Psych Exam 1

Ch 1-7, 9-11, 19, 20

mental health vs physical health

brain part of body, make mind.

stigma (definition)

mark of shame, disgust, or disapproval

Leads to misunderstanding, prejudice, and discrimination

stigma examples

mental health, HIV, STDs, cancer, disabilities, diabetes

public / self stigma

public stigma - societal judgement and disapproval
Self- Stigma -negative beliefs about mental illness become internalized. The person believes that they are to blame or that they cannot get help so that they avoid treatment

Goal of mental health delivery system

recovery!

culture - most important for nurse to...

-know their culture and how their cultural values may conflict -with the treatment
-understand their biases
-have cultural competence

Acculturation

the socialization process by which minority groups learn and accept selective aspects of the dominant culture

culture (definition)

way of life for ppl who identify or associate with one another on basis of some common purpose, need, or similarity of background and also totality of learned, socially transmitted beliefs, values, and behaviors that emerge from its members' interpersonal transactions that can be used to define them as collective

Cultural syndrome

a group of co-occurring symptoms that occur in one cultural group

Cultural competence:

set of academic and interpersonal skills that are RESPECTFUL and responsive to health beliefs, health care practices, 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 and to address health literacy needs

spirituality vs religiousness

spirituality- "transcendence" - can be a source of strength
religiousness - "worship" - often intertwined with beliefs about mental health

least restrictive environment

legally required
This is important because all patients have the right to self-determination (promotes growth and well-being by having basic psychological needs met, which will increase their chances for recovery).

patient right to refuse

Patients have the right to accept, refuse, and terminate treatment whenever they wish UNLESS they are a danger to themselves or others (suicidal or homicidal ideation) this is a federal law- supreme court decision 1999

aspects of competence:

patient should be able to communicate choices and be able to repeat back what they have heard from the healthcare team
patient should be able to understand relevant information and to paraphrase their understanding of the treatment
patient should be able to appreciate the situation and/or consequence of accepting/refusing treatment, should be able to discuss the disorder, the need for treatment, outcomes, and why the treatment is being suggested

can they refuse?

Unless the test question mentions that they are a threat to harm themselves or others, they can ALWAYS refuse medication.

voluntary admission

can leave any time

involuntary admission

must be danger to self or others (or unable to meet basic needs causing life endangerment)

informed consent

must be competent
mandatory for all patients
informed of treatment, benefit, risk, length, cost

HIPAA

A healthcare worker cannot give out any information about a patient to anyone who is not a proxy or have power of attorney
"neither confirm nor deny the patient is here"

continuum of care

integrated system of care, wide array of potential care

crisis care

short term emergency intervention- acute situations (e.g. 23 hour watch)

acute inpatient care

Involuntary admission requires a risk for harming oneself, a risk for harming others, or a significant inability to care for oneself. Patients who are no longer a risk for these qualifiers must be allowed to leave or be transferred to a less restrictive environment. Patients who voluntary admit themselves may leave at any time as long as they do not display any of the qualifying indicators. Stays last for 24 hours to several days and primarily focus on acute episodes of severe mental health illness symptoms.

step down

live at home, receive treatment during the day. stabilization without hospitalization

ACT (assertive community treatment)

reaches out to those in the community that need intensive assistance and may not be able to seek assistance on their own
The focus is stability and recovery, and the process may take up to 2 years. Services are continued for as long as the client remains eligible

community care

Least restrictive and almost always voluntary, this process focuses mainly on individual and group therapy. It includes individual therapy/counseling sessions, peer support services, self-help groups, relapse prevention care. Examples are individual psychological/psychiatric appointments, AA, NA, and SA.

Ethics

"Address how we treat each other, how we act, what we should do, and why we should do it."
so not at all complicated....just be good.
see also: trolley problem, sophies choice, effective altruism, robin hood, "alive", prisoners dilemma, \#justicefortuvix, ect...

Code of Ethics for Nurses:

"The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations" (ANA, 2010, p. 10).

Principles of Nursing Ethics

Autonomy, Beneficence, Paternalism, Justice, Non-maleficence, Veracity, Fidelity

Autonomy

- each person has the right to self; determination - helps pt come to their own decision
-\> application: nurse a nurse helps client explore their options and allows client to arrive at their own choice

Beneficence

- the quality/state of doing good so that individuals achieve their maximum healthcare outcomes
-\> application: a nurse helps a newly admitted pt feel safe in the facility

Paternalism

- the belief that knowledge and education authorize professionals to make decisions for the good of the patient.
-\> application: a pt is diagnosed with lung cancer, doctor suggests pt to stop smoking to better health

(is this an ethical principle though? is it? IS IT???)

Justice

treat all fairly and establish access for all. (this one seems easy, but it isn't always achieved - does everyone have access to the same quality of healthcare and doctors? do nurses delegate an equal amount of time to each of their patients?)

Non-maleficence

Do no harm. -Hippo in a crate.

Veracity

tell the truth/ honesty
-\> application: pt states nurse is talking about them and nurse responds with, "We were discussing ways to help you."

Fidelity

loyalty and faithfulness to one's obligations and duties
-\> application: a pt asks the nurse if they can remain in the room when they talk to their family member and the nurse stays with the pt in the room

* Legal Standard of Care

Legal authority to practice nursing is granted by the state in the form of licensure.

Scope of Nursing defines the practices and procedures that nurses are allowed/required to take in the scope of practice.
2 steps:
1) State legal statute known as the "nurse practice act"
2) Rules/regulations created/implemented by regulatory bodies to protect the public: APNA, ANA, ANCC, AANP

Standards of Practice:

Includes: clinical policy statements, standards of practice, standard operating procedures, clinical practice protocols, and clinical procedures
For nurses, ADPIE (Assessment, Diagnosis, Planning/Outcome Identification, Intervention/Implementation, and Evaluation) is the main standard of practice for care.

Tools for Psychiatric Nursing:

Most important tool in psych nursing: self, know who you are.
Critical reasoning - critical thinking and reflection
Reflection - continuing self - evaluation through observing, monitoring, and judging nursing behaviors with a goal of providing ideal interventions.

Psychodynamic

freud and friends. development of mental and emotional processes and their effects on behavior. What happened as a child will influence your behavior as an adult. Unconscious, Id,ego,superego (freud)
coping mechanisms

defense/coping mechanisms

maladaptive or adaptive mechanisms used to cope with difficult situations, emotional conflict, stressors

transferance

"patent in love with nurse"
patient projects past relationship onto nurse

counter-transference

"nurse in love with patient"
nurse projects past relationship onto client.

maslow

hierarchy of needs

hierarchy of needs

physical\>safety\>love\>esteem\>self-actualization

e.g. give up safety in order to get basic physical needs
"fight someone for food before starving to death"
OR give up esteem in order to get love
"left high society for a love marriage"

behavioral theories

classical conditioning, operant conditioning (skinner), cognitive distortions -.CBT

erikson stages

infant trust (vs mistrust)
toddler autonomy (vs shame/doubt)
preschool initiative (vs guilt)
school age industry (vs inferioity)
adolescence identity (vs role diffusion)
young adult intimacy (vs isolation)
adult generativity (vs stagnation)
older adult ego integrity (vs despair)

piaget

stages of cognitive development
ensorimotor, preoperational, concrete operations, and formal operations.

Hildegard Peplau

"Mother of Psychiatric Nursing"
focus nurse-patient relationship
anxiety \= energy from unmet expectations

Dorothea Orem

Self-Care Deficit Theory

Russian invasion of Ukraine

illegal, unprovoked, not on test.

Framework for mental health outcome

RECOVERY

recovery (definition)

Refers to the reduction or cessation of symptoms related to a patient's mental distress and their ability to function in society without their mental illness impeding that functioning.
Not a cure but a way of managing so that lives are not disrupted by their distress.
Example: A person with substance abuse disorder who is in recovery and sober is still considered a person with substance abuse disorder. Recovery is their sobriety and their ability to regain function and control over their lives.

Recovery Oriented Nursing Care:

Holistic, collaborate with client, improve health wellness, promote self directed life.

Holistic

treats the entire person, not just their disorder. This helps the person with self - efficacy and improves outcomes. It also combats stigmas and other barriers to care.

Collaboration with client

clients play a critical role in their own treatment, allowing them to be in control of their recovery.

Improved health and wellness

improving mental health improves physical health and vice versa. Improving mental health may also improve physical health by helping the client avoid dangerous and unhealthy situations such as homelessness and substance use.

Promotes a Self - Directed Life

clients are in control of their own lives and with proper care and treatment, can work to fulfill their full potential.

* Positive Mental Health:

Focusing/experiencing more desirable health related qualities or life events, rather than the negative ones. This promotes self esteem and allows the patient to see themselves as a more productive and worthwhile person while limiting ruination and stigma.

Person Centered Care:

The focus of care is on the person and not the disorder. Avoid statements like "the alcoholic" or the "bipolar person", instead use "the person with alcohol abuse disorder" or "the person suffering from bipolar disorder". Basically, treat the person as a human being first and the disorder as an aspect of what they are experiencing. Promotes empowerment by supporting individuals or communities to take control of their lives and their health.

Continuum of Decision Making: from most authoritative to most engaging

paternalistic -Most authoritative
Shared decision-making model
Informed choice model: -most engaging

Paternalistic model

Clinician knows best and makes the choices. Patient will do best if they follow instructions. Very little empowerment of the patient. Client may feel as though they are being treated as a child and may feel disrespected. Client is less likely to comply.

Shared decision-making model:

Clinician shares evidence and offers options. Patient is supported to consider options. Allows for some input from the patient and gives some empowerment under limitations. Patient may have moderate autonomy but may also feel left out.

Informed choice model:

Clinician offers evidence and options but does not offer an opinion. Patient choses the option based on what they feel is best for themselves. Give the patient the most autonomy and limits the influence of the clinician on the patient's choices.

Recovery interventions:

Psychoeducation, Social Inclusion, Employment/Education, Social Activities, Peer Specialists

Psychoeducation:

educates the patient on their disorder (signs, symptoms, triggers) and the methods, medications, therapy, and other treatment options

Social Inclusion

allows the patient to feel as though they are an integral part of something. Builds connections with other and fosters a sense of belonging.

Employment/Education

gives the patient a sense of purpose and a feeling of achievement. Allows the patient to reacclimate to society and fill a role in that society. Provides a positive outlook on the future.

Social Activities:

fosters relationships with other and integrates the client on operating in groups and with peers. Helps define social boundaries and promotes working with others.

Peer Specialists

provides role models for recovery and support groups that the client can identify with and turn to in times of need.

Barriers to recovery

-poverty - limit access, comorbid conditions, stress
-homelessness - limit access, instability, disconnect from society, stress,
-stigma - embarrassment, avoidance
-lack of services - rural/impoverished areas lack available services, geographical isolation

Education

Education is a critical step. Clients should be educated on how, when, and where to seek help when they need it. Learning methods for dealing with disorders such as recognizing signs or symptoms of an acute onset or triggers that may cause an onset. Education is also vital for the public to reduce stigmas and foster a society that not only accepts mental health treatment but views it a positive activity. This will help those in need find approval in accessing care and limit their avoidance.

Advocacy

Working and fighting for the clients builds trust and foster a positive treatment environment for the client while also helping to provide the client with the resources needed. Advocacy highlights abuse, neglect, and exploitation and works to reduce or eliminate these risks.

Self-examination

know thyself (self-awareness is first)
Must be introspective!
Consider biological, psychological, and social aspects
Foundational in establishing and maintaining a therapeutic relationship with pts
Goal: to be objective/nonjudgmental
Importance of clinical supervision

* Effective communication:

verbal and non-verbal

Verbal/nonverbal:

foundational for an effective nurse-pt relationship

Verbal

Involves: sender, a message, and a receiver
Communication is two-way
Formulate an idea, encode the message (ideas into words), and then transmits message WITH emotion to COMMUNICATE needs/problems
Is there a match between what pt meant to say and what nurse understood?

Nonverbal

Communicates more than verbal
Congruent? Always pay attention more to nonverbal
Assess for eye contact, posture, movement, facial expression, and gestures (communicates thoughts and feelings)
Culturally specific
Positive body language - eye level, relaxed posture, leaning forward, uncrossed arms/legs

* Principles of Therapeutic Communication

1. Primary focus is pt
2. Professional attitude
3. Use self-disclosure cautiously
4. Avoid social relationships
5. Maintain pt confidentiality
6. Assess intellectual competence
7. Use interventions from a theoretic base
8. Maintain a nonjudgmental attitude
9. Avoid giving advice
10. Guide pt to interpret rationally
11. Clarify statements
12. Avoid changing the subject unless best interest

Limit self-disclosure.

Focus interaction on patient's concerns. If you use self-disclosure, be purposeful and identify therapeutic outcomes. Redirect back - may feel rude. "Let's talk about you."

Passive listening:

sitting quietly and letting patient talk, ramble without focus or guidance. Does not foster a therapeutic relationship. Body language communicates boredom, indifference, or hostility.

Active listening

nurse focuses on what the patient is sating to interpret and respond to the message objectively. Nurse concentrates on verbal and nonverbal. Behaviors. Responds indirectly with open-ended statements, reflections, and questions that elicit additional responses from patient. Nurse avoids changing subject and follows patient's lead. ONE OF FIRST interventions to use in establishing therapeutic communication.

Nurse's job - communication

assessment and interpretation

Acceptance

Encouraging and receiving information in a nonjudgmental and interested manner Pt: I have done something terrible.
Nurse: I would like to hear about it. It's okay to discuss it with me. Establishes empathy and trust

Confrontation

Presenting the pt with a different reality of the situation Pt: My best friend never calls me. She hates me.
Nurse: I was in the room yesterday when she called. Redefines pt's reality, but can alienate pt - use with nonjudgmental attitude

Doubt

Expressing or voicing doubt when a pt relates a situation Pt: My best friend hates me. She never calls me. Guides pt towards other explanations - use only when nurse feels confident about the details

Interpretation

Putting into words what the pt is implying or feeling Pt: I could not sleep b/c someone would come in my room and rape me.
Nurse: It sounds like you were scared last night. Helps pt identify underlying thoughts and feelings

Observation

Stating to pt what the nurse is observing Nurse: You are trembling and perspiring. When did this start? Identifies pt's behaviors (verbal or nonverbal) when they are obvious and unusual for that pt

Open-ended statements

Introducing an idea and letting the pt respond Nurse: Trust means...
Pt: That someone will keep you safe Helps pt explore feelings or gain insight

Reflection

Redirecting the idea back to the pt for classification of important emotional overtones, feelings, and experiences - gives pts permission to have feelings they may not realize they have Pt: Should I go home for the weekend?
Nurse: Should you go home for the weekend? Helps nurse maintain a nonjudgmental approach when pt is asking for nurse's approval or judgement

Restatement

Repeating the main idea expressed - lets pt know what was heard (rephrasing) Pt: I hate this place. I don't belong here.
Nurse: You don't want to be here. Clarifies what the pt has said

Silence

Remaining quiet but nonverbally expressing interest during an interaction Pt: I am angry!
Nurse: (silence)
Pt: My wife had an affair. Allows pt to focusing on putting thoughts together and when pt needs to express ideas but not know quite how to do it

Validation

Clarifying the nurse's understanding of the situation Nurse: Let me see if I understand.
Nurse: I notice you pacing. Are you feeling anxious about the family visit? Allows nurse to understand a situation that pt is trying to describe

Advise vs support

There is a major difference between giving advice and supporting a pt through decision-making using therapeutic communication, allowing the pt to explore alternative ways of viewing their world. The pt comes to their own conclusion about the best approaches.

Key concepts communication

Silence (CRUCIAL) and listening - active vs. passive listening, respect - follow lead, redirect when necessary
Validation: refers to observation, thoughts, or feelings and seeks explicit feedback - "I notice you pacing..."
Strength-based communication - supportive

* Choosing a Communication Technique

Principles: This is not a social relationship
Assess and interpret meaning of pt's communication. Go beneath the verbal. Difference in teaching vs. advice. Respond respectfully. Go towards feelings - "It must be frustrating...." Identify the desired pt outcome.

* Techniques Inhibiting Communication

advice, agreement, disapproval, challenges, reassurance

Advice (barrier)

Telling a pt what to do Pt: I can't sleep. It is too noisy.
Nurse: Turn off the lights and shut your door. Nurse solves pt's problem, which may not be appropriate solution and encourages dependency on nurse

Agreement (barrier)

Agreeing with a particular viewpoint of a pt Pt: Abortions are sinful.
Nurse: I agree Pt is denied opportunity to change his/her view now that the nurse agrees

Challenges (barrier)

Disputing pt's beliefs with arguments, logical thinking, or direct order Pt: I'm a cowboy.
Nurse: If you are a cowboy, what are you doing in the hospital? Nurse belittles pt and decrease self-esteem - pt will avoid relating to nurse