Exam 1 Flashcards
(196 cards)
1
Q
What is mental health?
A
A state of wellbeing in which individuals:
- Reach their own potential
- Cope with normal stresses of life
- Work productively
- Contribute to the community
2
Q
What are traits of people with good mental health?
A
People who have the capacity for:
- Rational thinking
- Communication skills
- Learning
- Emotional growth
- Resilience
- Self-esteem
3
Q
What is the most important key for mental health?
A
Resilience
Self-esteem is important too
4
Q
What is another name for mental illness?
A
Mental disorder
5
Q
What is a mental illness defined as?
A
All psychiatric disorders that have a definable diagnoses
6
Q
What are mental illnesses related to?
A
Developmental, biological, or psychological disturbances in mental functioning
7
Q
An example of a mental illness where the ability to think being impaired
A
Altzheimer’s
8
Q
An example of a mental illness where emotions are affected
A
Major depressive disorders
9
Q
An example of a mental illness where behavioral alterations are apparent
A
Schizophrenia
10
Q
Explain the mental health continuum
A
At one end: Health/well being
In the middle: emotional problems or concerns
At the other end: mental illness
11
Q
Define resilience*
A
*Ability and capacity to secure resources needed to support well-being
(The single biggest protective factor for mental health)
12
Q
What is resilience characterized by?
A
Ability to secure needed resources
Capacity for regulating one’s own emotions and overcoming negative, self-defeating thoughts
13
Q
Which individual attribute or behavior is essential for recovery?
A
Resilience
14
Q
Examples of risk and protective factors involving social and economic circumstances
A
Family
Schools and peer groups
Socioeconomic status
Educational advancement
15
Q
Risk and protective factors involving environmental factors
A
Political climate and cultural considerations
Social and economic policies
(Marginalized populations = risk factor)
16
Q
Why is mental illness a physical illness?
A
The root of most mental disorders lies in intercellular abnormalities
17
Q
Define the diathesis-stress model?
A
Diathesis: biological predisposition
Stress: environmental stress/trauma
(Nature vs. Nurture)
18
Q
Explain what the diathesis-stress model is
A
The most accepted explanation for mental illness
The combination of genetic vulnerability and negative environmental stressors cause mental illness
19
Q
Define parity
A
Equivalence
20
Q
What was the Mental Health Parity Act (1996)?
A
Required insurance companies to provide equal treatment coverage for psychiatric disorders (but did not require them to cover it)
(But many insurance companies still place limits on mental health coverage)
21
Q
What was the Patient Protection and Affordable Care Act?
A
- Provides coverage for most uninsured Americans through expanded Medicaid eligibility (for very poor)
- Created health insurance exchanges to offer more choices
- “Insurance mandate” for coverage
22
Q
Define epidemiology
A
The quantitative study of the distribution of mental disorders in human populations
(to identify high-risk groups and high-risk factors)
23
Q
Define incidence
A
Number of new cases in a given time
24
Q
Define prevalence
A
Number of cases regardless of when they began
25
Define lifetime risk
Risk that one will develop a disease during a lifetime
26
Does the flu have a higher incidence or prevalence?
Higher incidence
| Because we don’t get the flu and keep the flu
27
Does diabetes have a higher incidence or prevalence?
Prevalence because once you are diagnosed with it, you always have it
28
How are mental disorders diagnosed?
- Use official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders
- Based on specific criteria influenced by multi professional clinical field trials
29
How are mental disorders classified?
Using clinical descriptions of mental and behavior disorders which have two broad classifications and subclassifications
30
What is evidence based practice in psychiatric mental health nursing?
Use nursing, psychosocial, neurobiological theories, and research
31
How does psychiatric mental health nursing promote mental health?
Through assessment, diagnosis, and treatment of behavioral and mental disorders
32
Most important trend affecting the future
Advocacy
33
In what ways does a psychiatric nurse advocate for their patients?
* Through direct and indirect care, nurses must:
- report abuse, neglect,
- uphold confidentiality,
- support the patient’s right to make decisions regarding treatment
34
What are trends that will affect the future of mental health?
```
Educational challenges
Demand for mental health professionals
Aging population
Cultural diversity
Science, technology, and electronic healthcare
Advocacy
Legislative involvement
```
35
Levels of Awareness in Freud’s psychoanalytic theory
Conscious
Preconscious
Unconscious
36
Define conscious according to Freud
Contains all the material a person is aware of at any one time
37
Define preconscious according to Freud
Contains material that can be retrieved rather easily through conscious effort
38
Define unconscious according to Freud
Includes all repressed memories, passions, and unacceptable urges lying deep below the surface
39
The three distinct systems of the personality according to Freud’s theory
Id
Ego
Superego
40
What is id?
Totally unconscious and impulsive
| Drives instincts and reflexes
41
What is the ego?
Problem solver and reality tester
| Attempts to navigate the outside world
42
What is the superego?
Moral component of personality
| Induces guilt and pride
43
What is classical psychoanalysis?
Freud’s premise that early intra psychic conflict is the cause for all mental illness
This theory is no longer thought to be valid
44
Define *transference
Unconscious feeling that the patient has toward you that was originally felt during childhood
EX: an older patient says “you remind me so much of my granddaughter”
45
Define *countertransference
*this is what we (as the nurse) feel toward the patient. This comes into play with how we treat patients (justice and fairness)
46
What is the psychodynamic theory?
- Newer psychoanalytic model that focuses more on here and now
- Uses tools of psychoanalysis
- Best candidates are the “worried well”
- Increased back and forth between therapist and patient
47
Define *interpersonal theory
The purpose of all behavior is to get needs met through interpersonal interactions and to reduce or avoid anxiety
48
Define anxiety according to Sullivan
Any painful feeling or emotion that arises from social insecurity or prevents biological needs from being satisfied
49
Define security operations according to Sullivan
Measures the individual uses to reduce anxiety and enhance security
50
Define self-system according to Sullivan
All of the security operations an individual uses to defend against anxiety and ensure self-esteem collectively make up the self-system
51
What is interpersonal therapy most effective in treating?
Grief and loss
Interpersonal disputes (relationship conflicts)
Role transition
52
Who established the foundations for interpersonal theory implications for nursing?
Hildegard Peplau
53
How did Peplau apply the Interpersonal Theory to nursing?
- Nurses are both participants and observers in therapeutic conversations
- Self-awareness helps keep focus on patient
- Lowering patients’ anxiety improves ability to think and function
54
What are behavioral theories?
Use conditioning to respond to a specific stimuli
55
How are behavioral theories applied to nursing?
Modifying or replacing behaviors
| Behavior management
56
What is behavioral therapy?
Assumes that changes in maladaptive behavior can occur without insight into the underlying cause
57
What is behavioral therapy best used to treat?
Phobias
Alcohol use disorder
Schizophrenia
And many other conditions
58
5 types of behavioral therapy
```
Modeling
Operant conditioning
Exposure therapy
Aversion therapy
Biofeedback
```
59
What is modeling behavioral therapy?
The therapist provides a role model for specific identified behaviors
60
What is operant conditioning behavioral therapy?
Basis for behavior modification
61
What is exposure therapy behavioral therapy?
Patients are encourages to face their fears to eliminate them
62
What is aversion therapy behavioral therapy?
Pairs a target behavior with a negative stimulus to extinguish the undesirable behavior
63
What is biofeedback behavioral therapy?
Used to control the body’s physiological response to stress and anxiety (like relaxing certain muscles) to reduce/eliminate pain
64
What do cognitive theorists believe?
- There is a dynamic interplay between individuals and the environment
- *thoughts come before feelings and actions
- Thoughts about the world and our place in it are based on our own unique perspectives, which may or may not be based on reality
65
Two of the most influential cognitive theories:
Rational-emotive behavior therapy
| Cognitive-behavioral therapy
66
How does rational-emotive behavior therapy work?
Aims to eradicate irrational beliefs by helping patients recognize thoughts that are not accurate
67
How does cognitive-behavioral therapy work?
Teaches pts to challenge distorted beliefs and change their way of thinking
In order to reduce symptoms of depression and anxiety
68
Which group does trauma-focused cognitive behavioral therapy focus on?
First developed to address sexual abuse trauma in children
Expanded for all ages
Still focuses more on children and adolescents
69
How does trauma-focused cognitive behavioral therapy work?
For trauma that is very difficult to get past,
Is short-term, and incoorporates cargivers and family therapy
Helps identify feelings and how to manage them (and replace negative thoughts)
70
What are dialectical strategies?
Integration of opposites (help the patient and therapist give up extreme positions)
71
Which type of patients was dialectical behavioral therapy developed for?
Individuals with intractable behavioral disorders involving emotional dysregulation (ex: women with borderline personality disorder)
72
How does dialectical behavioral therapy work?
Employs CBT elements:
- mindfulness
- distress tolerance
- interpersonal effectiveness
- emotional regulation
73
What is CBT mindfulness?
Being aware and present in the moment
74
What is CBT distress tolerance?
Tolerating pain instead of frantically trying to transform it
75
What is CBT interpersonal effectiveness?
Asking for what you want and being able to say no when needed
76
What is CBT emotional regulation?
Choosing and changing emotions that are problematic
77
What are implications for nursing regarding cognitive theories?
Recognizing the interplay between events, negative thinking and negative responses
Helping the patient identify negative thought patterns
78
What do humanistic theories focus on?
Human potential and free will to choose life patterns supportive of personal growth
Emphasize a person’s capacity for self-actualization
79
Main points of the theory of human motivation
- Psychology must go beyond negative experiences to include love, compassion, happiness, etc.
- Humans are active participants in life, striving for self-actualization
- When lower needs are met, higher needs can emerge
80
What is Maslow’s Hierarchy of Needs?
Humans are motivated my unmet needs
Humans are striving for self-actualization
When lower needs are met, higher needs can emerge
81
What are the implications for nursing regarding humanistic theories?
Key to successful nurse-patient relationships: emphasis on human potential and the patient’s strengths
Prioritizing: establishes what is most important in the sequencing of nursing actions
82
What does the biological model say?
**Recognizes that psychiatric illnesses are as physical in origin as physical illness, so it can take the blame off of the person
83
What type of treatments does the biological focus on?
Neurological
Chemical
Biological
Genetic
84
What does the biological model seek to understand?
How the body and brain interact to create:
Emotions
Memories
Perceptual experiences
85
How does biological model treatment work?
Targets the site of the illness using physical interventions such as drugs, diet, or surgery
86
Types of biological therapies:
Psychopharmacology therapy
| Brain stimulation therapies
87
Types of brain stimulation therapies
Electroconvulsive therapy
Transcranial magnetic stimulation - repetitive (rTMS)
Vagus nerve stimulation (VNS)
Deep brain stimulation (DBS)
88
What is electroconvulsive therapy (ECT)?
Used to induce a seizure to reset brain chemicals
89
Implications of biological theories for nursing
- Physical needs and physical care in nursing are part of a holistic approach to healthcare
- Focusing on the qualities of a therapeutic relationship
- Understanding the patient’s perspective
- Communicating in a way that facilitates the patient’s recovery
(All takes place alongside physical care)
90
What does the cognitive development theory say?
Our mental representations of the world (schemata) depend on the cognitive stage we have reached
91
What are the cognitive development stages?
Sensorimotor stage
Preoperational stage
Concrete operational stage
Formal operational stage
(Operations = thinking about objects)
92
What happens during the sensorimotor stage?
Birth to 2 yrs
Begins with basic reflexes
Continues to purposeful movement, spatial skills, hand-eye coordination
93
What occurs during the preoperational stage?
2-7 yrs
| Cannot think abstractly
94
What occurs during the concrete operational stage?
7-11 yrs
| Logical thought appears
95
What occurs during the formal operational stage?
11 yrs - adulthood
Conceptual reasoning
Can think abstractly and problem solve
96
What is the theory of psychosocial development?
Belief that personality continues to develop through old age
| And that development occurs in 8 predetermined and consecutive live stages, resulting in a positive or negative outcome
97
Which stage of psychosocial development occurs between age 12-20?
Identity vs. role confusion
98
Which stage of psychosocial development occurs during age 20-35?
Intimacy vs. isolation
99
Which stage of psychosocial development occurs between age 35-65?
Generativity vs. self-absorption
100
Which stage of psychosocial development occurs during age 65+?
Integrity vs. despair
101
What is the theory of object relations?
Object = significant person
| Past relationships influence sense of self and present relationships
102
What does the theory of object relations believe that psychological problems stem from?
The result of a disruption of early separation
103
What are two important theories of moral development?
Stages of moral development
| Ethics of care theory
104
What is the stages of moral development theory?
The framework for understanding the progression from black and white thinking about right and wrong to a complex decision making process
105
What are the three main categories of the stages of moral development?
Preconventional level
Conventional level
Postconventional level
106
Which stages are in the preconventional level?
Stage 1: obedience & punishment
| Stage 2: individualism & exchange
107
Which two stages are in the conventional level?
Stage 3: good interpersonal relationships
| Stage 4: maintaining social order
108
Which two stages are in the postconventional level?
Stage 5: social contract & individual rights
| Stage 6: universal ethical principles
109
Why is the ethics of care theory so important for nurses?
So we can target interventions
110
What does the ethics of care theory emphasize?
- Criticized the theories of moral development as favoring males
- Suggests that a “morality of care” should replace Kohlberg’s “justice view” of morality
- Relationships banding together
- Putting the needs of those we care for above the needs of strangers
- Ties progress to personal development and sense of self more than cognition
111
Implications of development theories for nursing
Developmental model is important part of nursing assessment
| Helps determine what types of interventions are most likely to be effective
112
Qualifications for psychiatric home care
Homebound
Having a mental health diagnosis
May experience coexisting medical problems
Can safely be managed in the home setting
Has identified treatment needs
113
Examples of why a patient may be homebound for psychiatric home care
Circumstances that impair their functioning such as:
Anxiety
Paranoid thoughts
Medical conditions
Impairment in ability to complete self-care
Impairment in thoughts
Memory impairment
114
Important considerations for the plan of care of a patient in psychiatric home care
- Plan must be completed upon admission and reviewed ever 60 days
- RN must include specific outcomes that are measurable
- Must include frequency and duration of visits
115
What is the difference between Intensive Outpatient Programs (IOP) and partial hospitalization Programs (PHP)?
IOP: patient is kept for 3-4 hours. For pts who need a little extra help that can’t be met by a counseling session
PHP: from 9-3 Mon-Fri. For pts who can still take care of themselves during the rest of the time
116
Example of a patient who would benefit from a PHP
** A patient who has a substance use disorder who just went through treatment but doesn’t trust themself to be at home while spouse is at work
117
What is ACT?
Assertive community care
| 24 hour care for people out in community with persistent psychiatric symptoms that are unable to come into treatment
118
Benefits of patient-centered health/medical homes
Has all types of care in one building
| Allows for patient to feel more comfortable because others won’t know what they are seeking care for
119
What is a comprehensive emergency service model?
Used for emergency psychiatric care
Dedicated psychiatric space and staff
Often affiliated with a full-service emergency department in a hospital or medical center
120
What is a hospital-based consultant model?
Has no dedicated space or separate staffing
| But has psychiatric staff on site for emergency psychiatric care
121
What is a mobile crisis team model?
Stabilization in the field to assess and de-escalate during psychiatric emergencies
122
Levels of prevention strategies for psychiatric emergencies:
Primary prevention
Secondary prevention
Tertiary prevention
123
Explain primary prevention strategies of psychiatric emergencies
Trying to stop something before it starts
| Teaching coping strategies to young people
124
Explain secondary prevention strategies to prevent psychiatric emergencies
Screenings to try to catch it early
| May not stop the disorder from beginning but can catch it before it progresses
125
Explain tertiary prevention strategies to prevent psychiatric emergencies
What happens once someone has a disorder (there is a diagnosis, event, or hospitalization)
Want to prevent it from getting worse, or from other problems occurring due to the disorder
126
Characteristics of the nurse in outpatient settings:
Strong problem-solving and clinical skills
Cultural sensitivity
Flexibility
Knowledge of community resources
*Autonomy
Promoting recovery and continuation of treatment
127
Problems that may affect the success of treatment for a patient who is being discharged from inpatient services into outpatient community services
- medication administration
- pt may not follow up with care (needs transportation)
- support system
- substance use history or current use
128
Settings for inpatient care
Crisis stabilization/observational units
General hospital and private hospitals
State psychiatric hospitals (most restrictive)
129
Ways a patient gets into inpatient care?
- Direct admission on referral
- Emergency department or crisis service
- Voluntary or involuntary
130
What are clinical pathways used for?
Used by inpatient units for standardization in treatment and to improve outcomes
131
What is milieu?
Surroundings and physical environment
132
What are the goals of unit design for therapeutic milieu?
Promote and environment of safety and empower patients to partner with clinical staff and take ownership of their own mental health and safety
133
Define ethics
The study of philosophical beliefs about what is considered right or wrong in a society
134
Define bioethics
Used in relation to ethical dilemmas surrounding healthcare
135
What is an ethical dilemma?
Conflict between two or more courses of action, each with favorable and unfavorable consequences
136
Principles of bioethics:
```
Autonomy
Beneficence
Nonmalificence
Justice
Fidelity
Veracity
```
137
What is autonomy?
Respecting the rights of others to make their own decisions
138
Example of autonomy
Patients have the right to refuse medication
139
What is beneficence?
The duty to promote good
140
Example of beneficence
Helping someone in their time of need (if a car accident just happened, helping the victims)
141
What is nonmaleficence?
Doing no harm to patient
142
Example of nonmaleficence
Protecting confidential info about a patient
143
What is justice?
Distribute resources or care equally
144
Example of justice
Spending equal time with patients that you like and don’t like
145
What is fidelity?
Maintaining loyalty and commitment; doing no wrong to a patient
146
Example of fidelity
Maintaining your competence (not working on a unit you haven’t been trained on)
147
What is veracity?
One’s duty to always communicate truthfully
148
Example of veracity
Telling a patient you don’t know if their going to die, but you will stay with them and take care of them
149
When is it ok for a patient to be commited involuntarily?
Mentally ill
*Danger to self or others
Gravely disabled
In need of treatment and illness prevents voluntary help seeking
150
What is emergency commitment used for?
Temporary admission if a person is confused or demented
| Used for observation, diagnosis and treatment
151
How long is emergency commitment, generally?
24-96 hours
| This time is used to determine if someone should be admitted involuntarily
152
What is a Writ of habeas corpus?
Used when patient’s believe they have been held without just cause.
A letter explaining why they shouldn’t be involuntarily committed that challenges unlawful detention
153
What does Least Restrictive Alternative Doctrine mean?
ALWAYS taking the least drastic or restrictive action
| If a pt can be treated in out patient setting, they should not be treated in inpatient
154
Discharge procedures from inpatient care
- Unconditional release (pt can just leave)
- Termination of the legal patient-institution relationship
- Release against medical advice (pt signs themselves out)
- Conditional release
155
Factors of conditional release
- usually requires outpatient treatment for a specified period of time with follow-through eval
- assisted outpatient treatment
- similar to conditional release but court-ordered
156
Patients’ rights under the law:
```
Right to treatment
Right to refuse treatment
Right to informed consent
Rights regarding psychiatric advance directives
Rights regarding restraint and seclusion
Rights regarding confidentiality
```
157
Which rights do patients have regarding informed consent?
- Patient must be informed of risks, benefits, and alternatives
- Person must voluntarily accept treatment (gone over with pt by the *physician, not the RN)
- Implied consent
- Capacity & competency must be considered
158
Example of implied consent
If you approach a pt with medication and the pt indicates a willingness to take the medication
159
Difference between capacity and competency
Capacity can fluctuate depending on someone’s mental state (ex: under the influence of drugs)
Competency is decided by a court to determine if someone can take care of their own needs
160
What rights do patients have regarding restraint and seclusion?
- Must have orders and documentation
- In an emergency, a nurse may place a pt in seclusion or restraint, but obtains written or verbal order as soon as possible thereafter
- Orders for restraint or seclusion are never written as an as needed or as a standing order
161
What are the two exceptions to patient confidentiality?
- Duty to warn and protect third parties (if a patient is a danger to themselves or others)
- Child and elder abuse reporting
162
What is Tort?
Any wrongful act, intentional or accidental, that results in an injury to another
163
What is intentional tort?
Willful or intentional acts that violate another person’s rights or property
164
Examples of intentional tort
Assault
Battery
False imprisonment (ex: restraining someone)
Invasion of privacy
Defamation of character (slander or libel)
165
What is unintentional tort?
Unintended acts against another that produce injury or harm
166
Examples of unintentional tort in nursing
Negligence
| Malpractice (most common)
167
5 elements to prove negligence
1 - Duty
2 - Breach of duty - Didn’t meet the standards of care
3 - Cause in fact - If it wasn’t up to what the nurse did or didn’t do, would this still have happened?
4 - Proximate cause - Could you have foreseen this?
5 - Damages - There must be damages to the patient
168
Legal standards nurses have to follow
State board of nursing
Professional organizations
Institutional policies and procedures
169
How must nurses act on questionable practice?
If another nurse does any of these: negligence, irresponsibility, or impairment,
We have a duty to report
170
How must a nurse report questionable practice?
```
Must document clearly and accurately first
Supervisor intervenes
(If unavailable, you must intervene to protect the patient)
```
171
How must a nurse document care?
Accurate and complete
Means of interprofessional communication
Patient has a right to review record
The record belongs to the insitution
172
What are retrospective record reviews used for?
Quality improvement
As evidence
Risk management purposes
To determine insurance reimbursements
173
How are medical records used as evidence?
To determine:
The extent of pt’s damages and suffering in a suit
Nature and extent of injuries in abuse cases
Nature and extent of physical or mental disability in disability cases
Nature and extent of injury and rehabilitative potential in workers’ compensation cases
174
Define minorities
Racially, ethnically, or culturally distinct groups that coexist, but are subordinate in some way to a dominant group
175
Define minority status
Not always fewer in numbers, but lacking political and social power
May be treated differently and discriminated against
176
Define race
Can be defined biologically, anthropologically, or genetically
Can be distinguished visually from one another based on physical characteristics
177
Define ethnicity
Sharing a common heritage and history
| Share worldview for thinking
178
Define culture
Shared beliefs, values, and practices
179
Which organization measures race and ethnicity in the United States?
U.S. Census Bureau
180
What is the purpose for measuring race and ethnicity in the United States?
Help the government understand the needs of its citizens
| Helps to identify disparities in health care along racial-ethnic lines
181
Characteristics of western tradition
Identity found in individuality
Values: autonomy, independence, self-reliance
Mind and body = separate entities
Disease has a cause, treatment is aimed at cause
Time is linear
Success is obtained in prepping for the future
182
Characteristics of eastern tradition
```
Family basis for identity
Body-mind-spirit = one entity
Time is circular and recurring
Born into fate; duty to comply
Disease caused by fluctuations in opposing forces
```
183
Characteristics of indigenous culture
Places significance on place of humans in natural world
Basis of identity is the tribe
Person is an entity only in relation to others
Disease caused by lack of harmony between individual and environment
184
What does ethnocentrism mean?
When you think your culture is the best
185
What is cultural imposition?
When someone imposes their culture on someone else
186
Things to keep in mind when using an interpreter for a patient
- Must be a medical interpreter
- Cannot be a family member or someone the patient knows
- Should be as closely matched to a patient’s age and gender as possible
187
Special at-risk populations for mental health and why?
Immigrants: discrimination
Refugees: reason they left their country
Cultural minorities: discrimination, disadvantaged, don’t have access
188
Five constructs of (ways to provide) culturally effective care
```
Cultural awareness (most important)
Cultural knowledge
Cultural encounters
Cultural skill
Cultural desire
```
189
How can someone be culturally aware?
- Examine beliefs, values, and practices of own culture
| - Recognize that during a cultural encounter, three cultures are intersecting (patient, nurse, setting)
190
How can someone gain cultural knowledge?
- Attend cultural events and programs
- Forge friendships with diverse cultural groups
- Studying
191
How should nurses learn cultural differences?
Establish rapport
Ask culturally relevant questions
Identify cultural variables to be considered
192
How do cultural encounters help nurses?
Deter nurses from stereotyping
Help them gain confidence in cross-cultural interactions
Helps them avoid or reduce cultural pain
193
What is cultural skill?
Ability to perform a cultural assessment in a sensitive way
194
What are ways a nurse can demonstrate cultural skill?
Use professional medical interpreter to ensure meaningful communication
Use culturally sensitive assessment tools
195
What is the goal for a patient who is from a different culture?
A mutually agreeable therapeutic plan that is:
- culturally acceptable
- capable of producing positive outcomes
196
What is cultural desire?
Genuine concern for patient’s welfare
Willingness to listen until patient’s viewpoint is understood
Having patience, consideration, and empathy
