Introduction to the World of Psychiatric Mental Health Nursing

Practice flashcards covering key terms, concepts, definitions, historical context, treatment settings, and patient rights in psychiatric mental health nursing.

What is comorbidity?

Two co-occurring chronic illnesses.

What significant legislation led to the mass movement of severely mentally ill persons from state hospitals to outpatient care?

Community Mental Health Act.

What does mental health parity mean in the context of insurance?

Equivalence in treatment coverage for psychiatric disorders compared to physical disorders.

What is the most accepted explanation for mental illness, combining genetic vulnerability with negative environmental stressors?

Diathesis-Stress Model.

What is meant by a dual diagnosis in mental health?

Co-occurring mental illness and substance use disorder.

What term has replaced "compliance" to describe a patient following their plan of care?

Adherence.

What is "revolving door treatment" in psychiatric care?

Repeated admissions to psychiatric inpatient units, often due to lack of community services or independent living skills, leading to frequent emergency department visits.

According to the notes, what is the definition of recovery in mental health?

A process of change through which individuals improve health and wellness, live a self-directed life, and strive to reach their full potential.

What is resilience, and what are its key characteristics?

The ability and capacity to secure resources to support well-being, characterized by optimism, a sense of mastery, and competence.

What is a Day Treatment Program?

A step below Partial Hospitalization Programs, offering structured activities and group therapy 1-2 days a week for 4 weeks or less, focusing on coping and social skills.

What is acute care hospitalization in psychiatric settings?

A highly structured setting optimizing safety and crisis intervention, with an average length of stay of 3-7 days.

When is long-term hospitalization recommended for psychiatric patients?

If a patient requires longer than 7 days for illness/symptom stabilization.

What are Partial Hospitalization Programs (PHP)?

Programs for those needing supervision but not inpatient hospitalization, offering six hours of group therapy multiple days a week to keep patients safe and reduce readmissions.

According to the World Health Organization, what is the definition of health?

"Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

According to the World Health Organization, what is the definition of mental health?

A state of well-being in which everyone can realize their own potential, cope with stresses, work productively, and contribute to the community.

According to the American Psychiatric Association, what is the definition of mental illness?

Health conditions involving changes in emotion, thinking or behavior (or a combination of these), associated with distress and/or problems functioning in social, work or family activities.

What are the three main categories of influences that contribute to mental health?

Biologic, Psychological, and Sociocultural Influences.

In 2021, what percentage of US adults had any mental illness (AMI), according to NIMH?

22.8% (57.8 million adults).

Which age group had the highest rate of mental illness in 2021?

Young adults aged 18-25 years (33.7%).

Name some early 19th-century theories of mental illness.

Inheritance theory, Moral degeneracy theory, Germ theory, and Septic foci theory.

What are the two main components of the Diathesis-Stress Model?

Diathesis (biological predisposition/vulnerability) and Stress (environmental stress or trauma).

What were some early treatments meant to "adjust" abnormal behaviors in the 1800s-1900s?

Restraining devices (padded helmet, hand mittens, straight jacket), chemical restraints, surgery (lobotomy), insulin therapy, hydrotherapy, sedative cold wet packs, and electro-shock therapy.

What was a common outcome for many patients after deinstitutionalization, despite new psychotropic medications?

Many struggled to transition, leading to homelessness, emergency department visits, re-arrests, and entry into the prison system.

What are key issues faced by the 2 million people with mental illness booked into jails yearly?

Most do not receive treatment, their mental illness worsens, high risk of victimization, difficulty finding jobs/housing after release, and high rates of homelessness or re-arrest.

When and why was the National Alliance on Mental Illness (NAMI) formed?

In 1979, by groups of individuals with mental illness (consumers) who advocated for their rights and fought discrimination and forced inpatient treatment.

What are key goals of the National Alliance on Mental Illness (NAMI)?

Communicating that mental illnesses are brain disorders, eliminating stigma and discrimination, advocating for people with mental illness, improving access to treatment services, and integrating mental illness into community life.

What were the core messages of the Surgeon General's Report on Mental Health?

Mental health is fundamental to a healthy life, mental health disorders are real health conditions with enormous consequences, effective treatments are available, and those with disorders should seek treatment.

What did the 2003 New Freedom Commission on Mental Health call for?

A streamlined system with less fragmented care, early diagnosis and treatment, adoption of recovery principles, and increased assistance with housing and employment.

What is the purpose of the Fayette County Mental Health Court (FMHC)?

To provide a treatment-oriented, person-centered approach, utilizing peer support and multidisciplinary teams to help individuals with serious mental illness (SMI) obtain treatment and medication instead of jail sentences, thereby reducing reoffending.

What is Tim's Law, enacted in Kentucky in 2017?

Kentucky's first Assisted Outpatient Treatment (AOT) statute, named for a man with schizophrenia, aimed at stopping the "revolving door" of jails, hospitals, and homelessness.

What did the Mental Health Parity Act of 1996 require?

Insurance companies to provide equal treatment coverage for psychiatric disorders compared to physical health conditions.

How did the Patient Protection and Affordable Care Act affect mental health care?

Expanded Medicaid eligibility, created health insurance exchanges, and included an "insurance mandate" for coverage.

How does the Mayo Clinic define stigma?

When someone sees you in a negative way because of a particular characteristic, attribute, or personal trait.

What is the DSM-5?

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, which are the official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders.

What is the title and certification process for a basic level psychiatric mental health registered nurse (PMH-RN)?

PMH-RN, who can add "BC" (RN-BC) after 2 years full-time work, 2000 clinical hours, 30 hours continuing education, and passing a certification exam.

What is the title and education required for an advanced practice psychiatric mental health registered nurse?

PMH-APRN, requiring a Master of Science or Doctorate degree.

Name some functions of an Advanced Practice Registered Nurse (APRN) in psychiatric mental health.

Health promotion, screening, evaluation, assessment, formulating differential diagnoses, ordering/interpreting diagnostic studies, conducting psychotherapy, and prescribing/managing medications.

Name some members of an interdisciplinary team in psychiatric mental health care.

Patient, Family/Significant others, RN, MD, CNS/APRN, Psychologist, SW/LCSW, Pharmacist, Recreational (Activity) Therapist, Certified Drug and Alcohol Counselor, Teacher (Child/Adolescent), and Mental Health Associates.

What is the average length of stay in an acute care psychiatric hospital?

3-7 days.

What are the primary admission criteria for inpatient psychiatric mental health care?

Danger to themselves (suicidal ideation/behaviors), danger to others (homicidal ideations), or inability to care for basic needs/gross impairment of judgment placing them at imminent risk.

What defines a voluntary admission to a psychiatric hospital?

Both the individual and health care professionals agree on the need for treatment and hospitalization, and the individual signs a consent for treatment.

What defines an involuntary admission in a psychiatric hospital?

Health care professionals feel admission is necessary, but the individual does not wish to be admitted, often under a 72-hour hold, after which a court petition may be sought for further care if needed.

List some rights of every hospitalized psychiatric patient.

Right to receive or refuse treatment, dignity, involvement in planning, protection from harm, legal counsel, communicate, confidentiality, and least restrictive means.

What is a key rule regarding orders for restraint or seclusion?

Orders are never written as an "as needed" or "standing order," and in an emergency, a nurse must obtain a written or verbal order as soon as possible after placement.

What are some exceptions to patient confidentiality in psychiatric care?

Duty to warn and protect third parties, and child and elder abuse reporting statutes.

What is a therapeutic milieu in an inpatient hospital unit?

The surroundings and physical environment that provide a sense of security/safety, foster social competence, offer a training ground for communication/coping skills, and include activities, rules, reality orientation, and groups.

What are the five key components that make up a therapeutic milieu?

Containment, Support, Validation, Structure, and Involvement.