chapter 8 Principles and Skills of Mental Health Care

After a suicidal client has been appropriately discharged from an inpatient mental health unit, the nurse recommends continued treatment with the client's outpatient psychiatrist. This is an example of which guideline for crisis intervention?

a) Control

b) Assessment

c) Responsibility

d) Follow-up

d) Follow-up

__________ is the ability to clearly see and understand the nature of things

insight

An anxious client refuses to eat with other clients in the dining room. The nurse recognizes the importance of nutrition and offers to serve the client's meals in the client's room. This is an example of which of the following?

a) Advocacy

b) Acceptance

c) Nurturing

d) Adaptation

a) Advocacy

Which of the following defines self-awareness?

a) Perceptions, thoughts, feelings, and actions

b) Consciousness of one's personality

c) Dependable and steady behaviors

d) Ability to exercise capability and accountability

b) Consciousness of one's personality

Which of the following stages is associated with a crisis?

a) Relapse

b) Anger

c) Disorganization

d) Acceptance

c) Disorganization

Which of the following is the foundation of therapeutic relationships?

a) Confidence

b) Sympathy

c) Dependence

d) Trust

d) Trust

Which of the following research-based practices is a valuable source of stress reduction for health care providers?

a) Reading

b) Massage

c) Music

d) Meditation

d) Meditation

A nurse who is caring for a mentally ill client establishes a supportive and honest relationship with the client and maintains client confidentiality. This is an example of which principle of mental health care?

a) Avoid emotional trauma.

b) Develop mutual trust.

c) Encourage dependence.

d) Encourage situational withdrawal.

b) Develop mutual trust.

A mentally ill client begins to argue and hit another client because of a money dispute. This is an example of which coping behavior?

a) Psychomotor

b) Cognitive

c) Affective

d) Somatic

a) Psychomotor

A nurse who is caring for a depressed client understands the significance of the client's depression as well as the overwhelming grief and loss issues felt by the client. This is an example of which of the following?

a) Comforting

b) Caring

c) Empathy

d) Sympathy

c) Empathy

An adult male client in an outpatient clinic has made great progress with conquering his social phobias. He is considered mentally healthy because he is now able to:

a. Cope and adjust to the stressors of daily life in an acceptable manner

b. Know when to take medication to control his anxiety

c. Contact his therapist any time he is feeling extreme anxiety

d. Adjust his medication dosages according to the stressors with which he is dealing

a. Cope and adjust to the stressors of daily life in an acceptable manner

A male client has learned to be successful with cognitive, or intellectual, coping mechanisms when faced with stressors, as evidenced by his ability to:

a. Confront stressors directly

b. Negotiate when faced with the problem

c. Ignore the problem to avoid the stress it causes

d. Use successful problem-solving skills

d. Use successful problem-solving skills

An adolescent female client with anger management issues is found destroying items in her room. What is the nurse's most appropriate response?

a. "Stop! Why are you destroying these things?"

b. "You need to stop that behavior. Destroying property is not allowed."

c. "Why do you feel you have the right to destroy those things?"

d. "You are very disappointing to me right now."

b. "You need to stop that behavior. Destroying property is not allowed."

A male client with bipolar disorder has been admitted to a mental health unit during a manic phase. To provide consistency for this client, the care plan should be:

a. Revised on a daily basis by the treatment team

b. Followed by each member of the treatment team

c. Allowed to be changed by the client as necessary

d. Evaluated primarily by the physician

b. Followed by each member of the treatment team

Addressing a client by Mr. or Ms. and his or her last name, unless the client asks the nurse to address him or her by another name, is an example of the therapeutic action of:

a. Self-awareness

b. Caring

c. Empathy

d. Advocacy

b. Caring

mentally healthy adult**

person who can cope with and adjust to the recurrent stresses of daily living in an acceptable way/realistic perceptions of their strengths and weaknesses

mentally ill pt*

preoccupation with thoughts of oneself, when an individuals problems become so overwhelming that one is unable to carry out the activities of daily living or function independently

experience and suffering living with mental illness*

is unique to each individual

7 principles of mental health care*

-do no harm (protect and keep pt and staff safe)

-accept each person as a whole person (holistic, accept differences)

-develop a mutual trust (truism, if you say youre gonna do something do it, advocacy)

-explore behaviors and emotions (identify behavior, perception)

-encourage responsibility

-encourage effective adaptation

-provide consistency

empathy

ability to recognize and share the emotions of another person without actually experiencing them (understanding and acceptance of the meaning and significance of that person behavior, willingness to see the world as the pt does)

behavior

perceptions, thoughts, feelings and actions

combative pt*

make sure staff and pt is safe, reason with the pt and deescalate the situation, dont ever have your back to the door/have a way out, dont wear anything around your neck

you give a pt handouts for schedule and they throw it out*

giving them the schedule is advocating for the pt

pt admitted and they dont wanna come out of their room, do activities, talk or eat*

nurse should continually consistently encourage them to do things, ask what they like to eat

pt exhibiting anger towards another pt*

we can talk to pt regarding observations we made and ask them are you really angry with this person

group therapy one person constantly doesnt let anyone else talk*

nurse should say i want you to stop interrupting and see what other people have to say

encourage effective adaption*

providers encourage the following crisis intervention, help with coping mechanism and one step at a time

coping behaviors

-psychomotor/physical: efforts to cope directly with problem (confrontation, fighting, running away, negotiating)

-cognitive/intellectual: efforts to neutralize threat by changing meaning of problem (making comparisons, substituting rewards, ignoring, changing values, using problem solving methods)

-affective/emotional: actions taken to reduce emotional distress, no efforts are made to solve problem (ego defense mechanisms such as denial and suppression)

crisis stages

perception, denial, crisis, disorganization, recovery, reorganization

pseudo-resolution*

pt never learned anything from crisis, no success despite interventions, opportunity for growth is missed

effective crisis interventions

care is needed immediately, control, assessment, pts disposition is determined, referral, follow up

caregivers self awareness*

consciousness of ones personality, be aware of own personal values and wont cloud your judgement, be aware of your personality, get pts to have self awareness

therapeutic actions of caring

address pt by Mr. or Ms. until otherwise instructed, respect pts unique personality, dont judge pts behaviors or attitudes, share with pt that every person has potential for change, show interest in the whole person not just the dx, customize info to the pts level of understanding, watch for nonverbal messages, promote self esteem, assess own interactions and communications

risk taking*

possibility of failure, failure provides opportunity for change, failure is a necessary part of change, give yourself permission to fail, encourages creativity, stimulates learning and sharpens ones judgement, consider your failure as a learning experience

professional boundaries*

crossed when caregivers become too helpful or controlling, cant be focused on oneself and on pt at same time/ continually balance with ones need to be caring, have positive outlook

positive outlook 5 tips

listen to yourself talk, change recurrent negative themes, be your own cheerleader, visualize future successes, act the part

how to develop a positive attitude

recognize negative thoughts, emotions and attitudes, reject and throw them out of your personality, replace each negative attitude by frequently repeating positive statements, repeat upbeat and enthusiastic words that help to build a feeling of success, visualize future successes, act the part

nurturing yourself*

be knowledgeable, value each individual as a human presence, be responsible and accountable for your actions, be open to new ideas, connect with others, support your colleagues, take pride in yourself, like what you do, recognize moments of joy in the struggles of living, recognize and accept your own limitations but strive to improve, rest each day and begin anew (be comfortable in work environment, manager should supply as much info to make staff feel more comfortable, if something changes or something new make people get in-serviced on it)

health care providers seek to

instill hope, empower others, encourage independence and help improve the other condition. when we are unable to achieve that, unable to alleviate suffering, we often experience a sense of frustration and failure