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What are the generalized and Advanced job positions for mental health nursing?
- Psychiatric mental health Rn
- Psychiatric mental health RN, certified
- Advance practice RN
- PMH clinical nurse specialist
- PMH Nurse Practicioner
What are the roles of a psychiatric nurse?
- Crisis intervention
- case manager
- Milieu management
- medication admin
- role model
What are some basic levels of intervention a nurse can complete?
- crisis intervention
- mileu management
- assisting clients with self-care
- admin/monitor psychobiological teratment
- health teaching/psycho education
- Psychiatric rehab
What are some advanced levels of intervention a nurse can complete?
- Basic levels plus:
- prescription of medication
- interpreting diagnostic and lab testing
- complementary intervention
- clinical supervisory activities
- expanded advocacy eactivites
Who are the members of a mental health interdisciplinary team?
- Family Members
- Social Worker
- Advanced Practice RN
- Medical physician
- Must or Art therapist
- Spiritual counselor
- Case manager
- Drug and Alcohol counselor
Describe the two different types of committment
- -voluntary admission by written consent to inpatient unit
- -can sign self out by written consent, must be within 72 hrs
- -re-eval within 72 hrs of d/c request or committed
- -involuntary admission (commitment) to unit for up to 120 hrs
- -hearing w/in 72 hrs of admission
- -d/c when no longer needing treatment or 120 hrs complete
- -may have second hearing if additional day required
Who is inpatient care reserved for? How is a person admitted?
- Threat of Violence to self (suicidal) or others (homicidal)
- Extremely disabled in need of short-term acute care
- Direct admission
- Hospital ED
- Voluntary or involuntary
What is outpatient mental health care?
- patient centered health.medical homes
- Community clinics
- psychiatric home care
- Assertive community treatment (ACT)
- partial hospitalization centers
- partial programs (daybreak/clubhouse)
- telephone crisis counseling and outreach
What is ACT?
- For clients with releated hospitalization, severe symptoms, or inability to participate in traditional treatment
- Multidisciplinary team
- work with clients in homes, agencies, hospitals, or clinics
- ACT team provides support and recourse, on call 24 hrs/day
How is psychiatric mental health care funded? How do uninsured clients pay?
- Private pay insurane
- managed care plans: HMOs, PPOs, MBHOs
- Uninsured clients pay through medicaid, medicare, social security disability income, supplement security income, veterans administration
What are some legislative acts that were created to help fund mental health care?
- Paul Wellstone and Peter Domenici Mental Health and Addition Equity Act of 2008:
- -restricts insurance companies from requiring higher premiums for mental health
- Affordable Care act:
- -insurance cannot deny client based on preexisting mental health diagnosis
What is the goal of mental health in community settings?
- maintain clients best psychosocial functioning in the community
What is the continuum of psychiatric treatment?
- Most acute care (short term)
- Intensive outpatient treatment (usually short-term)
- Transitional outpatient treatment (usually long-term)
- Ongoing outpatient treatment (long-term)
Name the ethical principles
- Beneficence: promoting good
- Autonomy: the right to make one's own decisions
- Justice: treating others fairly and equally
- Fidelity: observance of loyalty and commitment to the client
- Veracity: telling the truth
- Bioethics: ethics in the care of a person
- Nonmalificience: do no harm
- distributive justice: equal distribution of health care
What are a mental health client's rights?
- right to treatment
- right to refuse treatment
- right to informed consent
- rights relating to restraints/seclusion
- right to vote
Describe the right of confidentiality and its exceptions
- Right to keep personal information private
- -danger to self or others
- -child abuse/neglect or elder abuse/neglect
- -mandatory reporting of communicable diseases
- -mandatory reporting of GSWs
- -Duty to warn or protect (tarasoff ruling)
Unless you have written consent, the correct answer is "I can neither confirm nor deny that presence of that client on this unit"
When are restraints/seclusions legally authorized and what must be done? When are they contraindicated?
- Legally authorized:
- -behavior is physically harmful to self or others
- -less restrictive measures are ineffective
- -a decease in sensory over stimulation is needed
- -be ordered by HCO
- -specific time limit
- -clients condition reviewed q15min
- -reordered q4hr, prescriber eval withint 4hr
- -unstable medically
- -drug overdose
What are intentional torts? What are unintentional torts?
- false imprisonment
- defamation of character
- breach of confidentiality
Describe the concepts of crisis
- emotional pain,, distress, or instability triggered by a situational event or change in a person's life
- Normal coping mechanisms fail, resulting in inability to function as usual
- Acute and time-limited
- Presents opportunity for personal growth
- Precipitated by specific identifiable events
- Subjective in nature
- Occurs in all individuals and is not necessarily equated with psychopathology
Describe the types of crisis situations
- -new developmental stage is reached (Erikson) and old coping skills no longer helpful
- - ineffective defense mechanisms until new coping skills develop
- -events that are extraordinary, external, often unanticipated
- -crisis or disaster(natural, war, violence); not part of everyday life; unplanned
How would a nurse assess a client in crisis?
- assess for suicidal or homicidal tendencies first
- Perception of precipitating event
- situational supports
- personal coping skills
What are the goals of crisis intervention?
- expected outcome: reoslution of crisis and maintenance of pre-crisis functioning
- Early intervention: debriefing after incident
- More receptive to outside help at this time
- Acute stress disorder, PTSD, depression
What interventions can the nurse take during a crisis situation?
- assess scuicidality
- stay with client when they are 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 CISD?
- Critical Incident Stress Debriefing
- Seven stop model
- Goal is to dialogue, vent, stabilize, process, learn, teach, reentry
What are the levels of communication?
- Interpersonal: self talk
- Interpersonal: one on one, validates
- Small group: group therapy, goal directed
- Public: conferences, classrooms; audience
Describe effective listening and therapeutic communication techniques
- Effective listening:
- Stop talking, don't interrupt
- Look at speaker
- search for main point (feelings)
- Notice what is avoided or left out
- Evaluate how the message is delivered
- Therapeutic Comm techniques:
- -giving recognition
- -offering self
- -broad openings
- -general leads
- -making observations
- -presenting reality
- -open ended questions
- -formulating a plan of action
What are the goals of therapeutic communication?
- Encourage expression of feelings
- autonomous decision making
- encourage self disclosure
- promote insight
- encourage problem solving
- explore feelings
What are some non-therapeutic communication techniques?
- Giving false reassurance
- approving or disapproving
- agreeing or disagreeing
- giving advice
- requesting an explanation
- stereotypes comments
Describe active listening techniques
- Sit facing the client
- Open posture
- Lean towards client
- Eye Contact
Describe the nurse-client relationship
- This is the basis of all psychiatric nursing treatment approaches
- relationship has clear boundaries
- The nurse must be safe, confidential, reliable, and consistent
- Build a trusting relationship
What are the concepts of professional boundaries?
- Define the edge of appropriate behavior in a therapeutic relationship
- Ethical protection for the client
- Legal protection for clinician
- Enables treatment