essentials of mental health care

mental health

emotional and psychological well-being

wellness

good physical and mental health

mental disorders

heath conditions that cause changes in thinking, mood, and behavior related to distress or impaired functioning

recovery

improvement of health and wellness

mentally healthy individual

ability to appropriate interact with others, deal with stress from everyday life. realistically view the world

factors that influence mental health

-environment

-stress

-genetics (happens in the same family)

-physical disease (TBI, toxins, no oxygen, heavy metals)

-age

-hormonal imbalance

-parenting

-developmental delays

-changes in life

-sexual orientatioin

-religion

-interpersonal factors

-peer group

interpersonal factors

early family relationship may alter the person capability of functioning in an adult life

recovery pt. 2

a process of change, improve health and wellness, live a self directed life strive to reach full potential

diagnosis of mental health conditions

provides specific criteria for mental health disorder and diagnosis. no boundaries that separate one disorder from another. allows consistency with client diagnosis

stigmas of mental health

-public

-self

-lable

public stigma

individuals "marked" by a mental illness

self-stigma

internal stereotypes

- "not capable of normal functioning"

label avoidance

regular to seek treatment in order to not be "labeled" with mental illness

stigma

happens after label of diagnosis

aspects that support recovery

-health (physical as well)

-home

-purpose

-community

non stigma inducing vocabulary

-do not use hurtful words

-"I met a person with _______"

recovery oriented care

client and clinician work together to manage illness, set goals, improve coping skills, focuses on strengths and preferences. key aspects in partnership, asking for help, a supportive environment for their well being.

trauma-informed care

reflects upon the impact of past trauma and how that may be affecting a persons life. the potential impact on past trauma on well being, stable environmental for healing and recovering

trauma

emotional and psychological response from an event that really distressing. saftey and wellbeing of the person who experienced, also includes a witness as well. the feelings post event effects the individual

cultural identity

-cultural competence

-gender identity

religion and spirituality

effects how people view mental health and disorders. do not put your beliefs into the client

understand

your patients culture, and learn how to apply and cater to their beliefs. value beliefs and customs and behaviors

gender identity conflicts

the view of self concept of male and female, a blend of both or nether

religion

the degrees of how the persons believed, rituals, internal beliefs, external behaviors related to fatih

spirituality

a board and personal sense of connection to something greater than ones self, ennobles a sense of meaning, purpose, and connect, thru religion, nature, relationships or personal values.

rural population groups

leads to higher incidence of self harm due to lack of treatment and providers

polyvictimization

decline in health, anxiety, depression, drug abuse, increase in suicidal ideation

competency

-communicate choice

-understand relevant information

-appreicate the situation and its consequences

-use a logical thought process to compare the risk and benefits of treatment options

informed consent

state law and mandated. must be able to understand their treatment order to make a good decision. must be deemed competent to understand

consent

varies state to state. the cognitive ability to process information at a specific time. restate treatment details, verbalize disorder, why treatment is needed, what should happen as a result of that treatment, use a logical process to compare the risk and benefits of their treatment options.

Informed Consent

-organize written documentation

-educate on treatment option

-ensure form is signed before treatment is given

civil/state/federal rights

-involvement in plan of care for appropriate treatment

-refuse treatment

-leave hospital against medial advise

-legal counsel

-vote

-private phone calls

-lease restrictive environment/human care

-send and receive uncensored mail

-lodge a complaint

-participate in religious worship

-choice of providers

-enter a contractual relationship

least restrictive environment

serves a s protection for the patient (being watched, restraints, being held against their will, mental health care records

privacy

personal life of the client is not regulated by laws

confidentiality

protection of client information. breach of confidence when a nurse discloses that personal information. HIPPA

psychiatric advanced directives

allows competent clients the ability to document their wishes regarding treatment and care.

self0determination

-right to autonomy

-right to refuse

seclusion

the involuntary confinement of a client in an area where they are unable to leave

restraints

an intervention that restricts or reduces the client's ability to move (physical and chemical). deescalation techniques where tried and failed, danger to themselves and someone else prior to restraints, start with least restrictive. once the patient has deemed safe they should be taken off restraints

musts to remember

-must not be used as punitive measures

-must be used only as a last resort

-must be used for minimal amount of time necessary for saftey

0must only use the least number of restraint points and always have continuous observation

-must have specific order (NO PRN ORDERS ALLOWED)

restraints orders

every 24 hours

order of restraints

3. chemical

2. seclusion

1. physical

involuntary commitment

has the same rights as someone who voluntary admits themself, but they cannot leave or check yourself out. cna refuse medications

involuntary commitment

held for 42-92 in the ER, then voluntarily commit themselves to. if not, the judge decides their fate. has the right for a true legal procedure and legal representation

accountability

-assault and battery

-medical battery (failure to respect a clients advance directives)

-false imprisonment

-negligence

protection

-assess changes

-document

-involve family

-use team approach

-obey all policy and procedure

-ask

documentation

-assessments

-interventions

-observations

-evaluation

maslows hierarchy of needs

1. physiological needs

2. saftey needs

3. love and belonging

4. esteem

6. self-actualization

maslows hierarchy of needs is

the patients perspective of things

psychodynamic terms

-defense mechanisms

-transference

-countertransference

defense mechanisms

coping styles used by someone as protection from unwanted anxiety

transference

occurs when the client displaces attitudes and feelings that they experienced in other relationships onto the healthcare provider

countertransference

occurs when the healthcare provider displaces their attitudes and feelings from the past onto the client

social theory perspectives

-family dynamics

-formal support systems

-informal support systems

biogenic amines

-dopamine

-norepineohrine

-serotonin

-gamma ammiobutyric acid (GABA)

dopamine

help relive psychotic symptoms and used to read symptoms like delusions and hallucinations. rarely induces psychotic episode

norepinephrine

creates and maintains mood. also has been noted to occasionally induce manic episode

serotonin

relieves depression. increases the presence of serotonin. (other medications).

gaba

major neurotransmitter in CNS. results in calming effect

increased serotonin, norepinephrine and dopamine

can relive depression

psychonpharmacology (antidotes)

psychotropic drugs work by altering the concentration foe neurotransmitters

agonist

mimics and action of chemicals naturally found in the body

antagonist

interferes with an action

SSRI

interference with uptake

neurotransmitters also

-enhance the release

-inhibits enzymes

ssris fxn

after serotonin is released and transmitted, it is reabsorbed by reuptake. by blocking the repute, SSRI allows more serotonin to remain in the synapses. this allows for more effective communication leading to mood regulation and fxns.

maois

inhibits MAO enzyme. this resulting sin improvement of depression. foods high in tyramine should be avoided (food drug interactions)

-negative drug to drug inter actions (ssri). can lead to serotonin syndrome

-hypertensive crisis

foods high in tyramine

-wine

-cheese

-smoked meats

-liver

verbal communication

works we speaking. also includes the underlying emotion, context, and connotation

nonverbal communication

gestures, facial expressions, and body language, including eye contact, posture, and movements

if the verbal communication is failing

the nurse should accept and "trust" their body language

therapeutic communication

-limit self disclosure

-active listening

-passive listening

-selection of communication

active listening

focusing one what the client is is saying and underlying meaning. responding objectively. accomplished through open-ending questions.

passive listening

remains quiet and lets the client talk. lets them ramble,

when trying to find the proper form of communication

asses and interpret the meaning of the clients interpretation or wanting of the interaction

the intimate zone

learning to whisper, give hugs etc

the personal zone

revered for close friendships

the social zone

reserved for acquaintances

the public zone

normal interactions with those we don't know well

professional boundaries

nurse-clean relationship

nurse-client relationship

-caring for a client in a dependent state

-focus must remain on the client and their needs

-should only share personal info/experience on rare occasions

personal boundaries

-intimate

-personal

-social

-public

defense mechanisms/coping styles

-acting out

-denial

-displacement

-humor

-passive aggression

-projection

-rationalization

-regression

-repression

-sublimation

defense mechanisms are only maladaptive if

used consistently, interfere with everyday functions and quality of life

therapeutic relationship (focusses on the clients needs)

-rapport

-empathy(put yourself in their shoes)

-genuineness

-acceptance

-postive regard

-self awareness (do you have a bias)

orientation phase

begins when the nurse and client meet, and ends when the client begins to identify problems to examine

orientation phase includes

-establishing rapport

-identifies client ends

-established boundaries

-develops plan of care

-engages client in treatment

working phase

client and nurse work together to identify issues and concerns that may be causing problems. client expresses feelings and begins to feel stronger, gives insight into problems and develops coping skills.

resolution/termination phase

begin when the problems of the client are resolved and ends with the termination of the relationship. the client no longer needs professional services or exhibits dependent behavior

nursing process

Assessment

Diagnosis

Planning

Implementation

Evaluation

assessment in mental health

-every time you see the client

-assess medications and adverse reactions

-signs of trauma and psychological well being

-are they are harm to themselves or others

-establish rapport and try to understand problems

-how do they perceive their problem

-review of systems

-any history of substance use or abuse

-prevous stays in hospitals

-

planning in mental health

-goals are established and agree upon

-priority is assigned to needs, expected outcomes are developed by nurse and client

interventions in mental health

-recovery oriented and implemented for each area of assessment

-medication management

-pain management

-psychological and internal process of memory and judgement

-conflict resolution

-behavior therapy

milieu therapy

taking care of pt and environmental therapy

evaluation

evaluation of outcomes, outcomes must be measurable

eustress

good stress, brought on by positive events

distress

bad stress, brought on by negative event

acute stress

short term, less than a month, can recur. no in a state of constant stress

chronic stress

long term, negatively affect health and well being. waer and tear on body and brain

how you adapt to a stimuli

stress