2009 study guide Flashcards
(105 cards)
1
Q
what is mental health, what does it consider and what does it include?
A
a component of wellbeing
a dynamic state
The ability to cope with and bounce back from adversity, to solve problems in everyday life, manage when things are difficult, and cope with everyday stressors.
Mental health is made possible by supportive social, friendship and family environments, work-life balance, physical health and in many instances, reduces stress and trauma.
Having good mental health, or being mentally healthy, is more than just the absence of illness, rather it’s a state of overall wellbeing.
considers:
>how we feel about ourselves
>how we interact with others and the world around us
>personal growth and development
includes:
>being able to work productively and contribute to community life
>interacting with others and the environment in ways that promote subjective wellbeing and optimise development and use mental abilities
2
Q
what is wellbeing, what does it incorporate, what are it’s aspects and what is it influenced by?
A
Judging life positively and feeling good.
The balance point between an individual’s resource pool and the challenges faced
incorporates:
>enjorment of life
>ability to cope with and bounce back from stress and sadness
>being able to set and fulfill goals
>capability to build and maintain relationships
aspects:
- evaluative wellbeing or life satisfaction
- hedonic wellbeing - feelings of happiness, sadness etc
- eudemonic wellbeing - sense of purpose or meaning of life
influenced by:
>culture
>living conditions
>sociaio-political context
3
Q
what is mental illness, how is it diagnosed, what do they include?
A
a health condition that has a negative effect on the way an individual >thinks >feels >behaves >interacts
a general term that refers to a group of illnesses
diagnosed based on standardized criteria
include: >mood and anxiety disorders >eating disorders >psychotic disorders >personality disorders >PTSD >substance use disorders
4
Q
what is the biopsychosocial model of health?
A
a model that presumes that it is important to consider these 3 factors together then understanding and managing the problems
- biological
>physical health, neurochemistry, metabolic disorders, genetic vulnerability, immune/stress response, comorbidity - social and environmental
>peer groups, work, school, culture, socio-economic status, family circumstances - psychological
>self-esteem, attitudes/beliefs, perceptions, temperament, social skills, coping skills
5
Q
what is entailed in the socio-ecological understandings of health?
A
from 1-4 from most difficult to change to the easiest
- the person
>individual skills and circumstances - immediate environment
>connection, context, practical resources
>who is the individual directly connected to - eg. family, close friends, the house you live in, the school you go to, access to food and water etc. - indirect environment
>addressing stigma, social mobilisation
>the attitudes and stigma in the community that impacts you
>we promote health by addressing stigma and social mobilisation - wider context
>advocacy and activism
>government policies (access to childcare), subsidised medication, available resources, global warming
6
Q
what is a therapeutic relationship and its key aspects?
A
the relationship between a healthcare professional and a client or patient.
the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client.
key aspects include: >understanding and empathy >being there >individuality >providing support >demonstrating respect >clear boundaries >self awareness >beinggenuine >promoting equality
7
Q
why is a therapeutic relationship relevant to mental health and wellbeing?
A
therapeutic relationships are at the core of mental health nursing.
is required to: >perform assessment >provide non-judgemental care >encourage therapeutic engagement >implement therapeutic interventions >increase the efficacy of any nursing intervention in the acute mental health setting
8
Q
what is the difference between mental health and wellbeing?
A
mental health is a component of wellbeing that exists in the context of overall wellbeing. they can impact each other and there are also times where there are distinctions.
mental health is about the psyche only, wellbeing is about the whole body.
9
Q
what are risk and protective factors?
A
risk factors - things that increase the likelihood of illness or decrease health
> individual - disability, loss, genetics
family - expose to trauma, conflict, isolation
community - unemployment, discrimination, poverty
structural - social disadvantage, inequitable policies, war
protective factors - things that enhance people’s ability to cope, reduce exposure to risk or lessen the impact of disadvantage
> individual - personal resilience, temperament, self-esteem
family - supportive relationships
acceptance
positive attachment
community - access to education, sense of belonging, engagement in meaningful activity
structural - access to resources, cultural belonging, supportive government policies
10
Q
how do nurses use therapeutic relationships?
A
> develop self-awareness and using aspects of our personality, values, feelings and perceptions to establish relationships with patients
> engagement with people as a human, listening, connection a supporting
11
Q
what are some techniques to help develop a therapeutic relationship?
A
> establish shared goals
> devlop positive mutual trust, confidence and acceptance
> validation
> speak the patient’s language
> be respectful, curious, honest, and transparent
12
Q
how do we promote wellbeing?
A
by following health promotion principals
>provide people with skills and knowledge required to empower them to take control over their own health
13
Q
how do we enact self-compassion?
A
> not being too critical when you make a mistake - acknowledge that everyone makes them
> take time off for reflection/mindfulness - focus on the here and now
> recognize that there is more to life than what you’re thinking about
> pressure hobbies/interests that you enjoy - exercise, reading, cooking, eating, watching TV
> set small goals
14
Q
what is self-compassion?
A
> accepting that we are all failable and capable of making mistakes and being able o acknowledge and accept that
> higher levels of self-compassion are related to better wellbeing. being overly self-critical can negatively impact wellbeing
15
Q
what are the principles of health promotion?
A
components:
1. healthy public policies
>remove structural barriers and inequalities
>equitable distribution of resources
- creating a healthy environment
>safe and enabling spaces, free from violence and discrimination
>promotion of connection, growth, and wellbeing - strengthening community action
>collaborative action
>supportive stakeholder engagement - reorienting health services
>focusing on prevention, and socioecological approaches to mental health, diversity roles and settings - developing personal skills
>education, information, early identification and health literacy
16
Q
consider nursing strategies that promote health to prevent illness
A
?
17
Q
how do we promote health in infants?
A
- the person
>infants are linked to the parent/caregiver context
>ensuring access to universal health screening and antenatal/postnatal care
>immunisation and health screening - immediate environment
>promoting attachment, responsive parenting and play
>ensuring access to safe places to sleep and play as well as adequate food and nutrition
>reducing exposure to adversity within the familial unit
>promoting breastfeeding, safe sleep and clean air
3. indirect environment >community campaigns >accessible services >professional collaboration >social cohesion and community connection
- wider context
>recognition of parenting and children in policy (childcare, paid leave, family support etc.)
>cultural and social beliefs about families, parents and child rights
18
Q
how do we promote health in children?
A
1. person >immunisation >screening >emotinoal regulation >coping skills >resillience programs >attachement >sleep and nutrition
2. immediate environment >family support >kinship >parenting support >child safety in the home and family > neighborhood watch >DV screening >protective factors >exposure to danger
3. indirect environment >access to parks, transport, preschool, school, OOSH, health screening >teacher training and support >community nurses, appropriate services >school curriculum and programs >cross sectoral collaboration >bullying campaigns
4. wider context >child rights >climate >national policy >education >pollution and environments >child protection systems
19
Q
how do we promote health in adolescents?
A
1. person >social media >slef esteem programs >alcohol, drugs safe sex info >emotional regulation strategies >identity acceptance and expression >exercise, diet, sleep >psychoeducational >screening
2. immediate environment >family support >responding to emotions >support during transitions >peer influences >trusted adults >boundaries and safety >freedom/limits >access to education
3. indirect environment: >psychology/therapy services >social media regulation and safety >school climates and culture >bullying programs >multimodal support services
4. wider context >safe communities >policies to promote agency >lack of violence and crime >accessto education and employment pathways
20
Q
how do we promote health in adults?
A
- person
>what are their roles within the family/community
2. immediate environment >psychology/therapy services >social media regulation and safety >school climates and culture >bullying programs >multimodal support services
- wider context
>access to employment, health care and welfare
21
Q
how do we promote health in older people?
A
1. person >screening >sleep >diet >phsyical health >meaningful activity >cognitive support
2. immediate environment >family connection >grief and loss support >changin roles >values and individuality respected >sharing of story >self determination and control
3. indirect environment >appropriate care >skilled workers >awareness of mental health >meaningful activities >community and social activities >cultural and religious awareness
4. wider context >stigma >respect >social policy >aged care systems (funding/nurse availability) >access to natural environments
22
Q
what are the contemporary understandings/theories of resilience?
A
> the ability to cope with adversity, to “bounce back” or to positively adapt to stress adversity
often used to refer to things individuals can do when they experience challenges
>implies that some people have characteristics that make them more resilient than others
theories:
>innate resilience theory - some are and some aren’t
>toughen up theory - resilient is a bi-product of adversity. moderate exposure facilitates resource but too much can overwhelm
>back in my day theory - something to be taught and learnt. developmental process. learnt over time
>return to normal theory - resilience is a form of coping and a way of getting back to usual functioning
>continuum theory - resilience is at one end and vulnerability is at the other.
23
Q
why is self compassion important for nurses?
A
> vital to avoid burnout - a consequence of someone feeling their abilities to create positive change or have a positive role is diminished
> ability to be compassionate is diminished without self-compasion - people become cruel and sarcastic when talking about patients, colleagues, themselves and their job
>the nurse’s whole role is to show compassion!!
> lack of self compassion causes a lack of drive for achievement, resulting in feelings of frustration and lack of patience
24
Q
what is the nurse’s role in relation to health, wellbeing and illness?
A
> A nurse is a caregiver for patients and helps to manage physical needs, prevent illness, and treat health conditions. To do this, they need to observe and monitor the patient, recording any relevant information to aid in treatment decision-making.
> encourage patients and their families to participate in decision-making related to treatment or to discuss and express their feelings about situations associated with serious illness
25
what is coping?
cognitive and behavioural efforts to manage external and/or internal situations that exceed or overwhelm individual resources thus helping to achieve wellbeing
>ie. things we do to overcome adversity
1. we can modify the problems (active)
2. we can regulate our responses (passive)
26
how can nurses promote resilience?
1. view people as resilient - how we think about people affects how we talk to them and about them
2. identify and work with strengths within the individual and within their wider context
3. cultivate positive emotions
4. support hope - more important for adolescents upwards
5. identify coping strategies and frame them as such
6. try gentle cognitive reframing
7. fostering connection
8. support holistic health
9. with children - positive relationships with adults, support parenting, self-regulation skills and coping, connection and belonging, engagement with things
27
what is mental health promotion and its components?
thinking about why someone is doing something and what strengths and weaknesses they have as well as what resources they have access to and what motivates them to improve their mental health
the enhancement of the capacity of individuals, families, groups, or communities to strengthen or support positive emotional, cognitive, and related experiences.
28
how is mental health promotion different from mental health treatment?
mental health promotion is a largely preventative approach to increasing protective factors and reducing risk factors that may otherwise impact negatively on one's mental health whilst mental health treatment occurs secondary to diagnosis
mental health treatment is a component of mental health promotion (secondary prevention where in which primary prevention has lead to early diagnosis of a mental illness and treatment can be commenced to prevent more serious problems from developing)
29
why are engagement and connection important?
>engagement provides the meaningful purpose and a sense of connectedness throughout the life course
>remaining engaged in the present through connections with family and friends and pursuing an interest
>mediates sadness through bereavement
>provides access to supportive informal social networks
>strong intergenerational connections provided a sense pf being valued
30
what is empathy and how do we display it?
>putting yourself in someone else's shoes. the ability to understand other people's emotions. skills that you learn and develop over time affected by personally/emotional intelligence
>in order to display empathy, you need to be able to listen actively and be self-aware.
1. don't always offer answers of telling people what to do,
2. repeat back what we're hearing
3. perspective-taking
4. staying out of judgment
5. recognizing emotions in other people
6. communicating emotion
31
how do we build therapeutic relationships?
>will assist the nurse in understanding the patient's preferences regarding their environment, enabling them to feel safe and to trust in the care being provided
32
what is cultural safety and how can nurse practice it?
the effective nursing practice of nursing a person or family from another culture; it is determined by that person or family.
1. respecting the culture of the community by using appropriate language and behavior
2. never doing anything that causes the person to feel shame
3. supporting the persons right to make decisions about seeking culturally based care
33
what is humility?
>the quality of being humble
34
what is recovery?
>gaining and retaining hope, understanding of ones abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life, and a positive sense of self.
35
what are the relationships between recovery, nursing, and family?
>working with family can improve outcomes for clients and decrease stress for family members
>mental health is embedded with wellbeing and see of self. it is not possible to treat someone's mind without recognizing how this affects and is affected by their context
36
what do service users identify as desirable qualities of a mental health nurse?
>emoathy
>compassion
>effective communication
>knowledge of other health services
>hopeful
>non-judgemental
>fostering hope
37
why is empathy important?
>it is essential to effective treatment in recovery-oriented practice
>essential to facilitate engagement and build trust in therapeutic relationships
38
how might a nurse display cultural safety and humility/what do they need to think about?
cultural safety:
>respecting the culture of the community by using the appropriate language and behavior
>never doing anything that causes the person to feel shame
>supporting the person's right to make decisions about seeking culturally based care
humility:
>Ask for assistance when needed.
>View support as an opportunity to gain new knowledge.
>Admit when you make a mistake
39
what is relational recovery?
>a social process occurring through relationships particularly those with family
>an intrinsically social and relational process founded on people's independence on each other
>people are relational beings and their lives cannot be separated from the social contexts they are in
40
how can nurses engage with families?
> recognize the importance of relationships, roles and family in people's lives
>be welcoming, greet family and ask ho they are
>ask if they need any information - about how the service works if they know who to contact for one information, about the illness, etc.
>ask if they know about family/carer support organizations - offer to facilitate contact
>talk to consumers about their family. find out who they identify as important, who is supportive, and who is not
>remember that consumers and family may have disagreements/conflicts and. that consumers may not want the family to know information about them
41
how do we engage with people?
>be open
>non-judgemental
>ask for patient opinions
>acknowledge patient experiences
>enoucrga patients to share their experiences and knowledge
>adopt a partnership approach
>ask questions and be curious but also respect boundaries
42
what is a mental illness?
>a general term that refers to a group of illnesses
>a health problem that significantly affects how a person thinks, feels, behaves, and interacts with other people
>encompasses a wide range of signs. symptoms, experiences, and disorders
>dian=gnosed according to the Diagnostic and Statistical Manual of mental Disorders
43
what are some common mental illnesses?
>>mood and anxiety disorders
>eating disorders
>psychotic disorders
>personality disorders
>PTSD
>substance use disorders
44
what is personal recovery?
>a personal view of recovery is viewed as a journey that is a unique and personal experience for each individual
>abut gaining and retaining an understanding of one's abilities and limitations, engagement in active life, personal autonomy, social identity, meaning and purpose in life, and a positive sense of self
>a life journey of living a meaningful and satisfying life
45
what are some settings that mental health care might be provided in?
>primary health care settings - eg. headspace, GP
>non-governemtn organisations
>hospital - general units and specialist units, ICU, forensic units (adolescent, early psychosis, older people's perinatal, family, assertive outreach, aboriginal mental health)
>community settings - continuing care or acute/crisis (home-based care, traditional care, sustained care, liaison, collaborative care planning, advanced care, advocacy etc.)
>public or private system
46
how is personal recovery relevant to nursing?
we need to practice recovery-oriented practice to facilitate personal recovery!
>understand illness and health from the person's perspective, including their concerns, expectations, strengths, resources, and hopes. otherwise, we cannot possibly work towards recovery
>come to a shared understanding of the person's narrative with the person. this doesn't mean uncritical acceptance of what they believe, neither does it mean negotiationnu of their perspective
>focuses on building trust, being curious, and thinking about the meaning
47
what is the role of nurses in the mental health setting?
>konwledge and skills to promote and empowerment and resilience
>help patients to acknowledge their internal and external resources
>provide solution-focused approaches to communication in every nurse-patient interaction to emphasise strengths
>create positive and enabling nursing relationships
>strengthen self belief and self-esteem
>advocate, empower, connect and collaborate
>help people to identify things meaninful to them, foster hope for the future, identify reasons to live well, improve overall wellbeing
48
why is sleep important for mental health nurses?
>impaired sleep negatively impacts one's ability to be empathetic
>impaired sleep results in impaired emotional intelligence such as self-insight, perspective-taking, and relationship-enhancing behaviors
>sleep impairment leads to decreased ability to recognize emotions
>impaired sleep. leads to increased perceived unpleasantness to others experiencing pain
>poor sleep is associated with lower self-compassion, cross-cultural empathy, and mindfulness
>emotional processing can be compromised by insufficient sleep
49
why. do nurses need compassion?
>vital to the formation and maintenance of nurse-patient relationships
50
how do self compassion and sleep support wellbeing?
>sleep plays a critical role in overall health, wellbeing, and daytime functioning
>decreased sleep is associated with lower self-compassion and mindfulness
51
how does our own wellbeing impact others' wellbeing?
>poor overall wellbeing affects our self-compassion which can lead to burnout and an inability to be compassionate towards others
52
understand CHIME
```
1. connectedness
>peer support and social groups
>relationships
>support from others
>community
```
```
2. hope and optimism
>belief in recovery
>motivation to change
>hope-insiring relationships
>positive thinking and valuing effort
>having dreams and aspirations
```
3. identity
>rebuilding a positive sense of identity
>overcoming stigma
4. meaning
>meaning in mental health experience
>meaningful life and social roles
>meaningful life and social goals
5. empowerment
>personal responsibility
>control over life
>focusing upon strengths
53
how does personal recovery differ from medical recovery?
traditional:
>expectations of treatment and clinical outcome
>treatment is aimed at symptoms and functioning
>clinical outcome
personal recovery:
>personal aims and hopes for treatment and recovery (wellbeing, meaningful activity, and roles, purpose, and life goals)
>treatment aimed at wellbeing, activity, and social roles
>wellbeing, positive self-identity, meaningful roles and activities, sense of connectedness, a meaningful life
54
what is recovery-oriented practice and what does it involve?
the application of sets of capabilities that support people to recognize and take responsibility for their own recovery and wellbeing and to define their goals, wishes, and aspirations.
involves:
1. collaborative partnership-based approach
>therapeutic engagement based on respect, dignity, and non-judgment
>promote self-determination and autonomy
2. strengths-based approach
>focus on identifying and building on existing strengths
>positive hopeful attitude -change is inevitable
3. psychoeducation and self-management strategies
>build knowledge and skills
> recognize reciprocal nature of learning and development
>peer support
4. increase access and connection to natural supportive community resources
> prioritize the use of natural community resources
>connection and participation within the community
55
what types of distress exist?
?
56
how might we recognise distress?
```
>crying
>agitation - pacing, frown
>facial expression
>eyes darting around
>closed body language
>legs bouncing
>on edge
>withdrawing or seeking company
>shutting down/dissociating
```
57
how do we mindfully respond to distress (specific and general)?
1. mindful presence - attending and responding, acknowledging, observing verbal and non-verbal cues
2. speculative statements - "I wonder if...", "would you mind if..."
3. tolerating silence - calm your own inner panic
4. grounding - "I am here". "you are safe here"
5. directing without ordering "lets try..." "how about we..."
6. coupling - couple with peoples' ideas and agree " feel like I'm carrying the weight of the world" "yes, it feels like the weight o the world is on you"
7. amplification - amplify the feeling amongst words "i can't talk to anyone" "how awful it would be not to be able to talk to anyone"
8. representation - represent to content in feelings "there is no point" "no one understands so it feels useless"
9. language matching - use and extend their language "i feel like i could just float away" "i wonder when you will float back down"
10. responding to vitality - hold on to moments of spark "i love the beach but i cant go there anymore". "you love the beach"
58
how can relational mindfulness help us as nurses?
can help nurses develop skills to manage clinical stress and improve their health; increase overall attention, empathy, and presence with patients and families; and experience work satisfaction, serenity, decreased incidental overtime, and reduced job burnout
59
how do we assess mental health and illness?
>interviews, engagement and therapeutic support and direct observation
>mental health history, biographical history, substance use history, collaborative history, risk assessment, strengths-based assessment, mental state assessment
60
describe. the mental state examination
>forms a part of the comprehensive mental health assessment or can stand alone
>completed on admission, during treatment, prior to discharge and is reassessed over time
>used to determine changes in patterns of thinking, feeling and behavior over a period of time
61
what is the purpose of mental health assessment?
>used to determine changes in patterns of thinking, feeling and behavior over a period of time
62
what kinds of things does mental health assessment include?
1. appearance and behavior
2. mood and affect
3. speech
4. thought-form and content
5. perception
6. orientation, cognition and sensorium
7. memory
8, insight and judgment
63
what is the purpose of the MSE?
to determine changes in patterns of thinking, feeling and behaviour over a period of time
>to organise data about a person's current mental state/functioning
64
what are some of the key messages in the RoL guide?
?
65
why is the RoL guide important?
?
66
what are the experiences and presentations of mood disorders and anxiety disorders?
anxiety disorders can affect mood.
examples of mood disorders:
>depression - anger, sadness, abdominal pain, sleep disturbance, confusion, poor concentration, aggressiveness, irritability
>mania - elation or euphoria, irritability, sexual overactivity, mystical experiences, irresponsibility
>bipolar disorder
```
examples of anxiety disorders:
> generalized anxiety disorder
>social anxiety disorder
>panic disorder
>rapid breathing, nausea, unrealistic or excessive worry, decreased concentration, guilt, hopelessness, avoidance of social situation, obsessive or compulsive
```
67
how do nurses support people with depression or mania?
depression:
>physical state
>monitor diet/food intake - company during meals, preferred foods, frequent small meals
>promote sleep - encourage activity/exercise, scheduled rest periods/ no day naps
>assist with self-care - assist with bathing/dressing, promote independence, don't rush
>psychological state
>make a positive decision, use problems solving techniques, modify/reframe negative thinking, examine the accuracy of perceptions, use orienting information, give time/don't rush
> behavior
>monitor activities and social interaction - brief frequent contact. don't overwhelm with expectations around communication and engagement, focus on the ability to accomplish tasks and be productive, involve in activities where they can enjoy success, activity scheduling
>prevent injury - lack of energy, diminished concentration and fatigue all increase falls risk - monitor the environment, schedule low-risk activity, and plan activities according to the energy level
mania:
>physical state
>monitor dietary and fluid intake - prompts to eat/drink, nutritional snacks and drinks
>promote sleep - encourage rest periods and relaxation before bed, low environmental stimulus, and monitor for signs of fatigue
>assist with self-care - assist in maintaining hygiene, grooming, selecting clothes
>psychological state
>be consistent, engage in reality-based and concrete activities, assist a person to gain control over their thoughts, evaluate problems, identify realistic goals, improve focus and clarity of thoughts, slow down
> behavior - provide a safe environment with low stimulation and reduced clutter
medication:
>it takes several weeks for antidepressants to come into effect and side effects can be prominent in those weeks - make sure you try to maintain hope
>provide support and maintain hope and manage symptoms when waiting for pharmacological relief
>assist with strategies to manage side effects
68
what is depression (give types, symptoms and how they may affect functioning and experience)?
>a mood state characterized by lowered mood, and loss of interest or pleasure in activities.
3 types of depression:
1. mild - exaggeration of normal unhappiness. some difficulty continuing normal activities
2. major depression - unable to continue school, work or domestic activities except to a very limited degree
3. dysthymia - persistent depressive mood 2 years+ resulting in distress or impairment
symptoms:
>changes in appetite - can affect social life and cause weight loss or gain
>insomnia/hypersomnia/fatigue/loss of energy - alters interpersonal communication skills which can lead to changes in social life causing isolation
>feelings of worthlessness or excessive guilt
>diminished ability to think or concentrate - can negatively impact school/work performance
69
what is anxiety (give symptoms and how they may affect functioning and experience)?
>a future-oriented mood state associated with cognitive, physiological, and behavioral reactions designed to reduce the level of perceived danger within a situation
>incorporates fear( experienced in the present) and worry (thinking about the past/future)
symptoms:
>headache, diarrhoea, chest pain and tremors - can significantly impact on daily functioning
>easily distracted, decreased concentration, forgetfulness - can negatively affect work or school
>oversensitivity, anger, irritability - can negatively affect relationships
>avoidance of social situation - can negatively affect social life
70
what is bipolar disorder (give types, symptoms, and how they may affect functioning and experience)?
bipolar 1 disorder:
>the person experiences 1+ lifetime episodes of mania and usually depression
>severity and duration are often severe and may result in hospitalization
bipolar 2 disorder:
>the person experiences episodes of both hypomania and depression but no manic episodes
>severity does not typically lead to hospitalization
symptoms:
>lack of shame or guilt - can negatively affect relationships
>inadequate nutrition and less need for sleep - can have negative physical consequences without the individual even realizing
>ambitiousness and denial or realistic danger - can negatively impact work and school
>grnadioise acts - can affect public perception
71
what is panic disorder (give symptoms and how they may affect functioning and experience)?
>unpredictable and intense episodes of anxiety that occur in the form of panic attacks
symptoms:
>intense and uncontrollable anxiety and fear - can significantly affect mental health and ability to socialize
>fear of future panic attacks - causes dependence on others and avoidance of high-risk situations
72
how do we assess someone with depression, bipolar, anxiety, or panic disorder?
1. be curious
>be familiar with features across the lifespan
>never assume you know what is happening for another person
>develop systematic questions about severity, duration, distress, and associated symptoms
>use the person's own language (ie. age-appropriate)
2. be aware
>these experiences can be normal reactions to a difficult situation
>people will respond differently to different exposures
>many factors will contribute to these experiences
>eg. presence of other medication issues may be mistaken for anxiety
>eg. exposure to trauma
>eg. substance/medication misuse/withdrawal
>eg. ongoing stress
73
what are some verbal de-escalation skills?
>calm, gentle, soft tone
>tactful language
>talk slowly so the person has time to process and react rationally
74
how do experiences of individuals affect their personality (including personality disorders)?
>trauma is a contributing factor to the experience of severe anxiety - eg. migration, Aboriginal people
>experiences you have as a child affect your development as a young adult/adult and therefore shape your personality - ie. how you think and respond the certain situations
>people with personality disorder have developed their traits to protect themselves and get their needs met
>there is a significant relationship between bipolar and childhood trauma
75
think about how suicide and self harm might affect an individual?
?
76
what nursing approaches might be used when someone has suicidal or self harming tendencies?
1. holistic approach
>risk assessment tools should not replace meaningful discussion
>focus on needs assessment
>use conversation and view the individual holistically within their psychosocial context, empower them to access help, reduce stress, and maximize protective factors
2. build a positive working relationship with the person
>be aware the person is vulnerable
>be non-judgemental and supportive
>reach a shared understanding of the person's thoughts/behaviors
>view them as an individual with their own reasons to self-harm or attempt suicide
3. communicate respectfully
>tone fosters hope and optimism - don't be condescending or stigmatizing
>keep the focus on the individual and their story
4. support independence and decision making
>consider items that can be taken into the inpatient unit if possible - personal belongings help people to stay connected to things important to them
>identify who is part of their support network and encourage visitation and ongoing support
5. promote recovery and build resilience
>help the person develop self-management skills
6. support in times of transition
>follw-up with people who are discharged or between services
>communicate with other services
>keep family in the loop
7. work collaboratively with family and friends
>provide support and education on how to manage their own needs
>listen to family as an important resources regarding the person's life stressors, behavioural changes and available support
8. stay healthy yourself
77
how might nurses contribute to recovery from suicide/self-harm?
>help the individual to share their story
>seek to identify what the person needs rather than focus solely on assessing risk
>be able to identify psychosocial risk factors that may help us to understand a person's feelings and behaviors
>work with the person to explore their strengths and resources
>combat ignorance and stigma
>have knowledge of risk and protective factors
>reflect on and challenge their own assumptions
>effectively communicate
>collaborate with the person of concern and their family
78
what are some basic de-escalation techniques?
1. be open, honest, supportive, non-judgemental and confident without appearing arrogant
2. express genuine concern for the person, be non-threatening, and have a permissive, non-authoritarian manner
3. build trust and empathize
4. use strategies to help contain your own anxiety - focus the attention on assessment, acknowledge the feelings of fear
5. use calm, gentle tone, speak slowly and use tactful language
6. use eye contact and non-threatening body language where appropriate
7. take support with you and assess the area for potential weapons
8. encourage relocation to a quiet space or get other people to leave the room
79
how might personality be affected by childhood trauma?
>there is a strong link between experiences of bipolar personality disorder and childhood trauma
>some studies show that childhood trauma and neglect can change the structure of the brain, leading to schizophrenia
80
what is the difference between self-harm and suicide?
self-harm
>intentional direct injuring of the body tissue without intention to cause own death
suicide
>deliberately/intentionally causing one's own death
81
why might people partake in suicide or self-harm?
suicide:
>suicidal thoughts consistently present over an extended period of time
>unable to contemplate life continuing
>beliefs that others will be better off without me
>feelings of ongoing hopelessness
>well thought through and considered plan to end life
self-harm;
>frustration, anger, low self-esteem, distress
>way of communicating distress
>way of coping with negative feelings - problematic interpersonal communication
>response to underlying beliefs and negative coping strategy
82
how might a nurse ask about an individuals' suicidal/self-harming behaviours?
?
83
what are the challenges, and approaches to assessing and documenting risk?
approaches:
>look for particular attributes, characteristic and behaviours regarded as signs of potential risk
>this is then structured into categories of risk in order to communicate the observation and its significance to others
>this ten influences the level of care, surveillance and response delivered
includes:
>consideration of static (will not change) factors
>current or historical factors statistically associated with risk
>clinical judgement and intuition
challenges:
1. suicide is very confronting
2. iatrogenic risks are often considered
3. a focus on risk can lead to increased coercive care
4. people are expected to engage and recover while being scrutinised for risk
5. we are not very good at predicting risk
84
what is the role of the nurse when planning for safety?
ask the individual:
1. what are things that help you feel safe?
2. what can you do? what can others do? what can I do?
3. what helps you when you feel distressed?
85
what are some types of psychotic illnesses?
>schizophernia spectrum
86
what is the nursing role when supporting people who experience psychosis?
recovery-oriented approach:
1. collaborative partnership-based relationship
>therapeutic engagement based on respect, dignity, and non-judgment
>promote self-determination and autonomy
2. strengths-based approach
>focus on identifying and building on existing strengths
>opostivie hopeful attitude - change is inevitable
3. psychoeducational and self-manegement strategies
>build knowledge and skills
> recognize reciprocal nature of learning and development
>peer support
4. increase access and connection to natural supportive community resources
> prioritize the use of natural community resources
>connection and participation within the community
87
consider the experiences of people who have a diagnosis of schizophrenia
>hallucinations
>delusions
> disorganized speech
> disorganized behaviour
>anhedonia - loss of interest in pleasurable activities
>avolition - lack of motivation for goal-directed behaviour
>flat affect
>poverty of speech - reduced verbal output
>decline in self-care
>social isolation
>poor engagement with primary healthcare services
88
what is self-stigma?
a person with a mental health diagnosis becomes aware of public stigma, agrees with those stereotypes, and internalizes them by applying them to the self
89
why do people with a mental illness experience public and self-stigma?
public stigma refers to the negative attitudes held by members of the public about people with devalued characteristics. people with mental illness suffer this because uneducated people are not understanding and tend to be judgemental.
self-stigma occurs when people internalize these public attitudes and suffer numerous negative consequences as a result
90
what is psychosis (what are some symptoms and experiences of people diagnosed)?
>conditions that affect the mind, where there has become a loss of contact with reality
symptoms:
>bipolar affective
>depression
91
what is schizophrenia (what are some symptoms and experiences of people diagnosed)?
>schizophrenia is a serious mental disorder in which people interpret reality abnormally
```
symptoms:
>delusions
>hallucinations
> disorganized speech
>grossly disorganized or abnormal motor behavior (catatonia)
>negative symptoms
```
92
what are some experiences that people living with voices in their heads have?
>not being able to differentiate between your thoughts and the voices
>isolation.social stigma
>tiring
>intrusive - makes it diffu=icult to focus
>loss of identity - what is you and what is voices
>going to sleep
>feeling a lack of control/struggling for control
93
how might nurses support people who hear voices?
>be genuinely interested in people's experiences
>build hope - reframing understandings of recovery
>support people to access and consider ways to cope (eg. hearing voices network)
>support people with understanding, acceptance, and changing power
>support people to negotiate with their voices, profile their voices, and question beliefs that surround voices
94
what are some types of eating disorders?
1. bulimia nervosa
2. anorexia nervosa
3. OSFED (other specified feeding and eating disorders)
4. binge eating disorder
5, avoidant/restrictive food intake
6. PICA
>rumination disorder
>orthorexia nervosa
95
how might a nurse work with someone who has an eating disorder?
>build a therapeutic alliance
>understand the function of the eating disorder for the individual
96
what are some strategies for engaging people who hear voices?
>take time
>orient using environmental cues
>use clear, non-threatening, non-verbal communication
>speak slowly, calmly, and clearly
>use direct, straightforward language
>use the person's name as an anchor
>be self-aware, manage your own feelings and behaviors
>be patient and demonstrate accepting
>seek clarification, listen for themes and attend to feelings
97
why do people use drugs and alcohol and how does it affect. mental health, illness and wellbeing?
Drugs and alcohol change the way your brain and body work. They change the balance of chemicals that help your brain to think, feel, create and make decisions. If you're going through a tough time, it can be tempting to use drugs and alcohol as a coping strategy.
98
what are the professional and legal frameworks that impact mental health nursing and the types of care provided?
>NSW Mental Health Act
>professional standards
>eg. NMBA/AHPRA registered nurse standards for the practice
>criminal law
>state and local polices and procedures
99
what are some medications we use to treat mental health concerns (onset of action, side effects, mechanism of action) + the nursing role in supporting their use
>
100
what is the mental health act and what role does it play in mental health nursing?
sets out the circumstances in which persons with mental illness may be admitted to and treated in public hospital-based mental health facilities
>protects the rights of individuals unable to look out for themselves due to a mental health problem
>to ensure that patients with a mental illness don't end up in psychiatric facilities
>provides care in the restrictive sense
>if we didn't have an act, there would be around who can do what and when to a person with mental illness
>provides legal framework and parameters around the right of the state and people to intervene
>ie, sets out limits for how much we can intervene with someone's life
101
what do nurses need to think about when they engage with people (age, presentation, language, approach)?
?
102
what is the historical and current relevance of consumer/survivor/ex-patient movements (implications on nursing practice)?
?
103
why is it important to hear about consumer experiences?
?
104
what is the nursing role when collaborating with consumers in care?
?
105
critically consider seclusion and restraint as mental health treatments
?
