Foundational Mental Health Concepts PDF

# Foundational Mental Health Concepts ## Learning Objectives 1. Describe basic concepts related to mental health care. 2. Establish a safe environment for clients, nurses, and other staff. 3. Discuss psychiatric-mental health nursing and associated standards of care. 4. Apply principles of patient...

# Foundational Mental Health Concepts ## Learning Objectives 1. Describe basic concepts related to mental health care. 2. Establish a safe environment for clients, nurses, and other staff. 3. Discuss psychiatric-mental health nursing and associated standards of care. 4. Apply principles of patient-centered care while considering client diversity across the lifespan. ## Mental Health - Integral to overall health and well-being. - Includes emotional, psychological, and social aspects. - Impacts of mental health: - Affects thinking, feelings, and behavior. - Determines stress management, relationships, and decision-making. - Important at all stages of life: childhood, adolescence, adulthood. ## Mental Health vs Mental Illness ### Mental Health - Essential component of overall health. - Defined by the WHO as: - A state of complete physical, mental, and social well-being. - Not merely the absence of disease or infirmity. - Characteristics of mental health: - Realizes one's abilities. - Copes with normal stresses of life. - Works productively. - Contributes to the community. - Promotion, protection, and restoration of mental health are global concerns. ### Mental Illness - Defined by the American Psychiatric Association as: - Health conditions involving changes in emotion, thinking, or behavior. - Associated with emotional distress and impaired social, work, or family functioning. - Prevalence in the U.S.: - Nearly 1 in 5 adults (19%) experience some form of mental illness. - 1 in 12 (8.5%) have a substance use disorder. - 1 in 24 (4%) have a serious mental illness. - Impact of Poor Mental Health: - Increases risk of chronic physical illnesses (e.g., heart disease, cancer, stroke). - Associated with thoughts and intentions of suicide ## Mental Health Continuum ### Overview - Mental health fluctuates across an individual's lifespan. - Ranges from well-being to emotional problems and mental illness. ### Well-being - Located on the "healthy" end of the continuum. - Characteristics: - Good mental and emotional health. - Can cope effectively with everyday stressors. - No impairments in daily functioning despite occasional stress. ### Emotional Problems and Concerns - Mild to moderate distress. - Symptoms include: - Insomnia, lack of concentration, loss of appetite. - May lead individuals to seek treatment, often starting with primary care. ### Mental Illness - Significant level of distress and moderate to severe impairment in daily functioning (work, school, or home). - Includes common disorders (e.g., depression, anxiety) and less common ones (e.g., schizophrenia). - Characterized by: - Alterations in thinking, mood, or behavior. - Moderate to disabling functional impairments. ### Serious Mental Illness - Causes substantial interference in major life activities as defined by the Americans with Disabilities Act (ADA) `e.g., caring for oneself, concentrating, working`. - Examples: - Major depressive disorder. - Schizophrenia. - Bipolar disorder. - Potential for productive lives with effective treatment. - Roughly half of schizophrenia patients show recovery or significant improvement long-term. ### Diagnosis and Classification - Mental health providers use the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) for diagnosis. - Lists diagnostic criteria `e.g., feelings, behaviors, time frames`. - Over 200 types of mental illnesses exist, with varying intensity and durations: - Ongoing, short-term, or episodic `(comes and goes)`. ### Mental Health Providers - `[Text not clear]` ## Assessing Dysfunction and Impairment ### Definition of Mental Health Disorders - Involves dysfunction causing distress or impaired functioning. - Deviates from societal or cultural norms. - Comprised of three components: dysfunction, distress, and deviance. ### Dysfunction - Refers to disturbances in thinking, emotional regulation, or behavior. - Results from breakdowns in psychological, biological, or developmental processes. - Examples: - Cognition: Believing oneself to be an omnipotent deity `(delusion)`. - Emotion: Inability to experience pleasure `(anhedonia)`. - Behavior: Avoiding work due to fear of panic attacks. ### Distress - Psychological and/or physical pain `(e.g., emotional suffering after a loss)`. - May cause temporary or prolonged impairments in functioning. ### Impairment - Limits daily activities or social, work, or school participation. - Examples: - Inability to maintain personal hygiene, prepare meals, or pay bills. - Difficulty fulfilling life roles `(e.g., caregiver, parent, or student)`. ### Deviance - Behaviors that violate cultural norms or social expectations. - Determined by societal rules `(stated and unstated)`. ### Assessment by Nurses - Ongoing documentation of dysfunction, distress, and deviance. - Use of the World Health Organization Disability Assessment Scale (WHODAS): - Recommended by the DSM-5 for standardized assessment of health and disability across cultures. - Assesses functioning in six domains: - Cognition - Mobility - Self-care - Getting along - Life activities - Participation - Global Assessment of Functioning (GAF): - Previously used to measure the severity of mental illness and its impact on daily life. - Rated psychological, social, and occupational functioning on a scale of 0 to 100 `(higher scores indicate better functioning)`. - Omitted from the DSM-5 due to concerns about validity and reliability. ## Recovery ### Definition - Mental illness is treatable, and many individuals recover completely. - Recovery is a process of change that improves health and wellness, fosters self-direction, and enables individuals to reach their full potential. ### Dimensions Supporting Recovery - **Health**: - Managing or overcoming diseases. - Living in a physically and emotionally healthy way. - **Home**: - Having a stable and safe living environment. - **Purpose**: - Engaging in meaningful daily activities `(e.g., job, school, volunteerism, creative endeavors)`. - Gaining independence, income, and resources to participate in society. - **Community**: - Building relationships and social networks for support, friendship, love, and hope. ## Early Signs of Mental Health Problems - Mental health problems are common and can arise from daily stressors. - Approximately 1 in 5 Americans will experience mental illness in their lifetime. ### Role of Nurses - Nurses must identify signs and symptoms of diagnosed and undiagnosed mental health problems in clients across care settings. ### Common Signs in Adults and Adolescents - Constant worry or fear. - Persistent sadness or low mood. - Difficulty concentrating or confused thoughts. - Extreme mood swings or intense euphoria. - Prolonged irritability or anger. - Withdrawing from friends or social activities. - Trouble understanding or relating to others. - Changes in sleep patterns or low energy. - Changes in eating habits `(e.g., increased hunger or loss of appetite)`. - Altered sex drive. - Hallucinations `(sensing things that aren't real)`. - Lack of awareness of one's own emotions or behaviors `(insight issues)`. - Substance misuse `(alcohol, drugs, or medications)`. - Unexplained physical symptoms `(e.g., headaches, stomachaches, chronic pain)`. - Thoughts of self-harm or suicide. - Struggling with daily tasks or stress management. - Fear of weight gain or preoccupation with `[text not clear]` ## Mental Health Disorders in Children - Symptoms are behavioral because they're still learning how to talk. - Changes in school performance. - Excessive worry or anxiety, for example fighting to avoid going to bed or school. - Hyperactive behavior. - Frequent nightmares. - Frequent disobedience or aggression. - Frequent temper tantrums. ## Cultural Impact ### Cultural Values and Beliefs - Culture influences how individuals view certain ideas or behaviors. - It impacts whether or not the individual seeks help, the type of help sought, and the support available. - Marginalized communities are less likely to seek help or may wait until symptoms become severe. ### Four Ways Culture Impacts Mental Well-being - **Cultural Stigma**: - Mental health challenges may be seen as weaknesses or something to hide, making it harder for individuals to seek help or speak openly about their struggles. - **Describing Symptoms**: - Culture can affect how individuals describe or recognize their symptoms, influencing whether they discuss emotional or physical discomfort. - Some cultures may not express emotional pain openly. - Example: The Amish community is typically stoic and endures pain without complaint. - **Community Support**: - Cultural factors determine the level of support individuals receive from family and community in seeking mental health care. - Stigma around mental health may limit access to support and treatment. - **Resources**: - Finding culturally sensitive mental health treatment and resources can be challenging, as options may not be culturally relevant and sensitive. ## Causes of Mental Illness ### Complex Origins of Mental Health Disorders - There is no single cause for mental health disorders. - Researchers agree that multiple factors contribute to their onset. - And that an individual is not at fault for the condition, and they cannot simply turn symptoms on or off at will. - **Environmental**: Life experiences, trauma, and social influences can play a role. - **Biological**: Genetics and brain chemistry can contribute to mental illness. - **Genetic**: Inherited traits or family history may increase the likelihood of developing mental health conditions. ## Environmental Factors Impacting Mental Health - **Social Factors**: - Issues like racism, discrimination, poverty, and violence, often called “social determinants of health”, can contribute to mental illness. - **Adverse Childhood Experiences (ACEs)**: - 61% of adults have experienced ACEs, such as abuse, neglect, or growing up in a home with violence, mental illness, or substance misuse. - Chronic stress from ACEs can change brain development and increase the risk of mental illness and substance misuse later in life. - ACEs are linked to chronic health problems in adulthood. - **Individual Trauma**: - Events like abuse or violence can have long-lasting negative effects on a person's mental, physical, social, or spiritual well-being. - **Current Stressors**: - Stress from life events such as relationship problems, job loss, moving, or work challenges can also contribute to mental health issues. ## Biological Factors Impacting Mental Health - **Brain Chemical Imbalance**: - Imbalances in neurotransmitters `(like dopamine, GABA, glutamineserotonin, and norepinephrine)` can affect mood, thought, and behavior. - Physical illness, stress, medications, or diet can cause changes in these brain chemicals. - **Immune System and Inflammation**: - Disorders like depression and bipolar disorder may be linked to immune system issues and inflammation. ## Genetics and Mental Health - **Hereditary Patterns**: - Some mental illnesses, like major depressive disorder, schizophrenia, and bipolar disorder, have been linked to genetic predisposition. ## WHO Guidelines for Mental Health Care - Nurses are essential in protecting and promoting the mental well-being of all individuals, especially those with diagnosed mental disorders. - The World Health Organization (WHO) provides a guide for nurses and primary healthcare providers to assess and manage mental health and substance use disorders. ### Key Principles for Providing Mental Health Care - **Respect and Dignity**: - Treat individuals with mental health or substance use conditions with respect and dignity. - **Effective Communication**: - Use nonjudgmental, non-stigmatizing, and supportive communication to ensure care. - **Comprehensive Assessments**: - Conduct thorough assessments to determine the best course of care. ### Promoting Respect and Dignity #### Dos - Treat individuals with mental health and substance use conditions respectfully. - Protect patient confidentiality. - Ensure privacy. - Provide clear information about treatment risks and benefits `(in writing when possible)`. - Obtain the person's consent before providing treatment. - Promote independence and community living. - Offer options for decision-making. #### Don'ts - Do not discriminate against people with mental health and substance use conditions. - Do not ignore individual preferences when making care decisions. - Do not make decisions for or on behalf of individuals. - Do not use overly technical language when communicating with clients. ## Using Effective Communication Skills for Mental Health Care - Effective communication is key to providing quality mental health care. ### Create an Environment That Facilitates Open Communication - **Private Space**: - Meet in a private setting, if possible, to ensure confidentiality. - **Culturally Appropriate Introductions**: - Use culturally sensitive greetings and body language. - **Confidentiality**: - Explain to adults that the information shared will be kept confidential `(with exceptions for minors)`. - **Involve Caregivers**: - If caregivers are present, suggest speaking privately with the client and obtain consent to share information. - **Gender Sensitivity**: - For young people, consider having someone of the same gender present to maintain comfort. ### Involve the Person - Include the individual, and with their consent, their family or caregivers, in all aspects of assessment and treatment. ### Start by Listening - **Active Listening**: - Be empathetic and sensitive. - Let the person speak without interruption and ask for clarification if needed. - **Child-Specific Listening**: - For children, use simple language and ask about their interests `(e.g., toys, friends, school)`. - **Adolescent-Specific Listening**: - Acknowledge their feelings and situation to build trust. ### Be Friendly, Respectful, and Nonjudgmental - **Respect**: - Always treat the individual with respect. - **Nonjudgmental Approach**: - Avoid making judgments about behaviors or appearances. - **Calm and Professional**: - Remain calm, even in challenging situations. ### Use Good Verbal Communication Skills - **Simple Language**: - Avoid medical jargon. - Use clear and easy-to-understand language. - **Therapeutic Questions**: - Use open-ended questions `(e.g., "Tell me more about what happened?")` to encourage conversation. - **Summarize and Clarify**: - Restate key points to ensure understanding `(e.g., “So your brother pushed you off your bike and laughed when you fell?").`. - **Encourage Questions**: - Invite the person to ask any questions they may have about the conversation. ### Respond With Sensitivity to Traumatic Experiences - **Acknowledge Difficult Topics**: - Thank the person for sharing sensitive information `(e.g., sexual assault, violence, or self-harm)`. - **Extra Sensitivity**: - Show empathy when discussing difficult or traumatic experiences. - **Maintain Confidentiality**: - Remind the person that shared information will be kept within the treatment team to ensure appropriate care. ## Therapeutic Relationship in Nursing - Essential for All Nursing Care: - The therapeutic relationship is especially important in psychiatric care and is considered the foundation of client care & healing. - Focus on Compassion and Support: - While general nurses aren't expected to perform advanced psychiatric interventions, they should engage in compassionate, supportive relationships with patients and use therapeutic communication as part of nursing practice. - Purpose of the Relationship: - Establishes trust and rapport, facilitates therapeutic communication, and involves the client in decision-making about their care plan. ## Conducting Comprehensive Assessments ### Components of a Comprehensive Assessment: - Includes mental status examination, psychosocial assessment, physical exam, and laboratory review. ### Key Focus Areas: - Nurses are responsible for identifying mental health disorders, promoting the medical treatment of existing physical conditions, and advocating for individuals with mental health and substance use disorders who are at higher risk for preventable diseases `(e.g., infections, cardiovascular disorders)`. ## Introduction to Trauma-Informed Care (TIC) ### Trauma Definition: - Trauma results from an event or series of events that are physically or emotionally harmful. - It can have lasting adverse effects on an individual's physical, emotional, social, or spiritual well-being. ### Types of Traumas: - Human-made `(war, terrorism, sexual abuse, violence, medical trauma)`. - Natural disasters `(flooding, hurricanes, tornadoes)`. ### Nurse's Role: - Nurses should avoid projecting their own perspectives, as what may seem minor to them could be significant to the client. - Experience vs. Event: - The significance of trauma is determined by the individual's experience, not just the event. - Two individuals may experience the same event but interpret it differently based on various biopsychosocial and cultural factors. ### Resilience: - Resilience refers to the ability to rise above challenges or adversity. - Includes using available resources to cope with trauma and its consequences. ### Who Can Be Affected by Trauma: - Trauma can impact people of all cultures, ages, genders, and sexual orientations. - Individuals can also experience trauma indirectly `(e.g., witnessing or hearing about trauma)`. ### Types of Traumatic Experiences: - Single event, series of events, or Adverse Childhood Experiences (ACEs). ### Link Between Trauma and Mental Health: - Increased awareness of how trauma affects mental health, quality of life, and substance misuse. - Examples include the September 11 attacks, wars, natural disasters, and the COVID pandemic. ### Impact of Trauma: - Trauma can overwhelm a person's ability to cope and lead to stress reactions `"fight, flight, freeze"`. - Results in feelings of fear, vulnerability, and helplessness, which may have lasting effects. ### Temporary vs Prolonged Reactions: - Some individuals have temporary reactions to trauma. - Others experience prolonged reactions with long-lasting mental health consequences such as: - Post-traumatic stress disorder (PTSD). - Anxiety disorder. - Substance use disorder. - Mood disorders. - Psychotic disorder. ### Somatization: - Psychological stress may manifest as physical symptoms such as: - Chronic headaches. - Pain. - Stomachaches. ### Impact of Trauma on Daily Life: - Trauma can affect how an individual functions in everyday activities. - It can influence how they seek and respond to medical care. ### Recognition of Trauma Effects: - Individuals may not recognize the significant effects of trauma or may avoid discussing it. - Nurses may not ask questions to uncover a client's trauma history. - Nurses may feel unprepared or struggle to address trauma-related issues due to agency policies. ### Trauma-Informed Care (TIC): - TIC is a strengths-based framework that connects traumatic experiences to mental health. - Emphasizes physical, psychological, and emotional safety for both survivors and health professionals. ### Key Principles of TIC: - Acknowledges that clients may be retraumatized by unexamined agency policies and practices. - Stresses patient-centered care over applying general treatment approaches. - Enhances therapeutic communication between the nurse and client. ### Benefits of TIC: - Decreases risks of misunderstanding clients' reactions. - Promotes the need for referrals for trauma-specific treatment. - Encourages involvement of clients in goal setting and care planning. - Clients are more empowered, invested, and satisfied with TIC. ### Implementing TIC - Requires specific training and starts with the first contact a person has with an agency. - All staff members, from receptionists to administrators, need to understand the impact of trauma on clients. - Influences client interactions with staff and responsiveness to care plans and interventions. ## Stigma - Despite recent focus on mental health, harmful attitudes and misunderstandings persist. - Stigma is a cluster of negative attitudes and beliefs that lead to fear, rejection, avoidance, and discrimination against people with mental health disorders. ### Impact of Stigma - Nearly two-thirds of people with diagnosable mental health disorders do not seek treatment due to stigma. ### Efforts to Combat Stigma - The U.S. Surgeon General's Report in 1999 aimed to dispel the stigma of mental illness and its effects on help-seeking behavior. - The National Alliance on Mental Illness (NAMI) works to improve the lives of those with mental illness and reduce stigma through education, support, and advocacy. - NAMI encourages individuals to share their stories to challenge stereotypes, break silence, and document discrimination. ### Stereotypes and Media Influence - Nurses often share common stereotypes, such as the portrayal of clients with mental disorders as dangerous, violent, bizarre or unpredictable. - Fearful of “setting off” uncontrollable behavior and lack of skills in managing behavioral symptoms are concerns. ### Stigma in Nursing - Stigma and negative attitudes towards mental illness can still be found among nurses. - A review by Ross and Golder categorized health care professionals into three groups regarding stigma: - **Stigmatizers**: - Nurses with stereotypical attitudes toward clients with mental illnesses/ those involved in psychiatry. - **The Stigmatized**: - Nurses who have mental health disorders or perceive stigma related to their roles. - **De-stigmatizers**: - Nurses who actively work to reduce stigma surrounding mental health. ### Need for Education: - Many nurses in general medical settings feel unprepared to handle clients with mental health disorders. - Literature supports additional mental health education for entry-level and practicing nurses to improve their knowledge. ### Therapeutic Nurse-Client Relationship: - Establishing a therapeutic relationship is key in mental health care and helps reduce stigma. - Although nurses are not expected to perform advanced psychiatric interventions, they must engage in compassionate, supportive relationships with clients. - The American Nurses Association emphasizes that nurses should reflect unconditional positive regard for all patients in their practice. ## Boundaries - Boundaries are limits that define comfort levels in interactions with others. - Personal boundaries include physical, sexual, intellectual, emotional, and financial areas. - Healthy boundaries promote psychological safety, protect well-being, and reduce stress. - **Five Major Types of Personal Boundaries**: - **Physical**: Personal space, privacy, and body `(e.g., comfort with public displays of affection)`. - **Sexual**: Comfort level with intimacy and sexual attention `(e.g., sexual comments, touch)`. - **Intellectual**: Respect for thoughts and beliefs `(e.g., dismissal of ideas is disrespectful)`. - **Emotional**: Comfort in sharing feelings `(e.g., gradual sharing of emotions)`. - **Financial**: Preferences regarding money management `(e.g., spending/saving habits)`. ### Boundary Issues in Mental Health - Clients with mental health disorders may struggle with boundaries. - **Example**: - A person with bipolar disorder might have trouble with money and relationships during a manic episode. - They may spend large amounts of money quickly or have sex with someone they just met. - **Example**: - Someone with depression who stays in an unhealthy relationship, allowing their partner to treat them poorly. ### Nurses and Professional Boundaries - Nurses must establish and maintain professional boundaries while being respectful and caring. - Nurses have authority and access to sensitive information, which can make clients feel vulnerable. - Professional boundaries involve clinical judgment and limiting personal disclosures. - Dual relationships `(e.g., personal or business ties with clients)` must be openly acknowledged. ### Signs of Inappropriate Boundaries - Self-disclosure of intimate or personal issues with clients. - Engaging in behaviors that could be seen as flirting. - Keeping secrets with clients. - Feeling as though only you can help or understand the client. - Spending excessive time with one client. - Speaking negatively about colleagues or workplace with clients/families. - Showing favoritism toward a client. - Meeting clients outside of work. - Contacting clients via social media. ### Safety for Nurses and Clients: - Establishing professional boundaries is crucial for client safety, particularly for vulnerable mental health clients. - Nurses and students should keep personal information `(e.g., name, address, phone number, social media)` private. ## Establishing Safety ### Suicidal Thoughts & Mental Health - Common symptom of mental health disorders. - Usually resolves with treatment. - Suicide is still the 10th leading cause of death in the U.S. despite increased mental health focus. ### Warning Signs of Suicide - **Feelings**: - Feeling like a burden, isolated, trapped, or hopeless. - **Behavior**: - Increasing anxiety, anger, substance use, or extreme mood swings. - **Physical**: - Sleeping too little or too much, being in unbearable pain. - **Verbal Cues**: - Talking about wanting to die, making suicide plans, or seeking lethal means. ### What to Do to Prevent Suicide - **Call 911**: - If the person is in immediate danger of self-harm. - **Ask Directly**: - Ask if they are thinking about suicide. - It won’t "make them want to", it shows you care. - **Listen Without Judgment**: - Show empathy &care. - **Stay with Them**: - They are safe until help arrives. - **Remove Dangerous Objects**: - They could use to harm themselves. ## Establishing a Safe Care Environment for Clients ### Importance of Safe Care Environment - A priority nursing intervention to prevent suicide. - Nurses play a key role in creating a safe care space. ### National Patient Safety Goals: - Suicide prevention is a key goal in Behavioral Health Care. - Set by The Joint Commission for psychiatric hospitals and behavioral health care patients. ### New Requirements (2020): - Apply to: - Psychiatric hospitals. - Patients in general hospitals or critical access hospitals with behavioral health conditions. - Any patient expressing suicidal ideations during care. ### Key Requirements: - **Environmental Risk Assessment**: Check the surroundings for suicide risks. - **Suicide Screening**: Evaluate if the person has suicidal thoughts. - **Suicide Risk Assessment**: Assess how likely suicide may be. - **Documentation**: Record suicide risks properly. - **Evidence-Based Policies**: Follow proven guidelines and procedures. - **Follow-up Care**: Provide discharge instructions for care after leaving. - **Monitor Effectiveness**: Review how well safety actions are preventing suicides. ## Performing Environmental Risk Assessment & Suicide Screening ### Environmental Risk Assessment - Identifies physical features that could be used for suicide attempts. - Actions to protect high-risk clients include: - Continuous Monitoring: Keep close watch on clients. - Remove Harmful Objects: Take away objects in rooms that could be used for self-harm. - Assess Items Brought In: Check objects brought by clients and visitors. - Safe Transportation: Follow procedures to safely move clients around the hospital. ### Additional Measures in Psychiatric Settings: - Remove items like door hinges, anchor points, and hooks to prevent suicide by hanging. ### Impact: - The use of a Mental Health Environment of Care Checklist reduced suicide rates from 4.2 per 100,000 to 0.74 per 100,000. ## Screening for Suicidal Thoughts - **Screening Importance**: All patients aged 12 and older in acute healthcare should be screened for suicidal ideation `(thought of killing self)`. - **Co-occurring Issues**: Clients with medical conditions may also have mental health issues causing suicidal ideation. - **Validated Tool**: `[Text not clear]` ## Assessing Suicide Risk ### When to Perform a Suicide Risk Assessment: - Completed on patients who have screened positive for suicidal thoughts. - The risk for suicide varies depending on: - **Plan**: Do they have a plan for suicide? - **Intent**: Are they committed to completing the plan? - **Past Attempts**: Have they tried suicide before? ### What to Assess: - **Suicidal Ideation**: Ask about thoughts of suicide. - **Plan**: Ask if they have a specific plan and the method they plan to use. - **Intent**: Determine if they are serious about following through with the plan. - **Past Behavior**: Look for previous suicide attempts or self-harm. - **Risk Factors**: Identify factors that increase the risk of suicide. - **Protective Factors**: Consider what factors may help reduce the risk. ### Specific Plan = Higher Risk: - If the patient has a specific plan, the risk of suicide is higher. - The risk is also higher if the plan involves lethal methods that are easily accessible to the client. ### Example of Suicide Risk Assessment Tool: - Columbia Protocol (C-SSRS) is an evidence-based tool that uses simple, clear help identify if a person is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs. - **Example Questions**: - "Have you had thoughts of killing yourself?" - "Have you thought about how you might do this?” - "Have you done anything, started to do anything, or prepared to do anything to end your life?" ## Developing a Safety Plan for Suicide Prevention ### When to Develop a Safety Plan: - For clients assessed as high risk for suicide. ### Key Features of the Safety Plan: - **Prioritized**: - Organize coping strategies from most to least helpful. - **Client's Own Words**: - The client should write the plan in their own words. - **Brief & Easy to Read**: - The plan should be simple for the client to understand and use quickly. - **Collaborate with the client to create the plan.** - **Problem-solve with the client to identify barriers to using the plan.** - **Decide where the client will keep the safety plan and how they will access it during a crisis.** ## Document Level of Suicide Risk: - After screening and assessment, document the level of suicide risk and the plan for safety. - Communicate this information with the treatment team to ensure everyone is on the same page. - Nurses must complete documentation regarding the level of a client's suicide risk and associated interventions every shift or more frequently as needed, depending upon the client status. ## Follow Written Policies and Procedures: - Strictly follow agency policies regarding suicide prevention. - Failure to follow these policies can lead to safety risks `(e.g., failure to maintain one-to-one monitoring for high-risk clients)`. ## Provide Information for Follow-Up Care: - At discharge, provide written follow-up care information for the client. - Share this information with family or loved ones when appropriate. - Studies show that the risk of suicide is higher after discharge, so providing a safety plan and crisis contact numbers can reduce the suicidal behavior after leaving the organization. ## Monitoring Effectiveness of Suicide Prevention Interventions - Evaluate Policies and Protocols: Regular evaluation as part of quality improvement initiatives. - Zero Suicide Model: Implementing this model reduces suicidal behaviors. - **Resources**: - Zero Suicide Toolkit: Available online to guide implementation. - Training Video: Preventing suicide information for health workers. ## Establishing a Safe Care Environment for Nurses and Other Health Care Team Members ### Workplace Violence - Can range from verbal abuse to physical assault. - Nurses face the highest risk of physical violence, with 13.2 assaults per 100 nurses per year. ### Dress for Safety - Tuck away long hair to prevent it from being grabbed. - Avoid wearing earrings or necklaces that can be pulled. - Choose clothing that is neither overly tight `(to allow movement)` nor overly loose/scarf-like `(to avoid snags)`. - Use breakaway lanyards for glasses, keys, or name tags. - Avoid wearing stethoscopes around your neck. ### Be Aware of Your Work Environment - In rooms with escalating clients or visitors: - Position yourself between the door and the client for quick exit if needed. - Always note the locations of exits and emergency phone numbers, particularly when floating to unfamiliar areas. - Understand environmental stressors for clients: - Confusion, background noise, and overcrowding may heighten stress. - Times of increased disruption include mealtimes, shift changes, and patient transport. ### Be Attuned to Patient Behaviors - Violent behavior is often preceded by warning signs. - The more warning signs observed, the higher the risk for violence. ### Verbal cues to watch for: - Speaking loudly or yelling. - Swearing. - Using a threatening tone of voice. - Evidence of confusion or disorientation. ### Nonverbal and behavioral cues: - Irritability or being easily angered. - Boisterous behavior `(e.g., shouting, slamming doors)`. - Disheveled appearance` (e.g., neglected hygiene)`. - Defensive body language `(e.g., arms crossed tightly, clenching fists)`. - Heavy breathing, pacing, or restless agitation. - Signs of fear or anxiety `(e.g., terrified expression, fixed staring)`. - Aggressive or threatening posture. - Throwing objects or sudden behavioral changes. ## Use Violence Risk Assessment Tools ### Purpose of assessment tools: - Help identify individuals at risk for violent behavior. - Provide a shared understanding among healthcare providers to improve communication. - Aid in initial and ongoing evaluations `(daily, if necessary)` to predict imminent violence. ## Be Attuned to Your Own Responses - Stay aware of your emotions, feelings, responses, and instincts: - A "fight or flight" response may signal impending danger—trust your gut and act accordingly. - Monitor how you express yourself/how others respond: - Your communication may influence patient behavior. - Practice effective therapeutic communication to de-escalate potential violence. - Maintain self-awareness: - Recognize personal history `(e.g., trauma or adverse experiences)` that may affect how you respond. - Reflect on whether you may unconsciously mimic abusive behaviors seen in others. - Address fatigue, which can reduce alertness and appropriate reactions. ## Check Your Cultural Biases - Recognizing how our own particular cultural heritage, values, and belief systems affect how we respond to our clients and coworkers and how they, in turn, respond to us. ## Safety Strategies for Home Health Nurses - **Patient and Family Background Review**: - Check agency files for background checks on: - Patient history of violence, crime, drug/alcohol abuse, or mental health diagnoses. - Records of violence or arrests for family members. - **Entering Potentially Dangerous Situations**: - Bring a team member trained in de-escalation and crisis intervention. - **Communication and Emergency Preparedness**: - Always carry a fully charged cell phone. - Ensure someone knows your location at all times. - Establish and use a code word with your office or coworkers to signal trouble if you cannot directly call the police. ## What is Psychiatric-Mental Health Nursing - Focus: - Care for clients with medical illnesses who may also have concurrent mental health disorders. - Promote well-being through prevention, education, and care for mental health and substance use disorders. ### Activities of Psychiatric-Mental Health Nurse Specialists (Per American Psychiatric Nurses Association): - Partner with individuals to achieve recovery goals. - Promote health and maintain wellness. - Conduct intake screening, evaluation, and triage. - Manage cases. - Teach self-care activities. - Administer and monitor psychobiological treatment regimens. - Provide crisis intervention and stabilization. - Engage in psychiatric rehabilitation and intervention. - Educate patients, families, and communities. - Coordinate care. - Work within interdisciplinary teams. ### Board Certification for Psychiatric-Mental Health Nurses - **Eligibility**: - Bachelor's degree in nursing. - Two years of full-time work experience in psychiatric nursing. - Completion of 30 hours of continuing education in the specialty. - Pass a certification exam. - **Credential Earned**: - PMH-BC (Psychiatric-Mental Health-Board Certified) or RN-BC. ### Psychiatric-Mental Health Advanced Practice Registered Nurses (PMH-APRN) and nurse practitioners (PMHNP-BC) - **Qualifications**: - Registered Nurse (RN) with: - Master of Science in Nursing (MSN). - Doctor of Nursing Practice (DNP) in psychiatric nursing. - **Activities and Roles**: - Provide individual, group, couples, and family psychotherapy. - Prescribe medication for acute and chronic illnesses. - Conduct comprehensive assessments. - Offer clinical supervision to others. - Diagnose, treat, and manage acute or chronic illnesses. - Deliver integrative therapy interventions. - Order, perform, and interpret lab tests and diagnostic studies. - Provide preventive care, including screenings. ## Standards of Psychiatric-Mental Health Nursing - The American Psychiatric Nurses Association (APNA) sets specific standards for mental health nursing. - These standards build on the general guidelines from the American Nurses Association (ANA). - Details are in the Psychiatric-Mental Health Nursing: Scope and Standards of Practice document. - Focus on special interventions for mental health care, covered more in the "Implementation