mental health chp 3, 7 (week 2)

What is autonomy?

Right to determine their own destinies

What is benficience?

Duty to benefit or promote the good of others

What is non-maleficence?

To do no harm

What is justice?

All individuals should be treated equally and fairly

What is veracity?

Duty to always be truthful

What are ethical and legal issues in psychiatric mental health nursing?

- The right to treatment

- The right to refuse treatment

- The right to the least restrictive treatment alternative (counseling and outpatient treatment)

What are exceptions to HIPAA?

- Protecting the third party (Tarasoff Law)

- Suspected child or elder abuse (mandated reporter)

When can treatment be performed without informed consent?

- Patient is not mentally there to make sound decisions and treatment is needed to maintain safety

- When the patient is a child (consent from a legal guardian)

When can patients not refuse treatment?

When they are continuously showing they are a danger to themselves or others

When can providers override treatment refusal?

When patients are actively suicidal or homicidal

Why are restraints and seclusion controversial?

Can reduce trust from patient and produce trauma responses

What is the sequence of interventions for a crisis?

1. Verbal redirection to ground the patient

2. Stat PO antipsychotic (Ativan)

3. Emergency IM through the butt

4. Physical restraint

What is false imprisonment?

Illegally preventing patient from leaving the hospital

What are types of restraints?

- Chemical

- Physical

- Seclusion

What are types of physical restraints?

- 2 point: two limbs

- 4 point: four limbs

- Walking: patient can walk with hands cuffed

What is a chemical restraint?

Emergency IM cocktail (benadryl, ativan, haldol)

When do physical restraint orders expire?

- Adult: 4 hours

- Kids: 2 hours

What is required when using restraints?

Doctors order (considered false imprisonment without order)

What are nursing considerations for restraints?

- Use your judgement to determine if restraints can be taken off

- Assess the patient every 15 minutes: behavior, vitals, skin, bathroom, and water

- 1:1 monitoring (physical restraints)

What is the process of writing a hold?

- Must be LPS certified to write one: doctors, nurses, social workers, and cops

- Evaluate and assess patient

What are reasons for involuntary hospital admission?

- Danger to self (DTS): actively suicidal and engaging in hurting yourself

- Danger to others (DTO): threatening to hurt/kill someone and actively harming someone

- Gravely disabled (GD): cannot care for themself (food, clothes, or shelter)

What are the different hold lengths?

- 72 hour hold (5150)

- 14 day hold (5250)

- 30 day hold (5270)

What are nursing responsibilities regarding hospital holds?

- Acknowledge hold

- Monitor expiration date

- Understand hold status

What is a probable cause hearing (PCH)?

- Determines if patient has probable cause of staying at the hospital

- The court decides if the patient hold is still legal (patient can leave against medical advice)

What is a Riese petition hearing?

- Determines if patient is able to say no to taking medications

- Between doctor and the court

- Allows medications to be given through IM by force

What are types of law?

- Statutory: legislation (Nurse Practice Act)

- Common: court decisions/ruling (Tarasoff)

- Civil: unintentional and intentional torts

- Criminal: protection from conduct deemed injurious to the public

What are unintentional torts?

- Malpractice

- Negligence

What are intentional torts?

- Assault: threats

- Battery: unconsented touching

- Libel: written defamation of character

- Slander: verbal defamation of character

What is cognitive behavioral therapy (CBT)?

Turning negative thoughts into positive thoughts

What is the focus of cognitive behavioral therapy (CBT)?

Changing automatic thought patterns that contribute to mood and thought disturbance

What are automatic thoughts?

- Discounting positives

- All or nothing

- Mind reading

- Personalizing

What is discounting positives?

- Fixated on the negatives only

- "Even though I got the promotion, it was probably because no one else wanted the job"

What is all or nothing?

- Black or white thinking: minor inconvenience is the end of the world

- "I'm a failure at everything I do"

What is mind reading?

- Making assumptions as to what is going on in somebody's head

- "He thinks I'm foolish"

What is personalizing?

- Taking things too personal/serious

- "I'm the only one who failed"

What is dialectical behavior therapy (DBT)?

- Focuses on learning how to actively regulate behavior

- More action based to bring you back to reality/present

What are examples of dialectical behavior therapy (DBT)?

- Rubber band

- Grounding techniques: 5, 4, 3...

- Practicing mindfulness: journaling

What is milieu therapy?

Maintaining a safe and therapeutic vine by manipulating the environment

What are the elements of milieu therapy?

- Containment

- Structure

- Involvement

- Support

- Validation

What is containment?

Create a sense of safety and security

What is structure?

Patients know what, when, and where activities are taking place to feel in control and have something to look forward to

What is involvement?

Develop a sense of social community to see how the patient is progressing

What is support?

Offering emotional support and reinforcing expectations by promoting supportive interaction and redirecting patients

What is validation?

Support and affirm the needs of the individual by active listening and promoting autonomy

What is the role of the nurse in milieu therapy?

- Assessment of the patient's condition to see how they're progressing in their treatment

- Medication administration

- Establishing rapport and developing relationships