Psychiatric Mental Health Nursing Exam Outline PDF

qf425-Exam 1 Outline **[Chapter 1: Foundations of Psychiatric Mental Health Nursing]** **Describe the characteristics of mental health and mental illness.** Mental Health - Difficult to define. - No single, universal definition/ - Many components influenced by factors. - Dynamic, ever...

qf425-Exam 1 Outline **[Chapter 1: Foundations of Psychiatric Mental Health Nursing]** **Describe the characteristics of mental health and mental illness.** Mental Health - Difficult to define. - No single, universal definition/ - Many components influenced by factors. - Dynamic, ever-changing state. - Influencing Factors: - Individual (personal): person's biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities. - Interpersonal (relationship): include effective communication, ability to help others, intimacy, and a balance of separateness and connectedness. - Social/cultural (environmental): nonmedical factors that influence health, such as a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, education, employment, income and social protection, and food security. Mental Illness - Includes disorders that affect mood, behavior and thinking. - Depression, schizophrenia, anxiety disorders, addictive disorders. - Often indicate signs of distress and/or impaired functioning. - General Criteria for diagnosis: - Dissatisfaction with characteristics, abilities, accomplishments. - Ineffective or unsatisfying relationships. - Dissatisfaction with one's place in the world. - Ineffective coping with life events. - Lack of personal growth. **Purpose & use of American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders** - Diagnostic and Statistical Manual of Mental Disorders (DSM). - Taxonomy of American Psychiatric Association. - 3 purposes: - To provide a standardized nomenclature and language for all mental health professionals. - To present defining characteristics or symptoms that differentiate specific diagnoses. - Assist in identifying the underlying causes of disorders. - DSM Classification - Allows the practitioner to identify all factors that relate to a patient's condition: - All major psychiatric disorders (depression, schizophrenia, anxiety, etc.) - Medical conditions that are potentially relevant to understanding or managing the person's mental disorder as well as medical conditions that may contribute to understanding the person. - Psychosocial & environmental problems that may affect diagnosis, treatment, and prognosis of mental disorders. **Mental Illness and the 21^st^ Century** - Mental disorders are the leading cause of disability in the United States and Canada for people aged 15 to 44. - Economic burden exceeds that by all types of cancer. - Issues and Concerns: - "Revolving-door" effect due to deinstitutionalization. - Frequent psychiatric rehospitalizations. - Shorter hospital stays, decompensation, rehospitalization, dual diagnoses. - Homelessness, increase in physical illness comorbidities, lack of adequate community resources. **Psychiatric Nursing Practice** - Linda Richards: first American psychiatric nurse. - H. Peplau: therapeutic nurse-client relationship; interpersonal dimension (foundation for current practice). - J. Mellow: focus on client's psychosocial needs, strengths. **Discuss the American Nurses Association (ANA) standards of practice for psychiatric--mental health nursing.** - Basic-Level Functions: RN - Counseling: interventions & communication techniques, problem-solving, crisis intervention, stress management, behavior modification. - Milieu Therapy: maintain therapeutic environment, teach skills, encourage communication between clients and others, promote growth through role models. - Self-Care Activities: encourage independence, increase self-esteem, improve function and health. - Psychobiologic Interventions: administer medications, teach, observe. - Health teaching, case management, health promotion & maintenance. - Advance-Level Functions: NP - Psychotherapy - Prescriptive authority for drugs. - Consultation, liaison, evaluation **[Chapter 5: Therapeutic Relationships ]** **Describe how the nurse uses the necessary components involved in building and enhancing the nurse-client relationship (trust, genuine interest, empathy, acceptance, and positive regard).** - Trust: builds when the client is confident in the nurse and when the nurse's presence conveys integrity and reliability - Behaviors such as: caring, interest, understanding, consistency, honesty, promise keeping, listening, respect, approachability, etc. - Congruence: when words and actions match. - Genuine Interest: when nurse is comfortable w/ themselves, aware of strengths & limitations, & clearly focused, client perceives genuine person showing genuine interest. - Empathy: ability of the nurse to perceive the meanings and feelings of the client and communicate that understanding to the client. - Putting oneself in client's shoes. - Client and nurse giving "gift of self." - Different from sympathy (feelings of concern or compassion; focus shifting to nurse's feelings). - Acceptance: avoiding judgments of the person, no matter what the behavior. - However, be sure to set boundaries on inappropriate behavior. - Positive Regard: unconditional, non-judgmental attitude and implies respect. **Describe the importance of self-awareness and therapeutic use of self in nurse-client relationship.** - Self-Awareness: process of developing an understanding of one's own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths, and limitations and how these qualities affect others. - Therapeutic Use of Self: use of aspects of personality, experience, values, feelings, intelligence, needs, coping skills, perceptions to establish relationships beneficial to clients. - Concept developed by H. Peplau. - Believed that nurses must clearly understand themselves to promote their client's growth & avoid limiting clients' choices to those that nurses value. - Johari window: tool to learn about oneself; creates a "word portrait" of a person in four areas and indicates how well that person knows themselves and communicates with others; 4 quadrants. Goal is to move qualities from quadrants 2,3,4 into quadrant 1. - Open/public: self-qualities one knows about oneself, and others also know. - Blind/unaware: self-qualities known only to others. - Hidden/private: self-qualities known only to oneself. - Unknown: empty quadrant to symbolize qualities yet undiscovered by oneself or others. **Explain the importance of values, beliefs, and attitudes in the development of the nurse-client relationship.** - Values: abstract standards that give a persona sense of right and wrong and establish a code of conduct for living. - Values Clarification: - Choosing: when the person considers a range of possibilities and freely chooses the value that feels right. - Prizing: when the person considers the value, cherishes it, and publicly attaches it to themselves. - Acting: when the person puts the value into action. - Beliefs: ideas that one hold to be true. - Attitudes: general feelings or a frame of reference around which a person organizes knowledge about the world. **Identify self-awareness issues that can enhance or hinder the nurse-client relationship.** - Inappropriate boundaries: relationship becomes social or intimate. - Feelings of sympathy, encouraging client dependency. - The nurse who feels sorry for the client often tries to compensate by trying to please the client. - Nonacceptance of client and avoidance. **Describe the differences among social, intimate, and therapeutic relationships.** - Social: primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of a task. - Superficial Communication: focuses on sharing ideas, feelings, and experiences and meets the basic need for people to interact. - Advice is often given, roles may shift, outcomes are rarely assessed. - Acceptable in nursing, but for the nurse-client relationship to accomplish goals, social interaction must be limited. - Intimate: involves two people who are emotionally committed to each other. - Individual needs met, assistance with helping each other meet needs. - No place in the nurse-client interaction. - Therapeutic: focuses on needs, experiences, feelings, and ideas of client only. - Use of communication skills, personal strengths, understanding of human behavior by nurse. - Joint agreement on areas to work on, outcome evaluation. **Establishing a Therapeutic Relationship** - Orientation: begins when the nurse and client meet and ends when the client begins to identify problems to examine. - Establishment of roles. - Discussion of purposes, parameters of future meetings. - Clarification of expectations. - Identification of client's problems. - Nurse-client contracts/confidentiality, duty to warn/ self-disclosure. - Working Phase: divided into two subphases. - Problem identification: issues or concerns identified by client; examination of client's feelings and responses. - Exploitation: examination of feelings and responses; development of better coping skills, more positive self-image, behavior change, independence. - Transference: client to unconsciously transfer to the nurse feelings they have for significant others. - Ex: client had negative experience with authority figures (parent, teachers); they may display similar reactions of negativity to nurse. - Countertransference: nurse responds to client based on personal unconscious needs and conflicts. - Ex: if nurse is youngest in their family and as a child often felt as if no one listened, they may respond with anger to a client who does not listen, or resists help. - Termination: begins when client's problems are resolved. - Ends when a relationship is ended. - Deals with feelings of anger or abandonment that may occur; client may feel termination as impending loss. **[Chapter 6: Therapeutic Communication]** **Describe the goals of therapeutic communication.** - Therapeutic Communication: an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information. - Goals of therapeutic communication: - Establish therapeutic nurse-client relationship. - Identify the most important client concern; assess client perceptions. - Facilitate the client's expression of emotions. - Teach the client and family the necessary self-care skills. - Recognize the client's needs. - Implement interventions to address client's needs. - Guide the client toward acceptable solutions. **Identify therapeutic and nontherapeutic verbal communication skills.** Therapeutic: - These help the nurse: recognize the important issue, know what questions to ask, use therapeutic communication techniques, prevent jumping to conclusions, objectively respond to message. - Active Listening: refraining from other internal mental activities and concentrating exclusively on what the client says. - Active Observation: watching nonverbal actions as speaker communicates. - Accepting, broad openings, consensual validation, encouraging comparison, encouraging description of perceptions, encouraging expression, reflecting, etc. Nontherapeutic: - Responses cut off communication & make it more difficult for the interaction to continue. - Advising, belittling feelings, challenging, defending, probing, disagreeing, reassuring, making stereotyped comments, rejecting, requesting explanation, etc. Interpretating Signals or Cues - Cues are verbal or nonverbal messages that signal key words or issues for the client. - Overt: clear, direct statements. - Covert: vague, indirect messages. **Discuss nonverbal communication skills such as facial expression, body language, vocal cues, eye contact, and understanding of levels of meaning and context.** - Facial Expression: facial movements connect with words to illustrate meaning; this connection demonstrates speaker's internal dialogue. - Expressive: portrays person's moment-by-moment thoughts, feelings, and needs. - Impassive: frozen into an emotionless deadpan expression similar to a mask. - Confusing: opposite of what the person wants to convey. - Body Language: gestures, postures, movements, and body positions. - Closed body position: crossed legs or arms folded. - Interaction might threaten the listener who is defensive or not accepting. - Open posture: facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle. - Demonstrates unconditional positive regard, trust, care, and acceptance. - Vocal Cues: nonverbal sound signals transmitted along with the content. - Voice volume, tone pitch, intensity, emphasis, speed, and pauses augment the sender's message. - Eye Contact: looking into the other person's eyes during communication. - Used to assess the other person and the environment and to indicate whose turn it is to speak; increases during listening but decreases while speaking. - Silence: can indicate various things. - Understanding Meaning: - Meaning: messages often contain more meaning than just spoken words. - Understanding Context: - Validation of client findings from verbal and nonverbal communication. - Assessment focuses on who, what, when, how, and why. **Discuss boundaries in therapeutic communication with respect to distance and use of touch.** - Proxemics: the study of distance zones between people during communication. - Distance Zones: - Intimate (0-18 in.) - Personal (18-36 in.) - Social (4-12ft.) - Public (12-25 ft.) - Therapeutic communication: most comfortable when nurse and patient are 3-6 ft. apart. **[Chapter 7: Client's Response to Illness]** **Identify the roles that biologic makeup and physical health play in a client's emotional response.** - Age, growth, development: - Effect on coping with illness. - Expression of illness - Erikson's stages of psychosocial development; each stage dependent on successful completion of previous one. - Adult growth and development tasks. - Genetics and Biologic Factors: - Heredity and biologic factors are not under voluntary control. - Genetic makeup tremendously influences a person's response to illness and perhaps even to treatment. - Physical health and health practices: - Healthier the person = better they can cope with stress or illness. - Response to Drugs: - People differ in the metabolism and efficacy of medications. - Poor metabolizers: metabolize drugs more slowly; increases the frequency and severity of side effects. - Slower metabolism = need for lower doses. **Explain the importance of personal characteristics, such as self-efficacy, hardiness, resilience, resourcefulness, and spirituality, in a client's response to stressors.** - Self-Efficacy: belief that personal abilities and efforts affect the events in one's life. - Hardiness: ability to resist illness when under stress. - Commitment: active involvement in life activities. - Control: ability to make appropriate decisions in life activities. - Challenge: ability to perceive change as beneficial rather than just stressful. - Resilience and resourcefulness - Resilience: having healthy responses to stressful circumstances or risky situations. - Resourcefulness: involves using problem-solving abilities and believing that one can cope with adverse or novel situations. - Spirituality: involves the essence of a person's being and their beliefs about the meaning of life and the purpose of living. **Explain the influence of interpersonal factors, such as sense of belonging, social networks, and family support, on the client's response to illness.** - Sense of Belonging: feeling of connectedness with or involvement in a social system or environment of which a person feels an integral part. - Value: feeling needed and accepted. - Fit: feeling that one meshes or fits in with the system or environment. - Social Networks: groups of people one knows and with whom feels connected. - Helps reduce stress, diminish illness, and positively influence the ability to cope and adapt for both clients and their caregivers. - Social Support: emotional sustenance that comes from friends, family members, and even healthcare providers who help a person when a problem arises. **Explain the cultural factors that the nurse must assess and consider when working with clients from diverse backgrounds.** - Cultural Competency: emphasizes the need for health care systems and providers to be aware of, and responsive to patients' cultural perspectives and backgrounds. - Cultural Humility: lifelong process of being inquisitive and open to others. - Be self-aware, be aware of others, be egoless, self-reflect. - Beliefs About Causes of Illness: - Natural/unnatural - Religious/powerful forces - Biomedical - Factors in cultural assessment: - Communication, physical distance or space, social organization, time orientation, environmental control, biologic variations. **Explain the nurse's role in assessing and working with clients from diverse backgrounds.** - Seeking knowledge about client's values, beliefs, and health practices. - Client as best source of information. - Observation at the initial meeting of client's: - Preferences, health practices, beliefs. - Open, objective approach. - Self-Awareness Issues: - Maintain genuine, caring attitude. - Ask how client wants to be addressed. - Ask how nurse can promote spiritual, religious, and health practices. - Recognize own feelings and remember client's responses are unique.