Mental Health EXAM 1

Mini Mental Status Exam

assesses cognitive status

PHQ-9 (Patient Health Questionnaire)

screens, diagnoses, and measures depression

ACE (Adverse Childhood Events) Questionnaire

measures a child’s exposure to traumatic events

MOCA (Montreal Cognitive Assessment)

cognitive assessment for dementia

DSM-5-TR

Diagnostic Statistical Manual of Mental Disorders used to diagnose and classify mental illnesses

psychoanalysis

process of analyzing unconscious conflicts and resolving problems by talking about them with a psychanalyst

cognitive behavioral therapy

teaches methods to decrease anxiety/negative thoughts and encourages positive coping techniques

dialectal behavioral therapy

focuses on combining behavioral and cognitive therapies to encourage the self awareness of thoughts and how to reshape those thoughts. Teaches mindfulness, emotional regulation, and distress tolerance.

mindfulness

focuses on encouraging being present in daily life and not worry about the past or the future

eye movement desensitization reprocessing (EMDR)

has patient think about trauma while engaging in other forms of stimulation promoting the processing of traumatic events through stimuli

exposure and response prevention (ERP)

cognitive-based, focuses on exposure and eliminating the negative reactions to those repeated exposures

modeling

therapist acts as a role model to change specific behaviors

operant conditioning

a reward based system to encourage desired behaviors

systemic desensitization

patient with fear/phobia is repeatedly exposed to stimulus while relaxed and taught relaxation techniques to handle stress until phobia is gone

aversion therapy

pairs a negative stimulus with an undesired behavior. patient essentially has negative consequence for engaging in negative behavior

biofeedback

a device monitors bodily functions that clinicians can analyze to influence implementation of relaxation techniques

motivational interviewing

Patient-centered communication that helps patients identify their own motivation for change, empathy, reflective listening, and nonjudgmental communication

milieu therapy

uses the environment/community to promote therapeutic change

the role of group therapy in mental health treatment

allows for patients to have a sense of belonging and togetherness. improves communication skills and decreases feelings of stigma

characteristics as a result of healthy group process

sharing common feelings, concerns, stories, and experiences. decreases feelings of isolation, creating community of healing

electroconvulsive therapy (ECT)

treatment that induces a brief seizure under anesthesia to improve severe mental health conditions

transcranial magnetic stimulation (rTMS)

uses magnetic pulses to stimulate areas of brain to aid in mood regulation

vagus nerve stimulation (VNS)

treats epilepsy, device is implanted and connected to vagus nerve and delivers pulse to increase effectiveness of antidepressants and enhances mood

freud’s psychoanalytic theory

behavior is influenced by unconscious thoughts, feelings, conflicts, and past experiences, especially those from childhood. (Id = impulses, Ego = reality, Superego = morals)

Erikson’s psychosocial theory

Development occurs across the lifespan; psychosocial conflicts influence coping and relationships

sullivan’s interpersonal theory

personality develops through interpersonal relationships; healthy relationships promote mental health

peplau’s nursing theory

Orientation: getting to know pt + pt Hx, Identification: identifying primary problem with pt, Working: finding out treatment for pt + implementing treatment, Termination: objective goal is met, reinforce learning + continued recovery

acute care

provides intensive treatment and supervision in locked units for patients that may be harm to themselves or others → helps stabilize mental illness manifestations (can be state owned or correctional facility)

community care

clinics, schools, day-care centers, partial hospitalization programs, substance treatment facilities, forensic settings, psychosocial rehab programs, tele-crisis counseling centers, home healthcare; RNs stabilize/improve/educate/support via community settings

forensic care

aids needs of victims and perpetrators involved in legal/public proceedings

rehab

structured environment that focuses on cognitive and behavioral changes related to substance abuse, non suicidal self injury, eating disorder, and anxiety related disorders (usually partial hospitalization programs)

assertive community treatment

nontraditional case management by interprofessional team for clients with severe mental illness and those who are nonadherent. works in homes, hospitals, and clinics. most needed for homeless, incarcerated, and those who have no form of transportation

psychosocial rehabilitation programs

structured range of programs in a mental health setting → residential services, day programs, home-based services for those homebound

roles of RN in acute setting

assessment and data collection, developing/implementing/evaluating plans of care, milieu management, provide treatment via medication, facilitate health promotion

roles of APRN

maintain safety and structure, can prescribe/diagnose, care coordination, can work independently, supervise patients in acute care or community based setting, can manage care for entire facility, lead research and quality improvement

beneficence

doing good towards others

autonomy

client has right to make own decision accepting consequence of that decision and respecting others’ decision

justice

equal and fair treatment for all

fidelity

loyalty and faith to client and duty

veracity

honesty to client (aka maleficence)

specific inpatient patient rights

right to humane treatment and care, right to vote, right to grant/forfeiture of drivers’ license, right to due process of law, right to refuse treatment

voluntary admission

client chooses admission for mental health treatment, patient is “competent” and can refuse treatment of medication. Provider has ability to evaluate client and initiate involuntary admission if needed at the end of prior care

involuntary admission

client is admitted against their will b/c they are a danger to self/others, unable to meet ADLs, or require treatment and cannot seek it voluntarily. Patient can request legal review. Court order is required to extend admission beyond 24-72 hours. Clients can still be considered competent unless legally declared uncompetent

implied consent

verbal consent

informed consent

formal documentation of consent

kevin’s law

Michigan law allowing court-ordered assisted outpatient treatment for qualifying people with serious mental illness

seclusion

placing patient alone in a solitary room

restraints

physical/chemical methods used to restrict a patients movement

intentional tort

deliberate act that violates a clients rights, e.g., assault, battery, or false imprisonment

unintentional tort

Harm caused without intent due to negligence or failure to meet the standard of care (malpractice = negligence by professional)

how to maintain professional boundaries while promoting therapeutic patient care

keep relationship patient-centered, avoid favoritism and excessive time with one patient, avoid keeping secrets and inappropriate self disclosure, or allowing RNs own emotional needs to become focus

verbal communication

the words/messages are spoken, more consciously controlled

nonverbal communication

how the message is communicated without words, think body language

congruent communication

words and behaviors match

incongruent communication

words and behavior don’t match, indicates unspoken feelings

evidence based practice

best research evidence + clinical expertise + patient preferences

clinical judgement model

recognize cues → analyze cues → prioritize hypothesis → generate solution → take action → evaluate outcome

5 A’s of evidence based practice

Ask → Acquire → Appraise → Apply → Assess

Yalom’s curative factors

group members benefit from support, shared experiences, hope, and realizing they aren't alone