Mental Health
At least one reason someone may avoid seeking help for mental health issues
Public Stigma, Self Stigma, Label Avoidance
Legal act that provides protection against discrimination towards individuals with disabilities
American with Disabilities Act (ADA)
Define continuum of care
A continuum of care consists of an integrated system of settings, services, health care clinicians, and care levels, spanning illness-to-wellness states
–Provided over an extended time
–Across multiple organizations
–Maximizes the coordination of care
Theorist associated with psychoanalytic theory
Sigmund Freud
The nurse case manager knows case management is an example of which client care model?
A. The outcomes evaluation model of care.
B. The protocol management model of care.
C. The interdisciplinary care management model.
D. The risk assessment care management model.
Answer: C.
Case management is an example of the interdisciplinary care management model. Case management is the process of overseeing and organizing client care in collaboration with the client’s primary care physician or health care provider, consulting physicians, and ancillary care providers.
Type of recovery-orientated care model that aims for prevention of re-traumatizing individuals through recognizing indicators of trauma
What is trauma informed care
At least one reason someone may be involuntarily committed to a psychiatric unit
Mentally disordered
Dangerous to self or others, or
Unable to provide for basic needs
At least one example of coordination of care
Integration of appropriate services
Services tailored to patient’s strengths and limitations
No duplication of services
Collaboration among services
Case management, often by a nurse
Theorist associated with "the hierarchy of needs"
Maslow
The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, “How is Carol doing? She is my best friend and is seen at your clinic every week.” Which is the most appropriate nursing response?
1. “I cannot discuss any client situation with you.”
2. “If you want to know about Carol, you need to ask her yourself.”
3. “Only because you’re worried about a friend, I’ll tell you that she is improving.”
4. “Being her friend, you know she is having a difficult time and deserves her privacy.”
1.
Rationale: The nurse is required to maintain confidentiality regarding the client and the client’s care. Confidentiality is basic to the therapeutic relationship and is a client’s right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal client information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain client confidentiality.
What manual provides the criteria for diagnosis of a mental health condition
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
At least one example of "least restrictive" measures
Primary goal: Achievement of the highest level of functioning in the least restrictive environment
Patients have the right to refuse treatment
A person cannot be restricted to an institution when he or she can be successfully treated in the community
Medication cannot be given unnecessarily
At least one common barrier to recovery
-Poverty
-Homelessness
-Stigma
-Lack of services
Theorist behind the 8 stages of psychosocial development
Erik Erikson
On review of the client’s record, the nurse notes that the admission was voluntary. Based on this information, the nurse plans care anticipating which client behavior?
1. Fearfulness regarding treatment measures
2. Anger and aggressiveness directed toward others
3. An understanding of the pathology and symptoms of the diagnosis
4. A willingness to participate in the planning of the care and treatment plan
4.
In general, clients seek voluntary admission. If a client seeks voluntary admission, the most likely expectation is that the client will participate in the treatment program since she or he is actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee that a client understands her or his mental health problem, only the client’s desire for help.
Difference between implicit and explicit bias
Implicit Bias: Actions based on prejudice and stereotypes without intending to do so. This is an unconscious act or thought; however, it does show a familiar association.
Explicit Bias: Actions based on prejudice and stereotypes intending to do so. In this type people are very aware of their bias.
Define "Duty to warn"
When there is a judgment that the patient has harmed someone or is about to injure someone
At least two examples of mental health services in a continuum of care
-Crisis intervention
–23-hour observation, crisis stabilization
-Acute inpatient care
-Partial hospitalization
-Residential services
-Respite residential care
-In-home mental health care
-Outpatient care
–Intensive outpatient programs, supportive employment
Describe the difference between transference and countertransference
Transference is when the client redirects (transfers) an unconscious feeling, desire, or expectation from another person toward their therapist. In contrast to transference (which is about the client's emotional reaction to the therapist), countertransference can be defined as the therapist's emotional reaction to the client.
A client in the psychiatric unit is alert and oriented, but loud and verbally abusive to all health care personnel who enter the client’s room. Multiple staff members including the charge nurse have spoken to the client about the inappropriate behavior, but all attempts have been ineffective. The client has lorazepam (Ativan) IV ordered as needed for disorientation and agitation. Which client right would be violated if the nurse were to administer the medication to the client under these circumstances?
A. The client’s right to self-determination.
B. The client’s right to freedom from unreasonable restraint.
C. No client right is violated in this scenario.
D. The client’s right to considerate and respectful care.
Answer: B.
Administering lorazepam (Ativan), an anxiolytic, to an alert and oriented client because of verbally abusive behavior is an inappropriate use of the medication, thus violating the client’s right to freedom from unreasonable restraint.
At least two examples of social determinants of health
Economic Stability
Education Access and Quality
Health Care Access and Quality
Neighborhood and Built Environment
Social and Community Context
Which act requires patient authorization for the release of information with the exception of that required for treatment, payment, and health care administrative operations
HIPAA
Describe "Person-Centered Care"
-The person is actively involved in determining the best options for their health care circumstances
Requires:
-Person must be educated about the disorder and treatment options
-Collaboration skills to interact with the clinician
-Built on a strong nurse–patient relationship
-This approach shows improved engagement in health care and medication adherence
-Sense of connection based on caring, support, and continuity
Considered founder of psychiatric nursing
Hildegard Peplau
The Patient Self-Determination Act of 1990 mandates that all clients must be asked whether or not they have a(n):
A. Organ donation card.
B. Advance directive.
C. Last will and testament.
D. Funeral home or method of burial preference.
Answer: B. The Patient Self-Determination Act of 1990 mandates that all clients must be asked whether or not they have an advance directive. Organ donation card, last will and testament, and funeral home or burial preference are not included in the Patient Self-Determination Act.