Untitled Flashcards Set

Chapter 1: 

• Mental health: It is a State of well-being in which a person can realize their potential to cope with NORMAL stresses of life, work, and productivity, and make a contribution to the community 

• Mental illness:  is often seen as “strange,” or “different,” that this is a deviation from the norm, even though it was a rare occurrence

• Resilience: the ability for people to get resources they need to support their well-being 

  • Can effectively regulate emotions 

  • Do not  allow themselves to be caught up in negative, self-defeating thoughts 

  • Experience symptoms of emotional stress, but know how to cope effectively 

• Make sure that we are viewing the person not the disorder- don’t label the patient (pg. 11) 

Chapter 9: 

• Therapeutic communication is crucial to the formation of patient-centered therapeutic relationships; should be patient-centered where they are a full partner in their care 

• Therapeutic communication: 

  • Using silence: 

    • For most silence is uncomfortable. Then there is a rush to fill the void with questions or idle talk. This can cut off important thoughts or feelings of pt 

    • Silence is worthwhile if it is serving a function. May provide meaningful moments of reflection 

    • If silence is due to meds or certain disorders, gentle prodding can help 

    • Silence isnt always therapeutic. Prolonged frequent silence by nurse may hinder the interview. Patients need to know that they are being understood 

  • Active listening:

    • Nurses fully concentrate, understand, respond, and remember what the pt is saying verbally and nonverbally 

    • Undivided attention gives a feeling of pt not being alone 

    • Enhances self-esteem and encourages pt to find ways to deal with problems and problem solving 

  • Clarifying techniques:

    • Paraphrasing: 

      • Restate basic content in different, fewer words 

    • Restating: 

      • Active listening strategy which helps nurse to understand what the pt is saying 

      • Don’t use frequently= conveys inattention, disinterest, or mechanical 

    • Reflecting: 

      • Assisting pts to better understand own thoughts and feelings 

      • Could be a question or simple statement conveying nurses observations of pt 

    • Exploring: 

      • Enables the nurse to examine important ideas, experiences, or relationships fully 

  • Questions:

    • Open-ended questions: 

      • Encourage pt to share information about experiences, perspectives, or responses. 

      • Non-intrusive 

    • Closed-ended questions:

      • Use sparingly. 

      • Can give specific and needed information 

    • Projective questions: 

      • Usually start with “what if” to help pts 

      • Articulate, explore and identify thoughts and feelings 

    • Miracle questions: 

      • Goal-setting questions 

      • Helps pt to see what the futures would look like if a particular problem were to vanish 

Non-therapeutic communication: 

• Excessive questioning: 

  • Asking multiple questions consecutively and rapidly

  • puts a nurse as interrogator demanding information 

  • Conveys lack of respect of sensitivity to pts needs 

• Giving approval: 

  • Implies nurse is pleased by the manner of the pt 

  • The pt then tries to continue to do things to please the nurse 

  • Giving disapproval implies nurse has the right to judge 

• Giving advice: 

  • Nurse is interfering  with pts ability to make personal decisions, making them feel inadequate or could enable dependency on part of pt. 

• Asking “why” 

  • “Why” demands an explanation, implies wrong-doing and criticism 

  • Can be seen as intrusive and judgemental. Making pt defensive 

  • More useful to ask what is happening 

  • Questions that focus on who, what, where, and when get more information and aid in problem-solving 

Cultural considerations: 

• Cultural awareness can lead to the formation of positive therapeutic relationships 

• Always assess the pts ability to speak and understand English; interpreter as needed 

• Communication style varies with culture. 

  • Examples

    •  Hispanics are intensely emotional. 

    • French and italians show animated facial expressions and expressive hand gestures 

    • Asian culture= emotional restraint 

    • Germans and British show little facial emotions 

• Eye contact: 

  • Hispanics:  avoid eye contact which is a sign of respect to those in authority 

  • Japanese: direct eye contact shows lack of respect 

  • Chinese: gazing around when listening is polite 

  • Filipinos: try to avoid eye contact

  • Middle eastern women: direct eye contact implies sexual interest 

  • Native Americans see eye contact as disrespectful and aggressive 

  • Germans, russians, French, British, African Americans: maintain eye contract 

• Touch: 

  • Hispanics: Frequently physical contact 

  • Italian, French and russians accustomed to frequent touching. 

  • Germans, Swedish, and British Americans: touch is infrequent 

Chapter 5: 

• Western view: (US)

  • Western tradition: theories, understanding of mental health & illness in US comes from western philosophical & scientific framework based on western ideals, beliefs, and values 

  • Western tradition: individuality, values of autonomy, independence, self-reliance, mind-body = 2 separate entities, disease = cause which creates effect, individual has rights, values open communication, and truthfulness 

  • Nurses need to evaluate how this affects their nursing care 

• Eastern view: (Chinese, Indian philosopher inspo )

  • Eastern tradition 

  • Asia: based on Chinese and Indian philosophers & spiritual traditions of Confucianism, Taoism, Buddhism, and Hinduism 

  • Native Americans, African tribes, Australian, and New Zealand aborigines & others: 

    • Based on deep personal connections to the natural world and tribe

  • Family= identity 

    • Family interdependence & group decision-making

    • mind, body, spirit = ONE 

    • No separation between physical illness vs psychological

    • Believe in  reincarnation 

    • Disease caused by an imbalance in energy forces & imbalance between daily routine, diet, and those needing healthcare = vulnerability 

•  Indigenous culture views: (Australians, Hawaiians, Native Americans):

  • Those here for thousands of years like New Zealand Maoris, Australian aborigines, American natives, & native hawaiians

    • Identity =  tribe 

    • No conception of person 

    • Person is entity inly in relation to others 

    • Disease = lack of harmony of person with others or environment or lack of spiritual harmony

    • Deep relationship with nature

    • Mind, body, and soul are united

    • Knowledge of nature 

    • Ethics based on community needs 

• Impact of culture 

  • Deviance from cultural expectations can cause a problem and be defined as an illness 

  • Thoughts and behaviors in one culture may be healthy, but in others can mean a mental illness.

• Cultural barriers 

  • Actual interpreters for communication, not a family member 

  • Cultural concepts of distress: cultural syndromes way seem exotic or irrational to nurses in Western culture, but are understood by people within the group 

    • Ex: Anorexia & Bulimia = problems bound to western cultures; other cultures fo not value skinniness. 

• Culturally competent care 

  • Cultural competence: the ability to work effectively in cross-cultural situations & provide the best possible care to different racial/ ethnic backgrounds who speak different languages. 

    • Nurses adjust practices to meet patients cultural beliefs, practices, needs, & preferences 

  • Cultural awareness: Allows nurses to acknowledge the effect of their own culture

    • realizing many of their own morals are cultural, few are universal & that they have an obligation to be open & respectful of pts cultural norms. 

  • Cultural knowledge: Nurses should enhance their knowledge by attending cultural events & programs and attending services with different cultural groups where they talk about their norms. 

  • Cultural encounters: helps nurses to recognize, avoid, & reduce cultural pain that occurs when nursing care causes the pt. Discomfort or offense when by not being sensitive to cultural norms  

  • Cultural skill: asking specific questions can help pt feel heard and understood (pg. 88)

  • Cultural desire: nurse not acting out of a sense of duty but from a sincere & genuine concern for patients’ welfare. Exhibited through patience, consideration, & empathy 

Chapter 6: Mental health laws 

• Community Mental health Care Act of 1963 

  • Promoted deinstitutionalization of mentally ill 

  • Shift from institutionalized care to community-based care 

  • Increasing awareness of need to provide HUMANE care that respect rights 

  • Legal system more therapeutic approach with those with substance abuse disorders & mental health disorders 

  • More emphasis on rehabilitation then punishment 

  • Divert them to community resources to prevent reoffending & monitoring adherence

• Volunary addmission: 

  • Informal admission: least restrictive 

  • Voluntary admission: pt must understand need for treatment and be willing to be admitted 

  • Considered competent 

  • Right to refuse medication & treatments 

  • Right to request & obtain release 

  • Before release-revaluation may be necessary and this could result in involuntary admission 

• Involuntary consent: 

  • Court- ordered admission without consent 

  • Standards = mentally ill

    • Poses danger to self or others 

    • Gravely disabled (unable to provide basic needs) 

    • Unable to seek help voluntarily 

  • Mental healthcare provides (usually 2 physicians) certifying mental health status certifies detention and treatment 

  • Pt can go before judge, can be kept involuntarily 

  • Can also challenge based on least restrictive alternative doctrine (LEAST drastic action) 

  • Emergency commitment used for people who are so confused they cannot make decisions on their behalf or who are so ill in need of emergency admission 

  • Primary purpose of this is for observation,  diagnosis, & treatment who have mental illness or pose danger to themselves or others 

  • Range from 24-96 hrs depending on state 

  • Assisted outpatients treatment 

    • Can be preventative measure allowing court order before onset of psychiatric crisis that can result in inpatient admission 

• Discharge 

  • Release from hospitalization depends on pts admission status 

  • Conditional release: usually outpatients treatment for specified period to see if pt follows medication regimen, meet basic needs, able to reintegrated into community, if involuntary admitted, may be institutionalized 

  • Unconditional release: termination of patient- institution relationship 

  • AMA 

• Right to refuse treatment: 

  • When it comes to psychotropic drugs has been debated in courts 

  • Issue is of pts mental ability to give or withhold consent to treatment & their status under civil commitment statuses 

  • In emergency, can be medicated to prevent pt from causing serious harm to self or other without court hearing 

  • After court hearing, can be medicated  if all are met serious mental illness, benefits of treatment outweigh harm, can’t make reasoned decision, less-restrictive services found to be inappropriate 

• Trstraints and seclusions: 

  • Hx of restaraint and seclusion marked by buse, overuse, and tendency to use restraint as punishment esp before 1950 

  • APNA promotes culuture that minimizes use of seclusion and restraints; use least restrictive means for shorter time 

  • NOT a punishment 

  • Nurses consider the following BEFORE using restraints: 

    • Verbally intervening 

    • Reducing stimulation 

    • Actively listening 

    • Providing diversion

    • offering PRN meds 

  • Restraints are: 

    • Side rails 

    • Chemical 

    • Seclusion 

  • Orders and documentation for restraints and seclusion: 

    • In emergency, nurse can place pt in seclusion or restraint, but must get written or verbal order ASAP 

    • Orders for restraints or seclusion are never written as needing or standing order 

    • May be renewed for total 24 hrs, with limits according to age: adults (18+) up to 4 hrs; children 9-17 upto 2hrs; 8 and under have 1 hr limit 

    • After 24hrs, physician must personally assess pt 

    • Once pt is removed froim restraints or seclusion, new order is required to reinstitute intervention 

    • Nurse needs to document restraints or seclusion well & in treatment plan or care plan and needs to include: 

      • Behaviors leading up to restraints

        • What did the nurse do to deescaltae situation before restraints. 

      • Time of placement

        • & time of when doctor was contacted and order was obtained 

      • Time of release? 

    • Must be monitored through continuous observation. 

      • Assess pt in restraints every 15-30 min. For physical needs, safety, & comfort then document 

    • Pt must be protected from all source of harm 

• HIPAA:

• Nurses obligated to report pts threats of harm against specified victims or classes of victims to members of treatment plan 

• Most states require nurses to report cases of suspected abuse (child or elder) 

• Civil penalites for failure to report 

• Nurses are REQUIED to protect pts: 

  •  liable if suicide pt is left alone with means of self harm & will be held responsible for resutant injuries

  • medication errors

  • abuse of therapist- pt relationship(sexual misconduct)

  • Prevent harm when restrained 

  • Protect pts from other pts 

  • Potential threats from pts family or friends 

• Legal duty to intervene & report risks of harm to pt from peers 

Chapter 8: Therapeutic relationship: 

• Conecepts of nurse-pt relation: 

  • Most have exhausted all other support resources and are in need opf emotioanl support 

  • Each person has unique gifts that can be used to form bond with others. 

• Important of talk therapy: 

  • It can actually change brain chemistry very similar to how medications can 

  • Best treatment formost psychiatric problems is medication and psychotherapy

• Therapeutic relationships: 

  • Focus of relationship is on patient and their needs 

  • Very little self-disclosure from nurse, no personal info 

  • Can be brief but can be substantial, useful, and important to the pt 

  • Even a short encounter can have a powerful effect 

• Relationship boundaries: 

  • 1. Transference 

    • When pt unconsciously and inappropriately transfers onto nurse, feelings and behaviors related to figures in pts past, can be positive if positive outcomes occur (Does not need addressing) 

    • Negative transference needs attention

  • 2. Countertransference 

    • In reverse, nurse transfers feelings onto pt, results in overinvolvenment and hinders relationship. If strong feelings (postive and negative), are present probably contrtransference 

    • Working throught theses issues are crucial in accomplishing professional growth and helping pt to meet goals. 

• Focus on self awareness:

  • Self awareness=  key component to formingtherapeutic relationships. Can easily be threatened by others who express different ideals. 

  • Self-aware requires tha we understand our beliefs/values then to accept those differences in others 

Peplau’s model of nurse-patient relationships

• 4 phases: 

  • 1- preorientation phase 

    • Preparing

      • Charts, pts meds, labs, condition 

    •  evaluate own feelings

      • Being afraid of those with mental illness or saying the wrong thing 

• 2- Orientation phase 

  • Intro: who is the nurse, purpose, what does pt want to be called 

  • Establishing rapport: atmospher where trust and rapport can grow, nurture rapport by being genuine, empathetic, consistent 

  • Specifying contract: emphasizes pts participation and responsibility 

  • Explanation confidentiality: who else will know what is being shared and may it be shared with those on the treatment team

• 3- Working phase

  • Further data collected. Identifying problem-solving skills; providing educatio, symptom management, evaluate progress. In order to be able to educate others you have to be well educated yourself. Education is KEY, so pt to take active role in their own care 

• 4- Termination phase 

  • Summarize goals that were achieved, review events, discuss new coping skills that they are going to incorporate, discuss plans for future. 

Factors that promote pts growth 

1. Genuineness: ability to be open, honey and authentic in interactions by listening to and communicating clearly 

2. Empathy: attempting to iunderstand the world from the pts perspective. However, down spiral of students being able to display empathy? Why? Cna empathy be taught? 

   1. Empathy: We understand the feelings of others. 

   2. Sympathy: We feel pity or sorrow for others 

3. Positive regard: ability to view another person as being worthy of caring about and comone who has strengths and potential. Communicated by attitudes, actions