NUR2200 Week1 StudyGuide

NUR2200 Mental Health Nursing Week 1 Comprehensive Study Guide

SECTION 1: Stigma in Mental Health

  • Definition of Stigma:

    • Stigma is defined as a negative label or stereotype attached to a person or group, specifically referring to people with mental illness.

  • Sources of Stigma:

    • Stigma can arise from various sources including:

    • Family

    • Cultural perspectives

    • Hollywood and media portrayals

    • Healthcare workers themselves

  • Cultural Taboos:

    • Many families conceal mental illness out of shame. The instructor shared a personal anecdote about a Taoist exorcism performed on his sister due to her psychosis being misinterpreted as demon possession.

  • Examples of Stigmatizing Language:

    • Phrases such as "They're crazy" or "They're lazy", particularly in healthcare settings where patients may be urged to "just get out of bed" despite being unable to due to their condition.

  • Hollywood's Role:

    • Movies often depict mental illness in connection with violence and crime (e.g., psycho killers), which misrepresents true realities.

  • Family Stigma:

    • Families may isolate members experiencing mental illness rather than seeking professional help.

  • Rural Asia Example:

    • In Vietnam, some families may resort to caging or chaining loved ones with mental illness due to a lack of access to appropriate care and medication.

  • Exam Alert:

    • The documentary "Bedlam" by Dr. Rosenberg is crucial for understanding the history and treatment of mental illness in L.A. County, and will feature on the exam. Importance is placed on understanding inhumane treatment history versus the rights of patients today.

  • Key Analogy for Understanding Stigma:

    • Analogy highlighted: If a child broke their femur, you would never tell them to walk it off. This logic applies to mental health: if someone suffers from depression and cannot get out of bed, similar empathy should be applied. Mental illness is fundamentally a medical illness that requires respectful treatment.

  • Stigma Statistics:

    • Approximately 1 in 5 people in the United States has a mental illness (~20% of the population).

    • Those with serious mental illness typically die 20 years younger than the general population, emphasizing the need for early intervention.

  • Self-Stigma:

    • Patients frequently experience self-stigma, which leads to low self-esteem, feelings of shame, and a tendency to isolate themselves to conceal symptoms such as hearing voices.

  • Implicit Bias:

    • Nurses are advised to reflect on and examine their own implicit biases as they also contribute to stigma.

SECTION 2: The DSM-5

Diagnostic & Statistical Manual of mental Disorders

(1. PSYCHIATRIC, 2 PERSONALITY/MENTAL RETARDATION, 3 MEDICAL, 4 PSYCHOSOCIAL STRESSORS, GLOBAL ASSESSMENT FUNCTIONING)

  • Definition of DSM-5:

    • The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is the primary tool used to diagnose psychiatric conditions and is considered equivalent to the ICD-10 used in general medicine.

  • Usage of DSM-5:

    • While primarily focused on psychiatric conditions, the DSM-5 does also include neurological disorders. It is routinely updated approximately every 10 to 20 years.

  • Diagnosed Conditions via DSM-5:

    • The following conditions are diagnosed using the DSM-5:

    • Schizophrenia

    • Bipolar disorder

    • Depressive disorders

    • Anxiety disorders

    • Obsessive-Compulsive Disorder (OCD)

    • Post-Traumatic Stress Disorder (PTSD)

    • Eating disorders including Anorexia Nervosa and Bulimia

    • Sexual dysfunctions

    • Gender dysphoria

    • Neurodevelopmental disorders, such as autism

    • Addictions (includes caffeine addiction)

    • Neurological disorders, such as Major Neurocognitive Disorder (e.g., dementia).

  • Exam Alert:

    • It is critical to note that neurological disorders are included in the DSM-5. This can often be a trick question since many may assume it only pertains to psychiatric disorders.

SECTION 3: Legal & Ethical Concepts

  • Importance on the Exam:

    • The instructor emphasized that nursing ethics will be heavily tested on the upcoming exam.

  • The 7 Ethical Principles of Nursing:

    • These principles were taught through a LevelUpRN video, and examples provided in lecture are crucial. Each principle includes a definition and practical illustration:

    • Autonomy:

      • Meaning: The patient's right to make their own healthcare decisions.

      • Example: A patient has the right to refuse medication, and the nurse's role is to advocate for them, not force treatment.

    • Beneficence:

      • Meaning: Involves the action of doing good for the patient.

      • Example: Taking a patient who has been hospitalized outside for fresh air.

    • Non-Maleficence:

      • Meaning: The obligation to do no harm.

      • Example: Checking a medication label multiple times to prevent medication errors.

    • Justice:

      • Meaning: Treating all patients fairly, regardless of their background or circumstances.

      • Example: Providing equal pain relief (e.g., morphine vs. Tylenol) to patients presenting with similar pain levels.

    • Fidelity:

      • Meaning: Being faithful to commitments made to patients.

      • Example: If a nurse promises to return in 30 minutes with pain medications, they must follow through.

    • Veracity:

      • Meaning: Commitment to truth-telling.

      • Example: Providing patients with truthful information about potential side effects rather than offering reassurances.

    • Advocacy:

      • Meaning: Supporting and speaking up for the rights and wishes of the patients.

      • This principle is central to the role of nursing.

  • Exam Alert:

    • Expect scenario-based questions requiring identification of ethical principles at play.

  • Nursing as the Most Ethical Profession:

    • According to a Gallup Poll, nursing has ranked #1 in terms of honesty and ethical standards for 24 consecutive years, except for the year of the September 11 attacks, when firefighters briefly held that honor.

    • There are over 4 million nurses in the U.S., making it the largest healthcare profession, exceeding that of pharmacists and physicians.

    • Upon passing the NCLEX in California, nurses receive the Public Health Nurse (PHN) designation, qualifying them for county jobs.

  • Nurse Practice Act & Scope of Practice:

    • Each State has a Board of Nursing that defines the scope of practice, meaning what actions nurses may legally perform per their state license.

    • Nurses practicing in multiple states must be aware of each state's specific regulations.

    • The California Board of Nursing website allows individuals to look up nurse licenses, including any legal issues associated (e.g., DUIs).

  • American Nurses Association (ANA):

    • The ANA sets the ethical standards for nursing but is not responsible for defining the scope of practice (that's the role of the Nurse Practice Act).

    • The ANA articulates that an ethical dilemma arises from a conflict of values leading to distress among nurses, patients, or families.

  • Ethics Committee:

    • An interdisciplinary group which reviews ethical dilemmas in healthcare settings.

    • Important to note: The Ethics Committee does not impose decisions, but rather offers recommendations.

  • Exam Alert:

    • Understand the distinction between interdisciplinary teams, which involve professionals from different fields working together, and intraprofessional teams, which consist of professionals within the same category (e.g., nurses collaborating with nurses).

SECTION 4: Legal Concepts in Mental Health Nursing

  • 5150 Hold — Involuntary Psychiatric Hold:

    • Exam Alert:

    • The criteria for Justifying a 5150 hold include only three conditions:

      • DTS (Danger to Self): Exhibiting suicidal ideation.

      • DTO (Danger to Others): Expressed homicidal ideation.

      • GD (Gravely Disabled): Unable to care for self.

    • A patient under a 5150 hold can be detained for a maximum of 72 hours.

    • Only one of the three conditions must be met for a hold to be enacted; all three are not required.

    • Any condition outside these three criteria would necessitate voluntary admission only.

    • Even if a suicidal patient claims to feel safe and wants to go home, releasing them is not permissible without following protocol and documentation.

  • Tarasoff Law — Duty to Warn:

    • Exam Alert: Students must understand the Tarasoff Law as it will be tested.

    • Originating from a 1976 case where a patient confided to a psychologist about plans to murder a woman named Tatiana Tarasoff, who was subsequently killed after the psychologist failed to breach confidentiality.

    • Result: Tarasoff Law mandates that healthcare professionals must take reasonable steps to warn and protect potential victims when a specific harm is identified.

    • As a nurse, if a patient discloses intent to harm a particular individual, the nurse must:

    • Break confidentiality.

    • Notify the intended victim and law enforcement.

    • Place the patient under a 5150 hold as necessary.

    • Legal Liability:

    • Failing to warn can result in legal consequences for the nurse.

  • Confidentiality and Conditions to Breach:

    • Confidentiality is vital for building trust in mental health. However, it must be broken in the following circumstances:

    • If a patient poses a threat to themselves (e.g., suicidal ideation, necessitating a 5150 hold).

    • If a patient poses a threat to another person (applicable under Tarasoff Law).

    • In any case of suspected abuse — including child, elder, domestic violence, or sexual abuse (mandatory reporting required).

  • Mandatory Reporting:

    • In California, nurses are designated as mandatory reporters.

    • If abuse of any form is witnessed or suspected, it is mandatory to report.

    • Failure to report may lead to prosecution and loss of the nursing license.

  • 988 — Mental Health Crisis Hotline:

    • The 988 hotline serves as the national crisis and suicide prevention helpline, allowing individuals to call or text for assistance.

    • This new 3-digit number replaced the previous 10-digit crisis number and must be communicated to patients, friends, and family members.

  • Advance Directives in Mental Health:

    • Just as patients have medical advance directives, mental health patients may establish directives to appoint a trusted individual (e.g., an adult child) for decision-making during incapacitation.

  • Legal Terms Overview:

    • Negligence: Failing to perform within the expected standard of care.

    • Example: Administering a medication at noon instead of the ordered time of 9am.

    • Battery: Physical contact with a patient without consent; includes any form of harmful contact (e.g., spitting, threatening).

    • Assault: Threatening bodily harm that does not necessitate physical contact.

    • False Imprisonment: Wrongfully restricting a patient's freedom without legal justification (e.g., secluding a dementia patient without reason).

  • Restraints & Seclusion:

    • Exam Alert: Always select the least restrictive intervention first in crisis situations rather than resorting to restraints or seclusion.

    • Constraints such as these should only be employed when a patient presents an immediate danger to oneself or others.

    • Justification Examples:

    • Unjustified: A patient wants snacks before lunch — does not warrant restraints.

    • Justified: A patient expresses intent to harm another, actively moving to do so.

    • Order Protocol: Restraint orders are not standing or PRN; a new order is required once restraints are released.

    • Monitoring: It is crucial to check on restrained patients every two hours for circulation, skin integrity, positioning, and any bathroom needs.

  • Contraband Check — Inpatient Psychiatric Units:

    • Conduct thorough checks for contraband (items that may facilitate self-harm or harm to others) upon admission.

    • Common items to remove include shoelaces, belts, and sharp objects.

  • Creative Safety Measures:

    • It’s essential to remain vigilant, as patients have been known to conceal contraband, such as swallowing staples or hiding weapons.

SECTION 5: Treatment Settings

  • Treatment Setting Descriptions:

    • Inpatient (BHU):

    • Behavioral Health Unit, formally known as a psych ward or asylum. Patients receive stabilization and medication management in a safe environment.

    • Admission Types: Voluntary or involuntary under a 5150 hold.

    • Outpatient:

    • Involves discharging stabilized patients who then attend regular follow-ups, therapy sessions, or obtain medication.

    • Sitter/Line of Sight:

    • For patients at risk of suicide, a staff member continuously monitors the patient to ensure they are not left alone.

  • Term Updates:

    • Outdated terms such as "asylum," "institution," and "psych ward" are now collectively referred to as BHU (Behavioral Health Unit).

SECTION 6: Patient Rights

  • Historical Context of Patient Rights:

    • Prior to the 1950s, patients had minimal to no rights.

    • Involuntary commitments could be made by spouses, and cruel treatments, including lobotomies and unanaesthetized ECT, were permissible.

  • Key Patient Rights (Even under Involuntary Hold):

    • Right to refuse medication, except in cases of court-ordered treatment.

    • Right to make phone calls.
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