professionalism, clinical decision making, legal precepts

what are the six characteristics of professional identity?

• integrity

• compassion

• courage

• humility

• advocacy

• human flourishing

define clinical judgment

interpretation of pt needs, concerns, health problems, and decision to take action (or not)

what is the clinical judgment and decision making process?

1. noticing

2. interpreting

3. responding

4. reflecting

what are the components of a psych nursing assessment?

1. Hx (DSM-5, why are they here?)

2. gather data (medical, spiritual, cultural, sub, obj)

3. intuition

4. criteria based documentation

5. physical assessment

6. pain

7. labs

8. psychosocial assessment

9. MSE

why is orthostatic hypotension important to consider in psych?

many meds can cause postural hypotension. they can pass out. routine orthostatic BP checks occur

what defines as orthostatic/postural hypotension?

• SBP drops >/= 20

• DBP drops >/= 10

• HR inc of >/= 20

what type of assessment data can be drawn from psychological testing?

objective testing 

• millon

• intelligence testing

• MMPI (minnesota multiphasic personality inventory)

projective testing

• inkblot test (rorschach)

• thematic apperception tests

• word association

what is the mental status exam (MSE)?

evaluates mental functioning and cognitive impairments. it evaluates patient’s baseline

what is the mini mental status exam (MMSE)?

evaluates mental functioning for those with suspected cognitive mental disorders (tests orientation, memory, attention)

what are the six components of the MSE?

• general appearance and behavior

• speech and thought processes

• emotional state - mood and affect

• thought/mental content

• cognitive functioning

• insight and judgment

terms for appearance and behavior on the MSE

• physical

• dress

• grooming

• eye contact

• general health

• motor activity (psychomotor agitation v. retardation)

terms for speech on the MSE

• pace

• volume

• articulation

• prosody

• poverty of speech

• pressured speech

terms for thought process on the MSE

• linear

• goal directed

• blocking

• circumstantiality

• flight of ideas

• loose associations

• perseveration

• tangentiality

• concrete

terms for mood on MSE

• dysphoric

• elevated

• euphoric

• euthymic

• expansive

• irritable

terms for affect on the MSE

• broad

• restricted

• blunted

• falt

• inappropriate

• labile

other assessments for emotional state on the MSE

• energy level

• appetite/eating pattern

• sleep

terms for thought content on the MSE

• somatic

  • somatization → somatic delusion

• ritualistic

  • compulsions

  • obsessions

  • phobia

  • rumination

• destructive (homicidal or suicidal ideation)

• defensive (hallucinations)

• illusions

• delusions

types of delusions

• religious, somatic, ideas of reference, grandeur, persecution, thought insertion, thought withdrawal, thought broadcasting

terms for cognitive functioning on the MSE

• orientation

• attention

• concentration

define health care law

collection of laws that directly impact healthcare delivery, the business relationship of people in healthcare, or the relationship between patient and provider

social security act of 1965

established medicare for elderly and medicaid for poor

patient self determination act of 1991

advanced directives must be acquired at time of admission in any health care related facility

HIPPA

ensures patient confidentiality

patient protection and affordable care act of 2010

obamacare - expansion of medicaid and other coverage

controlled substance act

places all regulated drugs in one of five schedules based on it’s medical use, abuse potential, safety/dependence liability

people with mental illness have the same civil rights under

federal and state laws

what is involuntary commitent

legal process of placing a seriously mentally ill person into psych care or outpt treatment against their will when they are a danger to themselves and others or gravely disabled

what is the due process for involuntary commitment?

writ of habeas corpus?

• court order for law enforcement to justify detainment.

• legal way to challenge criminal conviction/prisoner confinement conditions

what are the legal considerations of patient confidentiality?

• HIPPA

• confidentiality after death

• confidentiality of professional communications

• confidentiality of HIV status

what are the exceptions of patient confidentiality?

• duty to warn and protect third parties

• child and elder abuse report

mental health parity and addiction equity act

ensures equal coverage of treatment for mental illness and addiction

what is a 5150?

a legal 72 hr hold if the patient is unwilling to accept treatment and they are a danger to self, others, or gravely disabled. requires a written advisement

what does gravely disabled mean?

the condition in which a person, due to mental illness, cannot provide for their basic needs for food, clothing, and shelter

what is a 5250?

a legal additional 14 day hold for continued DTS, DTO, and/or GD, unwilling to stay voluntarily, and need for advise of certification hearing

how do get a notice of certification?

you need an MD order

what is a 5270?

• additional 30 days

• administrative or certification hearing

• patient advisement

what is a 5260?

• if DTS occurs during a 5250

• 14 more days

• no hearing

• may request a writ

what is a 5300 et al?

• if DTO occurs during 5250?

• does not exceed 180 days

• no hearing

• right to attorney in jury trial

for legal holds, general information may be…

• released

• changed to voluntary

• request writ hearing (after 5150)

when is a conservatorship used?

• continued GD

• unwilling to accept treatment

lanterman-petric-short act

a temporary conservatorship up to 30 days. you need a hearing and lasts on a year (or can request review after six months)

conservator country public guardian

provides treatment, helps with finances and living arrangements

legal considerations for psychotropic medications

• have the right to refuse

• UNLESS in emergency

• reise hearing → judgment deems incompetent to make informed decisions

tarasoff act

duty to warn third party and duty to protect

levels of observation

• q 15 minutes

• close observation/constant visual observation/line of sight

• one to one - within arms length at all times, required MD order but instituted by RN

• MD order to lower any level of care