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Saturday, September 1, 2007

Mental Health

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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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