MH chap 7,8,9,10

• Cultural assessment


  • Use of a translator who can retain intent without inserting bias
  • Nurse must understand differences in how various cultures communicate
  • A medical interpreter does not replace your non verbal cues
• Various Factors Affecting Client's Response to Illness

  • Age, growth, development
  • Effect on coping with illness
  • Expression of illness
  • Erikson's stages of psychosocial development
  • Genetics, biologic factors
  • Physical health and health practices
  • Individual factors
  • Response to drugs
  • Self-efficacy
  • Hardiness (commitment, control, challenge)
  • Resilience and resourcefulness
  • Spirituality
• Slower metabolism


  Need for lower doses of drugs
• Healthier


  Better coping with stress or illness
• Differences in ethnic groups

  Related to metabolism, efficacy of drugs
• Elderly people


  More sensitive to drugs, their psychosocial health will affect how they respond to illness
• Interpersonal Factors


  • Sense of belonging
  • Value
  • Fit
  • Social networks and social support
  • Family support
• Cultural Social Factors


  • Belief about cause of illness
  • Factors in cultural assessment (communication, distance and socioeconomic factors)
• Nurse's Role


  • Seeking knowledge about clients cultural values, beliefs, health practices
  • Client as a best source of information
  • General cultural knowledge to guide nurses in initial meetings, decisions about what questions to ask
  • Understanding clients preferences, health practices and beliefs
  • Differences in value of emotions
• Factors Assessed in Mental Health Assessment

  • Client participation (Maslow's hierarchy of needs)
  • Client health status
  • Previous experiences or misconceptions about healthcare
  • Clients ability to understand the translator
  • Nurses attitude and approach
• General Appearance and Motor Behavior

  • Hygiene/grooming
  • Posture
  • Eye contact
  • Unusual movement/mannerisms
  • Automatisms, psychomotor retardation, waxy flexibility
• Mood and Affect


  Blunted, Broad, Flat, Inappropriate, Restricted, Labile
• Thought Process and Content

  • Circumstantial thinking
  • Delusions
  • Hallucinations
  • Flight of ideas
  • Ideas of reference
  • Loose association
  • Tangential thinking
  • Thought broadcasting
  • Tangential blocking
  • Thought insertion
  • Thought withdrawal
  • Word salad
• Assessing Judgment


  • Actions/behaviors
  • Insight
  • Self-Concept
• HIPAA


  Health Insurance Portability and Accountability Act
• Penalties for HIPAA Violation

  • Civil (fines)
  • Criminal (prison sentences)
• Involuntary Hospitalization


  Health care professionals respect client's wishes to not be treated unless they are imminent danger to self or others, in which case they are committed/treated until they are no longer a danger
• Client Rights


  • Right to refuse treatment
  • Informed consent
  • Least restrictive environment to meet needs
  • Confidentiality
  • Choice of providers
  • Treatment determined by professionals, not third party payers
  • Parity
  • Nondiscrimination
  • Treatment that affords greatest protection and benefit
  • Fair and valid treatment review processes
  • Treating professionals and payers held accountable for any injury caused by gross incompetence, negligence, or clinically unjustified decisions
• A client can refuse a medication unless they are actively trying to hurt themselves or others
• Types of Restraints


  • Manual/Human - holding a patient down
  • Mechanical - arms tied to bed, mittens, etc
  • Chemical - medication
• Principles/Restraints


  • Confidentiality
  • Choice of providers
  • Treatment determined by professionals, not third party payers
  • Parity
  • Nondiscrimination
  • Treatment that affords greatest protection and benefit
  • Fair and valid treatment review processes
  • Treating professionals and payers held accountable for any injury caused by gross incompetence, negligence, or clinically unjustified decisions
• All Types of Restraints

  • Restraint: direct application of physical force to person without permission
  • Manual/Human - holding a patient down
  • Mechanical - arms tied to bed, mittens, etc
  • Chemical - medication
• Seclusion


  Involuntary confinement in specially constructed, locked room equipped with security window or camera for direct visual monitoring
• Restricting a client to any room is also considered seclusion
• Restraint/seclusion only for shortest time necessary
• Restraint/seclusion permitted only when client is imminently aggressive/dangerous
• Torts


  Wrongful act, resulting in injury, loss or damage
• Types of Torts


  • Unintentional Torts
  • Intentional Torts
• Unintentional Torts


  • Negligence
  • Malpractice
• Elements to Prove Malpractice

  • Duty
  • Breach of duty
  • Injury or damage
  • Causation
• Negligence


  Failure to do what a reasonable person would do in same situation
• Malpractice


  Type of negligence referring to nurses/physicians
• Intentional Torts


  • Assault and Battery
  • False Imprisonment
• Three elements to prove liability for intentional torts

  • Willful, voluntary act
  • Intention to bring about consequences of injury
  • Act was a substantial factor in injury or consequences
• Ethics


  Moral Principles. Rightness and wrongness of actions and the ends of such actions
• Ethical Dilemma


  Conflict of ethical principles with no one clear course of action
• Utilitarianism


  Decisions bases on the greatest good for the greatest number
• Deontology


  Decisions based on whether action is morally right or wrong, with no regard for consequences
• Principles of Deontology


  • Autonomy: right to self determination, independence
  • Beneficence: duty to benefit others or promote good
  • Nonmaleficence: requirement to do no harm
  • Justice: fairness
  • Veracity: honest, truthfulness
  • Fidelity: obligation to honor commitments and contracts
• Loss


  A normal part of life and so is grief - everyone has loss at some point or another