Podcast
Questions and Answers
During which phase of the therapeutic relationship is the nurse primarily focused on gathering information from the client's chart, family, or team members?
During which phase of the therapeutic relationship is the nurse primarily focused on gathering information from the client's chart, family, or team members?
- Preinteraction Phase (correct)
- Orientation (Introductory) Phase
- Working Phase
- Termination Phase
A nurse consistently shows genuine congruence between feelings and expressions toward a client. Which of Rogers's therapeutic factors is the nurse demonstrating?
A nurse consistently shows genuine congruence between feelings and expressions toward a client. Which of Rogers's therapeutic factors is the nurse demonstrating?
- Unconditional Positive Regard
- Empathy
- Transference
- Genuineness (correct)
A client expresses anger towards a nurse, stating that the nurse reminds them of a judgmental relative. Which phenomenon is the client likely experiencing?
A client expresses anger towards a nurse, stating that the nurse reminds them of a judgmental relative. Which phenomenon is the client likely experiencing?
- Countertransference
- Genuineness
- Empathy
- Transference (correct)
Which therapeutic technique involves helping a client focus on a single idea when they are rapidly changing topics?
Which therapeutic technique involves helping a client focus on a single idea when they are rapidly changing topics?
A nurse tells a client experiencing auditory hallucinations, 'It must be frightening to experience that, but I do not hear those voices. It's just you and me in this room.' Which therapeutic technique is the nurse employing?
A nurse tells a client experiencing auditory hallucinations, 'It must be frightening to experience that, but I do not hear those voices. It's just you and me in this room.' Which therapeutic technique is the nurse employing?
Which nontherapeutic technique involves attempting to calm a client's concerns by asserting a positive outcome, potentially minimizing the client's feelings?
Which nontherapeutic technique involves attempting to calm a client's concerns by asserting a positive outcome, potentially minimizing the client's feelings?
During a mental status examination, which element refers to the patient's awareness of their own illness and maladaptive behaviors?
During a mental status examination, which element refers to the patient's awareness of their own illness and maladaptive behaviors?
A patient who was involved in a serious car accident reports only being able to recall limited details of the event. Which dissociative disorder is the patient most likely experiencing?
A patient who was involved in a serious car accident reports only being able to recall limited details of the event. Which dissociative disorder is the patient most likely experiencing?
A student who struggles with sports excels in academics, dedicating extra time and effort to achieve high grades. Which defense mechanism is the student employing?
A student who struggles with sports excels in academics, dedicating extra time and effort to achieve high grades. Which defense mechanism is the student employing?
A person who is angry at their boss yells at their spouse instead. Which defense mechanism is the person employing?
A person who is angry at their boss yells at their spouse instead. Which defense mechanism is the person employing?
Which behavioral therapy technique involves intentionally removing a reward for a maladaptive behavior to decrease its likelihood of recurring?
Which behavioral therapy technique involves intentionally removing a reward for a maladaptive behavior to decrease its likelihood of recurring?
During cognitive restructuring (ABCD method), what does the 'B' stand for?
During cognitive restructuring (ABCD method), what does the 'B' stand for?
Which therapeutic factor, according to Rogers, is characterized by genuine caring, acceptance, and prizing the client?
Which therapeutic factor, according to Rogers, is characterized by genuine caring, acceptance, and prizing the client?
If a nurse is attempting to de-escalate a potentially violent client, which intervention is most appropriate?
If a nurse is attempting to de-escalate a potentially violent client, which intervention is most appropriate?
Generalized Anxiety Disorder (GAD) is diagnosed when clients experience excessive worry about everyday issues for at least how long?
Generalized Anxiety Disorder (GAD) is diagnosed when clients experience excessive worry about everyday issues for at least how long?
In the context of the Johari Window, what does the 'Blind Spot' represent?
In the context of the Johari Window, what does the 'Blind Spot' represent?
During which phase of the therapeutic relationship is the primary focus on establishing trust and defining the roles of both the nurse and the client?
During which phase of the therapeutic relationship is the primary focus on establishing trust and defining the roles of both the nurse and the client?
During which phase of the therapeutic relationship would reviewing the progress that the client has made be most appropriate?
During which phase of the therapeutic relationship would reviewing the progress that the client has made be most appropriate?
What is the potential risk if a nurse does not maintain appropriate boundaries and becomes overly involved in a client's situation?
What is the potential risk if a nurse does not maintain appropriate boundaries and becomes overly involved in a client's situation?
According to Rogers, if a nurse can see beyond outward behaviors and understand the situation from the client's perspective, which therapeutic factor is the nurse demonstrating?
According to Rogers, if a nurse can see beyond outward behaviors and understand the situation from the client's perspective, which therapeutic factor is the nurse demonstrating?
What potential reaction should nurses be aware they may experience as a result of countertransference?
What potential reaction should nurses be aware they may experience as a result of countertransference?
Which therapeutic communication technique involves the nurse giving the client the autonomy to select the topic of discussion?
Which therapeutic communication technique involves the nurse giving the client the autonomy to select the topic of discussion?
A client is rapidly changing topics during a therapy session. Which therapeutic technique is most appropriate to use?
A client is rapidly changing topics during a therapy session. Which therapeutic technique is most appropriate to use?
Which therapeutic communication technique is demonstrated when a nurse encourages a client to develop a strategy for managing a specific problem?
Which therapeutic communication technique is demonstrated when a nurse encourages a client to develop a strategy for managing a specific problem?
A nurse nods and says, "Mmm. Hmm." to a client during a conversation. Which therapeutic technique is the nurse using?
A nurse nods and says, "Mmm. Hmm." to a client during a conversation. Which therapeutic technique is the nurse using?
What therapeutic technique involves stating observations like "You seem sad”?
What therapeutic technique involves stating observations like "You seem sad”?
Which therapeutic technique involves informing a client experiencing hallucinations that the nurse does not share the same sensory experiences?
Which therapeutic technique involves informing a client experiencing hallucinations that the nurse does not share the same sensory experiences?
A client states, "I can't work, I am so worried about everything." The nurse responds, "It's hard for you to concentrate on anything but your anxiety." Identify the therapeutic technique used by the nurse?
A client states, "I can't work, I am so worried about everything." The nurse responds, "It's hard for you to concentrate on anything but your anxiety." Identify the therapeutic technique used by the nurse?
A nurse says, "I'm not sure I follow. Could you explain that again?" Which therapeutic technique is the nurse employing?
A nurse says, "I'm not sure I follow. Could you explain that again?" Which therapeutic technique is the nurse employing?
What is the primary purpose of using silence as a therapeutic technique?
What is the primary purpose of using silence as a therapeutic technique?
A client says, "I won't be a bother to people much longer." The nurse responds, "Are you having suicidal thoughts?" What technique the nurse using?
A client says, "I won't be a bother to people much longer." The nurse responds, "Are you having suicidal thoughts?" What technique the nurse using?
A client states a delusional belief as a fact. Which therapeutic technique is most appropriate for the nurse to use?
A client states a delusional belief as a fact. Which therapeutic technique is most appropriate for the nurse to use?
What effect on therapeutic communications would "You should find a hobby you enjoy" likely have?
What effect on therapeutic communications would "You should find a hobby you enjoy" likely have?
What is the effect of the nontherapeutic technique of defending?
What is the effect of the nontherapeutic technique of defending?
What effect on therapeutic communications would "I'm sure the test results will turn out just fine" likely have?
What effect on therapeutic communications would "I'm sure the test results will turn out just fine" likely have?
What nontherapeutic technique involves introducing irrelevant topics into a conversation?
What nontherapeutic technique involves introducing irrelevant topics into a conversation?
What is the purpose of assessing 'Behavior and general appearance' during a Mental Status Exam (MSE)?
What is the purpose of assessing 'Behavior and general appearance' during a Mental Status Exam (MSE)?
Which aspect of the Mental Status Exam (MSE) focuses on evaluating abnormalities, obsessions, delusions, suicidal thoughts, and thought processes like loose associations?
Which aspect of the Mental Status Exam (MSE) focuses on evaluating abnormalities, obsessions, delusions, suicidal thoughts, and thought processes like loose associations?
During a mental status examination, assessing a client's consciousness, orientation, concentration, and memory falls under which category?
During a mental status examination, assessing a client's consciousness, orientation, concentration, and memory falls under which category?
Which of the following is a key characteristic of dissociative disorders?
Which of the following is a key characteristic of dissociative disorders?
A client suddenly moves to a new geographic location and is unable to recall their identity or past. Which dissociative disorder is most likely?
A client suddenly moves to a new geographic location and is unable to recall their identity or past. Which dissociative disorder is most likely?
Which ego defense mechanism is characterized by redirecting unacceptable drives or passions into socially acceptable forms?
Which ego defense mechanism is characterized by redirecting unacceptable drives or passions into socially acceptable forms?
What defense mechanism is being used when a person is extra friendly to someone after being caught misbehaving?
What defense mechanism is being used when a person is extra friendly to someone after being caught misbehaving?
Which behavioral therapy technique involves strengthening actions that are followed by rewards?
Which behavioral therapy technique involves strengthening actions that are followed by rewards?
What behavioral therapy technique involves teaching a client a behavioral skill by acting out scenarios and practicing them?
What behavioral therapy technique involves teaching a client a behavioral skill by acting out scenarios and practicing them?
What is aversion therapy designed to do?
What is aversion therapy designed to do?
What is the primary focus of Cognitive Behavioral Therapy (CBT)?
What is the primary focus of Cognitive Behavioral Therapy (CBT)?
As part of Cognitive Restructuring (ABCD method) during a therapy session; what does the activating event (A) refer to?
As part of Cognitive Restructuring (ABCD method) during a therapy session; what does the activating event (A) refer to?
Within the framework of Cognitive Restructuring (ABCD method), what is the belief ('B') component?
Within the framework of Cognitive Restructuring (ABCD method), what is the belief ('B') component?
According to Rogers, what is the importance of genuineness in promoting constructive change in clients?
According to Rogers, what is the importance of genuineness in promoting constructive change in clients?
According to Comer and Comer, what is the most important element of 'Deviance' thoughts, emotions, and behaviors?
According to Comer and Comer, what is the most important element of 'Deviance' thoughts, emotions, and behaviors?
A nurse attempts to verbally de-escalate a potentially violent client. Which intervention is most appropriate during de-escalation?
A nurse attempts to verbally de-escalate a potentially violent client. Which intervention is most appropriate during de-escalation?
What is the relationship between 'Anger' and the Kubler-Ross model of grief?
What is the relationship between 'Anger' and the Kubler-Ross model of grief?
Which assessment finding may indicate that a client has decided to commit suicide?
Which assessment finding may indicate that a client has decided to commit suicide?
When assessing a client who is hallucinating, what is an important question to ask?
When assessing a client who is hallucinating, what is an important question to ask?
Which statement best describes the concept of mental health?
Which statement best describes the concept of mental health?
A nurse is caring for a client who is struggling with a mental health disorder. What nursing action is most effective in reducing stigma associated with mental illness?
A nurse is caring for a client who is struggling with a mental health disorder. What nursing action is most effective in reducing stigma associated with mental illness?
A client consistently displays motivation for goal achievement, rational thoughts, the ability to foster social relationships, and the ability to resolve stress. According to the mental health continuum, which level of well-being is the client demonstrating?
A client consistently displays motivation for goal achievement, rational thoughts, the ability to foster social relationships, and the ability to resolve stress. According to the mental health continuum, which level of well-being is the client demonstrating?
How do nurses utilize the DSM-5 in mental health care?
How do nurses utilize the DSM-5 in mental health care?
A client is hesitant about making a significant decision regarding their treatment plan. How does the nurse best apply the ethical principle of autonomy in this situation?
A client is hesitant about making a significant decision regarding their treatment plan. How does the nurse best apply the ethical principle of autonomy in this situation?
A nurse on a treatment team consistently advocates for equal access to mental health services, regardless of clients' socioeconomic status or background. Which ethical principle is the nurse demonstrating?
A nurse on a treatment team consistently advocates for equal access to mental health services, regardless of clients' socioeconomic status or background. Which ethical principle is the nurse demonstrating?
A client requests that a nurse keep a promise to be present during a difficult family interaction later in the week. By honoring this request, which ethical principle is the nurse upholding?
A client requests that a nurse keep a promise to be present during a difficult family interaction later in the week. By honoring this request, which ethical principle is the nurse upholding?
When a client becomes agitated and aggressive on a psychiatric unit, what intervention reflects the principle of the least restrictive environment?
When a client becomes agitated and aggressive on a psychiatric unit, what intervention reflects the principle of the least restrictive environment?
What is a primary characteristic of informal admission to a mental health facility?
What is a primary characteristic of informal admission to a mental health facility?
A client is on restraints due to violent behavior. According to mandatory reporting guidelines, what assessment finding must be documented every 15-30 minutes?
A client is on restraints due to violent behavior. According to mandatory reporting guidelines, what assessment finding must be documented every 15-30 minutes?
A nurse observes a client pacing rapidly, speaking loudly, and clenching their fists. How should the nurse document this behavior in an objective manner?
A nurse observes a client pacing rapidly, speaking loudly, and clenching their fists. How should the nurse document this behavior in an objective manner?
During verbal de-escalation with a potentially harmful client, the team is responding to the client's threats to harm another client. What staff response demonstrates appropriate action?
During verbal de-escalation with a potentially harmful client, the team is responding to the client's threats to harm another client. What staff response demonstrates appropriate action?
What distinguishes psychotherapy from classic psychoanalysis?
What distinguishes psychotherapy from classic psychoanalysis?
A student who is struggling with feelings of inadequacy joins a community service group to feed the homeless. Which defense mechanism is the student employing?
A student who is struggling with feelings of inadequacy joins a community service group to feed the homeless. Which defense mechanism is the student employing?
Following a traumatic event, a person loses their vision despite no physical damage to their eyes. What defense mechanism might they be utilizing?
Following a traumatic event, a person loses their vision despite no physical damage to their eyes. What defense mechanism might they be utilizing?
A person who is arrested for drunk driving insists they only had a couple of drinks and refuses to acknowledge they have a problem with alcohol. Which defense mechanism are they employing?
A person who is arrested for drunk driving insists they only had a couple of drinks and refuses to acknowledge they have a problem with alcohol. Which defense mechanism are they employing?
A nurse is asked about a client's progress by an external party without the client's consent. According to the ethical guidelines, what is the appropriate nursing action?
A nurse is asked about a client's progress by an external party without the client's consent. According to the ethical guidelines, what is the appropriate nursing action?
During a stressful period at work, a nurse starts using childish phrases and seeks constant reassurance from colleagues. Which defense mechanism is the nurse displaying?
During a stressful period at work, a nurse starts using childish phrases and seeks constant reassurance from colleagues. Which defense mechanism is the nurse displaying?
A client is consistently critical of others while simultaneously believing they are 'absolutely evil'. Which defense mechanism reflects the client's perception?
A client is consistently critical of others while simultaneously believing they are 'absolutely evil'. Which defense mechanism reflects the client's perception?
A person consciously avoids thinking about a traumatic experience, despite feeling anxious about it. What defense mechanism are they utilizing?
A person consciously avoids thinking about a traumatic experience, despite feeling anxious about it. What defense mechanism are they utilizing?
What is the foundational principle of Roger's humanistic therapy?
What is the foundational principle of Roger's humanistic therapy?
According to Carl Rogers, what condition is necessary for constructive change to likely occur in a therapeutic climate?
According to Carl Rogers, what condition is necessary for constructive change to likely occur in a therapeutic climate?
During a Cognitive Behavioral Therapy session, the therapist uses Socratic questioning. What is the purpose of this technique?
During a Cognitive Behavioral Therapy session, the therapist uses Socratic questioning. What is the purpose of this technique?
What skill does assertiveness training aim to develop in clients?
What skill does assertiveness training aim to develop in clients?
What does the 'C' component represent in the ABCD model of Cognitive Restructuring?
What does the 'C' component represent in the ABCD model of Cognitive Restructuring?
According to Comer and Comer, which is the most important criterion for thoughts, emotions, and behaviors to be considered part of mental illness, and in need of intervention?
According to Comer and Comer, which is the most important criterion for thoughts, emotions, and behaviors to be considered part of mental illness, and in need of intervention?
According to Freud, what is the function of the ego?
According to Freud, what is the function of the ego?
Which statement best describes the goal of milieu therapy in a psychiatric setting?
Which statement best describes the goal of milieu therapy in a psychiatric setting?
What is the most important tool the psychiatric nurse has?
What is the most important tool the psychiatric nurse has?
What is the primary purpose of conducting a Mental Status Exam (MSE)?
What is the primary purpose of conducting a Mental Status Exam (MSE)?
In the context of a Mental Status Exam (MSE), what does the assessment of 'thought (form and content)' primarily involve?
In the context of a Mental Status Exam (MSE), what does the assessment of 'thought (form and content)' primarily involve?
Which factor may contributes to antisocial personality disorder?
Which factor may contributes to antisocial personality disorder?
What social/cultural factor contribute to the expression of anger?
What social/cultural factor contribute to the expression of anger?
What is the first step you should take when you determine a client may become violent?
What is the first step you should take when you determine a client may become violent?
A client is having difficulty expressing themselves verbally. What is an appropriate technique to utilize?
A client is having difficulty expressing themselves verbally. What is an appropriate technique to utilize?
What is the difference between experiencing 'normal worrying' and a diagnosis of GAD?
What is the difference between experiencing 'normal worrying' and a diagnosis of GAD?
A patient with anxiety is prescribed short-term Benzodiazepines which should do what?
A patient with anxiety is prescribed short-term Benzodiazepines which should do what?
Why is it important to allow a client to perform rituals for a sufficient amount of time?
Why is it important to allow a client to perform rituals for a sufficient amount of time?
Dissociation is a subconscious defense mechanism that helps a person protect their emotional self from recognizing the full effects of traumatic events by allowing the mind to do what?
Dissociation is a subconscious defense mechanism that helps a person protect their emotional self from recognizing the full effects of traumatic events by allowing the mind to do what?
Which dissociative disorder is characterized by the patient displaying two or more distinct identities or personality states that recurrently take control of their behavior accompanied by the inability to recall important personal information?
Which dissociative disorder is characterized by the patient displaying two or more distinct identities or personality states that recurrently take control of their behavior accompanied by the inability to recall important personal information?
Which dissociative disorder includes a type of dissociative amnesia in which the client travels to a new area and is unable to remember their own identity?
Which dissociative disorder includes a type of dissociative amnesia in which the client travels to a new area and is unable to remember their own identity?
Flashcards
Open self
Open self
Known to self and others
Hidden self
Hidden self
Known to self and unknown to others
Blind Spot
Blind Spot
Known to others and unknown to self
Unknown self
Unknown self
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Preinteraction Phase
Preinteraction Phase
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Orientation Phase
Orientation Phase
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Working Phase
Working Phase
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Termination Phase
Termination Phase
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Genuineness
Genuineness
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Unconditional positive regard
Unconditional positive regard
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Empathy
Empathy
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Transference
Transference
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Countertransference
Countertransference
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Broad openings
Broad openings
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Exploring
Exploring
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Exploring (therapeutic communication)
Exploring (therapeutic communication)
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Focusing (Therapeutic technique)
Focusing (Therapeutic technique)
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Formulating a Plan of Action
Formulating a Plan of Action
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General Leads
General Leads
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Giving Recognition
Giving Recognition
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Making Observations
Making Observations
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Offering Self
Offering Self
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Presenting Reality
Presenting Reality
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Reflecting
Reflecting
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Restating
Restating
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Seeking Clarification
Seeking Clarification
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Silence (Therapeutic communication)
Silence (Therapeutic communication)
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Verbalizing the Implied
Verbalizing the Implied
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Voicing Doubt
Voicing Doubt
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Advice Giving
Advice Giving
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Moralizing
Moralizing
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Belittling The Client's Feelings
Belittling The Client's Feelings
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Defending
Defending
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False Reassurances
False Reassurances
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Interpreting
Interpreting
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Introducing an Unrelated Topic
Introducing an Unrelated Topic
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Probing
Probing
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Stereotyped comments
Stereotyped comments
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Why Questions
Why Questions
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Undoing
Undoing
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Operant Conditioning
Operant Conditioning
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Token Economies
Token Economies
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Extinction (Behavioral)
Extinction (Behavioral)
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Modeling Role-Playing
Modeling Role-Playing
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Systematic Desensitization
Systematic Desensitization
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Relaxation Techniques
Relaxation Techniques
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Aversion Therapy
Aversion Therapy
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Cognitive Restructuring
Cognitive Restructuring
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Deviance
Deviance
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Distressing
Distressing
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Dysfunctional
Dysfunctional
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Calm, Caring Voice
Calm, Caring Voice
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Limits (de-escalation)
Limits (de-escalation)
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What is Mental Health?
What is Mental Health?
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How to Reduce Stigma?
How to Reduce Stigma?
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Terminology (Mental Health)
Terminology (Mental Health)
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Mental Health Continuum
Mental Health Continuum
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Excelling (Mental Health)
Excelling (Mental Health)
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Thriving (Mental Health)
Thriving (Mental Health)
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Surviving (Mental Health)
Surviving (Mental Health)
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Struggling (Mental Health)
Struggling (Mental Health)
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Crisis (Mental Health)
Crisis (Mental Health)
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Humility
Humility
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What is the DSM?
What is the DSM?
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Autonomy
Autonomy
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Beneficence
Beneficence
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Justice
Justice
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Nonmaleficence
Nonmaleficence
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Fidelity
Fidelity
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Least Restrictive Environment
Least Restrictive Environment
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Informal Admission
Informal Admission
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Consent
Consent
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Mandatory Reporting
Mandatory Reporting
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Major Psychotherapies
Major Psychotherapies
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Psychoanalysis
Psychoanalysis
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ID (Psychoanalysis)
ID (Psychoanalysis)
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Ego (Psychoanalysis)
Ego (Psychoanalysis)
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Superego (Psychoanalysis)
Superego (Psychoanalysis)
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Ego Defense Mechanisms
Ego Defense Mechanisms
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Altruism
Altruism
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Compensation
Compensation
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Conversion
Conversion
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Denial
Denial
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Displacement
Displacement
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Dissociation
Dissociation
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Identification
Identification
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Intellectualization
Intellectualization
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Projection
Projection
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Rationalization
Rationalization
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Reaction Formation
Reaction Formation
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Regression
Regression
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Repression
Repression
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Study Notes
- Mental health is a state of mental well-being enabling people to cope with life's stresses, realize abilities, learn/work well, and contribute to their community.
- Mental health provides the foundation for emotions, thinking, communication, learning, resilience, and self-esteem and is key to relationships, individual and emotional wellness and contributing to community or society.
- An individual's ability to complete daily living activities indicates their mental health.
- Mental wellness promotes optimal functioning in occupations, relationships, and developmental milestone achievements.
- Mental health is vital for interacting, logical thought, and a fulfilling life.
How Nurses Reduce Stigma
- Nurses reduce stigma by providing education/awareness, compassionate and holistic care, supporting patients/families, advocating, and leading by example.
- Act with integrity, show respect, and have humility in care delivery.
- The most inclusive nurses embrace client diversity.
- Empowered nurses use decision-making with optimism to solve patient problems.
- Core values of mental health nursing: empowerment, inclusivity, integrity, collegiality, invocation, transparency, and stewardship.
Biological Factors
- The brain is an organ that can malfunction.
Mental Health Terminology
- Avoid pejorative terms (crazy, psycho, nuts) and dehumanizing terms/statements
- Refer to clients as people, not disorders: use "people who have schizophrenia" instead of "schizophrenics"
Mental Health Continuum
- Mental health is a continuum where everyone experiences depressive symptoms at times, but people with mental illness get stuck and can't return to normal
Levels of Functioning
- Excelling: Mental wellness, absence of mental illness symptoms, the highest level of well-being with fulfillment and ability for personal success.
- Expect motivation for goals, rational thoughts, ability to foster social relationships/resolve stress.
- Thriving: Stress does not cause significant daily living impairment.
- The nurse looks for plans/actions that support stress processing and social activity.
- Surviving: Problems needing action are recognized; person feels on edge.
- The nurse should look for nervousness, irritability, distraction, or withdrawnness.
- Struggling: Client feels worthlessness, worried often, and that life is misery, but not all hope is lost.
- The nurse should look for poor performance, dysfunctions in sleep and apetite.
- Crisis: Mental health disorder end stage.
- The client is experiencing severe symptoms and needs assistance, the nurse should anticipate high level of worry, low mood, dysfunction in sleep, and irrational sleep.
Promoting Compassion
- Humility: Be kind and compassionate towards everyone because no one knows what struggles await.
About the DSM
- The DSM is a diagnostic guide used by mental health providers.
- The manual contains descriptions, manifestations, and needed criteria to diagnose a mental health disorder, of which there are 157.
- Nurses use the DSM-5 to plan, implement, and evaluate care; it also identifies expected findings for mental health disorders.
Ethical Principles
- Autonomy: The client's right to make their own decisions while accepting the consequences and respecting the decisions of others.
- Rather than giving advice to a client who has a difficulty making decisions, a nurse helps the client explore all alternatives and arrive at a choice.
- Beneficence: The quality of doing good;
- A nurse helps a newly admitted client who has a psychotic disorder to feel safe in the environment of the mental health facility
- Justice: Fair and equal treatment for all.
- Nonmaleficience: Loyalty and faithfulness to the client and to one's duty;
- A client asks a nurse to be present when they talk to their guardian for the first time in a year and the nurse remains with the client during this interaction
- Fidelity: Honesty when dealing with a client.
Client Rights
- Least restrictive environment: Clients should NEVER be restrained or secluded from staff convenience or punishment; less restrictive options attempted first.
- Other options include verbal instructions, warnings, interventions, diversion/redirection, and/or offering a PRN medication.
- Restraints may be used if less restrictive measures are ineffective and the client is a danger to self or others, and only with a provider's order.
- Facility policies about time limits must be followed, limits vary based on the clients age, and required close monitoring, assessments, and frequent documentation.
- Restriction measures must be discontinued as soon as they are necessary
- Informal Admission: The least restrictive form of admission.
- The client does not pose a threat to self or others and is free to leave the hospital at any time, even against medical advice.
- Consent: Clients have a right to receive and refuse treatment (including medication) unless is not mentally competent or poses a serious risk for themselves or others.
- In those cases, legal procedures must be followed, and the client is assigned an advocate.
- Only if the client provides consent should the nurse share information.
- Rights to be involved in the plan of care: Clients can choose their health care provider and be involved in the plan of care.
Mandatory Reporting
- For clients on restraints, complete documentation every 15-30 minutes (or according to facility policy), including: the event prior, alternative actions taken, time treatment began, behavior, foods/fluids offered/taken, needs, vitals, medication, restraints released.
Documentation
- Client behavior must be documented in a clear, objective way,
Responding to Violent Behaviors
- Staff response to disruptive, violent, or potentially harmful behavior (suicide threats or potential or actual harm to others) include timelines and the extent of response.
- Also document the time the provider was notified and any received prescriptions.
Psychotherapies
- Psychotherapy involves more verbal therapist-to-client interaction than psychoanalysis.
- The client and therapist develop trust to explore the clients' problems.
Psychoanalysis
- Freud's psychoanalytic theory of personality is based on interactions of 3 parts: id, superego, and ego,.
- Id: The most primitive part of the psyche, operates on the pleasure principle by pushing us to fulfill our basic and carnal desires.
- Ego: Develops as the psyche matures; operates on the reality principle by helping the id find realistic ways to obtain (or delay) gratification.
- Superego: Develops as a person incorporates values from parents and other respected figures; operates on the moral principle by helping restrain shameful desires of the id and persuade the ego to pursue noble goals.
Social/Cultural Factors related to violence
- Role models, seeing aggression modeled in the home,, community, or popular media, can teach children to act aggressively.
- Sometimes aggressive behaviors are reinforced and glamorized.
- Anger is expected in men, while other emotions are not.
Environmental Factors related to violence
- Problems in the milieu_ can increase aggression.
Client History
- Determine acts of violence in the past
- Note diagnoses and prescribed medications
- Look for prodromal behaviors (e.g., defiant affect, rigid posture, clenched fists, jaw, agitation, pounding, talking loudly, profanity, making threats) which indicate possible outburst.
- Open self: Known to self and known to others
- Hidden self: Known to self and unknown to others
- Blind Spot: Known to others and unknown to self
- Unknown self: Unknown to other and self
Phases of a Therapeutic Relationship
- Preinteraction Phase: The nurse prepares for the interaction by:
- Obtaining information from the chart
- Getting input from the client's family
- Getting input from team members
- Examining any feelings that may interfere with working with this particular client
- Orientation (Introductory) Phase: Focuses on:
- Building trust and rapport
- Defining roles
- Mutually determining goals
- During this phase many clients are discharged
- Working Phase:
- The client and nurse work toward the selected goals if able to continue
- The nurse provides feedback and support during this process
- Termination Phase:
- The client and nurse review and acknowledge the progress that has been achieved
- This phase can elicit negative emotions such as anxiety or feelings of abandonment; important to explore these feelings with the client
Rogers's Therapeutic Factors
- Genuineness: Occurs when there is congruence between what the nurse feels and expresses to the client
- Artificialness is extremely easy to detect
- Nurses keep the focus on the client to increase trust and avoid reversing the nurse-client relationship
- Unconditional positive regard: Nurses must believe in the dignity and value of every individual
- Not an approval of every action, statement, or belief of a client
- Positive feelings and self-acceptance increase when clients realize they are valued by others
- Many psychiatric clients have a very low view of self
- Empathy: Ability to see beyond outward behaviors and understand the situation from the client's perspective
- Nurses should avoid becoming emotionally involved to maintain objectivity
- Positive emotions and self-awareness increases when clients realize they are understood by another person
Transference and Countertransference
- Transference: Occurs when the nurse reminds the client of another person
- Manifestations may include anger, hostility, affection, and over-dependence
- Either scenario can interfere with the therapeutic relationship
- Countertransference: Occurs when the client reminds the nurse of another person.
- May also occur as a reaction to transference
- Nurses must avoid being drawn into feelings of anger, flattery, power/dominance, etc.
Therapeutic Techniques
- Broad openings: Allows the client to choose the topic of discussion
- Exploring: Delving into a topic that seems useful to discuss
- Focusing: Helps a rapidly changing client focus on a single idea or thought; not appropriate if the client is extremely anxious
- Formulating a plan of action: Encouraging the client to come up with a plan for dealing with a problem or future situation
- General leads: Giving short verbal or nonverbal encouragement for the client to continue talking
- Giving recognition: Noticing a positive behavior from the client
- Making Observations: Verbalizing perceptions of the client
- Offering self: Making yourself available to the client by offering time, presence, and attention
- Presenting reality: Informing the client that misperceptions are not real when clients experience hallucinations gently, in a non-threatening empathetic manner
- Reflecting: Directing questions and feelings back to the client so they can be recognized and accepted
- Restating: Repeating the main idea of what the client has said
- Seeking clarification: Seeking to understand what a client meant
- Silence: Allowing time for the client to gather thoughts, think through an issue, experience a strong emotion, etc
- Verbalizing the implied: Putting into words what the client has only implied or hinted at
- Voicing doubt: Expressing uncertainty regarding a client's perceptions or beliefs. Used when clients express delusions in a non-confrontational, nonjudgmental manner
Nontherapeutic Techniques
- Advice giving: Telling the client what to do
- Moralizing: Approving or disapproving of a client's ideas or behaviors
- Belittling the client's feelings: Communicating to a client that you do not believe their feelings are legitimate
- Defending: Attempting to protect someone or something from the client's criticism. Reveals a lack of empathy and encourages the client to double down in their criticism
- False reassurance: Attempting to calm a client's concerns by asserting that there will be a good outcome. Minimizes the client's concerns and discourages communication
- Interpreting: Attempting to force a meaning or interpretation onto a client
- Introducing an unrelated topic (non-sequiturs): Changing the topic, giving evidence of poor listening skills or a desire to keep the conversation superficial
- Probing: Persistent questioning of the client
- Stereotyped comments: Clichés that discourage the client from expressing heavy thoughts or emotions
- Why questions: Asking the client to explain or defend self
Mental Status Exam (MSE)
- The Mental Status Exam is based primarily on observational data gathered by nurses and interview questions.
- Used to establish a baseline, evaluate changes over time, facilitate diagnosis, plan effective care, and evaluate response to treatment in clients with mental health and addiction
- Components Assessed:
- Behavior and general appearance including posture, dress/grooming, manner, as well as agitation, hyperactivity, psychomotor retardation, unusual movements, catatonia, etc.
- Emotions include mood and state, emotional state and visible expression including description and variability
- Speech includes rate, amount, style and tone of speech
- Thought content and processes include abnormalities, obsessions, delusions and suicidal and homicidal thoughts and thought process as well as loose associations, tangential thinking, word salad, and neologisms, circumstantial thought, and concrete versus abstract thought
- Perceptual disturbances include illusions and hallucinations
- Impulse control includes ability to delay, modulate or inhibit expressions or behaviors
- Cognition includes consciousness, orientation, concentration and memory
- Knowledge, insights and judgment includes the capacity to identify possible courses of action, anticipate consequences, and choose appropriate behavior, and extent of awareness of illness and maladaptive
Dissociative Disorders
- Dissociation: Occurs in stress disorders as a subconscious defense mechanism that helps a person protect their emotional self from the effects of traumatic events.
- Allows the mind to forget or remove itself from the painful situation or memory. Dissociation occurs during or after the event
- Essential features of a disruption in the usually integrated functions of consciousness, memory, identity, or environmental perception
- Often interferes with a person's relationships, ability to function in daily life, and ability to cope with the realities of the traumatic event
- Dissociative amnesia: The patient cannot remember important personal information, usually related to the traumatic event
- Dissociative identity disorder: The patient displays two or more distinct identities or personality states that recurrently take control of their behavior accompanied by the inability to recall important personal information (formerly multiple personality disorder)
- Dissociative fugue: Type of dissociation amnesia where the client travels to a new area and is unable to remember their own identity and some of their past; can last weeks to months and usually follows a traumatic event
- Fugue experience occurs when patient suddenly moves to a new geographic location with no memory of past events and often the assumption of a new identity
- Depersonalization/derealization disorder: Persistent or recurrent feeling of being detached from the mental process or body (depersonalization) or sensation of being in a dream-like state in which the environment seems foggy or unreal (derealization); NOT psychotic or out of touch with reality
Ego Defense Mechanisms
- Altruism: Reduces pain by helping others.
- Example is doing volunteer work for a suicide prevention organization after losing a loved one to suicide
- Compensation: Covering up a real or imagined weakness by emphasizing some other strength.
- Example is a student who is uncoordinated in sports works hard and excels in academics
- Conversion: Converting strong emotional stress into a physical symptom
- Example is witnessing a violent murder and becoming blind, even though the eyes appear to function correctly
- Denial: Not acknowledging reality because it is too painful or difficult
- Example is being arrested twice for drunk driving but refusing to admit a drinking problem
- Displacement: Redirecting anger at another object, person, or situation
- Example is yelling at your spouse when you are actually angry at your boss at work
- Dissociation: Temporarily losing connection to the outside world to escape the pain
- Example: A child who is being abused feels separated from her body, almost as if she is existing in a different realm
- Identification: Attempting to improve feelings about self by emulating an admired person
- Example: Dressing like a favorite professional athlete
- Intellectualization: Avoiding painful emotions by focusing on logic and reasoning
- Example is using cold, clinical terminology when describing a close relative's health condition
- Projection: Attributing your own unacceptable thoughts, feelings, or behaviors to someone else
- Example: Stealing money but then accusing that person of stealing from you
- Rationalization: Justifying unacceptable feelings or behavior by giving excuses.
- Example: Cheating on an exam because the teacher has "unrealistic standards"
- Reaction formation: Feeling negative or unacceptable feelings but demonstrating the opposite
- Example: Buying a gift for a coworker who grates on your nerves
- Regression: Returning to childlike, immature behaviors during a time of stress
- Example: Stomping your feet and slamming the door when you get into a fight with your college roommate
- Repression: Unknowingly pushing an unpleasant thought or memory out of your consciousness
- Example: Being abused as a child but not remembering it as an adult
- Splitting: Seeing people, situations, or events as either completely good or completely evil
- Example: Thinking your mother is absolutely evil because she grounded you for the weekend
- Sublimation: Redirecting unacceptable drives or passions into socially acceptable forms
- Example: Taking out feelings of hostility or rage on the football field or some other rigorous workout
- Suppression: Consciously deciding to ignore a thought, emotion, or desire
- Undoing: Trying to reverse a negative or guilty feeling by doing something to make up for it.
- Example: Being extra friendly after being caught misbehaving
Behavioral Therapy
- Behavioral theory: The science of behavior that can be observed
- Behaviorists believe Freudian hypotheses about the mind, dreams, etc. are unscientific and unnecessary
- Psychological problems caused by learned maladaptive responses can be unlearned
- Operant conditioning: Actions followed by rewards are strengthened and more likely to occur again; this is known as reinforcement
- Token economies: Used to regulate behavior by emphasizing and rewarding positive behaviors and removing those rewards when misbehaving
- Approach is commonly used in elementary schools
- Extinction: Involves intentional removal of a reward for a maladaptive behavior to decrease its likelihood of recurring
- Example: Teaching parents to ignore and walk away when a child throws a temper tantrum
- Modeling (role-playing): Teaching a client behavioral skill by acting out scenarios and practicing them
- Systematic desensitization: Technique in which therapists help clients extinguish phobias by experiencing increasingly anxiety-provoking situations
- Relaxation techniques are typically practiced during these exposures
- Relaxation techniques (reciprocal inhibition): Teaching clients proven techniques that decrease anxiety and stress.
- Aversion therapy: Helping a client avoid a behavior by teaching a client to associate it with something negative
- Example: Prescribing disulfiram to treat alcoholism, causing extreme discomfort when the patient consumes alcohol
Cognitive Behavioral Therapy (CBT)
- Thoughts are affecting behaviors, emotions, and other thoughts
- Cognitive-Behavioral Triangle: Emphasizes the link between thoughts, behaviors, and emotions
- Changing thoughts or behaviors, you can indirectly change your emotions
- Cognitive Restructuring (ABCD Method): Teaching a client to recognize that negative emotions involve a predictable pattern that can be challenged and changed
- A (Activating event): Someone walking by you and doesn't acknowledge you
- B (Belief): You believe that person no longer likes you
- C (Consequence): Feeling worthless or depressed, withdrawal, or avoid others
- D (Dispute): Disputing beliefs and replacing them with more beneficial ones
Rogers's Therapeutic Factors
- Rogers described three conditions that are necessary for a therapeutic climate:.
- Genuineness: Believed constructive change is likely to occur if you are real/transparent with the client
- Unconditional positive regard: Believed constructive change is likely to occur if you feel genuine caring/acceptance/prizing/love for the client
- Empathy: Believed constructive change is likely to occur if you can understand the inner world of the client
Comer and Comer
- Deviance: Thoughts, emotions, and behaviors that are relatively rare (this is not the most important criterion)
- Distressing: Thoughts, emotions, and behaviors that are upsetting to the person in other words, they would like it to go away
- Dysfunctional: Thoughts, emotions, and behaviors that disrupt the person's daily life as they interfere with work and personal relations
- Dangerous: Thoughts, emotions, and behaviors that create a significant safety risk
De-Escalation Techniques
- To use if you determine a client may become violent:
- Use a calm, caring voice
- Set limits and identify consequences
- Tell the client you are concerned and would like to listen
- Seek to understand what is behind the anger/aggression
- Reduce stimulation and loud noise
- Respect the client's personal space
- Give the client options
- Attempt to redirect attention to a positive activity
Generalized Anxiety Disorders (GAD)
- Clients experience ongoing, excessive worrying about everyday issues
- The anxiety causes significant distress
- Cognitive symptoms, mood symptoms, and physical symptoms are often present
- GAD is more severe than the occasional worrying everyone experiences, and is excessive, disruptive, and enduring
- Pharmacotherapy: Common medications include antidepressants, buspirone, and benzodiazepines.
Kübler-Ross Model of Grief
- Clients experiencing a painful loss go through some predictable stages: -Denial: Clients have difficulty accepting loss; denial is a common first reaction. -Anger: Grieving clients experience powerful anger -Bargaining: Grief clients attempt to strike a deal with God for an alternative plan -Depression: Grieving clients experience intense feelings of sadness, sorrow, and loss -Acceptance: Clients come to accept loss
Additional Information
- Clients experiencing mania have increased caloric needs and may have difficulty sitting down to eat meals; provide frequent high-protein, high-calorie, portable foods and drinks
- Promote good sleep hygiene and minimize caffeine use during manic episodes and frequent rest periods during the day -Withdrawal: Is the client letting go, saying goodbye? Examples include sending flowers with a note, taking out a life insurance policy, getting finances in order, giving away possessions -Mood shifts: Is there a sudden change in the client's mood (positive or negative)? -A sudden, positive shift often means the client has decided to commit suicide
- Pay attention to indirect statements; assess for suicidal ideation when phrases like "I don't have anything worth living for anymore" and "I wish I could fall asleep and never wake up.” -A sudden improvement in a client's mood can indicate the client intends to commit suicide in the near future -Assess the hallucinations' content is happening for clients that are hallucinating -Determine whether the client has poor insight or believes the commands must be obeyed -Command hallucinations can be a potential psychiatric emergency.
About SSRIs
- SNRIs: Desvenlafaxine Duloxetine Venlafaxine
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