320 Exam #1

How do we counteract the negative effects of stigma?

-Having contact w/ stigmatized group

-Use of non-stigmatizing, persons first language (example: person with schizophrenia not schizophrenic patient)

What is the goal of treatment of mental disorders?

****RECOVERY: the process of change through which individual improve their health and wellness, live a self-directed life, and strive to reach their full potential

To alter the persons immediate, dysfunction, appraisal of the situation and perception of long term consequences

Help patient to begin to analyze their thoughts as incrongruent w/ reality

What is Epidemiology?

-the study of patterns of disease distribution and determinants of health within populations or aggregates and associated factors (how disease spread and what causes them in certain groups of people)

**does not determine the causes of illnesses

What is epidemiology in terms of mental health?

-->helps understand the overall status of groups and related factors

What is the downward economic spiral on mental health?

families living in poverty are under tremendous financial and emotional stress which may trigger or exacerbate mental health problems

this then makes it even more difficult to provide the basic needs of food/shelter/etc.

these issues then prevent families from addressing psychological needs

this can then causes frustration and hopelessness which can leads to depression, alcoholism, or abuse

and it just keeps going down and down

Why is cultural competence in MH nurses important?

cultural competence can improve treatment engagement, therapeutic relationships, and treatment outcomes

How does cultural humility expand cultural competence in MH nursing?

its an evolving perspective that fosters application of diversity and helps reduce health disparities

-Recognizing patients as experts of their own experiences.

-Encouraging ongoing self-reflection and awareness of personal biases.

-Emphasizing openness, egolessness, and respect in interactions.

-Avoiding assumptions based on prior experience with similar cultural groups.

Under what circumstances is it appropriate to breach confidentiality?

-Risk to harm to self

-Risk to harm to others → Mandated to report (mandated by law to report)

-Abuse reporting

-Public health concerns

-Legal requirements

What criteria is used for involuntary commitment?

Mandated treatment without the person's consent but with a court order through state civil laws

1. Mentally ill to the degree that the person's thought or mood grossly impairs judgement, behavior or ability to negotiate demands of life

2. Dangerous to self or others

3. Unable to provide for basic needs (ex. Gravely disabled)

How does self awareness contribute to the Nurse-client relationship?

"Know Thyself"

-What physical problems or illnesses have you experienced?

-What significant traumatic life events (e.g., divorce, death of significant person, abuse, disaster) have you experienced?

-What prejudiced or embarrassing beliefs and attitudes about groups different from yours can you identify from your family, significant others, and yourself?

-Which sociocultural factors in your background could contribute to being rejected by members of other cultures?

How would the above experiences affect your ability to care for patients?

How is the use of silence a form of therapeutic communication?

allows patient to gather thoughts and to proceed at their own pace

What is considered positive body language?

Sitting at the same eye level as the patient with a relaxed posture that projects interest and attention.

Leaning slightly forward helps engage the patient

Uncrossed arms and legs project openness and a willingness to engage in conversation

What are forms of therapeutic communication?

-nurse focus on the patient and patient-related issues

-Activities should have a definite purpose

-Conversation should focus only on the patient

-Self-disclosure should NOT BE INVOLVED unless it benefits the patient/directs the conversation in a way to benefit the patient

-Should have identified therapeutic outcomes

-Giving advice, agreement, active listening, positive verbal and nonverbal cues, etc.

What body zone that is appropriate for therapeutic communication?

3-12 ft

What is the intimate Body Zone?

6-18 inches (0.5-1.5 ft)

What is the Personal Body Zone?

18-47 inches (1.5-4 ft)

What is the Social Body Zone?

47 inches-3 yards

What is the Public Body Zone?

over 3 yards

What is the Nurse-client relationship: orientation phase?

nurse and patient meet; ends when the pt begins to discuss the problems to be examined

-goal is to develop trust and security

-discuss confidentiality

-discuss estimated time of relationship (termination phase)

-outlines responsibilities

What is the Identification/working phase?

patient identifies problems to work on;

patient is psychologically vulnerable and emotionally dependent on the nurse;

nurse must recognize counter-transference and prevent it from ruining the professional relationship

What is the Transference phase?

unconscious assignment to others of the feelings and attitudes from the patient to others based on past experiences

What is Counter-transference?

the provider's emotional reaction to the patient based on personal unconscious needs and conflicts

What happens during the Resolution phase?

-when problems get resolved and ends with the termination of the relationship

How do nurses maintain professional boundaries?

Do not accept gifts

Do not give out personal information (such as phone numbers)

Do not favor patients

Do not keep secrets

Friendship is allowed if it precedes the hospital/medical setting

OR when another nurse is unable to care for the friend

Sexual relationships are not permitted.

Client is always the focus

What are non pharmacologic sleep interventions?

(always used first because of the side-effect risks associated with the use of sedatives and hypnotics)

Go to bed only when tired or sleepy

Establish a consistent bedtime routine

Avoid stimulating foods, beverages, or medication

Avoid naps in the late afternoon or evening

Eat lightly before retiring and limit fluid intake

Use your bed only for sleep or intimacy

Avoid emotional stimulation before bedtime

Use behavioral and relaxation techniques

Limit distractions

What are outcome indicators for r/t schizophrenia with hallucinations?

-could be hallucination control (reduce frequency or intensity)

-coping strategies

-adherence to medical regimen

-social interactions skills (makes eye contact and participates in group activities)

-safety behavior (remains from acting on commands of hallucinations)

What is Cultural brokering?

the act of bridging, linking, or mediating, messages, instructions, and belief systems between groups of people of differing cultural systems to reduce conflict or produce changes (requires cultural competence)

(someone working with two different groups iof people to get them to work with each other)

What is an MSE?

mental status exam

What are the components of an MSE?

-affect

-attention and concentration

-abstract reasoning and comprehension

-immediate/short-term memory check

What is affect of a MSE?

the person's capacity to show outward emotional expression

How to test attention and concentration in an MSE?

-ask pt to start with 100 and subtract 7 until reaching 65 (without a pencil or paper) OR subtract 3 from 20 OR asking the pt to spell the word "world" backward

How to test abstract reasoning and comprehension in a MSE?

-give the patient a proverb (short commonly known saying) to interpret

examples: "people in glass houses should not throw stones" OR "a rolling stone gathers no moss" OR "a penny saved is a penny earned"

How to test immediate/short-term memory in an MSE?

-give the patient 3 unrelated words to remember and as them to recite them right after you tell them and then after 5-15 minutes ask them to recite the words again

How to test Insight and Judgement in an MSE?

during the patient interview determine/evaluate whether the patient can make logical decisions (judgement)

AND do they admit to something being wrong/recognize a problem/compare thoughts to others (insight)

What is the Nursing Intervention: Reminiscence?

thinking about or relating of past experiences; is used as a nursing intervention to enhance life review in older patient

Encourages patients, either in individual or in group settings to discuss their past and review their lives

Through this they can identify past coping strategies that can support them in a current stressful situation

Can use it to maintain self-esteem, stimulate thinking, and support the natural healing process of life review.

What is the Nursing Intervention: Psycho-education?

systemic, structure, didactic-teaching learning interaction that focuses on enhancing knowledge and skills related to mental health and wellness

Goal: is to changes in knowledge and behavior; provide the person and family with knowledge about the about the disorder and treatment and the skills to participate in treatment decisions

Use it to meet educational needs of patients by adapting teaching strategies to their disorder-related deficits

Is a continuous process of assessing, setting goals, developing learning activities, and evaluating for changes in knowledge and behavior

What is the Nursing Intervention: Behavior Modification?

a specific, systematized behavior therapy technique that can be applied to individuals, groups, or systems

Aim is to reinforce desired behaviors and extinguish undesired ones

Can be used for various problematic behaviors, like dysfunctional eating, addictions, anger management, and impulse control

Can often be used in the care of children and adolescents

Why is there bias against women in leadership positions in the military?

???

When was VANAP integrated with civilian schools?

2007

Veterans with PTSD

-to diagnose: must be have been exposed to actual or threatened death, serious injury, or sexual violence

-symptoms: startled reaction with hyper-vigilance, avoidance of memories, external reminders, anhedonia with detachment, being upset when reminded of the event, dreams with sleep disturbance

-very common with veterans

What is combat-related trauma vs. non-combat related trauma?

combat related trauma: occurs while engaging in warfare activities that involve injuries, loss of comrades on the battlefield, and improvised explosive devices

non-combat related trauma: occurs outside of direct combat and includes trauma such as military sexual trauma (MST), witnessing violence, and serious accidents

What is a moral injury vs perpetuation?

moral injury: violates moral beliefs or causes one to question the justness of the world "I knew it was wrong, and I can't forgive myself"

perpetuation: The act of causing something harmful to continue or the fact of something harmful continuing after a moral injury takes place

What is the Health Belief Model?

-One of the 1st theories of health behavior

-A psychological theory that explains health behaviors by stating people are more likely to act if they believe they are at risk, the condition is serious, benefits outweigh barriers, they feel capable of acting, and are prompted by cues to action.

-reminds nurses to think carefully about what motivates a person to change

What are the six components of the HBM?

1. Perceived susceptibility: "will something happen to me?

2. Perceived severity: "if something does happen to me, will it be a big problem?"

3. Perceived benefits: "if i do what is suggested, will it really help me?"

4. Perceived barriers: "assuming i do what is suggested will there be barriers that will be unpleasant.."

5. Cues to action: "can i really do this?"

6. Self efficacy: "can i really do this?"

What is the transtheoretical model?

Used in health promotion activities that Conceptualize the process of intentional behavior change in alcohol and drug abuse, as well as in smoking cessation programs.

Six stages are associated with behavior change.

Stages:

1. Pre-contemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

6. Termination

How do we assess the quality of the Internet Health Information? ON TEST

Accuracy

Authority

Bias/Objectivity

Currency/Timeliness

Coverage

What is the Elizabeth Poor Law?

-1601

-guaranteed assistance for poor, blind, and "lame" individuals

-menial care was generally provided in almshouses supported by local government

-the goal was to regulate the poor and provide a refuge during illness

-categorized poor based on their ability or willingness to work

Who was Lillian Wald and what did she do?

-She became a prominent leader of public health nursing during these decades (1905) helped solve social problems and healthcare issues

-She was the first public health nurse in the U.S.

-She believed the poor should have access to health care

-made the visiting nurse service of NYC and established the first public health nursing program

Who is Mary Breckinridge and what did she do?

-Established FNS (frontier Nursing Service)

-Introduced the first nursing midwives into the US

-Efforts to reduce pregnancy complications and maternal mortality (1/3rd reduction achieved)

What was the emphasis of nursing school courses taught in diploma schools in the 20th century?

they emphasized on-the-job training? hands on experience?

What is a windshield survey?

-A windshield survey is conducted from a car and provides a visual overview of a community. Refer to video and handouts in modules

-survey of the community to help understand potential environmental health risks

- noting the proximity of trash sites, dump sites, factories, transportation routes etc.

What is the choice of priority related to community problems?

-make the community the center of your focus

Improved health of community is the priority

collective or common good of population

What are the categories for health professional core competencies?

-analytic/assessment

-policy development/program planning

-communication

-cultural competency

-community dimensions of practice

-basic public health sciences

-financial planning and management

-leadership and systems thinking

What is the Planning Phase of community nursing process?

Analyzing and establishing priorities among community health problems already identified

-establish goals and objectives

-identify intervention activities

-plan to evaluate the effectiveness of interventions

What are the steps in the affective domain?

1. Knowledge: recieve the information

2. Comprehension: Responds to info received

3. Application: values the info

4. Analysis: makes sense of the info

5. Synthesis: organize the info

6. Evaluation: adopt behaviors to be consistent with new values

Affective feelings? difficult to change deeply rooted attitudes beliefs, interests and values

What are the aspects of group support?

-follower: seeks and accepts the authority or direction of others

-gatekeeper: controls outsiders access to the group

-leader: guides and directs group activity

-maintenance: provides physical and psychological support for group members, thereby holding the group together

-peacemaker: attempts to reconcile conflict between members or takes action in response to influences that disrupts the group process and threaten its existence

-task specialist: focuses on direct movement towards the main work of the group

What are adult learning characteristics or reasons adults learn new info?

-when they think they need to know something

-new information is compatible with their prior life experiences

-they value persons providing info

-they believe they can make any necessary changes that are implied by the new info

What are the parts ssessing the Quality of Internet Health Information?

-accuracy

-authority

-bias/objectivity

-currency/timeliness

-coverage