Mental ~ Health/Psych ~
*CaRd* 2 successful performance of mental function, resulting in productive activities, fulfilling What is mental health? relationships, and the ability to adapt to change and cope with adversity. health conditions marked by alterations in What is a mental disorder? thinking, mood, or behavior that cause distress, impair ability to function, or both. clinically significant behavioral or psychological syndrome experienced by a What is mental illness? person and marked by distress, disability, or the risk of suffering disability, or loss of freedom. Who developed a conceptual framework for psychiatric nursing Hildegarde Peplau practice, focused on nurse-patient relationships? Serve as a member of interdisciplinary team,providing specialized nursing knowledge(has understanding of medical What are the roles of the issues that impact the mentally mental health nurse? ill);Promote,maintain,restore,&rehabilitate individuals,family,&community;Pt advocate,educator,&case manager A categorical classification system with standard diagnostic criteria listed and used to diagnose a DSM-TR-IV --> Diagnosis & Statistical Manual mental disorder. This of Mental Disorders (uses a 5 axis system) system gives a more comprehensive picture of the client's functioning. *CaRd* 1
What is Axis 1? What is Axis 2? What is Axis 3? What is Axis 4?
What is Axis 5? What is the main role of the psychiatric mental health nurse?
clinical disorders (bipolar disorder, alcohol abuse) personality disorders and mental retardation (borderline personality) general medical conditions (hypertension, Diabetes, COPD) psychosocial and environmental problems (homeless, no family support, no job) global assessment of functioning (GAF), written as numbers (0-100) meaning "current level of functioning/highest level of functioning in the past year" (35/75) to provide leaderships for the group
authoritative statements by professional What are the Standards of organizations that describe the responsibilities Care? for which nurses are accountable. resulting in productive activities, fulfilling What 3 things result from relationships, and the ability to adapt to mental health? change and cope with adversity. When society labels or blames the mentally ill What is Stigma? individual for his/her problems. When a person is suffering from both a mental What is Dual Diagnosis? disorder and also a substance. giving a condition a label does not explain or confer any reality on it other than the name Explain and give an itself and the cluster of behaviors subsumed example of tautology. under it. "He acts like a schizophrenic because he has schizophrenia." The nurse is a member of an interdisciplinary team,recognizing that clients are more than What is the role of the ppl w/ diagnoses,these teams function psychiatric nurse as a collaboratively to provide comprehensive team member? care.Collaboration implies that members work toword a common goal&share responsibility
What are biological influences on mental health? What are psychological influences on mental health? What are sociocultural influences on mental health?
What is mood?
What is affect? Flattened affect Blunted affect Restricted affect Labile affect What is a hallucination? What is a delusion? What is an illusion? Circumstantiality Flight of ideas
prenatal, perinatal, and neonatal events;physical health status;nutrition;hx of injuries;neuroanatomy;& physiology. interactions with parents,siblings,peers,&others within the environment;intelligence quotient;selfconcept;skills;creativity;&emotional developmental level. family stability, ethnicity, housing, child-rearing patterns,economic level,religion,values,& beliefs. self-reported by the patient;what the patient says he/she is feeling.(Nurse:"How are you feeling today? Pt:"Depressed." Nurse:"On a scale of 1-10, how depressed are you?" Pt:"9." Nurse:"Are you thinking of suicide?" Pt:"Yes." Nurse:"What is your plan?") it is what the nurse sees; Does the patient look sad,happy,or smiles frequently? Look at duration,intensity,& appropriation of affect. Usually the first sign of improvement. decreased emotional range lack of emotional reactivity one expression all the time shifting from one affect to another a perception of environment that is not real; can be visual, auditory, tactile(feeling), gustatory(taste), or olfactory(smell). false beliefs that cannot be corrected by reason. false beliefs that can be corrected by reason. unnecessary detail during story, but eventually come back to main idea rapidly shifting from one topic to another; seems very fragmented.
Loose associations Neologism Preservation
Tangential Thought blocking
Word salad
Avolition
Insight
Judgment
Psychosis Tardive Dyskinesia
lacks logical explanation between thoughts and ideas; topics are somewhat linked. patient's coin their own words. Ask the patient what the word means. excessive continuation of a response, word, phrase, idea, or activity;common in head injury patients. Very repetitive. Inability to get the point of a story. Speaker introduces many unrelated topics until the original topic of discussion is lost. can't remember what they were telling you. Patient loses train of thought. incoherent speech consisting of both real and imaginary words, lacking comprehensive meaning, and occurring in advanced schizophrenic states; doesn't make sense, e.g. "horses make sugar cat." a psychological state characterized by general lack of desire, motivation, and persistence.Those suffering will not start or complete any major tasks. Commonly seen in patients with schizophrenia. awareness or ability to understand the true nature of one's own situation&accept some personal responsibility,esp regarding this illness;a person's ability to analyze the problem objectively. a person's ability to form vaild conclusions&behave in a socially appropriate manner; to interpret one's environment&situation correctly & adapt one's behavior & decisions accordingly. a mental disorder characterized by symptoms, such as delusions or hallucinations, that indicate impaired contact with reality. a disorder characterized by restlessness and
Alogia
Anhedonia Immediate Memory Recent Memory Remote Memory
Emergency Admission
Voluntary Admissions
Battery Forensic Psychiatry Mental health professionals determine whether the defendant is
involuntary rolling of the tongue or twitching of the face, trunk, or limbs, usually occurring as a complication of long-term therapy with antipsychotic drugs. A poverty of thinking that is inferred from observing the client's language & speech. The pt's inability to speak because of mental deficiency, mental confusion, or aphasia. Loss of pleasure in hobbies or activities of interest; a characteristic of depression. memory of things just exposed to. "What did you have for breakfast?" happened in the past week. "What have you been doing during the past few days?" distant past. "What year did you graduate from high school?" "Tell me what you remember about your childhood." admission to a psychiatric hospital that occurs when a client acts in a way that indicates that he or she is mentally ill &, as a consequence of the particular illness, is likely to harm self or others. admission to psych hosp that occurs(1)through a client's direct request by coming to the hosp or(2)following eval of a client who is determined dangerous to self or others or unable to adequately meet own needs in community,but is willing to submit to tx. touching another person without his or her permission. the use of psychiatric knowledge and techniques in questions of law, as in determining legal insanity. 1)Ability to assist the attorney with defense;2)Understanding of the nature&consequences of the charge against
competent by assessing which 3 states of competency? Autonomy
him or her;3)Understanding of courtroom procedures. the right to make decisions for oneself. It implies that a person not only chooses to make his or her own decisions but freely accepts their consequences.
What is a common misconception concerning that all admissionto a mental hospital involve patients voluntarily the loss of civil rights.However, the patient admitted to mental keeps all civil rights. hospitals? any mentally ill person suffering from substance abuse desiring admission to a Informal Voluntary treatment facility for diagnosis or treatment Admission may be admitted upon the patients request without formal application. any mentally ill person suffering from substance abuse desiring admission to a Formal Voluntary treatment facility for diagnosis and/or Admission treatment who is deemed suitable for formal voluntary admission by the admitting physician. patient signs a formal request to be discharged and has to be discharged at the 72 hour notice end of 72 hours if not committed by the coroner. a nurse may place a hold on a client for a justified reason (suicidal). The client cannot Legal Hold leave until the physician sees them; These are the nurses responsibility. signed by the physician and good for 72 hours from the time of signature. Patient can be PEC PEC (Physician's if one or more of the following:Injurious to self Emergency Certificate) (suicidal) or others (homicidal) or gravely disabled CEC (Coroner's Coroner decides if patient who is PEC'd needs
Emergency Certificate)
OPC (Order of Protective Custody)
Noncontested admission
Judicial admission
List 6 patient rights.
List 4 other patient rights.
M'Naghten Rule
to be committed. Once CEC is signed by coroner, it is good for 15 days from the time that the PEC was signed and dated. a family member can institute this and the patient must be seen by the Coroner, who is a physician within 12 hours to PEC, CEC, or voluntary admit or discharge the patient. If the coroner is not a physician, the MD must see the patient. a lawyer can have a patient committed judicially if they are unable to sign a voluntary admission form (patient's with dementia, Alzheimer's). court orders commitment lasting 30-90 days,then pt must be re-evaluated.If the judge decides on court or judicial commitment in a formal hearing,the court is required to notify the pt so they can retain a lawyer if they choose to contest the commitment. Right to tx using least restrictive alternative/environment;Right to confidentiality of records;Right to give or refuse consent to tx;Right to freedom from restraints&seclusion;Right to access personal belongings;Right to refuse ECT or psychosurgery. Right to daily exercise,visitors,writing material&uncensored mail,use of telephone;Right to access courts&attorneys;Right to employment compensation;Right to be informed of rights. legal case stating that persons who donot understand the nature&implication of murderous actions bc of insanity cant be held legally accountable for murder;NOT GUILTY by reason of insanity;Provided a basis for legal decisions in American Courts since 1851
man was placed in an institution for illegally carry a dangerous weapon. He was kept for 4 Rouse vs. Cameron years, but did not receive treatment; therefore he could not improve enough to be discharged. *Right to treatment* US Supreme Court first recognized *right to Griswold vs. Connecticut personal privacy* *Right 2 tx*Men Hlth sys of Alabama was sued 4 inadequate tx program&Crt ruled 2 stop using pts 4 hospital labor needs,ensure Wyatt vs. Stickney humane envir,develop&maintain min staffing standards,est institutional human rts committees,&provide least restrictive environmts Boston St Hosp sought *right to refuse tx*Ruling prohibitd hosp from forcing nonviolent pts to take meds against their Rogers vs. Olin will,based on right to privacy.Informed consent must be given be4 drug tx could begin;Meds can only be forced if 2 MDs say pt needs meds Pt did not receive treatment during his 14 Whitree vs. State of New years of hospitalization, and that if he had, he York would have been released 12 years earlier*Right to tx* *Right to refuse tx based on right to privacy*Legal obligation of mental health professionals 2 obtain informed consent b4 Rennie vs. Klein admin psychotropic meds.For adolescent pts at OLOL, parents must be called to obtain informed consent b4 new meds are given. established duty to warn of threatened suicide. Meier vs. Ross General Physician was deemed liable for not protecting Hospital the patient. Tarasoff vs. the Regent of Pt told therapist he planned2kill an identifiable the University of California girl when she returned from vac.Therap notified police&they took pt in2 custody but
Jackson vs. Indiana & Fouca vs. Louisiana
Megan's Law Pelau identified 6 sub roles within the work role of the nurse. List them. Mother-surrogate Technician
Manager
Socializing agent
Health teacher
Counselor or psychotherapist
released him;girl returned&he killed her;her parents claimed the therapist had a duty 2warn their daughter of the threats requires that the nature of the commitment bear some reasonable relation2the purpose for which the individual is committed.Ruling recognized that persons who are no longer mentally ill no longer require hospitalization.*SEXUAL predators are an exception* New York's version of the Sex offender registration and notification law Mother-surrogate; Technician; Manager; Socializing agent; Health teacher; Counselor or psychotherapist. fulfills needs associated with mothering basic needs, such as bathing, feeding, dressing, toileting, disciplining, and approving. the focus is on competent, efficient and correct performance of technical procedures. management and manipulation of the environment and manipulation of the environment to improve conditions for client recovery. participation in social activities with the client (Get the client involved--play cards with them). identification of learning and provision of information required by the client or family to improve the health situation. (teach client new coping skills and about their meds. Make sure patient knows what med they need to take, time; quiz them). the use of "interpersonal techniques" to assist clients to learn to adapt to difficulties or changes in life experiences (1 to 1 interaction with patient--be their counselor).
Therapeutic Relationships
What is a therapeutic tool?
Trust
Unconditional positive regard
Genuineness What are the obstacles to establishing a therapeutic relationship? Transference
Counter Transference
Pre-Interaction Phase Orientation (Intro) Phase
a close, helping relationship based on trust, which allows the nurse and client to work collaboratively. the purpose: to help clients solve problems, cope more effectively and achieve developmental goals. Self. It is the ability to use one's personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions. Use self when interacting with the client. implies a feeling of confidence in another person's presence,reliability,integrity,veracity,&sincere desire to provide assistance when requested;the basis of a therapeutic relationship&is linked to self disclosure. Respect for families and patients implies the dignity and worth of an individual regardless of his or her unacceptable behavior. the ability to be open,honest,& "real" in interactions with the client;implies congruence between what is felt and what is being expressed. Judgmental attitudes;Excessive probing;Lack of self-awareness;Transference;Counter Transference the nurse evokes emotion on the patient; i.e. the nurse takes out stress on the patient&the patient feels like a victim. something the patient does to evoke emotionsin the nurse; (behaviors of abusive patients reminds the nurse of her childhood abuse by her father.) phase to obtain information about the client; examine one's own feelings, fears, & anxieties about working with a particular client. phase to establish rapport&build a
foundation;introduce self&learn the client's name;communicate interests to client;set parameters,let pt know what will happen&what is expected,gather data;discern focal problem,set goal,&begin plan. that Trust is established;Patient is verbalizing Before moving from the feelings;Patient understands the purpose of Orientation phase to the the relationship&the nurse's role;Having next phase, be sure of discussed patient what? strengths&weaknesses&priorities for nursing interventions. phase in which patient is actively working toward achieving goals;Nurse is giving Middle or (Working) Phase feedback&support for behavior change;May be some regression;May use therapeutic confrontation. Identify past behaviors that are ineffective 4coping w/major prob;Develop plan,prac implementing&evaluating its Tasks for Working Phase effectiveness;Integrate a new selfconcept/attitude toward one's illness;Increased hopefulness toward future;Develop plan of action;Independence phase begins in orientation;pts may regress bc they fear facing the future alone(loss is a universal fear);review progress of pt,answer Termination Phase questions&celebrate victories;Nurse can share pos feelings for pt,admiration&enjoymt of the relationship;educate family space contacts w/pt further apart;express feelings about loss of relationship;more Tasks in Termination relaxed interaction,less intense;focus on Phase future;discourage cues that lead to new areas of exploration;referralsto community resources. revealing personal information should be Self Disclosure limited but appropriate;used to help pt open up
to you,not to meet your own needs;keep brief;dont imply your situation is like your pts;dont reveal painful life experiences that you have not mastered. When should the nurse disclose what the patient has shared? What is the purpose of therapeutic communication? Therapeutic communication suspected child/elder abuse;criminal cases;government request. to allow patients the autonomy to make choices when appropriate;communication should always be value-free,advicefree,&reassurance-free.*NO OPINIONS* planned process of interaction in which the nurse demonstrates empathy,uses effective communication skills,&responds to the clients thoughts,needs,&concerns. interactions in which the nurse uses ineffective responses that result in clients feeling defensive, misunderstood, controlled, minimized, alienated, or discouraged from expressing their thoughts and feelings. content&context;should concrete,esp be when a pt is experiencing anxiety;*AVOID BEING ABSTRACT* includes speaker's thoughts,feelings,needs,&values;represents a more accurate/congruent message;It includes body language,eye contact,facial expression,&tone of voice;Body position should be open;Usually,silence,is an excellent therapeutic technique. refraining from other internal mental activities;attentiveness to the patient in a physical&psychological manner. removal of distractions(turn TV off,turn lights on),using eye contact,close proximity,relaxed physical position,calm voice. can be comforting&therapeutic, but is an
Non-Therapeutic communication
Verbal
Nonverbal
Active Listening List things that signal active listening. Touch
Active Observations
Environmental List other factors that influence communication.
invasion of personal space;Must have relationship with pt;May be misinterpreted by pt with a thought disorder. watching speaker's non-verbal&speech pattern; this includes congruence,anxiety,agitation,& slow processing. noise(actual); physiological(hearing loss,sedative effects of meds,pain); psychological(paranoia, anger, fear,& apathy).
Perception; Past experience; Culture; Gender; Age/Developmental level Therapeutic communication technique defined as an active process of receiving Listening information&examining one's reaction to the message received. Therapeutic communication technique defined as repeating to the pt the main thought he has Restating expressed. (eg."You're having a rough time at home?") Therapeutic communication technique defined as asking the client to verify the nurse's understanding of what he is thinking or Sharing perceptions feeling.(eg."You're smiling,but I sense that you're really angry w/me or it seems like you are upset about something.") Therapeutic communication technique defined as identifying underlying issues experienced by client that emerge repeatedly during the Theme identification course of the relationship.("It seems that every time you talk about your relationship w/your g/f, u change the subject.") Therapeutic communication technique defined Empathetic understanding as an understanding from the client's view.("You feel left out bc you feel your mother pays more attention to the baby?")
Broad openings
Immediacy
Paraphrasing
General leads
Reflection
Focusing
Voicing doubt
Clarifying
Therapeutic communication technique defined as encouraging the pt to select topics for discussion.Communicates a desire to begin a meaningful interaction.Allows client to define the problem or issue. Therapeutic communication technique defined as focusing on the here & now.("Tell me how that makes you feel now.") Therapeutic communication technique reflects meaning of the client's message in the nurse's words.Allows for clarification.Lets pt know the nurse understands the message.("So your saying you won't return 2 live w/your husband even if he goes2counseling?") Therapeutic communication technique defined as encouraging the patient to continue elaborating; Communicates nurse's interest in listening.("Go on, and, then, uh-huh...") Therapeutic communication technique defined as revealing the emotion/feeling underlying the pt's message;Conveys empathy;Repeating to the pt the main thought&feeling he has expressed.("It sounds like you are feeling hopeless about this situation.") Therapeutic communication technique that encourages the client to expand upon one part of a statement.Concentrates on a single issue;Useful for clients who are confused or overwhelmed about many issues at the same time.("Let's talk alittle more about__.") Therapeutic communication technique defined as a gentle way of challenging the pt's perceptions;Encourages pt to reconsider what he has just said.("Really?,that's hard to believe;I'm not sure I'm getting an accurate picture.") Therapeutic communication technique defined
as attempting to put into words vagueideas or unclear thoughts of the pt to enhance the nurse's understanding or asking the client to explain what he means.("I'm not sure what u mean by__,could u elaborate?") Therapeutic communication technique defined as allowing for teaching & clarification.("You Informing will have several options for group home in Baton Rouge.") Therapeutic communication technique defined as encouraging the pt to think about solutions Encouraging Formulation w/out the nurse giving advice;Helps the pt of a plan problem solve.("What do you think you should do about this?") Therapeutic communication technique that helps pt become more aware of inconsistencies in statements Confrontation-Testing vs.behaviors;Allows for gentle Discrepancies confrontation.("You say that you want to participate in this group,but I notice that you have missed the last 3 meetings.") How to confront a patient? 1)Describe inconsistent behaviors;2)Offer two possible interpretations,ask for feedback. Therapeutic communication technique defined as voicing what the pt has hinted at or Verbalizing the Implied suggested; Opens area of discussion more specifically.("You seem to feel lonely & deserted.") Therapeutic communication technique defined as presentation of alternative ideas for the pt's consideration relative to his problem Suggesting solving.(*INCORRECT*-->"Have you ever considered journaling?"); (*CORRECT*-->"You should journal.") Powerful therapeutic communication technique Silence that demonstrates acceptance of the pt&a willingness to offer self;Allows the pt&nurse
time to gather thoughts&decide if they are willing to share feelings;*Can create paranoia in schizophrenic pt* Questions should be ___. Open-ended. Bc open-ended questions Why? encourage the pt to expand on the subject. Therapeutic communication technique defined when you are setting limits,it is better to tell the pt what you want them to do,rather than Positive Reframing criticize their negative behavior.("Speak in a calm voice,&tell me what you would like." Rather than "STOP YELLING!") Non-Therapeutic communication technique Social Responding defined as engaging in superficial conversation that is not client centered. Non-Therapeutic communication technique Using close-ended defined as narrowing the conversation & stifles questions exploration. Non-Therapeutic communication technique Changing the subject defined as introducing unrelated topics, usually to decrease nurse's anxiety. Non-Therapeutic communication technique defined as discounting the pt's feelings;Making comparisons that imply the pt's problems are Belittling smaller than they perceive.("Don't be silly.Everybody gets down in the dumps sometimes.I've felt that way myself before.") Non-Therapeutic communication technique defined as wise sayings that are Stereotyped comments automatic&lack empathy.("Time heals all wounds.Keep your chin up.Everything happens for a reason.") Non-Therapeutic communication technique Giving False Reassurance defined as suggesting there is no real problem. Non-Therapeutic communication technique Moralizing defined as passing judgment by imposing your own values;Implies the pt's thinking is wrong.
Non-Therapeutic communication technique Interpreting defined as making intrusive comments.("I think you are in denial.") Non-Therapeutic communication technique defined as making specific suggestions.("I think you should try journaling."); Instead offer Advising suggestions.("Some people benefit from journaling.Do you think it would work for you?") Non-Therapeutic communication technique defined as denying the pt's perception;forcing Challenging the pt to prove what he is saying.("If ou are dead,why is your heart still beating?") Non-Therapeutic communication technique defined as arguing or justifying your position Defending rather than attempting to hear the pt's concern. Non-Therapeutic communication technique Requesting an explanation defined as asking the pt to provide reasons for their feelings or behaviors.("Why do you think that?") acting out or irrational behavior;superficial talk;transference reactions;counterList Resistance behaviors. transference reactions;gift giving(tell the pt thank you,&you appreciate it,but it is against the rules);'why' questions are not therapeutic;summarizing to terminate convo. What is ECT? Electroconvulsive therapy Today, modern ECT is Major depression used for what? ECT is effective because it A grand mal seizure,&to be therapeutic, it causes what? should last from 30 to 60 seconds. It somehow changes the chemical structure of the brain, providing only temporary relief; How does ECT work? However, some pt's have to return to the hospital,while others may never need another tx.
ECT tx may be used when drugs do not take effect for 3 weeks and pt is severely depressed or psychotic. 1)keep client NPO;2)give Atropine as List Nursing ordered(given to dry secretions);3)ask client to Responsibilities before an urinate before tx;4)remove all metal ECT. objects;5)take vital signs;6)***Be POSITIVE*** =) IV line is inserted;electrodes are placed on temples;insert biteblock;Methohexital(anesthesia)is List procedures during an given;Succinylcholine(muscle relaxer)is ECT. given;admin pre-tx O2(100%);electrical impulses are given;seizure will last 2060secs;monitor HR,BP,&EEG;ventilate pt What are indications for severe depression(85-90% of clients ECT? treated);catatonia;mania. There are no absolute contraindications,but much caution is used if ECT is given to pts Contraindications for ECT. w/recent MI, recent CVA, or intracranial lesion;not given to pt's w/brain tumor bc of increased intracranial pressure;*Cardiac&brain lesions are MAIN contraindications Advantages of ECT. Safe, Fast, & Economical. Why is the patient given The O2 prepares the patient for periods of 100% O2 as pre-tx for an apnea when they have the seizure. ECT? An ECT produces faster Antidepressants. results than ___. __ is given 30 minutes before an ECT to dry up Atropine(an Anti-cholinergic) secretions & prevent aspiration. Only temporarily provides relief; Most pt's receive between 6-10 tx's.(Pt's should be Disadvantages of ECT. gaining points & improving on mini-mental assessments w/tx's) When may an ECT tx be used?
Who is the 'Father' of Psychosurgery, & won the Moniz. Nobel prize in 1949? In 1891, the first psychosurgery was performed by __ in Burckhardt; One died, one developed Switzerland. There were 6 epilepsy, & one improved. clients. What was the outcome? bc of destruction of brain tissue&bc its an irreversible procedure.Many questioned the Why are there so many Informed Consent,arguing whether this concerns with consent can truly be informed?Some have psychosurgery? suggested that violent ppl have this surgery;Fears of an "ethnic cleansing"approach 1)Depression&anxiety;2)Depression-related What are indications for pain;3)Obsessive-compulsive Psychosurgery? disorders;4)Aggression. Therapies that do not involve surgery &/or invasive procedures; *Always try to do the Somatic Therapies "least restrictive" intervention first;(i.e. Time out; Seclusion & Restraint) How are restraints Restraints are taken off one limb at a time. removed from a person? What meds may be given Haldol, Ativan, & Benadryl are the psych at any point to avoid using 'cocktails'; given IM. restraints on a pt? Seclusion or isolation; 5-point restraint; List 3 types of restraints. Chemical restraint. Before any physical restraint or intervention that confines the patient is First, verbal intervention, then remove patient applied, every effort must from environment(seclusion). be made to assist the patient with other types of intervention. What should
be used first? Verbal interventions; & they can also prevent What is the least restrictive further escalation if utilized at the very signs of measure? Why the least? aggression. Always use LEAST restrictive to avoid false imprisonment!! used to decrease stimuli & protect the pt &/or Isolation others,as well as to avoid property damage. The nurse needs MD's orders for seclusion or Seclude/restrain pt, .... THEN get Dr.'s orders restraints, but what ASAP!! =) happens in an emergency episode? Document all least restrictive measures&the client's response;Document client's What should the nurse behavior,the reason for document? restriction,&justification of the type of restraint used. An inappropriate decision Allegations of assault,battery,or false to restrain or isolate a imprisonment; that is why explicit client could expose a documentation is required!!! nurse to what? used to manage behavior & is considered a "chemical restraint";meds do not cure mental Psychopharmacotherapy illness;physical&psychiatric assessmts must be performed before med is prescribed. to relieve or reduce symptoms of dysfunctional thoughts,moods,actions,mental illness,or Purposes of disorder; Also to improve client's Psychopharmacotherapy. functioning&increase client's adherence/compliance. The psychiatric-mental Structures & maintains a therapeutic health nurse provides environment in collaboration w/the client what? &other health care providers. environment designed to promote healing experience and to promote a corrective setting Therapeutic Milieu for the enhancement of the client's coping abilities, interpersonal skills, social function
Main purposes of a Therapeutic Milieu.
Self-governance
and activities of daily living. 1)sets limits on disturbing&maladaptive behavior;2)teaches psychosocial skills;3)teaches adaptive coping skills;4)develops emotional&social skills;5)allows client to participate in 'nursingprocess';6)allows client to have voice in his care. refers to the patient's right to control some decision making.
Everything a nurse does is to benefit the patient & the physiological&psychological needs of the promote wellness, by client are met. ensuring that..... Med admin&pt response to meds;developmentof a 1-to-1 The nurse is also relationship;setting limits on unacceptable responsible for what? behavior;& client education(a must for psych pt's, to teach coping skills,&what is acceptable,hygeine,etc...) 1)correct client's perceptions of the Describe the goals of stressors;2)change the client'scoping Milieu management in the mechanisms from maladaptive to care of the mental health adaptive;3)improve client's interpersonal clients. relationship skills;4)teach the client effective stress management strategies; Identify the elements of Boundaries;Safe environment;& Trusting the therapeutic milieu. environment. provide structure to define the work, goals, and time frame. Maintain inter-personal Boundaries relationship between client and nurse. Client knows his/her responsibilities. non-threatening; Lets client know it is o to Safe environment express their feelings. consistency between words&actions;(follow Trusting environment through with promises&what you say)
to provide&manage a structured environment;set the tone of the uint&see that the guidelines are upheld;serve as an What is the nurse's role in emotional sounding board(open to the Milieu Environment? listening);support client's privacy&autonomy;model supportive&respectful behavior;teach&model coping skills the emotional&interpersonal needs of the Therapeutic Milieu is pt;Encourage pt participation;it helps control designed to meet what? problematic behaviors&assist pt in developing new coping skills. a mode of tx that focuses on modifying observable&at least in principle,quantifiable behavior by means of systemic manipulation Behavior Therapy of the environment&variable thought to be functionally related to the behavior;precise approach in behavioral change. person who stated that learning, or behavioral change, occurs bc of experiences that over Ivan Pavlov time result in conditioned response learning or classical conditioning. __ modifies behavior by manipulating the Treatment environment. theory which states that a stimulus elicits a Pavlov's theory of response(eg. a red delicious apple will conditioning stimulate one's salivary glands). theory that states that the results of a person's behavior determines whether the behavior will Skinner's Theory of recur in the future.(a child is permitted to stay Operant Conditioning home from school bc he did not finish his homework.) helps to eliminate client's fears or anxieties by stressing relaxation techniques that inhibit Desensitization anxious responses.Pt's are taught ways to relax as they vividly imagine a fear. Behavior Modification a method of attempting to strengthen a desired
Positive Reinforcement
Negative Reinforcement
Aversive Stimulus
Cognitive Therapy
Group Therapy Characteristics of a therapeutic group.
behavior or response by reinforcements, either positive or negative. used to strengthena desired behavior. involves removing a stimulus immediately after a behavior occurs so that the behavior is more likely to occur; this increases the probability that a behavior will recur by removal of an undesirable reinforceable stimulus. follows a behavioral response&decreases the probability that the behavior will recur(giving a spanking). emphasizes the role of thoughts in how people feel&act;teach client to change maladaptive beliefs through positive selfstatements&refuting irrational beliefs;uses confrontation;By changing thoughts, a person can change feelings&behavior. members share a common purpose&are expected to contribute to the group to benefit others&to receive benefit from others in return. cohesiveness,goal-directed,interpersonal communication,group atmosphere. clear goals are set, interpersonal communication, create environment in which they feel valued and accepted, democratic styles of leadership promote a more cohesive environment, continually monitor group interactions. become aware that one is not alone&that others share the same problems.Gain insight into one's problems&behaviors&how they affect others.Give oneself the benefit of others.Gain inspiration of hope.Interacting with others&Feeling acceptance&belonging. it represents the cast structure of ideas,attitudes,habits,languages,
Leader Behavior
Benefits
Culture
rituals,cermonies,&practice peculiar to a particular group of people.