NCM 117 PSYCH

• Professional standards are used to determine safe and acceptable practice and assess the quality of care when legal problems or lawsuits arise
• The Standards of Practice outlines the areas of practice and phenomena of concern for psychiatric mental health nurses
• Phenomena of concern describe the 13 areas of concern that mental health nurses focus on when caring for clients
• Standards of Care incorporate phases of the nursing process, specific types of interventions for nurses in psychiatric settings, and outline standards for professional performance, quality of care, performance appraisal, education, collegiality, ethics, collaboration, and research and resource utilization
• • Interpersonal, organizational, sociocultural, spiritual, or environmental circumstances or events affecting mental and emotional wellbeing of individuals, families, or communities
  • Psychological symptoms occurring with altered physiological status
  • Elements of recovery including the ability to maintain housing, employment, and social support for seeking meaningful lives
  • Societal factors such as violence, poverty, and substance abuse
• 13 areas of concern for psychiatric-mental health nurses include:

  • Promotion of optimal mental and physical health and wellbeing and prevention of mental illness
  • Impaired ability to function related to psychiatric, emotional, and physiological distress
  • Alterations in thinking, perceiving, and communicating due to psychiatric disorders or mental health problems
  • Behaviors and mental states indicating potential danger to self or others
  • Emotional stress related to illness, pain, disability, and loss
• • Symptom management, side effects, or toxicities associated with self-administered drugs, psychopharmacological intervention, and other treatment modalities
  • Barriers to treatment efficacy and recovery posed by alcohol and substance abuse and dependence
  • Self-concept and body image changes, developmental issues, life process changes, and end-of-life issues
  • Physical symptoms occurring with altered psychological status
• Restraints - 4-point restraint (upper and lower limb) in a bed with no foam; requires MD's order
• • Prescriptive Authority and Treatment: Use prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations
  • Consultation: Provide consultation to influence the identified plan, enhance the abilities of other clinicians to provide services for patients, and effect change
  • Evaluation: Evaluate progress toward attainment of expected outcomes
  • Quality of Practice: Systematically enhance the quality and effectiveness of nursing practice
  • Education: Attain knowledge and competency reflecting current nursing practice
• Standard of Practice:

  • Assessment: Collect comprehensive health data pertinent to the patient's health situation through MSE
  • Diagnosis: Analyze assessment data to determine diagnoses of problems, including level of risk. Objective cues = subjective cues = MSA and NPI. NANDA based
  • Outcomes Identification: Identify expected outcomes for an individualized plan
  • Planning: Develop a plan prescribing strategies and alternatives to attain expected outcomes
  • Implementation: Implement the identified plan
  • Coordination of Care: Coordinate care delivery
• • Resource Utilization: Consider factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services
  • Leadership: Provide leadership in the professional practice setting and the profession
• • Health Teaching and Health Promotion: Employ strategies to promote health and a safe environment. Teach on how to adapt and cope
  • Millieu Therapy: Provide, structure, and maintain a safe and therapeutic environment in collaboration with patients, families, and other healthcare clinicians
  • Pharmacological, Biological, and Integrative Therapies: Incorporate knowledge of pharmacologic, biologic, and complementary interventions with applied clinical skills to restore the patient's health and prevent further disability
• • Professional Practice Evaluation: Evaluate one's own practice in relation to professional practice standards and guidelines, relevant statuses, rules, and regulations
  • Collegiality: Interact with and contribute to the professional development of peers and colleagues
  • Collaboration: Collaborate with patients, family, and others in the conduct of nursing practice
  • Ethics: Integrate ethical provisions in all areas of practice
  • Research: Integrate research findings into practice
• • Psychobiologic Interventions: Administer medications (no medication administration to children, observe only), teach, observe, health teaching, case management, health promotion and maintenance
• Areas of Practice:

  Basic Level Functions

  • Counseling: Interventions and communication techniques, problem-solving, crisis intervention, stress management, behavior modification
  • Millieu Therapy: Maintain therapeutic environment, teach skills, encourage communication between client and others, promote growth through role modeling
  • Self-Care Activities: Encourage independence, increase self-esteem, improve function and health, hygiene routines
• Areas of Practice:

  Advanced Level Functions

  • Psychotherapy: Professional patient interaction
  • Prescriptive authority for drugs
  • Consultation and liaison
  • Evaluation
  • Program development and management
  • Clinical supervision
• Diagnostic and Statistical Manual of Mental Disorders 5th edition, Text Revision (DSM-5):

  • Taxonomy published by the APA and revised as needed
  • Describes all mental disorders, outlining specific diagnostic criteria for each based on clinical experience and research
  • Used by all mental health clinicians to diagnose psychiatric disorders
  • Provides a standardized nomenclature and language for all mental health professionals
  • Assists in identifying causes of disorders
  • Helps in understanding the reason for admission and building knowledge about the nature of psychiatric illness
• • Mental illness or mental disorder is a clinically significant behavior or psychological syndrome associated with distress or disability, not a reasonable response to a situation
  • Positive Mental Health: Johada's six major categories include attitudes toward self, growth and development, personality integration, autonomy and independence, perception of reality, and environmental mastery
  • Human Behavior: Maslow's hierarchy of needs is based on self-actualization attainment
• Mental Health - Illness Continuum and Human Behavior:

  • Mental health and mental illness should be viewed in the context of ethnocultural factors and influence
  • Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity
  • Wellness-Illness Continuum: Views health and illness as a dynamic continuum focusing on levels of wellness
  • Concepts include totality, uniqueness, energy, self-integration, energy use, and inner/outer worlds
• Abraham Maslow developed a hierarchy of needs based on the attainment of self-actualization, where one becomes highly evolved and attains their full potential
• Lower-level needs must be met first in order to advance to the next level of needs
• Physiological and safety needs must be met before issues related to love and belonging can be addressed, through self-actualization
• Maslow's Hierarchy of Needs:

  • Self-Actualization = Self-fulfillment/reach highest potential
  • Self-Esteem = Seek self-respect, achieve recognition
  • Love/Belonging = Giving/Receiving affection, companionship
  • Safety & Security = Avoiding harm; order, structure, protection
  • Physiological = Air, water, food, shelter, sleep, elimination
• Hans Selye divided the stress syndrome into 3 stages: Alarm Stage, Resistance, Exhaustion
• Fight or Flight Response:

  • Physiological response activates the adrenal glands and cardiovascular system in response to a stressful situation
  • Beneficial in the short term in an emergency situation
  • Ongoing chronic psychological stressors lead to physical and emotional depletion
• Diathesis-Stress Model:

  • Views behavior as the result of genetic and biological factors
  • Genetic predisposition results in a mental disorder when precipitated by environmental factors
• Johari's Window:

  • Technique that helps people better understand their relationship with themselves and others
  • Created by psychologists Joseph Luft and Harrington Ingham in 1955
  • Used for self-awareness and insight into human behavior
• Central Nervous System:

  • Composed of the brain, spinal cord, and associated nerves that control voluntary acts
  • Consists of the Cerebrum, Cerebellum, Brain Stem & Limbic System
• Cerebrum:

  • Divided into two hemispheres
  • Corpus Callosum connects the two hemispheres
  • Left Hemisphere controls the right side of the body and is the center for logical reasoning and analytic functions
  • Right Hemisphere controls the left side of the body and is the center for creative thinking, intuition, and artistic abilities
• Brainstem:

  • Includes the midbrain, pons, and medulla oblongata
  • Reticular Activating System influences motor activity, sleep, consciousness, and awareness
  • Locus Ceruleus is associated with stress, anxiety, and impulsive behavior
• Limbic System:

  • Area of the brain above the brain stem that includes the thalamus, hypothalamus, hippocampus, and amygdala
  • Thalamus regulates activity, sensation, and emotion
  • Hypothalamus is involved in temperature regulation, appetite, endocrine function, sexual drive, and impulsive behavior
• Neurotransmitters:

  • Chemical substances manufactured in the neuron that aid in the transmission of information throughout the body
  • Dopamine is involved in the control of complex movements, motivation, cognition, and regulation of emotional responses
• Brain Imaging Techniques:

  • Computed Tomography (CT) visualizes the brain's soft tissues for diagnosis
  • Magnetic Resonance Imaging (MRI) produces more tissue detail and contrast than CT
  • Positron Emission Tomography (PET) & Single-Photon Emission Computed Tomography (SPECT) are used to examine brain function
• PET provides better resolution with sharper and clearer pictures and takes about 2 to 3 hours; SPECT takes 1 to 2 hours
• PET and SPECT brain imaging techniques are primarily used for research, not for the diagnosis and treatment of clients with mental disorders
• Limitations of brain imaging techniques:

  • The use of radioactive substances in PET and SPECT limits the number of times a person can undergo these tests
  • Risk of allergic reaction to the substances
  • Some clients may find receiving intravenous doses of radioactive material frightening or unacceptable
  • Imaging equipment is expensive to purchase and maintain, limiting availability
  • Some persons cannot tolerate these procedures due to fear or claustrophobia
  • Changes in disorders like schizophrenia at molecular and chemical levels cannot be detected with current imaging techniques
• Psychosocial Theories:

  • Psychoanalytic Theories by Sigmund Freud
  • Known as the Father of Psychoanalysis
  • Supports the notion that all human behavior is caused and can be explained (deterministic theory)
  • Believed that repressed sexual impulses and desires motivate much human behavior
• Components of Personality:

  • ID: Reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses
  • SUPEREGO: Reflects moral and ethical concepts, values, and parental and social expectations
  • EGO: Balancing force between the id and superego, represents mature and adaptive behavior
• Levels of Awareness:

  • Conscious: Perceptions, thoughts, and emotions in a person's awareness
  • Preconscious: Not currently in awareness but can be recalled with effort
  • Unconscious: Realm of thoughts and feelings that motivate a person, includes defense mechanisms and instinctual drives or motivations
• Stages of Psychosexual Development by Sigmund Freud:

  • Theory based on the belief that libido drives human behavior
  • Children progress through five stages: oral, anal, phallic/oedipal, latency, and genital
  • Psychopathology results from difficulty transitioning between stages or remaining stalled at a stage