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What is the role a psychiatric nurse?
- crisis intervention
- case manager
- milieu management
- medication administration
- role model
What is the goal of the acute care setting? an example?
- Goal: stabilization and return to community
- ex. ER
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
- community clinics
- 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)
- Veterans Administration
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
- civil rights
what are the clients rights under the law?
- right to:
- receive treatment
- refuse treatment
- 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?
- unstable medically
- suicidal tendencies
- 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)
- introductory phase
- fact phase
- thought phase
- reaction phase
- symptom phase
- teaching phase
- re-entry phase
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?
- communication styles
- use of eye contact
- perception of touch
- cultural filters
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?
- giving recognition
- offering self
- broad openings
- general leads
- making observations
- presenting reality
- 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
- giving advice
- requesting an explanation
- stereotyped comments
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
- Open Posture
- Lean toward the client
- Eye contact
How ca you develop a therapeutic relationship?
- establish rapport- a mutual regard
- develop trust
- maintain confidentiality
- be genuine
- demonstrate empathy
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
- enables treatment
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?
- establishing rapport
- parameters of the relationship
- formal or informal contract
- terms of termination
What is the working phase of the nurse-client relationship?
- maintain 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
- review situations of relationship
- exchange memories