Evidence Based Practice

Client-centered care

individualizing care for the specific needs of a client and involving the client with decisions.

e, the client can make decisions when given choices pertaining to their care.

10 areas that comprise the disturbing events of ACEs:

Exploring

when the nurse asks for more information to better understand what the client is communicating.

Clarification

The nurse is not demonstrating clarification. Clarification allows the client to confirm that the nurse understands what they have communicated.

Restating

The nurse is not demonstrating restating. Restating is when the nurse repeats back what the client has said.

Paraphrasing

The nurse is not demonstrating paraphrasing. Paraphrasing lets the client know the nurse understands what the client has communicated.

Client Centered care

• allow the client any freedom of choice

• some freedom in their schedule,

• address the client's request or issue;

characteristics are essential for the nurse to effectively implement therapeutic use of self

1. emotionally balanced

2. assertiveness in facing life’s challenges

3. being with client

4. ability to purse ones own goals

5. compassionate care for clients

recovery model for clients who have an SMI

client will likely not be manifestation-free.

they will have a good quality of life within the framework of their disorder

ACT team

Clients who have a serious mental illness and are not able to maintain normal responsibilities of life would benefit from ACT.

The ACT team assists the client so that they can work through difficulties and challenges, reducing their number of hospitalizations.

The Attachment-Self Regulation-Competency (ARC) model is

built on understanding the effects of adverse childhood experiences (ACEs) and provides some ideas for prevention of further abuse.

ACEs effects

ACEs has a negative effect on clients because it forces these clients to live in survival mode, which makes it difficult for them to self-regulate and manage daily life.

planning step of the nursing process

consists of the nurse planning interventions to assist clients in reaching established goals.

Evaluation step of the nursing process

nurse evaluating the interventions that have been carried out for the client to determine their effectiveness. (Did the intervention work?)

Implementation step of the nursing process

consists of the nurse taking actions to implement the specified plan of care for the client. (putting the plan of care into action)

Assessment

The nurse is performing the assessment step of the nursing process by gathering and synthesizing health data that is pertinent to the client’s care.

Mental Health Theories and Therapies:Mental Health Theories and Therapies

1. ensure the client's computer or electronic device is connected to the internet. (no internet → pt can’t attend session)

2. it is up to the client to decide who they would like in the room during their therapy appointment.

3. The nurse does not need to verify the client's history and medication list before a telehealth appointment.

4. The client does not need to meet the therapist in person before the initial appointment

A nurse is teaching a client about therapy. What does a nurse have to teach them?

Clients have the right to refuse therapy

Therapy is not required + therapy is not required to be offered to every client.

Therapy can be requested or started at any time.

Providers can select whether it will benefit a client's care, but it is dependent upon the individual's diagnoses and needs.

Nurse can instruct the client on the benefits of the different types of therapies and what types of diagnoses the therapies can assist with.

What is the difference between a suicide attempt and self harm?

A suicide attempt is when a person harms themselves with the intent to die, but a person who self-harms has no intention of killing themselves.

• With self-harm, a client tries to harm themselves by inflicting physical pain, but they do not have the intention to kill themselves. A suicide attempt is when the person tries to kill themselves.

The two terms are used for different purposes.

Psychoanalytic therapy

The purpose of psychoanalytic therapy is to help the client be able to learn adaptive coping skills. Psychoanalytic therapy is conducted by examining the unconscious mind and how it influences a person's thoughts, feelings, and behaviors.

Psychoanalytic therapy is performed one-on-one with a therapist.

Group therapy

is a chance to meet with other clients who have similar diagnoses to share insight into using coping skills related to the diagnoses.

Family therapy

is aimed at meeting the client's family unit's needs

Telehealth therapy

allows the client to complete therapy virtually at home.

Seclusion

Seclusion is used when a client is a danger to themselves or others.

If the client is acting out, the nurse should deescalate the situation, and then help the client to understand why they are acting out.

Seclusion is a de-escalation technique that involves involuntary confinement in a locked location. There is no indication that the nurse is using seclusion.

Cognitive therapy

can examine the adolescent's past experiences and how it is impacting their current behaviors. This therapy can be used with both adolescents and children, and it assists in helping them understand current behaviors and responses.

Electroconvulsive therapy (ECT)

ECT is not recommended for young children and adolescents. ECT is often used for adults who have mental illnesses, such as bipolar disorder, schizophrenia, or depression.

Restraints

Restraints are to be used only when the client is a danger to themselves or others, and all other least restrictive options have failed.Instead, the nurse should assist the client in understanding why they are behaving in a certain manner.

Why promotion of mental health is important?

Mental health promotion focuses on promoting positive mental health and preventing exacerbation of mental illness manifestations.

Although the nurse could discuss the benefit of therapies, they are not required to implement therapy to improve the client's mental health.

This can assist the client in being able to use positive coping skills or a positive adaptive response to prevent hospitalization.

While mental health promotion assists the client in promoting their well-being, it does not necessarily mean that the client can come off their medication

Transcendence

A person in this stage understands the meaning or purpose of their life.

Ego integrity vs. despair

Life experiences provide a sense of dignity.

Life goals have been completed and death is not feared.

Failure to meet these stages results in disappointment in how the person's life has gone.

Generativity vs. stagnation or self-absorption

A person in this stage has contributed to society and can express satisfaction with their life

Intimacy vs. isolation

A person in this stage has the ability to form lasting relationships with others, and there is respect between them.

psychodynamic theory

psychodynamic theory is based on Freud's psychoanalytic theory that human behavior is influenced by childhood experiences.

biological model theory,

accident and physical concerns are impacting their mental health.

ex: A client who reports they recently fractured their leg in a car accident

humanistic theory

as the client perceives the world based on experiences.

moral development theory,

as they may be concerned with the approval of others based on society grouping.

Complementary and alternative therapie

treatments for clients with interventions that are based in biomedical treatment instead of traditional medical treatment

These can be used in conjunction with traditional medicine for clients.

ex: yoga, pet therapy, Meditation

nurses in mental health facilities

collect initial data

recognize clients need for therapy

advocate the clients right to treatment

medication administration

assist in supporting the client as they engage in the therapy.

Group therapy

psychosocial therapy in which multiple clients meet with a therapist. In this setting, ideas and insights are shared for the purpose of assisting in improving one's coping skills.

Health promotion is related to

helping the client increase control over and improve their health.

how mental health promotion can be used for clients

Following suicide precautions

• Suicide precautions are a part of prevention and wellness promotion, and can also be based on milieu therapy. This can encompass one-on-one observation or supervision, documenting the client's location every 15 min, searching the client's belongings for potential self-harm instruments, and ensuring the client takes prescribed medications.

Assisting the client in using adaptive coping skills

• Assisting the client to use adaptive coping skills is a part of prevention and wellness promotion

• As a part of tertiary prevention, the nurse focuses on interventions to reduce the disabling effects of mental illnes.

Allowing the client to use exercise equipment when anxious is correct.

• Allowing the client to use exercise equipment when anxious is a tertiary prevention measure. With teaching adaptive coping skills, nurses want to support a client's use of skills when experiencing anxiety.

Nurses roles related to therapy

The nurse should discuss ensuring a therapeutic nurse-client relationship with clients on the unit because it builds trust with the clients and promotes their wellbeing.

The nurse should be familiar with, not implement, each type of therapy.

The nurse should be able to assist the client with potential interventions and teachings related to the therapy.’

While a client might be prescribed medications, it is not required for them to have the medications prior to therapy unless prescribed in that manner.

While a client does have the ability to request what types of therapy they would like, the type of therapy is often prescribed by the provider.

Mental health clients who are hospitalized represent an aspect of a nurse's responsibility. Nurses are to expand their focus of mental health care to include care in all settings. Because mental health is a universal concern, expanded focus must include population health, the issues related to mental health disparity, and the prevalence of substance use disorder in the nurse's role in integrated health and telehealth.

Instrumental relativity orientation

Kohlberg Theory

In stage two, instrumental relativity orientation, behaviors are guided by a concern for self and wanting to satisfy an individual's own needs, with others' needs being a secondary consideration.

Postconvention

Postconvention is the fifth stage regarding social contract legalistic orientation. Those who reach this level have developed their own stem of values that help them distinguish between right and wrong behaviors.

Conventional

Conventional is the third stage, known as interpersonal concordance orientation. Behaviors are guided by the expectations of others. Approval is often based in one's society grouping.

Preconventional

Preconventional is the first stage where a person responds to good and bad based on cultural guidelines and understands there are consequences.

Humanistic theorists

humanistic theory is based on humanism.

Abraham Maslow contributed to the concept of this theory.

Sigmund Freud

developed the psychodynamic theory.

Erik Erikson

Erik Erikson developed the psychosocial stages of development.

John Watson

John Watson developed the behavioral theory.

milieu therapy

according to milieu therapy the room should not have any items to promote self destructive behaviors

according to milieu therapy the room should ensure the clients safety

Warning signs of suicide

• When a client begins to give away their possessions, it can be a warning sign that they are planning to kill themselves. The nurse should further explore the client's behaviors and symptoms.

id

"The id is often an area that is used for instant gratification."

This can include gratification of physical needs or desires.

superego

The superego is the part known for personal morals and right versus wrong.

ego

he ego is the part known for rationality.

behavioral therapy

type of psychotherapy that focuses on modifying a client's maladaptive behaviors, patterns, and responses, instead of using adaptative behaviors. The therapy follows the concept that behaviors are learned and can have negative consequences.

Psychoanalytic therapy

Holds that the unconscious mind influences a person's thoughts and feelings.

Individual therapy

is working one-on-one with a therapist through talk therapy.

Cognitive therapy

based on the belief that problems are rooted in a person's past.

CBT Cognitive behavioral therapy

CBT can be used to assist the person in adapting to functioning with tics.

CBT is a form of therapy that is effective for a variety of mental illnesses, including depression, anxiety, and eating disorders.

The therapy assists clients in adapting and changing their thinking patterns.

CBT is not a therapy primarily used for an intellectual developmental disability.

Justice

involves caring for all clients equally and with the same level of fairness.

Autonomy

involves allowing the client to make decisions about their care.

Nonmaleficence

involves advocating for treatment modalities that result in the least amount of harm while achieving a beneficial outcome.

beneficence

. Beneficence involves acting in a manner that is "for the good" or in a way that benefits others.

Setting Boundaries

Research indicates that setting boundaries increases a child's sense of security. Setting boundaries reduces any misunderstanding, establishes expected behaviors, and provides an understanding of consequences. + This will assist the children to understand their goals for treatment and avoid the consequences of their behavior.

• basically if you know what not to do you avoid bad consequences = child feels secure

Best practice suggests that when a child understands boundaries and consequences of their behavior, they are more likely to avoid bad behaviors.

All children do not automatically rebel when boundaries are set.

Veracity

The nurse is demonstrating veracity. Veracity involves being truthful and honoring the verbal commitment made to a client.

Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy and confidentiality of a client's health information.

No Surprises Act

requires providers to inform clients of the cost of treatment and whether the provider is covered by their insurance.

Affordable Care Act of 2010

The Affordable Care Act of 2010 made health care affordable for most Americans. It ensures that health care coverage for underinsured Americans, or those with pre-existing conditions, cannot be denied health care coverage.

The Affordable Care Act of 2010 mandates mental health parity. Parity is equal coverage for physical and mental health care, which is guaranteed under the Affordable Care Act of 2010.

Nurse Practice Act

Nurse Practice acts vary from state to state and are not congressional acts.

preventive strategy for nurse burnout.

Shared governance, where nurses have a voice about policies and staffing decisions, has been identified as a preventive strategy for burnout.

Having a supportive team helps prevent burnout and has been identified as the most effective strategy for reducing burnout. Other strategies that help to prevent burnout include shared governance, supportive leadership, a good professional identity, and consistent self-care.

Requesting an increase in pay will not change feelings of burnout.

Self-scheduling work shifts allows nurses to have more control over work-life balance and helps reduce burnout. Strategies for reducing burnout include engagement in shared governance, effective communication, supportive teams, supportive leadership, and consistent self-care.

Seclusion

should only be considered if the client is being harmful to themselves or others, and after other de-escalation attempts have failed.

Sedative

The nurse should expect the provider to prescribe a sedative. Sedatives are frequently used to calm clients who are agitated. They act fast and are usually well tolerated.

Occupational therapists

Occupational therapists work with clients to provide skill assessments and rehabilitation, such as those related to work or school.

Social worker

The nurse should refer the client to a social worker. Social workers provide client support and advocacy related to living situations.

A social worker provides social support, such as housing, financial assistance, and insurance. Some licensed social workers assist with creating treatment goals for clients.

think money and housing

Substance use counselor

Substance use counselors specialize in treatment of individuals who have a substance use history

Pharmacist

Pharmacists assist clients with questions related to medications.

involuntary admission, or assisted inpatient treatment, i

An involuntary admission, or assisted inpatient treatment, is when a client is admitted without their request or consent. It is initiated when a client is exhibiting severe manifestations or is considered to be a danger to themselves or others.

Clients who are involuntarily admitted are provided legal counsel and have the right to be present and testify on their own behalf in these judicial hearings.

When a client is voluntarily admitted

When a client is voluntarily admitted, they can ask to be discharged by submitting a request in writing. The provider must reassess the client within a timeframe dictated by state law to determine if the client is stable enough for discharge. In most states, the timeframe is 72 hr.

Incivility

Incivility is an act or behavior that shows disrespect and lack of courtesy. Such acts, whether intended or unintended, are considered acts of aggression and can affect the well-being of the individual and negatively impact the work environment.

Jokes at the expense of other team members is an example of incivility.

Anger

Anger is an emotional expression toward someone or something when feeling deliberately wronged.

bullying

Jokes at the expense of other team members is an example of incivility. However, if this action becomes repeated and focused on a specific group or individual, then it would be considered bullying.

ethical dilemma.

Ethics describes a conflict between two or more actions where each action has a favorable and unfavorable consequence

ethical reasoning.

"Ethics involves reasoning about what one should do as a guide for what one actually does."

Ethics

provides the nurse with a set of moral principles and standards, and is a basis for determining intentions, motives, and actions. A nurse's ethics is the basis from which conduct, including practices and decisions, is made.

"Ethics provides a system of moral principles or standards for governing conduct."

MY ANSWER

bioethics

thics explains the moral inquiry into issues raised by advances in medicine and the life sciences."

Complications of physical restraints

Positional asphyxia is correct. A client who has been placed in physical restraints can assume positions in which they are unable to breathe. The nurse should continuously monitor the client who is in restraints to ensure the client's safety.

Food aspiration is correct. A client who has been placed in physical restraints can have limited movement and ability to position themselves and are at risk for food aspiration. The nurse should continuously monitor the client who is in restraints to ensure the client's safety.

Cardiac arrest is correct. A client who has been placed in physical restraints can experience increased physiological and psychological stress, which can place them at an increased risk for cardiac arrest. The nurse should continuously monitor the client who is in restraints to ensure the client's safety.

When a fellow nurse or client confides that they are experiencing manifestations of burnout, depression, or another mental health concern,

it is appropriate to encourage them to seek professional mental health care.

Milieu therapy

includes structuring the components of the mental health facility to maintain therapeutic interactions and activities for the client. The environment should be structured to include activities and a schedule that ensures safety and are balanced with the client's dignity and independence to ensure autonomy toward recovery and improved functioning in dail

The nurse should create an environment that promotes safety for the client and others and is beneficial for promoting recovery of the client. These elements are the foundation for maintaining a therapeutic milieu.

Although all members of the mental health care team participate in milieu therapy, it is the nurse's responsibility to ensure a therapeutic milieu.

Client Competency

Competency is a legal term that must be determined in a court of law following a hearing and presentation of evidence. Health care providers cannot determine a client's competence.

A client is considered to be legally competent unless deemed incompetent by a judge following a hearing, regardless of their diagnosis or condition.

A client who is deemed incompetent will have a legal surrogate or representative that will make decisions on their behalf, as long as they are considered to lack competence in a court of law. Once a client is determined to be competent, all decision-making returns to the client.

The nurse should include that clients are considered to be competent until following a hearing and a decision by a judge.

Battery

Battery is making contact with another person without their consent. The person does not need to be injured for battery to occur; the contact must simply be unwanted or offensive to the person.

Negligence

is the most common unintentional tort. Medical malpractice is a type of negligence that is specific to health care providers.

False imprisonment

False imprisonment refers to the use of seclusion or restraints and applies when a client is held unlawfully. This means that the use of seclusion or chemical or physical restraints is done inappropriately or without meeting legal criteria.

False imprisonment is the confinement of a client when there is no legal reason to do so. Most claims of false imprisonment result from the use of seclusion or restraints.

Nurses can be accused of false imprisonment if they use any type of restraint for a client, including a chemical restraint that is unwarranted or inappropriate. Unwarranted or inappropriate use is based on adherence to legal criteria.

False imprisonment is the unlawful physical confinement of a client and usually refers to the act of seclusion or restraints.

Providers and nurses can be accused of false imprisonment if a client presents for treatment and is admitted involuntarily to a mental health unit without a provider determining the client meets specific legal criteria for such an admission.

Assault

Assault can be a verbal threat made toward a person that causes that person to feel apprehension or fear of being touched. No physical harm needs to occur for a person to claim assault has occurred.

Verbal threats to place a client in seclusion are an example of assault.

Duty to warn

If a client makes a threat to harm or kill someone else, the nurse must report this to the client's provider, who is legally obligated to notify the person of such intent. Duty to warn is a law in most states.

Exceptions for maintaining client confidentiality

A client tells a nurse that they intend to kill a coworker is correct. The nurse should include the exception of duty to warn when discussing client confidentiality. If a client makes a threat to harm or kill someone else, the nurse must report this to the client's provider, who is legally obligated to notify the person of such intent. Duty to warn is a law in most states.

A nurse is subpoenaed to testify in court about a client they cared for is correct. The nurse should include that a nurse may share confidential client information when legally obligated to do so via a court order. When a nurse's documentation is used in court, the nurses who cared for the client can testify in the case and share necessary information that would otherwise be considered confidential.

An older adult client reports their caregiver allows them to eat one meal per day is correct. The nurse should include the exception of reporting client abuse. When a client reports or a nurse suspects abuse or neglect, the nurse is legally required to report this information to the appropriate agency.

Crimes such as battery or murder are reportable.

A client tells a nurse that they plan to hang themselves when they are discharged is correct. The nurse should include that an exception to maintaining client confidentiality is if a client expresses the intent to harm themselves. The nurse should notify the provider of this finding and initiate interventions to ensure the client's safety.

OSHA

is the organization that is tasked with ensuring worker safety, including providing oversight for workplace violence (ex: client and their family member to health care professionals)

The Joint Commission

evaluates health care organizations for quality, safe, and effective care.

The Department of Health and Human Services

is tasked with enhancing the health and well-being of all Americans.