Ethical/Legal of Mental Health Nursing/ Therapeutic Comm

• Psychiatric mental health Rn
• Psychiatric mental health RN, certified

• Advance practice RN
• PMH clinical nurse specialist
• PMH Nurse Practicioner

• Counseling
• Crisis intervention
• case manager
• Milieu management
• Educator
• medication admin
• role model
• advocate
• rehabilitation

• Counseling
• crisis intervention
• mileu management
• assisting clients with self-care
• admin/monitor psychobiological teratment
• health teaching/psycho education
• Psychiatric rehab

• Basic levels plus:
• psychotherapy
• prescription of medication
• interpreting diagnostic and lab testing
• consultation-liaison
• complementary intervention
• clinical supervisory activities
• expanded advocacy eactivites

• Rn
• client
• Family Members
• Psychiatrist
• Social Worker
• Advanced Practice RN
• Psychologist
• Medical physician
• Pharmacist
• Ot/PT
• Must or Art therapist
• Spiritual counselor
• Case manager
• Drug and Alcohol counselor

• 201:
• -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
• 302:
• -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

• 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

• PCP
• 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
• Internet
• telepsychiatry

• 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

• Private pay insurane
• managed care plans: HMOs, PPOs, MBHOs
• Medicaid
• Medicare
• Uninsured clients pay through medicaid, medicare, social security disability income, supplement security income, veterans administration

• 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

• maintain clients best psychosocial functioning in the community
• desinstitutionalization

• Most acute care (short term)
• Intensive outpatient treatment (usually short-term)
• Transitional outpatient treatment (usually long-term)
• Ongoing outpatient treatment (long-term)

• 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

• right to treatment
• right to refuse treatment
• right to informed consent
• rights relating to restraints/seclusion
• right to vote

• Right to keep personal information private
• EXCEPT:
• -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"

• Legally authorized:
• -behavior is physically harmful to self or others
• -less restrictive measures are ineffective
• -a decease in sensory over stimulation is needed
• MUST:
• -be ordered by HCO
• -specific time limit
• -clients condition reviewed q15min
• -reordered q4hr, prescriber eval withint 4hr
• Contraindicated:
• -unstable medically
• -dementia
• -suicidal
• -drug overdose
• -punishment
• -seizures

• Intentional:
• Assault
• battery
• false imprisonment
• defamation of character
• breach of confidentiality
• Unintentional:
• negligence
• malpractuce

• 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

• Maturational:
• -internal
• -new developmental stage is reached (Erikson) and old coping skills no longer helpful
• - ineffective defense mechanisms until new coping skills develop
• Situational:
• -events that are extraordinary, external, often unanticipated
• Adventitious:
• -crisis or disaster(natural, war, violence); not part of everyday life; unplanned

• assess for suicidal or homicidal tendencies first
• Perception of precipitating event
• situational supports
• personal coping skills

• SAFETY
• 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

• 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

• Critical Incident Stress Debriefing
• Seven stop model
• Goal is to dialogue, vent, stabilize, process, learn, teach, reentry

• Interpersonal: self talk
• Interpersonal: one on one, validates
• Small group: group therapy, goal directed
• Public: conferences, classrooms; audience

• Effective listening:
• SOLAR
• 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:
• -accepting
• -giving recognition
• -offering self
• -silence
• -broad openings
• -general leads
• -restating
• -reflecting
• -exploring
• -making observations
• -presenting reality
• -open ended questions
• -formulating a plan of action

• Encourage expression of feelings
• autonomous decision making
• encourage self disclosure
• promote insight
• encourage problem solving
• explore feelings

• Giving false reassurance
• rejecting
• approving or disapproving
• agreeing or disagreeing
• giving advice
• requesting an explanation
• interpreting
• stereotypes comments

• Sit facing the client
• Open posture
• Lean towards client
• Eye Contact
• Relax

• 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

• Define the edge of appropriate behavior in a therapeutic relationship
• Ethical protection for the client
• Legal protection for clinician
• Enables treatment