N325 C1: Intro to Community and MH Nursing
Assessment: Components of mental health: (2) Ability to: (5)
-absence of signs/ sxs of mental disorder -freedom from excessive mental/ emotional disability 1 function in world w/o significant impairment 2 reason logically 3 demonstrate mental and physical competence 4 perceive self, others, and events accurately 5 recognize strengths, weaknesses, capabilities, limitations
MH: Legal considerations Implementation/Intervention (2) Mandated Reporting: (Duty to warn/protect) (3)
-Crisis intervention (bioethical-legal considerations) -least restrictive interventions Mandated Reportting: 1 Tarasoff Act (HI, DTO) - Duty to warn potential Victim 2 Abuse/Neglect: Elder, Child, Dependent Adult Abuse 3 Infectious (ID)/ Communicable Disease (CD) -> report to department of public health who reports to state and CDC
You would describe the nursing role as... (3)
-across age and care spectrum -more emphasis on MH& CH/PH -if you work in the NICU you still have to deal with parents from birth to end of life
Mental Illness in the Community HX of MH Treatment (3) Examples (8) Joan of arc had visions of God, felt as if she were a prophet, and was.... What are insane asylums referred as? Example of a modern day one? What Psychosurgery do we still do? (2) What horrible thing happened in san francisco?
-Cultural Beliefs -Custody-> families-> abuse/ neglect -Stigma-> inhumane tx, practices and isolation 1. Skull drilling, sorcery to drive out evil spirits 2. Witch hunts, burnings, exorcisms 3. Insulin shock therapy, ice cold or hot water dunkings 4. Sedatives, leeches, opium 5. Dungeons, 'insane asylums, straightjackets 6. 'Gyrating chairs' to restore equilibrium 7. Psychosurgery- lobotomies 8. Electroshock therapy burned at the stake Social Warehouses, San Quentin Jail Lobotomies for epilepsy and Parkinsons's Disease (DBS-> deep brain stimulation, last resort but also used for depression, bipolar, schizophrenia) 7 sheet reatment in St. Mary's (wrap in 7 sheets, left in bed for 7 days)
Public Health System
-Foundation of HC (healthcare system) -Seeks to ensure Health of Community or Population is protected, promoted, ensured -May overlap with Primary Care System -Mandated through laws developed @national, state or local level -Multiple levels- federal, state and local systems
If someone gets more noisey/ yells "I'm going to kill you" what should the nurse do? If someone says, you are the "worst nurse", how should the nurse respond? What are ways that nurses can practice self-care? T/F Psych units tend to have the most assaultive behavior.
-Get even more calm/ quiet. Set limits. Be confident. -Get the focus back on the pt, "What can I do for you? How are you feeling?" Exercise, journaling, seeking supports/ counseling F. Psych units tend to have LESS assaultive behavior, there are more assaults in med surg, geriatrics, ICU.
Where are we now? (3)
-Integrated Healthcare 1. Medical Therapies 2. Behavioral therapies (All nurses using approaches at the bedside in any setting) 3. Patient Self-Management/Care (Pt-centered, Supports, CAMs, etc.) -Nursing assesments of Symptoms-> SYMPTOM-MANAGEMENT (Nursing Roles across all levels)
5150 DTS-SI other criteria (3) Example
-Intent to hurt themselves -A specific Plan -Means to carry out the plan "I'm suicidal I'm going to walk in traffic yes i'm going to do it" intent= "yes im going to do it" specific plan= "walk in traffic" means: pt is ambulatory then pt can write 5150
Nurse Essentials (5)
-Knowledge, understanding -Competent Nursing and Communication Skills -Compassion, Presence (being alert/ paying attention), Patience -Self-awareness & Objectivity (Biases Awareness, Ability to assert self & set limits) -Genuine empathy (ability to understand what someone is going through)
Define mental health. What quality about this is important? Define resilience. Define Mental illness. Based on criteria and involving _____.
-Mental Health ...(is) the ability to engage in productive activities & fulfilling relationships with other people, to adapt to change, & to cope with adversity". (SELF-ACCEPTANCE) -on a continuum (some days we are healthy others we aren't) ** Resilience: main factor in MH & recovery; process of adapting, coping, acceptance, positive outlook, is forward moving (even with stressors, setbacks). Nursing Role- id, enhance, build! Mental Illness: All diagnosable mental disorders Based on criteria and involving IMPAIRMENT IN FUNCTIONING
List three examples of mental illness (MI) other than depression and anxiety. What MI plagues baby boomers as they get old?
-PTSD, drug and alcohol addiction, ADD -Alzheimer's
Primary Care System (6) Health people 2020 main goal? Who did this before us? SEE PHOTO: Memorize 5 levels of pyramid.
-Personal HC- 1st contact and continuous, comprehensive and coordinated care -Managed Care (HMO&PPOS) (medicare and medicaid) -Comprehensive range of services -Universally accesisble care to community -Self-care% self-management in health and social welfare of life -Declaration of Alma Alta-> Healthy People 2020 *Main goal= universal care and coverage; soviets 1978 (healthcare is a fundamental right)
Community-based care ***
-Setting-specific care: "sick" persons and families IN community (where live, work, attend school, etc) Focus: "Illness Care"-management of acute and chronic conditions IN community (coordinated care by generalist RN's or specialty RN's) -ANYBODY can participate in it, illness in community
Health Disparities What are some populations at-risk or that are vulnerable? Nursing role? Primary care (preventitive services) features? Care pyramid? (primary/specialties/hospitals)
-Uninsured (across life spectrum), impoverished, marginally housed, homeless/migrants, others r/t age, gender, health, socioculturalpolitical, environmental, ethnic factors -All levels of policy/formation, assessment, advocacy to improve access and health of at risk groups -Most affordable, least costly (reduce HC costs), most accessible, most effective for improved outcomes, most preventive care for all people (risk reduction) -Primary care (lower third of pyramid) followed by specialties, then hospitals
Psychiatric Advanced Directives (PAD)
-legal document -WRITTEN BY PATIENT when competent (during well periods, planned ahead) -allows 2nd party to act on behalf of pt if becomes acutely ill and unable to make treatment decisions -related to treatment preferences
Public Health Nurse (PHN) vs Community Health Nurse (CHN) Home Health NUrse
PHN= certified by the BRN, participates in specialized care working with a diverse, vulnerable population CHN= anybody who works in the community can call themselves this or a home health nurse
TCOM status vs. riese/ conservatorship
TCOM= short-term
Why are we a HC system in transition? Explain. Care environment MUST improve collaboration, integration of services, why? The majority of jobs are in _____ care. Ex?
We used to be a very in-patient hospital centric model and are know in transition to be a more population centric-model. 1/3 hospitals predicted to close by 2020 r/t restructuring, high costs, poor quality and customer satisfaction Ambulatory care. (Non in-patient care, residential care, SNF/s home care) Ex: Flight nursing, anything out int he community, international nursing
When you discharge someone from the hospital it is very important that the person has...
a followup appointment with primary care
Community health involves both ____ and ___ diseases. Examples?
chronic: diabetes, HTN, depression, alcoholism communicable: measles, tick/lyme
Public health model (A) vs medical model (B) 1 Primary focus on ___ 2 ___ service ethic 3 Emphasis on ___ 4 Interventions target
1 A population B individual 2 A Public, tempered by concerns for the individual B Personal, conditioned by awareness of social responsibilities 3 A Prevention and health promotion for the whole community B Diagnosis, treatment, and care for the whole pt 4 A The environment, human behavior, lifestyles, and medical care B Places predominant emphasis on medical care
What is the nursing process? What three things to know about prioritization?
ADPIE-D (Assess, dx, plan, implement, evaluate, document) ABCs, Maslow's, Safety/ Trust-building
PHN reports to local and state department of public health, national level called the ____. Mobilize groups, talk to agencies, gather people together and link people to services is what role of a PHN? SARS: 5 colorado nurses prevented outbreak what role of a PHN? Uphold laws, safety laws in terms of schools: you have to be vaccinated to go to public schools school nurses. What role of a PHN? PHN examples of what they do:
CDC, Center of Disease and Control Planning Diagnosis/ Identify Intervention -Conduct research, make policies, lead immunization programs
Highest demographic for suicide
Caucasian males over the age of 75
ex: "i'm going to kill my landlord" HI What is the nurse's next question? Then what action must the nurse take place? After a 5150 the patient goes to a... what does it entail?
Do you have any thoughts of harming anyone else? -TELL/WARN THE VICTIM (duty mandated by the terror soft act) 5250, holding a person for TWO weeks if they still intend with a plans/ means you can repeat the 5250
Community health, nursing role? Who is the client? Focus on who else? New CH trends?
Talking about diseases. What puts somebody at risk for depression, SUD, PTSD? Risk factors/ risks? -Focus on Population Health (Individuals, Families, or Aggregates (Groups) IN a community -The Community= client -Those at-risk for problems or diseases, assess and identify to intervene and prevent risks/ complications -Social Media/ Telemedicine/ Telepsychiatry
What's wrong with this definition of community? "A group of people living in defined geographic area, who gain their personal & social identity from shared values, norms, cultural aspects & are arranged in a social structure according to relationships that community has developed over time."
There are communities that don't define themselves by geography. e.g. the LGBTQIA community
"To be vulnerable to others is to be in a position of being ___ or ___, as well as ___, by them.
hurt, ignored, helped
In regards to the epidimiology of mental ilness (MI) what is the incidence? annual prevalence? lifetime prevalence?
incidence- 1 in 3 people will have a new diagnosable mental disorder in the next 12 months prevalence (new + remission cases) annual prevalence- 1 in every 3 people in a 12 mo period lifetime prevalence- 1 in 2 over a lifetime
Community settings
wide variety of programs, cost-effective ex: PH, community health, home care, residential and ambulatory care, outpt services
mental health- where are we now?*** hospital based care (3) What is a 5150 (Landerman Petrus Act)? What is criteria for hospital admission that the nurse is constantly reassesing for?
-expensive care, safety, stabilization focus -only most ill who are imminent risk of self and/or other harm, and or the inability to take care of their basic needs -We take away pt's civil rights (to leave a hospital voluntary) for up to 72 HOURS #1 -DTS-SI (danger to self, suicidal ideation) -Thoguhts of wanting to hurt yourself/ intentionally wanting to harm yourself -Not an actual act but they are telling you they want to hurt themselves (NOT an attempt) #2 -DTO-HI (danger to others, homicidal ideation) #3 -GD Grave Disability -Book def: someone who cannot provide the basic life necessities such as food, shelter and housing -Problem with def: applies to 16000 homeless people -we put this label on those too psychotic/ so out of it that they cannot function and are a danger to themselves unintentionally e.g. people wandering in middle of highway/ strets
Mental Health: Legal Considerations AL MH patients have legal rights to: (8)
1 humane tx and care with respect, dignity and freedom from harm and discrimination 2 vote 3 due process of law (including pressing charges against another person) 4 informed consent (interpretive services prn) 5 confidentiality (terror soft is only real exception) 6 WRITTEN PLAN OF CARE/ tx (must include D/C, f/u care & particip. & care plan review) 7 communication with those outside care facility 8 care in LEAST restrictive env. needed to keep other cleint's safe
Conservatorship (cons, t-con)
-court-appointed person ("conservator") -has legal relationship and permission to make personal decisions for another (ward, mentally ill person) -may apply to 1 aspect of care (tx) or everything - hosuing, finances, etc. -legal documents outlines scope, specific to each individual -Due to patient's inability to fulfill basic requirements to protect self (safety and health wise) e.g. suicidal person refuses to seek or accept treatment, person engaes in self-harm (DTS), risky behaviors or multiple suicide attempts -refuses help and is r/t serious underlying mental illness -unless specified, conservator has all powers that parents has over a minor (can direct MH tx and suicide prev. measures) BEST EXAMPLE: amanda bynes (psychotic, bipolar, decompensated)
Stigma (2) definition and function example? when homeless people become invisible or pushed out of sight this is an example of: Internal stigma vs external stigma
-drivers of things that create inequity -creates isolation, either self-imposed or by external factors -person suffering with depression who says I'm tired and feels to shameful about it -marginalization -internal: person is shameful so they don't speak up, paranoid you're going to posion them, etc. external: racism, institutional racism e.g. people have decades misdiangosed african americans with schizophrenia
BIOETHICS Beliefs of what is right or wrong= ___ More than just being a 'good person'.= __ when nurses are unable to act ethically, feel overwhelmed, frustrated, fatigued.= ___ Nurses directly report abuse to the ____ then it is reported to the ____. A promotion of independence (*most commonly violated by health care providers; ie. Rt to refuse meds). B fairness, impartiality (ie. ICU nurse devotes equal attention to pt who attempted suicide as to pt w/brain trauma). C faithfulness, promises kept and carried out (come back to pt if you say you will come back in 5 minutes) do no wrong. (ie. maintain skills thru education). D= promotion of good v. harm for client (individual, community). (ie. spend extra time to help calm a very anxious pt). E= avoiding intentional harm F= intent to tell the truth (ie. honest about symptoms, med & side effect education)., never lie and say "this injection won't hurt" includes trust building G= uses therapeutic & assertive communication to role model appropriate behavior and language; a professional standard, and important element for safe and healthy boundaries. , professionalism Autonomy, Rt to Tx, Rt to Refuse Tx, Rt to Communicate w/ others, Privacy/Confidentiality, Informed Consent-HIPPA. are ____ rights. Rt to vote, humane care/tx, socialize, press charges, exercise, religious freedom/practice (same for incarcerated persons). are ____ rights. Suicide is a permanent solution to a temporary problem We usually can get people better, something that we do want to fix. What situation in which suicide is okay?
1 morals 2 ethics (Basing your actions on a set of principles. (e.g. Jesuit Mission) Part of clinical decision-making & practice.) 3 moral distress San Francisco Department of Public Health (DPH) then CDC A= autonomy, LEAST RESTRICTIVE, do you know what this med is for? let patient dress themselves B= social justice C= Fidelity D= beneficence E= non-maleficence F= veracity G= respect Patient rights, Civil rights Physician-Assisted Suicide
General needs of severely mentally ill Basic human needs model (Maslow's hierachy of needs) (5) + (5) important ones
1 physiological 2 safety/ security 3 love/ belonging 4 self esteem 5 self actualization 1 basic life necessities 2 life is meaningful 3 access to meds 4 support for family emmbers 5 "integrated services
Analysis of current U.S. HC Delivery system Costs? In comparison to Canada? drivers of healthcare cost in U.S.? Quality? Access? Policy, funding and budget cuts?
-$$$, high use of expensive, least preventive services, -Most costly system in the world, 40% GDP on healthcare -administrative costs (highly paid hospital administrators, bureaucracy, red tape) -Canada provides universal coverages for its citizens and is the second largest spender on healthcare -lowest qual. of 20 industrial countries, lowest on measure of quality such as pt satisfaction -Insuranced tied to jobs, barriers to access, impoverished, undocumented, marginalized groups, stigma (soci-cultural) -New HC bill if passed would leave 23 million more Americans uninsured by 2026 (repeal ACA vs new plan) -Current admin want to cut children health insurance program by 20%, cuts to medicaid, 1 in 3 kids are covered
Involuntary Admission/ Hold/ Commital1 5150: (Lanterman-Petris Act) length? criteria? 5250: length? criteria? 6000? criteria? 3 criteria for SI and HI?
-Admission to facility against pt's wishes -takes away civil rights to leave voluntarily -maintains all other civil liberties (except right to leave pt can vote, receive mail sue) 5150: 72 HRS 1 DTS- SI (Danger to Self- Suicidal Ideation) 2 DTO- HI (Danger to Others- Homicidal Ideation) 3 GD (Gravely Disabled) 5250: +14 Days (5150 criteria extended) 6000: voluntary admission CRITERIA FOR SI/HI: 1. INTENT 2 PLAN 3 MEANS
All MH patients have Legal rights to: Least Restrictive Care
-Apply RN skills first (i.e. TC, behavioral, MAB etc DEESCALATION) -Document behavioral reason -Document other methods tried before more restrictive intervention -Seclusion and restraints: written order by provider needed -Time limited 24 hrs: Rewritten Q24 hrs (or per P&P) -Assesed/documented safety, physical needs/VS, behavior P&P) offered food, fluids, toilets, meds administered -EM situation: charge RN may use seclusion and restraints without order 1st (must obtain written order within 15-30 minutes or per P & P)
Riese hearing: what is it? consideration? EXCEPTIONS Why is riesing controversial?
-Emergency medication without patients permission -Judge hears case, considers both sides, and renders decision -Court has found that in the best intere tof pt to give them meds (even if pt is unwilling or refuses meds) -HC providers (RN) can force pt to take meds without pt's permission -must offer PO meds first and give pt opporunity to make the "right" choice, if pt still refuses an explanation and IM are given ("show of force" may be needed") *If not conserved and not riesed, there still may be emergent situations when staff can administer IM meds without these legal allowances in place: -staff must fill out a denial of rights form -essential to know pt's history of violence. harm and -communicate history with multi-disciplinary team -retraumatization: gang rape victim being riesed IM 6 guys *just because someone is on a 5150 and 5250 they can still come into the hospital and REFUSE all treatment
Community-oriented care***
-Holistic HC to improve QOL (biopsychosocial-environemental) -Focus: health promotion and disease/ disability prevention of populations -keeps pt out of acute care -Preserve, promote, protect and maintain health via Community Dx and Investigation of Major Health and Environmental problems, health surveilance, monitoring and eval of community/ population health status -traditional and emerging roles: involves pt in own care: SLEF-CARE (Partnerships, RECOVERY model, Personal safety- requires self-awareness: requisite for community oriented practice, ongoing community and self-assessment) -role of PHN -involve pt in own care
Why can't we force a patient to live in a shelter? Why do some people leave AMA to live in Golden Gate Park? What is the main issue? T/F psych pts will have breakthrough symptoms or will relapse completely? Why do we have epidemics? (Petussis/ measles) What happened in the 1980's in terms of the history of MH? What would you say the role of mental health treatment is? What is the new approach of treating people? (telling vs)
-Patient Rights -Programs have rules while golden gate park has no rules and people can smoke crack, have pets, community -Issue of policy, lack of affordable housing, patients rights issues ballooned due to HIV epidemic/ crack cocaine T -People aren't immunizing, aren't as healthy, living in close corners, lack of access to care, immigrate - Explosion of Biological Psychiatry: More EBP focus for treatment -Treatment, Side effects are bothersome, sometimes life threatening -Imperfect System -Barriers: Access, Budget-Funding limits, PH & MH cuts -Talk Therapy- many models -RECOVERY model- Self-Help movement -Holistic focus, Complementary (CAMs) -ECT, TMS, Psychosurgery, & DBS -Prisons role- higher rates than community samples -SYMPTOM-management -MOTIVATIONAL interviewing
History of Mental Health: 1800's-1950's? 1954? 1960's? 1970-80's Now?
1800's-1950's: State Mental Hospital -"Warehouses" -Social control; same treatment for all 1954: Psychotropic Medications Introduced~ First drug was Thorazine -Deinstitutionalization (People in long-term institutions were freed into society, institutions closed, flawed concept because a pt on psychotics meds is not cured, 30-40% will have breakthrough symptoms or will relapse completely) 1960: Civil Rights/ Community MH Movement 1970-80s: Significantly reduced inpatients -faulty system with new problems -homelessneess, crack cocaine; HIV Now: Chronic Homelessness -Opioid epidemic, pain is the 6th vital, treated with oxycontin, Vicodin, chronic problems such as back pain are treated with opiates, fentanyl, heroine, creates homelessness issue
A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious client. The client recently lost employment and could no longer afford prescribed medications. The client says, "Only a traitor would make me go to the hospital." Which one of the following would be the best initial nursing intervention? A. With the client's consent, contact resources to provide medications without charge temporarily. B. Arrange a bed in a local homeless shelter with nightly on-site supervision. C. Hospitalize the client until the symptoms have stabilized. D. Ask the client, "Do you feel like I am a traitor?"
A. With the client's consent, contact resources to provide medications without charge temporarily.
Responsibilities of Community Nurse (summary CHN & PHN Roles
ADPIE 1 Assessment- Assess/monitor health status of individuals and groups in community (vs. institutionalized patients) 2 Diagnosis: Identify and investigate unmet needs, risk factors, comm. health problems + hazards, environmental management (communicable diseases, immunization status, education/ surveillance) 3 Planning -Mobilize community, collaborate, coordinate and link people to services) -Inform, educate, empower, communicate health issues -develop plans, PH policies, partnerships and programs to identify and solve problems and meet needs 4 Implementation/ Intervention -Enforce laws, safety regulations to protect community 5 Evaluation/ Follow-up -Evaluate quality, efficacy, accessibility of services -Advocacy + referrals -Assurance of PH services to community -Research new solutions to health
Insurance will not pay for continued private hospitalization of a mentally ill client. The family considers transferring the client to a public hospital but expresses concern that the client will not get any treatment if transferred. Which one of the following is the most therapeutic nursing response? A "By law, treatment must be provided. Hospitalization without treatment violates patients' rights." B "All clients in public hospitals have the right to choose both a primary therapist and a primary nurse." C "You have a justifiable concern because the right to treatment extends only to provision of food, shelter, and safety." D "Much will depend on other clients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a client who is stable."
Answer: A
The best resource for the nurse who wants information on the leading causes of morbidity and mortality in a local region of the country is which of the following? a Hospital records and statistics b State & local health department records. c The local chamber of commerce d The obituary columns of local newspapers.
Answer: B Rationale: Departments of Public Health (DPH) are the best resources for epidemiological data and statistics about a population and/or geographical area. In rural communities, the sheriff's department will have this information at the local level.
Which one of the following ethical principles refers to the individual's right to make his or her own decisions? A Beneficence B Autonomy C Veracity D Fidelity Which one of the following characteristics would be more applicable to a community health nurse (CHN) than to a nurse working in an operating room?
Answer: B - autonomy for both
Which one of the following would be considered the most effective health teaching strategy for a group of adolescents to provide safer sex education? a. Provide a group health statistics and education class related to sexually transmitted infections. b. Provide a movie on the biology of sexual infection transmission for the adolescents to view. c. Use role play to demonstrate and enhance safer sex skills and discussions. d. Provide a group question and answer forum for safer sex practices.
Answer: C Rationale: Remember that when HESi (or any test writer) asks a question about a large topic such as 'Groups' or 'Aggregate Health Education', the focus will be on some large concept directly related to that topic. For Group Education, the big concepts include tools or EB, effective interventions that are unique or particularly useful when applied to aggregates or in group education. Active learning and interactive tools/interventions are the most EB and effective interventions especially with particular developmental groups such as adolescents. The best answer is the USE of ROLE PLAY which enacts role modeling, practice in a safe setting with helpful peer feedback to increase a client's confidence and skills for future use in 'real world' situations. The more one practices, the more likely they will be prepared to deal with a variety of situations in their greater lives with increased confidence and better coping and skills.)
What is a disparity? Risk factors for health disparities? What role do nurses play in reducing heath disparities? How do nurses impact health for at-risk groups?
Disparity= unequal access to care, care in general based on race gender -Finances/ income, billing insurance, lack of access to care, race, gender, etc. -Education and Empathy (recognize your own biases) -Be a role-model/ advocate for vaccines/ immunizations, understand what is real evidence and learn how to read articles/ social media
Integrated care approach example? DEFINE IT.
Dual Diagnosis A Psychiatric MH disorder WITH substance use disorder(s) (SUD) -Collaborative care: treat both simultaneously -If you're depressed you're going to use opiates and if you use opiates it will make you depressed.
Over a period of several weeks, one male participant of a socialization group at a community daycare center for older adults monopolizes most of the group's time and interrupts others when they are talking. What is the best action for the nurse to take in this situation A Talk to him outside the group about his behavior. B Ask him to give others a chance to talk. C Allow the group to handle the problem. D Ask him to join another group.
Answer: C- Allow the group to handle the problem. Rationale: 'After several weeks the group is in the working phase and the group members should be allowed to determine the direction of the group. The nurse should ignore the comments and allow the group to handle the situation. (A) is incorrect because a good leader should not have separate meetings with group members, as such behavior is manipulative on the part of the leader. (B) is incorrect because it is dictatorial and not in keeping with good leadership skills. (D) is incorrect because it is avoiding...' the purpose of the group (socialization). Monopolizing members likely behave this way outside of group in the world, so the object of a socialization group is to allow members to give feedback in a safe and controlled environment.
Which of the following rights did the client lose by being admitted involuntarily to a psychiatric hospital? The right to which one of the following? a. send and receive mail. b. vote in a national election. c. make a will or legally binding contract. d. sign out of the hospital against medical advice.
Answer: D-sign out of the hospital against medical advice. Rationale: The only civil rights that the client gives up are the right to voluntarily leave the hospital. Involuntary admission is when a person other than the patient applies for the client's admission. The client is entitled to a legal hearing within a certain number of days or hours (state dept). Requires health certification of a hc provider. Legal and civil rights of hospitalized clients apply including, the rights to: wear their own clothes, keep personal items and reasonable amt of cash, have individual storage space, reasonable access to a phone, private conversations, receive and send mail, see visitors daily, refuse shock and lobotomy treatments.
Which of the following is an example of population-focused practice? (Select all that apply) a. Agreeing to meet with local schoolteachers about asthma observed in quite a few of the children b. Assessing Ms. Saunders, determining her blood pressure, and reporting any noted risk factors to her physician c. Assessing the confusion concerning cholesterol among senior citizens at the center and presenting a program on nutrition to the group d. Diagnosing a child's injury as possible child abuse, reporting the findings to Children's Protective Services.
Answers: A & C. Rationales: Both are focused on groups (aggregates) rather than an individual client.
You are an experienced RN and are floated to the psychiatric unit. You are providing teaching to John, a newly admitted client on the psychiatric unit, regarding his daily schedule. Which one of the following would be an appropriate teaching statement? Select all that apply A. "You will participate in unit activities and daily groups." B. "You will be given a schedule daily of the groups we would like you to attend." C. "You will be required to attend a psychotherapy group that I lead." D. "You will see your provider daily in a one-to-one session to discuss your symptoms and medications." E. "You will receive your prescribed medications every morning. Your medications include the antidepressant, Prozac, which will help with your mood, anxiety and sleep problems."
Answers: A, B, D, E Rationale: All are within the scope of practice of an RN and would be information to impart to a client. Only advanced practice RN's (and other mental health professionals) with special training provide psychotherapy.
True or False? A 22 year old male client tells the outpatient clinic nurse that he wants to hang himself with his bed sheet at home. He lives on the 2nd floor of an apartment building and states he wants to die because his girlfriend cheated on him. He complains of poor sleep lately, has a history of high academic, social and occupational achievement and a very supportive family. He says he intends to carry out this plan later today. This client is 5150-able. True or False? True or False? A 20 year old female is day 3 post-op S/P appendectomy at UCSF. She tells her med-surg nurse that she wants to walk out in traffic and get hit by a bus. She is ambulatory and scheduled to be discharged today. She reports that her pain is too much and she wants to 'end it all' if they discharge her. She has a history of mental health problems including multiple suicide threats that she did not carry out. She is manipulative, seems to seek meds and tries to gain your attention with small frequent requests. She says she intends to carry out this plan as soon as 'no one is looking' if they decide to discharge her. This client is 5150-able. True or False?
Answers: TRUE for both cases Rationale: Both cases the patient meets criteria for a 5150 for Danger To Self (DTS) related to Suicidal Ideation (SI) : 1 with specific plan that is potentially harmful 2 intent to carry the plan out and, 3 a means or access to carry out the specific plan. The fact that one patient may be manipulating, seeking attention or blackmailing the system does not matter.
T/F nurses have the right to overmedicate someone
F. least amount of med. to get the job done!
Development of Community-Public Health Where it all began: Who was first C&PH Nurse? What did she do? (3) What was the leading killers from the first C&PH nurse to the early 1900's? Leading killers now for the U.S.? What percent/ amt of americans live in rural areas? Concerns about them?
Florence Nightingale: 1st Nurse Epidemiologist -Recorded statistical data R/T poor sanitation (cholera/ dysentery) to see how changes to air and water had an affect on health. -Lowered mortality rates and disease rates and imrpoved health -hospital reforms: decreased mortality rates within first months (health promotion, illness prevention) *Communicable and Infectious diseases were the leading killers for Nightingale -PH improvements *Chronic diseases: obesity, diabetes, HTN, MH disorders, aging population living longer (most geriatrics cared for in "community" where they live -aging and retiring nurses -23% or 72 million, their access to HC
Infleuncing factors for MH disorders: "Nature" vs "Nurture" examples
Nature: inherited factors, genetics, inherited predisposition, inherited capacities/abilities, limitations, pregnancy environment, experience (contraception to birth), biochemical, hormonal, psychoneuroimmunologic (PNI) factors Nurture: FAMILY composition, birth position, bonding/ atachment, members mental health CULTURE subcultures, value, belief systems, perception of self, cognitive abilities DEVELOPMENTAL EVENTS completion of clearly defined stages, reoslution of developmental crises
DSM Old DSM-4th edition= How many axes? what were they? New DSM-5th edition= how many axes? what are they? SEE PRACTICAL APPLICATION IMAGE!
OLD: 5 axes 1 Clinical disorders (major psychiatric d/o) 2 personality disorders+ developmental disorders 3 general medical conditions 4 psychosocial and environmental problems 5 global assessment of functioning (GAF score) 100= HIGHER functioning NEW: 3 axes 1 all clinical disorders (major psychiatric, personality, developmental, general medical conditions) 2 psychosocial + environmental problems 3 GAF score
What are the 6 QSEN competencies?
Quality Improvement (QI) Safety Evidence based Practice Healthcare Informatics Patient Centered Care Teamwork and Collaboration
Review: Restraints: Clients may be restrained only: (3) Nursing responsibilities (2) General procedures (5)
Restrained only: 1 in an emergency 2 for a limited time 3 for self-protection (danger to self-harm or injury) Reason: 1 notifiy HCP that client is restrained 2 document facts r/t need for restraint GP: 1 least restrictive measures tried first (communication, de-escalation etc) 2 apply correct per facility guidelines 3 check frequently to avoid skin, circulation problems 4 remove asap 5 document need for, application of, monitoring and removal
Harm Assessment: Questions KNOW THIS! Priority? *NO YES OR NO QUESTIONS! OPEN-ENDED T/F Minors are not holdable under 5150. If pt has family stigma against MI and SI then what should the nurse do?
SI or HI: Do you have any feelings of wanting to hurt yourself or anyone else right now? Yes= +SI or +HI 1 Plan: Do you have a plan? If sow hat is it? 2 Intent: How serious are you about following through with this plan? 3 Means/Access: "Do you have a bottle of Tylenol?" "How can you get up there" Keep client (or others) safe from harm. Safety is the hihgest priority FALSE. Minors are holdable. Parents can't override 15 yo DTS- SI. Ask, what are your concerns? What is your understanding of MI/ your daughter's illness? What are your worries?
