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Mental Health - Unit 1 (Exam 1 part 1 of 3)
Mental Health (Nur 253)
Galen College of Nursing
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NUR-253 CONCEPT OF MENTAL HEALTH COURSE
GALEN COLLEGE OF NURSING
KEY CONCEPTS WORKSHEET UNIT 1
CHAPTER 1, 7, 8 ,
EXAM 1 ( part 1 of 3) Yellow on Exam There are factors that can impact an individual’s mental Health and wellbeing. Identify some examples in the following categories.
Personal Individual attributes and behaviors, how we manage thoughts and feelings, how we navigate everyday pressures, ability to respond to social cues, how we participate in social activities, how we view ourselves, biological and genetic factors, RESILIENCE
Social & Economic Immediate social surroundings, FAMILY – sets the stage in promoting confidence and coping skills or for instilling anxiety and feelings of inadequacy, social and peer groups, socioeconomic status = resources available to support mental health
Environmental Access to basic needs, are mental health services available? Cultural beliefs, attitudes and practices
What is resilience and what contributes to an individual developing it?
Resilience is the ability and capacity for people to secure the resources they need to support their well-being. Promote well-being by regulating emotions, maintaining positivity and overcoming crises. Does not mean being unaffected by stressors, rather you are effective at regulating emotions and not focusing on negative, self-defeating thoughts.
Define protective factors.
Characteristics that are associated with a lower likelihood of negative outcomes or reduce a risk factor’s impact on a situation -Positive attitudes, values or beliefs. Family or social support. Access to resources
Define risk factors.
Characteristics (biological, psychological, family, community or cultural level) that are associated with a higher likelihood of negative outcomes -Negative family or cultural support, stigma, no access to resources
What is the DSM 5 and how is it utilized?
Diagnostic and Statistical Manual – describes criteria for 157 disorders This manual identifies disorders based on specific criteria Also serves as a tool for collecting epidemiological statistics about the diagnosis of psychiatric disorders. Only item that can diagnose -Differs from ICD-10 which is the "coding” associated with a specific diagnosis
Screening is not a Diagnosis. Provide examples of patient rights:
The right to be free from excessive or unnecessary medication, the right to privacy and dignity, the right to the least restrictive environment, the right to an attorney-clergy-private care providers, the right to not be subjected to invasive treatments without fully informed consent, right to refuse treatment, right to informed consent, right to advance directives, right to confidentiality Patient can refuse treatment even if they are involuntarily committed
There are two exceptions when HIPPA can be violated to protect a patient or others. Explain the circumstances when this can happen.
-Duty to warn: an obligation to warn others when they may be in danger from a patient OR -Duty to protect: when a therapist determines that a patient presents a serious danger of violence to another (In these situations, you HAVE to warn the person that is at risk)
-MUST report child and older adult abuse (state laws vary)
Describe a scenario when a patient may be voluntarily admitted and another when a patient may be involuntarily admitted to a locked psychiatric unit.
- Voluntary Admission: patient signs themselves in, they understand that they need some extra assistance, have the right to request release whenever they choose (may have to undergo evaluation before being released)
- Involuntary Admission: occurs when a patient is unsafe to themselves or others – can be court mandated
- the Writ of Habeas Corpus: allows a patient to file a petition for release if they believe they are being held against their will
What are some examples of the purpose of the Psychiatric Assessment?
Establish rapport Obtain an understanding of the current problem or chief complaint Review the patient’s physical status and obtain baseline Assess for risk factors affecting the safety of the patient or others Perform a mental status exam Asses psychosocial status Identify mutual goals for treatment Formulate a plan of care Document data in a retrievable format
What assessment data is obtained when completing the mental status exam portion of a psychiatric assessment?
Appearance, attitude, behavior: grooming, eye contact, motor behavior, speech Mood and affect: (mood = subjective, affect = objective) Perceptual disturbances: hallucinations and illusions Thought form: HOW are they thinking (organized, tangential, etc) Thought content: WHAT are they thinking about Cognition and sensorium: orientation, concentration, memory Insight and judgment: insight into current circumstances, is their mental state impairing their judgment?
Identify things that a nurse needs to consider when completing a pediatric psychiatric assessment. How would you approach an interview with a child to make them feel more comfortable?
-main caregiver can provide insight into a child’s behavior, performance or conduct (remember that a separate interview with child may be necessary when a child is hesitant or reluctant to share information when a caregiver is around = possible abuse) -always consider developmental levels -assess through a combination of interview and observation -verbal expression may be difficult for some children – ask them to tell story, draw a picture or engage in specific therapeutic games
Identify things that a nurse needs to consider that maybe unique when completing a psychiatric assessment with an adolescent.
-adolescents are concerned with confidentiality (they’re scared you will turn around and repeat everything back to their parents) -privacy DOES exist for adolescents, use your best judgment or consult with supervisor if a situation is questionable -provide explanation and information to adolescents, they want and need to be involved in their own treatment -threats of suicide, homicide, abuse or behaviors that put patient or others at risk MUST be reported -don’t create a fake sense of confidentiality, make sure patient is aware of what can and cannot be shared to others
Identify things that a nurse needs to consider that maybe unique when completing a psychiatric assessment with an older adult.
-do not stereotype – do not EXPECT them to be physically or mentally deficient -rule out medical causes before assuming it is “just their age” -evaluate preexisting physical, sensory, motor or medical issues -make proper accommodations to limitations
What are some mental health issues that are common among older adults?
Depression, anxiety, cognitive deficits, neurocognitive disorders -older adults are less likely to be accurately diagnosed and treated for mental health disorders than younger adults
expectations, explain confidentiality 3. Working phase: a STRONG working phase allows patient to safely experience increased levels of anxiety and recognize their dysfunctional responses – NURSE: gather further data, identify problem solving skills and self-esteem, provide education about disorder and medications, promote symptom management, evaluate progress 4. Termination phase: the “end” of the relationship – summarize goals and objectives that were achieved, review education, discuss new coping skills, review past situations, exchange memories, discuss plans for the future
In order to be more self- aware what do we need to consider about ourselves in order to keep the focus on the patient?
Self awareness is a key component to forming a therapeutic relationship We need to recognize our own values and beliefs – also need to acknowledge that our values and beliefs are not necessarily right and definitely are not right for EVERYONE Being self-aware helps us accept the uniqueness and differences in others.
Identify examples of non-verbal communication.
-body behaviors: posture, gestures, body movement -facial expressions -eye expression and gaze -voice -personal appearance and physical characteristics
What are some things to consider when using silence as a therapeutic communication technique?
-do not rush to fill silence, it may cut off important thoughts and feelings -silence is NOT the absence of communication -silence is only worthwhile as long as it is serving a function and not scaring the patient -silence can provide meaningful moments of reflection -provides an opportunity to contemplate thoughts, weigh alternatives, formulate new ideas or gain a new perspective -use patience and gentle prompting -use sparingly in children and adolescents as they tend to find silence extremely uncomfortable and are unable to comprehend whether what they have said is being understood
What is the difference between paraphrasing & restating? Describe a scenario when restating might be an appropriate clarifying therapeutic communication technique.
-paraphrasing: restating the basic content of a patient’s message in different, fewer words -restating: involves repeating the same key words that the patient has just spoken
These strategies allow the nurse to understand what the patient is saying and allows the patient to feel heard and/or clarify if needed.
When would it be appropriate to utilize reflective statements as a therapeutic communication technique with a patient?
Reflective statements are used to assist patients to better understand their own thoughts and feelings. Your goal is to make patient aware of their own inner feelings and encourage them to OWN them. Perceiving your concern may allow the patient to share their feelings.
What can you learn about a patient by asking a projective question?
“What if” questions – used to help people articulate, explore and identify thoughts and feelings. Can help people imagine thoughts, feelings and behaviors they might have in certain situations. Able to facilitate a patient’s thinking about problems differently and to identify priorities.
When preparing for a patient interview what 3 things should you consider, that will support the development a therapeutic relationship?
- Pace: allow the patient to set the pace of the interview
- Setting: enhance feelings of security
- Seating: same height as patient (whether seated or standing), face to face, do not allow yourself or the patient to feel trapped
When interviewing a patient what are some behaviors that may interfere with the development of a therapeutic relationship?
-arguing, minimizing, or challenging the patient -false reassurance -interpret or speculate -question or probing about sensitive subjects that patient does not wish to discuss -trying to sell the patient on accepting treatment -join in attacks -participate in criticism
Mental Health Exam 1 study guide (unit 1 –2) Unit 1= ch 1,7,8, Chapter 1: Mental health and Mental illness page 1-17--------------------------------------------------------------------------------------------------------------------- Mental health- state of well being in which individual reach own potential, cope w/ normal stresses of life, work, productivity to community. Brief resilient coping scale- scale from score 4-3 low resilient copers; 14-16 medium; 17-20 high resilient copers Diathesis stress model- biological predisposition and stress represents environmental stress or trauma = explains mental illness PMH-RN- RN nurse with AS or BSN chooses to work in psych mental health Mental health is brain based therefore a physical illness Mental illness adverse outcomes risk factors- genetics, poor social environment, economic hardship, poor health policy,
- Resilience – capacity for people to secure resources for wellbeing; positive way to handle stress Barrier – patient doesn’t want to deal with/ or seek care (no health insurance ect) -Incidence- number of cases in given time -Prevalence- number of cases regardless of when they began Mental health parity act of 1996 – equal insurance for mental health issues annual and lifetime benefits DSM5- book with psy diagnosis = only diagnostic ( screenings not DX Review Questions Ch
- Nurses completes orientation in psy unit; Nurse would expect PMH ARNP to perform which added intervention? Prescribe psychotropic medication
- A fam has long hx of conflicted relationship. Comment that reflects healthy mental perspective? “I will make some changes in my behavior for good of the fam.”
- Which disorder is an example of culture bound syndrome? Running amok (S Asian term)
- Which is the most prevalent mental disorder in US? Alzheimer's
- Measuring outcome between depressed patient one group w/ supportive intervention vs antidepressant is which type of study? Clinical epidemiology
- Which component of treatment of mental illness is specific to QSEN Quality Safety Education for Nurses? Care is centered on patient. Confidentiality with adolescent is so important (don’t tell parents) = suicide homicide and sexual abuse are the only exceptions With child assess with toy and relationship with parents Subjective – from person Objective = what Practioner can see Examples: Ineffective coping related to; as evidence by Chapter 7 Nursing Process and Standards of Care page 103-123------------------------------------------------------------------------------------------------------- ANA Standard of Nursing practice six step problem solving Approach= ADOPIE aka Assess, Dx, Outcome ID, plan, implement, Evaluation QSEN-QT PIES= Quality and Safety Education for nurses improvement Teamwork collab patient centered care informatics evidence based care Psych in children usually REGRESS; (return to prev levels of development) use interview , observation ( at play, drawing, Psych in Adolescents confidentiality is key= only exception threats of suicide, homicide, sexual abuse, risk to others shared w/ other professional Psych Older adult= assess physical limitations, if hard of hearing speak slowly & clear louder tones, seat close to you, Language barrier- use interpreter, translator (transcribe written docs) Nursing Diagnostic statement= 1. problem (unmet need) / potential problem,2. probable cause 3. Supporting data (objective / subjective) Psych plans= safe, compatible appropriate, realistic/ individualized, evidenced based Psych implementation= by RN Psych consultation, RX, psychotherapy= ARNP only Review Questions Ch 7
- Intervention shows nurses understanding of initial action associated w/ assessment of patient beliefs= ask patient role of spirituality in daily life
- Disadvantage inherent SOAPHIE= documentation isn't listed in chronological order
- Scale used for new admit /DX major depressive disorder= Beck inventory
- Desired outcome of insomnia patient 5 hrs nightly within 7 days. Pat sleeps avg of 4 hrs nightly and 4 hr afternoon nap= outcome never demonstrated/ nurse next action=examine interventions for revision of target date
- Pat goes to ED admin nurse suspects medical prob as cause for psych symptoms labs show elevated bun & creatine next step? Assess renal hx
- Adolescent questions speaking to nurse during interview “ why should I talk to you. You will just tell my parents. Nurse should respond What you say about feelings is private however suicidal thinking must be reported to treatment team.
- Nurse assess patient recent memory What question yields desired info? What did you have for breakfast this morning?
Kinesic communication= non-verbal communication made w/ body movement; facial expressions, body posture, gestures Proxemics- significance of physical distance between individuals. Personal physical boundaries Chapter 9 review questions
- Nursing statement is example of reflection? “you look sad.”
- When should nurse be most alert on possibility of communication errors resulting in harm of patient. Change of shift report
- Patient tells you he is looking forward to meeting with new psychiatrist but frowns and avoids eye contact, nursing therapeutic response? ”you say you look forward to meeting, but you appear anxious and unhappy.”
- Schizophrenia pat tells you last night demons tried to attack me last night, best therapeutic response? ”you seem upset. Please tell me more about what you experienced last night.”
- When using clarification nurse would say.” Am I correct in understanding?”
6. Patient is parent who’s child was killed in car accident. Nurse reaches out hand; what is analysis. “gesture is premature. Patient cultural and
individual interpretation of touch unknown
Mental Health - Unit 1 (Exam 1 part 1 of 3)
Course: Mental Health (Nur 253)
University: Galen College of Nursing
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