Mental Health Nursing - Exam 1

wellness

multi-factorial determination of health, includes emotional, spiritual, occupational, financial, environmental, social, and intellectual components; lack of function in one area puts strain on another area

mental disorder

clinically significant disturbances in cognition, emotion regulation, or behavior that reflect a dysfunction in the psychological, biologic, or developmental processes underlying mental dysfunction; usually associated with distress or impaired functioning

**disturbs everyday function**

Florence Nightingale

• held a holistic view of a patient who lives within a family and community

• she was especially sensitive to human emotions and recommended interactions that today would be classified as therapeutic communication

Linda Richards

• the first trained nurse in the United States

• opened the Boston City Hospital Training School for Nurses in 1882 at McLean Hospital, a mental health facility

Effie Taylor

integrated psychiatric nursing content into the curriculum at Johns Hopkins’ Phipps Clinic

Harriet Bailey

wrote the first psychiatric nursing textbook, Nursing Mental Disease

Hildegard Peplau

• contributed to educational programs for psychiatric nursing

• developed the first graduate psychiatric nursing program in 1954 at Rutgers University

premoral treatment era

• created more issues than solutions in mental health care

• 800 BC to colonial period

moral treatment period

• period of insane asylums

• 1790-1990

Philippe Pinel

advocated for basic human rights and humane treatment

Dorothea Dix

• crusader for the humane treatment of patients with mental illness

• was responsible for much of the reform of the mental health care system in the 19th century

• helped establish state hospitals

instituionalization

• 1900-1955

• began to formalize mental health care

Sigmund Freud

• began psychoanalytic movement

• coined the terms neurosis and psychosis (most severe mental health issues, debilitates daily functions)

National Mental Health Act

• 1946

• federal government provided grants to states to support existing outpatient facilities and programs to establish new ones

Hill-Burton Act

provided substantial federal support for hospital construction, which expanded the number of psychiatric units in general hospitals

psychopharmacology

• 1950s and beyond

• revolutionized the treatment of people with mental illness

• mental health community was hopeful that a medication had been discovered to cure severe mental illness

• medications calmed the patients and reduced some of the symptoms

deinstintuionalization

the release of those confined to mental institutions for long periods of time into the community for treatment, support, and rehabilitation, became a national movement

mental health healthy people 2030 goals

• reduce the suicide rate

• reduce suicide attempts by adolescents

• reduce the proportion of adolescents who engage in disordered eating behaviors in an attempt to control their weight

• reduce the proportion of persons who experience major depressive episodes

rate

total cases in population/total population

aka. cases/non-cases

prevalence

total number of people who have the disorder within a given population at a specific time regardless of how long ago the disorder started

point prevalence

basic measurement that refers to the proportion of individuals in the population who have the disorder at a specified point in time, percentage

incidence

refers to the rate that includes only new cases that have occurred within a clearly defined time (typically one year)

stigma

dynamic social/interactional process in which the stigmatized person is labeled as different and linked to negative stereotypes

public stigma

when a person is publicly “marked“ as having a mental illness, this makes it difficult for people to obtain work, independent living, and maintain relationships

ex. “people with mental illnesses are dangerous“

self stigma

when negative stereotypes are internalized by the person with a mental illness, a person agrees with the public statement

ex. “I have depression because I’m lazy”

label avoidance

avoiding treatment to avoid being labeled as “mentally ill“

recovery

ultimate goal of mental health nursing care

recovery oriented treatment

based on belief that mental illness/emotional disturbance is treatable and that recovery is expected, partnership between patient and clinician, multi-factorial approach

trauma informed care

integral to quality care as it incorporates a basic realization/understanding on the impact of trauma on individuals, families, groups, organizations, and communities; nurses learn to understand the signs of trauma and respond appropriately

culture

way of life for people who identify or associate with one another on the basis of some common purpose, need, or similarity of background but also the totality of learned, socially transmitted beliefs, values, and behaviors; dynamic/constantly changing

acculturation

when minority groups learn and adopt selective aspects of dominant culture

cultural identity

set of cultural beliefs to which one looks to for standards of behavior, a person often belongs to many

cultural competence

• the ability to interact effectively with people of different cultures

• involves a set of academic and interpersonal skills that are respectful of and responsive to the health beliefs, health care practices, and cultural and linguistic needs of diverse patients to bring about positive health care outcomes

linguistic competence

• the capacity to communicate effectively and convey information that is easily understood by diverse audiences

• not only refers to the appropriate use of words, grammar, and syntax, but also to the practical aspects such as choice of discussion topics, taking turns, use of metaphors, and the “hidden rules” of interactions

Buddhism

• religion and philosophy originating in ancient India around 2,500 years ago, founded by Siddhartha Gautama (the Buddha)

• teaches that life involves suffering, and by following the Four Noble Truths and the Eightfold Path, one can end suffering and achieve nirvana, a state of enlightenment and liberation

• core practices include meditation, ethical living, and cultivating wisdom and compassion, rather than worshiping a god

Christianity

• God: Father, Son, and Holy Ghost

• Bible

• teachings of Jesus through the apostles and the church fathers God’s love for all creatures is a basic belief

• salvation is gained by those who have faith and show humility toward God

• brotherly love is emphasized in acts of charity, kindness, and forgiveness.

Confucianism

• a Chinese ethical and philosophical system

• focused on morality, ethics, and social harmony, emphasizing virtues like benevolence, ritual propriety, and respect for elders

• self-cultivation through virtuous action in society

• key aspects include filial piety (respect for family), the Five Key Relationships (ruler/subject, father/son, husband/wife, elder/younger brother, friend/friend), and the idea that a good ruler governs with moral virtue

Hinduism

• an ancient and diverse spiritual path encompassing a wide range of beliefs and practices, rather than a single organized religion

• core concepts include Brahman (the supreme spiritual reality), Atman (the individual soul's connection to Brahman), Karma (the law of cause and effect), and Samsara (the cycle of rebirth)

• the ultimate goal is to achieve Moksha, or liberation from the cycle of rebirth

Islam

• a strictly monotheistic Abrahamic religion whose followers, Muslims, believe in one God (Allah) and that Muhammad is his final messenger

• holy text is the Qur'an, which some believe contains God's word revealed to Muhammad

• core idea is meaning "submission to God's will," is demonstrated through the Five Pillars of Islam and a life lived according to divine guidance, aiming for spiritual peace and a righteous life

Judaism

• an ancient, monotheistic religion and the collective cultural and spiritual heritage of the Jewish people, centered on a covenant with one God first revealed to Abraham, and detailed in the Torah (the first five books of the Hebrew Bible)

• key aspects include a belief in a single, eternal God, observance of Halakha (Jewish law), the significance of the Torah as a guide for life, and the cultural identity of Jewish people through traditions, holidays, and community

• worship occurs in synagogues, and there are different movements (Orthodox, Conservative, Reform) that interpret Jewish law in various ways

Shintoism

• "Way of the Kami"

• Japan's indigenous polytheistic and animistic religion, centered on reverence for the supernatural entities called kami, who are spirits found in nature and people

• emphasizes purity, harmony, and community, with rituals and festivals designed to connect with the kami and ensure blessings

• lacks a founder or rigid doctrines, instead growing from ancient traditions and varying across the country, with shrines (jinja) serving as places of worship and gateways to the spirit world

Taoism

• an ancient Chinese philosophical and religious tradition centered on living in harmony with the "Tao," or "the Way"—the underlying, undefinable force of the universe

• key principles include wu wei (effortless action), embracing naturalness, simplicity, and the balance of yin and yang

• it encourages a way of life that flows with nature and the universe, fostering spontaneity, acceptance, and inner peace through self-cultivation and practices like meditation and martial arts

spirituality

• develops over time

• dynamic, conscious process

• consists of 5 attributes

  • meaning

  • belief

  • connecting

  • self-transcendence

  • value

religiousness

• participation in a community of people who have a common way of worshipping

• can be expressed through a set of religious beliefs

• primarily seen through actions

informed consent

a legal procedure to ensure that the patient knows the benefits and costs of treatment

autonomy

a patient may choose to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or prejudice

involuntary commitment

the mandated treatment without the person’s consent but with a court order

Patient Self Determination Act

• passed in 1991

• any patient receiving care at ANY healthcare facility that receives reimbursement from medicare/medicaid (CMS) must include a patient in all health care decisions made for or about them

advanced care directive

written instructions for health care when individuals are incapacitated…can be used to protect a mentally ill patient during periodic times of poor decision making

living will

• specifies what treatment may or may not be given in the event someone is unable to make these decisions

• needs to be witnessed by two people and notarized

power of attorney

also called health proxies, makes health care decisions on an individual’s behalf if person is incapacitated

psychiatric advance directive

allow competent individuals, with two witnesses, to document treatment of choice during periods of mental instability…a physician can override this with a court order if the patient is informed

Americans with Disabilities Act

• passed in 1990

• ensures that people with disabilities, including those with mental illnesses and addictions, have legal protection against discrimination in the workplace, housing, public programs, transportation, and telecommunications

• an employer is free to select the most qualified applicant available, but if the most qualified person has a mental disorder, this law mandates that reasonable accommodations need to be made for that individual

• accommodations include any adjustments to a job or work environment, such as restructuring a job, modifying work schedules, and acquiring or modifying equipment

The Joint Commission and CMS

any healthcare organization that accepts federal funds is accredited by both of these organizations

competency

• the degree to which a person can understand and appreciate the information given during consent process, patient’s cognitive ability, at a specific time

• a legal determination, but no clear consensus of definition across US

incompetent

unable to understand and appreciate the information given during the consent process

• possible to force treatment on person

• forced treatment denigrates an individual

• may result in less successful treatment

4 things a patient must be able to do

1. communicate choices

2. understand relevant information

3. appreciate the situation and its consequences

4. use a logical thought process to compare risks and benefits of treatment process

least restrictive environment

• patient cannot be restricted to an institution if person can be treated successfully in the community

• medication cannot be given unnecessarily

• a patient cannot be locked into a room unless other interventions were tried first

seclusion

involuntary confinement of a person in a room or area where a person is physically prevented from leaving, used only for safety purposes or behavior management, can actually worsen patient outcomes

restraint

• most restrictive safety intervention

• can be physical or chemical

• should be used only after other interventions have been used and patient continues to be a danger or self or others

• supervision is required for patient

• can only be ordered by a provider

trauma informed care

being aware of, and sensitive to, doing no further harm to survivors of trauma by ensuring the patient feels connected, valued, informed, and hopeful of recovery

voluntary admission

a patient enters the facility willingly and is able to maintain all civil rights and free to leave at any time (even against medical advice)

involuntary admission

• patient admitted without consent, but via a court order

• there must be evidence that the patient is mentally disordered, danger to self or others, unable to provide for basic needs

• patient still has the right to refuse treatment and may need separate court order to have competency hearing to determine if patient is able to refuse medication

privacy

part of an individual’s personal life that is not governed by society’s law and government intrusion, health care workers must protect this

confidentiality

• ethical duty of nondisclosure

• involves two people: the person who discloses the information and the person with whom the information is shared

forensic

pertains to legal proceedings and mandated treatment of persons with mental illness, those with mental health disorders often do not get adequate treatment when incarcerated

fitness to stand trial

determines whether a person is able to consult with a lawyer with a reasonable degree of rational understanding of the facts of the alleged crime and of the legal procedures

unfit to stand trial

patient is unable to understand the nature and purpose of the proceedings or assist in the defense

Not Guilty by Reason of Insanity

• NGRI

• the accused is unable to determine right from wrong or to be unable to control his or her actions at the time of the crime

Guilty but Mentally Ill

• GBMI

• criminal conviction, patient is sent out to correctional system, mental illness is considered a factor in the crime, but patient is still considered to know difference between right and wrong

probation

sentence of conditional or revocable release under supervision for a specified period of time

Brady Bill

• requires a background check on those seeking ownership of a firearm

• meant to prevent those with mental illness or criminal backgrounds from owning a gun

assault

threat of unlawful force to inflict bodily injury upon another, must be imminent and cause reasonable apprehension in the individual

medical battery

intentional and unauthorized harmful or offensive contact occurs when a patient is treated without consent

negligence

breach of duty of reasonable care resulting in personal injuries

crisis intervention teams

• CTI

• interdisciplinary mental health and first responders who provide protection to those with mental health illess and those around them

23 hour observation

• short-term treatment that serves the patient in immediate but short-term crisis

• admits individuals to an inpatient setting where services are provided at a less-than-acute care level

• the individual is often experiencing suicidal or homicidal ideation

crisis stabilization

• used when immediate crisis does not resolve

• usually lasts fewer than 7 days and has a symptom-based indication for hospital admission

• primary purpose is to control precipitating symptoms through medications, behavioral interventions, and coordination with other agencies for discharge planning

acute inpatient care

• most intensive and most restrictive environment

• can be voluntary or involuntary admission

partial hospitalization

day programs that focus on behavioral therapy, social skills training, basic living skills, symptom identification and relapse prevention, nutrition and wellness, group therapy

residential settings

• provide a place for a person to reside over a 24 hour period of time on an ongoing basis

• these places provide interdisciplinary care

• can be public or private

respite care

a brief stay for a patient with a mental illness when caregivers need a break or is unable to care for them

transitional care

to help prevent readmission within 30 days of discharge, interventions used between discharge and first follow up appointment

beneficence

utilizing knowledge to develop an environment in which individuals can achieve their maximal health care potential

justice

duty to treat all fairly, distributing risks and benefits equally

nonmaleficience

duty to cause no harm

paternalism

the belief that knowledge and education allows a health care provider to make decisions for the good of a patient

veracity

the duty to tell the truth

fidelity

faithfulness to obligations and duties to keeping promises

biopsychosocial framework

consists of three separate interdependent domains

1. biologic

2. social

3. psychological

biologic approach

• biological theories related to mental health plus the biologic activities related to other health problems

• also related to exercise, sleep, nutrition, plus neurobiologic theories

psychological approach

theoretical basis of the psychological processes (thoughts, feelings, and behaviors) that influence one’s emotion, cognition, and behavior

social approach

• theories that account for the influence of social forces encompassing the patient, family, and community within cultural settings

• social settings do not cause psychiatric illness, but manifestations and treatment can be affected

psychoanalytic theory

• theory made by Sigmund Freud

• study of the unconscious

• personality development (id, ego, superego)

• anxiety and defense mechanisms

• object relations and identification