MH Exam 1 Study Guide.docx

**[MH Exam 1 Study Guide]** **[Chapter 1]** - [Identify what mental illness looks like in US culture] - Mental illness refers to all psychiatric disorders that have definable diagnoses. These disorders are manifested in significant dysfunctions that may be related to devel...

**[MH Exam 1 Study Guide]** **[Chapter 1]** - [Identify what mental illness looks like in US culture] - Mental illness refers to all psychiatric disorders that have definable diagnoses. These disorders are manifested in significant dysfunctions that may be related to developmental, biological, or psychological disturbances in mental functioning. Ability to think, emotions, and behaviors may be affected. - [Mental health continuum] - On one end of the continuum is mental health. A sense of well-being describes the general state of people in this category. Well-being is characterized by adequate to high-level functioning. Although individuals at this end of the continuum may experience stress and discomfort resulting from problems of everyday life, they experience no serious impairments in daily functioning. - At the opposite end of the continuum is mental illness. Individuals may have emotional problems or concerns and experience mild to moderate discomfort and distress. Mild impairment in functioning such as insomnia, lack of concentration, or loss of appetite may be felt. If the distress increases or persists, individuals might seek professional help. Problems in this category tend to be temporary, but individuals with mild depression, generalized anxiety disorder, and attention-deficit disorder may fit into this group. - [Resilience] - Resilience is the ability and capacity for people to secure the resources they need to support their well-being. People who are resilient are effective at regulating their emotions and not focusing on negative, self-defeating thoughts. - [DSM-5 ] - The DSM identifies disorders based on specific criteria. The DSM also serves as a tool for collecting epidemiological statistics about the diagnosis of psychiatric disorders. - A common misconception is that a classification of mental disorders classifies people, when the DSM actually classifies disorders. For this reason, the DSM and this textbook avoid the use of stigmatizing labels such as he is "a schizophrenic" or "an alcoholic." Viewing the person as a person and not an illness requires more accurate terms such as "an individual with schizophrenia" or "my patient has major depressive disorder." - [Psychiatric-Mental Health Nurse Education Levels] - Basic level registered nurses: completed a nursing program, passed the state licensure examination, and are qualified to work in most any general or specialty area. - Psychiatric-mental health registered nurse (PMH-RN): is a nursing graduate who possesses a diploma, an associate degree, or a baccalaureate degree and chooses to work in the specialty of psychiatric-mental health nursing. - RN-BC: 2 years of full-time work as a registered nurse, 2000 clinical hours in a psychiatric setting, and 30 hours of continuing education in psychiatric nursing, a baccalaureate-prepared nurse may take a certification examination - Advocacy as it relates to mental illness - Psychiatric-mental health advanced practice registered nurse (PMH-APRN): licensed registered nurse with a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) in psychiatric nursing. Diagnostic privileges, prescriptive authority, and the ability to provide psychotherapy **[Chapter 2]** - [Freuds ID EGO and SUPEREGO] - Id - The id is totally unconscious and impulsive, The id lacks the ability to problem solve and is illogical. - Ego - The problem solver and reality tester, the ego attempts to navigate the outside world. It is able to differe A3ntiate subjective experiences, memory images, and objective reality. - Superego - The superego, which develops between the ages of 3 and 5, represents the moral component of personality. The superego consists of the conscience (all the "should nots" internalized from parents and society) and the ego ideal (all the "shoulds" internalized from parents and society). - Review classical psychoanalytical therapy- goals, tools, etc - The purpose of classical psychoanalytic sessions is to uncover unconscious conflicts. Specific tools include: - Free association---Analysts actively encourage patients to freely share whatever thoughts or words come to mind to access the unconscious. - Dream analysis---Patients are encouraged to share the content of dreams, which the therapist analyzes for symbolic meanings (e.g., "I was falling" could be interpreted as the patient feels unable to control situations). - Defense mechanism recognition---The analyst assists the patient in recognizing and subsequently changing the overuse of maladaptive defense mechanisms, such as denial, projection, and rationalization - [Transference and countertransference] - Transference refers to unconscious feelings that the patient has toward a healthcare worker that were originally felt in childhood for a significant other. - Countertransference refers to unconscious feelings that the healthcare worker has toward the patient. - [Psychodynamic psychotherapy] - Psychodynamic therapy is rooted in traditional psychoanalysis and uses many of the same tools, such as free association and dream analysis, and concepts such as transference and countertransference. However, the therapist has increased involvement and interacts with the patient more freely than in traditional psychoanalysis. The therapy is oriented toward the here and now and makes less of an attempt to reconstruct the developmental origins of conflicts. - [Interpersonal theory] - Interpersonal therapy is an effective short-term therapy. The assumption is that psychiatric disorders are influenced by interpersonal interactions and the social context. The goal of interpersonal therapy is to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships. - Using interpersonal theory in nursing practice emphasizes the importance of building therapeutic relationships with patients through effective communication, collaboration, and emotional support. This approach promotes holistic, patient-centered care by addressing both physical and psychological needs, fostering patient autonomy and emotional growth. - [Hildegard Peplau interpersonal theory framework for nursing] - The approach is patient-centered, emphasizing personal growth, emotional support, and the nurse's roles as educator, counselor, and advocate. - She was also the first nurse theorist to describe the nurse-patient relationship as the foundation of nursing practice. She also shifted the focus from what nurses do to patients to what nurses do with patients. Self awareness. - - [Nurse Theorists] [Nursing Theorist] [Focus of Theory] [Contribution to Psychiatric-Mental Health Nursing] -------------------------------- ------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Patricia Benner Caring as foundation for nursing Benner encourages nurses to provide caring and comforting interventions. She emphasizes the importance of the nurse-patient relationship and the importance of teaching and coaching the patient and bearing witness to suffering as the patient deals with illness. Dorothea Orem Goal of self-care as integral to the practice of nursing Orem emphasizes the role of the nurse in promoting self-care activities of the patient; this has relevance to the seriously and persistently mentally ill patient. Sister Callista Roy Continual need for people to adapt physically, psychologically, and socially Roy emphasizes the role of nursing in assisting patients to adapt so that they can cope more effectively with changes. Betty Neuman Impact of internal and external stressors on the equilibrium of the system Neuman emphasizes the role of nursing in assisting patients to discover and use stress-reducing strategies. Joyce Travelbee Meaning in the nurse-patient relationship and the importance of communication Travelbee emphasizes the role of nursing in affirming the suffering of the patient and in being able to alleviate that suffering through communication skills used appropriately through the stages of the nurse-patient relationship. - [Maslow\'s hierarchy ] - Physiological needs: The most basic needs are the physiological drives---needing food, oxygen, water, sleep, sex, and a constant body temperature. If all needs were deprived, this level would take priority over the rest. - Safety needs: Once physiological needs are met, safety needs emerge. They include security; protection; freedom from fear, anxiety, and chaos; and the need for law, order, and limits. Adults in a stable society usually feel safe, but they may feel threatened by debt, job insecurity, or lack of insurance. It is during times of crisis, such as war, disasters, assaults, and social breakdown, when safety needs take precedence. Children, who are more vulnerable and dependent, respond far more readily and intensely to safety threats. - Belonging and love needs: People have a need for intimate relationships, love, affection, and belonging and will seek to overcome feelings of loneliness and alienation. Maslow stresses the importance of having a family and a home and being part of identifiable groups. - Esteem needs: People need to have a high self-regard and have it reflected to them from others. If self-esteem needs are met, they feel confident, valued, and valuable. When self-esteem is compromised, they feel inferior, worthless, and helpless. - Self-actualization: Human beings are preset to strive to be everything they are capable of becoming. Maslow said, "What a man can be, he must be." What people are capable of becoming is highly individual---an artist must paint, a writer must write, and a healer must heal. The drive to satisfy this need is felt as a sort of restlessness, a sense that something is missing. It is up to each person to choose a path that will bring about inner peace and fulfillment. - First, an emphasis on human potential and the patient's strengths is key to successful nurse-patient relationships. Second, the model helps to establish what is most important in the sequencing of nursing actions. - [Eriksons 8 stages of development] - 1\. Trust vs. Mistrust (Infancy: 0-18 months) - Definition: In this stage, infants learn to trust their caregivers when their needs for food, comfort, and affection are met. Failure to meet these needs consistently can lead to mistrust of people and the world. - Nursing Implication: Nurses must provide reliable, nurturing care to establish trust with infants and their families, ensuring a foundation for healthy emotional development. - ### 2. Autonomy vs. Shame and Doubt (Toddler: 18 months-3 years) - Definition: As toddlers gain motor skills and independence, they develop autonomy by making choices. If caregivers are overly controlling or critical, the child may feel shame or doubt their abilities. - Nursing Implication: Nurses should encourage toddlers' independence in activities like feeding or dressing, while providing safety and positive reinforcement to build confidence. - ### 3. Initiative vs. Guilt (Preschool: 3-5 years) - Definition: Preschoolers begin to assert control and initiate activities. If they are encouraged, they develop initiative; if discouraged or punished, they may feel guilt about their desires and actions. - Nursing Implication: Nurses promote initiative by allowing preschoolers to make small choices and explore, while guiding behavior and reinforcing appropriate actions. - ### 4. Industry vs. Inferiority (School Age: 5-12 years) - Definition: Children develop a sense of industry as they learn to complete tasks, succeed in school, and master new skills. If they experience failure or lack encouragement, they may feel inferior and doubt their abilities. - Nursing Implication: Nurses support school-age children by encouraging participation in tasks, acknowledging achievements, and helping them develop a sense of competence. - ### 5. Identity vs. Role Confusion (Adolescence: 12-18 years) - Definition: Adolescents explore their personal identity and try to establish a clear sense of who they are. Failure to establish a strong identity can lead to role confusion, where the individual is unsure of their place in society. - Nursing Implication: Nurses provide support for adolescents by facilitating self-expression, encouraging healthy exploration of identity, and offering guidance on decision-making and coping with peer pressure. - ### 6. Intimacy vs. Isolation (Young Adulthood: 18-40 years) - Definition: In this stage, individuals seek to form intimate, loving relationships. Success leads to strong relationships, while failure can result in loneliness and isolation. - Nursing Implication: Nurses promote emotional well-being by supporting young adults in forming close relationships and helping them cope with social or relationship challenges. - ### 7. Generativity vs. Stagnation (Middle Adulthood: 40-65 years) - Definition: Adults focus on contributing to society through work, family, and community involvement. Failure to find a sense of productivity can result in stagnation and a feeling of unfulfillment. - Nursing Implication: Nurses help middle-aged adults maintain life balance and fulfillment by encouraging involvement in meaningful work, family life, and community activities. - ### 8. Ego Integrity vs. Despair (Late Adulthood: 65+ years) - Definition: In later life, individuals reflect on their lives. A sense of fulfillment leads to ego integrity, while regrets or dissatisfaction may lead to despair. - Nursing Implication: Nurses support older adults by facilitating life review, addressing fears about aging or death, and helping them find meaning in their life experiences. - [Medical/biological model of mental illness] - assumes that abnormal behavior is the result of a physical problem. It focuses on neurological, chemical, biological, and genetic issues. The biological model locates the illness or disease in the body---usually in the limbic system of the brain and the synapse receptor sites of the central nervous system---and targets the site of the illness using physical interventions such as drugs, diet, or surgery. [Chapter 4] - [Treatment modalities] - Psychiatric home care: community-based treatment modality. Medicare requires that four elements be met in order for these services to be reimbursed: (1) homebound status of the patient, (2) presence of a psychiatric diagnosis, (3) need for the skills of a psychiatric registered nurse, and (4) development of a plan of care under orders of a physician or advanced practice registered nurse. Medicare allows two groups of healthcare providers to be involved in psychiatric home care. They are social workers with a master's degree and psychiatric registered nurses. Social workers provide counseling and medical social services such as linking people with necessary healthcare and services. - Patient-centered medical homes (PCMHs) or primary care medical homes: The focus of care is patient centered and provides access to physical health, behavioral health, and supportive community and social services. Patients are provided with a range of support for preventive care, acute care, chronic disease management, and end-of-life issues. - 1\. Patient centered---Care is relationship based with the patient and takes into account the unique needs of the whole person. The patient is a core member of the team. - 2\. Comprehensive care---All levels (preventive, acute, and chronic) of mental and physical care are addressed. Physicians or advanced practice nurses lead teams that include nurses, physician assistants, pharmacists, nutritionists, social workers, educators, and care coordinators. - 3\. Coordination of care---Care is coordinated with the broader health system, such as hospitals, specialty care, and home health. - 4\. Improved access---Patients are not limited to Monday through Friday from 9 a.m. to 5 p.m. to get the care they need. In addition to extended hours of service, these homes provide e-mail and phone support. Electronic communication (e.g., follow-up e-mails and reminders) and record keeping are viewed as essential aspects of this process. - 5\. Systems approach---Evidence-based care is provided with a continuous feedback loop of evaluation and quality improvement. - Community mental health centers: provide emergency services, community/home-based services, and outpatient services across the lifespan. Common treatments include medication prescription and administration, individual therapy, psychoeducational and therapy groups, family therapy, and dual-diagnosis (mental health and substance use) treatment. - Assertive community treatment (ACT): work intensively with patients in their homes or in agencies, hospitals, and clinics---whatever settings patients find themselves in. Creative problem solving and interventions are hallmarks of care provided by mobile teams. The ACT concept takes into account that people need support and resources after 5 p.m. Therefore, teams are on call 24 hours a day. - Intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs): They provide structured activities along with nursing and medical supervision, intervention, and treatment. These programs tend to be located within general hospitals, psychiatric hospitals, or community mental health facilities. Meet M-F for 6hrs - Telepsychiatry: a subset of telemedicine, is providing therapy and even prescription services from a distance, usually through videoconferencing. - [Behavioral crisis] - When the pt is a danger to themselves or others. - [Prevention] - Primary prevention occurs before any problem manifests and seeks to reduce the incidence or rate of new cases. - Secondary prevention is also aimed at reducing the prevalence of psychiatric disorders. Early identification of problems, screening, and prompt and effective treatment are hallmarks of this level. While it does not stop the actual disorder from beginning, it is intended to delay or avert progression. - Tertiary prevention is the treatment of disease with a focus on preventing the progression to a severe course, disability, or even death. Tertiary prevention is closely related to rehabilitation, which aims to preserve or restore functional ability. - [Purpose of emergency psychiatric admissions] - The primary goal in emergency services is to perform triage and stabilization - [Patient rights] - Right to be treated with dignity - Right to be involved in treatment planning and decisions - Right to refuse treatment, including medications - Right to request to leave the hospital, even against medical advice - Right to be protected against harming oneself or others - Right to a timely evaluation in the event of involuntary hospitalization - Right to legal counsel - Right to vote - Right to communicate privately by telephone and in person - Right to informed consent - Right to confidentiality regarding one's disorder and treatment - Right to choose or refuse visitors - Right to be informed of research and to refuse to participate - Right to the least restrictive means of treatment - Right to send and receive mail and to be present during any inspection of packages received - Right to keep personal belongings unless they are dangerous - Right to lodge a complaint through a plainly publicized procedure - Right to participate in religious worship - [Therapeutic milieu ] - refers to surroundings and physical environment. In a therapeutic context, it refers to the overall environment and interactions within that environment.. It is an all-inclusive term that recognizes the people (patients and staff), the setting, the structure, and the emotional climate as important to healing. Structured aspects of the milieu include activities, rules, reality orientation practices, and environment. - [Multidisciplinary Approach ] - A multidisciplinary team facilitates group therapy, individual therapy, other therapies (e.g., art and occupational), and medication management. - Involves a team- MD, psychologist, psychiatrist, social worker, nurses, etc. Chapter 36 - [Conventional and integrative health care] - Conventional healthcare is a system of care in which healthcare professionals such as nurses, doctors, pharmacists, and therapists treat symptoms and diseases with drugs, surgery, and radiation. - Integrative care places the patient at the center of care, focuses on prevention and wellness, and attends to the patient's holistic needs, including the physical, mental, and spiritual - [Natural or herbal products]- benefits and contraindications - Ginseng: - Contraindications: do not use with anticoagulants as ginseng may increase the effectiveness. - Kava: used for anxiety and insomnia - Contraindications: may be hepatotoxic - St. Johns Wort: MDD - Contraindications: Do not use with SSRI's as it can cause serotonin syndrome.Can affect metabolism of birth control and HIV medications. - [Mindfulness based interventions] - Mindfulness-based interventions have been increasingly useful in conditions such as depression, anxiety, and chronic pain. - Yoga, exercise, acupuncture, manipulation therapy. - [Homeopathy vs naturopathy] - In homeopathy, small doses (dilutions) of specially prepared plant extracts, herbs, minerals, and other materials are used to stimulate the body's defense mechanisms and healing processes. Homeopathy is based on the law of similars, meaning like cures like. - Naturopathy emphasizes health restoration rather than disease treatment, and a naturopathic physician may combine nutrition, homeopathy, herbal medicine, hydrotherapy, light therapy, therapeutic counseling, and other therapies. The underlying belief is that the individual is responsible for recovery.