Mental Health Nursing

mental health

state of wellbeing where people reach their potential, cope with normal stressors, work productively, and contribute to society

mental illness

significant dysfunction in mental state related to development, biology, or psych disturbances

Diathesis-Stress Model

most psych disorders result from combo of genetic vulnerability and negative environmental stressors

Mental Health Parity Act

equal insurance coverage for mental health care as physical health care

epidemiology

study of distribution of mental disorders to identify high-risk groups and factors

incidence

# of new cases in a given timeframe

prevalence

# of current cases regardless of when they began

lifetime risk

risk one will develop a disease in the course of life

DSM-5

guidelines on clinical manifestations of disorders from APA, influenced by multiprotection clinical field trials

International Classification for Nursing Practice (INCP)

provides standardized nursing diagnoses

International Classification of Diseases (ICD-10)

clinical descriptions of disorders and associated codes

Adverse Childhood Experiences (ACEs)

abuse; violence against a parent; living w/ someone w/ substance use disorders, mental illness, or ever incarcerated

these people are more sensitive to stress later in life

General Adaptation Syndrome (GAS)

1. alarm / acute stress stage - symp nervous system activates, on alert

2. resistance / adaptation stage - sustained resistance, may be able to renew and repair under stress

3. exhaustion - resources depleted, stress becomes chronic

tend and befriend stress response

stress response of tending for children and leaning on social support networks - more common in women

stress mediators

perception, temperament, social support, culture, religion

reactive attachment disorder

consistent pattern of inhibited, emotionally withdrawn behavior, unresponsive to caregiver offering support

disinhibited social engagement disorder

no normal fear of strangers, unfazed by separation from caregivers

attachment disorders (treatment and consequences of not treating)

treatment: individual and family therapy

consequences w/o treatment: lack of trust, relationship insecurity

PTSD

seen as flashbacks, hypervigilance, avoidance, mood alterations, sleep problems, self-blame, detachment, loss of interest

polyvagal theory (threat response)

myelinated ventral vagal response - “on”, not overwhelmed

unmyelinated ventral vagal response - fight or flight arousal

dorsal vagal response - dampens sympathetic nerve system to curb overwhelm

myelinated ventral vagal response

“on”, not overwhelmed

unmyelinated ventral vagal response

fight or flight arousal

dorsal vagal response

dampens sympathetic nerve system to curb overwhelm (sleep, mind-numbing, depression)

PTSD treatment

1. provide safety/support system

2. Regulate emotions & arousal

3. Catch up on social skills (development in children)

PTSD meds

antidepressants, SSRIs

PTSD diagnosis timeframe

3 days-1 month after trauma typically

acute stress disorder

shorter timeframe of manifestations than PTSD, very similar in many ways - treated similarly

dissociative amnesia

inability to recall important personal info, traumatic or stressful nature

depersonalization

(self) being an observer of one’s own body & mental processes

derealization

(outside world) surroundings are unreal/distant; walking in fog, bubble, or dream

dissociative disorder treatment goals

personality integration:

• increase personal identity

• increase role performance

• decrease anxiety

ethics

philosophical beliefs of right and wrong

bioethics

healthcare related ethical dilemmas - conflict between to actions with favorable and unfavorable consequences

principles of bioethics

autonomy, beneficence, nonmaleficence, justice, fidelity, veracity

pharmacogenetic testing

helps to identify what medication to use on a specific patient based on genetic testing

psych admissions

voluntary - patient has the right to leave

involuntary - law enforcement related

emergency - can’t leave without medical clearance, may have been committed by court

writ of habeus corpus

formal written order to free the person

least restrictive alternative doctrine

choosing the least drastic action

discharge

unconditional

release AMA (against medical advise)

conditional

assisted outpatient

unconditional discharge

no other treatment required for discharge

release AMA (against medical advise) discharge

only for non-court ordered admissions; worse health outcomes, increased readmission, delayed care, and higher costs

conditional discharge

requires other out-patient treatment

assisted out-patient discharge

court ordered, similar to conditional discharge

patient rights

right to treatment, right to refuse treatment, right to informed consent

mental capacity

ability to make informed decisions

competency

degree of mental soundness to make decisions

advance directives

wishes for medical treatment, may include DNR orders and proxy assignment

restraint

can be utilized in an emergency, needs new orders every time and requires check-ins every 15 minutes

chemical restraints

medications to help sedate / subdue

confidentiality

ethical responsibility prohibiting information disclosure without patient consent

confidentiality exceptions

duty to warn and protect third parties

tort law

wrongful acts that result in injury to others, can be intentional or unintentional

intentional tort examples

assault, battery, false imprisonment, invasion of privacy, defamation

unintentional tort examples

negligence, malpractice

factors to prove negligence

duty, breach of duty, cause in fact (actual cause), proximate cause (legal cause), damages, institutional policies and practices

reporting process for negligence, irresponsibility, and impairment

document clearly and accurately beforehand

supervisor intervenes, if unavailable, then you do

patient can review record

record belongs to the institution

retrospective record reviews

used in lawsuit, abuse, disability, and workers comp cases

forensic nursing

appointment of nursing principles in court, nurse educates court and provides medical opinions

minorites

racial/ethical/culturally distinct groups that coexist but are subordinate in some way to the dominant group

minority status

not always fewer in numbers, but lacking in political and social power

race

defined biologically, anthropologically, or genetically; can be based on physical characteristics

ethnicity

common heritage, shared worldview

culture

shared beliefs, values, and practices

western tradition [science]

values individuality, autonomy, and self-reliance; mind and body separate; time is linear; success through preparation for the future

eastern tradition [balance]

values family; body/mind/spirit are one entity; time circular/recurring; duty to comply to fate; disease caused by opposing forces

indigenous culture [harmony]

values identity in tribe; places significance on place of humans in natural world; disease due to lack of harmony w/ the environment

enculturation

transmission of culture’s beliefs to members

ethnocentrism

universal tendency to think one’s beliefs are the only correct/ natural way

cultural imposition

people/groups try to impose beliefs and behaviors on others out of a superiority complex

cultural barriers

communication, stigma, misdiagnosis, genetic variations

culture-based at risk populations

immigrants (choose to move), refugees (forced to leave homeland), cultural minorities

acculturation

learning beliefs, values, and practices of the new cultural setting

assimilation

adaptation to and implementation of the new culture

culturally congruent practice

applying evidence based care that corresponds with patient values, practices, and worldviews

cultural competence

process of demonstrating culturally congruent practice

includes cultural awareness, knowledge, encounters, skills, and desire