Need to know from each module

Importance of actively listening

-using empathy and SOLAR during interactions

-giving the pt your full attention and tryiing to understand what they are saying both verbally and nonverbally

Empathy

*ability to understand and acknowledge another persons feelings without judging them

“It sounds like youre feeling really alone right now”

Empathy is different than sympathy (sympathy focusses of the nurses emotiuonal reaction and can shift attention away from the patient)

Avoid: why questions= “Why are you upset” instead do “Can you tell me what is upsetting you”

How to demonstrate active listening

-maintain eye contact, avoid interrupting, remain silent when appropriate, observe facial expressions, use SOLAR

*matters because it helps to build trust and the nurse to identify emotional distress/risks and unmet needs

different phases of a therapeutic interaction Peplau

Preorientaion

Preorientation= nurse prepares for the interaction, might review the medical chart, idenfity biases, and plan how to establish a therapeutic relationship

*self awareness and preparation

Peplau orientation

-introduce yourself and explain the role

-establish trust and identify the clients concerns

-set boundaries and expectations

*trust/boundaries and goal settings

Peplau working phase

-trying to make progress toward goals

-encouraging expression of feelings and promoting insight, encourage independence

Peplau termination

-ending the relationship

-review goals and accomplishments

peplau phases

preorientation= prepare

orientation= establish trust

working= make progress

termination= ending relationship and reviewing progress

Therapeutic communication

want to build trust and rapport with patient

Transference

CLIENT to NURSE

-pt transferring feelings and attitudes towards nurse

-can be positive or negative

*postive= pt sees the nurse as caring and trustworthy because they remind the pt of someone they love

*negative= pt becomes angry or distrustful because the nurse reminds them of someone who hurt them

Countertransference

*NURSE to CLIENT

-nurses past or unresolved medications influencing feelings toward client

Milieu

thereapeutic environement of a mental health unit

-includes the physical setting, relaitonships, routines, rules, and interactions that support patients recovery

*Safety= protect staff, client, and visitors from physical harm, Safety comes before other goals

*Structure= maintaining routines and having therapeutic activites, helps to decrease anxiety

*Norms= estbalish shared expectations for appropriate behavior, explalining unit roles, model healthy communication, helps clients learn socially appropriate behaviors

*Limit setting= establish clear boundaries for unsafe or inappropriate behavior, state expectations calmly and clearly, reamin consistent and nonjudgmental

*Balance= maintain a balance between individual needs and the needs of the group

Nurse as manager of the milieu

• monitoring the emotional and physical safety of the unit

• setting limits and enforcing rules

• encouraging participation in therapeutic activities

• promoting prostive relationships between clients

• deesculate situations

Mental health assessment

AKA mental status examination

Appearance

• clothing and appropriatness

• hygiene and grooming

• posture

• eye contact

• apparent age

Behavior

• slowed movements, abormal movements, agitation, coopertion

Speechj

• rate

• volume

• rhythm

Mood

• how the pt is feeling

Affect

• the nurses observatio of the clients emotional expression

• flat (no expression)

• blunted (reduced but shows something)

• restricted (limited range of emotion)

• labile (rapidly changing emotions)

• incongruent (emotional expression does not match situation or mood)

Throught process (how their thoughts are organized)

• linear/goal directed

• FOI (rapid shifts between topics)

• thought blocking (sudden interruption of thoughts)

• loose associations (thoughts shift beween ideas with little logical connection)

• Circumstantial (includes excessive detail but eventually answers orginal question

• Tangential (does NOT answer original question)

Thought content

• what are they thinking about

• delusions, obessions, phobia, SI, HI, guit

Perception

• assess for hallucicaiton and illusions

  • Types: auditory, visual, tactile (feeling things on skiin), olfactory (smell), Gustatory (tasting things)

• illusions= misinterpretation of an actual external stimulus

Cognition

• orientation

• attention and concetration

• memory

• ability to follow directions

• abstract thinking when approraite

Insight

• the client's awareness and understanding of their illness and situation

• might be poor or fairl or good

• poor= nothing wrong with me

Judgement

• the ability to make appropriate decisions and recognize consequences

• assess by asking how the client would respond to a realistic situation

Suicide and safety assessment

• SI?

• do you have a plan

• intent to act on the plan?

• access to means = do they have the material

• previous attempts

• any recent stressors

• protective factors= things that keep them here like family, pets, job

Purpose for the DSM-5

the gold standard for diagnosising

• organizes mental health disorders into diagnostic categories

• used to help diagnose mental helath disorders, it does not replace a full assessment

• helps guide treatment decisions when combinded with comphensive assesment

Lithium

levels + liquid+ low sodium = toxicity

check lithium levels, hydration, sodium

Clozapine

caution with infection

-think ANC= agranulocytosis

Haloperidol

hard muscles

-EPS, rigidity, NMS

Olanzapine

Obesity/metabolic

-weight, glucose, lipids

SSRI

Serotonin sydrome risk

setraline and proxetine

Venlafaxine

watch BP

Alprazolam

addictive and sedating

Buspirone

back burner= takes time to work, anxiety

therapeutic relationships in nursing vs formal therapy provided by advance practice nurses

-nurses iin psy do not provide therapy

-focuses on trust, support, and communication, often shorter connections, help pts feel supported

APN

-use specific approaches and use therapy

-focuses on treating mental health conditions

-planned and structured settings

Factors that influence mental health

-biological (genetics, physical health)

-psychological (coping skills, self esteem, emotional regulation, and past expereinces)

-social (family realtionships, housing, social support)

-environemental (safety, access to helathcare

-mental health is a continuum

Stigma

-negative attiude, belief, or sterotype about a person or gorup bases on characterisitc

-can delay people seeking mental health

-causes shame, embarrassment, and isolation

-decreases self esteem

-can contribute to discrimination in healthcare and employment

Nurses role in combating stigma

-use respectful language

-educate patients, familes

-encouage treatment and support without judgement

Healthy people 2030

• improve mental health and emotional wellbeing

• reduce suicide and suicide related deaths

• prevent and reduce substance use disorders

• improve early identification and treatment of mental health conditions

-is a national initiative that establishes measurable health objectives to improve the health and well-being of people in the US

Hildegard Peplau

considered founder of psychiatric mental health nursing because of her developmetn of the iinterpersonal relations theory

-nurse and pt relationship is focused on pt needs and growths

recovery model

want to focus more on recovery, patient participates in shared decision making

-focused on quality of life, stregthns, and goals

-recovery does not necessarily mean the complete absence of symptoms

-a person can recover while continuing to manage a mental health conditon

First person language

= addict = person with a substnce use disorder (not just calling someone an addict)

Psychiatric mental health nurse practitioner

-PMHNP is a APRN who provides advanced psychiatric care which may include

• psychiatric assessment and diagnosis

• medication managment

• pscyotherapy

• treatment planning and follow up

interdisciplinary treatment team

as members from various fields to provide holistic care to

patients with mental health disorders.

Self awareness

• recognizing your own feelings, beliefs, biases, values

self reflection

• examining your expeiriences and responses to understand how they affect your nursing practice

Self care for mental health nurses

• getting good sleep and nutrition

• taking breaks and using time off

• setting professional boundaries

• seeking supervision and peer support

• practiticing stress managment techniques

• recognizing signs of burnout

Why might someone get admitted to a facility for mental health

• danger to themselfves

• danger to others

• unable to take care of themselves

ANA standards and code of ethics

the american nurses association establishes professional standards and ethical guidance for nursing practice

*ANA code of ethics outlines the nurses eithical responisbility to patients, the profession, and socieity

• autonomy= respect pts rights to make decisions

• beneficence= to do good by pt

• Nonmaleficence= avoid causing harm to pts

• Malpractice= professional negligence

• Negligence= failure to do or not to do what a reasonable person would do under the circumstances

Rights of all pts

Maintain civil rights, right to tx plan, refuse tx (except in emergencies or court-

ordered), and to be in the least restrictive environment.

involuntary admission

occur when emergency care is needed. Patient is dangerous to self or others or

is unable to provide for basic needs. Hospitalization against one’s will and also called a 3DH or 72 hr. hold. Client still retains all rights.

--did not admit themselves

-within 3 court days/72 hours

• pt signs themselves in as voluntary

• pt is discharged after being evaluated by admiting psychiatrist that pt is no longer in danger

• by end of 72 hours, psychiatrist files affidavit with probate court—probate court schedules hearing held and eiither pt is discharged, or pt is probated by court; then next hearing will be scheduled (have to stay)

Voluntary admission

ccur when the patient agrees, gives informed consent for admission and retains

all rights. Client has a right to demand and obtain release however doesn’t necessarily mean they will be discharged. Nurse must alert physician if requested.

Probate

judicial commitment. Involuntary patients have the same rights as voluntary patients

Confidentiality in mental health

A priority in mental health care. Release of Information (ROI) is needed to give

information about admission.

Warn and protect

a nurses duty is to warn and protect

*if pt is threatening someone that person needs to be warned

Malpractice

professional negligence

Negligence

is failure to do or not do what a reasonable person would do under the circumstances.

Elements to establish negligence include: duty to care, reasonable care (standard of care), breach of

duty, and injury caused by a breach of duty

assault, battery, and false imprisionment

*threatening to force meds = assault

*touching without consent-= battery

*unlawful restraint= false imprisionment

milieu

safety, support, limit setting, norms, balance, maintance