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What is the definition of a mentally ill person?
- A person with a substantial disorder:
- 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
- Grave disability
What are the pt rights for an involuntary admission?
- Right to:
- Least restrictive treatment
- Representation by an attorney
- Treatment plan
- 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
- Explore fears
- 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
- Terminate completely
What are the halmarks of a therapeutic relationship?
- Goal oriented
- 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?
Cannot identify pt as drug/alcohol abuser or disclose other hx unless it is relevant and necessary to pt care.
- Child abuse (Under 18 yo)
- Elder abuse (Over 65 yo)
- Medical emergency
- Subpoena from a court
- Duty to warn: must inform possible victim if pt has informed you that he intends to harm someone.
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.
- 1:1 interaction
- Use de-escalation
- Containment as last choice
- Predictable staff
Basic interventions and assessments
- Orientation-Time, place, person, & situation (X 4)
- Support pts expressing themselves in safe place
- Work on modifying behavior
- Occupational therapy, ie putting a billfold together.