Affects cognitive, volitional (free will) or emotional processes
Grossly impairs judgment
Impairs capacity to recognize reality
Impairs ability to control behavior
What are the criteria for an involuntary mental health hold?
Can be 72hr mental health hold or 5 day drug/alcohol hold:
Danger to self
Danger to & others
What are the pt rights for an involuntary admission?
Least restrictive treatment
Representation by an attorney
Must be allowed to sign in voluntary if is willing
Is given and signs a Pt. Bill or Rights
Pt. has the right to refuse medication
More rights in Chapter 9 of Stuart
What are some legal/court issues reguarding mental health?
Court ordered medication-Patients can be given meds against their will
Insanity is a legal definition not used in mental health treatment
Not guilty by reason of insanity: Ordered to treatment facility and released when determined to be “sane.” More a legal designation than a medical one.
How are mental health behaviors composed?
A healthy person uses all three elements while an unhealthy person operates with one or more of the elements missing, i.e. compulsive action progresses from feelings to actions without much or any rational thought involved.
When does a behavior become a disorder?
Interference with social and occupational functioning (school work & attendance in children)
Impairment in Activities of Daily Living
What are the phases of nurse/patient interaction
What is the preorientation phase?
Prior to working with patients:
Explore past experiences and own feelings
Assess personal strengths & limitations
Assess communication knowledge & skills
Explore own values
What is the introduction/orientation phase?
Introduce self and set contract
Who, what, when, where, & purpose: establishing basics of interactions so that pt knows what to expect.
Ask pts why they seek help & now—Why Now?: For peds, ask how they're feeling about being here.
Sets the tone of the relationship
Set goals with patient
Establish trust in atmosphere of acceptance
Explore patient’s thoughts and feelings
Prepare for termination
Patient tests the boundaries
How do you handle requests for personal information?
What is included in the termination phase?
Review progress & goal attainment
Help patient set future goals
Explore feelings of rejection, sadness, loss, anger
Each discuss the meaning of the relationship unless schizophrenic
Patient can act sicker or resist leaving
What are the halmarks of a therapeutic relationship?
focused on the present
disclosure on provider's side only to help pt.
navigated with knowledge and skill
One-sided for client.
What are some exceptions to pt confidentiality?
Child abuse (Under 18 yo)
Elder abuse (Over 65 yo)
Subpoena from a court
Duty to warn: must inform possible victim if pt has informed you that he intends to harm someone.
Cannot identify pt as drug/alcohol abuser or disclose other hx unless it is relevant and necessary to pt care.
What is milieu therapy?
Influence of environment on patient safety through therapeutic environment
Role of the nurse:
--Monitor environmental stimulation and
--Talking and laughing
--Feel (tension, hostility, safe, comfortable, calm), ie what does it take for the patient to feel safe?
What measures can be taken to maintain a therapeutic milieu?
Ask people to lower voice
Turn down radios & TVs
Ask people to move to places to visit
Ask patients to go to their rooms
Use Quiet Rooms & restraints (for pts who are threatening others or themselves)
Select wall colors
Offer prn medication as needed
Use distraction, i.e. games, change setting, snacks, change topic, etc.