Blueprint Exam 1+study
Blueprint Exam 1+study
Blueprint Exam 1+study
Maslow emphasized and individual’s motivation in the continuous quest for self-actualization. An
individual’s position within the hierarchy may reverse from a higher level to a lower level based on life
circumstances
Maslow describes self-actualization as being “psychologically healthy, fully human, highly evolved, and
fully mature.”
1. Self-Actualization: the individual possesses a feeling of self-fulfillment and the realization of his or
her highest potential
2. Self-Esteem/Esteem of Others: the individual seeks self-respect and respect from others, works to
achieve success and recognition in work, and desires prestige from accomplishment
3. Love and Belonging: needs are for giving and receiving of affection, companionship, satisfactory
interpersonal relationships, and identification with a group
4. Safety and Security: needs at this level are for avoiding harm, maintaining comfort, order, structure,
physical safety, freedom from fear, and protection
5. Physiological Needs: basic fundamental needs include food, water, air, sleep, exercise, elimination,
shelter, and sexual expression
Phases in the Nurse-Client Therapeutic Relationship - What Occurs in Each Phase, Nursing
Interventions/Actions
Pre Interaction Phase: This is before you meet your client. This phase is about collecting
information previous to see the client to make sure you know as much as possible about
him/her. Obtain information from the chart, significant others or other health team members.
The downfall is that you can have preconceived judgments about the patient. Examine one’s
own feelings, fears, and anxieties about working with a particular client. The nurse needs to be
aware of how these preconceptions may affect her ability to care for individual clients
Interactions may remain on a superficial level until anxiety subsides. Several interactions may be
required to fulfill the tasks associated with this phase
Working Phase:
- Overcoming resistance behaviors on the part of the client as the level of anxiety rises in
response to discussion of painful issues
• Transference: occurs when the client unconsciously displaces (or “transfers”) to the nurse
feelings formed toward a person from the past
- This feelings toward the nurse may be triggered by something about the nurse’s
appearance or personality characteristics that remind the client of the person
- Transference can interfere with the therapeutic interaction when the feelings being
expressed include anger and hostility. Anger towards the RN can be manifested by
uncooperativeness and resistance to the therapy
- In case of transference the nurse should work with the patient in sorting out the past
from the present and assist the patient into identifying the transference and reassign a
new and more appropriate meaning to the current nurse-patient relationship. The goal
is to guide the patient to independence by teaching them to assume responsibility for
their own behaviors, feelings, and thoughts, and to assign the correct meanings to the
relationships based on present circumstances instead of the past
- These responses may be related to unresolved feelings toward significant others from
the nurse’s past or they may be generated in response to transference feelings on the
part of the client. The nurse may be completely unaware or only minimally aware of
what’s happening
Termination Phase:
- Therapeutic conclusion of relationship occurs when:
A plan of action for more adaptive coping with future stressful situations
has been established
Feelings about termination of the relationship are recognized and explored
(the client may feel sad & feel a loss & show behavior and as a result
transference can occur
The nursing process is the same for mentally ill patients, there is only some differences on how you do
the assessment, in which you focus on psychological and social factors, observation of the client and
his/her environment, subjective/objective data.
The patient is more looked in a holistic way. You also assess for spirituality, learning needs, suicidal
thoughts. The most important assessment is to diagnose the level of risk which requires priority, as it
can be a life-threatening potential
Biological makeup
autonomy and independence
self-esteem
capacity for growth
vitality
ability to find meaning in life
What is the DSM? “Diagnostic and Statistical Manual of Mental Disorders (DSM-5)”
Behavioral - observable behaviors and what one can do externally to bring about
behavior changes.
Operant Conditioning – people learn from their behavior from their history or past
experiences.
Mental Health: State of wellbeing which every individual realizes their own potential, can cope with
stress of life, work productively and fruitfully and is able to make a contribution to community.
• ‘Mental wellbeing’ – a positive concept. Refers to resilience and good functioning, also
incorporates flourishing, happiness and getting the most out of life
Mental illness: A clinically recognizable set of symptoms related to mood, thought, cognition and
behaviour that is associated with distress and interferes with normal functioning.
Resilience or “hardiness,” sense of belonging, reality orientation, and coping or stress mgmt. abilities.
Process of:
- adapting
- recognizing feelings
- dealing with those feelings
- learning from the experience
Interpersonal factors:
• effective communication
• helping others
• intimacy
• maintaining a balance of separateness and connectedness
Social/Cultural factors:
• sense of community
• access to resources
• intolerance of violence
• support of diversity among people
• mastery of the environment
• positive yet realistic view of the world
Therapeutic Relationships
• Therapeutic use of self “distinct gifts” each one of us has that can be used to creatively
form positive bonds with others
o Influenced by personality characteristics of patient and nurse
• Steps: Identify and explore patient needs, establish clear boundaries, explore alternative
problem solving skills, encourage behavioral change
• Boundaries
o Physical boundaries, informal boundaries, personal space
o Self-Check on Boundaries
o Peplau’s Model
- Using Silence: it allows the client to take control of the discussion, if he or she desires. The
nurse can be silent, or the patient or both
- Placing the Event in Time or Sequence: clarifies the relationship of events in time
- Encouraging Comparison: asking the client to compare similarities and differences in ideas,
experiences, or interpersonal relationships
- Restating: lets client know whether an expressed statement has or has not been understood
- Reflecting: directs questions or feelings back to client so that they may be recognized and
accepted
- Seeking Clarification and Validation: striving to explain what is vague and searching for
mutual understanding
- Verbalizing the Implied: putting into words the feelings the client has expressed only indirectly
o Feedback is useful when is descriptive rather than evaluative and focused on the
behavior rather than on the client
o It’s directed towards behavior that the client has the capacity to modify
- Another therapeutic technique is to help the person put their thoughts/experiences into feeling
as oppose to telling them what to do
- Giving Reassurance: may discourage clients from further expression of feelings if client
believes the feelings will only be belittled
- Giving Approval or Disapproval: implies that the nurse has the right to pass judgment on the
“goodness” or “badness” of client’s behavior
- Agreeing/Disagreeing: implies that the nurse has the right to pass judgment on whether
client’s ideas or opinions are “right” or “wrong”
- Giving Advice: implies that the nurse knows what is best for client and that client is incapable
of any self-direction
- Probing: pushing for answers to issues the client does not wish to discuss causes client to feel
used and valued only for what is shared with the nurse
- Making Stereotyped Comments, Clichés, and Trite Expressions: these are meaningless in a
nurse-client relationship
- Using Denial: blocks discussion with the client and avoids helping him or her identify and
explore areas of difficulty
- Interpreting: results in the therapist’s telling client the meaning of his or her experience
- Introducing an Unrelated Topic: causes the nurse to take over the direction of the discussion
Levels of Anxiety
- Severe Anxiety goal to lower patient’s anxiety level to moderate or mild before
proceeding with anything else.
Low, calm, and soothing voice
Walking with patient if they’re unable to sit still
Help patient to take deep even breaths
Psychodynamic Theories
Intrapsychic/Psychoanalytic Theories
Freud (1936) saw a person’s innate anxiety as the stimulus for behavior. He described defense
mechanisms as the human’s attempt to control awareness of and to reduce anxiety.
Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of
being in control of a situation, to lessen discomfort, and to deal with stress. Because defense
mechanisms arise from the unconscious, the person is unaware of using them. Some people overuse
defense mechanisms, which stops them from learning a variety of appropriate methods to resolve
anxiety-producing situations. The dependence on one or two defense mechanisms also can inhibit
emotional growth, lead to poor problem-solving skills, and create difficulty with relationships.
Interpersonal Theory
Harry Stack Sullivan (1952) viewed anxiety as being generated from problems in interpersonal
relationships. Caregivers can communicate anxiety to infants or children through inadequate nurturing,
agitation when holding or handling the child, and distorted messages. Such communicated anxiety can
result in dysfunction such as failure to achieve age-appropriate developmental tasks. In adults, anxiety
arises from the person’s need to conform to the norms and values of his or her cultural group. The
higher the level of anxiety, the lower the ability to communicate and to solve problems and the greater
the chance for anxiety disorders to develop.
Hildegard Peplau (1952) understood that humans exist in interpersonal and physiologic realms; thus, the
nurse can better help the client to achieve health by attending to both areas. She identified the four
levels of anxiety and developed nursing interventions and interpersonal communication techniques
based on Sullivan’s interpersonal view of anxiety. Nurses today use Peplau’s interpersonal therapeutic
communication techniques to develop and to nurture the nurse–client relationship and to apply the
nursing process.
Behavioral Theory
Behavioral theorists view anxiety as being learned through experiences. Conversely, people can change
or “unlearn” behaviors through new experiences. Behaviorists believe that people can modify
maladaptive behaviors without gaining insight into their causes. They contend that disturbing behaviors
that develop and interfere with a person’s life can be extinguished or unlearned by repeated
experiences guided by a trained therapist.
CULTURAL CONSIDERATIONS
Asian cultures often express anxiety through somatic symptoms such as headaches, backaches,
fatigue, dizziness, and stomach problems.
One intense anxiety reaction is koro, or a man’s profound fear that his penis will retract into the
abdomen and he will then die.
Accepted forms of treatment include having the person firmly hold his penis until the fear
passes, often with assistance from family members or friends, and clamping the penis to a
wooden box. In women, koro is the fear that the vulva and nipples will disappear.
Susto is diagnosed in some Hispanics (Peruvians, Bolivians, Colombians, and Central and
South American Indians) during cases of high anxiety, sadness, agitation, weight loss, weakness,
and heart rate changes.
The symptoms are believed to occur because supernatural spirits or bad air from dangerous
places and cemeteries invades the body.
Ex: “My heart is pounding. I think I’m going to die!” to “I can stand this. This is just
anxiety. It will go away.”
Decatastrophizing involves the therapist’s use of questions to more realistically appraise the
situation.
Ex: “What is the worst thing that could happen? Is that likely? Could you survive that? Is
that as bad as you imagine?” The client uses thought-stopping and distraction techniques
to jolt himself or herself from focusing on negative thoughts
- Splashing face with cold water
- Snapping a rubber band worn on the wrist
- Shouting
Assertiveness training helps the person take more control over life situations.
Ex: using “I” statements to identify feelings and to communicate concerns or needs to
others.
- “I feel angry when you turn your back while I’m talking”
- “I want to have 5 minutes of your time for an uninterrupted conversation
about something important”
- “I would like to have about 30 minutes in the evening to relax without
interruption.”
Psychotropic: psychiatric medications that alter chemical levels of the brain = impact mood + behavior
Antipsychotics, antidepressants, mood stabilizers, ADHD drugs, anti-anxiety
NEUROTRANSMITTERS:
Dopamine: r/t psychosis (schizophrenia)
Serotonin: mood disorders (depression)
Mode of action:
- Potentiates GABA (neurotransmitter important in relaxation)
- CNS depressant
Pregnancy class D **
Most common:
- Diazepam (Valium) LONG ACTING
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Lorazepam (Ativan)
- Chlordiazepoxide (Librium): not used for anxiety but can be used for alcohol withdrawal
symptoms
- Midazolam (Versed): used in conscious sedation
Patient Teaching:
Do NOT combine with alcohol
NOT for long-term use as tolerance/addiction develop
Don’t discontinue abruptly
Take as directed
Nursing Considerations:
- Check renal and hepatic function
- NOT for patients at high risk for suicide
- Assess for R/f falls
- Contraindicated in sleep apnea
- Long-term use means patient need deeper sedation during operative procedures
Benzodiazepine TOXICITY
Very frequently used in overdose/suicides
Mode of action:
- Binds to serotonin, dopamine receptors
Pregnancy class B **
- safe for long-term use
Antihistamine:
Hydroxyzine (Vistaril, Atarax)
Side Effects:
Drowsiness
Ataxia
Hypotension
Beta blockers: Anticonvulsants:
Atenolol (Tenormin) Carbamazepine (Tegretol)
Propranolol (Inderal) Gabapentin (Neurontin)
Valporic acid (Depakote)
Mode of action:
- Alleviate anxiety by working on the GABA neurotransmitter
- Elevate levels of serotonin
Side Effects:
HA
Anhedonia
Somnolence
Nausea
Insomnia
Sexual dysfunction
Weight gain
Mania
Suicide risk
Platelet dysfunction
Antidepressants: SSRI’s
Mode of action:
- Similar to benzodiazepines, also muscle relaxant properties
Side Effects:
- Impaired judgment & thinking
- Thrombocytopenia
- Leukocytopenia
- Dyspnea
- Pulmonary hypertension
- Liver toxicity
Melatonin
Contraindicated:
- Hepatic disease
- CVA
- Depression
- Neurologic disorders
Valerian root
Contraindicated:
- Alcohol use
- Pregnancy & lactation
- Must stop weeks before surgery
Anxiety Disorder
Characterized by persistent, excessive worry.
Treatment/management/interventions of anxiety:
CBT
Meds
Meditation, relaxation techniques
Journaling
Exercise
Distraction
Guided Imagery
Building self esteem
Dietary adjustments
Symptoms:
- Worry
- Restlessness
- Fatigue
- Difficult concentrating
- Irritability
- Tension
- Sleep disturbances
Phobic disorder:
Irrational fear and anxiety triggered by a specific stimulus or situation
Disability occurs due to narrowing of activities etc. to avoid contact with object/situation
Social phobia:
Fear of social or performance situations
Hypersensitivity to criticism
Low self-esteem, poor social skills
Often leading to avoidance behavior
Specific phobia:
Anxiety provoked by exposure to specific feared object or situation – often leading to distress &
avoidance
Agoraphobia:
Fear of having a panic attack after having one previously
OCD – obsessive compulsive behavior:
Panic disorder:
The presence of recurrent, unexpected panic attacks followed by at least one month of persistent
concern about having another panic attack, or a significant behavioral change r/t the PA
2 types:
Panic disorder with agoraphobia
Panic disorder without agoraphobia
Symptoms:
- Recurrent, intrusive recollections of the event
- Dreams of event
- Avoid talking/thinking about the trauma
- Decreased interest and participation in important activities
- Detached
Predisposing factors:
Background
Presence of preexisting mental disorder
Patient’s pre morbid personality
Panic attack:
Not a disorder in itself
A discrete period of intense fear or discomfort in the absence of real danger
Obsessive–Compulsive and Related Disorders
compulsions – ritualistic or repetitive behaviors or mental acts that a person carries out
continuously in an attempt to neutralize anxiety
Dermatillomania – compulsive skin picking, often to the point of physical damage; an impulse control
disorder
exposure – behavioral technique that involves having the client deliberately confront the situations
and stimuli that he or she is trying to avoid
obsessions – recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause
marked anxiety and interfere with interpersonal, social, or occupational function
oniomania – compulsive buying; possessions are acquired compulsively without regard for cost or
need for the item
trichotillomania – compulsive hair pulling from scalp, eyebrows, or other parts of the body; leaves
patchy bald spots that the person tries to conceal
Often have sleep pattern disturbances, lack basic nutrition, and get no exercise.
Multiple prescriptions for pain or other complaints.
Nursing diagnoses:
Ineffective Coping
Ineffective Denial
Impaired Social Interaction
Anxiety
Disturbed Sleep Pattern
Fatigue
Pain
Clients with conversion disorder may be at risk for disuse syndrome from having pseudoneurologic
paralysis symptoms. In other words, if clients do not use a limb for a long time, the muscles may
weaken or undergo atrophy from lack of use.
Treatment outcomes for clients with a somatic symptom illness may include the following:
The client will identify the relationship between stress and physical symptoms.
The client will verbally express emotional feelings.
The client will follow an established daily routine.
The client will demonstrate alternative ways to deal with stress, anxiety, and other feelings.
The client will demonstrate healthier behaviors regarding rest, activity, and nutritional intake.
Ex: Nurse: “Let’s take a walk outside for some fresh air.” (encouraging collaboration)
Client: “I wish I could, but I feel so terrible, I just can’t do it.”
Nurse: “I know this is difficult, but some exercise is essential. It will be a short walk.”
(validation; encouraging collaboration)
CLIENT/FAMILY EDUCATION
Establish daily health routine, including adequate rest, exercise, and nutrition.
Teach about relationship of stress and physical symptoms and mind–body relationship.
Educate about proper nutrition, rest, and exercise.
Educate client in relaxation techniques: progressive relaxation, deep breathing, guided imagery,
and distraction such as music or other activities.
Educate client by role-playing social situations and interactions.
Encourage family to provide attention and encouragement when client has fewer complaints.
Encourage family to decrease special attention when client is in “sick” role.
TERVENTIONS
Health teaching
Establish a daily routine.
Promote adequate nutrition and sleep.
Expression of emotional feelings
Recognize relationship between stress/coping and physical symptoms.
Keep a journal.
Limit time spent on physical complaints.
Limit primary and secondary gains.
Coping strategies
Emotion-focused coping strategies such as relaxation techniques, deep breathing,
guided imagery, and distraction
Problem-focused coping strategies such as problem-solving strategies and role-
playing
Points to Consider – Somatoform Disorders
Carefully assess the client’s physical complaints. Even when a client has a history of a
somatoform disorder, the nurse must not dismiss physical complaints or assume they are
psychological. The client actually may have a medical condition.
Validate the client’s feelings while trying to engage him or her in treatment; for example, use a
reflective yet engaging comment such as “I know you’re not feeling well, but it is important to
get some exercise each day.”
Remember that the somatic complaints are not under the client’s voluntary control. The client
will have fewer somatic complaints when he or she improves coping skills and interpersonal
relationships.
conversion disorder – sometimes called conversion reaction; involves unexplained, usually sudden
deficits in sensory or motor function related to an emotional conflict the
client experiences but does not handle directly
disease conviction – preoccupation with the fear that one has a serious disease
disease phobia – preoccupation with the fear that one will get a serious disease
emotion-focused coping strategies – techniques to assist clients to relax and reduce feelings of stress
fabricated and induced illness – factitious disorders characterized by physical symptoms that are
feigned or inflicted on one’s self or another person for the sole
purpose of gaining attention or other emotional benefits; also called
factitious disorder, imposed on self or others
illness anxiety disorder – preoccupation with the fear that one has a serious disease or will get a
serious disease; also called hypochondriasis
internalization – keeping stress, anxiety, or frustration inside rather than expressing them outwardly
la belle indifférence – a seeming lack of concern or distress; a key feature of conversion disorder
Munchausen’s syndrome – a factitious disorder where the person intentionally causes injury or
physical symptoms to self to gain attention and sympathy from health-
care providers, family, and others
Munchausen’s syndrome by proxy – when a person inflicts illness or injury on someone else to gain
the attention of emergency medical personnel or to be a hero for “saving” the victim
pain disorder – has the primary physical symptom of pain, which generally is unrelieved by analgesics
and greatly affected by psychological factors in terms of onset, severity, exacerbation,
and maintenance
primary gain – the relief of anxiety achieved by performing the specific anxiety-driven behavior; the
direct external benefits that being sick provides, such as relief of anxiety, conflict, or
distress
psychosomatic – used to convey the connection between the mind (psyche) and the body (soma) in
states of health and illness
secondary gain – the internal or personal benefits received from others because one is sick, such as
attention from family members, comfort measures, and being excused from usual
responsibilities or tasks
somatization – the transference of mental experiences and states into bodily symptoms
Utilitarianism is a theory that bases decisions on “the greatest good for the greatest number.”
Decisions based on utilitarianism consider which action would produce the greatest benefit for the
most people. Deontology is a theory that says decisions should be based on whether or not an
action is morally right with no regard for the result or consequences. Principles used as guides for
decision making in deontology include autonomy, beneficence, nonmaleficence, justice, veracity, and
fidelity.
All these principles have meaning in health care. The nurse respects the client’s autonomy
through patient’s rights and informed consent, and by encouraging the client to make choices about
his or her health care. The nurse has a duty to take actions that promote the client’s health
(beneficence) and that do not harm the client (nonmaleficence). The nurse must treat all clients
fairly (justice), be truthful and honest (veracity), and honor all duties and commitments to clients
and families (fidelity).
Many dilemmas in mental health involve the client’s right to self-determination and
independence (autonomy) and concern for the “public good” (utilitarianism). Examples include the
following:
Once a client is stabilized on psychotropic medication, should the client be forced to remain
on medication through the use of enforced depot injections or through outpatient
commitment?
Are psychotic clients necessarily incompetent, or do they still have the right to refuse
hospitalization and medication?
Can consumers of mental health care truly be empowered if health-care professionals “step
in” to make decisions for them “for their own good?”
Should physicians break confidentiality to report clients who drive cars at high speeds and
recklessly?
Should a client who is loud and intrusive to other clients on a hospital unit be secluded from
the others?
A health-care worker has an established relationship with a person who later becomes a
client in the agency where the health-care worker practices. Can the health-care worker
continue the relationship with the person who is now a client?
To protect the public, can clients with a history of violence toward others be detained after
their symptoms are stable?
When a therapeutic relationship has ended, can a health-care professional ever have a social
or intimate relationship with someone he or she met as a client?
Is it possible to maintain strict professional boundaries (i.e., no previous, current, or future
personal relationships with clients) in small communities and rural areas, where all people in
the community know one another?
The nurse will confront some of these dilemmas directly, and he or she will have to make decisions
about a course of action. For example, the nurse may observe behavior between another health-care
worker and a client that seems flirtatious or inappropriate. Another dilemma might represent the
policies or common practice of the agency where the nurse is employed; the nurse may have to
decide whether he or she can support those practices or seek a position elsewhere. An example would
be an agency that takes clients with a history of medication noncompliance only if they are scheduled
for depot injections or remain on an outpatient commitment status. Yet other dilemmas are in the
larger social arena; the nurse’s decision is whether to support current practice or to advocate for
change on behalf of clients, such as laws permitting people to be detained after treatment is
completed when there is a potential of future risk for violence.
SELF-AWARENESS ISSUES
All nurses have beliefs about what is right or wrong and good or bad. That is, they have values just
like all other people. Being a member of the nursing profession, however, presumes a duty to clients
and families under the nurse’s care: a duty to protect rights, to be an advocate, and to act in the
clients’ best interests even if that duty is in conflict with the nurse’s personal values and beliefs. The
nurse is obligated to engage in self-awareness by identifying clearly and examining his or her own
values and beliefs, so they do not become confused with or overshadow a client’s. For example, if a
client is grieving over her decision to have an abortion, the nurse must be able to provide support to
her even though the nurse may be opposed to abortion. If the nurse cannot do that, then he or she
should talk to colleagues to find someone who can meet that client’s needs.
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.
Levels of Care Within the Healthcare Community (Interventions at Each Level)
Primary prevention
• Primary prevention is defined as reducing the incidence of mental disorders within the population
• It is focused on targeting groups at risk and providing educational programs
• The services are offer in settings that are convenient to the public such as churches, schools,
colleges, community centers, YMCA and YWCA, workplace of employee organizations, meeting of
women’s group, health fairs and community shelters
Secondary Prevention
It deals with reducing the prevalence of psychiatric illness by shortening the course
(duration) of the illness
There is already an existing problem and you do interventions to prevent that it gets worst
Ex. If a couple is married and are having marital problems, you recommend counseling
o Provision of care for individuals in whom illness symptoms have been accessed:
Reducing the residual defects that are associated with severe and persistent mental illness
o Ex: A person has chronic mental illness and you do rehabilitation so that the
condition does not get worst
Nursing care at the tertiary level of prevention can be administer on an individual or group
basis and in a variety of settings such as inpatient hospitalization, day and partial
hospitalization, group home or halfway house, shelters, home health care, nursing homes,
and community mental health centers.
Case Manager: is the nurse responsible for negotiating with multiple health care providers to
obtain a variety of services for the client. The case manager coordinates the
person care across the entire spectrum of what is happening in the community
The role of the psychiatry nurse is to assist the client’s successful adaptation to stressors within
the environment
Goals are directed toward change in thoughts, feelings, and behaviors that are age-appropriate
and congruent with local and cultural norms
The nursing process is the same for mentally ill patients, there is only some differences on how you do
the assessment, in which you focus on psychological and social factors, observation of the client and
his/her environment, subjective/objective data. The patient is more looked in a holistic way. You also
assess for spirituality, learning needs, suicidal thoughts. The most important assessment is to
diagnose the level of risk which requires priority, as it can be a life-threatening potential
Restraints and Seclusion
Seclusion: the involuntary confinement of a patient alone in a room or area
from which the patient is physically prevented from leaving, equipped with a
security window or camera for direct visual monitoring.
Verbal intervention
Behavioral care plan
Medication
Decrease in sensory stimulation
Removal of problematic stimulus
Presence of OS
Frequent observation or one on one observation
Chemical Restraint:
o Medication provided as a way to reduce:
Symptoms and treat illness
High levels of agitation and aggression
Consider the use of ‘chemical restraint’ in ED & MHU
Is it for the provision of care OR behavioral modification?
Symptom amelioration is not the principal focus of strengths
recovery models of MH
Fine balance between symptom amelioration & unwanted
side effects resulting in non-adherence to all forms of
treatment.
Nursing Considerations:
Apply primary terms and concepts (i.e automony, morals, values, etc): Principles of Bioethics
Bioethics: ethics that encompass all those perspectives that seek to understand
human nature and behavior, the domain of social science, and the natural world.
Broadly grouped under the rubric of “life sciences”.
The heart of bioethics are 3 paramount human questions.
1)What kind of person should I be in order to live a moral life and make good
ethical decisions?
2)What are my duties and obligations to other individuals whose life and well-
being may be affected by my actions?
3)What do I owe the common good or the public interest in my life as a member
of society?
autonomy: self-determination; being independent and self-governing.
beneficence: principle of doing good.
morals: like ethics, concerned with what constitutes right action; more informal
and personal than the term ethics.
nonmaleficence: principle of avoiding evil.
fidelity: keeping promises and commitments made to others.
breach of duty: the nurse (or physician) failed to conform to standards of care,
thereby breaching or failing the existing duty; the nurse did not act as a
reasonable, prudent nurse would have acted in similar circumstances
Principle Moral Rule Implications for Nursing Practice
Autonomy Respect the rights Provide the information and support
(self- of patients or their patients and families need to make the
determination) surrogates to make decision that is right for them, including
health care collaborating with other members of the
decisions. health care team to advocate for the
patient.
Torts
Assault and battery – Assault being the threat or an attempt to do bodily harm and
battery is when the assault is followed through with. This includes the willful, angry or
violent way you could touch even something that was attached to or on a person, like
their cloths. So, an aide undressing someone in an angry willful way could be considered
battery. Threatening to do it would be assault. Giving a shot to a person who refused is
battery.
Invasion of Privacy – Which is constitutional right via the Constitution. HIPPA also
falls under this umbrella. So, ALL their information is private, spoken/written/electronic,
even just the reason for their visit with no name attached to it is private.
Fraud – Is willful and purposeful misrepresentation that could cause, or has caused, loss
or harm to a person or property. Misrepresentation of a product is a common fraudulent
act. A person fraudulently misrepresenting oneself to obtain a license to practice nursing
may be prosecuted under the state’s Nurse Practice Act. Also, misrepresenting the
outcome of a procedure or treatment may constitute fraud.
Unintentional Torts
Liability involves four elements that must be established to prove that malpractice or
negligence has occurred: duty, breach of duty, causation, and damages. Duty refers to an
obligation to use due care (what a reasonably prudent nurse would do) and is defined by
the standard of care appropriate for the nurse–patient relationship. Breach of duty is the
failure to meet the standard of care. Causation, the most difficult element of liability to
prove, shows that the failure to meet the standard of care (breach) actually caused the
injury. Damages are the actual harm or injury resulting to the patient. These all relate to
Standard of Care, or what a reasonably prudent Nurse would or would not have done.
For example, if a man were admitted to a psychiatric facility stating he was going to
kill his wife, the duty to warn his wife is clear. If, however, a client with paranoia were
admitted saying, “I’m going to get them before they get me,” but providing no other
information, there is no specific third party to warn. Decisions about the duty to warn
third parties are usually made by psychiatrists or by qualified mental health
therapists in outpatient settings.
SAFE QUESTIONS
Stress/Safety: What stress do you experience in your relationships? Do you feel safe in
your relationships? Should I be concerned for your safety?
Afraid/Abused: Have there been situations in your relationships where you have felt
afraid? Has your partner ever threatened or abused you or your children? Have you ever
been physically hurt or threatened by your partner? Are you in a relationship like that now?
Has your partner ever forced you to engage in sexual intercourse that you did not want?
People in relationships/marriages often fight; what happens when you and your partner
disagree?
Friends/Family: Are your friends aware that you have been hurt? Do your parents or
siblings know about this abuse? Do you think you could tell them, and would they be able to
give you support?
Emergency plan: Do you have a safe place to go and the resources you (and your children)
need in an emergency? If you are in danger now, would you like help in locating a shelter?
Would you like to talk to a social worker/a counselor/me to develop an emergency plan?
CULTURAL CONSIDERATIONS
Although domestic violence affects families of all ethnicities, races, ages, national
origins, sexual orientations, religions, and socioeconomic backgrounds, a specific
population is particularly at risk: immigrant women. Battered immigrant women face
legal, social, and economic problems different from U.S. citizens who are battered and
from people of other cultural, racial, and ethnic origins who are not battered.
The battered woman may come from a culture that accepts domestic violence.
She may believe she has less access to legal and social services than do U.S. citizens.
If she is not a citizen, she may be forced to leave the United States if she seeks legal sanctions
against her husband or attempts to leave him.
Language barriers may interfere with her ability to call 911; learn about her rights or legal
options; and obtain shelter, financial assistance, or food.
It may be necessary for the nurse to obtain the assistance of an interpreter whom
the woman trusts, make referrals to legal services, and assist the woman to contact
the Department of Immigration to deal with these additional concerns.
Cultural Differences and Appropriate (nursing) Interventions/Responses (i.e. Communication,
Dietary, etc.
Do not assume that all individuals who share a culture or ethnic group are the same. This is stereotyping
and should be avoided.
A. Communication: How to communicate with someone who does not speak your language
and you do not have a translator?
Ex: special food accommodation. You need to find out dietary preferences (may possibly allow
family members to bring food for the patient specially kids)
C. Meds:
- Be sensitive to each cultural perspective of health care practitioner and needs in medication
(i. e., folk medicine, healer, curanderos etc.).
- You may need to bring this people to help the client collaborate with the treatment)
D. Strive to gain pt.’s trust. Do that by understanding and accommodating to pt.’s culture