Week 1 Lecture- Behavioral Health

According to the WHO, what is mental health?

A state of complete physical, mental, and social wellness, not just absence of disease.

NCLEX KEY: Health should be viewed as what type of concept?

Holistic

What 3 major factors influence mental health?

Intrapersonal, interpersonal, and social/cultural factors

What are intrapersonal factors?

Factors within the person such as biology, personality, and self-concept

What are interpersonal factors?

Relationships with family, peers, and others

What are social/cultural factors?

Environment, society, culture, and social expectations

What criteria may indicate mental illness?

Ineffective coping, dissatisfaction, poor relationships, lack of growth

NCLEX KEY: Mental illness usually involves what 3 major things?

Functional impairment, dissatisfaction, and coping failure

A client cannot maintain relationships, feels dissatisfied with life, and copes poorly with stress. What does this suggest?

Possible mental illness

What is the purpose of the DSM-5?

Defines disorders, provides diagnostic language, and helps identify causes

Why is the DSM-5 important in mental health care?

It standardizes psychiatric diagnoses

Who advocated humane treatment for mentally ill patients?

Dorothea Dix

What improvements did Dorothea Dix advocate for?

Shelter, food, clothing, and humane treatment

What major psychiatric breakthrough occurred in the 1950s?

Development of psychotropic medications

Who developed psychoanalytic theory?

Sigmund Freud

Approximately what percentage of adults experience mental illness?

18.6%

Mental illness is the leading cause of disability for what age group?

Ages 15-44

True or False: Most adults with mental illness receive treatment.

False

What percentage of adults with mental illness are treated?

About 1 in 4

What percentage of children with mental illness are treated?

About 1 in 5

What is deinstitutionalization?

Movement of clients from hospitals to community settings

What is the "revolving door" effect?

Frequent relapse and readmission due to inadequate community support

Why are homelessness and mental illness commonly linked?

Many homeless individuals have severe mental illness and substance abuse issues

What major problem contributes to repeated psychiatric admissions?

Lack of community resources

What is the goal of managed care?

Balance quality of care with cost of care

Who developed the therapeutic nurse-client relationship?

Hildegard Peplau

What are the basic-level psychiatric nursing roles?

Counseling, milieu therapy, self-care assistance, teaching, case management

What are advanced psychiatric nursing roles?

Psychotherapy, prescribing, consultation, evaluation

What is inpatient psychiatric treatment used for?

Acute stabilization and high risk situations

Which treatment setting provides 24-hour supervision?

Inpatient hospitalization

Which clients are appropriate for outpatient treatment?

Stable clients needing therapy or medication management

What is ACT (Assertive Community Treatment)?

Intensive community support for chronic high-risk mental illness

What is the purpose of crisis stabilization?

Short-term emergency intervention to prevent hospitalization

What is Partial Hospitalization Program (PHP)?

Structured daytime treatment while living at home

What is a residential/group home setting?

Supportive living environment with varying supervision

What is the focus of residential treatment?

Long-term structure and independent living skills

What are major goals of community mental health care?

Medication adherence, work skills, housing, relationships, self-esteem

Why are social skills and ADLs important in psychiatric care?

They improve independent functioning

What factors interfere with success in community treatment?

Substance abuse, medication noncompliance, criminal behavior, suicidal ideation

What are examples of residential settings?

Group homes, halfway houses, assisted living, foster care

NCLEX TRAP: What is most important in the clubhouse model?

Peer support and community integration

True or False: Physician-client relationship is the center of the clubhouse model.

False

What are the 4 pillars of integrated behavioral health?

Primary care, mental health care, substance abuse treatment, social services

What rights do psychiatric clients have?

Privacy, treatment participation, least restrictive care, right to refuse treatment

When can patient rights be restricted?

Only when safety risks exist

If restrictions are placed on a client, what is required?

Documentation and justification

When can involuntary hospitalization occur?

When client is danger to self or others

What must be true for involuntary admission?

Threat must be imminent

What is restraint?

Physical or mechanical restriction of movement

What is seclusion?

Isolation in a locked room

When should restraints or seclusion be used?

Only when client is dangerous and alternatives failed

What must occur within 1 hour of restraint use in adults?

Provider evaluation

How often are adult restraint orders renewed?

Every 4 hours

How often are child restraint orders renewed?

Every 2 hours

What nursing responsibilities are required during restraints?

Circulation checks, skin checks, fluids, toileting, emotional assessment

Why should nurses monitor circulation during restraints?

To prevent injury and impaired blood flow

What should nurses explain to families about restraints?

Criteria for release and safety reasons

What is the Tarasoff Principle?

Duty to warn identifiable victims of serious threats

When does duty to warn apply?

Serious threat + identifiable victim + access to means

True or False: Confidentiality always overrides safety concerns.

False

A client states, "I'm going to shoot my doctor tonight." What nursing/legal principle applies?

Duty to warn

What are unintentional torts?

Malpractice and negligence

What are intentional torts?

Assault, battery, false imprisonment

Which tort is most commonly tested on NCLEX?

Malpractice

What 4 things must be proven for malpractice?

Duty, breach, injury, causation

A nurse fails to follow standards of care and the client is harmed. What may this be?

Malpractice

What is utilitarianism?

Greatest good for greatest number

What is deontology?

Duty-based ethics

What ethical principle means patient choice?

Autonomy

What ethical principle means "do good"?

Beneficence

What ethical principle means "do no harm"?

Nonmaleficence

What ethical principle means fairness?

Justice

What ethical principle means truthfulness?

Veracity

What ethical principle means keeping promises?

Fidelity

Which ethical principle most often overrides others in safety situations?

Nonmaleficence

A client refuses medication but becomes dangerous. Which principle overrides autonomy?

Safety/nonmaleficence

What is an ethical dilemma?

Situation where principles conflict and no clear answer exists

What is the M'Naghten Rule?

Inability to understand wrongfulness or control actions

What is the least restrictive intervention for agitation?

Verbal de-escalation

What intervention should ALWAYS be attempted before restraints?

Verbal de-escalation

What is the LAST intervention for dangerous behavior?

Restraints or seclusion

True or False: Restraints can be used for staff convenience.

False

Why are restraints used?

Safety only

What are the 3 phases of Peplau's therapeutic relationship?

Orientation, working, termination

During which Peplau phase is trust established?

Orientation

During which Peplau phase does most therapeutic work occur?

Working phase

During which Peplau phase does the relationship end?

Termination

True or False: Patient rights disappear during psychiatric hospitalization.

False

What is the preferred goal of community psychiatric care?

Treatment in the least restrictive environment

What major issue limits community psychiatric care success?

Inadequate resources

What often results from inadequate community resources?

Revolving door admissions

What ethical principle involves allowing clients to make decisions?

Autonomy

What ethical principle focuses on preventing harm?

Nonmaleficence

What ethical principle focuses on helping others?

Beneficence

What are the highest-priority dangerous psychiatric cues?

Suicidal ideation, homicidal ideation, command hallucinations, severe agitation

Why are command hallucinations dangerous?

Client may act on harmful voices

Why is withdrawal with risk of DTs considered dangerous?

Can become life-threatening

A severely agitated client begins threatening staff. What is the nurse's first intervention?

Verbal de-escalation

A client becomes violent despite verbal interventions. What may be necessary?

Medication or restraints/seclusion

A nurse locks a client in a room for refusing medication. Is this appropriate?

No, restraints/seclusion cannot be punishment