Mental Health Exam 1

Discuss future challenges and opportunities for mental health care in the United States.

Challenges: -More acutely ill patients -Patients are covered by insurance for shorter periods of time, often don't see the benefits of their treatment as a result -Clinical opportunities are becoming harder to obtain: less educational experiences -Workforce: jobs are not equal to high demand -Lack of treatment: more disability, suicide, etc. Opportunities: -Community nursing: more access to low income, rural patients -APNs can treat -Aging population: more alzheimers. dementia, more need for nurses -Expand cultural competency to meet growing populations -Electronic healthcare: distance treatment

Discuss major functions of the brain and how psychotropic drugs can alter these functions.

*Major Functions 1. Monitor changes in the external world 2. Monitor the composition of body fluids 3. Regulate the internal organs 4. Control basic drives: hunger, thirst, sex, aggressive self-protection 5. Mediate conscious sensation 6. Store and retrieve memories 7. Regulate mood (affect) and emotions 8. Think and perform intellectual functions 9. Regulate sleep cycle 10. Produce and interpret language 11. Process visual and auditory data *Psychotropic drugs:....

Identify two attitudes and four actions that may reflect the nurse's positive regard for a patient.

- ATTITUDES - willingness to work with the patient (shows positive regard/respect) and ... - ACTIONS - attending, suspending value, judgments, helping patients develop their own resources, ...

Compare and contrast the range of verbal and nonverbal communication of different cultural groups in the areas of (a) communication style, (b) eye contact, and (c) touch. Give examples.

- COMMUNICATION STYLE: calm façade may mask severe distress = "Expression of positive or negative emotions is a private affair, and open expression of them is considered to be in bad taste and possibly a weakness". German and British = tend to highly value the concept of self-control and may show little facial emotion in the presence of great distress or emotional turmoil - EYE CONTACT: Presence vs absence of eye contact. DON'T USE TO TO ASSESS: attentiveness, judge truthfulness, or make assumptions on the degree of engagement one has with a patient (*Can portray respect vs disrespect, gender affects eye contact) - TOUCH: Usually considered a gesture of warmth, support, and consolation. Can ALSO be seen as an invasion of privacy. Figure out if the facility has a "no touch" policy

Define and discuss the roles of empathy, genuineness, and positive regard on the part of the nurse in a nurse-patient relationship.

- EMPATHY - when the helping person attempts to understand the world from the patient's perspective - GENUINENESS - nurse's ability to be open, honest and authentic in interactions with patients - POSITIVE REGARD - respecting a person and viewing another person as being worthy of caring about and as someone who has strengths and achievement potential.

Describe the communication process.

- COMMUNICATOR: Senders and receivers are both communicators *THEY'RE INDEPENDENT* - MESSAGE: The content and the ideas that are being exchanged. *also consists of nonverbal* - CHANNEL: Method by which the communication takes place - FEEDBACK: messaging takes pace with a constant feedback being given by both parties *FEEDBACK IS FOR ONE = MESSAGE IS FOR THE OTHER* - ENCODING/DECODING: Individuals encode (develop) messages and send to the other and decode (determine meaning) messages received from the other - CONTEXT: Frames and influences our interactions *SOCIAL - stated or unstated rules or norms that guide communication *RELATIONAL - interpersonal history and the type of relationship that is involved *CULTURAL - influence that our cultural identities have on the communication - ENVIRONMENTAL NOSIE: Noise disturbs the message flow and serves as a barrier to interaction *PHYSICAL - experienced by such conditions as loud until, background music, or overhead announcements *PHYSIOLOGICAL - biological factors (illness, headache, or fatigue) that reduce the quality of interactions *PSYCHOLOGICAL - the factors within a person's mind such as not wanting to converse or being preoccupied about finances

Identify three advanced practice psychiatric mental health nursing interventions.

- CONSULTATION - to influence the identified plan, enhance, the abilities of other clinicians to promote services for healthcare consumers, and effect change. - PRESCRIPTIVE AUTHORITY AND TREATMENT - prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal law and regulation - PSYCHOTHERAPY - individual, couples, group, and family psychotherapy using evidence-based psychotherapeutic frameworks and nurse-patient therapeutic relationships

Compare the different approaches you would consider when performing an assessment with a child, an adolescent, and an older adult.

- Child: Children can express their inner feelings and emotions, but caregivers are often able to describe the child's behavior performance, conduct, and can interpret the child's words and response. Separate interviews are better in cases that there is a a possibility of abuse. Consider developmental levels while evaluating children. Children tend to REGRESS when STRESSED. Children are assessed through a combination of interview and observation. EX: watching children play (assesses their functioning). Ask the child to tell a story, draw a picture, or engage in therapeutic games (especially if the child is having difficulty with verbal expression). - Adolescent: VERY concerned about confidentiality (Fear if you will repeat anything they say). Certain zones of privacy exist even for adolescents. Use your best judgement in those situations. When in doubt consult with clinical instructor or supervisor. Give and overview of how information will be communicated, what will be shared, who it will be shared with, and when. THREATS OF SUICIDE, HOMICIDE, SEXUAL ABUSE, OR BEHAVIORS, THAT PUT THE PATIENT OR OTHERS AT RISK FOR HARM ARE SHARED WITH OTHER PROFESSIONALS AS WELL AS WITH THE PARENTS. Identify risk factors: use HEADSSS(Home environment, education and employment, activities, drug/alcohol/tobacco use, sexuality, suicide risk/symptoms of depression/other mental disorders, Safety). - Older adult: 5 sense and brain function being to diminish. Important to not stereotype older adults because they can be at different deficient stages mentally and physically. THEY STILL NEED SPECIAL ATTENTION. Assess limitation: sensory (seeing or hearing), motor (walking or balancing), medial (back pain, cardia and or pulmonary deficits). THOSE PROBLEMS CAN INCREASE ANXIETY, EMBARRASSMENT, OR PHYSICAL DISCOMFORT.

Explain the three phases of the nurse-patient relationship.

- DESIGNED TO FACILITATE THE PATIENT'S BOUNDARY MANAGEMENT, INDEPENDENT PROBLEM SOLVING, AND DECSION-MAKING THAT PROMOTES AUTONOMY - Reorientation phase - Preparing for your assignment = Using the chart, before meeting with your patient recognize your own thoughts and feelings - Orientation phase - (can last for a few meetings or over a long period of time) First time you meet the patient = Introduction, establish rapport, specify a contract , explaining confidentiality - Working phase - Strong working relationship allows the patient ot safely experience increase levels of and recognize dysfunctional responses = Gather further data, identify problem-solving skills and self-esteem, providing education about the disorder, promotion symptom management, providing medication education, and evaluating progress. - Termination phase - (Discuss termination during the first meeting and again during the working stage at appropriate times) = Summarize the goals and objectives achieved, review patient education and provide handouts, discuss ways for the patient to incorporate new coping strategies, reviewing situation that occurred during the nurse-patient relationship, exchanging memories

Discuss the influences of disparate values and cultural beliefs on the therapeutic relationship.

- DISPARATE VALUES - abstract standards and represent an ideal, either positive or negative, (EX = self-reliance, honesty, cleanliness, organization, justice, respect) - CULTURAL BELIEFS - Opinion or conviction, confidence, trust, faith, religious tenets (SELF-AWARENESS - understand what we value and those beliefs that guide our behavior)

Demonstrate the use of four techniques that can obstruct communication, highlighting what makes them ineffective.

- Excessive questioning - casts the nurse in the role of interrogator who demands information without respect for the patient's willingness or readiness to respond - Giving approval or disapproval - ensure the message that is being conveyed doesn't come off as positive or negative judgment - Giving advice - nurse is interfering with the patient's ability to make personal decisions - Asking "why" questions - "why" demands a justification for actions and implies wrongdoing

Differentiate between the use of an interpreter and a translator when performing an assessment with a non-English-speaking patient.

- Interpreter: "someone who interprets the spoken words of a foreign language speaking person or someone who uses ASL." - Translator: "Individual who speaks one or more languages in addition to English who translates the written word."

Identify three personal and two environmental factors that can impede communication.

- PERSONAL: Depression (slow thinking and reduced communication), anxiety (cause a lack of concentration), mania (inability to focus for any length of time) - ENVIRONMENTAL: background noise, lack of privacy and uncomfortable accommodations

Identify and give rationales for suggested (a) setting, (b) seating, and (c) methods for beginning the nurse-patient interaction.

- Pace: critical to any kind of counseling to permit the patient set the pace of the interview, no matter how slow or halting the progress may be - Setting: enhances feelings of security is important to the therapeutic relationship - Seating: nurse should be in the same vertical space (height) as the patient, that is, standing or sitting

Perform a psychosocial assessment, including brief cultural and spiritual components.

- Psychosocial assessment: Gives information to figure out how to develop a plan of care. FIND THE CHIEF COMPLAINT (THIS SHOULD BE WRITTEN IN THE PATIENTS WORDS!!). Patient's psychosocial history is the sujective part of the assessment. Focus I sthe patient's perceptions and recollections or current lifestyle and life in general. Identify the patients support (family, friends, education, work experience, coping styles, and spiritual and cultural beliefs. - Spiritual/religious assessment: Have the potential to exert an influence on how people understand meaning and purpose in their lives and how they use critical judgement to solve problems. * Spirituality - how we find meaning, hope, purpose, and a sense of peace in our lives (inner phenomenon centering on universal personal questions and needs). * Religion - external system that includes beliefs, patterns of worship, and symbols (connects personal and spiritual beliefs with a larger organized group or institution). BELONGING TO A RELGIIOUS COMMUNITY CAN PROVIDE SUPPORT DURIGN DIFFICULT TIMES.

Explain three principles a nurse follows in planning actions to reach agreed-upon outcome criteria.

- SAFE: Must be safe for the patient, other patients, staff and family - COMPATIBLE AND APPROPRIATE: Compatible with other therapies and with the patient's personal goals and cultural values and also institutional rules - REALISTIC AND INDIVIDUALIZED: * Within the patient's capabilities: age, strength, condition, willingness to change. * Based on the number of staff available * Reflective of the actual available community resources * Within the student's' or nurse's capabilities

Describe how the use of imaging techniques can be helpful for understanding mental illness.

- Structural (CT and MRI): provide overall images of the brain and layers of the brain - Function (fMRI, PET, SPET): reveal physiological activity in the brain * PET - useful in identifying phsycial and chemical changes as they occur in living issue ( radioactive substance is injected and is detected as bright spots) *can detect: oxygen utilization, flucose metabolism, blood flow, neurotransmitter-recepter interaction* * EEG - a recording of electrical signals from the brain *can show the state a person is in- asleep, awake, anesthetized-because the characteristic patterns of current differ for each of these states* * CT - X-ray images *can detect: lesions, abrasions, areas of infarct, aneurysm* * MRI - *Can detect: brain edema, ischemia, infection, neoplasm, trauma* * fMRI - *Can detect: brain edema, ischemia, infection, neoplasm, trauma* * SPECT - *Can detect circulation of cerebrospinal fluid (similar function to PET*

Compare and contrast a social relationship and a therapeutic relationship regarding purpose, focus, communications style, and goals.

- THERAPEUTIC RELATIONSHIP - straight forward language, respect patients as partners in decision-making, address patients concerns, maximize communication skills, understanding of human behaviors, and personal strengths to enhance the patient's growth *PATIENT CENTERED* (Identify the needs of the patient and explore them, Establish clear boundaries, Encourage alternative problem-solving approaches, Help the patient develop new coping skills, Support behavioral change) - NON-THERAPEUTIC RELATIONSHIP - primarily initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task. MUTUAL needs are met during social interactions. Communication = giving advice and sometimes meeting basic dependency needs (lending money). ROLES MAY SHIFT!!

Analyze what is meant by boundaries and the influence of transference and countertransference on boundary blurring.

- TRANSFERENCE - the patient unconsciously and inappropriately displaces (transfers) onto the nurse feelings and behaviors related to significant figures in the patient's past. - COUNTERTRANSFERENCE - when the nurse unconsciously displaces feelings related to significant figure sin the purse's past onto the patient.

Demonstrate the use of four techniques that can enhance communication, highlighting what makes them effective.

- Using Silence - specific channel for transmitting and receiving messages - Active Listening - nurses focus, response, and remember what the patient is sayin verbally and nonverbally (enhances self-esteem and encourages the patient to direct energy toward finding ways to deal with problems = strengthens patient's abilities to solve problems) - Clarifying Techniques: *Paraphrasing: restate the basic content of a patient's message in different, usually fewer, words *Reflecting: means of assisting patients to better understand their own thoughts and feelings (can be a question or a simple statement) *Exploring: enables the nurse to examine important ideas, experiences, or relationships more fully - Questions: *Open-ended: encourage patients to share information about experiences, perceptions, or responses to a situation *Closed-ended: can give you specific and needed information (when used sparingly) *Projective:start with "what if" to help people articulate, expore, and identify thoughts and feelings

Discuss the differences between verbal and nonverbal communication.

- VERBAL COMMUNICATION: consists of all the words a person speaks (when talking we: communicate our believes/values, perceptions/meanings, convey interest and understand/or insult and judge, convey messages clearly or convey conflicting or implied messages, convey clear, honest feelings or disguised, distorted feelings) - NONVERBAL COMMUNICATION: tone of voice, emphasis on certain words, and the manner in which a person paces speech. (Phsycial appearance, body posture, eye contact, hand gestures, sighs, fidgeting, and yawning)

Identify the steps nurses are advised to take if they suspect negligence or illegal activity on the part of a professional colleague or peer.

-Duty to intervene and report risks of harm to patient -Document the evidence clearly before making serious accusations -Immediately inform a supervisor, if this is not an option, intervene to protect the patient

Explain how the multidisciplinary treatment team collaborates to plan and implement care for the hospitalized patient.

-Formulates a full treatment plan -Nurse usually leads the planning meeting -Treatment plan is the guide to follow to enable patient to be discharged -Assessments made by intake team and nurse provide basis of care -Psychiatrist or APN provides orders within limited timeframe -Medical problems are sent to medical doctors or APNs

Identify Peplau's framework for the nurse-patient relationship.

-Her theory is mainly concerned with the processes by which the nurse helps patients to make positive changes in their healthcare status and well-being. -nurses are both participants and observers in therapeutic conversations. She believed it was essential for nurses to observe the behavior not only of the patient but also of themselves. This self-awareness on the part of the nurse is essential in keeping the focus on the patient and in keeping the social and personal needs of the nurse out of the nurse-patient conversation.

List the standard admission criteria for inpatient hospitalization.

-Most come from emergency department or crisis intervention service -voluntary or involuntary -risk to harm yourself or others

Describe the nursing process as it pertains to outpatient settings.

-Provide nursing care; assist with medication management as prescribed, under direct supervision -Consult with staff about care planning and work with nurse practitioner or physician to promote health and mental healthcare; collaborate with staff from other agencies -Take leadership role within mental health treatment team -Participate in research at agency or mental health authority; serve as preceptor to undergraduate nursing students

Explain the purpose of patient-centered medical homes and implications for holistically treating individuals with psychiatric disorders.

-The focus of care is patient centered and provides access to physical health, behavioral health, and supportive community and social services. -support for preventive care, acute care, chronic disease management, and end-of-life issues 1. Patient centered 2. Comprehensive care 3. Coordination of care 4. Improved access 5. Systems approach

Evaluate the role of community mental centers in the provision of community-based care.

-provide emergency services, community/home-based services, and outpatient services across the lifespan -Common treatments include medication prescription and administration, individual therapy, psychoeducational and therapy groups, family therapy, and dual-diagnosis (mental health and substance use) treatment

Identify the conditions that must be met for reimbursement of psychiatric home care.

1. homebound status for the patient 2. presence of psychiatric diagnosis 3. need for skills of a psychiatric nurse 4. development of a plan of care under orders of a physician or advanced practice registered nurse

Discuss the nature/nurture origins of psychiatric disorders.

1800's - Germ theory of illness, mental illness was thought to be biological, dismissed because no causative factors Psychological theories were explored i.e., depression comes from childhood memories 1952 - Thorazine was found to calm agitated patients, more biological research was done diathesis-stress model—in which diathesis represents biological predisposition and stress represents environmental stress or trauma—is the most accepted explanation for mental illness. This nature-plus-nurture argument asserts that most psychiatric disorders result from a combination of genetic vulnerability and negative environmental stressors.

Summarize the social influences of mental health care in the United States.

1979 - NAMI was formed, called for patients to be able to make decisions about their mental healthcare vs. giving providers total control. Also brought about the concept of recovery defined now as "a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential." The focus is on the consumer and the consumer's abilities. 1990 - decade of the brain. Emphasis on neuroscience, and how the brain impacts our health and wellness. 1999 - first surgeon general's report on mental health. Basically established that (1) mental health is fundamental to overall health and (2) there are effective treatments. The report is reader-friendly and a good introduction to mental health and illness. 2003 - President's new freedom commission on mental health: called for a streamlined system with less fragmentation in the delivery of care. The commission advocated for early diagnosis and treatment, adoption of principles of recovery, and increased assistance in helping people find housing and work. WAY more detail on page 7

Describe how a neurotransmitter functions as a chemical messenger.

A chemical substance that functions as a neuromessenger Released form the axon terminal of they presynaptic neruron on excitation. It then crosses the space, or synapse, to an adjacent postsynaptic neuron when it attaches to receptors on the neuron's surface. *THIS INTERACTION FROM ONE NEURON TO ANOTHER, BY WAY OF A NEUROTRANSMITER AND RECEPTRO, THAT ALLOWS THE ACTIVITY OF ONE NEURON TO INFLUENCE THE ACTIVITY OF OTHER NEURONS*

Apply legal considerations of patient privilege (a) after a patient has died, (b) if the patient tests positive for human immunodeficiency virus, or (c) if the patient's employer states a "need to know."

A) Do not divulge information after death, that couldn't be shared prior to death (Dead Man's Statute) B) C) Employers are not subject to information unless the patient allows them to

Develop awareness of the balance between the patient's rights and the rights of society with respect to the following legal concepts relevant in nursing and psychiatric mental health nursing: (a) duty to intervene, (b) documentation, and (c) confidentiality.

A) Duty to intervene: it's important that the patient has confidentiality, but it is the nurse's duty to intervene if the patient wants to hurt themselves, or others, so that that person can remain safe B) Documentation: patient has a right to see the medical record, but it belongs to the institution. C) Confidentiality: one of the most important legal concepts in psychiatry. Only patients can waive the right to confidentiality.

Discuss other community-based care providers including assertive community treatment (ACT) teams, partial hospitalization programs, and alternate delivery of care methods such as telepsychiatry.

ACT - intensive case management -available 24 hours a day -work with patients in their homes, clinics, hospitals -hard to reach populations with high rehospitalization rates PHP - step between hospitalization and outpatient -meet M-F 6hrs/day (partial hospitalization) -structured activities, intervention, and treatment -supervised by nurses and physicians -coping strategies used outside, and discussed in group Telepsychiatry -treatment and prescriptions through videoconfrencing -reduce delays in care, reach people in rural areas, eliminating transportation barrier

Describe the continuum of mental health and mental illness.

Almost linear, you can go from one end to another. On one end - Mental health: sense of well being, adequate to high functioning. No serious impairments in day to day life. On the other end - Mental illness: can range from mild to severe mental illness. One may feel mild discomfort and alterations in functioning and seek help. Others that are severely impacted also fall in this category. You can go from one end to the other, back and forth.

Compare and contrast a DSM-5 medical diagnosis with a nursing diagnosis.

DSM-5: diagnose psychiatric disorder Nursing diagnosis: framework for identifying appropriate nursing interventions for dealing with the patient's reaction to the disorder

Describe direct and indirect advocacy opportunities for psychiatric mental health nurses. Direct Indirect

Direct care: -As patient advocate: -report abuse or neglect -protect patient confidentiality -support patient's right to make decisions Indirect action: -Active in consumer mental health groups (NAMI) -Review legislation affecting healthcare

Identify how the Diagnostic and Statistical Manual, 5th edition (DSM-5) is used for diagnosing psychiatric conditions.

Dominant method for categorizing and diagnosing mental illnesses 2013 - latest edition, describes 157 disorders Identifies disorders based on certain criteria Used in all mental health settings where diagnosis can be made DSM 5 diagnoses disorders, not people.

Explain how epidemiological studies can improve medical and nursing care.

Epidemiology, as it applies to psychiatric-mental health, is the quantitative study of the distribution of mental disorders in human populations Helps identify high risk groups and risk factors associated with illness onset, duration, and recurrence Comorbidity - presence of 2 or more disorders (same time, or in sequence) Incidence - info about the risk of contracting disease, number of new cases of mental disorders in a healthy population in a given time (usually one year) Prevalence - total number of cases, existing and new, in a given population for a specific period of time, regardless of when they became ill Nurses treat problems associated with illness

Explain to a classmate the importance of clinical supervision.

Focus is on your skills wihin the context of the nurse-patient relastionship (can occur one on oen and in group discussions)

Relate problems that can arise when nurses are insensitive to cultural aspects of patients' communication styles.

Healthcare professionals need to be familiar with the cultural meaning of certain verbal and nonverbal communicaitons. CULTURAL AWARNESS IN INITIAL FACE-TO-FACE ENCOUNTERS WITH A PATIENT CAN LEAD TO THE FORMATION OF POSITIVE THERAPEUTIC ALLIANCES WITH MEMBERS OF A DIVESE SOCIETY. *Unrecognized differenes in cultural identities can result in assessment and intervetniton atha tre not optimally respectful of the patient and can be inadvertently biased or predjucided*

Provide explanations for situations in which health care professionals have a duty to break patient confidentiality.

If the patient is a threat to themselves or others "Duty to warn"

Analyze the continuum of psychiatric care and the variety of care options available.

Movement is fluid, can go up or down -Could be discharged inpatient as acute, but need intensive outpatient to maintain that level of functioning -May reverse on treatment continuum, and need higher level of care -decompensation - deterioration of mental health

Understand the use of attending behaviors (e.g., eye contact, body language, vocal qualities, and verbal tracking).

Nonverbal behaviors that reflec the degree of attending and are highly culturally influenced.

Describe the role of the primary care provider and the psychiatric specialist in treating psychiatric disorders.

PCP - can diagnose and treat, may not be ideal due to short appointment lengths. Patient may feel more comfortable, and may not need further care psychiatric specialist - educational background and experience in psychiatric care, would be better equipped to deal with more severe mental health disorders

Conduct a mental status examination (MSE).

Part of the assessment in all areas of medicine. PURPOSE IS TO EVALUATE AN INDIVDIUAL'S CURRENT COGNITIVE PROCESS.

Discuss a patient's civil rights and how they pertain to restraint and seclusion.

Patient has the right to different treatment options prior to restraints or seclusion being used

Describe the specialty of psychiatric mental health nursing and list three phenomena of concern.

Psychiatric mental health nursing - the nursing specialty that is dedicated to promoting mental health through the assessment, diagnosis, and treatment of behavioral problems, mental disorders, and comorbid conditions across the life span -Assist those in crisis, or with life problems, or long-term mental health disorders -Also defined as: promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders phenomena of concern—human experiences and responses • Promotion of optimal mental and physical health and well-being • Prevention of mental and behavioral distress and illness • Promotion of social inclusion of mentally and behaviorally fragile individuals • Co-occurring mental health and substance use disorders • Co-occurring mental health and physical disorders • Alterations in thinking, perceiving, communicating, and functioning related to psychological and physiological distress • Psychological and physiological distress resulting from physical, interpersonal, and/or environmental trauma or neglect • Psychogenesis and individual vulnerability • Complex clinical presentations confounded by poverty and poor, inconsistent, or toxic environmental factors • Alterations in self-concept related to loss of physical organs and/or limbs, psychic trauma, developmental conflicts, or injury • Individual, family, or group isolation and difficulty with interpersonal relations • Self-harm and self-destructive behaviors, including mutilation and suicide • Violent behavior, including physical abuse, sexual abuse, and bullying • Low health literacy rates contributing to treatment nonadherence

Evaluate the premises behind the various therapeutic models discussed in this chapter.

Psychoanalytic Theory - Sigmund Freud -levels of awareness: conscious: aware of, preconscious: not aware, but easily retrievable w/ conscious effort, unconscious: repressed memories, urges, passions effecting the conscious -personality structure: id (unconscious, impulsive) , ego (attempt to navigate the outside world), superego (moral) -defense mechanisms: ego develops defense mechanisms to prevent anxiety, operate on unconscious level, deny, falsify, distort reality to make it less threatening. -psychosexual stages of development: table 2.1, pg. 19 in book Psychodynamic theory -rooted in psychoanalysis: free association, dream analysis, transference, countertransference -increased therapist involvement Interpersonal Theory - Henry Stack Sullivan -humans need interaction, loneliness is the most painful human condition -behavior is due to needing interpersonal relationships Classical conditioning -provide a stimulus to change/start a behavior Behavioral theory -behaviorism: measurable and objective -socially learned Operant conditioning -learning through rewards and punishment for voluntary behaviors -reinforcement THIS ONE IS NOT DONE, IT'S JUST SO LONG

Explore the role of resilience in the prevention of and recovery from mental illness and consider resilience in response to stress.

Resilience is the ability and capacity for people to secure the resources they need to support their well-being. People who are resilient are able to effectively regulate emotions, and not focus on negative, self-defeating thoughts "Brief Resilient Coping Scale" in box 1.1 pg. 4

Discuss at least five patient rights, including the patient's right to treatment, right to refuse treatment, and right to informed consent.

Right to treatment - right to quality care, especially in cases of involuntary commitment Right to refuse treatment - patients may withhold consent or withdraw consent at any time, even if involuntarily committed. Can also retract consent given, verbally or written. CAN BE MEDICATED WITHOUT COURT IF 1. person has a serious mental illness 2. person's functioning is deteriorating and if the person is suffering/exhibiting threatening behavior 3. benefits outweigh harm 4. person lacks capacity to make reasoned decision 5. less-restrictive services have been found inadequate Right to informed consent - Patient has been provided with basic info regarding risks/benefits, and alternatives to treatment. -Informed of: 1. Nature of the problem or condition 2. Nature and purpose of proposed treatment 3. Risks and benefits of treatment 4. Alternative treatment options 5. Probability that the proposed treatment will be successful 6. Risks of not consenting to treatment -Implied consent: ex. handing pt medicine, they take it, consent is implied -Capacity: person's ability to make an informed decision - may possess capacity one minute, and lack it another -Competency - degree of mental soundness a person has to make decisions of carry out specific acts Rights regarding psychiatric advance directives: -Made when patient is week, expresses treatment preferences Rights Regarding Restraint and Seclusion: -Need a doctor's order, written or verbal, ASAP -Adults 18+: up to 4 hrs -9-17y/o: 2 hrs -Under 9: 1 hr -Assessed frequently, every 15-30 min for physical needs

Discuss the purpose of identifying the rights of hospitalized psychiatric patients.

To make sure that patient's rights are always being respected, and that they are aware of those rights so that they can make the best choices for themselves, and their treatment.

Identify legal terminology (e.g., torts, negligence, malpractice) applicable to psychiatric nursing and explain the significance of each term.

Tort: -any wrongful act, intentional or accidental, that results in injury to another Intentional torts: -willful or intentional acts that violate another person's rights or property Assault: -intentional threat designed to make another person fearful that you will cause that person hard -Verbal threats, or pretending to hit a patient are both examples of assault in HC setting Battery: -actual harmful or offensive touching of another person False imprisonment: -occurs when a person is confined in a limited area or within an institution Invasion of privacy: -breaking a person's confidences or taking photographs without explicit permission Unintentional torts: -unintended acts against another person that produce injury or harm Negligence: -most common unintentional tort -defined as the failure to use ordinary care in any professional or personal situation when there is a duty to do so Malpractice: -professional negligence -five elements: 1. Duty 2. Breach of duty 3. Cause in fact 4. Proximate cause 5. Damages

Compare and contrast the terms ethics and bioethics and identify five principles of bioethics.

ethics - branch of knowledge and philosophical beliefs about what is right or wrong in a society, what ought to be rather than what is bioethics - study of specific ethical questions that arise in healthcare 1. 2. 3. 4. 5.