Wk1: mental health nursing Flashcards

Question

What are the 5 care principles of trauma informed care/practice?

Answer 1

- safety - trustworthiness - choice - collaboration - empowerment - respect for diversity

Answer 2

- ensure treatment is not re-traumatising people Ways clinicians can do this: * Realises the effect of trauma on the person and potential path to recovery * Recognises signs and symptoms of trauma in consumers, families/carers, staff * Strives for a therapeutic relationships that develop trust and safety * Accepts and respects the person and their safety * Focuses on the person’s strengths * Maximizes the individual’s choice and control over their recovery * Actively seeks to resist re-traumatisation

Answer 3

- collaborative care approach - ensuring shared decision making. This promote * Autonomy and empowerment * Informed choice and decision making * Mutual participation * Recovery

Answer 4

- partnering with t he client and carers - consideration of context of their presenting illness - consideration of psychological circumstances e.g. drug induced psychosis/ living away from home/ studying at university/ unsupportive partner

Answer 5

- consider their age - consider population group - Consider their cultural traditions and religious practise and how these may be impacting the clients presentation, therapeutic engagement and treatment plan. e.g. i.e., use of elders in clients of Torres Strait Island decent, need to access to a prayer room, refusal of some medications due to pork derivatives

Answer 6

- ascertain their health care preferences - incorperate preferences where relivant - empower clients and carers - help them identify their strengths - support their recovery - aim in decreasing their resistance to services

Answer 7

- recovery plans - management plans - behavioural plans

Answer 8

- provide psychoeducation - implement therapeutic engagement approaches - administer medications - document mental status examinations - document risk assessments - activley monitor physical health - educate clients and carers of legal rights

Answer 9

They have a unique role in the recovery journey Their feelings, experiences and questions may vary considerably as they encounter unexpected situations that they have little experience of and no preparation for. Experience strong emotions of: - fear - confusion - grief and loss - wondering how they will cope wondering what the cause of their loved one’s mental illness is - wondering why they in - particular have been affected by mental illness - wondering what other people will think - wondering what the situation means for their family.

Answer 10

In accordance with the Victorian Mental Health Act (2014) - a person can nominate another person prior to admission, on admission or at any time to receive information and provide support in the event that they become unwell and require compulsory treatment. - In most cases, the nominated person is a carer or family member. - However, where a person nominates someone other than a carer to be their nominated person, a carer must still receive information and have their views considered.

Answer 11

- person must always consent - key events and information about treatment that will be necessary for effective participation in a consultation or action taking in care. - if a patient is unable to consent or refuses to consent to sharing information, carers can be given information if they need the information to provide care to a patient and to prepare for their caring role. - A person disclosing information in these circumstances must have regard to the patient’s views and preferences, including any preferences expressed in an advance statement.

Answer 12

The aims of the therapeutic relationship are; - To facilitate the communication of distressing thoughts and feelings, inclusive of the carer's perspectives - Assist the client with problem solving & help facilitate activities of daily living. - Help clients examine self-defeating behaviours and test alternatives. - Promote self-care and independence, in collaboration with their carer.

Answer 13

Orientation phase - in which the client and nurse mutually identify the issues / problems. (carers are an invaluable source of knowledge in this phase of the relationship) Identification phase - in which the client / carer identifies with the nurse, thereby accepting help Exploitation phase - in which the client and carer make use of the nurses help Resolution (termination) phase - the client accepts new goals and the therapeutic relationship is terminated

Answer 14

A display of genuineness, transparency and self-disclosure. Other characteristics - Relating in a sincere and honest manner - Matching your body language, gestures, expressions and tone to the sentiment that you are expressing - Not pretending to be an expert - acknowledging that the client knows more about themselves than you do - making it clear that you are only knowledgeable in particular areas, not everything - admitting that you may need to find out more about something or admitting that you don’t understand - making referrals to other professionals or seeking help from other nurses if needed - Being honest with the client about your own feelings - Appropriately using self-disclosure e.g. to help the client develop new insight into a problem - Promoting autonomy - Being transparent in motives and intentions - agreeing on goals together - telling clients if confidentiality has to be broken

Answer 15

The following are things you would be doing if you were demonstrating unconditional positive regard. - Awareness of prejudice toward the client - Avoiding imposing your views on the client - Avoiding using judgemental expressions e.g. “should, must, ought” - Avoiding stereotyping and assuming - Remembering that different does not mean wrong

Answer 16

- its active - unique to the person and what they want. - can be with or without mental health problems and be in recovery - they may need to continue with medication or support and this is recovery - it may include recovery Personal recovery= supporting people the way they wish to be supported - it cannot be assessed by anyone but the person

Answer 17

= underpins mental health policy/practice and refers to the application of capabilities that support people to recognise and take control of their own recovery * Embracing the possibility for recovery, focusing on the strengths of the person * Maximising self-determination and self-management of mental health * Assisting families/carers to understand challenges and opportunities related to the person’s experiences

Answer 18

Uniqueness of the individual - Real choices - Attitudes and rights - Dignity and respect - Partnership and communication - Evaluating recovery

Answer 19

Recovery model - grounding and implementing principles of recovery Wellness Recovery Action Plan (WRAP) - Tools to support self-management with a focus on recovery-oriented mental health services - helps people self manage and identify and mange things that make their mental health better or worse - promotes use of wellness toolbox Strengths Model (strengths-based approach) - Moves away from focuses on a person’s deficits or ‘what’s wrong’ to focus on the person’s strengths and resources (Slade et al. 2014) - focused on what they can build on CHIME recovery framework (connectedness, hope and optimism about the future, identity, meaning in life and empowerment) - Focuses on upholding principles of recovery = and the ‘CHIME factors’

Answer 20

- Promote optimal quality of life, autonomy, hope - Support inclusion - Challenging stigmatising attitudes and discrimination - Involve the person/client in all decisions regarding their care and treatment (and carers/families, nominated person) - Care and treatment should be tailored to meet the specific needs of the person/client - Be responsive to Aboriginal and Torres Strait Islander people, people from different cultural backgrounds, immigrant and refugee backgrounds, lesbian, gay, bisexual, transgender and intersex people - Focus on strengths - Less restrictive practice - reduce coercion, seclusion and restraint

Answer 21

Purpose: Relevance:

Answer 22

- to guide treatment and diagnosis of people with mental health problems - to ensure the least restrictive treatment is provided e.g. community over hospital * To provide for the assessment of persons who appear to have mental illness and the treatment of persons who have mental illness; and * To provide for persons to receive assessment and treatment in the least restrictive way possible with the least restrictions on human rights and dignity; and * To protect the rights of persons receiving assessment and treatment; and * To enable and support persons who appear to or have mental illness & their ability; (i) to make, or participate in, decisions about their assessment, treatment and recovery; (ii) to exercise their rights under this Act; and * To provide oversight and safeguards in relation to the assessment of mentally ill persons; and * To promote the recovery * To ensure that persons who are assessed and treated under this Act are informed of their rights under this Act; * To recognise the role of carers in the assessment, treatment and recovery of persons who have mental illness.

Answer 23

1. Persons receiving MH services should: a) Be provided treatment in the least restrictive ways possible (voluntary admission preferred) b) Be provided with the aim of best therapeutic outcomes, promoting recovery and full participation c) Be involved in all decisions about their assessment, treatment and recovery, and supported to participate and make decisions with their preferences respected d) Be allowed to make decisions that involve a degree of risk e) Have their rights, dignity and autonomy respected and promoted f) Have their other health needs (including physical health, and AOD) recognised and responded to g) Have individual needs recognized and responded to (culture, language, communication, age, disability, religion, gender, sexuality or other) h) Ensure Aboriginal persons have their distinct culture and identity recognised and responded to i) Ensure children and young people have their best interest recognized and promoted as primary consideration j) Ensure children, young people and other dependent of people receiving MH services have their needs, well-being and safety recognised and protected k) Ensure carers (incl. children) for people receiving MH services should be involved in decisions about assessment, treatment and recovery whenever possible l) Ensure carers (incl. children) for people receiving MH services should have their role recognised, respected and supported 2. A MH service provider must have regard to the MH principles 3. A person must have regard to the MH principles in performing any duty or function or excerising any power under or in accordance with the MHA

Answer 24

= to protect the rights and dignity of patients Communication: patients have the right to communicate lawfully. Mental Health Tribunal: makes and reviews orders and determines treatment applications. e.g. use of ECT Statement of rights: patients must be given a statement of rights at key points in their assessment/treatment. Restrictive interventions: are strictly regulated. e.g. exclusion or restraint Electroconvulsive therapy: ECT is a safe and effective treatment for some mental illness. Neurosurgery: can only be performed with the patient’s informed consent and mental health tribunal approval.

Answer 25

= condition that is characterised by a significant disturbance of thought, mood, perception or memory Note: no mention of behavioural disturbances

Answer 26

1. A person is not to be considered to be mentally ill by reason only of any one or more of the following: a) that the person expresses or refuses or fails to express a particular political opinion or belief; b) that the person expresses or refuses or fails to express a particular religious opinion or belief; c) that the person expresses or refuses or fails to express a particular philosophy that the person expresses or refuses or fails to express a particular sexual preference, gender identity or sexual orientation; (e) that the person engages in or refuses or fails to engage in a particular political activity; (f) that the person engages in or refuses or fails to engage in a particular religious activity; (g) that the person engages in sexual promiscuity; (h) that the person engages in immoral conduct; (i) that the person engages in illegal conduct; (j) that the person engages in antisocial behaviour; (k) that the person is intellectually disabled; (l) that the person uses drugs or alcohol; (m) that the person has a particular economic or social status or is a member of a particular cultural or racial group; (n) that the person is or has been involved in family conflict; * (o) that the person has been previously treated for mental illness.

Answer 27

= a presumption of capacity to make treatment decisions regardless of age or MHA legal status. A patient has capacity to give informed consent if the person: a) understands the information he or she is given b) is able to remember the information c) is able to use or weigh information d) is able to communicate the decision he or she makes Includes principles to provide guidance around determining capacity (s 68(2)) a) Capacity to give informed consent is specific to the decision that needs to be made b) A person’s capacity to give informed consent may change over time c) It should not be assumed that a patient lacks capacity to give informed consent based only on their age, appearance, condition or behaviour d) A determination that a patient lacks capacity to give informed consent should not be made because the patient makes a decision that could be considered unwise e) A capacity assessment should occur at a time and in an environment in which a patient’s optimal level of capacity can be most accurately assessed

Answer 28

A person gives informed consent if the person has: a) The capacity to give informed consent to the treatment b) Been given adequate information to make an informed decision c) Been given a reasonable opportunity to make the decision d) Given consent freely without undue pressure or coercion e) Not withdrawn consent or indicated any intention to withdraw consent If the patient is incapable of informed consent &/or lacks capacity to decide (s71): * Authorised psychiatrist can make a treatment decision (except ECT & Neurosurgery for Mental Illness) if there is no less restrictive way for the person to be treated In determining least restrictive treatment authorised psychiatrist must consider: * Patient’s views and preferences (including in advance statement) * Views of nominated person, guardian, carer, parent of patient <16 * Likely consequences for the patient if proposed treatment is not performed * Any second psychiatric opinion

Answer 29

* Supported decision making is viewed under the Act as central to recovery-oriented practice * The Mental Health Act 2014 (Vic) enables compulsory patients to make decisions about their treatment and to determine their individual path to recovery * Nurses are encouraged under the Act to support patients to make or participate in decisions about their treatment

Answer 30

The Mental Health Act 2014 (Vic) promotes supported decision making through: * Advance statements (s.20) – gives patients greater control over treatment and informs about patients treatment preferences * Nominated Person – receives information and supports patients as per s.23 which outlines the role of the nominated person * Second psychiatric opinion – promotes patient self-determination and a dialogue between clinicians and patients about treatment options. The right to a second opinion is s.79 Other initiatives to promote supported decision making: * Advocates – assist patients to participate in decisions about their assessment, treatment and recovery

Answer 31

Advanced statement= enables a patient to record their treatment preferences in the event that they become unwell and require compulsory mental health treatment. This is stored on the CMI database for MHS’s to access. Changes to patient preferences are discussed later Advance statements: * Has an explanation provided in section 19 * Can be made at any time provided a patient understands what an advance statement is and the consequences of making it. The nominated person can withdraw consent to be the nominated person and needs to take reasonable steps to inform the patient under section 27 of the Mental Health Act 2014 (Vic) * Must be signed, dated and witnessed by an authorised witness which includes registered medical practitioner, mental health practitioner or any person authorised to witness statutory declarations Can be revoked or have contents renewed as per section 21 of the Mental Health Act 2014 (Vic) either by: * making a revocation; or * making a new advance statement * must be considered whenever a substitute treatment decision is made * Can be overridden if the preferred treatment is not clinically appropriate or not ordinarily provided by the mental health service. Consider how this would effect the persons' trust in the health care service. * Written reasons for overriding an advance statement must be provided within 10 days of a request for such reasons

Answer 32

A person can nominate another person to receive information and support them while they are a compulsory patient A nominated person: - Must be willing, available and able to fulfil the functions and responsibilities of the nominated person. The nominee may be under 18 years of age Role includes: - Providing the patient with support and help represent their interests - Receive information about the patient - Be consulted about the patient’s treatment - Assist the patient to exercise their rights A nomination: - Must include a statement from the nominated person saying they agree to be the nominated person & a nominated person may decline the nomination at any time - Must be in writing, signed and dated by the person making the nomination and witnessed by an authorised witness which includes persons set out previously and authorised to witness statutory declarations - Can be made or revoked at any time provided the patient understands what a nomination is and the consequences of making or revoking it (s.26)

Answer 33

An ambulance paramedic, police officer, medical practitioner employed by a designated mental health service or mental health practitioner (See below)

Answer 34

1. Any power, duty or function of the authorised psychiatrist to a consultant psychiatrist except the power to further delegate. 2. The powers, duties and functions of an authorised psychiatrist relating to Assessment Orders to a registered medical practitioner including: 1. Power to examine a person and extend the duration of an Assessment Order (AO) 2. Power to assess a person subject to an Assessment Order (AO) and to make a Temporary Treatment Order (TTO) 3. Power to revoke an Assessment Order (AO).

Answer 35

approved mental health service

Answer 36

= is a registered nurse, registered psychologist, registered occupational therapist or social worker employed by a designated mental health service

Answer 37

One that - Promotes voluntary treatment in preference to compulsory treatment - Seeks to minimise the use and duration of compulsory treatment to ensure that the treatment is provided in the least restrictive and least intrusive manner possible - Establishes compulsory treatment orders comprising of: - Assessment Orders (commence s.28) - Temporary Treatment Orders (commence s.45) - Treatment Orders (commence s.52)

Answer 38

= is the first step in initiating compulsory treatment - used to assess the person to determine whether they have a mental illness and need compulsory treatment - registered medical practitioner or a mental health practitioner may make an Assessment order if they have examined the person and are satisfied that the criteria for an Assessment order apply to the person Criteria (all 4 must be met for a person to be placed on an assessment order) - The person appears to have a mental illness - Due to mental illness, the person requires immediate treatment to prevent: - Serious deterioration in the person’s mental or physical health - Serious harm to the person or another person - If the person is made subject to an Assessment order, the person is able to be assessed - There is no less restrictive means reasonably available for the person to be assessed *when under an assessment order they can't be given treatment without consenting if its urgent, risk to themselves or other, or if they have immediate health issues

Answer 39

= the of an Assessment order (s.34): - Community Assessment order: maximum 24 hours (can stay home and receive treatment) - Inpatient Assessment order: maximum 72 hours (to allow for transport), 24 hours once the person is received at the MH service - Variation of Assessment orders can be made (s.35) (e.g. community to in-patient and visa versa) - Once made, the authorised psychiatrist will either revoke the Assessment order (criteria no longer applies) or make the person subject to a Temporary Treatment Order

Answer 40

= A Temporary treatment order can be made by an Authorised Psychiatrist after assessing a person (with an Assessment order) that enables the person to be compulsorily treated (for a maximum of 28 days) - In the community; or - Taken to, and detained and treated in a designated mental health service The Authorised Psychiatrist who makes a person subject to a Temporary treatment order must be satisfied that the person meets the criteria (same as AO)

Answer 41

The Mental Health Tribunal is responsible for making a person subject to a Treatment order must be satisfied that the person meets the criteria (same as AO) - would look at someone going to be on one of these if they are nearing the end of the 28 day temporary treatment order and the person still requires treatment. A treatment order is made by the Tribunal and enables a person to be compulsorily treated - In the community; or - Taken to, and detained and treated in a designated mental health service/hopsital The duration of a community treatment order for a person over 18 years is 12 months; under 18 years is 3 months. The duration of a inpatient treatment order for a person over 18 years is 6 months; under 18 years is 3 months. Variations can be made, but needs to go back to the Mental Health Tribunal

Answer 42

- An Authorised Psychiatrist who made a person subject to an Assessment order cannot make the person subject to a TTO (a safe guard to reduce the likely hood of treatment being restrictive) - The patient cannot discharge themselves from compulsory status or hospital. - Patients AWOL would be reported to Police and returned to a MHS when located (under s.352) - The patient must have any leave from hospital approved by the Authorised Psychiatrist (AP) - The Authorised Psychiatrist in making a TTO, or the MHT in making a TO, must take the patient’s and nominated person’s views, beliefs and preferences into account, along with the advance statement (if completed) and wishes of family &/or carers (parent if under theage of 18) - A person subject to a TTO/TO can apply to the MHT to have the order revoked at any time - If treatment criteria is not met (even just one component), an authorised psychiatrist must revoke an order at any time

Answer 43

Definition provided in s.78 for an “entitled patient” which is any compulsorily detained person subject to TTO/TO, security and forensic patients to access a second opinion - Can be requested at any time - Written report of the second opinion will be provided to the patient, authorised psychiatrist, nominated person and others - Second opinions will continue to be provided by psychiatrists working in public mental health services, however patient can seek the second opinion from any psychiatrist - Funds committed to second opinions from psychiatrists working in private practice to promote access and choice. To ensure access for all - Promotes dialogue between clinicians and compulsory patients about treatment

Answer 44

A police officer may apprehend a person if satisfied that: - The person appears to be mentally ill; and - The person needs to be apprehend to prevent serious and imminent harm to themselves or others The police member is not required to exercise clinical judgement and is only required to have reasonable grounds to form the belief that a person is mentally ill and has or is likely to harm themselves/others No form required for s351 Police must arrange to have the person taken to a registered medical practitioner or mental health practitioner for examination Assessment order process begins The Act enables police to release the person from their custody into the care of a hospital when safe to do so

Answer 45

= Seclusion means the sole confinement of a person to a room or any other enclosed space from which it is not within the control of the person confined to leave” (Mental Health Act 2014 (Vic), p. 12) Seclusion can be used in a designated mental health service in order to prevent imminent and serious harm to the person or another person (s110) Must be authorised by either an authorised psychiatrist, or if the authorised psychiatrist is not immediately available, a medical practitioner or the most senior registered nurse on duty (s.111)

Answer 46

1. The person in seclusion must be monitored in accordance with section 112. 2. Be reviewed as clinically appropriate to his or her condition at intervals of not more than 15 minutes by a registered nurse or medical practitioner; and 3. Subject to sub-section (4), an AP must examine a patient in seclusion as frequently as the AP deems is appropriate in the circumstances, but at intervals not less than 4 hourly; and 4. If it is not practicable for the AP to examine the patient at a frequency the AP deems appropriate, the patient must be examined by a registered medical practitioner as directed by the AP Additionally, the patient should … - Be supplied with bedding and clothing which is appropriate in the circumstances - Be provided with food and drink at the appropriate times - Be provided with adequate toilet arrangements - Cease the seclusion when it is no longer necessary

Answer 47

= “Bodily restraint means a form of physical or mechanical restraint that prevents a person having free movement of his or her limbs, but does not include the use of furniture (including beds with cot sides and chairs with tables fitted on their arms) that restricts the person's ability to get off the furniture” (Mental Health Act 2014 (Vic), p. 4) - Can only be used in a designated mental health service if it is necessary - To prevent imminent and serious harm to the person or another person - To administer treatment or medical treatment to the person - Must be authorised by either an authorised psychiatrist, or if the authorised psychiatrist is not immediately available, a medical practitioner or the most senior registered nurse on duty (s.114, urgent use s.115)

Answer 48

Similar to seclusion only that a person under restraint must be continually monitored by a nurse. 1. If bodily restraint is used the person must be monitored in accordance with this section 2. Must be under continuous observation by a registered nurse or registered medical practitioner 3. A registered nurse or registered medical practitioner must clinically review the use of the restraint as often as appropriate, but not less frequently than every 15 minutes 4. Subject to subsection (5) an authorised psychiatrist must examine the person as appropriate, but not less frequently than every 4 hours 5. If the authorised psychiatrist cannot conduct the examination or it is not practicable, this can be delegated to a registered medical practitioner

Answer 49

The Mental Health Tribunal comprises of three members: - - someone of legal background - community member - psychiatrist or registered medical practitioner

Answer 50

The role of the Mental Health Tribunal is to: - Make TO (s.55) after considering the AP application and views of patient / relevant others - Revoke a TTO or TO - Decide the initial setting where treatment will be provided (inpatient or community) or transfer to another DMHS - Hear and determine applications for ECT on a patient who does not give consent or a person under the age of 18 years - Hear and determine applications for neurosurgery * Also hears applications related to Court Secure Treatment Orders and revocation of Secure Treatment Orders (initiated by the patient), applications for leave by security patients, interstate

Answer 51

An AP can make an application to the MHT to perform a course of ECT on a patient (who is not a young person) if - The patient does not have the capacity to consent - The authorised psychiatrist is satisfied that there is no less restrictive way for the person to be treated For a young compulsory person, the tribunal must determine - Does the young person have capacity to give informed consent? - Yes – tribunal cannot approve ECT without informed consent - No – is ECT the less restrictive treatment option? For a young voluntary person the tribunal must determine - Does the young person have capacity to give informed consent? - Yes – tribunal cannot approve ECT without informed consent - No – has the parent provided consent to Tribunal ECT application?

Answer 52

The role of the chief psychiatrist is to: 1. To provide clinical leadership and expert clinical advice to mental health service providers in Victoria; and 2. To promote continuous improvement in the quality and safety of mental health services provided by mental health service providers; and 3. To promote the rights of persons receiving mental health services from mental health service providers; and 4. To provide advice to the Minister and the Secretary about the provision of mental health services by mental health service providers The role of community visitors is to: - Inquire into whether service is being provided in accordance with the MHA (incl. objectives and principles) - Visit and inquire into the adequacy/standards of services/accommodation and opportunities for recreation, occupation, education, training - Help people receiving MH services resolve issues, seek support, make complaints The mental health complaints commissioner - “The Mental Health Complaints Commissioner is independent, specialist body established under the Mental Health Act 2014 (the Act) to safeguard rights, resolve complaints about Victorian public mental health services and recommend improvements” - an independent body that can investigate complaints - key for advocacy

Answer 53

The MHA 2014 mandates when a persons mental health information must be disclosed and to whom, for example: - To carers where a decision will directly affect the carer or the care relationship - To carers when it is required for a carers to be able to perform, or prepare for, their caring role - To nominated persons, guardians and parents of patient under 16 years Breaches of confidentiality can continue to occur if a duty of care exists, for example: - A patient making suicidal and/or homicidal threats - Notifying the police of potential hazards when asked to perform ‘welfare’ checks on patients

Answer 54

- Advocates assist patients to understand and exercise their rights and support them to participate in decisions about their assessment, treatment and recovery - Not prescribed in the MHA - Advocacy services exist in the form of consumer and carer consultants employed by MHS - The Mental Health Complaints Commissioner is established under the Act to safeguard rights and resolve complaints about Victorian Public mental health services and recommended improvements

Wk1: mental health nursing Flashcards

(78 cards)