Unit Three - Mental Health and Illness Mgmt

Characteristics of well-being on mental illness continuum

occasional stress to mild distress

no impairment

adequate-high level functioning

Characteristics of emotional problems or concerns on mental illness continuum

mild to moderate distress

mild or temporary impairment

Examples of emotional problems or concerns

insomnia, decreased concentration, decreased appetite

Characteristics of mental illness on continuum

marked distress

moderate to disabling or chronic impairment, long term

requires intervention

Examples of mental illness

altered thinking, mood, behavior

patient receives a diagnosis here

3 categories of risk or protective factors

Individual attributes and behaviors

Social and economic

Environmental

Subcategories of individual attributes and behaviors

Biological, genetic, resilience

What is resilience?

ability & capacity to secure needed resources for well-being

not falling victim to negative, self-defeating thoughts!!

Subcategories of social and economic

family/peers, $$$, education

Subcategories of environmental

basic needs, access to mental health, culture

What influences our mental health?

What influences our definition of mental health/illness?

What is the nurse’s role in mental health?

help our patients develop more resilience to cope with the natural stressors of life!

Recognize characteristics of mental health

rational thinking

effective communication

learning and productivity

effective coping

self-care, control, awareness, and esteem

emotional growth

resilience

How does culture play a role in mental illness (treatment, stigma, resources)

How does western culture differ from the beliefs of other cultures?

How can the nurse apply the understanding of these differences to patient care?

What are the different levels of care in the mental health arena and their properties?

What are the roles of the inpatient care team?

Criteria for Louisiana inpatient admission:

can be 1, 2, or all 3 of these

1. danger to self

2. danger to others

3. gravely disabled

HAVE to have a DSM-5 diagnosis and there HAS to be a reasonable expectation that the hospitalization will improve the presenting issues

When can a patient be discharged?

What is the nurse’s role in protecting patient rights?

PCP’s role in care continuum

Common and familiar, patients are comfortable here. Often seek PCP input when physical symptoms arise (resulting from mental illness)

Disadvantages of PCP’s in mental health

Time constraints (15 min visits)

Not equipped to treat psychiatric disorders. Can prescribe a medication but have limited training and expertise to give effective treatment and resources

Psychiatric care providers disadvantages

Super limited. Long wait lists

Patient centered medical homes advantages

“One stop shop”. Many providers there

Patient centered, comprehensive, coordinated, great access, systems approach.

Community mental health centers

federally funded centers that offer free of low-cost sliding scale care. very effective

Are community health centers common?

They exist in larger cities with larger populations with larger demand

Psych home care requirements for Medicare

patient is homebound

psych diagnosis

actually need psych RN or social worker

physician or APRN orders and plan of care

Characteristics of assertive community treatment (ACT)

Case mgmt type function - intensive

On call

Creative problem solving with social situations (transportation, finances)

Expensive

What kind of patients is ACT for?

Those with severe, persistent psych symptoms that keep them from complying with treatment, so they have expensive repeat hospitalizations.

Options for psych care in between inpatient and outpatient?

Intensive Outpatient Programs (IOP)

Partial Hospitalization Programs (PHP)

Intensive Outpatient Programs (IOP) time

3-5 times a week for 3 hours

Partial Hospitalization Programs (PHP) time

5 days a week for 6 hours

What treatment is provided in IOP and PHP?

structured activities, group therapy, individual therapy, rec therapy, pharmacological management

goal of emergency care in psych

triage and stabilization

How common is it to see psych in an emergency department?

it’s the second most common visit reason

Mobile crisis team

professionals in the field that connect with people in crisis face to face. they help them and remove them from the public with the most dignity as possible

Specialty settings of mental health care

pediatric

geriatric

Veteran’s

forensic

alcohol & drug use disorder (need more than 10 day standard in inpatient. 28)

nonprofessional self-help options like AA

Basic level of psych RN practice

Coordination of care (planning and documentation)

Health teaching & maintenance (includes anticipatory guidance)

Milieu therapy (provides, structures, maintains safe & therapeutic environment)

Pharmacological, biological, integrative therapies (meds)

Difference between psychotherapy and psychoeducation

Education can apply to everyone. When you start getting into WHY someone specifically has a problem, then you’re getting into therapy

Education includes no personal history