Exam 1 Terms Flashcards
(130 cards)
1
Q
Define resilience
A
Ability and capacity to:
- secure resources needed to support well-being
- regulate one’s own emotions
- overcome negative, self-defeating thoughts
2
Q
Most accepted explanation for mental illness
A
Diathesis-stress model
3
Q
What is Diathesis?
What is stress?
A
Biological predisposition (nature)
Environmental stress or trauma (nurture)
4
Q
Act that required insurance companies to provide equal treatment coverage for psychiatric disorders
A
Mental health parity act
5
Q
Act that allowed coverage for most uninsured Americans, health insurance exchanges, and insurance mandate
A
Patient protection and affordable care act
6
Q
Study of the distribution of mental disorders
A
Epidemiology of mental disorders
7
Q
What does epidemiology of mental disorders identify?
A
High-risk groups and high-risk factors
8
Q
Number of new cases of a disease in a given time
A
Incidence
9
Q
Number of new cases regardless of when they began
A
Prevalence
10
Q
Example of high incidence
A
The flu because we don’t get the flu and keep it
11
Q
Example of high prevalence
A
Diabetes because once someone is diagnosed with it, they will always have it
12
Q
Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders
A
DSM5
13
Q
What is the DSM5 based on?
A
Scientific criteria influenced by multi professional clinical field trials
14
Q
Which type of theories and research does psychiatric mental health nursing use?
A
Nursing, psychosocial, neurological theories
Evidence based practice
15
Q
How will mental health nursing be affected in the future?
A
Educational challenges
Demand for mental health professionals
Aging population
Cultural diversity
*Advocacy through direct and indirect care
Legislative involvement
16
Q
List Freud’s Levels of Awareness
A
Conscious - all material person is aware of
Preconscious - Material that can be retrieved rather easily through conscious effort
Unconscious - repressed memories, passions, & unacceptable urges
17
Q
Important terms from classical psychoanalysis still used today
A
Transference
Countertransference
18
Q
Unconscious feeling that the patient has toward you
A
Transference
19
Q
Unconscious feeling the nurse has toward the patient
A
Countertransference
20
Q
Psychoanalytic model that focuses on here and now
A
Psychodynamic theory
21
Q
Best candidates for this therapy are “worried well”
A
Psychodynamic therapy
22
Q
Therapy with increased back and forth between therapist and patient
A
Psychodynamic Therapy
23
Q
Theory that believes all behavior is to get needs met through interpersonal interactions and to reduce or avoid anxiety
A
Interpersonal theory (Sullivan)
24
Q
Parts of Sullivan’s Interpersonal theory
A
Anxiety
Security operations
Self-system
25
What are security operations?
What we do to get our needs met
26
What is the self-system?
Made up of all the security operations an individual uses to defend against anxiety and ensure self-esteem
27
Therapy that is most effective in treating grief and loss
Interpersonal therapy
28
Therapy that is most effective in treating interpersonal disputes
Interpersonal therapy
29
Therapy that is most effective for treating role transition
Interpersonal therapy
30
Implications for nursing for interpersonal therapy
Patient is both a participant and observer (Hildegard Peplau)
Must use self awareness to keep focus on patient (know your triggers)
31
Theories that use conditioning to respond to a specific stimuli
Behavioral theories
32
Implications in nursing regarding behavioral theories
Used to modify or replace behaviors
33
Techniques used in behavioral therapy
Modeling
Operant conditioning
Exposure therapy
Aversion therapy
Biofeedback
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Therapist provides role model for specific behaviors
Modeling
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Uses positive reinforcement to increase desired behaviors
Operant conditioning
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Patient is encouraged to face their fears
Exposure therapy
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Therapy that pairs target behavior with negative stimulus
Aversion therapy
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Therapy used to control body’s physiological response to stress and anxiety
Biofeedback
39
Theories that believe thoughts come before feelings and actions
Cognitive theories
40
Theories that believe 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
Cognitive theories
41
Two of the most influential cognitive theories
Rational-emotive behavior therapy (Ellis)
Cognitive-behavioral therapy (beck)
42
Therapy that helps patient recognize thoughts are not accurate and to eradicate irrational beliefs
Rational-emotive behavior therapy
43
Therapy that teaches patient to recognize negative thinking (depression & anxiety) and replace it with positive thoughts
Cognitive-behavioral therapy
44
Therapy that helps with very serious traumas. Helps identify feelings and how to manage them
Trauma-focused cognitive behavioral therapy
45
Therapy for people who think in extremes and have disorders involving emotional dysregulation
Dialectical behavioral therapy
46
Implications for nursing regarding cognitive therapies
Recognize the interplay between events, negative thinking, and negative responses
Help the patient identify negative thought patterns
47
Theory that believes psychology must go beyond experiences of hate, pain, misery, etc. and also include love, compassion, happiness, etc.
Theory of human motivation
48
Theory that believes humans are motivated by unmet needs
Maslow’s Hierarchy of Needs
49
Implications in nursing regarding Maslow’s hierarchy of needs
Helps establish sequence of nursing actions
50
Order (starting at the bottom) of Maslow’s hierarchy of needs
Physiological needs (food, water, oxygen)
Safety
Love and belonging
Esteem (self-esteem)
Self-actualization
Self-transcendence
51
Recognizes that psychiatric illnesses are as physical in origin as psychical illness
Biological model
52
Model that targets the site of illness using physical interventions (drugs, diet, surgery)
Biological model
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Therapy that uses medication to treat psychiatric illness
Psychopharmacology therapy
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Brain stimulation therapy used to induce a seizure to reset brain chemicals
Electroconvulsive therapy (ECT)
55
Stages of Cognitive development (Piaget)
Sensorimotor stage
Preoperational stage
Concrete operational stage
Formal operational stage
56
Theory that believes personality continues to develop through old age
Theory of psychosocial development (Erickson)
57
Eight stages of Erickson’s theory of psychosocial development
‣ Trust vs. Mistruct (0-1.5 yrs)
‣ Autonomy vs. Shame-doubt (1.5-3 yrs)
‣ Initiative vs. Guilt (3-6 yrs)
‣ Industry vs. Inferiority (6-12 yrs)
‣ Identity vs. Role confusion (12-20 yrs)
‣ Intimacy vs. Isolation (20-35 yrs)
‣ Generativity vs. Self-absorption (35-65 yrs)
‣ Integrity vs. Despair (65+ yrs)
58
Theory that believes psychological problems were largely the result of a disruption of separation
Theory of object relations (Mahler)
59
Theories that are an important part of nursing assessment
Theories of moral development
60
Framework for understanding the progression from black and white thinking about right and wrong to more complex thinking
Stages of moral development
61
List the 3 main stages of moral development
Preconventional level
Conventional level
Post conventional level
62
What are the two stages in the preconventional level of moral development?
Stage 1: obedience and punishment (obedience is method to avoid punishment)
Stage 2: individualism and exchange (know not everyone thinks the way they do. If they or others choose to break rules, they risk punishment)
63
What are the two stages of the conventional level of moral development?
Stage 3: good interpersonal relationships (believe people should get along and have similar values)
Stage 4: maintaining social order (“rules are rules” mindset returns, but this time bc individual has broader view of society)
64
What are the two stages of the postconventional level of moral development?
Stage 5: social contract and individual rights (social order is still important, but it must be good)
Stage 6: universal ethical principles (believe actions should create justice for all, and we are obliged to break unjust laws)
65
Theory that emphasizes relationships and banding together, putting the needs of those we care about above those of strangers
Ethics of care theory
66
Theory that ties progress to personal development and sense of self more than cognition
Ethics of care theory
67
Qualifications for a patient seeking home healthcare
Homebound
Mental health diagnosis
May have coexisting medical problems
Can safely be managed in home
Has identified treatment needs
68
Describe the continuum of care for outpatient and inpatient mental health settings
Primary care = least restrictive and most common
State hospital = most acute and most restrictive
69
Type of outpatient psychiatric care for people with persistent psychiatric symptoms who can’t come in for treatment (provides 24 hour treatment)
ACT (assertive community care)
70
What are intensive outpatient programs?
For patients who need a little extra help that can’t be met by a counseling session
(3-4 hours)
71
What is partial hospitalization?
For patients who can still take care of themselves the rest of the time
(9-3 mon-fri)
72
List the levels of prevention strategies
Primary: teaching young people coping sills
Secondary: screenings to catch disorders before they progress
Tertiary: after someone has diagnosis, try to prevent it from getting worse or from other problems occurring
73
List the roles of a nurse in an outpatient setting
Strong problem solving and clinical skills
Cultural sensitivity
Flexibility
Knowledge of community resources
Autonomy
Promoting recovery and continuation of treatment
74
Settings for inpatient care
Crisis stabilization/observational units
General hospitals/private hospitals
State psychiatric hospitals (most restrictive)
75
Type of plan inpatient units use to improve outcomes
Clinical pathways
76
Patient surroundings and physical environment
Milieu
77
Goal of milieu
Promote environment of safety and empower patients to partner with staff and take ownership of their own health and safety
78
Racially, ethnically, or culturally distinct groups that coexist, but are subordinate in some way to a dominant group
Minority
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Can be defined biologically, anthropologically, or genetically
Race
80
Sharing a common heritage, history, and world view for thinking
Ethnicity
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Set of shared beliefs, values, and practices
Culture
82
Beliefs of western tradition
Identity found in individuality
Values autonomy, independence, self-reliance
Disease has a cause, treatment aimed at cause
83
Beliefs of eastern tradition
Family basis for identity
Born into fate
Disease cause by fluctuations in opposing forces
84
Beliefs of indigenous culture
Basis of identity is the tribe
Person is an entity only in relation to others
Disease caused by lack of harmony with environment
85
List some at-risk populations
Immigrants
Refugees
Cultural minorities
86
List the 5 constructs of culturally effective care
Awareness
Knowledge
Encounters
Skill
Desire
87
What is the difference between ethics and bioethics?
Ethics = beliefs about what is right or wrong in society
Bioethics = ethical dilemmas surrounding healthcare
88
6 principles of bioethics
Autonomy
Beneficence
Nonmaleficence
Justice
Fidelity
Veracity
89
Patients have rights over their own body
Autonomy
90
Duty to promote good
Beneficence
91
Doing no harm to a patient
Nonmaleficence
92
Distribute resources and care equally
Justice
93
Maintain loyalty and commitment
Fidelity
94
One’s duty to always communicate truthfully
Veracity
95
Types of hospital admissions
Voluntary
Involuntary
Emergency commitment
96
Requirements for a patient to be admitted to the hospital involuntarily
Mentally ill
Danger to self or others
Gravely disabled
In need of treatment and illness prevents voluntary help seeking
97
When is emergency commitment used?
Temporarily (24-96 hours) to observe patient and determine if they should be admitted involuntarily
98
When a patient is released and they can just leave the hospital
Unconditional release
99
Release that requires outpatient treatment with follow through evaluation
Conditional release
100
Release that is court ordered and requires outpatient treatment with follow through evaluation
Assisted outpatient treatment
101
Letter patient can write explaining why they don’t think they should be kept involuntarily
Writ of Habeas Corpus
102
Law that states the least drastic restrictive action should always be taken
Least restrictive alternative doctrine
103
Patient rights regarding restraint and seclusion
- Must have orders and documentation
- In emergency, nurse can place pt in seclusion or restraint and obtain order ASAP thereafter
- Orders for restraints are never written as needed or standing order
104
What are the exceptions to patient confidentiality?
Duty to warn and protect 3rd parties
Child and elder abuse
105
Any wrongful act, intentional or accidental, that results in injury to another
Tort
106
Examples of unintentional tort
Negligence
Malpractice (most common)
107
When should you act on questionable practice by another nurse?
If they show negligence, irresponsibility, impairment, or criminal activity
108
What is the process for reporting another nurse of negligence?
Document clearly and accurately first
Superior intervenes; if unavailable you must intervene
109
How can a nurse protect themself from patient violence?
Always document patient’s potential for violence
Communicate observations to colleagues
New laws enhance criminal charges and penalties for striking nurses
110
Publication that has basis for certification criteria
ANA publication: psychiatric-mental health nursing
111
Publication that has legal definition of psychiatric mental health nursing
ANA publication: mental health nursing
112
How should you assess children differently than adults?
Caregivers will provide a lot of info
Must consider development levels
Assessment will be a combo of interview and observation
113
How should you assess adolescents differently than adults?
Special concern with confidentiality
Need to use best judgement
But always tell parents if patient is a danger to themself or others
114
How should you assess older adults differently than adults?
Assess senses, motor function, and brain function
Do not assume they will be physically or mentally deficient
115
What is the difference between interpreter and translator?
Interpreter = someone who interprets spoken foreign language
Translator = someone who translates written word
116
What is a mental status exam?
Objective
Evaluation of individuals current cognitive processes
117
What is a psychosocial assessment?
Subjective
Assessment to provide additional info from which to develop plan of care
118
Difference between personal relationships and therapeutic relationships
Personal relationships are to meet mutual needs
Therapeutic relationships are focused on the patient’s needs, goals, and strengths
119
How can you use therapeutic use of self?
Instrument for delivery of care
Use interpersonal communication techniques as tools of intervention
120
List the phases of the nurse-patient relationship
Preorientation phase
Orientation phase
Working phase
Termination phase
121
What happens during the Preorientation phase of nurse patient relationships?
Reviewing pt history
Recognizing your thoughts and feelings about meeting the pt
Anticipating ground rules
122
What occurs during the orientation phase of the nurse patient relationship?
Establishing rapport and trust
Setting parameters of the relationship
Discussing confidentiality
123
What occurs during the working phase of the nurse patient relationship?
Gather further data
Goal setting
Promote pt’s problem-solving skills
Build self-effect
Facilitate behavior change
Promote use of alternative adaptive behaviors
124
What occurs during the termination phase of the nurse patient relationship?
Review goals achieved
Incorporate use of new coping strategies and application for future issues
Reflection and lessons learned
Express feelings of ending the therapeutic relationship
125
Why is therapeutic communication imperative to nursing care?
Human interactions are an underlying cause of medical errors and preventable deaths
Human factors, leadership, and communication are top root causes of sentinel events
126
What are communication skills vital for as a nurse?
Consistently demonstrate professionalism
Communicate care needs of pts to other staff
Communicate with patient
Effectively manage time and provide basic care needs
127
List the therapeutic communication techniques
Using silence and listening
Presence - full attention
Clarifying techniques
Statements that let pt know you listened
Use of questions (mostly open ended)
128
List the kinds of statements you can say to a patient to let them know you were listening
Reflections**
Restating
Paraphrasing
Summarizing
Acknowledging/affirming
129
List non therapeutic communication techniques
Excessive questioning
Expressing approval or disapproval
Giving advice
Asking why
130
List effective communication techniques
- clear distractions from your mind and focus on the pt as a unique individual. Be present
- gather info using open-ended questions and reflections
- validate the patient (affirm and acknowledge)
- listen, don’t tell
- avoid aggressive verbal and nonverbal communication
