What is the goal of the acute care setting? an example?
Goal: stabilization and return to community
Who is impatient psych care admission reserved for? what are the admission options? Criteria to justify admissions?
reserved for: suicidal, homicidal, extremely disabled in need of short term acute care
Admission options: direst admissions, hospital ER
Justify admissions: danger to self or others; unable to fulfill basic needs
can be voluntary or involuntary
What are examples of outpatient psych mental health care?
primary care provider
patient-centered health/medical homes
psychiatric home care
assertive community treatment
partial hospitalization centers
partial programs- (day break/clubhouse)
What is assertive community treatment (ACT)?
-who is it for? -how does it work?
For clients with repeated hospitalizations, severe symptoms or inability yo participate in traditional treatment
works with the client in the home, agencies and hospitals/clinics
ACT team provides support and resources; on call 24hr
How is psychiatric health care funded?
private pay insurance
managed care plans ( health maintenance organizations HMOs, preferred provider organizations (ppos), managed behavioral health care organization)
How do uninsured clients get funding?
social security (social security disability income (SSDI) supplement security income (SSI)
What are the ethical principles?
Beneficence: promoting good
Autonomy: the right to make one's own decision
Justice: Treating others fairly and equally
Fidelity: observance of loyalty and commitment to the client
Veracity: telling the truth
What is an ethical dilemma?
conflict between two or more courses of action, each with favorable and unfavorable consequences
What are the mental health laws>
states regulate care of mentally ill
community mental health center act 1963
what are the clients rights under the law?
right to informed consent
rights relating to restraints/seclusion
Explain confidentiality as it relates to psych care?
right to keep personal information private, but there are limits to it if there is danger to self or others, child abuse/neglect, duty to warn or protect(i cannot confirm nor deny the presence of that client)- tarasoff ruling
(state laws requiring reporting of certain communicable disease; law reporting gun shot wounds)
What is a 201 admission?
a voluntary admiss. the person applies in writing to enter hospital for tx
in order to be discharged, must request in writing, request must be acted on in 72 hours
typically treating psychiatrists has 72 hours to hold until eval can be performed
re-evaluate for involuntary status
What is a 302 commitment?
set of procedures enabling system to deprive person of his liberty through detainment in a mental hospital, even though he/she broke no laws, but because he/she is a danger to him/herself or others or unable to care for self
When are restraints and seclusion legally authorized? what must be done when using restraints?
authorized: behavior is physically harmful to self or others
less restrictive measures are ineffective, a decrease in sensory over stimulation is needed
must: hcp ordered, specific time limited period, client's condition reviewed every 15 minutes, reordered every 4 hours; prescriber eval every 4 hours
When are restraints contraindicated?
drug over dose
punishment of client
What are intentional torts? unintentional?
intentional: assault, battery, false imprisonment, defamation of character, breach of confidentiality
unintentional: negligence, malpractice
What is a crises?
an emotional pain, distress or instability triggered by a situational event or change in a person's life
What are the different types of crises?
maturational: internal, new development stage is reached, old coping skills are no longer helpful; ineffective defense mechanisms until new coping skills develop (erikson)
situational: arise from events that are extraordinary, external, often unanticipated
What is an adventitious crises?
crises of disaster; not part of everyday life; unplanned; may result from a natural disaster, war, riots, and crime of violence
What nursing assessments should be done for a client experiencing a crises?
*First assess for suicidal or homicidal ideations or gestures
then assess perception of precipitating event, situational supports, and personal coping skills
What implementation should the nurse do?
Basic level: patient safety (most important)
early level: debriefing after an incident
others: assess suicide, stay with client if actively suicidal, implement safety contract, encourage eating, assist with ADLs, discuss clients feelings and options, teach relaxation techniques, refer to grief counseling
What is the expected outcome for a client in a crises?
Resolution of crises and maintenance of pre-crisis functioning
What are the 7 steps in critical incident stress debriefing (CISD)
What are the levels of communication?
intrapersonal: self talk: rose vs gray colored glasses
interpersonal: one-to-one interaction: validates
Small group: group therapy: goal directed
Public: conferences, classrooms: audience
What are some cultural barriers to communications?
use of eye contact
perception of touch
What are the types of communication?
verbal and non verbal
What is verbal communication?
all words a person speaks;
conveys (interest and understanding, insult and judgment, clear or conflicting messages, honest or distorted feelings.
What makes therapeutic communication different then verbal communication?
is OTHER focused
listening is key
What are the tips to therapeutic communication?
stop talking, don't interrupt, limit distractions, look at speaker
search for the main point: feelings
notice what is avoided
evaluate how the message is delivered
What are therapeutic techniques?
formulating a plan of action
What are the clarifing techniques?
What questions can you ask to elicit a client's response?
open ended questions
close ended questions
What are the goals of therapeutic communication?
encourage expression of feelings
autonomous decision making
encourage self disclosure (promote insight)
encourage problem solving
What are non-therapeutic techniques?
giving false reassurance
approving or disapproving
agreeing or disagreeing
requesting an explanation
What is active listening?
be attentive to the client
verbal and non-verbal
creates climate for communication
climate open and honest
What does the acronym SOLER stand for?
Sit facing the client
Lean toward the client
How ca you develop a therapeutic relationship?
establish rapport- a mutual regard
What are the concepts of the nurse client relationship?
the basis of all psychiatric nursing treatment
to establish that the nurse is safe, confidential, reliable, consistent
relationship with clear boundaries
What is the concept of professional boundaries?
defines the edge of appropriate behavior in a therapeutic relationship
ethical protection for the client
legal protection for the clinician
What is Peplau's model of the nurse-client relationship
Nurse: skills knowledge (expert; facilitates)
Client: wants to find solution
wants to feel better
wants to find an advocate
The relationship evolves: there are phases (orientation, working, termination)
What is the orientation phase of the nurse-client relationship?
parameters of the relationship
formal or informal contract
terms of termination
What is the working phase of the nurse-client relationship?
facilitate behavioral change
overcome resistant behaviors
evaluate problems and goals
gather further data
promote client's: problem solving skills, self esteem, use of language
What is the termination phase of the nurse client relationship?
summarize goals and objectives achieved
discuss ways for client to incorporate new coping strategies learned