Mental Health NUR 415 - Exam 2

Family Dynamics
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1. The relationship between patients and their families and members of the clinical team belong at the heart of care delivery
2. Care providers' knowledge of self and self-care are fundamental requirements for quality care and healthy interpersonal relationships
3. Healthy relationships among members of the healthcare team lead to the delivery of quality care and result in high patient, staff and physician satisfaction.
Displacement• If a person is angry but cannot direct their anger toward the source without consequences, they might "take out" their anger on a person or thing that poses less of a risk.Rationalizationor example, a person who is turned down for a date might rationalize the situation by saying they were not attracted to the other person anyway. A student might blame a poor exam score on the instructor rather than their own lack of preparation.Types of boundariesClear, Diffuse, and Rigid Boundaries.Clear Boundaries•adaptive and healthy. All members understand the boundaries and are firm yet flexible and provide a structure that adapts to chance. Family members have a sense of self. Appropriate roles.Diffuse Boundariesresult in unclear boundaries and a lack of independence. Problems defining who they are. This leads to over-involvement with one another. Issues with parent/child boundary. Expression of separateness or independence is viewed as being disloyal to the family. Members are prone to psychological psychosomatic symptoms.Enmeshment•the overinvolvement between individuals in the family. In an example, when one person becomes emotionally escalated and the other family member does as well. A good example of this is when a teenage daughter gets anxious and depressed and her mom, in turn, gets anxious and depressed.Differentiationthe ability to possess a strong identity and sense of self while maintaining an emotional connection with the family, is also discouraged. In general, they are discouraged from expressing their own views.Rigid Boundairesopposite of diffuse. Families with this demand adherence to rules and roles - some apparent and some less so - regardless of circumstances or outcomes. Members may avoid each other and become disengaged. They lead highly separate and distinct lives. They do not learn the intimacy in the family setting.Family TherapyTwo major aims are: •Improve the skills of the individual members. •Strengthen the functioning of the family.CohesivenessHow much time the family spends togehterCommunicationRespectfully listening to each otherAppreciationDo all individual members of the family contribute in meaningful ways; feeling of gratitude.Commitmentdo they consider the impact of their actions on the family as a whole and in a manner that promotes unity?Coping•do the family members demonstrate the ability to support one another during times of crisis?Beliefs and Valuesdoes the family identify with or practice within a collective moral, ethical, or spiritual set of standards?Core Values of family therapyCohesiveness, Communication, Appreciation, Commitment, Coping, Beliefs and Values.Identified PatientAn individual in the family typically regarded by others as the problem.Triangulationoccurs when one family member will not communicate directly with another family member but will communicate with a third family member. Also can be in regards to splitting. Nurse can be involved in this if child does not want to tell parents, spouse does not want family to know etc. Interrelated: Family TriangleApplying the nursing process to Family DynamicsAssessment: •Genograms •Self-Assessment Nursing Diagnosis Outcomes Identification Planning Intervention: EvaluationGenogramclinical summary and format for providing information and defining relationships across at least three generations.Self Assessment throughout providing care regarding Family Dynamics-Dealing with similar family situations to your own can be triggering. - Nurses should be aware of their own personal backgrounds, family history, and styles of interacting with their own family members. -You could become triangulated in a patient's family.Nursing Diagnosis related to Family dysfunction•Risk for caregiver role strain •Caregiver role strain •Readiness for enhanced parenting •Chronic low self-esteem •Compromised family copingInterventions applied to Family Dynamics•Family psychoeducation •Advanced practice interventions (Cognitive Behavioral Therapy - CBT)Aims of Family Therapydecrease emotional reactivity, strengthen communication, and encourage personal differentiation.Which comments by a nurse demonstrate use of therapeutic communication techniques?Why do you think these events have happened to you? I noticed your hands trembling when you told me about your accidentPurpose of Stress, Relaxation, and SpiritualityStress, coping (resilience), and spirituality Exemplar: Relaxation: progressive muscle relaxation and yogaDefinition of Spirituality"Spirituality is the most basic, yet probably the least understood, aspect of holistic nursing." ●Hard to define ●All persons are spiritual ●Spirituality and religion are NOT synonymous.Spiritualityderived from latin spiritus (breath) and relates to Greek pneuma (breath) - refers to vital spirit or soul. Essence of who we are and how we are in the world and, like breathing, is integral to our existence as human beings.What is Religion?an organized system of beliefs shared by a group of people and practices related to that system. -Because religion offers a particular structure, nurses may be more comfortable discussing spiritual concerns when they arise within an identifiable religious context rather than the broader view of spirituality.What is spiritual caregiving in Holistic Nursing?●Nurturing the spirit - the way nurses care for a nurture themselves influences the ability to function effectively in a healing role with another. ●Developing centering, mindfulness, awareness ●Listening and intentional presence ●Using story and metaphorWhat is spiritual Intervention?●Fostering connectedness ●Touching ●Praying and meditating ●Ensuring opportunities for rest and leisureStressWe all know stress, every demand causes stress in the body! It is natural. On that note, early exposures to highly stressful situations sensitizes people to stress later in life. Unknown if severe stress causes vulnerability to mental illness, or if vulnerability to mental illness influences the likelihood of adverse stress responses.Responses to Stress - Early ResponseFight-or-Flight: Aggression or Withdrawal: -Increased BP, HR, RR, and cardiac output. Some people become frozen...some people don't like the fight-or-flightGeneral Adaptation Syndrome (GAS)Selye's concept of the body's adaptive response to stress in three phases—alarm, resistance, exhaustion. 1.Alarm Stage: initial, brief, and adaptive response to the stressor. a.Sympathetic response b.Hypothalamic-pituitary-adrenal axis (HPA) 2.Resistance Stage: or, adapting stage. 3.Exhaustion Stage: attempts to resist are proved to be futile.What is distress?negative, draining energy that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue. (ex. Death of loved one, financial overload, school/work balance)What is eustress?positive, beneficial energy that motivates and results in feelings of happiness, hopefulness, and purposeful movement. (ex. Much needed vacation, playing a favorite sport, birth of a baby, new job).What is the impact of serotonin and stress?a brain catecholamine that plays an important role in sleep, mood, sexuality, appetite and metabolism. Main neurotransmitter in depression, and may medications increase availability of serotonin. During times of stress, production becomes much more active.What is stress and the Immune System?Noted that stress, through the HPA and the sympathetic adrenal medullary axes can induce immune system changes. Can make it stronger...or weaker.What are the Mediators of Stress Response?-Perception -Individual temperament -Social support -Support groups -Culture -Spirituality and religionAssessing Coping style based on 4 personal attributes?1.Health-sustaining habits (medical compliance, proper diet, relaxation, pacing oneself) 2.Life satisfactions (work, family, hobbies, human, spiritual solace, arts, nature) 3.Social supports 4.Effective and healthy responses to stressManaging Stress with Relaxation TechniquesPoor management of stress has been correlated with number of physical and emotional conditions. There are alternatives for stress relief... -Biofeedback -Deep breathing exercises -Guided imagery -Progressive relaxation -MeditationWays to relax?-Exercise -Cognitive reframing -Journaling -Humor!Immune Response and Effect of Acute StressActive Immune Surveillance Innate/adaptive immune response Efficient clearance of activating agents Resolution ImmunoPathology - Local and Systemic Inflammatory mediators increase In self Allergen/Antigen Response.Immune Response and Effect of Chronic StressIn self antigen response Autoimmune response Allergen induced immune activation ImmunosuppressionHealth outcomes related to Acute StressBeneficial: Removal of pathogens, efficient healing, resolved inflammation, resistance to infection and cancer Harmful: Inflammatory diseases, autoimmune disease, low grade chronic inflammation.Health outcomes related to Chronic StressHarmful: Inflammatory diseases, autoimmune diseases, chronic inflammation, decreases in efficient healing, removal of pathogens, resistance to infections. Beneficial: Pro-Inflammatory diseases, Autoimmune diseases, Low grade chronic inflammation.The Communication ProcessAn interactive process between two persons who send and receive messages to on anotherCommunication - StimulusOne person has a need to communicate to another.Communication - SenderThe personal initiating interpersonal contact.Communication - Messageinformation sent or expressed.Communication - Channelauditory, visual, smell, tactile, or combo.ReceiverPerson who receives and interprets the message and responds to sender by providing feedback.Peplau's Two Main Principles for Guiding CommunicationClarity - ensures that the meaning of the message is accurately understood by both parties "as the result of joint and sustained effort of all parties concerned" Continuity - promotes connections among ideas "and the feelings, events, or themes conveyed in those ideas"What can affect CommunicationPersonal - Patients may have difficulty communicating due to psych disorder. Cultural differences, even with interpreters. Also cognitive. Environmental - Background noise, alarms, lack of privacy, lack of comfort. Relationship - Level of inequality. When two people are friends/colleagues the relationship is symmetrical.Verbal vs. Non-VerbalVerbal - Spoken Non-Verbal - tone, emphasis, cadence, body language.Double Blind Communicationcharacterized by two or more mutually contradictory messages given by a person in power.Therapeutic Communication TechniquesSilence - Not everyone wants a response or answer. Silence can allow for processing and ability to verbalize how one feels. Active Listening - Actively listening to how someone feels. Try not to always be on computer or only doing tasks entire time. Clarifying - Paraphrasing, Restating, Reflecting, Exploring, etcNon-Therapeutic Communication TechniquesExpressive Questioning - Asking too many questions, especially unrelated ones. Asking "why" Giving Advice - People likely are not looking for advice but are looking to vent. Not everything needs a solution, sometimes it just needs to be discussed for the patient to get it off their chest. Giving Approval/Disapproval - It is not your job to approve or disapprove of someone else's situation. This is likely not why they are telling you things.Cultural Considerations•Communication style •Use of eye contact •Perception of touch •Cultural FiltersInformation Communication Technology: AppsSuicide Safe - helps integrate suicide prevention strategies into practice and addresses risk among patients. Knowbullying - provides info and guidance on ways to prevent bullying and build resilience in children. Talk.They Hear You - interactive game for parents and caregivers to prep for important conversations (ie underage drinking)Clinical interviewThe nurse will employ active listening to better understand the patient's situation. •Prepping: think of your pace, the setting, seating. •Introductions •Initiating the InterviewHow does knowledge of communication and interviewing techniques and foundational Nursing interrelate?Knowledge of communication and interviewing techniques is the foundation for developing any nurse-patient relationship. Goal-directed professional communication is referred to as therapeutic communication.Which factors can minimize or enhance communication?Several factors can minimize, enhance, or otherwise influence the communication process: culture, language, knowledge level, noise, lack of privacy, presence of others, and expectation.Suicide IdeationThinking about personal death. Including the wish to be dead, considering methods of accomplishing death, and formulating plans to carry the act out.Suicideintentional act of killing self by any means.Suicide Attemptany act with intention of death whether or not fatal.Completed Suicideself injurious acts results in their death.ComorbiditiesPsychiatric disorders are risks factors for suicide because these disorders are present at the time of 90% of completed suicides (American Foundation for Suicide Prevention, 2015).Comorbidities - Depressionmost commonly associated with suicide, and approx 50% of those who commit suicide experienced depression at time of death.Comorbidities - PTSDAnorexia and PTSD patients have a greater risk for suicide as well. •Loss of relationships, financial issues, and impulsivity are also common in this population.Comorbidities - Schizophrenia•Schizophrenia pts have eight-fold increased risk. •Many pts who commit suicide have alcohol in their system at time of death. This is a depressant, dulls the senses.Risk Factors of Suicide - Biological•May run in families. •Serotonin levels.Risk Factors of Suicide - Psychological•Cognitive styles of thinking such as all-or-nothing thinking, inability to see different opinions, and perfectionism.Risk Factors of Suicide - Environmental Factors•Copycat Suicide follows a highly publicized suicide of a prominent figure/idol/peer. Societal FactorsRisk Factors of Suicide - Cultural•Religious beliefs •Family values •Sexual orientation •In 2013 race was a significant factor in deaths by suicide in the US.Suicide Rates amongst Ethnicities/CulturesSuicide rates highest among whites. In 100,00 people, •11.7 Native American/Alaska Natives •6 Asian/Pacific Islanders •5.3 Hispanic •5.4 African AmericansImportant Risk Factors of SuicideHistory of Substance Abuse, Physical Disability or Illness, Losing a friend or family member to suicide, Exposure to Bullying behavior, Mental Health conditions, recent death/loss, access to harmful means, relationship problems, previous suicide attempts.Warning Signs of Suicide1. Talking about feelings of hopeless or having no reason to go on living 2. Making a wall or giving away personal possessions 3. Exhibiting Reckless behaviors, such as excessive alcohol or drug consumption. 4. Avoiding social interactions with others 5, Expressing Rage or intentions to seek revenge 6. Appearing anxious or agitated.Lethality: indicates how quickly a person would die by that mode, and you can use this to decide risk level.Interventions for SuicidePrevention is a primary intervention and includes activities that provide support, information, and education to prevent suicide. Safety Plan: 6 step plan that includes warning signs, coping mechanisms, people/places of distraction, how to find help..6 Step Plan to overcome Suicide1. Warning Signs 2. Internal Coping Strategies 3. People and Social Settings for Distraction 4. People to contact for help 5. Professionals/Agencies to Contact 6. Making the Environment SafeInterventions for Suicide PreventionIntervention Pharmacological Interventions: antidepressants, antipsychotics, anti-anxiety meds. Somatic Interventions: ECT (electroconvulsive therapy) - need to really weight benefit vs risk. Health Teaching/Promotion Case ManagementWhat is non-suicidal self-injury?Self-injury that are deliberate and direct attempts to inflict shallow, yet painful injuries to the surface of the body without intention of ending one's life. For these behaviors to be significant, they usually last about a year and happen repeatedly. Majority of self-injurers do not seek help. This can also be used as self-punishment.Statistics around Suicide13-23% - ESTIMATED amount of adolescents that engage in self-injurious behavior. 17-35% - Of 20 to 29 year olds who report engaging in the behavior. 6% - Of the US population has engaged in this behavior at some time in their life.Comorbidities of Suicide•Depression •Anxiety •Eating disorders •Substance use disordersRisk Factors of Suicide•Biological: dopamine, serotonin and norepinephrine are affected. •Societal: learned behavior from peers and try it themselves.Cycle of Self-Injury>>Negative thoughts>>Tension Building>>Urge to Act>>Action>>Relief>>Guilt/Shame>>Self Harm is notSuicide but it may become suicidePlan of Care for Individuals with Suicide Ideationa caring attitude towards the patient, bearing hope of recovery, observing signs of self-harm, and evaluating need of medication. •Limit setting for safety. •Developing self esteem. •Discovery of motive for self injury/role it served •Learning self injury can be self-controlled. •Replacing injury with coping skills. •Entering a maintenance phase.Nursing Intervention for Suicide•Care for wounds injuries. •Establish therapeutic alliance. •Teach coping skills. Advanced therapies are cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and group therapy.Which example of behavior in a family system demonstrates double bind communication?. A wife tells her husband, "You go ahead with your bowling trip. Try not to worry about me falling on my crutches while I'm alone at home."The nurse is admitting a patient to the hospital. The patient states that he is a very spiritual person but does not practice any specific religion. The nurse understands that these statements:Are reasonable.Which statement by a depressed patient will alert the nurse to the patient's need for immediate, active intervention?"I have no one to turn to for help or support."A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention, and the rationale for this action?Placing this client on one-to-one suicide precautions because the more specific the plan, the more likely the client will attempt suicideThe treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the team's decision?Able to participate in a plan for safety; family agrees to constant observationAfter years of dialysis, an 84-year-old states, "I'm exhausted, depressed, and so over these attempts to keep me alive." Which question should the nurse ask the spouse when preparing a discharge plan of care?"How often is your spouse left alone?"Which statement made by the nurse demonstrates the best understanding of non-verbal communication?"When my patient responds to my question I chekc for congruence between verbal and non-verbal communication to validate the reponse"Which nursing statement is an example of reflection?"You look sad"When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient?Change of shift reportDuring an admission assessment and interview, which channels of information communication should the nurse be monitoring? SATA a. auditory b. visual c. Written d. Tactile e. OlfactoryA. b. d. e. - Auditory, visual, tactile, and olfactoryWhich principle about the nurse-patient communication should guide a nurses fear about "saying the wrong thing" to a patient?Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic? a. "A new psychiatrist is a chance to start fresh; I'm sure it will go well for you." b. "You say you look forward to the meeting, but you appear anxious or unhappy." c. "I notice that you frowned and avoided eye contact just now. Don't you feel well?" d. "I get the impression you don't really want to see your psychiatrist—can you tell me why?"B. "You say you look forward to the meeting, but you appear anxious or unhappy."Which student behavior is consistent with therapeutic communication?Summarizing the essence of the patients comments in your own wordsJames is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, "Last night, demons came to my room and tried to rape me." Which response would be most therapeutic? a. "There are no such things as demons. What you saw were hallucinations." b. "It is not possible for anyone to enter your room at night. You are safe here." c. "You seem very upset. Please tell me more about what you experienced last night." d. "That must have been very frightening, but we'll check on you at night and you'll be safe.""You seem very upset. Please tell me more about what you experienced last night."Therapeutic communication is the foundation of a patient centered interview. Which of the following techniques is NOT considered therapeutic?Asking why questionsCarolina is surprised when her patient does not show up for a regular scheduled appointment. When contacted the patient states "I don't need to come see you anymore." I have found a therapy app on my phone that I love. How should Carolina respond?That sounds exciting, would you be willing to visit and show me the app?What assessment question is focused on identifying a long-term consequence of chronic stress on physical health? a. "Do you have any problems with sleeping well?" b. "How many infections have you experienced in the past 6 months?" c. "How much moderate exercise do you engage in on a regular basis?" d. "What management techniques do you regularly use to manage your stress?"B. How many infection have you experienced in the past 6months.Which nursing assessments are directed at monitoring a patient's fight-or-flight response? Select all that apply. a. Blood pressure b. Heart rate c. Respiratory rate d. Abdominal pain e. Dilated pupilsA.b.c.E - BP, HR, RR, Dilated PupilsThe patient you are assigned unexpectedly suffers a cardiac arrest. During this emergency situation, your body will produce a large amount of: a. Carbon dioxide b. Growth hormone c. Epinephrine d. AldosteroneEpinephrineWhich question is focused on the assessment of an individual's personal ability to manage stress? Select all that apply. a. "Have you ever been diagnosed with cancer?" b. "Do you engage in any hobbies now that you have retired?" c. "Have you been taking your antihypertensive medication as it is prescribed?" d. "Who can you rely on if you need help after you're discharged from the hospital?" e. "What do you do to help manage the demands of parenting a 4-year-old and a newborn?"B.D.E. - Do you engage in any hobbies now that you have retired? Who can you rely on if you need help after you're discharged? What do you do to help manage the demands of parenting a 4 y/o newborn.When considering stress, what is the primary goal of making daily entries into a personal journal? a. Providing a distraction from the daily stress b. Expressing emotions to manage stress c. Identifying stress triggers d. Focusing on one's stressC. Identifying Stress TriggersJackson has suffered from migraine headaches all of his life. Fatima, his nurse practitioner, suspects muscle tension as a trigger for his headaches. Fatima teaches him a technique that promotes relaxation by using: a. Biofeedback b. Guided imagery c. Deep breathing d. Progressive muscle relaxationD. Progressive Muscle RelaxationHugo is 21 and diagnosed with schizophrenia. His history includes significant turmoil as a child and adolescent. Hugo reports his father was abusive and routinely beat him, all of his siblings, and his mother. Hugo's early exposure to stress most likely: a. Made him resilient to stressful situations b. Increased his future vulnerability to psychiatric disorders c. Developed strong survival skills d. Shaped his nurturing natureB. Increased his future vulnerability to psych disordersHugo has a fraternal twin named Franco who is unaffected by mental illness, even though they were raised in the same dysfunctional household. Franco asks the nurse, "Why Hugo and not me?" The nurse replies: a. "Your father was probably less abusive to you." b. "Hugo likely has a genetic vulnerability." c. "You probably ignored the situation." d. "Hugo responded to perceived threats by focusing on an internal world.B. "Hugo likely has genetic vulnerability."First responders and emergency department healthcare providers often use dark humor in an effort to: a. Reduce stress and anxiety b. Relive the experience c. Rectify moral distress d. Alert others to the stressA. Reduce Stress and AnxietyYour 39-year-old patient Samantha, who was admitted with anxiety, asks you what the stress-relieving technique of mindfulness is. The best response is: a. Mindfulness is focusing on an object and repeating a word or phrase while deep breathing. b. Mindfulness is progressively tensing, then relaxing, body muscles. c. Mindfulness is focusing on the here and now, not the past or future, and paying attention to what is going on around you. d. Mindfulness is a memory system to assist you in short-term memory recall.C. Mindfulness is focusing on the here and now, not the past or future and paying attention to what is going on around you.Your 24-year-old patient is planning to leave the family to start a new job in a city 400 miles away. Which statement made by the patient best demonstrates a healthy sense of family support? a. "I've always been independent. That's how I was raised." b. "If I get in trouble financially, I know mom and dad will help me out." c. "I don't need anyone's help. Everyone has their own problems to deal with." d. "I'm going to miss everyone terribly, but I know they will support me in this decision."D. "I'm going to miss everyone terribly, but I know they will support me in this decision."A nurse works with patients whose families are attending family therapy. The nurse should recommend psychoeducational family therapy for which family? a. A family whose members have problems establishing and respecting boundaries. b. A family whose teenaged children are routinely making major family decisions. c. A family whose 18-year-old son has been diagnosed with schizophrenia. d. A family who communicates primarily using dysfunctional techniques.c. A family whose 18-year-old son has been diagnosed with schizophrenia.A 10-year-old shares that he doesn't like spending weekends with his father "now that dad's girlfriend moved in." The nurse will discuss the issues with the child and parents based on an understanding of the stresses present in which type of family structure? a. Unmarried biological b. Cohabitating c. Blended d. OtherB. CohabitatingWhich statement is an example of a parent demonstrating the dysfunctional communication technique of generalizing? a. "I want to be a good mother, but my husband just isn't involved with the kids." b. "I keep the peace by seldom asking any of the family to help with chores." c. "My wife's priorities are the kids, her parents, and then her job." d. "The kids never listen to me even when I threaten them."d. "The kids never listen to me even when I threaten them."Just before you escort the Juarez family in for a meeting, their 17-year-old son confides to you that he is gay. He says he has not told any other adult, including his parents. What is your best response to him? a. "Your parents have a right to know about this." b. "How do you think your parents would react if you told them?" c. "That's your decision, but you need to be careful about risky sexual behavior." d. "Lots of famous people are gay. You don't need to worry."b. "How do you think your parents would react if you told them?"When performing an intake assessment on a family, you wish to map the family's structure and information that reflect both the family's history and current functioning. This assessment tool is called a: a. Mini-mental status exam b. Beck depression inventory c. Genogram d. Histogramc. GenogramWhile you are working with a family whose son was admitted due to a psychotic break, you observe the mother say to her son, "What, no hug for your Mom?" As the son embraces his mother, she stiffens, which results in the young man backing away. She responds, "You only care about yourself." What behavior is this mother engaging in? a. Triangulation b. Scapegoating c. Double binding d. Differentiationc. double bindingWhich of the following family members should you refer to individual therapy rather than family therapy? a. A mother who has anxiety controlled by medication. b. A father who is questioning his sexuality. c. A son who is verbally abusive toward his parents. d. A daughter who has been treated for alcohol use disorder.b. a father who is questioning his sexualityYou are evaluating the family therapy experience. Which behavior would indicate that further family therapy is needed? a. Wife talks to her husband through their children. b. Son's grades have risen from a "D" average to a "C" average. c. Daughter's headaches have subsided. d. Mother has stopped using illicit substancesa. Wife talks to her husband through their childrenEmotional support is an important family dynamic because it allows family members to: a. Feel secure enough to explore aspects of their personality. b. Feel isolated and fearful even though family members are near. c. Grow without boundaries within the family unit. d. Have bursts of anger without recourse or shamea. feel secure enough to explore aspects of their personality.Which patient statement does not demonstrate an understanding of a suicide safety plan? a. "Going for a really long, hard run helps clear my mind and stops the suicidal thoughts." b. "I will take extra medication if I start getting those self-destructive feelings." c. "My sister is always there for me when I start getting suicidal." d. "I keep the suicide prevention phone number in my wallet."b. "I will take extra medication if I start getting those self-destructive feelings."Which interventions will help make the environment on the unit safer for patients with suicidal ideation? Select all that apply. a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected. d. Patient doors are kept open. e. Staying within listening distance of the patient.a.b.c.d. a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected. d. Patient doors are kept open.What are the nursing responsibilities to a patient expressing suicidal thoughts? Select all that apply. a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication. e. Discussing triggers of depression.a.b.c.d. a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication.When considering community suicide prevention programs, what population should the nurse plan to service with regular suicide screenings? Select all that apply. a. 10- to 34-year-olds b. Males c. College-educated adults d. Rural population e. Native Americana.b.e. a. 10- to 34-year-olds b. Males e. Native AmericanResearch supports that which intervention implemented on a long-term basis significantly reduces the incidence of suicide and suicide attempts in a patient diagnosed with bipolar disorder? a. An antipsychotic medication b. Electroconvulsive therapy (ECT) c. One-on-one observation d. Lithiumd. LithiumGladys is seeing a therapist because her husband died by suicide 6 months ago. Gladys tells her therapist, "I know he was in pain, but why didn't he leave me a note?" The therapist's best response would be: a. "He probably acted quickly on his impulse to kill himself." b. "He did not want to think about the pain he would cause you." c. "He was not able to think clearly due to his emotional pain." d. "He thought you may think it was an accident if there was no note."c. "He was not able to think clearly due to his emotional pain."Martin is a 23-year-old male with a new diagnosis of schizophrenia, and his family is receiving information from a home health nurse. The topic of education is suicide prevention, and the nurse recognizes effective teaching when the mother says: a. "Persons with schizophrenia rarely die by suicide." b. "Suicide risk is greatest in the first few years after diagnosis." c. "Suicide is not common in schizophrenia due to confusion." d. "Most persons diagnosed with schizophrenia die of suicide."b. "Suicide risk is greatest in the first few years after diagnosis."Sigmund Freud, Karl Menninger, and Aaron Beck theorized that hopelessness was an integral part of why a person ends one's life by suicide. A more recent theory suggests suicide results from: a. Elevated serotonin levels b. The diathesis-stress model c. Outward aggression turned inward d. A lack of perfectionismb. The diathesis-stress modelWhich person is at the highest risk for suicide? a. A 50-year-old married white male with major depressive disorder who has a plan to overdose if circumstances at work do not improve. b. A 45-year-old married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide once as a teenager. c. A young single white male who misuses alcohol, is hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden. d. An older Hispanic male who is Catholic, living with a debilitating chronic illness, recently widowed, and who states, "I wish that God would take me too."c. A young single white male who misuses alcohol, is hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden.Kara is a 23-year-old patient admitted with major depressive disorder and suicidal ideation. Which intervention(s) would be therapeutic for Kara? Select all that apply. a. Focus primarily on developing solutions to the problems that lead the patient to feel suicidal. b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate. c. Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings.b.d.e.f. b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.When should an assessment be conducted for suicide?- At intake for any patient with a psychiatric complaint - history of non-suicidal self-injuries - previous suicide attempt - mental illness/diagnosis or substance use disorder - When a patient experiences sadness, low mood - recent loss or hopelessness or having no purpose - When a patient acts anxious, agitated, or reckless or shows rage and talks about seeking revenge - When a patient displays extreme mood swings - At each subsequent session as long as the patient remains at risk - Any time a patient has any other identified potential risk factorsWhat to document during each assessment?Document each assessment while the patient remains at risk and include: Findings • Risk factors• Interventions to contain, manage and mitigate risk.What are the elements for assessing suicide?There are two elements to assess: Elicitation of suicidal ideation & Identification and weighing of risk factorsHow do I assess ideation and risk?At minimum, ask directly for presence and nature of suicidal thoughts. • Determine frequency and circumstances; characterize thoughts as passive ideation ("I would be better off dead") or active ideation with a plan ("I am planning to shoot myself") • Make use of available assessment tools, e.g., the Scale for Suicide Ideation (SSI), Beck Scale for Suicide Ideation (BSS) or Columbia-Suicide Severity Rating Scale (C-SSRS) • Determine if there is current intent or a plan • Ask for plan details, including rehearsals • Determine if there's a history of thoughts, wishes, impulses, self-injuries or suicide attempts • Assess availability and lethality of means • Assess attitude, beliefs and values about suicide • Ask patient about barriers to suicide, reasons for living and dying • Consider and be sensitive to the different cultural views regarding suicide • Determine if anything is different this time that will raise or lower risk • Determine if patient shared ideation with anyone • Identify any support person who might be helpful in reducing the risk.How do we weigh risk factors?Patients are at greater risk for suicide if they have experienced: • Psychiatric hospitalization within the past year • More than one risk factor (increases risk of suicide) • Recent discharge from inpatient psychiatric unit, emergency department, or residential addiction treatment • Lack of treatment access, discontinuities in treatment, or fragmented care • Active psychotic symptoms • Depression; bipolar disorder, alcohol and other substance use disorder; schizophrenia; borderline personality disorder; psychopathology with psychotic symptoms, or dementia accompanied by depression • Depressive disorders accompanied by anxiety • Nonadherence to medication treatment for schizophrenia/psychosis • Abrupt discontinuation of Lithium treatment • Recent or impending loss • Stressful life events, such as divorce, loss of a job • Early separation from the military • History of impulsive or self-destructive behavior • Access to firearms or other lethal means • Past suicidal behavior, previous suicide attempts, or repeated self-harm • Family history of suicideHow do we manage a suicidal patient?If risk does not appear severe and imminent: • Mitigate, eliminate risk factors • Strengthen barriers and reasons for not committing suicide • Develop outpatient safety plans, including a family support plan • Establish a therapeutic alliance • Treat underlying disorderWhat are the top high-risk diagnoses for completed suicides?• Depression, especially with psychic anxiety, agitation and/or significant insomnia • Bipolar disorder • Alcohol and other substance use disorders • Schizophrenia • Borderline personality disorder • Psychotic symptoms accompanied by psychopathology • Dementia accompanied by neuropsychiatric symptoms of depression and over the age of 60.Tips for Diffusing Angry Patients1. Stay Safe 2. Check in with your own emotions 3. Show Empathy 4. Show Respect 5. Allow them to vent 6. Use effective questioning techniques 7. Determine If You Played A Role And Take Responsibility 8. Is the problem habitualWhat is scapegoating?it's another way of dealing with problems in society. Instead of taking responsibility to make things better, you blame someone else instead!. This behavior has negative consequences like being more aggressive and violent. aggression, scapegoating can be destructive to a person's health and vitality and may damage their confidence, relationships and mental health. People with narcissistic personalities often blame their bad behaviour on their marriage partner.Examples of scapegoatingThe purpose of a scapegoat is to pass responsibility onto someone else. Dont accept liability, "They made Jennifer the scapegoat, but it wasn't all her fault."