Chapter 1 Practicing the Science and the Art of Psychiatric Nursing

Question 1

Three fundamental elements of patient advocacy include:

Answer 1

• To ensure that patients are informed of their rights in a particular situation, including the right to refuse treatment.
• To support patients and decisions they make.
• To protect patients, which includes reporting threats to their well-being

Question 2

Inherent in the responsibilities of advocating for patients include the following protections:

Answer 2

• Privacy
• Confidentiality
• Protection in participation in research
• Standards and review mechanisms
• Acting on questionable practices
• Addressing impaired practice

Question 3

Psychiatric–mental health nursing, a core mental health profession, employs a purposeful use of?

Answer 3

self as its art and a wide range of nursing, psychosocial, and neurobiological theories and research evidence as its science

Question 4

In psychiatry the evidence-based focus extends to treatment approaches in which there is scientific evidence for psychological and sociological treatment methodologies, as well as?

Answer 4

evidence related to the neurobiology of psychiatric disorders and psychopharmacology. Therefore evidence-based practice strives to decrease the gap between research and practice

Question 5

The mental health recovery model is more of a social model of disability than a?

Answer 5

medical model of disability. Therefore the focus shifts from one of illness and disease to an emphasis on rehabilitation and recovery

Question 6

The concept of recovery refers primarily to?

Answer 6

managing symptoms, reducing psychosocial disability, and improving role performance

Question 7

Holistic interventions are designed to increase recovery as evidenced by?

Answer 7

engagement in work and engagement in community/social life, as well as a reduction of symptoms

Question 8

The principles of the recovery model have been adopted by a number of countries and states. The focus of the recovery model has the following mandates:

Answer 8

• Mental health care is to be consumer and family driven.
• Care must focus on increasing consumer’s ability to be successful in coping with life’s challenges, facilitating recovery, and building resilience—not just managing symptoms.
• An individualized plan of care is to be at the core of consumer-centered recovery—recovery-oriented services that allow consumers to realize improved mental health and quality of life.
• Consumers must be partners in decision making in all aspects of care

Question 9

Her contributions went far beyond what she brought to the field of psychiatric nursing. She introduced the concept of advanced nursing practice and promoted professional standards and regulation through credentialing among a multitude of other contributions to nursing

Answer 9

Hildegard Peplau (1909 to 1999)

Question 10

The emergence of evidence-based nursing practice in the United States originated from the evidence-based practice movement in the?

Answer 10

medical community in England and Canada during the 1980s and 1990s

Question 11

The University of Minnesota defines EBP as

Answer 11

“the process by which the best available research evidence (from well-designed studies), clinical expertise, and patient preferences are used for making clinical decisions.”

Question 12

the 5 A’s:

Answer 12

1. Ask a question. Identify a problem or need for change for a specific patient or situation.
2. Acquire literature. Search the literature for scientific studies and articles that address the issue(s) of concern.
3. Appraise the literature. Evaluate and synthesize the research evidence regarding its validity, relevance, and applicability using criteria of scientific merit.
4. Apply the evidence. Choose interventions that are based on the best available evidence with the understanding of the patient’s preference and needs.
5. Assess the performance. Evaluate the outcomes, using clearly defined criteria and reports, and document results.

Question 13

Clinical practice guidelines are systematically developed statements that?

Answer 13

identify, appraise, and summarize the best evidence about prevention, diagnosis, prognosis, therapy, and other knowledge necessary to make informed decisions about specific health problems

Question 14

3 things that clinical practice guidelines do

Answer 14

(1) identify practice questions and explicitly identify all the decision options and outcomes
(2) identify the “best evidence” about prevention, diagnosis, prognosis, therapy, harm, and cost-effectiveness
(3) identify the decision points at which this “best evidence” needs to be integrated with individual clinical experience and patients’ needs and goals in deciding on a course of action.

Question 15

Clinical algorithms are?

Answer 15

step-by-step guidelines prepared in a flowchart format
- helpful in deciding what medication to use considering a wide variety of variables related to the patient’s personal situation (e.g., age, gender, current medications, ethnic origin, allergies)

Question 16

Clinical/critical pathways are usually specific to the institution using them. They are most often used in relation to?

Answer 16

hospitalized patients and target a specific population (e.g., suicidal patient, bipolar patient–manic, a depressed patient, an individual with schizophrenia)

Question 17

Level Ia: Evidence from systematic reviews or meta-analyses of randomized controlled trials
Ib: Evidence from at least one randomized controlled trial
-What is the level type of evidence?

Answer 17

(A) Based on hierarchy I evidence

Question 18

IIa: Evidence from at least one controlled study without randomization
IIb: Evidence from at least one other type of quasi-experimental study-What level type of evidence?

Answer 18

(B) Based on hierarchy II evidence or extrapolated from hierarchy I evidence

Question 19

III: Evidence from nonexperimental descriptive studies, such as comparative studies, correlation studies, and case control studies

Answer 19

(C) Based on hierarchy III evidence or extrapolated from hierarchy I or II evidence

Question 20

IV: Evidence from expert committee reports or opinions and/or clinical experience of respected authorities

Answer 20

(D) Directly based on hierarchy IV evidence or extrapolated from hierarchy I, II, or III evidence

Question 21

Three areas inherent in the “art” of nursing addressed are?

Answer 21

(1) caring, (2) attending, and (3) patient advocacy

Question 22

Caring is the?

Answer 22

most natural and the most fundamental aspect of human existence”

Question 23

A survey by Schoenhofer and colleagues (1998) used a group process method (13 groups of 3 to 5 people each) to synthesize what was meant by caring to the participants. The following three themes emerged from the shared narratives:

Answer 23

1. Caring is evidenced by empathic understanding, actions, and patience on another’s behalf.
2. Caring for one another by actions, words, and being there leads to happiness and touches the heart.
3. Caring is giving of self while preserving the importance of self.

Question 24

Evidence-based practice includes not only evaluating research but also ?

Answer 24

integrating it with input from experts and patients

Question 25

Examples of uncaring behaviors include?

Answer 25

denying patients’ feelings, responding with indifference to patients’ concerns, and failing to check to see if medications given to relieve discomfort or distress are working. These are examples of behaviors that violate a patient’s integrity and dignity and are never justified

Question 26

Benner (2004) states that comforting includes providing?

Answer 26

social, emotional, physical, and spiritual support for a patient that is consistent with the holistic approach to nursing care

Question 27

Attending refers to an?

Answer 27

intensity of presence, being there for and in tune with the patient

Question 28

Attending behaviors may include?

Answer 28

listening, touching, or giving attentive physical care

Question 29

in nursing, being a patient advocate is not a legal role but rather an ethical one. a patient advocate is one who?

Answer 29

speaks up for another’s cause, who helps others by defending and comforting them, especially when the other person lacks the knowledge, skills, ability, or status to speak for himself/herself

Question 30

Advocacy in nursing includes a commitment to patients’?

Answer 30

health, well-being, and safety across the life span, and the alleviation of suffering and promoting a peaceful, comfortable, and dignified death

Question 31

Nurses advocate for patients when they?

Answer 31

advise patients of their rights (including the right to refuse treatment), provide accurate and current information so patients can make informed decisions, and support those decisions

Question 32

Psychiatric mental health nurses function as advocates when they engage in?

Answer 32

Public speaking, write articles for the popular press, and lobby congressional representatives to help improve and expand mental health care for everyone

Question 33

Evidence-based practice (EBP) is a process by which the?

Answer 33

best available research evidence, clinical expertise, and patient preferences are used for making clinical decisions

Question 34

The “5 A’s” process to delineate the multistep process of integrating best evidence into clinical practice includes

Answer 34

(1) asking, (2) acquiring, (3) appraising, (4) applying, and (5) assessing

Question 35

The mental health recovery model is one of helping people with psychiatric disabilities effectively manage their?

Answer 35

symptoms, reduce psychosocial disability, and find a meaningful life in a community of their choosing.

Question 36

Some sources for obtaining research findings are?

Answer 36

(1) Internet mental health resources, (2) clinical practice guidelines, (3) clinical algorithms, and (4) clinical/critical pathways

Question 37

The “art” of psychiatric mental health nursing, according to Benner, includes: (select all that apply)

1. caring.
2. attending.
3. patient advocacy.
4. ethics.

Answer 37

1. caring
2. attending
3. patient advocacy

Question 38

The “science” of psychiatric mental health nursing includes: (select all that apply)

1. a sense of tradition.
2. nursing theory.
3. psychosocial theory.
4. neurobiological theory

Answer 38

2. nursing theory.
3. psychosocial theory.
4. neurobiological theory

Question 39

Caring is: (select all that apply)

1. an attitude that one communicate.
2. a way of being with the patient.
3. intensity of presence.
4. giving of self.

Answer 39

1. an attitude that one communicate.
2. a way of being with the patient.
3. giving of self.

Question 40

Patient advocacy:

1. is a legal role.
2. requires courage.
3. is an optional aspect of nursing.
4. was developed in 2007.

Answer 40

2.requires courage

Question 41

When an experienced psychiatric nurse listens carefully to a patient’s detailed recounting of a traumatic emotional experience, the nurse is:

1. acting as a patient advocate.
2. using an attending behavior.
3. interpreting “best evidence.”
4. using a systematic approach to care.

Answer 41

2.using an attending behavior