essential.

The Right to Refuse Medications

All persons have right to refuse medication except when, by refusing medication, they represent danger to themselves or others. Hospital policy should inform nurse of protocol emergency administration. Document all attempts of educating client in medical record. Only court approval can override client's decision.

the right to treatment

All persons with mental illness or mental retardation treated in psychologically and physically humane facilities. Ensure patients in psychiatric emergency room receive timely assessments/care. Preventing use of restraints on patients except as last resort. Institute appropriate discharge planning to place patients into least restrictive setting. Promote staff accountability. Accurate data: treatment, flow, disposition.

sexual misconduct

Sexual misconduct: expression of any thoughts, feelings, gestures that could be construed by client as romantic or erotic. Deemed unethical; has no place in nursing. Boundaries: limits that permit client and mental health professional to have therapeutic relationship based on needs of client. Violations of Boundaries

primary ftn of self=help groups

All self-help groups perform two major functions: support and education. Some groups take on third function: advocacy. Education: practical information; coping techniques; related experiential knowledge from members' shared experiences. Mutual help to members through interactive newsletter, correspondence, telephone, video, online exchange. Advocacy promotes specific educational, political, social cause or change in community or society.

group theraphy phisical space

Size of space adequate for size of group. Comfortable and inviting space. Adequate seating.

herbal therapies

St. John's wort Ginkgo Kava Valerian root Chamomile

autocritic leader democratic laissez-faire leader

Autocratic leader: more authoritative or directive role determining rules and conduct of group and controlling group interactions. Democratic leader: less authoritative while facilitating group; members have more say and responsibility for how group functions. Laissez-faire leader: directionless or disorganized, losing productivity while tries to determine rules and decisions; hands-off approach.

conflict stage of therapy group

Testing stage of group. Judgmental statements regarding group members and leader common.

evidence-based practices

Therapeutic touch (TT) Reiki Tai chi Acupuncture Qi Gong

Electroconvulsive Therapy (ECT)

Treatment to treat clinical depression. Not responded to trial of psychotropic medication. Cannot receive psychotropic medications because of other medical conditions. Severely depressed; immediate intervention needed. Informed consent must be obtained. Medical examination performed. Emergency management procedures in place. Adequate client supervision provided during and after treatment. History of effective use, abuse, misunderstanding. Understand benefits and side effects of this treatment.

autonomy

(self-determination): underlying principle; allows clients to make own decisions.

battery vs assault

Battery- doing physical harm Assault- harm but doesn't have to be physical. Verbal.

initial stage of therapy group

Beginning of group. Sets stage for orientation to group. Role of leader to orient group. Rules set by leader or jointly by leader and group

Self-Healing and Self-Regulation

Breathing, centering, inner reflection, journaling are complementary therapies. Used for self-care, self-healing, self-awareness. Offer insight into holistic nursing process. Release tensions of day. Concentrate one's attention. Open oneself to new ideas and greater awareness for healing journey. Understanding more about ourselves helps to understand others. Nurse's belief system about illness, spirituality, health, self-healing can impact client and plan of care. Experiential healing practices expand capacity for intuitive knowing, awareness of subtle cues, insight, compassion. Biofeedback, relaxation, meditation, and breathing are self-healing and self-regulating practices. Self-regulation practices depend deeply on person's own inner commitment and participation.

duty to protect

Clients from harm. Client's inability due to illness to distinguish between dangerous situations.

spirituality

Dimension of every human life. Nurses can help clients recognize their ability to cope with natural flow of life. Help clients recognize difference between religious beliefs and spiritual beliefs. Forgiveness, prayer, meditation, reconciliation, connection to family and community.

Practicing holistic healing arts offers:

Direct experience of the therapy. Opportunity to explore personal impact. Understanding of own personal path. Knowledge of how our beliefs, expectations, attitudes are impacted. Enhancement of our sense of well-being and empowerment.

discharge planning

Discharge planning and plans for aftercare treatment developed by multidisciplinary treatment team in collaboration with client, family, significant others to ensure client's agreement and compliance.

- Neurofeedback

EEG biofeedback, offers a vehicle with which to work with epilepsy, sleep disorders, ADHD, and trauma; requires specialized education and practice.

termination stage of therapy group

Ending of group or separation of member or members from group. May be sense of grieving or loss. Expectation that learning will be transferred to experiences outside of group.

ANA Code of Ethics for Nurses with Interpretive Statements

Ethical responsibilities. Emphasizes nurse's role as client advocate.

positive role models group

Experienced or veteran members demonstrate to new members that success, coping, recovery possible. Model competence. Provide encouragement and hope.

research statement should include to pt

Explanation of purpose of research. Duration of subject's participation. Description of study procedures. Explanation of any experimental aspect. Explanation of foreseeable risks or discomforts that may result. Description of benefits expected. Discussion of alternative procedures or treatments available. Statement confidentiality will be maintained. Who can be contacted for information. Who can be contacted if research-related injury occurs. Statement that participation voluntary. Statement that one can withdraw at any time without penalty or loss of benefits.

Seclusion and Restraints

Used only as last resort after all other therapeutic interventions have failed; and only to prevent clients from harming themselves or others; never be used as forms of punishment. Training aimed at ensuring treatment appropriate; individual's rights not violated. Restraints permissible under state law: how to initiate and apply safely; who can apply restraints; type of written orders needed and from which level of practitioner; length of time clients may be kept restrained or in seclusion; interventions needed to monitor care; physical care interventions; necessary documentation. Aware of negative consequences of using restraints on clients with history of sexual abuse.

Informed Consent

VOLUNTARY; AUTONOMY; CONTINUOUS Clients have right to determine their own treatment. Doctrine of informed consent: Requires practitioner to provide information relevant to making decision. Client to voluntarily make decision. Competent to do so; able to comprehend proposed treatment and choices available; verbalize choice. Proposed treatment in words client understands. Possible risks and side effects of treatment. Possibility for successful outcome. Alternatives to proposed treatment. Course of illness if treatment not instituted. based on autonomy Continual process, not single occurrence; client regularly receives information. Document in healthcare record. Risks of withholding information. Sharing thoughts and feelings can help. Recommendation for treatment and diagnostic model used. Risks and benefits of proposed treatment. Other treatment options: less expensive and shorter duration. Reasons for psychotherapy. Insurance coverage; restrictions by insurance carrier. Plans for continuous evaluation of client's status.

Therapy Group Size

Varies according to type of group. Ideal size 6-8 members. May limit type of information discussed. May limit amount of time and attention given to individual or issue. Size direct influence upon dynamics or interactions of group.

selection of mmebers for therapy group

Varies with type, size, purpose of group. Group members' current interpersonal relationships and level of functioning. Individual assessment. Members able to interact with others, to give and receive feedback.

holistic nursing practice model

Variety of settings Treatment: relieving stress, anxiety, headaches, hypertension, pain. Evaluation by nurse practitioner or physician to rule out non-stress-related physical conditions. Develops plan of care. Explores treatment options. Develops self-healing practices. Explores meaning of crisis and illness. Develops family support. Deal with bereavement, loss, death.

description of holistic nursing

Who nurse is rather than what nurse does. Quality of presence and being. At its best, all nursing holistic. Specialty with defined scope and standards of practice. Instrument of healing. Facilitator in healing process.

• Reiki

a form of Japanese spiritual healing with roots in Tibetan Buddhism; believe that human energy flows through pathways in the body that can be sensed by trained practitioners. Similar to therapeutic touch.

The Variety of Self-Help Groups

about 400 self-help groups for specific illnesses and disorders; number of national self-help groups increases as needs identified; nurses who work with self-help groups can learn from the groups and expand impact of nursing interventions.

gate keepr

allows for acceptance of members in group;reminds group members of tasks at hand; allows for interactions and flow of information.

monopolizer

attention seeker: actively participates but tends to dominate.

• Omega-3 fatty acids

beneficial fro brain development and functioning, blood clotting, and muscle contraction and relaxation; fish, flaxseed, leafy green vegetables, vegetable oils, and supplements. Effective in reducing cardiovascular disease risk factors and rheumatoid arthritis. High dose may interfere with blood thinners and some antihypertensive meds.

Member with characterologic difficulty or severe personality disorder:

can be inappropriate for group depending on degree of impairment in function.

Psychiatric advance directive (PAD):

client opportunity to share, in writing, his or her wishes regarding treatment; right to change or revoke advance directive. Balancing clients' rights and protection of public legislative and nursing concern. Advocating treatment for mentally ill population and maintaining their rights is priority of psychiatric nurses.

observer

comments on what is happening, remains aloof and apart

boring member

contributes little other than what member feels expected; feels expected. Offers no opinions and shares little with group, thus avoiding conflict; rarely initiates interaction, spontaneity, or tension relief.

Involuntary Outpatient Treatment

court-ordered treatment with specific guidelines and criteria; should be last resort.

Holistic nursing

directed at healing the whole person.

• Chamomile

effective antianxiety agent and in tea form, promoted to enhance relaxation and sleep.

belmont report

focus on 3 ethical principles- autonomy, beneficence, justice. for research

harmonizer

group peace maker

special/personal interst member

has special agenda/goals

Albee's prevention equation

how groups help prevnt/lessen incidence of psychopahtology and stress related illness by strengthening 1. social support 2. coping skill 3. competence

Ethics in nursing

how nurses carry out responsibilities and render care to clients.

4 stages of therapy group

initial conflict working termination

• Therapeutic touch (TT

invites nurses to focus on their intention to heal, center, assess, and then treat by directing life energy to the client using their hands.

facilitator

keeps group on track

tension reliever

maintains calm and reduce conflict; refocus on group

transference

members' feelings about individual influenced by feelings regarding someone in past. pt to nurse

silent member

minimal active participation; withdrawan

• Tai chi

noncombative martial art that consists of slow, gentle movements, combined with breathing techniques and meditation, to improve the flow of qi, or life energy, thereby calming the mind and promoting health; most consistent evidence of health benefits is for bone health, cardiopulmonary fitness, balance, and falls prevention.

Interpersonal theory

parataxic distortion or distorted view of interactions bc our perceptions of how we perceive others and how we think other view us are inaccurate.

justice

people treated equally and fairly.

IRB in research with child

potential benefits, risks, discomforts of research to children; justification for inclusion.

components of informed consent

proposed treatment in words client understands Possible risks and side effects of treatment Possibility for successful outcome Alternatives to the treatment.

HIPPA

providers do not need consent for 3 purposes: to provide treatment, to get payment; to carry out healthcare operations

seclusion/restraint guideline

restraint-both physical and drugs only in emergency Never writen as prn order need to evaluate within 1 hour need to report any death regarding No restraint with sexual abused case

• Yoga

stress-related chemicals cytokine interleukin-6 and C-reactive protein, may be responsible for the calming effect and improved mood associated with medication.

Group dynamics

study of what happens in a group including communication and interpersonal relationships.

• Reflexology

the practice of massaging the hands and feet with an awareness that the whole body system is mapped onto the hands and feet.

Alternative therapies

these therapies in place of conventional treatment.

Complementary therapies

these therapies together with traditional treatment modalities.

beneficience

to act in client's welfare by preventing harm and doing no harm.

- Progressive muscle relaxation

to help clients recognize the difference btw tension and relaxation in the body, and learn how to relax as will. Caution with muscle spasm client

countertransference

underlying feelings and thoughts in nurse towards client.

- Biofeedback training

use technology, including electronic thermometers, electromyography, electroencephalography, heart rate monitors, blood pressure monitors, and electro-dermal response to feed back information to clients who can learn to regulate or change an imbalance in their systems; client need screen for non-stress-realted causes of symptoms by NP or physicians before biofeedback process.

• Valerian root

used for anxiety and insomnia; believed to affect the amygdala and inhibit the break down of GABA, thereby inducing sedation.

• Kava

used for short-term treatment of anxiety or stress. Haven't gone to FDA. FDA issued advice with potential risk for severe liver damage. Potentiates drugs that act on the CNS, including alcohol, benzodiazepines, and barbiturates, and it may decrease the effects of levodopa.

• Ginkgo

used to treat age-related memory impairment, dementia, and senility; potentiates the action of anticoagulants and increases the effects of MAOIs (a class of antidepressants)

• St. John's Wort

used to treat depression, anxiety, and insomnia. More effective for mild to moderate depression than for a severe depression. Caution in photosensitivity leading to a rash and possible blisters in fair-skinned people. History of affective disorder, mania, or hypomania may triggered by this remedy. It alters levels of the neurotransmitters serotonin and dopamine. Serotonin syndrome may occur when it is used with serotonin reuptake inhibitors. It also stimulates a drug-metabolizing enzyme.

- Autogenic training

using self-statements suggesting heaviness and warmth; effective in treating anxiety and depression by reducing the intensity of symptoms; most important aspect is to learn any relaxation practice from the inside-out- practice with yourself, family, and your colleagues.

- Hypnosis

verbal way to reduce arousal with relaxation, imagery, and concentration. It is the result of focused attention and concentration; voluntary and reversible. Effective in treating pain, addiction, anxiety, and posttraumatic stress, and inducing anesthesia, sleep, and memory. Can help client to achieve symptom control and improve confidence and self-esteem.

focus of interpersonal therapy group

what is happening in present (here and now) in the group.

acupuncture

• Acupuncture: effective complement to conventional arthritis management and reduce pain and functional impairment of osteoarthritis of the knee. Doubts on efficacy and safety remain - adverse effect of pneumothorax and infections.

Qi GOng

• Qi Gong: ancient system of healing and energy medicine from China.