Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Mental Health


Published on

Mental Health Nursing

Published in: Health & Medicine
  • very well done slide! great health info!
    Are you sure you want to  Yes  No
    Your message goes here

Mental Health

  1. 1. Unit 1 Course Introduction Mental Health and Illness Legal/Ethical Professional Standards
  2. 2. Qualities of Mentally Healthy Person <ul><li>Relative happiness </li></ul><ul><li>Self control </li></ul><ul><li>Reality orientation </li></ul><ul><li>Effective at work and social roles </li></ul><ul><li>Accurate self concept (locus of control, self esteem) </li></ul>
  3. 3. DSM IV Diagnostic and Statistical Manual <ul><li>Axis I: Major mental disorder </li></ul><ul><li>Axis II: Personality disorder/mental retardation </li></ul><ul><li>Axis III: General Medical Conditions </li></ul><ul><li>Axis IV: Psychosocial/Environmental factors affecting the situation </li></ul><ul><li>Axis V: Global Assessment of Functioning Scale (GAF) </li></ul>
  4. 4. Professional Standards <ul><li>ANA Standards from Cover of Text </li></ul><ul><li>Patient Care Standards </li></ul><ul><li>Rationale for Standards </li></ul><ul><li>RN responsibility-how it fits with legal and ethical aspects of the profession </li></ul>
  5. 5. Ethical Positions <ul><li>Beneficence: duty to do what is of benefit to others </li></ul><ul><li>Autonomy: Right to self determine choices affecting oneself </li></ul><ul><li>Justice: right to fair treatment </li></ul><ul><li>Fidelity (non maleficence):doing no wrong to client, acting with loyalty </li></ul>
  6. 6. Patient’s Bill of Rights <ul><li>Maintain civil rights: vote, contracts, religious </li></ul><ul><li>Client consent: refuse treatment, grievance </li></ul><ul><li>Communication: mail and phone/full and private </li></ul><ul><li>Freedom from harm: unnecessary restraint, isolation, medication </li></ul><ul><li>Dignity/respect </li></ul><ul><li>Confidentiality: both written (libel) and oral (slander) </li></ul><ul><li>Participation in care plan </li></ul>
  7. 7. Other legal points of interest <ul><li>Parens patriae: state as “parent” </li></ul><ul><li>Police power:right of state to protect society </li></ul><ul><li>Least restrictive alternative—guiding principle in mental health </li></ul><ul><li>Tarasoff decision—duty to warn </li></ul>
  8. 8. Voluntary Admission <ul><li>Signs self in, needs order, may be instead of involuntary admit. </li></ul><ul><li>For insurance to pay, often must show major mental illness, dangerousness, inability to manage as outpatient, start of Rx requiring close supervision </li></ul><ul><li>If requests d/c prematurely may get: regular d/c, AMA, or commitment petition filed. </li></ul>
  9. 9. Involuntary Admission <ul><li>If police bring in—called IDO immediate detention order, requires exam then decision re status </li></ul><ul><li>EDO—emergency detention order, signed by qualified medical personnel (ie MD). To court in 72 hours for decision. </li></ul><ul><li>If the decision is to commit at this time, it is called a temporary commitment (90 + 90). This decision is based on four criteria. </li></ul><ul><li>After 90 + 90 can be placed on indefinite commitment with a yearly review. </li></ul>
  10. 10. Types of Therapeutic Approaches (review!) <ul><li>Psychoanalytic </li></ul><ul><li>Rational Emotive Therapy </li></ul><ul><li>Cognitive Therapy </li></ul><ul><li>Behavioral Therapy </li></ul><ul><li>Milieu Therapy </li></ul><ul><li>Group Therapy </li></ul><ul><li>Medical/biologic therapy </li></ul>
  11. 11. Stages of Therapeutic Relationship <ul><li>1. Preorientation; prep, values clarification, history </li></ul><ul><li>2. Orientation: establish trust, boundaries, and client contract </li></ul><ul><li>3. Working: deal with problems and changing behavior </li></ul><ul><li>4. Termination: discuss progress, referral, say good bye </li></ul>
  12. 12. Refresh yourself regarding: <ul><li>HIPAA </li></ul><ul><li>Professional Dress </li></ul><ul><li>Know where to go for your clinical </li></ul>
  13. 13. Unit 2 Communication and Assessment Therapeutic communication Dealing with Upset people Anxiety levels, Mental Mechanisms Intro to assessment
  14. 14. Review of Communication Issues <ul><li>Content and Process in a verbal message </li></ul><ul><li>Congruent and Incongruent communication </li></ul><ul><li>Therapeutic use of self </li></ul><ul><li>Differentiate transference and counter-transference </li></ul><ul><li>Positive regard </li></ul><ul><li>Empathy versus sympathy </li></ul>
  15. 15. Therapeutic approaches <ul><li>Accepting, recognizing </li></ul><ul><li>Offering self </li></ul><ul><li>Broad openings and general leads </li></ul><ul><li>Restating and reflecting </li></ul><ul><li>Encouraging comparison and description of perception </li></ul><ul><li>Making observations </li></ul><ul><li>Focusing </li></ul><ul><li>Exploring </li></ul><ul><li>Seeking clarification </li></ul><ul><li>Presenting reality </li></ul><ul><li>Voicing doubt </li></ul><ul><li>Verbalizing the implied </li></ul><ul><li>Encouraging formulation of a plan of action </li></ul>
  16. 16. Non therapeutic approaches and common errors <ul><li>False reassurance </li></ul><ul><li>Agreeing/disagreeing </li></ul><ul><li>Giving advice </li></ul><ul><li>Probing </li></ul><ul><li>Defending </li></ul><ul><li>Asking why </li></ul><ul><li>Belitting feelings </li></ul><ul><li>Using denial </li></ul><ul><li>Interpreting </li></ul><ul><li>Changing the subject </li></ul><ul><li>Rejecting </li></ul><ul><li>Repetitive closed questions </li></ul><ul><li>Body language indicates hurry or frustration </li></ul><ul><li>“ Is there anything you want to talk about?” </li></ul>
  17. 17. Fight or Flight <ul><li>Fight </li></ul><ul><li>Responds to stress, threat and uncertainty with conflict, anger, violence </li></ul><ul><li>Review Symptoms of Fight or Flight Response! </li></ul><ul><li>Flight </li></ul><ul><li>Responds to stress, threat, and uncertainty with anxiety, fear, etc </li></ul>
  18. 18. Dealing with an Upset Person <ul><li>Body language: Calm, warm, open posture at a side angle. Good eye contact, no staring. </li></ul><ul><li>Voice tone: Assertive, audible, calm, low, slow. </li></ul><ul><li>Keep verbal responses short and simple. </li></ul><ul><li>Your response should match their behavior—they talk, you talk; they act; you act. </li></ul><ul><li>Give choice between 2 acceptable options </li></ul>
  19. 19. Conflict Management and Anger <ul><li>Anger is a problem if it explodes out uncontrollably or if it is held in excessively </li></ul><ul><li>Staff and clients both have anger issues </li></ul><ul><li>Often anger leaks out in subtle ways: sarcasm, excessive humor, making people wait, silent treatment, physical ailments, overly polite behavior, crying, acting superior </li></ul>
  20. 20. Styles of Conflict Management—Which fit you the best? <ul><li>Forcing—I win, you lose </li></ul><ul><li>Confronting—Care enough to be honest </li></ul><ul><li>Compromising—Both partly win </li></ul><ul><li>Smoothing—I give in to make you feel better </li></ul><ul><li>Withdrawing—Anger is too scary to face, I withdraw </li></ul>
  21. 21. General Tips for Conflict Management <ul><li>Realize that anger is a normal emotion, discover what the anger is about! </li></ul><ul><li>Find out/ask for what you need </li></ul><ul><li>Deal with the person you are angry with </li></ul><ul><li>Each person is responsible for his/her own behavior </li></ul><ul><li>Think before you speak </li></ul>
  22. 22. More General Tips… <ul><li>What are the implications of fighting this battle? Worth it? </li></ul><ul><li>Respect for the person is vital </li></ul><ul><li>If you have a complaint, bring a solution to the table. Don’t just bring problems… </li></ul><ul><li>Bring everyone who has a real stake in the issue together to deal with it. </li></ul>
  23. 23. Peplau’s Mild Anxiety <ul><li>Increased ability to perceive, heightened senses </li></ul><ul><li>Effectively learn, work toward goal, good awareness </li></ul><ul><li>Slight restlessness, mild tension </li></ul><ul><li>No intervention needed </li></ul>
  24. 24. Peplau’s Moderate Anxiety <ul><li>Narrowed perceptual field, sees less of what is going on—selective inattention </li></ul><ul><li>Able to do some problem solving with help </li></ul><ul><li>Shaky voice, less concentration, headache, insomnia, pacing, some minor fight or flight symptoms </li></ul>
  25. 25. Interventions for Moderate Anxiety <ul><li>Problem solving/talk therapy. “Sit down with client individually BID for ___min. allow client to vent concerns and assist client to identify positive problem solving strategies.” </li></ul><ul><li>Cognitive reframing </li></ul><ul><li>Teaching </li></ul><ul><li>Anxiety reduction techniques – relaxation training, meditation, counting, deep breathing </li></ul>
  26. 26. Peplau’s Severe Anxiety <ul><li>Small perceptual field, attend to irrelevant detail or scattered thoughts </li></ul><ul><li>Self absorbed, feedback doesn’t help much </li></ul><ul><li>Impending dread/doom, purposeless activity, hypervent, tachy, loud rapid speech </li></ul><ul><li>Can’t effectively problem solve or see connections </li></ul>
  27. 27. Peplau’s Panic level of Anxiety <ul><li>Terror and emotional paralysis, hallucinations or delusions take place of reality </li></ul><ul><li>Mute or extreme agitation, irrational, hypervigilant, hyperactive </li></ul><ul><li>Sleepless, not eating, all fight or flight in place </li></ul>
  28. 28. Interventions for all levels of Anxiety <ul><li>Maintain your presence </li></ul><ul><li>Decrease environmental stimuli </li></ul><ul><li>Remain calm </li></ul><ul><li>Speak slowly, clearly, simply </li></ul><ul><li>Base further intervention on level of anxiety and situation </li></ul>
  29. 29. Interventions for Severe or Panic Anxiety <ul><li>Medication—anti-anxiety or anti-psychotic </li></ul><ul><li>Provide short, firm concrete directions to assist the client to calm </li></ul><ul><li>Protect the client from self injury, either intentional or related to inattention or poor reality testing </li></ul><ul><li>Protect the milieu from disruption and injury—discuss </li></ul>
  30. 30. Criteria for Restraint and Seclusion <ul><li>Client imminently harmful to self or others </li></ul><ul><li>Client endangering facility </li></ul><ul><li>Less restrictive measures are not satisfactory </li></ul><ul><li>Client request (rare) </li></ul><ul><li>Must show that criteria were met in your documentation or be at risk for false imprisonment </li></ul>
  31. 31. Proper Restraint/Seclusion order includes: <ul><li>Type of restraint or seclusion (discuss) </li></ul><ul><li>Reason (from frame earlier) </li></ul><ul><li>Specific time limits (agency and state boundaries apply). NO PRN order. </li></ul><ul><li>MD signature. Agency may specify that MD see the client within a certain time frame. </li></ul>
  32. 32. RN Care Issues in R/S: <ul><li>Frequent checks or constant observation, documented (aid can do). </li></ul><ul><li>Protect client privacy; hygiene, ROM, body alignment (discuss frequency). </li></ul><ul><li>Safe/secure application of restraints (will hold ct, applied correctly). Assess circulation, abrasion, alignment, warmth, no harmful objects in area. </li></ul><ul><li>Nutrition, fluid, elimination needs Q2hr </li></ul><ul><li>Reasonable release criteria set, moniter progress towards release at least Q2hr </li></ul>
  33. 33. Issues with R/S <ul><li>Assault: verbal threat, namecalling </li></ul><ul><li>Battery: physical abuse, harm, unwelcome contact </li></ul><ul><li>False imprisonment: habeas corpus </li></ul><ul><li>Can medicate against will only in case of imminent risk of violence to self or others, otherwise not (discuss court order exception) </li></ul>
  34. 34. Other considerations… <ul><li>Get uninvolved clients out of the way </li></ul><ul><li>One person does the talking with client </li></ul><ul><li>Do not attempt to be a hero, always have adequate help before intervening </li></ul><ul><li>Once a limit has been set, it should not be negotiated, sends message that fosters acting out. </li></ul><ul><li>Least restrictive alternative </li></ul>
  35. 35. Defense Mechanisms (ch 13) <ul><li>On a continuum of relative maturity: mature-neurotic-immature-psychotic </li></ul><ul><li>All serve to protect the human from perceived threats (conflict, shame, fear, anger) </li></ul><ul><li>Relatively unconscious, though we can become aware of them </li></ul>