Mental Health Exam 1 Review

Define Mental Health

Condition of well-being in which an individual can positively function in their daily life & is able to cope with stressors as they appear

Define Mental Illness

Health conditions involving changes in emotion, thinking, or behavior

Distress & problem functioning in social, work, & ADLs

What is D5M-TR?

Diagnostic & Statistic Manual of Mental Disorders, 5th Ed., Text Revision

Principle diagnostic tool for defining & diagnosing mental health conditions 

D5M-TR Use

Classifies, provides criteria, & clinical manifestations for mental health disorders

Collects morbidity/mortality data 

When are mental illnesses diagnosed?

Individual experiences a manifestation associated with a mental illness over a period of time.  

What does D5M-TR include?

Includes criteria & manifestations for mental health illnesses 

D5M-TR Purpose

Assists providers in using common diagnostic language to describe clients with mental health disorders. 

How Do Nurses Use D5M-TR

Use it as a reference to assist with planning, implementing, & evaluating care. 

Define Stigma

Society’s negative attitude against an individual/group

Stems from fear & not being able to understand 

Define Self-Stigma

Adopting a negative view of self

Internalized shame about their condition viewed as a character flaw.

Define Public-Stigma

Negative attitude generally by the public toward others

Expressed in discriminatory attitudes & actions

Define Institutionalized Stigma

Governmental policies/organizations limit opportunities for those with mental illness

Intentional or Unintentional 

Define Bias

Stereotyping, prejudice, or even discrimination against a group of people

How YOU view a group/individual

Define Stereotype

Oversimplified belief or generalization about a group

Negative or Positive

Define Prejudice

A belief, attitude, or feeling about an individual/group not based on facts.

Negative

Define Discrimination

Unjust treatment of an individual/group of people based on a category they are perceived to be in.

What are the 2 Types of Bias

Implicit & Explicit

Define Implicit Bias

Bias occurs outside of conscious awareness

Define Explicit Bias

Conscious

Intentional display bias toward someone causing discrimination

What is the Mental Health Continuum

Range of mental health with adaptive wellness on one end & maladaptive coping on the other end

Zones of Mental Health Continuum (5)

Excelling

Thriving

Surviving

Struggling

Crisis

Excelling (4)

Highest level of well-being, no mental illness symptoms;

Motivation, rational thought, social relationships, & resolve stress.

Thriving

Client experiences stressors but is able to resolve them

Surviving (5)

Not a state of distress but problems need action;

Person on edge; nervous, irritability, distracted, social withdrawal. 

Struggling (3)

Client feels worthless & worried, life is misery, hopelessness

Poor performance, sleep & appetite dysfunction

Crisis (5)

Mental Health Disorder End Stage; Severe Symptoms & Needs

High worry, low mood, suicidal, irrational thinking, Absentism

Mental Health Continuum Self Check: Healthy

Healthy functioning & wellbeing

Have coping mechanisms for normal daily stressors

Mental Health Continuum Self Check: Reacting

Acute stress & difficulty coping with stress, while still able to perform ADLs

Reacting Manifestations (10)

Irritability, impatience, nervousness, sadness, worry, procrastination, forgetfulness, sleep impairment, intrusive thoughts, & social withdrawal 

Mental Health Continuum Self Check: Injured (3)

Client deteriorated & could quickly become an emergency

Distress & no healthy coping strategies over period; ADLs impaired

Mental Health Continuum Self Check: ill

Clinical Disorder; Severe & persistent functional impairment

Requires emergency attention & professional treatment;

ill Manifestations (9)

Inability to cope with stress/emotions, changes in thoughts, behavior, & actions, severe anxiety, panic attacks, depression, overwhelmed, fatigue, disturbed reality, suicidal 

What is the Diathesis-Stress Model?

2 Part theory that explains why not everyone exposed to same stress develops a disorder

Suggests that Diathesis & Stress is needed for mental illness

Define Diathesis

Genetic/biological predisposition for mental illness

Stronger Predisposition = Less Stress needed for disorder

Define Stress (theory)

Psychosocial or Physiological Stress

What is Trauma-Informed Care?

Care that recognizes impact of trauma on a client & provides care that avoids re-trauma, builds trust, & empowers client.

Trauma Informed Care Framework (5)

Safety

Compassion & Trustworthiness

Support & Collaboration

Empowerment

Client-Centered Care

Trauma-Informed Care Considerations/Issues (3)

Culture - Provide care that respects cultural value, past experiences, & individual identity

History - Recognize trauma history & that it may be tied to racism, poverty, discrimination, etc.

Gender - Respect individual identity & pronouns

Define Cultural Competence

Providing knowledgable, respectful, & individualized care to clients of different cultural backgrounds

What Does Cultural Competence Involve? (7)

Self-Awareness, Knowledge, Skill, Sensitivity, Proficiency, Dynamicity, & Recognition of Power Imbalances

How to Determine Cultural Competence (4)

Self-Awareness - Assess personal biases & assumptions

Knowledge - Learn about other cultures beliefs, values, & practices

Sensitivity - Engage in cross-cultural activities/interactions with a variety of clients

Skill - Refine cultural assessment & integrate cultural considerations into care.

Giger & Davidhizar Model

Helps nurse guide cultural care (practices, diets, beliefs, values etc.)

What Are Cultural Health Beliefs

Cultural values/practices about understanding health, illness, & treatments

Involves complementary & alternative therapies & herbal supplements

Examples of Cultural Competence in Care (6)

Adhering to dietary preferences

Spiritual services

Licensed medical interpretor

Respecting nonverbal norms

Allowing time for prayes/rituals/practices

Including family into care

Factors Impacting Culturally Competent Care (4)

Race/Ethnicity/Nation – different cultural norms, stigma, or health beliefs. 

Gender Identification – lack of respect for identity may discourage care 

Language & Culture – communication barriers, misunderstanding of health concepts 

Provider diversity – lack of providers sharing/understanding clients cultural/racial/language background 

Resulting Impact of Barriers to Cultural Competence (4)

Lack of access to culturally appropriate resources 

Lack of quality care for clients' values 

Perceived discrimination 

Discouragement/discontinuance of treatment 

Define A Therapeutic Mileu

Therapeutic & Social Environment organized & focused on healing

Structured towards recovery & assists in developing life & social skills impaired by mental illness

Physical Environment of a Therapeutic Mileu

Ensure Safety & Healing

Psychosocial Environment Factors of a Therapeutic Mileu (4)

• Awareness for intention to heal  

• Experiences for personal wholeness 

• Healing Relationships 

• Collaborative therapies 

Beneficence

To do good & act in client’s best interest

Nonmaleficence

To do no harm; prevent/minimize harm

Autonomy

Clients should be able to be involved & make rational decisions related to their care.

Justice

Fair & equal treatment for ALL clients

Self-Determination

Right to refuse treatment

Confidentiality

Health information only shared with those involved in client care & with others only if client consents.

Define Capacity

Medical Term

Client’s ability to understand information, use reasonable thought, communicate their wishes & understand the consequences of their decisions

Capacity - able to provide informed consent

How is Capacity Determined?

Determined by Provider through Assessment

Capacity may fluctuate during illness & decision maker is directed to surrogate decision maker

Define Competence

Legal term

Client’s global ability to make decisions & assume responsibility for themselves

How is Competence Determined?

Determined by a judge during a hearing/presentation of evidence

If deemed incompetent assigned legal surrogate, guardian, or representative assumes responsiblitity

Define Torts

Civil wrongful act resulting in harm/violation of client’s rights

Represents breach of duty of nurses

Define Unintentional Torts

Nurse did not use forethought in the action/omission of action but harm still occurred.

Define Intentional Torts

Nurse knowingly performed unsafe, unlawful actions/act of omission

Criminal action

Define Negligence

A person is careless & fails to provide basic standard of care to another person

Most Common Unintentional Tort

Define Malpractice

Specific type of negligence when a professional fails to follow standards of care when there is an expectation & duty to do so

Unintentional Tort

Define False Imprisonment

Confinement of a client when there are no legal grounds to do so; Seclusion, restraints, etc.

Intentional Tort

Define Assault

No physical harm needed; verbal harm or action perceived to be threatening. 

Intentional Tort

Define Battery

Physical contact that is offensive or unwanted; Client can claim battery regardless if harm occurs 

Intentional Tort

Define Restraints

Physical/Chemical means of restricting a client’s free movement or thought

Should be done ONLY in cases of behavioral emergency in which a client poses danger to themselves or others

Drugs used in Chemical Restraints (5)

Antipsychotics, Neuroleptics, Anxiolytics, Mood Stabilizers, Sedatives

Common - Benzodiazepines

Define Seclusion

Patient placed in a seclusion room that is safe, free of stimulation, and monitored by closed-circuit television.

Risks of Restraints

Aspiration of food, positional asphyxia, cardiac arrest, & death

Restraint Safety Considerations (8)

Never leave clients in prone/supine position

Check on restraints every 15 minutes

Notify provider ASAP after restraints

Revaluate need for use after 1 hr

Document behavior leading to restrains

Frequently assess cardiac/respiratory status, skin integrity, circulation, ROM

Allow for basic care needs - hydration, food, elimination

Support & reassure of their safety

Hierarchy of Restraints (5)

Verbal De-escalation

Timeout - least restrictive

Seclusion

Physical Restraints

Chemical Restraints - most restrictive

Define Recovery

Personal process of improving mental health, finding hope, & living a meaningful life, even if symptoms remain

Define Rehabilitation

Professional support & services that help people develop skills, independence, & social functioning.

Define Relapse

Recurrence or worsening of symptoms after a period of improvement

Biomedical Model

Mental illness viewed as a biological/physiological disorder

Recovery Model

Emphasizes hope, empowerment, & client-driven goals, not just symptom control. 

What is the Code of Ethics?

Set of Principles for Conduct & Responsibilities of Nurses to provide quality & ethical care

9 Provisions/Guidelines

Respect for human dignity

Commitment to patient

Advocacy & protection of client rights

Accountability & responsibility

Self-care & professional growth

Creating an ethical environment

Advancing profession through inquiry

Collaboration & global health

Social justice & maintaining Integrity of profession 

Goal of Code of Ethics

Guides nurses in decision-making during ethical dilemmas

What is a Nurse-Client Relationship

A relationship built on trust, respect, & professionalism

Important - establish boundaries, collaborate on goals, promote autonomy & client-centered care

Nurse-Client Relationship Components (5)

• Needs of patient identified & explored 

• Clear boundaries established 

• Problem-solving approaches taken 

• New coping skills developed 

• Behavioral change encouraged 

Nurse-Client Relationship Benefits

Improves emotional & physical wellbeing of client

Define Transference

Unconscious effort of the client to redirect their previously experienced feelings/emotions toward the nurse

Define Countertransference

Unconscious effort of the nurse to redirect their previously experienced feelings or emotions toward the client.

Define Client-Centered Care

Care is centered around the client’s values & preferences

Client is an active participant & collaborates to develop their treatment plan & goals

Nurse During Client-Centered Care

Empathetic active listener

Fosters a supportive environment & sees client as a whole person. 

Components of Therapeutic Communication (5)

Open-Ended Questions

Close-Ended Questions

Clarification

Summarizing
SURETY

Define Open-Ended Questions

Allows for client to express needs & feelings allowing for more information to be collected for a focused treatment plan

Define Close-Ended Questions

Questions that allow only for a yes/no answer; does not allow for depth

Define Clarification

Nurse asks patient to restate/explain their message to ensure accurate understanding & prevent misinterpretation

Involves - Restating, Reflecting, Paraphrasing, & Exploring

Define Summarizing

Restating of major key concepts in a conversation about change

Effective transitional technique to move onto next phase of treatment planning

Define SURETY

Sit at an angle

Uncross arms & legs

Relax

Eye Contact - if culturally appropriate

Touch - if culturally appropriate

Your intuition

Building Trust & Rapport

Creates safe, respectful relationship that encourages open communication & promotes adherence

Define Trust

Believing a characteristic to be true in something or someone. 

Client’s more willing to engage in care.

Define Rapport

Built when client feels understood & treatment is perceived as transparent.

Connection