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exam 1 lecture 1 mental health
Terms in this set (111)
Freud, Kraepelin, Bleuler
psychoanalysis; brain is a specific organ
least restrictive environment!!! institutions geared toward most acute symptoms NOT side effects
community mental health
de-institutionalization--get ppl into the community but not w/ community centers giving meds but not caring about other symptoms; people went to the streets bc no where else to go
decade of the brain
lobes/ neurotransmitters/ target but w/ no side effects!!!
about how much of the prison population has a mental disorder?
diagnosis & statistical manual of mental disorders (DSM)
created by APA
DSM I: 1952; DSM IV-TR: 2000; DSM-5: 2013
2 axes system for assessment (where there used to be 5)
Axis I: DSM Diagnosis (emphasized this one)
Axis II: personality DO, intellectual disabilities
Axis III: medical conditions
Axis IV: psychosocial problems, current stressors
Axis V: GAF-global assessment of functioning (emphasized this one)
a client/patient must have how many signs?
depression is or is not a symptom
is a symptom!
Axis I means
you hit the critieria
GAF is the test of life
GAF is scored out of
to be admitted, you have to be under what number?
the average person hovers where??
did deinstitutionalization improve the quality of life for people w/ mental illness?
yes--least restrictive environment, sense of family/community, less expensive
no--streets, prisons, ED when needing help, no resources. no community centers like promised!!!!
nurses do NOT diagnose, we intervene
1. self: me
2. drugs: meds/psychopharmacology
3. environment: milieu management
french for general environment
patient acuity actually higher but length of stay shorter
nurses must use self & nursing process to:
convey respect & maintain pt. dignity
establish therapeutic relationship
identify immediate needs (emphasized)
provide intervention for behaviors dangerous to self or others (safety first!!!)
assess full range of client needs using multiple sources
provide holistic quality care (like does insurance cover medication) SHE EMPHASIZED THE HELL OUT OF THIS ONE
provide d/c planning
obtain medication history
seek individual's perspective on: 1. medication wasn't effective, 2. problems w/ side effects, 3. past & present complaints
monitor medication effectiveness, presence of side effects
educate pt. & family about effects & side effects
assess need for PRN medication
emphasize need for medication compliance in symptom management & control
milieu activities emphasis--help individual cope w/ immediate needs & stressors
structured milieu includes groups that are problem-focused, goal-oriented, relevant to pt. needs
nurse: assists individual to apply info obtained in groups to own situation; teaches problem solving skills
continuum of care
role of nurse is to assess & direct or escort the patient to appropriate services
MDT team collaboration coordinates care
team may include: pros, pts or consumers, families, insurance representatives, nursing homes, group homes/medical clinic
determining placement of care continuum
assess & refer to services that are: least restrictive environment, most effective, most cost conscious
provides ongoing guidance to appropriate care levels: safety, intensity of supervision needed, severity of symptoms
developing a continuum of care
develop a new conceptualization of system: focus more on recovery & reintegration, less on symptom stabilization, involves consumers & family, focus on holistic issues
protected the gravely disabled, for those at risk for accidental harm
protect the acutely psychotic, who are unable to meet their basic needs
provide through medical & psychiatric eval
treat toxic reactions to medications
treat withdrawal from substances
two goals: assist individuals to attain initial stabilization & safe level of functioning; assess for appropriate referrals for after care
d/c planning begins at admission!!!!
least restrictive environment:
1. commitment to a state hospital: Bryce, Sercy
2. day treatment (5 times per week); living at home/state facility
3. day treatment (1-3 days per week); home/facility but gaining skills for employment and living in community
scheduled follow-up w/ therapist & prescribing clinician; living in community/boarding homes
continuum of care treatment options
traditional outpt services: clinic or private services, day treatment: minimal supervision, psychiatric home care, self-help groups: generally led by non-professionals (AA), residential services: usually state-ran (extended care, group homes, halfway homes, supervised apt. living programs, foster care & boarding homes
intensive outpt. services (assertive community treatment)
promote improved level of well-being
helping healthy people avoid problems (ex: wellness)
early intervention in identifying problems or risk factors
help manage a complicated long-term problem
hospital & community based care
prevent disability & relapse
can leave at any time AMA, coming into ED and "feeling depressed"
competent & came in willingly, may be able to refuse treatment but cannot leave
emergency care: 72 hours before they can leave, can refuse meds while there; if they are threat to themselves/other then hospital files & case goes to court to make them stay; "probable cause" & safety
options for involuntary pts:
short-term observation & treatment
long-term commitment: inpt facility (60-180 days)
conservators & guardians
basic levels of communication:
interpersonal: b/n people
small group communication: reports
public communication: health fairs, etc.
vocabulary: choose your words for pt's understanding
connotative meaning: words carry emotions --> miscommunication
intonation: tone of voice, communicates feelings
appearance, posture, gait, facial expressions, eye contact, gestures, sounds, loads of other subtleties
over 90% of communication is
privacy, furniture, proxemics
body language, might be incongruent w/ words, validate the meaning
sensory limitations, developmental disabilities, speech impediments, pain, deformities, injury
it is important that the nurse addresses what is happening w/ the pt at time of communication
talk directly about your feelings to prevent further escalation unless the pt. is extremely aggressive or hostile
meets personal needs of both self & patient
confidentiality might or might not be observed
listener might not be objective
directed by pro
meets pt's needs
info shared w/ health care team
listener is objective
therapeutic communication cont.
goal is creating beneficial outcome for client that reflects ownership of their healthcare
be attentive both verbally & nonverbally
face pt, open posture, lean towards pt., eye contact
making observations on the non-verbals
an attempt to find the meaning behind the behavior
phrase your observation tentatively so that you're questioning my perception, not behavior
what is major cause of anxiety/discomfort?? not knowing, simple lack of misinfo
if you don't know, ASK
the ability to understand & accept another's reality
to perceive feelings & communicate understanding
encourages clients to express own thoughts & feelings; not answered w/ yes or no
"how has this medication affected your vision?"
"sense of possibility"
"i believe you will find a way to face your situation bc i've shared w/ me examples of your courage in the past"
meaningful communication depends on people understanding each other
unclear/ambiguous message, ASK
"do you mean...?"
use appropriate language
techniques: restating, reflecting, paraphrasing, exploring
used to establish truth/accuracy
"are you saying that you did not get your medication today?
"you are holding your side. are you having pain there?"
indirect statement (NCLEX loves these)
calls for response from client
"tell me about your physical therapy today"
"you were telling me about...."
repeating all/part of message back; allows for sender clarification
"you say you are anxious about your surgery?"
concise review of interaction shows you understand what's being expressed & can bring closure to interaction
let sender know what message was heard
sender can add info or clarify
can allow client time to gather their thoughts & check their own emotions
gives nurse time to decide how best to continue
often provides therapeutic use of self
offer to work WITH pt for their benefit, not FOR them
pt is always focus of in the interaction!
don't feed delusion, but ALSO DO NOT ARGUE OR BELITTLE
goal is to provide ALTERNATE line of thought
like "presenting reality" using statements that express uncertainty
not agreeing or disagreeing but encouraging pt. to reconsider
"really?" "isn't that unusual?"
hypothetic for when pt. is stable
barriers to communication
process should not be threatening to client
focus is on me, not pt
allows for sorrow & pity, not understanding pt. issues
goal should be education & solution focused
"losing your leg is a major change...."
you are closing information gathering!!!!!!
may be disrespectful to pt's experience/distress
you're blocking expression of feelings
can be traumatic when truth is learned
feel pressured to express same feelings as nurse
imply right or wrong
no room for discussion
do not impose your attitudes, beliefs, values, or morals
pt. should make decision since problem & solution are theirs
taking away client's responsibility
makes clients feel independent
belittle pt's experiences & keep your interactions superficial
can be both pos. and neg.
"many have it much worse", "yes, everyone feels like that"
asking personal questions
questions should be RELEVANT to situation
when pt expresses criticism, listen so you can uncover what is really upsetting them
implies client is not permitted to criticize/express their feelings
automatically defending, don't do it, just listen
requesting an explanation
can be intimidating
are closed ended
changing the subject
implies you're uncomfortable or anxious
is rude and shows no empathy!
TEST TAKING HINT
connotation is everything
there are really no adjectives that are "distractors"
therapeutic use of self
verbal & non-verbal communication
silence & therapeutic listening
components: actively alert, eye contact, attending posture, concentrating, being patient, displaying openness
silence & therapeutic listening
offering empathy/support: through use of self
asking open-ended questions
organizing, synthesizing, interpreting info
responding verbally & nonverbally
therapeutic use of self offers
sensitivity, objectivity, empathy, genuineness, touch: use judiciously can be misinterpreted
common interference's are a nurse's:
fears, feelings, lack of knowledge, insecurity, ineffective responses
ineffective responses & behaviors
first psychiatric nursing theorist
promotes growth & learning for pt. & nurse
therapeutic relationship vs. providing therapy BC WE DO NOT PROVIDE THERAPY
three stages of therapeutic relationship:
stage 1: orientation phase
stage 2: working phase
stage 3: termination phase
building trust w/ clients
managing emotions: ours & theirs
exploring of feelings, expectations, goals
change vs. stabilization
in-depth data collection
reality testing & cognitive restructuring
promoting change---change is hard, 2 steps forward & 1 step back
evaluation, summary of progress
discussion of termination
initial pt. assessment
specifies an adaptive behavior
must be realistic & achievable
written in measurable, behavioral terms "pt. will sleep 7 hours"
short-term outcomes: attainable in 3-6 days
long-term outcomes: require follow-up after d/c "will attend therapy 3 days a week"
planning & intervention
nursing care plans: are standardized, goal: expedite treatment of activities to achieve outcomes in cost-effective manner
nursing focus: facilitation & education; verbal strategies to guide problem solving
considers pt. progress
reassessment, reformulate nursing diagnoses, more realistic outcomes
determines need for pt. referral
considers quality & effectiveness of nursing interventions
role of inpt. nurse on behavioral health unit encompasses:
therapeutic relationships, administering medications, & maintaining safety
what is culture??
internal & external behaviors & thought patterns that are learned & shared
values, beliefs, norms of person/group/community, to help individual's function in life, assists w/ understanding & interpreting life's occurences
if you don't know, ASK
knowledge of cultural impact on person/community
skills to promote effective care
incorporates cultural competence in interactions w/ peers, students, families, & communities
KEY TO PT'S RECOVERY PROCESS
barriers to culturally competent care
miscommunication b/n nurse & pt
lack of knowledge & sensitivity
pt's unaware of nurse's cultural perspectives, therefore misinterpreting health care commendations from nurse
failure to assess pt's cultural perspective
not just physical, gives life depth and meaning
making sense of life
hope, plans, fears
individuals relating to each other w/ issues of meaning & belonging
spirituality is connected to
a transcendent source, such as God, a higher power, or universal spirit often expressed w/ in religious community
distinguish spirituality from
religious perspective, emphasize the human spirit & relationship to other human spirits not dependent on notion of higher power
culture is a group's shared
values, beliefs, norms
a nurse begins work at an agency that provides care to members of a minority ethnic population. the nurse will be better able to demonstrate cultural competence after:
exploring commonly held beliefs and values of the population
a Hispanic parent says, "an old woman gave my baby the evil eye." the health care provider determines that the infant is physically healthy. the most culturally competent intervention would be to:
bring a root doctor into the consultation to restore the baby's lost soul
which questions should the nurse ask to determine an individual's worldview? select all that apply
what is more important: the needs of an individual or the needs of a community?
how would you describe an ideal relationship b/n individuals?
of what importance are possessions in your life?
a depressed pt. expresses feelings of hopelessness, helplessness, and powerlessness. the pt's spiritual distress is related to an inability to:
find meaning & hope through choices
a pt says, "I am a Christian." the nurse understands that Christianity includes which groups?
mormon, catholicism, greek orthodox
a chinese-american infant is seen in a well-baby clinic. the parent reports that the baby is irritable and not eating well. the nurse notices several skin abrasions on the thighs & upper arms. what is the nurse's most appropriate intervention
ask if the parent has used coining
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