Studied by 1 personwhat is the most important treatment for patients with a mental disorder
recovery
(recovery is not a cure)
how is mental health conceptualized by the World health organization
a state of well-being in which the individual realizes his or her own abilities, can cope with life’s normal stresses, can work productively and fruitfully and can make a contribution to society.
Definition of mental health
emotional + psychological well- being of a person who has the capacity to interact w others, deal w ordinary stress, and perceive one’s surroundings realistically
definition of wellness
purposeful process of individual growth, integration of experience, and meaningful connection with others, reflecting personally valued goals and strengths resulting in being well and living values – having a purpose in life.
definition of mental disorders
clinically significant disturbances in cognition, emotion regulation, or behavior that reflect a dysfunction in the psychological, biological, or developmental processes underlying mental dysfunction.
what is a mental illness also known as
mental disorder
what are mental illness/mental disorders classified as
A syndrome
definition of syndrome
a set of symptoms that cluster together that may have multiple causes and may represent several different disease states that have not yet been defined
How are mental disorders categorized
Mental disorders are NOT categorized by biology such as medical diseases→ they are defined by clusters of behaviors, thoughts, and feelings (no lab test)
what is the #1 leading disease for middle to high income countries
depression
definition of epidemiology
the study of patterns of disease distribution and determinants of health within populations, contributes to the overall understanding of the mental health status of population groups, or aggregates, and associated factors
what is epidemiology used to establish
evidence of mental disorders
definition of rate
the proportion of the cases in the population when compared with the total population.
equation for rate
(cases in population/total population [cases + non cases])
It is expressed as a fraction, in which the numerator is the number of cases and the denominator is the total number in the population, including the cases and non cases.
what is therm average rate used to measure
used for measures that involve rates over specified time periods
definition of prevalence
refers to the total number of people who have the disorder within a given population at a specified time regardless of how long ago the disorder started
Definition of point prevalence
the basic measure that refers to the proportion of individuals in the population who have the disorder at a specified point in time ( t ).
point prevalence equation
(cases at t/population at t)
This point can be a day on the calendar, such as April 1, 2015, or a point defined in relation to the study assessment, such as the day of the interview.
incidence definition
refers to a rate that includes only new cases that have occurred within a clearly defined time period. The most common time period evaluated is 1 year.
The study of incidence cases is more difficult than a study of prevalent cases because a study of incidence cases requires at least two measurements to be taken: one at the start of the prescribed time period and another at the end of it.
stigma definition
Stigma can be defined as a mark of shame, disgrace, or disapproval that results in an individual being shunned or rejected by others.
what are the three types of stigmas
public stigma, self- stigma, and label avoidance
definition of public stigma
occurs after individuals are publicly “marked” as being mentally ill. When individuals with mental illness act or say things that are odd or unusual or tell others that they have a mental illness, they are at risk of being publicly identified as having a mental illness and are subject to prejudice and discrimination.
definition of self stigma
occurs when negative stereotypes are internalized by people with mental illness.
definition of label avoidance
avoiding treatment or care in order not to be labeled as being mentally ill, is another type of stigma, and one of the reasons, that so few people with mental health problems actually receive help
how is the recovery from mental disorders process described
Recovery from mental disorders and/or substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential
how is culture defined
culture is not only a way of life for people who identify 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, + behaviors that emerge from its members interpersonal transactions
definition of acculturation
describes the socialization process by which minority groups learn + adopt selective aspects of the dominant culture. Their culture changes as a result of the influences of the new environment
definition of culture identity
set of cultural beliefs which one looks for standards of behavior
what is linguistic competence
the capacity to communicate effectively and convey information that is easily understood by diverse audiences, is an important part of cultural competence
what is culture competence
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
why is Understanding the impact of literacy levels so important
it is integral to providing culturally competent care.
Hispanic culture norms
Tend to use all resources before seeking help from mental health professionals.
TX barriers include language, beliefs, values, cost of care, and concerns about immigration status. May first seek help through supportive home care and counseling from the church.
Care sought if bilingual and bicultural mental health facilities are available.
African American culture norms
Older members are treated with great respect**
Extensive family networks relied on for support.
African American stigmas
African americans with mental illnesses suffer from DOUBLE STIGMA from their own culture and from longtime racial discrimination (it may even come from the healthcare community itself).
Diagnosis and treatment of blacks are often racially biased, leading to less access to care bc of a lack of health insurance. They are disproportionately diagnosed as having schizophrenia when compared to other groups. Over-diagnosis may be because the interviewer perceived that the PT was not being honest in their responses.
Asian Americans, Polynesians, Pacific Islanders cultural norms
Asian cultures have a tradition of denying or disguising the existence of mental illnesses because it is an embarrassment to the family.
Asian Americans may experience CULTURE-BOUND SYNDROME, such as neurasthenia (characterized as fatigue, weakness, poor concentration, irritability, memory loss, aches, and pains, and sleep disturbances).
Associated with Korean cultures,, “suppressed anger syndrome,” is expressed anger, sensations of heat, and feelings of hate. Rates of suicide is higher in Native Hawaiian adolescents and older Asian American women
Native a\American cultural norms
They emphasize respect to the Earth and nature, from which come survival and comprehension of life and the relationship with a higher spiritual being.
Shamans, or medicine men, are central to most cultures. They are healers believed to possess psychic abilities. Healing treatment relies on herbal medicines and healing ceremonies and feasts.
Varying views of mental illness among tribes. In some cultures, mental illness is seen as a supernatural possession, as being out of balance with nature. but in certain groups, ppl with mental illness are stigmatized.
Suicide is stigmatized but little difference between physical and mental illnesses is not.
Women in minority groups stigmas/ norms
Greater conflicting feelings and psychological stressors than men.
Adjustment to defined roles in culture versus different roles in larger predominant society.
Compartmentalization of work and family lives.
Compared to men, more Asian American women suffer from depression, yet are less likely than white women to seek out mental health care.
Poverty impacts on mental health
Widespread among all cultural groups. Financial and emotional stress triggering or exacerbating mental health problems such as being trapped in a downward spiral with increasing tension and stress or feelings of powerlessness and low self-esteem.
Homeless population is most at risk for being unable to escape poverty**
Rural cultures mental health implications
Most mental health services are found in urban areas bc most people live near cities.
Those living in rural areas have limited access to health care which leads to fewer people being DX for mental health problems and becomes problematic for kids and older ppl who have specialized needs
The suicide rate in rural areas is higher than that of urban areas bc firearms are most commonly used.
Treatment approaches possibly accepted in one part of the country but not in another
spirituality definition
one’s self as part of a spiritual force. It is a connection to life; a way of interpreting life events. And it is a source of hope, joy, comfort, and guidance on life’s journey.
how does spirituality develop
It develops over time and is a dynamic, conscious process characterized by 2 movements of transcendence (going beyond the limits of ordinary experiences): either deep within the self or beyond the self. Self-transcendence involved self-reflection and living according to one’s values. Transcendence beyond self is explained by a feeling of connection and mutuality to a higher power.
definition of religiousness
(different from spirituality) is the participation in a community of people who gather around common ways of worshipping. Religious beliefs often define an individual’s relationship within a family and community.
what religion dominates western society
Judeo—Christian
what religion dominates eastern and middle eastern cultures
Islam, Hinduism, and Buddhism
definition of self-determinism
promotes growth and well-being toward human potential through having basic psychological needs met including autonomy (initiation and control of one’s actions), competence (perceived effectiveness in social interactions), and relatedness (connections and belongingness with others)
example of self determinism in health care
A patient’s right to refuse treatment, to choose the second or third best health care recommendation rather than the first, and to seek a second opinion are all self-deterministic acts.
what does the self determination act state
Patients have the following rights:
Be provided with information regarding advance care documents
Be asked at admission or enrollment whether they have an advance care document and that this fact be recorded in the medical record.
Be provided with information on their rights to complete advance care documents and refuse medical care
definition of advanced care directives
written instructions for health care when individuals are incapacitated
Must be witnessed by two people and notarized and applies only if the individual is unable to make his or her own decisions as a result of being incapacitated or if, in the opinion of two physicians, the person is otherwise unable to make decisions for him- or herself
living will definition
states what treatment should be omitted or refused in the event that a person is unable to make those decisions
what is a power of attorney
for health care appoints a proxy, usually a relative or trusted friend, to make health care decisions on an individual’s behalf if that person is incapacitated
what does the americans with disability act state
ensures that people with disabilities, such as severe mental disorders, have legal protection against discrimination in the workplace, housing, public programs, transportation, and telecommunications.
definition of competency
the degree to which the patient can understand and appreciate the information given during the consent process, refers to a patient’s cognitive ability to process information at a specific time
How do you determine competency
Communicate choices
Understand relevant information
Appreciate the situation and its consequences
Use logical thought process to compare the risks and benefits of treatment options
Defintion of communication choices
ability to express choices
Patient attributes: patient should be able to repeat what he or she heard
Definition of understanding relevant information
capacity to comprehend the meaning of the information given about treatment
Patient attributes: Patient should be able to paraphrase understanding treatment
define using a logical thought process to compare the risk and benefits of treatment options
capacity to reach a logical conclusion consistent with the starting premise
Patient attributes: Patient should be able to discuss logical reasons for the choice of treatment
define appreciating the situation and its consequences
capacity to grasp what the information means specifically to the patient
Patient attributes: patient should be able to discuss the disorder, the need for treatment, the likely outcomes, and the reason the treatment is being suggested
what happens if a person is judged incompetent
(i.e., unable to understand and appreciate the information given during the consent process), it is possible to force treatment on the individual.
what is informed consent
legal procedure to ensure that the patient knows the benefits and costs of treatment
Mandated by state laws
what does the right to be treated in the least restrictive environment mean
an individual cannot be restricted to an institution when he or she can be successfully treated in the community
An individual cannot be restrained or locked in a room unless all other “less restrictive” interventions are tried first
what is voluntary commitment
Full legal rights are retained
Individual is free to leave at any time even if it is against medical advice
If hospitalization is required, the person enters the treatment facility, participates in the treatment planning process, and follows through with the treatment
what is involuntary commitment
Confined hospitalization of a person without the person’s consent but with a court order
Each state and the District of Columbia have separate commitment statutes
The individual must be (1) mentally disordered, (2) dangerous to self or others, or (3) unable to provide for basic needs
Have the right to receive treatment, but also have the right to refuse it (the state trend is to grant patients the right to refuse treatment whether they are competent or incompetent)
Commitment procedures vary considerably among the states. Most have provisions for an emergency short-term hospitalization of 48 to 92 hours authorized by a certified mental health provider without court approval
The judge must order the commitment
definition of privacy
refers to that part of an individual’s personal life that is not governed by society’s laws and government intrusion. Protecting an individual from intrusion is a responsibility of health care providers.
definition of confidentiality
can be defined as an ethical duty of nondisclosure. Providers who receive confidential information must protect that information from being accessed by others and resist disclosing it.
when is a persons fitness to stand trial determined
Once a mental illness is diagnosed in a person who has committed a crime
why can a person be found unfit to stand trial
because of mental or physical condition, he or she is unable to understand the nature and purpose of the proceedings or to assist in the defense
what does the term not guilty but mentally ill mean
The accused is judged to not know right from wrong or to be unable to control his or her actions at the time of the crime
Subject to involuntary treatment in a secure facility (a.k.a. Hospital setting)
definition of guilty but mentall ill
criminal conviction, and person is sent to correctional facility
Assault definition
Threat of unlawful force to inflict bodily injury upon another.
An assault must be imminent and cause reasonable apprehension in the individual
medical battery definition
Intentional and unauthorized harmful or offensive contact, occurs when a patient is treated without informed consent.
Example = a clinician who fails to obtain consent before performing a procedure is subject to being accused of medical battery.
Failure to respect a patient’s advance directives is considered medical battery.
negligence definition
Breach of duty of reasonable care for a patient for whom a nurse is responsible that results in personal injuries
Simple mistakes are not negligent acts -→ like forgetting to give a pt. a cup of water
what are nurses responsible for documenting
Observations of the patient’s subjective and objective physical, psychological, and social responses to mental disorders and emotional problems
Interventions implemented and the patient’s response
Observations of therapeutic and side effects of medications
Evaluation of outcomes of interventions
what do medications prescribed on a PRN basis also require
a separate entry, including reason for administration, dosage, route, and response to the medication.
definition of autonomy
Each person has the fundamental right of self-determination
Ex: patient has the right to choose or refuse treatment
definition of beneficence
The health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential
“Doing good”
Ex: provide pain medication for a patient as soon as they arrive at the ER
definition of justice
The duty to treat all fairly, distributing the risks and benefits equally
Justice becomes an issue in mental health when a segment of a population does not have access to health care
Ex: offering the same treatment to two patients regardless of financial status
definition of non maleficence
The duty to cause no harm, both individual and for all
“Do no harm”
Ex: avoiding negligent care
definition of paternalism
The belief that knowledge and education authorize professionals to make decisions for the good of the patient
Ex: laws that require seatbelts
definition of veracity
The duty to tell the truth and not withhold information
Ex: delivering bad news in an honest and compassionate way
definition of fidelity
Faithfulness to obligations and duties
Keeping promises
Ex: a nurse tells a patient she will be back to check on him in 30 minutes, so the nurse comes back in exactly 30 minutes and is not late
what does the The biopsychosocial framework consist of
three separate but interdependent domains: biologic, psychological, and social.
Each domain has an independent knowledge and treatment focus but interacts and is mutually interdependent with the other domains.
what does the biologic domain consist of
the biologic theories related to mental disorders and problems as well as all of the biologic activity related to other health problems. Examples include exercise, sleep, and adequate nutrition to mental health conditions
what does the psychological domain consist of
contains the theoretical basis of the psychological processes—thoughts, feelings, and behavior that influence one’s emotion, cognition, and behavior
what does the social domain consist of
includes theories that account for the influence of social forces encompassing the patient, family, and community within cultural settings
what is the most important tool of psychiatric nursing
the self.
Through relationship building, patients learn to trust the nurse, who then guides, teaches, and advocates for quality care and treatment
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