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Mental Health

Module 3 & 4 - Introduction to the Psychiatric Care Environment

QuestionAnswer
7 principles of mental health Develop mutual trust, explore behaviors & emotions, encourage responsibility, encourage effective adaptation, & provide consistency
What are coping mechanisms? Resources used to decrease discomforts of stress
Psychomotor, cognitive, and affective Coping mechanisms
Efforts to cope directly with the problem; hitting, fighting, confrontation Psychomotor (physical)
Efforts to neutralized by changing meaning of problem Cognitive (intellectual)
Actions taken to reduce emotional stress; no efforts are made to solve the problem; ego defense mechanisms such as denial and suppression Affective (emotional)
Multi-category guide used to aid physicians with mental health diagnosis DSM-IV
Assessment, Diagnosis, Planning, Intervention, Evaluation Nursing Process
Includes information about both the physical and psychological functions of an individual Health history
Age, Gender, Ethnicity, Belief system, Income, Education Sociocultural assessment areas
Unresponsive emotions Flat effect
Excessive feelings of well being Euphoria
Motor restlessness, often seen with anxiety Agitation
Having both positive and negative feelings Ambivalence
Perceptions that have no external stimulus; someone hears a voice that no one else hears Hallucinations
Alterations in perceptions that have a basis in reality; external stimuli are present, but the client perceives them differently (client perceives person that is walking down the hall as a wolf) Illusions
Rapid changes from one thought to another unrelated thought Flight of ideas
False beliefs that cannot be correct by reasoning or explanation Delusions
Strong fears of certain things, places, or situations Phobias
Includes events that occurred within the last 2 weeks; Alzheimer's, anxiety, and depression are diseases that may contribute to loss Recent memory
Involves not being able to recall birth place, schools attended, ages of family members, and background; long term loss is seen in patients with organic physical problems such as conversion & dissociative disorders Remote memory
Takes place within oneself and are commonly referred to as our "self-talk" or "self-dialogue"; conversations we have with ourselves when solving problems, making plans, and reacting emotionally Intrapersonal communications
Listening, open ended questions, restating, focusing, reflection, and silence Therapeutic Communication Techniques
Failure to listen, parroting, and giving advice Non-therapeutic techniques
Client repeats last word heard Echolalia
Being aware of clients circumstances, don't be judgmental; be empathetic Therapeutic relationship
Trust, Empathy, Autonomy, Caring, Hope Components of the therapeutic relationship
Risk taking process whereby an individual's situation depends on the future behavior of another person Trust
The ability to recognize and share emotions of another person without actually experiencing them Empathy
Ability to direct and control one's activities or destiny Autonomy
The energy that allows caregivers to unconditionally accept all people, even when they are most unlovable Caring
Multidimensional dynamic life force characterized by confident yet uncertain expectation of achieving a future good Hope
Acceptance, Rapport, Genuineness Characteristics of a therapeutic relationship
What are the phases of therapeutic relationship? Preparation, Orientation, Working, and Termination
Gather all data or information; may review past medical records, current records, interactions with others in clients life, and looks for recurring patterns of behavior to develop a picture of the client Preparation phase
Develop mutual trust; establishes caregiver as significant in life of client Orientation phase
Identify and address client's problem(s) Working phase
Assist client to review what was learned and transfer this learning to interactions with others Termination phase
Client may stop taking medications because of distressing side effects; others simply feel that they do not need their medications; whatever the reason, caregivers are in excellent position to monitor and encourage Non-compliance
Client's emotional response, based on earlier relationships. Ex: client had a bad experience with a previous nurse, therefore client treats current nurse poorly Transference
Barrier in the therapeutic relationship based on the caregivers inappropriate emotional response. Ex: problems at home trickle into the care of the client and takes it out on the client Countertransference
Persons behavior becomes a threat to safety of self/others; People within the environment are not able/willing to support the mentally troubled person; person perceives him/herself as unable to cope or maintain behavioral control Criteria for inpatient admission
Becomes a way of life for many chronically mentally troubled individual; revolving door syndrome Recidivism
Physical properties of an environment have an effect on clients Physical surroundings
Can agitate or hyper-activate an individual Environment temperature and humidity
Can trigger delusions or hallucinations Flickering lights
Can result in overstimulation and aggressive behaviors Bright lights
Can present inaccurate stimuli, resulting in misperceptions of actual objects Lighting too low
Can have a calming or agitating effect on clients Environmental noise
Active process of receiving information and examining reactions to messages received; "Maintaining eye contact and receptive nonverbal communication Listening
Encouraging client to select topics for discussion; "What are you thinking about?" Broad openings/Open ended questions
Repeating main thought expressed by client; "you say that your mother left when you were 5 years old?" Restating
Attempting to put into words vague ideas or unclear thought of client; asking client to explain what he/she means; "I'm not sure what you mean. Could you tell me about that again" Clarification
Directing back client's ideas, feelings, questions, and content; "You're feeling tense and anxious, and it's related to a conversation you had with our husband last night?" Reflection
Lack of verbal communication for therapeutic reason; Sitting with client and nonverbally communicating interest and involvement Silence
The foundation of therapeutic relationships Trust
Who defines professional boundaries Caregiver; must be balanced because one cannot focus on the client and the self at the same time
Provides information regarding a client's physical state and the need for medication Physician
Assesses the client's family, work, and social interactions Social worker
Learns about the client's nutritional status Dietitian
Explore the client's emotional and cognitive (intellectual) functioning Psychiatrist and Psychologist
Assesses how the illness or disability affects the client's activities of daily living Nurse
Contribute information through their observations and interactions with the client Other care providers
Tool that is used to facilitate diagnosis and guide clinical practice DSM-IV
Uses the DSM-IV to make mental health diagnoses Physician
Assessment, Diagnosis, Planning, Interventions, Evaluation Nursing (therapeutic) Process
Is continual and involves interviewing client & family members, reviewing charts and lab values Assessment
Data sorted into related areas, and problems are identified (Priority problems first, such as ABC's) Diagnosis
"Expected outcomes" then are used to monitor the clients progress (coping may occur in harmful, unsafe ways) Planning
Planned actions are implemented; medications, leading group therapy Interventions
Effectiveness of care is determined; ex: patient with major social phobia went grocery shopping and bought groceries Evaluation
Concentrates on the cultural, social, and spiritual aspects of an individual Sociocultural assessment
Six areas of sociocultural assessment Age, Gender, Ethnicity, Belief system, Income, Education
What is assessed in health history? General appearance, speech, motor activity, and behavior during the interaction
The part of consciousness that perceives, sorts, and combines information Sensorium and cognition (upper level thinking)
What nursing interventions are used to help with memory Calendars and clocks
Immediate memory Having client repeat three words that have relation to one another
What are clients with a clear sensorium oriented to? Time, place, and person
Messages sent and received without the use of words Non-verbal communication
How is nonverbal communication expressed? Appearance, body motions, use of space, and non-language sounds
Concentrating on the speaker, listening objectively, making sure nonverbal messages match verbal messages, following up, and clarifying Therapeutic listening skills
What must you do in order to communicate effectively with mentally and emotionally troubled clients? Realize that every interaction is part of the total therapeutic process, climate of trust and respect must be established, and clients need a routine
According to Maslow, what needs must be met before higher levels can met? Physiological needs
Clients who follow prescribed treatments In compliance
What percentage of patients do not comply with their prescribed therapeutic course? Forty to eighty
Created by: tandkhopkins