intro

Question 1

health

Answer 1

complete physical, mental, and social well being
not just absence of disease or illness
enjoyment of self and env

Question 2

mental health

Answer 2

continuum
individuals reach own potential, cope with stress, work productively, contribute to community

Question 3

mental illness

Answer 3

health conditions involving changes in emotion, thinking, behavior (or combo)
associated with distress and/or problems functioning in social, work, family activities

Question 4

attributes of mental health

Answer 4

rational thinking, resiliency, self esteem, self awareness, emotional growth, self care, learning and productivity, communication skills, meaningful relationships, spiritual satisfaction

Question 5

elements that contribute to mental health

Answer 5

biologic
psychologic
sociocultural

Question 6

biologic elements of mental health

Answer 6

prenatal, perinatal, neonatal events
physical health
nutrition, hx of injuries, neuroanatomy (all brains are different), physiology

Question 7

psychologic elements of mental heatlh

Answer 7

interaction, IQ, self concept, skills, creativity, emotional dev level (changes throughout life)

Question 8

sociocultural

Answer 8

fam stability, ethnicity, housing, child rearing patterns, strict or loving upbringing, economic level, religion, values and beliefs

Question 9

resilience

Answer 9

ability and capacity to secure resources needed to support wellbeing
characteristized by optimism, sense of mastery, competence
essential to recovery -> adapting
can determine incidence, severity, and prognosis of mental illness

Question 10

incidence and prevalence

Answer 10

1/5 adults
F > M
18 - 25 yo highest

Question 11

early 19th century theories

Answer 11

inheritance
moral degeneracy: mentally ill by virtue of bad character
germ theory -> segregation
septic foci theory -> remove infection by sx = cure (bleeding, leaches, etc)

Question 12

diathesis stress module

Answer 12

diathesis = biological predisposition
stress -> env or trauma
most accepted explanation for mental illness
combo of genetic vulnerability and negative env stressors

Question 13

early tm

Answer 13

1800 - 1900
s/s behavior (under control of person): can be adjusted by restraining (phys or chm), sx (lobotomy), insulin, hydrotherapy, sedative cold wet packs, electroshock

Question 14

lunacy act

Answer 14

asylums and institutions
1845

Question 15

mental health treatment act

Answer 15

mental hospitals
1930

Question 16

mental health units

Answer 16

acute care
in reg hospitals
1970s

Question 17

1990

Answer 17

community mental health
less hospital time, transition to community

Question 18

2000

Answer 18

integrate primary and mental health care

Question 19

deistitutionalization

Answer 19

mass movement of severely mentally ill from state hospitals to out pt care
many hospitals closed, more meds (psychotropic), greater nursing role

Question 20

deinstitutionalization and lack of community spaces

Answer 20

lacked self care skills
many went to prison - dont get treatment and become worse, cant get resources or jobs with criminal records
cyclic pattern: homeless, ED, re-arrested
revolving door treatment -> many go to ED
also influenced by managed care (health insurance): decreased LOS, increased stringent admission criteria
still limited community support

Question 21

victimization

Answer 21

much higher rate
verbal abuse, bully, threat, theft, physical assault, rape
former partners and fam -> exploit and abuse
hcp
institutions can be dangers -> staff and other pts
many prefer danger in community over danger in institution

Question 22

social influences on mental health care

Answer 22

consumer movement/recovery
national alliance on mental illness (NAMI)
surgeon generals report on mental health
new freedom commission on mental health

Question 23

consumer movement/recovery

Answer 23

people with MI advocate for their rights, fought against discrimination and forced treatment

Question 24

national alliance on MI

Answer 24

1 group that fought for rights
dedicated to building better services, treatment, research, support, awareness, decrease stigma
communicate that MI are brain disorders
eliminate stigma and descrimination
advocate for people with MI
improve access to tm services
integrate MI into community life

Question 25

NAMI services

Answer 25

support groups, educational programs, public awareness events, fam-fam, in our own voice, participation station (hangout with MI), warm line (crisis line-ish), NAMI walk

Question 26

report of the surgeon general

Answer 26

1999 2 main points: MH is fundamental and necessary to healthy life, there is effective tm avail disorders are real health conditions with enormous consequences range of tm avail for most seek tm bc it can help

Question 27

new freedom commission on MH

Answer 27

2003 called for streamline system with less fragmentation in care advocate for early dx and tm principles of recovery increased assistance with housing and employment link btw mental and overall health, family and consumer driven, eliminate disparities, screenings and referrals at primary, more tech and housing

Question 28

fayette county mental health court

Answer 28

systems navigator = peer support specialist -> match participants to housing and support services multidisciplinary team of judges, prosecutors, providers, case workers, peer support specialists provide a tm oriented, person centered approach to address individual needs based on tm jurisprudence and restorative justice principles to reduce reoffending get out of jail and MH services needed get referral, staff screen for eligibility, get out of jail if follow tm plan

Question 29

tim's law

Answer 29

dont perform well in com (stopped meds), guardians can advocate for out pt tm anosognosia = dont believe they have illness assisted out pt tm

Question 30

MH parity act

Answer 30

parity -> equivalence insurance companies provide equal tm coverage for psych disorders and substance abuse disorders

Question 31

pt protection and affordable care act

Answer 31

coverage for most uninsured americans expanded medicaid eligibility (for very poor) create health insurance exchanges to offer more choices insurance mandate for coverage

Question 32

barriers to delivery of adequate and accessible mental hc

Answer 32

need is increasing limited access: transportation, wait time, income/cost/insurance provider limitations: #, knowledge stigma

Question 33

stigma

Answer 33

widespread fear and misunderstanding of MI heightened by focus on extraordinary S in film and literature major clinical and public health issue, burden on those with MI fight: talk openly, educate self and others, be conscious of language, show empathy and compassion, stop criminalization, advocate for reform, encourage equality in how MH is perceived

Question 34

recovery

Answer 34

is possible, even if cure isnt process of change through which individuals improve their health and wellness, live a self directed life and strive to reach their full potential

Question 35

dual dx

Answer 35

co occuring MI and substance use disorder

Question 36

co morbidity

Answer 36

can be 2 MI or medical 2 co occurring chronic illnesses

Question 37

adherence

Answer 37

used to be compliance managing care based on plan of care developed as part of hct, stick to this developed poc

Question 38

DSM-5

Answer 38

official medical guidelines of APA for dx psych disorders based on specific criteria influenced by multiprofessional clinical field trials

Question 39

psych nurses

Answer 39

private practice, hospitals, community health, universities and colleges

Question 40

basic psych nursing

Answer 40

RN-BC, 2yrs (2000 hrs), 30 hr continuing education

Question 41

advanced practice psych nursing

Answer 41

master or dr screen, eval, promo, edu assess/examine formulate differential dx order, conduct, interpret labs, dx, procedures psychotherapy direct and provide home health prescribe, monitor, manage, eval meds integrated MH services in general health settings

Question 42

skills of all nc with roots in psych

Answer 42

safety (thoughts and env), tc, nurse -pt relationship, milieu management, relaxation, motivational interviewing, self efficacy, suicide, manage aggressive behavior, psychopharm, crisis intervention, disaster MH, instill hope

Question 43

interdisciplinary team

Answer 43

plan of care pt -> self efficacy (design own poc) fam/SO, RN, MD, CNS/APRN, psychologist, SW/LCSW, pharmacist, recreational (activity) therapist, drug and OH counselor, teacher, mental health associates

Question 44

acute care setting

Answer 44

get pt stable enough and send elsewhere highly structured, optimize safety, address crisis, intervention, 3-7 days avg (peds longer)

Question 45

long term care setting

Answer 45

rec if pt needs > 7 days for stabilization, not locked unit

Question 46

partial hospitalization

Answer 46

alternative for pt that need some supervision but not appropriate for in pt transitional step decrease readmission, med monitoring, coping skill

Question 47

specialty treatment settings

Answer 47

peds, geriatric, vets, forensic, OH and drugs, self help, eating disorder, all male, all F, co-ed

Question 48

day treatment

Answer 48

step below PHP (partial program) -> allow fam to work, during day adult, ongoing, chronic need structure of scheduled activity for 2-3 days/wk, group focused improve coping skills, enhance strength, address shortcomings, improve functioning and independence, build social skills that foster + interpersonal relationships 4 wks or less

Question 49

day treatment staff

Answer 49

psychiatrists, psychologists, RN, social workers

Question 50

in pt

Answer 50

admission: voluntary or involuntary danger to self or others cant care for basic needs, and/or gross impairment of judgement, imminent risk, cant protect self

Question 51

voluntary admission

Answer 51

pt or guardian and hcp agree with need consent form signed

Question 52

involuntary admission

Answer 52

72 hr hold, can sign voluntary, court can be petitioned for further care 72 hrs only when court is open

Question 53

patient rights

Answer 53

same rights recieve or refuse tm, dignity, involvement in poc, AMA, protection from harm, legal counsel, communicate, confidentiality, least restrictive means implied consent: cant communicate but willing to take med capacity and competency

Question 54

restraint and seclusion

Answer 54

first: verbally intervene, decrease stim, diversion, prn meds, listen orders and doc, nurse can do in emergency then get order, never prn or standing chm -> agitation, less restrictive than phys or mech least restrictive means of tm: assess -> decrease stim (go to rm) -> prn meds (oral) -> seclusion area (escort) -> IM prn meds -> restraints if danger

Question 55

confidentiality exceptions

Answer 55

warn and protect 3rd parties child and elder abuse confidential even after death

Question 56

therapeutic milieu

Answer 56

surroundings and phys env of unit, provides sense of security/safety/management interact with peer and staff help pt engage and increase social competence and self worth real life training ground to practice communication and coping skills activities, unit rules, reality orientation practices and groups

Question 57

therapeutic milieu components:

Answer 57

containment: locked unit, basic needs of food, shelter, safety, security support: encouragement, praise, + feedback, autonomy and coping validation: privacy, cultural needs, feelings lead to clients holistic health structure: control and limit maladaptive behaviors and setting limits involvement: promote self efficacy