mental health exam 1

goal for every mental health Pt

RECOVERY

mental health…

-is an essential piece of total wellness

-helps determine how we handle stress, relate to others, and make choices

wellness

-is NOT the absence of disease

-everyone has the potential to be mentally healthy

true/false: you can have a mental illness but be mentally healthy

TRUE

behavioral health inequity

-mental health is a BASIC HUMAN RIGHT

-requires addressing SDOH, racial/ethnic disparities, service access barriers, and language barriers

behavioral health equity

the right of all individuals, regardless of race, age, ethnicity, gender, disability, SES, sexual orientation, or geographical location, to access high-quality and affordable healthcare/support

true/false: SDOH has no impact on mental health

FALSE- SDOH has a larger impact than any biological cause/predisposition

mental disorders

-conditions involving altered thinking, mood, or behavior

-association with distress or impaired functioning (logical thinking: schoziphrenia, mood: depression)

-disorders defined by clusters of behaviors, thoughts, and feelings…NOT UNDERLYING BIOLOGIC PATHOLOGY (5/9 symptoms for 2wks, etc)

diagnostic classification

criteria for diagnosis (5/9 symptoms)

major barriers to tx of mental health

-public stigma

-self stigma

-label avoidance

public stigma

publicly marked/labeled for having a mental illness (media)

self stigma

agreeing with public stigmas

label avoidance

fear of being labeled as mentally ill, so no care is sought

implicit bias

internal human bias

explicit bias

aware of beliefs and making decisions based on them

recovery

-single most important goal

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

-mental illnesses are treatable

-recovery is an expectation

-role of RESILIENCE (ability to adapt to adversity)

guiding principles of recovery

-emerges from hope

-person driven

-occurs via many pathways

-holistic

-supported by peers and allies

-supported through relationship and social networks

-culturally based and influenced

-supported by addressing trauma

-involves individual, family, and community strengths and responsibility

trauma-informed care

adverse childhood experiences (abuse, neglect, loss, incarcerated parents, etc)

trauma-informed approaches

-hx of trauma common in people with mental health issues (ACE’s, lasting adverse effects)

-prevention of re-traumatizing individuals

-nurses must recognize indicators of trauma

-integral to recovery-oriented care

4 primary ethical principles

1. autonomy

2. beneficence

3. nonmalificence

4. justice

secondary principles

-veracity (tell the truth)

-fidelity (being faithful to obligations, follow-through)

-paternalism (making decisions for someone else)

self-determinism

-a fundamental right to choose one’s own health-related behaviors

-a self-determined individual is internally motivated to make choices based on personal goals

KEY VALUES: personal autonomy and avoidance of dependence on others

self-determination act

deciding one’s own care

bill of rights

necessary because of vulnerability to abuse and mistreatment (individualized care plan, right to know about meds, etc)

americans with disabilities act (ADA)

legal protection against discrimination towards individuals with disabilities (can’t get fired d'/t mental hospitalization)

competency

-legal determination (can vary situationally)

-understand relevant information (S/E, dosage, etc)

-appreciate the situation and consequences (pros/cons)

-use a logical thought process to compare options

-communicate choices (unconscious Pt’s)

informed consent

legal procedure before any form of tx

voluntary commitment

-full legal rights

-can make all of their own choices (signed themselves in, can sign themselves out)

involuntary commitment

-confined hospitalization of a person WITHOUT THE PERSON’S CONSENT

-mentally disordered

-dangerous to self or others

-unable to provide for basic needs (can’t feed themselves, take meds, etc)

least restrictive environment

-patients have the right to refuse tx (can’t force someone to stay if they can receive care outpatient, cannot overmedicate)

-a person cannot be restricted to an institution when he/she can be successfully treated in the community

-medication cannot be given unnecessarily

promotion of patient safety

-observation (how they look/act)

-de-escalation (remove them from source of exacerbation)

-seclusion (separating them to a locked, empty room, suicide risk, throwing things)

-restraints (if Pt is going to hurt themselves/others, 4-pt LAST RESORT, need an order, document everything!)

privacy

protecting a person’s personal life from intrusion

confidentiality

ethical duty of nondisclosure (provider has information about Pt and should not disclose it)

breach of confidentiality

release of patient information without the patient’s consent in the absence of legal compulsion or authorization

health insurance portability and accountability act (HIPAA)

requires patient authorization for the release of information with the exception of that required for tx, payment, and healthcare administrative operations

mandates to inform

-legal obligation to breach confidentiality

-DUTY TO WARN: when there is judgement that the Pt has harmed someone or is about to harm someone (Tarasoff vs. Regents of UC)

laws and psychiatry

-fitness to stand trial

-NGRI: not guilty by reason of insanity (must prove that they didn’t know the difference between right/wrong, and not in control of actions)

-GBMI: guilty but mentally ill (if 2 things can’t be proven)

misconceptions of the insanity plea

-very few insanity pleas are successful (less than 1%)

-insanity is usually determined by whether the person has substantial appreciation or understanding of the criminality (wrongfulness) of his/her conduct

-public safety: patients are more likely to be the victims than the perpetrators

documentation

-document both symptoms that are present and symptoms that are absent

-always needed for patients who are suicidal, homicidal, aggressive, or restrained in any way

-avoid judgemental statements (ex→ Pt manipulating staff)

psychoanalytic theory (FREUD)

-study of UNCONSCIOUS (dream interpretation, ink blots, etc)

-personality development

-anxiety and defense mechanisms (coping skills, denial)

-psychoanalysis

-transference and countertransference

humanistic theory

MASLOW: hierarchy of needs

ROGERS: human potential for goodness

cognitive theories (BECK)

internal thinking process, thought distortions

goals/principles of cognitive theories

-monitor, recognize, examine, substitute, alter dysfunctional beliefs

-structured/short term

-techniques

-best used in conjunction with behavior therapy

classical conditioning (behavioral) PAVLOV

stimulus/response

operant conditioning (behavioral) SKINNER

reinforcement stimulus (pigeons)

behavior modification

-shaping

-modeling

-contracts

-token economy/time out

-systematic desensitization/flooding

psychosocial development (developmental) ERIKSON

8 stages of development

cognitive development (developmental) PIAGET

learning in children (thought process)

social theories

-family dynamics (interpersonal and social interactions)

-formal and informal social support (formal: group homes, informal: friends/fam)

-role theories

-sociocultural (LEININGER: transcultural health care)

spiritual concepts

religion vs. spirituality (what gives life meaning)

spiritual interventions

-especially important during periods of suffering and pain

-focus on helping person find meaning

-improving hope and quality of life

hildegard peplau

-considered founder of psychiatric nursing

-interpersonal involvement of nurse with client

-empathetic linkage

nursing model (peplau)

-roles of nurses

-phases of nurse-patient relationship (therapeutic relationships, started legitimate nursing MH research)

relevance of spirituality to mental health nursing

taking personal beliefs and applying them to our care