Psychiatric Mental Health Nursing

what is mental illness

disorders with definabke diagnosis

significant disfunction in mental functioning r/t developmental, biological, physiological disturbances

sociocultural defined

risk and protective factors

individual attributes and behaviors

environmental, social, and economic circumustances

resiliance

ability and capacity to secure resources needed to support well-being; essential recovery

risk

internal and external aspects that lead to reduced capacity or reduced resources

important elements

tempermant

optimism

sense of mastery, efficacy

competence

social determinants of health

education access and quality

economic stability

social and community context

neighborhood and built environment

health care access and quality

social determinants of health pt2

conditions of the environment where people are born, live, learn, work, play, age

can contribute to health desparities- economic differences, unequal resources for education, healthcare, natural or built environment, community cohesion

the social determinants of health are closely interrelated with the concepts of equity and inclusion, health policy, and communication

social determintats nursing care

assessment

health promotion

access to care

patient teaching support improvements in health outcomes

diathesis

biological predisposition (such as schizophrenia)

stress

environmental stress or trauma

nature/nurture: the diathesis-stress model

most accepted explanation for mental illness

combination of genetic vulnerability and negative environmental stressors

assertion

most psychiatric disorders result from a combination of gent vulnerability and negative environmental stressors

incidence

number of new cases in a given time period

prevalence

number of cases in a given time period of time regardless of when they began

lifetime risk

risk that one will develp a disease in the course of a lifetime

DSM-V

mental health professionals use the diagnostic and statistical manual of mental disorders, 5th editions

official medical guidelines of the american psychiatric association for diagnosing psychiatric disorders

levels of care in mental health

primary care providers

specialty care- psychiatrists, psychiatric NPs, psychologists, counselers

home care/respite care

assertuve community treatment (court-ordered Tx)

intensive outpatient programs

specialty programs (residential)

emergency care/crisis care

inpatient care

state hospital

voluntary admission

self refferal and professional referra;

involuntary admission

initiation, criteria, process

self-referrak

a person can go to a hospital’s intake center or emergency room or call a crisis

professional referral

a person can go to a hospital’s intake center or emergency room or call a crisis line

professional referral

a primary care, psychiatrist or community mental health team can refer a person to a facility

initiation

often startef by a doctor, law enforcement, or sometimes a family member/concerned person

criteria

based on severe mental illness posing an imminent risk of harm of self or others (DTS/DTO), persistently or Acutely Disable (PAD), or gravely disabled (GD)

process

a professional assesses the indvidual; if criteria are met, a petition is filed, leading to hospital admission under the AZ statute Title 36. this is an involuntary process

involuntary commitment steps -once it determined a petition is needed, the individual is brought to facility and receives an evauluation

• must be seen by two psychiatrists

• if the psychiatrists recommends inpatient care, individual is admitted

• can be held for 72 hrs (AZ) involuntarily for more evaluation

involuntary commitment steps- individual is entitled to a court hearing 7-14 days after being petitioned

• psychiatrists present diagnostic findings and treatment plan to the court

• patient can comment and provide their own details

• judge can dismiss or place patient under court-ordered treatment (COT)- Title 36

• COT is one year in length and at time of expiration, patient must be evaluated for compliance and COT is either dismissed or renewed

involuntary commitment steps- patient must comply with all inpatient and outpatient care once on court-ordered treatment

failure to comply results in revocation and patient is involuntarily admitted to level 1 facility (locked inpatient) for evaluation and stabilization

implications for Nursing Care

patients under the 72 hour petition patient can refuse all care, including medications

if they exhinit dangerous behavior to themselves, staff, or other patients…

they can recieve their PRN medications against their consent

support a COT request during court hearings

behaviors including refusal to medications

patients who are court-ordered must comply with all tx including medications

oral- first offered) or injectable (voluntarily or without consent) medications

includes outpatient requirements (weekly check in with case manager, attending all appointments and maintaining contact)

patients’ rights under the law

right to treatment

right to refuse treatment

right to informed consentrig

right to informed consent

indicates that the patient has been provided with basic understanding of risks, benefits, and alternatives

person must voluntariy accept treatment

to be effective legally, the consent must be accompanied by information provided by a physician or advanced practice provider

rights under the law continued

rights regarding involuntary commitment

rights regarding restraint and seclusion

right to confidentiality

right to confidientality expectations to the rule

duty to warn and protect third parties

child and elder abuse reporting statutes

Tort Law

a civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (the defendent)

Intentional tort

willful or intentional acts that violate another person’s rights or property

assualt, battery, false imprisonment, invasion of privacy, defamation of charchter (slander or libel)

unintentional tort

unintended acts against another that produce injury or harmn

negligence

failure to use ordinary care or perform to the standard of care

anyone can be negligent

malpractice

a type of negligence that looks at standards of care and the professional status of the caregiver. must be a professional

mental health documentation

intake to progress

ensuring continuity

legal compliance

quality care

• detailing symptoms, assessments, tx plans, interventions, risks (suicide/violence), medication, and outcomes

  • objectivity, clarity, timeliness, and linking all aspects to tx goals for medical necessity

the Milieu

the healing environment

all people, the setting, the structure and environment, and the emotional climate are important and necessary for healing

safety essential to healing

activities suupoort healing and growth

integrative nursing principles

person-centered and relationship-based

nature has healing properties that contribute to well-being

humans have the innate capacity for health and well-being

the health of the caregivers is linked with the health of those they serve