Psychiatric Mental Health Nursing Review

Flashcards covering key vocabulary and concepts from the lecture notes.

Healthy People 2030 objectives related to General Mental Health and Mental Disorders

Increase treatment for individuals with both substance use and mental health disorders; Increase depression screening during primary care visits for adolescents and adults.

Healthy People 2030 objectives related to Adolescents

Increase: treatment for adolescents with depression, treatment for children and adolescents with trauma symptoms, treatment for children and adolescents with serious emotional disturbances.

Healthy People 2030 objectives related to Cancer

Improve quality of life for cancer survivors.

Healthy People 2030 objectives related to Children

Increase appropriate treatment for children and adolescents with ADHD, general mental health problems, autism spectrum disorder (by age 4), anxiety or depression, behavior problems; Increase preventive mental health care provided in schools.

Healthy People 2030 objectives related to Hospital and Emergency Services

Reduce ER visits related to nonmedical use of prescription opioids.

Healthy People 2030 objectives related to Injury Prevention

Reduce suicide rates; Reduce suicide attempts among adolescents.

Healthy People 2030 objectives related to LGBT

Reduce suicidal thoughts in lesbian, gay, or bisexual high school students and transgender students.

Healthy People 2030 objectives related to Parents or Caregiver

Reduce anxiety and depression in caregivers of people with disabilities.

Healthy People 2030 objectives related to People with Disabilities

Reduce delays in preventive care due to cost and serious psychological distress in adults with disabilities.

Healthy People 2030 objectives related to Pregnancy and Childbirth

Increase the proportion of women who get screened for postpartum depression.

Healthy People 2030 objectives related to Schools

Increase the proportion of public schools with a counselor, social worker, and psychologist.

Objective for Reducing Mental Health Issues

Reduce emergency department visits for nonfatal intentional self-harm injuries.

Mental Health Status Improvement Objectives

Reduce the suicide rate, suicide attempts among adolescents, disordered eating behaviors in adolescents attempting to control weight, and the prevalence of major depressive episodes.

Treatment Expansion Objectives

Increase mental health treatment availability in primary care settings, treatment for children with mental health issues, mental health screening in juvenile residential facilities, employment among individuals with serious mental illness, treatment for adults with mental health disorders, integrated treatment for co-occurring substance use and mental health disorders, depression screening by primary care providers and for youth during primary care visits, and access to mental health services for homeless adults.

Key Components of New Freedom Commission on Mental Health

Mental health is recognized as essential to overall health; Care is consumer- and family-driven; Eliminate disparities in access to and quality of mental health services; Promote early screening, assessment, and referral as routine practices; Ensure high-quality mental health care and accelerate research efforts; Utilize technology to improve access to care and mental health information.

Hildegard Peplau's Contributions to Nursing

Introduced concepts of interpersonal relations and the therapeutic relationship in psychiatric–mental health nursing; Viewed nursing practice as independent from physicians; Advocated for the use of self as a therapeutic tool in nursing; Developed the first graduate psychiatric nursing program in 1954 at Rutgers University; Contributed to the advancement of psychiatric nursing education.

Mental Health

A universal condition that shapes the way we think, feel, and communicate; A state of well-being where the individual realizes their abilities, can cope with life’s normal stresses, can work productively, and can contribute to society.

Conditions Managed by Psychiatric Nurses

Psych nurses manage co-occurring mental health and substance use disorders, co-occurring mental health and physical health disorders; manage alterations in cognition and functioning due to psychological or physiological distress; address psychological and physiological distress caused by trauma, neglect, or environmental factors; treat complex clinical presentations influenced by poverty and toxic environments; support individuals with altered self-concept; address isolation and difficulties in interpersonal relationships; prevent and treat self-harm; respond to violent behaviors; improve health literacy.

Impact of World War II on Mental Health Views

Began to be seen as something that could affect anyone; Volunteers were disqualified from military service due to psychological unfitness; Veterans developed psychiatric and emotional problems.

1946: National Mental Health Act

Created the National Mental Health Advisory Council; Established the National Institute of Mental Health (NIMH); Provided federal grants to existing outpatient facilities and for the development of new outpatient programs.

Hill–Burton Act

Provided federal funding for hospital construction; Expanded psychiatric units in general hospitals.

Recovery from mental disorders and/or substance use disorders

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Recovery-oriented treatment

Is based on the belief that mental illnesses and emotional disturbances are treatable and that recovery is an expectation.

Four dimensions that support recovery

Health, home, purpose and community

Stigma

Prevents many individuals from seeking or continuing mental health treatment; Contributes to discrimination, social isolation, and human rights violations against people with mental illness.

Definition of Stigma

A dynamic social/interactional process where individuals are: Labeled as different; Linked to negative stereotypes, leading to social distancing and exclusion.

Public Stigma

Occurs when individuals are publicly identified as having a mental illness; leads to prejudice and discrimination; common stereotypes include dangerous, unpredictable, incompetent.

Self-Stigma

When individuals internalize public stereotypes; leads to low self-esteem and beliefs like 'I must be incompetent.'

Label Avoidance

Avoiding treatment to escape being labeled or stigmatized.

Combating Stigma

Contact with people who have mental illness helps reduce stigma; Use non-stigmatizing language (e.g., 'person with schizophrenia,' not 'schizophrenic'); avoid terms like psycho, nuts, maniac, funny farm; avoid jokes and language that reinforce stereotypes or suggest incompetence.

Cultural Syndrome

A cluster or group of co-occurring symptoms found in a specific cultural group, community, or context.

Stereotypes

Occurs when individuals with mental illness internalize public stereotypes and begin to agree with them; leads to low self-esteem and reduced self-worth.

Label Avoidance

Type of stigma that occurs when an individual avoids treatment or care in order not to be labeled as being mentally ill.

Recovery-oriented care

Focuses on addressing human suffering and death.

Social Factors and Mental Health

Ethnic and racial minorities face social inequality that increases exposure to racism, violence, discrimination, and poverty, thus increasing mental health risk and symptom severity.

Consequences of Poverty on Mental Health

Poverty creates chronic financial and emotional stress, which leads to worsening mental health symptoms and limited access to psychological care.

Core Beliefs in Buddhism

Life is inherently filled with misery, unhappiness, and suffering; no ultimate reality exists behind the world.

Causes and Resolution of Suffering in Buddhism

Desire is the root cause of all human suffering and misery; the end of suffering comes through the extinction of desire and emotion.

Path to Nirvana

Follows the 'middle path,' avoiding extremes of self-denial and self-indulgence; key practices include personal meditation, contemplation, good deeds, and compassion toward others.

Confucianism

Considered a philosophy or ethical system, not a religion; focuses on how people should act toward one another in society.

Core Beliefs in Confucianism

People are born inherently 'good'; emphasis on moral character, sincerity in behavior, and respect for parents and authority figures.

Path to Personal Growth in Confucianism

Improvement through self-responsibility, introspection, compassion for others, and self-transcendence.

Self-transcendence

The experience and appreciation of a dimension beyond oneself, facilitates spiritual growth.

Atheism Vs Agnosticism

Agnosticism: the belief that whether there is a God and a spiritual world, or any ultimate reality is unknown and probably unknowable. Atheism: the belief that no God or Deity exists.

Spirituality and Religiousness

Spirituality is individual and personal, not necessarily tied to religion; religiousness involves community participation and organized worship.

Living will

An advanced care directive that states what treatment should be omitted or refused in the event that a person is unable to make those decisions because of incapacitation.

Competency

A legal determination regarding a patient’s ability to make decisions, relating to the cognitive ability to understand and appreciate information during the consent process.

Competency vs. Rationality

Competency = Ability to understand and make informed decisions. Rationality = Quality or logic of the decision itself. A competent patient can make irrational decisions.

Least Restrictive Environment

Individuals have the legal right to refuse treatment and must be treated in the least restrictive setting appropriate to their condition. A person cannot be institutionalized if they can be effectively treated in the community.

Voluntary Admission (or Commitment)

Patient agrees to hospitalization and retains all civil rights, able to leave at any time.

Involuntary Commitment

Mandated treatment without consent, but with a court order. Must meet criteria: mentally disordered, dangerous to self or others, unable to meet basic needs ('gravely disabled').

Breaching Confidentiality

Occurs when a nurse shares a patient's personal information without the patient's consent. Adult patients have the legal right to privacy, even from their family.

Acts created inorder to protect different types of patients in different scenarios or situations.

Guarantees them legal protection, offering protection of self-determinism, protection against discrimination in employment, and protection against mistreatment in health care settings.

The Patient Self-Determination Act

Requires hospitals, health maintenance organizations, skilled nursing facilities, home health agencies, and hospices receiving Medicare and Medicaid reimbursement to inform patients at the time of admission of their right to be a central part of any and all health care decisions made about them or for them.

Self-Determinism

The right of individuals to make their own health-related decisions based on personal goals, values, and preferences, rather than external rewards or pressure.

Crisis Care Overview

An organized and rapid approach to assist individuals in acute mental distress, with the goal of stabilizing symptoms and avoiding unnecessary hospitalization.

Crisis Intervention

Short-term, goal-focused treatment (usually < 6 hours) located in EDs, psychiatric hospitals, and crisis centers, that focuses on stabilization, symptom reduction, and relapse prevention.

Crisis Intervention Teams (CIT)

Trained police officers and mental health professionals who respond to psychiatric crises in the community, aiming to reduce criminal justice involvement and ensure appropriate psychiatric referral.

23-Hour Observation

Short inpatient stay (up to 23 hours) used for brief but severe crises, such as suicidal/homicidal ideation, rape trauma, or detoxification.

Crisis Stabilization

Lasts < 7 days for non-resolving crises needing short inpatient stay, with goals to manage acute symptoms and coordinate aftercare.

Self-help groups (e.g., Alcoholics Anonymous)

Provide peer support for people striving to abstain from alcohol or drug use, including counseling, mentoring, and encouragement.

Partial hospitalization

For patients with acute psychiatric symptoms who show a decline in social or occupational functioning, cannot live independently, but don’t require 24-hour care and are not an imminent danger to self or others.

Intensive outpatient

Help high-risk, vulnerable individuals maintain stability after returning to daily life, with emphasis on relapse prevention, stabilization, and support in the community.

Supported Employment

Help individuals with severe mental illness gain and maintain competitive jobs, providing vocational rehabilitation, job training, and on-site support.

Therapeutic Foster Care

Addresses the needs of patients needing a family-like environment and high support. Patients live with specially trained foster families, training includes medication and crisis management.

In-Home Mental Health

The provision of skilled mental health nursing care under the direction of a psychiatrist or physician for individuals in their residences, emphasizing personal autonomy of patient.

Case Management

Coordinate care by locating services, linking patients with them, and monitoring their use which aims to meet individual health needs efficiently and reduce costs.

Nonmaleficence

The ethical duty to not intentionally cause harm to others, requiring healthcare professionals to avoid actions that could harm patients.

Paternalism

The practice of making decisions for others based on the belief that the professional knows what is best due to their knowledge and expertise.

Veracity

Is the duty to tell the truth, building trust and forming the basis for effective communication.

Justice

The ethical principle that emphasizes fairness and equity in the distribution of healthcare and other societal goods.

Autonomy

Refers to a person’s right to make their own informed, voluntary decisions about their health and life.

Beneficence

The ethical duty to actively do good—to promote the well-being of patients and communities and to minimize harm.

Fidelity

The ethical principle that emphasizes faithfulness to one’s obligations, duties, and promises in the nurse-patient relationship, the profession, and society.

PMH-APRN Role

A licensed registered nurse (RN) with advanced education (master’s or doctoral level) and nationally certified as Clinical Nurse Specialist (CNS) or Psychiatric Nurse Practitioner (PMHNP).

BSN Role

Use the nursing process to care for individuals with actual or potential mental health problems, psychiatric disorders, or co-occurring psychiatric and substance use disorders.

Behavior therapy is in what domain?

Psychological

Founder of psychoanalysis

Sigmund Freud

Freud's beliefs

The unconscious mind could be accessed through dream analysis and free association; Developed a personality theory (id, ego, superego), Formulated the theory of infantile sexuality (psychosexual stages of development)

Humanistic therapy

Humanistic therapy emphasizes self-exploration, self-acceptance, and reaching one’s full potential. It focuses on personal growth, self-awareness, and maturity.

Id

The id is formed by unconscious desires, primitive instincts, and unstructured drives, including sexual and aggressive tendencies that arise from the body.

Ego

The ego consists of mental mechanisms like perception, memory, motor control, and defense mechanisms. It controls movement, perception, and contact with reality.

Superego

The superego enforces ethics, standards, and self-criticism. It develops from identification with parents and important figures during early childhood.

Empathy

Empathy, the capacity to assume the internal reference of the client in order to perceive the world in the same way as the client, is used in the therapeutic process.

Transference

Transference is the unconscious assignment to a therapist or nurse of a patient’s feelings and attitudes that were originally associated with important figures such as parents or siblings.

Countertransference

The therapist or nurse’s reactions to a patient that are based on interpersonal experiences, feelings, and attitudes (countertransference) can significantly interfere with the nurse–patient relationship.

Modeling

Pervasive imitation; one person trying to be similar to another person

Long-Term Outcome of Successful Basic trust vs. mistrust

Drive and hope

Long-Term Outcome of Successful Autonomy vs. shame and doubt

Self-control and willpower

Long-Term Outcome of Successful Initiative vs. guilt

Direction and purpose

Long-Term Outcome of Successful Industry vs. inferiority

Method and competence

Long-Term Outcome of Successful Identity vs. role diffusion

Devotion and fidelity

Long-Term Outcome of Successful Intimacy vs. isolation

Affiliation and love

Long-Term Outcome of Successful Generativity vs. stagnation

Production and care

Long-Term Outcome of Successful Ego integrity vs. despair

Renunciation and wisdom