Chapter 5 Settings for Psychiatric Care Flashcards
Patient-Centered Medical Homes (PCMH) received strong support from the Affordable Care Act of 2010. These health homes were developed in response to fragmented care that resulted in?
some services never being delivered while others were duplicated. The focus of care is patient-centered and provides access to physical health, behavioral health, and supportive community and social services.
Electronic communication (e.g., follow-up emails and reminders) and record keeping are viewed as essential to this process.
major depression, a common psychiatric disorder, may interfere with motivation to?
seek care because the illness often causes feelings of apathy, hopelessness, and anergia (lack of energy)
Treatment options for mental disorders are presented in order of acuteness, beginning with those in the?
least restrictive environment—the setting that provides the necessary care while allowing the greatest personal freedom.
The number of people in state-managed psychiatric hospitals began to decrease with the creation of?
Medicare and Medicaid during the 1960s Great Society reform period.
In the 1999 Olmstead decision, the Supreme Court decreed that keeping people in psychiatric hospitals was “unjustified isolation.” The opinion of the court was that?
mental illness is a disability and institutionalization is in violation of the Americans With Disabilities Act, and that all people with disabilities have a right to live in the community.
the Ohio Department of Mental Health and the Ohio Department of Alcohol and Drug Addiction Services—Do what?
certify, monitor, and fund agencies that provide services. These agencies may be for profit or nonprofit.
The introduction of chlorpromazine (Thorazine), the first antipsychotic medication, in the early 1950s contributed to?
hospital discharges
Our current system of psychiatric care includes inpatient and outpatient settings. Decisions for level of care tend to be based on the?
condition being treated and the acuteness of the problem. However, these are not the only criteria. Levels of care may be influenced by such factors as a concurrent psychiatric or substance abuse problem, medical problems, acceptance of treatment, social supports, and disease chronicity or potential for relapse.
Disadvantages to being treated by PCPs include?
time constraints, because a 15-minute appointment is usually inadequate for a mental and physical assessment. Because PCPs typically have limited training in psychiatry, they may lack the expertise in the diagnosis and treatment of psychiatric disorders
Patient-centered medical homes (PCMHs) or primary care medical homes received strong support from the Affordable Care Act of 2010 under President Obama. These health homes were developed in response to fragmented care that resulted in?
some services never being delivered while others were duplicated. The focus of care is patient centered and provides access to physical health, behavioral health, and supportive community and social services. Services range from preventive care and acute medical problems to chronic conditions and end-of-life issues.
Patient-centered medical homes (PCMHs) or primary care medical homes According to the Agency for Healthcare Research and Quality (2011), these homes have five key characteristics:
- Patient centered—Care is relationship based with the patient (family) and takes into account the unique needs of the whole person. The patient is a core member of the team who manages and organizes the care.
- 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.
- Coordination of care—Care is coordinated with the broader health system such as hospitals, specialty care, and home health.
- Improved access—Patients do not wait until Monday through Friday from 9 AM to 5 PM to get the care they need. In addition to extended hours of service, these homes provide e-mail and phone support.
- Systems approach—Evidence-based care is provided with a continuous feedback loop of evaluation and quality improvement.
Community mental health centers (CMHCs) developed from President Kennedy’s Community Mental Health Centers Act of 1963, signaling a new policy preference for?
Community care as opposed to institutionalization. Although only about 700 of the anticipated 2800 CMHCs were funded, the legislation marked a change in direction and led to state laws and budgets favoring community care. CMHCs are regulated through state mental health departments and funded by the state. Some areas may provide local funding. Because of this limited government funding, financial support services may be restricted to those whose income and medical expenses make them eligible. Typically, fees are determined using a sliding scale based on income and ability to pay.
Community-based facilities provide comprehensive services to prevent and treat mental illness. These services include?
assessment, diagnosis, individual and group counseling, case management, medication management, education, rehabilitation, and vocational or employment services. Some centers may provide an array of services across the life span, whereas others may be population specific, such as adult, geriatric, or children.
People with serious mental illness may benefit from psychiatric rehabilitation in the community. This is a social model that emphasizes and supports?
recovery and integration into society rather than a medical model of dysfunction. Serious disorders can result in isolation, poverty, and regression. These services focus on the development of social skills, the ability to access resources, and the acquisition of optimal social, working, living, and learning environments
Psychiatric home care can be provided by any mental health professional, but it is typically nurses with inpatient experience who are able to provide biologically based and psychotherapeutic care while working through agencies such as visiting nurses. Home care may reduce the need for costly and disruptive hospitalizations and may provide a more comfortable and safe alternative to clinical settings. To qualify for reimbursement, patients must have a?
psychiatric diagnosis, be under the care of a PCP, and be homebound. The designation of homebound generally is given when patients cannot safely leave home, if leaving home causes undue stress, if the nature of the illness results in a refusal to leave home, or if they cannot leave home unaided. However, Medicare reimbursement does allow for the person to leave home once a week for religious services and once a week for hair care.
Intensive outpatient programs (IOPs) provide structured programs to bridge the gap between inpatient and outpatient treatment for people who require more than outpatient care or who may need a transition from an intensive setting. Treatment includes?
individual and group therapy and psychosocial education for at least 4 hours per week.
Partial hospitalization programs (PHPs) have been around since the 1960s, and like IOPs, function as an intermediate step between outpatient and inpatient care. They are the most intensive of outpatient options and tend to be?
- 4 to 8 hours per day for up to 5 days a week
- Structured programs provided w/nursing and medical supervision, intervention, and treatment
- located w/general hospitals, in psychiatric hospitals, and as part of community mental health programs
- Patients whose symptoms are under control spend a certain number of hours at the facility each day and at night return to their homes, where family and friends can support them
- coping strategies learned during program can be applied and practiced in the outside world, and later explored and discussed
- multidisciplinary team facilitates group therapy, individual therapy, other therapies (e.g., art and occupational), and pharmacological management
- Patients who are admitted to PHPs are closely monitored in case of need for readmission to inpatient care.
Registered nurses who work in outpatient settings provide nursing care for individuals with mental illness, alcoholism, substance abuse problems, mental retardation, or developmental disabilities, as well as their families or caretakers. Community mental health nurses work to?
develop and implement a plan of care along with the multidisciplinary treatment team. They may choose to be certified in psychiatric mental health nursing or hold advanced practice degrees.
Community mental health nurses need to be very knowledgeable about community resources such as?
- shelters for abused women, food banks for people with severe financial limitations, and agencies that provide employment options for people with mental illness.
- Nurses may assess patient and living arrangements in the home, provide teaching, refer to community supports, and supervise unlicensed care staff
- important concept for community mental health nurses is viewing entire community as a patient. This perspective promotes community interventions such as conducting stress reduction classes and facilitating grief support groups.
Inpatient facilities
- provide 24-hour nursing care in a safe and structured setting for people who are in need of restrictive environment
- caring for those who are in need of protection from suicidal ideation, aggressive impulses, medication adjustment and monitoring, crisis stabilization, substance abuse detoxification, and behavior modification
- Referrals for inpatient treatment may come from PCP or mental health provider, agencies, another hospital unit, emergency facilities, or nursing homes
- Hospital admissions made under services of psychiatrist, a PCP may have admitting privileges
Inpatient facilities: Patients may be admitted voluntarily or involuntarily. Units may be unlocked or locked. Locked units provide?
privacy and prevent elopement—leaving before being discharged (also referred to as being “away without leave” or AWOL). There may also be psychiatric intensive care units (PICUs) within the general psychiatric units to provide better monitoring of those who display an increased risk for danger to self or others.
The therapeutic milieu is essential to successful inpatient treatment. Milieu refers to the?
environment in which holistic treatment occurs and includes all members of the treatment team, a positive physical setting, interactions between those who are hospitalized, and activities that promote recovery.
Inpatient care provides structure in which patients eat meals, receive medication (if necessary), attend activities, and participate in individual and group therapies on a schedule. For those younger than the age of 18, school attendance is required. Patients are active participants in their?
plans of care and have the right to refuse treatments as long as they have not been declared incompetent. Advocates are usually available to provide advice and counsel for people who have doubts, and most facilities distribute a patient’s bill of rights on admission or have it clearly posted.
MEMBERS OF THE TREATMENT TEAM
- Psychiatric nurse generalists
- Advanced practice psychiatric nurses
- Psychiatrists
- Psychologists
- Social workers
- Counselors
- Occupational therapists
- Physical therapists
- Art therapists
- Recreation therapists
- Pharmacists
- Medical personnel
- Mental health workers or psychiatric aides
- Pastoral counselors
- Consumer providers
licensed registered nurses whose focus is on mental health and illness. They may or may not have certification in psychiatric mental health nursing.
Psychiatric nurse generalists
have post–baccalaureate degrees and work as either clinical nurse specialists (CNSs) or nurse practitioners (NPs) and have state certification. Both assess health and psychiatric disorders, provide psychotherapy, and prescribe medications. CNSs tend to focus more on leadership, program development, education, and psychotherapy, whereas NPs focus on differential diagnoses, treatment, medication management, and psychotherapy
Advanced practice psychiatric nurses
