Mental Health Nursing Textbook PDF

Davis Advantage for Psychiatric Mental Health Nursing, Tenth Edition. Chapters 2, 8 & 11 Mental Health and Mental Illness: Historical an...

Davis Advantage for Psychiatric Mental Health Nursing, Tenth Edition. Chapters 2, 8 & 11 Mental Health and Mental Illness: Historical and Theoretical Concepts The Nursing Process in Psychiatric-Mental Health Nursing Milieu Therapy – The Therapeutic Community Arizona College of Nursing Las Vegas Copyright ©2021 F.A. Davis Company  Objectives for Chapter 2 After reading this chapter, the student will be able to: 1. Discuss the history of psychiatric care. 2. Define mental health and mental illness. 3. Discuss cultural elements that influence attitudes toward mental health and mental illness. 4. Describe psychological adaptation responses to stress. 5. Correlate adaptive and maladaptive responses to the mental health/mental illness continuum. Copyright ©2021 F.A. Davis Company  Mental Health (continued_2)  Mental health This modified version of Robinson’s definition of mental health used by this text: ‒ “The successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings and behaviors that are age-appropriate Copyright ©2021 F.A. Davis Company  Maslow’s Hierarchy of Needs Copyright ©2021 F.A. Davis Company  Mental Illness (continued)  The American Psychiatric Association (2013), in its Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), defines mental disorder as a syndrome characterized by clinically significant disturbance in an individual’s: - cognition - emotional regulation - or behavior - interferes social, occupational, or other important activities in a certain period of time - demonstrates impaired daily functioning and maladaptive responses Copyright ©2021 F.A. Davis Company  DSM-5 “Purple Book”  The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM- 5)  the taxonomic and diagnostic tool published by the American Psychiatric Association (APA).  used by providers/clinicians Copyright ©2021 F.A. Davis Company  Example #1 Copyright ©2021 F.A. Davis Company  Example #2 Copyright ©2021 F.A. Davis Company  Historical Overview of Psychiatric Care  Primitive thoughts regarding mental disturbances:  an individual dispossessed of his or her soul  evil spirits or supernatural or magical powers had entered the body  may have broken a taboo or sinned against another individual or God. Copyright ©2021 F.A. Davis Company  Historical Overview of Psychiatric Care (continued_1)  Hippocrates theorized mental illness was caused by irregularity in the interaction of four body fluids. Copyright ©2021 F.A. Davis Company  Historical Overview of Psychiatric Care (continued_1)  Middle Ages: mental illness is associated with witchcraft and the supernatural  ”ship of fools” – mentally ill people were set to sea alone in boats Copyright ©2021 F.A. Davis Company  Historical Overview of Psychiatric Care (continued_2)  Middle of 18th century: first hospital in America to admit patients with mental illness was established in Philadelphia Benjamin Rush - father of American psychiatry Copyright ©2021 F.A. Davis Company  Historical Overview of Psychiatric Care (continued_2) Copyright ©2021 F.A. Davis Company  Historical Overview of Psychiatric Care (continued_2) Copyright ©2021 F.A. Davis Company  Historical Overview of Psychiatric Care (continued_3)  19th century brought the establishment of a system of state asylums. The result of the work of Dorothea Dix ‒ Former New England schoolteacher who lobbied tirelessly on behalf of the mentally ill population  1873: the emergence of psychiatric nursing Linda Richards: 1st American Psychiatric Nurse Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company  Historical Overview of Psychiatric Care (continued_4)  1946: Government passed the National Mental Health Act It provided funds for the education of psychiatrists, psychologists, social workers, and psychiatric nurses. Copyright ©2021 F.A. Davis Company  Tips Regarding the Concept of Mental Health SAFETY IS DEFINITELY Always watch your Always verify A PRIORITY! back Therapeutic communication: Avoid arguing with Always remember knowing more about mentally ill patients Maslow’s your patient and staying neutral There’s more communication Psych medications Not all mental health opportunities with have a lot of side patients are your patient in mental effects “psychotic” health compared to the medical setting Copyright ©2021 F.A. Davis Company  Davis Advantage for Psychiatric Mental Health Nursing, Tenth Edition. Chapters 8 & 11 The Nursing Process in Psychiatric-Mental Health Nursing Milieu Therapy Copyright ©2021 F.A. Davis Company  Objectives  After reading the chapters, students will be able to: 1. Define nursing process. 2. Identify six steps of the nursing process and describe nursing actions associated with each. 3. Describe the benefits of using nursing diagnosis. 4. Discuss the list of nursing diagnoses approved by NANDA International for clinical use and testing. 5. Define and discuss the use of case management and critical pathways of care in the clinical setting. 6. Apply the six steps of the nursing process in caring for a client in the psychiatric setting. 7. Describe the six areas of focus identified by The Institute of Medicine (and Quality and Safety Education for Nurses [QSEN] competencies) as critical to the improvement of health care. 8. Document patient care that validates use of the nursing Company process. Copyright ©2021 F.A. Davis  Milieu Therapy Copyright ©2021 F.A. Davis Company  Milieu Therapy A scientific structuring of the environment in order to effect behavioral changes and improve the psychological health and functioning of the individual (Skinner, 1979). Copyright ©2021 F.A. Davis Company Copyright ©2021 F.A. Davis Company  Interdisciplinary Team in Mental Health Consulting Clinical Psychiatric Psychiatrist MD: IM or psychologis nurse FNP t Mental Social Occupation Recreation health worker al therapist al therapist technician Music Art Dietitian Chaplain therapist therapist Copyright ©2021 F.A. Davis Company  Nursing Case Management Copyright ©2021 F.A. Davis Company  Nursing Case Management (continued_1)  Aims of case management aims to organize patient care outcomes are achieved within an allotted time frame decrease fragmentation of care while striving to contain cost of services Copyright ©2021 F.A. Davis Company  The Nursing Process (continued_1) Nursing Process Steps: Assessment Diagnosis Outcome Identification (Criteria) Planning Implementation Evaluation Copyright ©2021 F.A. Davis Company  Example of Assessment Tool (FA Davis) Copyright ©2021 F.A. Davis Company  Brief Mental Status Exam (MSE) Copyright ©2021 F.A. Davis Company  Outcome Criteria/Goals/Planning Copyright ©2021 F.A. Davis Company  Implementation (Example) Copyright ©2021 F.A. Davis Company  Evaluation Copyright ©2021 F.A. Davis Company  Davis Advantage for Psychiatric Mental Health Nursing, Tenth Edition. Chapter 5 Ethical and Legal Issues Copyright ©2021 F.A. Davis Company  Introduction Nursing competency and patient care accountability are Legislation determines compromised when the what is “right” or “good” nurse has inadequate within a society. knowledge about the laws that regulate the practice of nursing. Copyright ©2021 F.A. Davis Company  Core Concepts Ethics is a branch of philosophy that deals with systematic approaches to distinguishing right and wrong behavior. Bioethics is the term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health. Copyright ©2021 F.A. Davis Company  Core Concepts (continued_1) Moral behavior is defined as conduct that results from serious critical thinking about how individuals ought to treat others. Values are personal beliefs about what is important and desirable. Values clarification is a process of self- exploration through which individuals identify and rank their own personal values. Copyright ©2021 F.A. Davis Company  Core Concepts (continued_2) A “right” is defined as, “a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and an entitlement to a benefit or service.” A right is absolute when there is no restriction whatsoever on the individual’s entitlement. A legal right is one in which the society has agreed and formalized into law. Copyright ©2021 F.A. Davis Company  Ethical Considerations (continued_1) ethical theory that promotes action based on the end Utilitarianis result that produces the m most good (happiness) for the most people. decisions and actions are bound by a sense of duty Kantianism Directly opposed to utilitarianism Copyright ©2021 F.A. Davis Company  Ethical Considerations (continued_1) Christian Do unto others as you would have them do unto you. ethics Natural Do good and avoid evil. Human knowledge of the difference law between good and evil directs theories decision-making. Ethical Decisions are based on what is best for the individual making the egoism decision. Copyright ©2021 F.A. Davis Company  Ethical Considerations (continued_2) 1. An operating room nurse asks a psychiatric nurse, “How can you work with the mentally ill day in and day out?” The psychiatric nurse replies, “It’s just the right thing to do.” The psychiatric nurse is operating from which A. Kantianism ethical framework? B. Christian ethics C. Ethical egoism D. Utilitarianism Copyright ©2021 F.A. Davis Company  Ethical Considerations (continued_3) Correct Answer: A Kantianism focuses on the morality of actions. Actions are judged as right or wrong based on ethical principles. The nurse’s response indicates a Kantian perspective. Copyright ©2021 F.A. Davis Company  Ethical Dilemmas Ethical dilemmas are situations that require individuals to make a choice between two equally unfavorable alternatives. Taking no action is considered an action taken. Copyright ©2021 F.A. Davis Company  Ethical Principles Autonomy emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected. Beneficence refers to The term “advocacy” one’s duty to benefit means acting on or promote the good of another’s behalf as a supporter or defender. others. Copyright ©2021 F.A. Davis Company  Ethical Principles (continued_1) Abstaining from negative acts toward another Nonmaleficence Includes acting carefully to avoid harm Principle based on the notion of a hypothetical Justice social contract between free, equal, and rational persons Principle that refers to Veracity one’s duty to always be truthful Copyright ©2021 F.A. Davis Company  A Model for Making Ethical Decisions Problem Assessment identification Plan Implementation Evaluation Copyright ©2021 F.A. Davis Company  Ethical Issues in Psychiatric/Mental Health Nursing  The right to treatment Anyone admitted to the hospital has the right to treatment.  The right to refuse treatment (including medication) Patients have the right to refuse treatment unless immediate intervention is required to prevent death or serious harm to the patient or another person. Copyright ©2021 F.A. Davis Company  Ethical Issues in Psychiatric/Mental Health Nursing (continued_1)  The right to the least restrictive treatment alternative If a client can be adequately treated in an outpatient setting, they should not be hospitalized. If hospitalized, the patient should not be sedated, restrained, or secluded unless less restrictive steps were unsuccessful. Copyright ©2021 F.A. Davis Company  Legal Considerations The Nurse Practice Act defines the legal parameters of professional and practical nursing. Types of laws Statutory Common law law Copyright ©2021 F.A. Davis Company  Classifications Within Statutory and Common Law Torts Civil law protects the private and property rights of individuals and businesses. Contracts Criminal law provides protection from conduct deemed injurious to the public welfare. Copyright ©2021 F.A. Davis Company  Legal Issues in Psychiatric/Mental Health Nursing Confidentiality and right to privacy Health Insurance Portability and Accountability Act (HIPAA) Doctrine of privileged communication Exception: A duty to warn Exception: Suspected child or elder abuse Informed consent Knowledge Competency Free will Copyright ©2021 F.A. Davis Company  Restraints and Seclusion Copyright ©2021 F.A. Davis Company  Restrains and Seclusion Restraints generally refers to a set of leather straps used to restrain the extremities of an Restraints are never individual whose to be used as behavior is out of punishment or for the control and who poses convenience of staff. an immediate risk to the physical safety and psychological well-being of him or herself and others. Copyright ©2021 F.A. Davis Company  Example of Seclusion Room Copyright ©2021 F.A. Davis Company  Example of Restraints Copyright ©2021 F.A. Davis Company  Glove or Mitten Restraint Copyright ©2021 F.A. Davis Company  Spit Mask Copyright ©2021 F.A. Davis Company  Belt/Lap Restraint Copyright ©2021 F.A. Davis Company  Things to remember  nurses must be aware of the policies that govern the use of restraints  restraints can either be physical or chemical  seclusion and/or restraint should be used for the shortest duration necessary  do not forget to obtain order from MD, nurses can initiate restraints if all less restrictive measures were unsuccessful  order must be renewed every 24 hours  time limit for seclusion or restraints until it needs to be re-evaluated if deemed necessary 18 years and older: 4 hours 9 to 17 years: 2 hours 8 years and younger: 1 hour Copyright ©2021 F.A. Davis Company  Things to remember  once in seclusion or restraints, monitor every 15 to 30 minutes and assess the following (depending on facility protocol): pain behavior need to use toilet vital signs offer food and fluids DO NOT FORGET TO DOCUMENT. Copyright ©2021 F.A. Davis Company  Legal Issues in Psychiatric/Mental Health Nursing (continued_3) Voluntary admissions Involuntary commitments Emergency commitments The mentally ill person in need of treatment Involuntary outpatient commitment The gravely disabled client Copyright ©2021 F.A. Davis Company  Nevada Legal Hold (L2K) Copyright ©2021 F.A. Davis Company  Nevada Legal Hold (L2K) Copyright ©2021 F.A. Davis Company  Negligence vs Malpractice Malpractice Negligence “An act or continuing The failure to exercise the conduct of a professional standard of care that a that does not meet the reasonably prudent person standard of professional would have exercised in a competence and results in similar situation provable damages to his or Any conduct that falls below her client or patient. Such the legal standard an error or omission may be established to protect through negligence, others against ignorance, or intentional unreasonable risk of harm, wrongdoing.” (Hill & Hill, except for conduct that is 2018) intentionally, wantonly, or willfully disregards others’ rights. Copyright ©2021 F.A. Davis Company  Lawsuits in Mental Health Nursing Defamation of Breach of character Invasion of confidentiality Libel privacy Slander False Assault Battery imprisonment Copyright ©2021 F.A. Davis Company  Ethical Considerations (continued_4) 2. As a last resort, an agitated, physically aggressive patient is placed in four-point restraints. The patient yells, “I’ll sue you for assault and battery.” The unit manager determines that the nurses are protected A. under The client is voluntarily which condition?committed and poses a danger to others on the unit. B. The client is voluntarily committed and has a history of being a danger to others. C. The client is voluntarily committed because of a history of violent behavior. D. The client is involuntarily committed and is refusing treatment. Copyright ©2021 F.A. Davis Company  Legal Issues in Psychiatric/Mental Health Nursing (continued_8) Correct Answer: A As a threat to others, the client can be restrained despite objections and voluntary commitment. Copyright ©2021 F.A. Davis Company  Ethical Considerations (continued_5) 3. A nurse gave a patient 5 mg of haloperidol (Haldol) for agitation. The patient’s chart was clearly stamped “Allergic HALDOL.” The client suffered A. anaphylactic Intentional tortshock and died. How would B. Negligence the nurse’s actions be labeled? C. Battery D. Assault Copyright ©2021 F.A. Davis Company  Legal Issues in Psychiatric/Mental Health Nursing (continued_9) Correct Answer: B The nursing action was an unreasonable and careless act. The nurse was negligent and could be held liable for the patient’s death. Copyright ©2021 F.A. Davis Company  Avoiding Liability Effective communication Accurate and complete documentation in the medical record Complying with the standards of care Knowing the client Practice within the nurse’s level of competence and scope of practice Copyright ©2021 F.A. Davis Company