Module 3 & 4 - Introduction to the Psychiatric Care Environment
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| 7 principles of mental health | Develop mutual trust, explore behaviors & emotions, encourage responsibility, encourage effective adaptation, & provide consistency
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| What are coping mechanisms? | Resources used to decrease discomforts of stress
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| Psychomotor, cognitive, and affective | Coping mechanisms
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| Efforts to cope directly with the problem; hitting, fighting, confrontation | Psychomotor (physical)
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| Efforts to neutralized by changing meaning of problem | Cognitive (intellectual)
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| Actions taken to reduce emotional stress; no efforts are made to solve the problem; ego defense mechanisms such as denial and suppression | Affective (emotional)
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| Multi-category guide used to aid physicians with mental health diagnosis | DSM-IV
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| Assessment, Diagnosis, Planning, Intervention, Evaluation | Nursing Process
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| Includes information about both the physical and psychological functions of an individual | Health history
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| Age, Gender, Ethnicity, Belief system, Income, Education | Sociocultural assessment areas
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| Unresponsive emotions | Flat effect
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| Excessive feelings of well being | Euphoria
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| Motor restlessness, often seen with anxiety | Agitation
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| Having both positive and negative feelings | Ambivalence
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| Perceptions that have no external stimulus; someone hears a voice that no one else hears | Hallucinations
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| 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
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| Rapid changes from one thought to another unrelated thought | Flight of ideas
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| False beliefs that cannot be correct by reasoning or explanation | Delusions
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| Strong fears of certain things, places, or situations | Phobias
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| Includes events that occurred within the last 2 weeks; Alzheimer's, anxiety, and depression are diseases that may contribute to loss | Recent memory
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| 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
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| 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
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| Listening, open ended questions, restating, focusing, reflection, and silence | Therapeutic Communication Techniques
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| Failure to listen, parroting, and giving advice | Non-therapeutic techniques
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| Client repeats last word heard | Echolalia
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| Being aware of clients circumstances, don't be judgmental; be empathetic | Therapeutic relationship
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| Trust, Empathy, Autonomy, Caring, Hope | Components of the therapeutic relationship
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| Risk taking process whereby an individual's situation depends on the future behavior of another person | Trust
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| The ability to recognize and share emotions of another person without actually experiencing them | Empathy
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| Ability to direct and control one's activities or destiny | Autonomy
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| The energy that allows caregivers to unconditionally accept all people, even when they are most unlovable | Caring
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| Multidimensional dynamic life force characterized by confident yet uncertain expectation of achieving a future good | Hope
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| Acceptance, Rapport, Genuineness | Characteristics of a therapeutic relationship
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| What are the phases of therapeutic relationship? | Preparation, Orientation, Working, and Termination
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| 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
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| Develop mutual trust; establishes caregiver as significant in life of client | Orientation phase
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| Identify and address client's problem(s) | Working phase
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| Assist client to review what was learned and transfer this learning to interactions with others | Termination phase
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| 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
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| 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
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| 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
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| 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
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| Becomes a way of life for many chronically mentally troubled individual; revolving door syndrome | Recidivism
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| Physical properties of an environment have an effect on clients | Physical surroundings
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| Can agitate or hyper-activate an individual | Environment temperature and humidity
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| Can trigger delusions or hallucinations | Flickering lights
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| Can result in overstimulation and aggressive behaviors | Bright lights
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| Can present inaccurate stimuli, resulting in misperceptions of actual objects | Lighting too low
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| Can have a calming or agitating effect on clients | Environmental noise
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| Active process of receiving information and examining reactions to messages received; "Maintaining eye contact and receptive nonverbal communication | Listening
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| Encouraging client to select topics for discussion; "What are you thinking about?" | Broad openings/Open ended questions
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| Repeating main thought expressed by client; "you say that your mother left when you were 5 years old?" | Restating
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| 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
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| 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
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| Lack of verbal communication for therapeutic reason; Sitting with client and nonverbally communicating interest and involvement | Silence
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| The foundation of therapeutic relationships | Trust
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| Who defines professional boundaries | Caregiver; must be balanced because one cannot focus on the client and the self at the same time
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| Provides information regarding a client's physical state and the need for medication | Physician
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| Assesses the client's family, work, and social interactions | Social worker
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| Learns about the client's nutritional status | Dietitian
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| Explore the client's emotional and cognitive (intellectual) functioning | Psychiatrist and Psychologist
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| Assesses how the illness or disability affects the client's activities of daily living | Nurse
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| Contribute information through their observations and interactions with the client | Other care providers
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| Tool that is used to facilitate diagnosis and guide clinical practice | DSM-IV
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| Uses the DSM-IV to make mental health diagnoses | Physician
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| Assessment, Diagnosis, Planning, Interventions, Evaluation | Nursing (therapeutic) Process
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| Is continual and involves interviewing client & family members, reviewing charts and lab values | Assessment
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| Data sorted into related areas, and problems are identified (Priority problems first, such as ABC's) | Diagnosis
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| "Expected outcomes" then are used to monitor the clients progress (coping may occur in harmful, unsafe ways) | Planning
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| Planned actions are implemented; medications, leading group therapy | Interventions
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| Effectiveness of care is determined; ex: patient with major social phobia went grocery shopping and bought groceries | Evaluation
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| Concentrates on the cultural, social, and spiritual aspects of an individual | Sociocultural assessment
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| Six areas of sociocultural assessment | Age, Gender, Ethnicity, Belief system, Income, Education
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| What is assessed in health history? | General appearance, speech, motor activity, and behavior during the interaction
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| The part of consciousness that perceives, sorts, and combines information | Sensorium and cognition (upper level thinking)
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| What nursing interventions are used to help with memory | Calendars and clocks
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| Immediate memory | Having client repeat three words that have relation to one another
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| What are clients with a clear sensorium oriented to? | Time, place, and person
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| Messages sent and received without the use of words | Non-verbal communication
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| How is nonverbal communication expressed? | Appearance, body motions, use of space, and non-language sounds
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| Concentrating on the speaker, listening objectively, making sure nonverbal messages match verbal messages, following up, and clarifying | Therapeutic listening skills
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| 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
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| According to Maslow, what needs must be met before higher levels can met? | Physiological needs
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| Clients who follow prescribed treatments | In compliance
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| What percentage of patients do not comply with their prescribed therapeutic course? | Forty to eighty
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