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Mental Health Recovery Model vs. EBP Model
- Recovery - Consumer and family driven
- EBP - increases gap between research and practice
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Hildegard Peplau
- Mother of Psych nursing
- Trust is needed between nurse and patient
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Milieu
everything going on around the patient
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The 5 A's of EBP
- Ask a question.
- Aquire the literature
- Appraise the literature
- Apply the evidence
- Assess the performance
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Clinical algorithms
provide step-by-step guidelines prepared in a flowcart
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Attributes of Nursing
- Caring
- Attending
- Patient advocacy
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The sucessful performance of mental functions, resulting in the ability to engage in productive activites, enjoy fulfilling relationships, and make changed or cope with adversity.
Mental Health
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7 signs of Mental Health
- Happiness
- Control over behavior
- Apprasial of reality
- Effectiveness in work
- Healthy self-concept
- Satisfying relationships
- Effective coping strategies
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A clinically significant behavioral or psychological syndrome experienced by distress, disability, or the risk of suffering disability or loss of freedom.
Mental Illness
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Emotional intelligence
Put emotions at the center of skills for living
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Recognizing your emotions as they occur
Managing your emotions internally
Emotional self-control
Recognizing emotions in others
Handling relationships
....are all abilities of?
Emotional intelligence
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Resiliency
The ability to recover or adjust to misforturne and change
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Emotional contagion
Our tendency to automatically mimic the emotion that we see in the other person
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A part of us that deals with relationships and the valuse and addresses questions of purpose and the meaning of life.
Union of people.
Non-religious.
Grounding sense of identity
Spirituality
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Epidemiology definition
the quantitative study of the distribution of disorders in human populations
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Prevalence rate definition
the proportion of a population with a mental disorder at a given time.
(How common in a population)
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Purpose of mental health epidemiology
- Identifies high risk groups
- Identifies high risk factors
- Uses information to improve clinical practives and plan public health policies
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A broad field that addresses what happens to people with illnesses who are seen by clinical providers.
Clinical epidemiology
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Mental Health parity
- Equality for mental health
- requires mental health insurers to provide same benefits are provided for med-surg coverage
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Culture and mental illness
Must consider norms of the culture prior to diagnosing.
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Axis II
Personality disorder or Mental retardation
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Axis III
Medical disorders related to mental disorder
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Axis IV
Socioeconomic, enviornmental problems
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Axis V
GAF #now/#in the past year
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GAF
- Global Assessment of Functioning scale
- Scale of 0-100 (100 being the best)
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Importance of Nurse-Client Relationship
- To build trust
- First and most pivotal step in achieving effective management.
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Genuineness
- Enhances therapeutic relationships
- Ability to meet person to person
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Empathy
- Enhances therapeutic relationships
- Understanding what another person is going through
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Positive Regard
- Enhance therapeutic relationships
- Viewing an individual as having worth
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Safety to enhance a therapeutic relationship
Providing a safe environment.
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Confidentiality to enhance therapeutic relationship
Can not keep secrets that may jeopardize a client's well-being
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Reliability to enhance therapeutic relationships
keep appointments, don't make unrealistic promises
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Clear boundries
- Enhance therapeutic relationships
- enhance safety
- Maintain focus on client
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Goals of therapeutic nurse-client relationships
- Facilitating communication of distressful thoughts
- Assisting problems solving and with ADLs
- Helping client to examine self-defeating behaviors and find alternatives
- Promoting self-care and independence.
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Social relationships
- A friendship
- Mutual needs are met
- Give advice
- Roles may shift during interaction
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Intimate relationships
- Emotional commitment
- Mutual needs are met
- Personal and intimate information is shared.
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Therapeutic relationship
- Consistently focused on clients problems and needs, not the nurse.
- Clients problems are explored, solutions are discussed and implemented
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Non-therapeutic nurse-client relationship issues
- Nurse trying to meet her own needs
- Nurse tries to solve clients problems
- Nurse takes on role or friend or family
- Poor boundries
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Clinical solution to non-therapeutic relationships
seeking peer counseling to help get a healthy perspective and maintain therapeutic relationship.
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Auto-diagnosis
- Nurse needing to to aware of own triggers and issues
- Self-reflection
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Boundries
invisible lines that define the amount and kind of contact between individuals
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Why do we have boundaries?
- To determine patterns of how people relate
- Promote feelings of safety
- Promote autonomy
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Clear boundries
- Firm but flexible
- Promotes safety
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Diffuse boundries
- Little distinction between individuals
- Loss of autonomy
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Transference
A client unconsciously transfers unresolved feelings, attitudes and wishes into present significant relationships in an attempt to resolve them in a more satisfying way.
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Counter transference
- A nurse/therapist displaces onto the client, feelings related to people in the nurse's past relationships.
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Modeling
- Values formed through the example of others.
- Vivid example of values in action.
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Values
- Provide a framework for which life goals a person will develop.
- Culturally oriented.
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Pre-orientation phase of Nurse-Client relationship
- Prior to meeting the client
- Quick auto-diagnosis/self-reflection.
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Orientation phase of Nurse-Client relationship
- Establish trust, parameters, contract, confidentiality, boundaries.
- Meet the patient
- *Termination begins
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Working phase of Nurse-Client relationships
- Maintain relationship
- Gather further data
- Promote clients skills, self-esteem, use of language
- Facilitate behavioral changes
- Evaluate problems and goals
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Termination phase of Nurse-Client relationship
- Deal with intense feelings
- Summarize goals and objectives
- Provide client with community resources
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Communication
The process of sending a message to one or more persons
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Stimulus
one person has a need to communicate with another
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Sender of communication
initiates interpersonal contact and sends messsage
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Receiver of communication
- Evaluates and interprets message
- Gives feedback
- Validation of message is most important
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Clearest messages are:
well organized and expressed in a manner that is familiar to the receiver
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Use of silence
- NOT an absence of communication
- worthwhile as long as it is serving some function and not frightening to the client
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Active listening
- Paying undivided attention to what client is saying and doing
- Do not focus on self
- Done in a environment which is free from distrctions
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Clarifying techniques for communication
- Paraphrasing, restating, reflecting, exploring
- Give opportunity to check that the message was correctly understood.
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Paraphrasing
Receiver restates in different words that basic content of the clients message
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Restating
- repetition of the same keywords that client has spoken
- restate feelings as well
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Reflecting
Nurse reflects back on the feelings without repeating the exact words
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Exploring
- Enables further examination of important ideas, relationships and experiences.
- ie...asking for an example
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Open-ended questions
- Can not be answered in a few short words
- Increases participation
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Closed-ended questions
- Can be answered with yes or no
- * Use with clients experiencing high level of anxiety or have disorganized thinking.
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Indirect or Implied questions
- Can be used when you dont want to pressure client.
- Use sparingly
- Avoid with paranoid clients
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Giving approval or disapproval during communication
Ineffective techniques of communication
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Asking "why" questions during communication
Imply criticism and feels like an interrogation.
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Why do people want to commit suicide?
To solve a problem or stop the pain
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Reg flag for suicide awareness
- Someone states that they are hopeless
- Early morning rising
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Causes of suicide within a hospital
Absent or incomplete suicidal ideation during initial assessment or reassessment
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Biologic reasons for committing suicide
- Neurotransmitter imbalance
- Genetics
- Alterations in brain structure (esp. frontal lobe)
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Psychological reasons for committing suicide
- interpersonal conflicts
- negative thinking patterns
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Sociological factors for committing suicide
isolation from a group
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Suicidal ideation
Direct or indirect thoughts of suicide
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Suicidal threats
Direct written or verbal messages of intent to committ
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Suicidal gestures
- Actions resulting in minor injury
- No intent to die
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Suicidal attempts
Serious actions with intention to die
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Antidepressants and risk for suicide
Contribute to suicide behavior -- SSRIs -- d/t having more energy and still being depressed, now they have to energy to do it.
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Risk factors for suicide
- Suicide plan
- Previous attempts
- Social support
- Recent losses
- Medical problems
- Alcohol/drugs
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SADPERSONS scale
- Assessment tool to determine suicide risk
- Range from 0-10
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Interventions for suicide risk
- Do not leave alone
- Communicate to team
- Accept and Listen
- Instill hope
- Initiate precautions
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"No self harm" contracts
- Specify length of time
- Not a guarantee that client won't hurt themselves
- Continue to monitor
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Depression in children
More hyperactive and aggitated
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Resources for family of suicide
NAMI - National Alliance of Mental Illness
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Schizophrenia
- Brain disease caused by too much dopamine
- Treatable NOT curable - life long meds
- Genetic disposition
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Criteria for Schizophrenia
- Lasting 6 months
- Active symptoms for 2 months
- 2 of the following active symptoms: Delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms
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GABA system
- Inhibitory system
- Neurotransmitters calm you down
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Gludamate
- Excitatory system
- Neurotransmitters excite you
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Anhedonia
inability to experience pleasure/joy
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Positive symptoms
- Extra symptoms present in someone
- Delusion
- Speech
- Hallucinations
- Waxy flexibility
- Akathesia
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Circumstantiality
- (+) symptom
- Go off tract but eventually come back
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Tangeniality
- (+) positive symptom
- Go off tract and never come back
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Perservation
- (+) symptom
- Keeps going on about a thought
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Associative looseness
- (+) symptom
- Jump from topic to topic
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Neologisms
- (+) symptom
- Word that patient makes up
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Echolalia
- (+) symptom
- Imitate another persons speech
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Clang association
- (+) symptom
- Associating a work that sounds familiar
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Word salad
- (+) symptom
- No words match up
- Random words
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Hallucination
- (+) symptom
- Sensory perception when no external stimuli exists
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Akathesia
- (+) symptom
- Extreme motor agitation can not stay still.
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Echopraxia
Imitate actions of another person
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Negative symptoms
- Things missing in a person
- Energy, pleasure, desire...
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Anhhedonia
Lack of pleasure
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Dysphoria
depressed, sad mood
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Schizophreniform
S/S more than 1 month but less than 1 year
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Schizoaffective
- Happens generally later in life
- Severe mood swings
- Some psychotic s/s
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Brief psychotic episode
- Sudden onset
- At least 1 (+) symptom
- Lasting at least 1 day but less than 1 month
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Shared psychotic episode
Involves 2 individuals and they share the same delusion
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Delusional disorder
- Non-bizarre delusions
- At least 1 month in duration
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Psych assessment
- Medical exam
- Use of meds and compliance
- Safety
- Assess support system
- Assess relationships
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