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Chapter 4

Terms in this set (86)

Psychiatric mental health nursing in the outpatient or community settings requires strong problem-solving and clinical skills, cultural competence, flexibility, solid knowledge of community resources and comfort in functioning more autonomously than acute care nurses.
Patients need assistance with problems related to individual psychiatric symptoms, family and support systems, and basic living needs, such as housing and financial support.
Community treatment hinges on enhancing patient strengths in the daily environment, making individually tailored psychiatric care improvement.

Nurses are adept at understanding the system and coordinating care. They "can work between and within systems, connecting services and acting as an important safety net in the event of service gaps".

The role of the outpatient or community psychiatric mental health registered nurse has grown to include service provision in a variety of these treatment settings, and nursing roles have developed outside traditional treatment sites.

Individuals suffering from a serious mental illness tend to cycle through correctional systems and generally comprise more than 50% of the incarceration population.
The nurse's role is not only to provide care to individuals as they leave the justice system and re-enter the community, but also to educate police officers and justice staff in how to work with individuals entering the criminal system.

The percentage of homeless persons with serious mental illness has been estimated to be more than 26%, the challenge with these patients is making contact with the individual who are outside the system and in desperate need of treatment.
Some patients are admitted directly to inpatient care based on a psychiatrist or primary care provider referral; however the majority of patients reciting inpatient acute psychiatric care are admitted through the emergency department

13% of ED visits are due to mental health and/or substance abuse conditions

The admission criteria to a hosptital begin with the premise that the person is suffering from a mental illness, and there is evidence of one or more of the following:
-Imminent danger of harming self
-Imminent danger of harming others
-Unable to care for basic needs and/or gross impairment of judgement, placing an individual at imminent risk based on inability to protect oneself.

If symptoms meet the admission criteria, they are given the option of being admitted on a voluntary basis, which means that they agree with the need of treatment and hospitalization.
If patients do not wish to be hospitalized, but psychiatric mental health professional feel that admission is necessary, they can be admitted against their wishes, commonly known as involuntary admission

Patients can petition the court for release
If admission is contested, the treating psychiatrist is required to present the case to the court, supporting hospitalization as necessary for the safety of the patient or others and explaining how the patient will benefit from treatment.
The court then decides whether or not to continue hospitalization.

Involuntary vs. voluntary = legal status

Regardless of legal status, a patient maintains his or her rights related to refusal of medication administration
Safe environment is essential component of any patient setting
Protecting patient is essential but protecting staff and other patients is of just as much importance

Staff members check all personnel property and clothing for any unsafe items
Some patients are at greater risk of suicide, mental health nurses are skillful in evaluating this risk through questions and observations

Centers for Medicare and Medicaid Services have also put more emphasis on patient safety and have identified several preventable hospital-acquired injuries for which they will not provide reimbursement

Tracking patients whereabouts and activities is done periodically or continuously, depending upon patient's risk for harming themselves or others
For actively suicidal patients one-to-one observation is essential since even checking on a patient every 15 mins may not prevent a suicide that takes only several minutes

Visitors = another potential safety hazard
Visits may be overwhelming or distressing
Visitors can bring unsafe items - staff need to inspect bags

Intimate relationships between patients are discouraged - risk for STDs, pregnancy and emotional distress at a time when patients are vulnerable and may lack the capacity for consent

Aggression and violence may occur from being confined
Psychiatric staff have specialized training that promotes healthy, safe and appropriate interactions.
Most units are locked since some patients are hospitalized involuntarily and elopement (escape) must be prevented in a way that avoids an atmosphere of imprisonment