- Information
- AI Chat
NSG221 Exam 1 Blueprint
Mental Health Nursing (NSG221)
Herzing University
Preview text
Topic Item s
Topic Notes Location
Characteristics of mental health and mental illness Influencing factors
3
Item s
Foundatio ns and Theories of Psychiatric -Mental Health Nursing
Mental health has many components, and a wide variety of factors influence it. These factors interact; thus, a person’s mental health is a dynamic, or ever-changing, state. Factors influencing a person’s mental health can be categorized as individual, interpersonal, and social/cultural.
Individual, or personal, factors include a person’s biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities.
Interpersonal, or relationship, factors include effective communication, ability to help others, intimacy, and a balance of separateness and connectedness.
Social/cultural, or environmental, factors include a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive yet realistic view of one’s world.
NSG221.01.
01.
Brain structures and function Neurotransmitter s- overall types and functions (using list in modules)
3
item s
Foundatio ns and Theories of Psychiatric -Mental Health Nursing
TABLE 2. 1 Major Neurotransmitters
Type Mechanismof Action Physiologic Effects
Dopamine Excitatory
Controls complex movements, motivation, cognition; regulates emotional response Norepinephrine (noradrenaline) Excitatory
Causes changes in attention, learning and memory, sleep and wakefulness, mood Epinephrine (adrenaline) Excitatory Controls fight or flight response
NSG221.01.
01.
Serotonin Inhibitory
Controls food intake, sleep and wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions
Histamine Neuromodulator
Controls alertness, gastric secretions, cardiac stimulation, peripheral allergic responses
Acetylcholine Excitatory orinhibitory
Controls sleep and wakefulness cycle; signals muscles to become alert
Neuropeptides Neuromodulators
Enhance, prolong, inhibit, or limit the effects of principal neurotransmitters Glutamate Excitatory Results in neurotoxicity if levelsare too high γ-Aminobutyric acid Inhibitory
Modulates other neurotransmitters Freud 3 item s
Foundatio ns and Theories of Psychiatric -Mental Health Nursing
Freud conceptualized personality structure as having three components: the id, ego, and superego (Freud, 1923, 1962). The id is part of one’s nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses. The id seeks instant gratification, causes impulsive unthinking behavior, and has no regard for rules or social conventions. The superego is part of a person’s nature that reflects moral and ethical concepts, values, and parental and social expectations; therefore, it is in direct opposition to the id. The third component, the ego, is the balancing or mediating force between the id and the superego. The ego represents mature and adaptive behavior that allows a person to function successfully in the world. Freud believed that anxiety resulted from the ego’s attempts to balance the impulsive instincts of the id with the stringent rules of the superego.
Conscious refers to the perceptions, thoughts, and emotions that exist in the person’s awareness, such as being aware of happy feelings or thinking about a loved one. Preconscious thoughts and
NSG221.01.
01.
stagnation (middle adult) establishing the next generation Ego integrity vs. despair (maturity) Wisdom
Accepting responsibility for oneself and life
Piaget’s four stages of cognitive development are as follows:
Sensorimotor birth to 2 years: The child develops a sense of self as separate from the environment and the concept of object permanence, that is, tangible objects do not cease to exist just because they are out of sight. He or she begins to form mental images.
Preoperational—2 to 6 years: The child develops the ability to express self with language, understands the meaning of symbolic gestures, and begins to classify objects.
Concrete operations—6 to 12 years: The child begins to apply logic to thinking, understands spatiality and reversibility, and is increasingly social and able to apply rules; however, thinking is still concrete.
Formal operations—12 to 15 years and beyond: The child learns to think and reason in abstract terms, further develops logical thinking and reasoning, and achieves cognitive maturity.
Interpersonal nursing theory and RN role functions
3
item s
Foundatio ns and Theories of Psychiatric -Mental Health Nursing
Harry Stack Sullivan (1892–1949) was an American psychiatrist who extended the theory of personality development to include the significance of interpersonal relationships. He thought that inadequate or nonsatisfying relationships produce anxiety, which he saw as the basis for all emotional problems
Hildegard Peplau (1909–1999) saw the role of the nurse as a participant observer. Peplau developed the concept of the therapeutic nurse-patient relationship, which
NSG221.01.
03.
includes four phases: orientation, identification, exploitation, and resolution. 1. The orientation phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions. 2. The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger. 3. In the exploitation phase, the client makes full use of the services offered. 4. In the resolution phase, the client no longer needs professional services and gives up dependent behavior. The relationship ends. Peplau’s concept of the nurse–client relationship, with tasks and behaviors characteristic of each stage, has been modified but remains in use today.
Roles of the Nurses in the Therapeutic Relationship. Peplau also wrote about the roles of the nurses in the therapeutic relationship and how these roles help meet the client’s needs. The primary roles she identified are as follows: ● Stranger—offering the client the same acceptance and courtesy that the nurse would to any stranger. ● Resource person—providing specific answers to questions within a larger context ● Teacher—helping the client learn either formally or informally ● Leader—offering direction to the client or group ● Surrogate—serving as a substitute for another, such as a parent or sibling ● Counselor—promoting experiences leading to health for the client, such as expression of feelings Peplau also believed that the nurse could take on many other roles, including consultant, tutor, safety agent, mediator, administrator, observer, and researcher. These were not defined in detail but were “left to the intelligence and imagination of the readers” (Peplau, 1952, p. 70).
Behavioral, Humanistic, existential
3
item s
Foundatio ns and Theories of
Behaviorism focuses on the client’s observable performance and behaviors and external influences that can bring about behavior
NSG221.01.
04.
Serotonin. Some antidepressants block serotonin reuptake, thus leaving it available longer in the synapse, which results in improved mood & norepinephrine. Some antidepressants block the reuptake of norepinephrine, while others inhibit MAO from metabolizing it.
Many psychotropic drugs must be given in adequate dosages for some time before their full effects are realized. For example, tricyclic antidepressants can require 4 to 6 weeks before the client experiences optimal therapeutic benefit.
As a rule, older adults require lower dosages of medications than younger clients to experience therapeutic effects. It may also take longer for a drug to achieve its full therapeutic effect in older adults.
Psychotropic medications are often decreased gradually (tapering) rather than abruptly. This is because of potential problems with the rebound (temporary return of symptoms), recurrence (of the original symptoms), or withdrawal (new symptoms resulting from discontinuation of the drug).
Involuntary commitment- criteria Confidentiality- exceptions Crisis- types
3
item s
Legal and Ethical Issues and Treatment Modalities, Settings, and Therapeuti c Programs
Involuntary Hospitalization - Health care professionals respect these wishes unless patient is a dangers to themselves or others (i., they are threatening or have attempted suicide or represent a danger to others). Clients hospitalized against their will under these conditions are committed to a facility for psychiatric care until they no longer pose a danger to themselves or to anyone else
One exception to the client’s right to confidentiality is the duty to warn. As a result of this decision, mental health clinicians may have a duty to warn identifiable third parties of threats made by clients, even if these threats were discussed during therapy sessions otherwise protected by privilege.
When making a decision about warning a third party, the clinician must base his or her
NSG221.02.
01.
decision on the following: ● Is the client dangerous to others? ● Is the danger the result of serious mental illness? ● Is the danger serious? ● Are the means to carry out the threat available? ● Is the danger targeted at identifiable victims? ● Is the victim accessible? Crisis Types:
● Maturational crises, sometimes called developmental crises, are predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career. ● Situational crises are unanticipated or sudden events that threaten the individual’s integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family member. ● Adventitious crises, sometimes called social crises, include natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks; riots; and violent crimes such as rape or murder.
Math calc IV drip rate Conversions ounces to mL
3
item s
Foundatio ns and Theories of Psychiatric -Mental Health Nursing
NSG221.01.
01.
Legal terms and nursing
1
item
Legal and Ethical
A tort is a wrongful act that results in injury, loss, or damage. Torts may be either unintentional or intentional.
NSG221.02.
02.
Veracity is the duty to be honest or truthful. Fidelity refers to the obligation to honor commitments and contracts.
Ethical dilemma is a situation in which ethical principles conflict or when there is no one clear course of action in a given situation.
Points to Consider When Confronting Ethical Dilemmas ● Talk to colleagues or seek professional supervision. Usually, the nurse does not need to resolve an ethical dilemma alone. ● Spend time thinking about ethical issues, and determine what your values and beliefs are regarding situations before they occur. ● Be willing to discuss ethical concerns with colleagues or managers. Being silent is condoning the behavior
Types of therapy Group therapy- RN role
2
item s
Legal and Ethical Issues and Treatment Modalities, Settings, and Therapeuti c Programs
Psychotherapy Groups. The goal of a psychotherapy group is for members to learn about their behavior and to make positive changes in their behavior by interacting and communicating with others as a member of a group. Family Therapy. Family therapy is a form of group therapy in which the client and his or her family members participate. The goals include understanding how family dynamics contribute to the client’s psychopathology, mobilizing the family’s inherent strengths and functional resources, restructuring maladaptive family behavioral styles, and strengthening family problem-solving behaviors Education Groups. The goal of an education group is to provide information to members on a specific issue—for instance, stress management, medication management, or assertiveness training. Support Groups. Support groups are organized to help members who share a common problem cope with it. Complementary medicine includes therapies used with conventional medicine practices (the medical model). Alternative medicine includes therapies used in place of conventional treatment. Integrative medicine combines conventional medical therapy and CAM therapies that
NSG221.02.
01.
have scientific evidence supporting their safety and effectiveness.
Crisis Types:
● Maturational crises, sometimes called developmental crises, are predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career. ● Situational crises are unanticipated or sudden events that threaten the individual’s integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family member. ● Adventitious crises, sometimes called social crises, include natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks; riots; and violent crimes such as rape or murder.
Principles of discharge – preventing relapse
1
item
Legal and Ethical Issues and Treatment Modalities, Settings, and Therapeuti c Programs
Assertive community treatment (ACT) programs provide many of the services that are necessary to stop the revolving door of repeated hospital admissions punctuated by unsuccessful attempts at community living.
Partial hospitalization programs (PHPs) are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions
NSG221.02.
02.
Psychiatric rehab & recovery
1
item
Legal and Ethical Issues and Treatment Modalities, Settings, and Therapeuti c Programs
Goals of Psychiatric Rehabilitation
● Recovery from mental illness ● Personal growth ● Quality of life ● Community reintegration ● Empowerment
NSG221.02.
03.
Professional boundaries Working phase of nurse-patient relationship
2
item s
Therapeuti c Relationshi ps and Assessmen t in Psychiatric Mental Health
TABLE 5. 2 Phases of the Nurse–Client Relationship
Working Orientation Identification Exploitation Termination Client ● Seeks assistanc e ● Conveys needs ● Asks question s ● Shares preconce ptions and expectati ons of nurse based on past experien ce
● Participat es in identifying problems ● Begins to be aware of time ● Responds to help ● Identifies with nurse ● Recognize s nurse as a person ● Explores feelings ● Fluctuates dependen ce, independe nce, and interdepe ndence in relationshi p with nurse
● Makes full use of services ● Identifies new goals ● Attempts to attain new goals ● Rapid shifts in behavior: depende nt and independ ent ● Exploitati ve behavior ● Self- directing ● Develops skill in interpers
● Abandon s old needs ● Aspires to new goals ● Becomes independ ent of helping person ● Applies new problem- solving skills ● Maintains changes in style of communi cation and interactio n ● Shows positive
NSG221.03.
02.
● Increases focal attention ● Changes appearan ce (for better or worse) ● Understan ds continuity between sessions (process and content) ● Testing maneuver s decrease
onal relations hips and problem- solving ● Displays changes in manner of communi cation (more open, flexible)
changes in view of self ● Integrate s illness ● Exhibits ability to stand alone
Nurse
● Respond s to client ● Gives paramet ers of meetings ● Explains roles ● Helps
● Gathering data ● Maintains separate identity ● Exhibits ability to edit speech or control
● Continue s assessm ent ● Meets needs as they emerge ● Understa nds
● Sustains relations hip as long as client feels necessar y ● Promotes family interactio
focus on cues ● Helps client develop responses to cues ● Uses word stimuli Professional Boundaries
2
item s
Therapeuti c Relationshi ps and Assessmen t in Psychiatric Mental Health
Inappropriate Boundaries
The nurse must maintain professional boundaries to ensure the best therapeutic outcomes. It is the nurse’s responsibility to define the boundaries of the relationship clearly in the orientation phase and to ensure those boundaries are maintained throughout the relationship. The nurse must act warmly and empathetically but must not try to be friends with the client
NSG221.03.
03.
Active listening Therapeutic communication strategies
2
item s
Therapeuti c Relationshi ps and Assessmen t in Psychiatric Mental Health
Active listening and observation help the nurse: Recognize the issue that is most important to the client at this time. Know what further questions to ask the client. Use additional therapeutic communication techniques to guide the client to describe his or her perceptions fully. Understand the client’s perceptions of the issue instead of jumping to conclusions. Interpret and respond to the message objectively.
NSG221.03.
04.
Active listening- suicide ideation Elements of nonverbal communication- cultural
2
item s
Therapeuti c Relationshi ps and Assessmen t in
Clients may use many word patterns to cue the listener to their intent. Overt cues are clear, direct statements of intent, such as “I want to die.” The message is clear that the client is thinking of suicide or self-harm. Covert cues are vague or indirect messages that need interpretation and exploration—for example, if a client says, “Nothing can help me.” The nurse is unsure, but it sounds as if the client might be saying he or she feels so hopeless and helpless that he or she plans to commit suicide. The nurse can
NSG221.03.
05.
application Psychiatric Mental Health
explore this covert cue to clarify the client’s intent and to protect the client. Most suicidal people are ambivalent about whether to live or die and often admit their plan when directly asked about it. When the nurse suspects self-harm or suicide, he or she uses a yes-or-no question to elicit a clear response. Theme of hopelessness and suicidal ideation: Client: “Life is hard. I want it to be done. There is no rest. Sleep, sleep is good ...
forever.” Nurse: “I hear you saying things seem hopeless. I wonder if you are planning to kill yourself.” (verbalizing the implied) Other word patterns that need further clarification for meaning include metaphors, proverbs, and clichés. When a client uses these figures of speech, the nurse must follow up with questions to clarify what the client is trying to say.
When a client makes specific threats or has a plan to harm another person, health care providers are legally obligated to warn the person who is the target of the threats or plan. The legal term for this is duty to warn. This is one situation in which the nurse must breach the client’s confidentiality to protect the threatened person. SAD PERSONAS mnemonic for the Suicide Risk Assessment
- Sex
- Age
- Depression
- Previous attempt
- Ethanol abuse
- Rational thought loss
- Social supports lacking
- Organized plan
- No spouse
- Access to lethal means
- Sickness The presence of each factor is given a point value of 1. Total scores range from 0 to 10. Higher scores indicate greater patient suicide risk.
Older adult abuse indicators
1
item s
Therapeuti c Relationshi ps and Assessmen t in Psychiatric Mental Health
NSG221.03.
03.
Cultural competence
2
item s
Therapeuti c Relationshi ps and Assessmen t in Psychiatric Mental Health
Culturally competent nursing care means being sensitive to issues related to culture, race, gender, sexual orientation, social class, economic situation, and other factors.
Factors in Cultural Assessment Giger (2016) identifies a model for assessing clients using six cultural factors: communication, physical distance or space, social organization, time orientation, environmental control, and biologic variations
Nurse’s Role in Working with Clients of Various Cultures To provide culturally competent care, the nurse must find out as much as possible about a client’s cultural values, beliefs, and health practices. Often, the client is the best source for that information, so the nurse must ask the client what is important to him or her—for instance, “How would you like to be cared for?” or “What do you expect (or want) me to do for you?” (Andrews & Boyle, 2015). A client’s health practices, and religious beliefs are other important areas to assess. The
NSG221.03.
04.
NSG221 Exam 1 Blueprint
Course: Mental Health Nursing (NSG221)
University: Herzing University
This is a preview
Access to all documents
Get Unlimited Downloads
Improve your grades
