Exam 1 Mental Health Chapter 1

Chapter 1 Me, Meds, Milieu ME: nurse-patient relationship > “How should I talk to the patient?” MEDS: medication skills > “What kind of medications should she or he be taking?” MILIEU: creating a safe therapeutic > “What environmental issues will promote health & safety?” Psychotherapeutic!management:!3!interventions! -Therapy is provided by nurses who have a graduate degree -Nurses are taught how to be therapeutic >communication >respect >understanding of mental mechanisms, adaptation styles, & coping strategies >mastering therapeutic intervention skills -Knowledge of psychiatric meds -Application of nursing process: How are the meds assisting the pt? -Determining when drug related problems are occuring & what to do next -When to provide PRN meds -Providing patient teaching about meds -A proactive approach to care that forges therapeutic benefits from patient’s surroundin whether in the hospital, outpatient setting, or home -The 5 environmental elements the nurse must consider in creating a therapeutic miliie 1. Safety: keeping the patient free from danger or harm 2. Structure: the physical environment, regulations, & schedules 3. Norms: specific expectations of behavior (acceptance, non-violence, privacy) 4. Limit setting: clear & enforceable limitations on behaviors 5. Balance: negotiating the line between dependence & independence Continuum!of!Care:!All!the!places!to!implement!me,!meds, &!milieu -Continuum of care provides individuals with a. Wide range of treatment options **The first step after a mental health problem is to confirm its existence** >Next: ask “Does this person need hospitalization?” ~~RISK ASSESSMENT~~ 1. Is the person dangerous to self or others? 2. Is the person gravely disabled? 3. Is the person acutely psychotic? 4. Is the person suicidal or homicidal? If necessary, dx Residential services, outpatient planning is started services, self-help resources admission -The role of nurses is to assess the individual’s current level of functioning & direct th individual to appropriate resources >Multidisciplinary team collaboration coordinates care >Includes professionals, patient, families, representatives from insurance compa nursing homes, group homes, or medical clinical -Determination of appropriate level of care is based on: >Safety >Intensity of supervision needed >Level of functioning >Type of tx needed -Currently, average length of hospital stay is 3 to 5 days; largely driven by economic d >Goals are crisis intervention & safety >Staffing must be cost effective while maintaining quality of service >Acuity of patients has increased >Discharge planning begins immediately after admission -The highest priority for admission to hospital based care is safety for self & others -Provdies care for individuals who are experiencing toxic reactions to meds of other substances & provides safe detoxification from substances -Provides care for someone with a medical illness that may present with behavioral sy or complicates an existing psychiatric illness -Available to help individuals who need long term care -NURSING HOMES are available for people who require 24 hour supervision & medi care; often required for individuals with severe developmental disabilities, dementia & chronic medical illnesses -GROUP HOMES might provide temporary or permanent housing for individuals with mental disorders -HALFWAY HOUSES were traditionally available for individuals recovering from che dependency; residents were expected to seek employment & participate in cooking cleaning chores; residents also attended self-help groups that met on site, such as AA -APARTMENT LIVING provides varying degrees of supervision & programming; sta be on site on a daily basis offering group sessions & activities, or they might visit p to provide medication assistance and facilitate attendance at various appointments -FOSTER CARE & BOARDING HOMES are generally staffed by non professionals b professional supervision available on an intermittent basis -SHELTERS provide room & board to homeless people -JAIL is also a major facility “housing” the mentally ill -Traditionally occurs in mental helath clinics & private offices -Person providing counseling may be a psychiatrist, psychologist, social worker, psych nurse, or other professional -Number of visits per week or month depend on the individual’s needs -For individuals who need minimal supervision, structured activities, & ongoing treatm benefit -Vary in length 4 to 8 hours per day & 1 to 5 day per week -Depending on community, these programs might provide treatment for specific popul based on age or type of problem -Meetings are conducted by members, not professionals & may take place on a weekly -Can be addiction based, survivor based, disorder based, loss based, medical based, or prevention based Addiction based - alcoholics anonymous, narcotics anonymous, ove eaters anonymous . Survivor based - suicide survivor, incest survivors anonymous, adul children of alcoholics Disorder based - eating disorders, bipolar disorder Loss based - divorce, grief, bereavement Medically based - lupus, cancer. AIDS Prevention based - parenting, relationship boundaries Primary!Care -Individuals with mental health problems such as anxiety, depression, & other mental issues seek help for these problems in primary care offices >3 reasons for this: 1. Stigma of mental health care (no one will know) 2. Lack of knowledge about who to see & where to get help 3. Reduced access to care Nursing!process! -Apply nursing process to provide comprehensive nursing care -Effective use in the areas of psychiatric rehab, crisis intervention, home care, therapy consultation & liaison, resource linkage, & advocacy enhances these services