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